A more proactive approach needed to combat dengue

A more proactive approach needed to combat dengue

• This is true for other mosquito-borne illnesses as well
• Collective failure needs to be turned into success through community participation

New Delhi, 26 October 2017: As per recent reports, there have been 650 fresh cases of dengue in the capital city of Delhi in the past one week. This has taken the confirmed cases of dengue this year to 5,870. Estimates also indicate that the death toll due to this condition today stands at three. The IMA indicates that dengue is spreading alarmingly in Kerala, West Bengal, and Karnataka; and has taken the form of a mysterious illness in Indore with arthritis. Collectively, we have failed in controlling the mosquito menace.

It has taken over a decade for doctors to understand that dengue 1 and 3 strains are not dangerous and cause only platelet deficiency with thinning of blood. Dengue 2 and 4 strains are dangerous as they lead to platelet destruction along with thickening of blood due to capillary leakage and rise in haematocrit. It is time to convert this biggest failure to success.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Any mosquito container index above 5% requires a community integrated cluster approach for mosquito density reduction together with effective anti-larval measures. Mosquito repellent impregnated mosquito nets are not available to patients. Anti-larval measures; temephos, an organophosphate larvicideteme; and mosquito fish or Gambusia, a freshwater fish also are not available to the common man. There is a need to bring about a paradigm shift in our thinking. We need to over report and act in time. There is no point acting when the cases have started. Often, the civic bodies publicly act in monsoon season. They may be planning ahead but public awareness and public involvement must start much ahead of time. Even the recent CAG report mentions that under reporting of dengue is disastrous to the society. We need to act on all the mosquitos (aedes, culex, and anopheles) and not just on aedesalone.”

All campaigns thus far have focused on a day biter; wearing long sleeved shirts and pants during the day; and that there is no need to use night mosquito nets. However, precautions need to be taken throughout the day as the mosquito only recognizes the light and not the day or night.

Adding further, Dr Aggarwal, said, “It is true that disease spreading mosquitos do not make noise but noise producing nuisance mosquitos unless addressed to will not create a public movement. One must report all the suspected cases and not wait for confirmation of the diagnosis. We have failed because the government has been insisting to notify only ELISA confirmed cases. An SMS should be sent to all doctors practicing in specific areas with a case so that they can become a part of the public health action chain.”

Few other points to be considered include the following.
• Machine reading of platelet count can be defective. There can be an error of 20%. A platelet count of 10,000 by machine reading can mean it is actually 50,000.
• A community approach means that 100% of the society talks about dengue. Every premise must indicate that it is mosquito free. When you are invited to someone’s house, you should ask “I hope your premises are mosquito free”. When you invite, write, “welcome to my house, it is mosquito free”.
• One of the five greatest vows of Jainism is Non-attachment/Non-possession or Aparigraha. It talks about not storing unwanted things. However, in today’s era, our roofs and verandahs are full of left over tyres, utensils, plastic utensils, etc. We buy a new car tyre and keep the old one on our roof top. We need to change this habit.
• We have forgotten to plant Tulsi and Peepal in our premises and stopped the daily Yagna, all which have anti mosquito properties.
• Also, the idea of checking your house once a week needs a change. One needs to be alert every day. It should be a part of your routine. You do not clean your premises once a week. Make it a habit to look for the breeding places.

Dengue Revisited

Dengue Revisited

Dr KK Aggarwal

Napoleon Hill once said that “Most great people have attained their greatest success just one step beyond their greatest failure.”

It’s time for all of us to convert our biggest failure, to control mosquito menace, into success.

Today dengue is in alarming condition in Kerala, West Bengal, Karnataka and a mysterious illness in Indore (? Zika ? Alpha Virus) with arthritis.

We all must agree that collectively we have failed in controlling the mosquito menace. Any mosquito container index above 5% requires community integrated cluster approach for mosquito density reduction together with effective anti-larval measures. Mosquito repellent impregnated mosquito nets are not available to patients. Anti-larval measures such as temephos (an organophosphate larvicide) and mosquito fish or Gambusia (a freshwater fish) also are not available to a common man.

Then what is the answer? We need a paradigm shift in our thinking.

We need to over report and act in time. There is no point acting when the cases have started. Often the civic bodies publically act during monsoon season. They may be planning ahead but public awareness and public involvement must start much ahead of time. Even the recent CAG report mentions that under reporting of dengue is disastrous to the society.

We need to act on all mosquitos - Aedes, Culex and Anopheles. Acting only on Aedes will not work.

The campaign that “Aedes is a day biter and only breeds in indoor fresh water” will not work. Even if this is true, then by killing Aedes you may end up increasing the density of Culex and malaria causing Anopheles mosquito. But the fact is that Aedes can breed and bite in the evening or night also.

Culex mosquito, which causes filarial and Japanese encephalitis, is already rampant in many states.

Aedes, which causes Chikungunya, West Nile, Zika and Dengue can spread by the bite of infected female Aedes aegypti (indoor) or A. albipecto (outdoor) mosquito. 

It is true that Aedes aegypti are more dangerous because they can fly up to 200 m and only feed on human blood whereas the Aedes albopictus that thrives outdoors can only fly as far as 80 m and feed on animal blood other than human blood. However, the outdoor Aedes cannot be ignored.

  

The entire campaign until now has focused on Aedes being a day biter, wear long sleeved clothing during the day and no need to use night mosquito nets. But precautions need to be taken all through the day. The mosquito only recognizes the light and not day or night.

That the mosquito only breeds in clear water also needs to be re-learnt. Aedes breeds in stagnant water anywhere inside or outside the house. Rain water is the most important source and can collect in any plastic container inside or outside the house. Even collected garbage in open areas can have left over plastic cups or tiny bottle caps with collected rainy water collections providing ideal atmosphere for mosquito breeding.

It is true that disease-spreading mosquitoes do not make noise but noise-producing nuisance mosquitoes unless addressed will not create a public movement.

The law says that dengue and Chikungunya are notifiable diseases, but one can notify within seven days of diagnosis. Aedes mosquito takes up to three meals in a day and by seven days will bite over 21 people in the vicinity. Municipal anti-mosquito and anti-larval actions must occur within hours of its detection. The very purpose of notification is lost if the disease is not notified within hours of even suspected cases.

All suspected cases must be reported without waiting for confirmation of the diagnosis. We have failed because the government has been insisting on notification of only ELISA confirmed cases.

An SMS should be sent to all doctors practicing in that PIN code area with a case so that they can become a part of the public health action chain.

All public health measures should start right when the first case is suspected in a state, colony or house. An SMS should go to the local councillor, MLA, MPs, all practicing doctors, local chemists, NGOs, RWAs, local IMA Branch, State IMA Branch, IMA Headquarters and other Specialty Organizations to join the public health chain efforts.

It has taken over a decade for us doctors to understand that dengue 1 and 3 strains are not dangerous and causes only platelet deficiency with thinning of blood and dengue 2 and 4 strains are dangerous as they lead to platelet destruction along with thickening of blood due to capillary leakage and rise in hematocrit.

Platelet transfusion is not required in absence of active bleeding and thickening of blood. Timely fluid resuscitation is more important and not platelet resuscitation. Remember a raid fall in platelets along with a rapid rise on hematocrit is dangerous and not rapid fall of platelets alone.  

Dengue becomes serious when fever is subsiding. We admit dengue cases with high fever and always are in an urgency to discharge them when fever was subsiding.

Now we know that the machine reading of platelet count can be defective. There can be an error of 20%. A platelet count of 10,000 by machine reading can mean that the platelet count is actually 50,000.

Hospital beds should be reserved only for severe dengue and severe Chikungunya cases. Just because one can claim reimbursement in Mediclaim or PSU, one should not be admitted. If it was the US, Medicare by now would have come out with admission guidelines.

The message has been going that fogging has no answer. But at this stage of container index of > 40, we need not just ground fogging, but also aerial fogging.

When Zika threat came up Brazil, they deployed army to join and made it a public movement. All political parties reach every house during election process then why can’t each one of them reach every house and make the anti-mosquito and anti-larval measures more effective.

Breeding checkers are only with Municipal Corporation and they also have regulatory powers to put fine. We need breeding checkers in private sector also. The Skill development Ministry should start courses so that anyone can hire a breeding checker on weekly basis to check their premises.

Community approach means that 100% of the society talks about dengue. Every premise must write that their premises are mosquito free. When you are invited to someone you should ask “I hope your premises are mosquito free” and when you invite somebody write “Welcome to my house and it is mosquito free”.

Even today most hospitals do not provide mosquito nets to dengue or Chikungunya patients. It is true they may be having anti- larval mesh doors or mesh windows but for secondary prevention of dengue or Chikungunya we need to ensure that medial establishments are certified as mosquito-free.

In flats or apartments, the mosquitoes may be breeding in the roof top belonging to one of the owners and if he is out of station for a holiday, the anti-larval measures may remain deficient. The RWAs may use their powers to check all unoccupied or closed premises including hostels, hotels and construction places in that premises.

One of the five great vows of Jainism is Non-attachment/Non-possession or Aparigraha. It talks about not storing unwanted things. But in today’s era our roofs, verandas and courtyards are full of left over tires, utensils, plastic utensils etc. We buy a new car tire and keep the old one on our roof top. We need to change this habit.

We have forgotten to plant Tulsi and Peepal in our premises and stopped the daily Yagna, all which have anti-mosquito properties.

The new strategy must focus on small collections of water like in bottle caps, finding mosquitoes lower in the room under the table or the bed, to look for them in all three parts of the house roof tops, verandas and inside the rooms, including unused toilets accessories.

Also, the slogan to check your house once a week needs a change. One needs to be alert every day. It should be a part of your daily routine. You do not clean your premises once a week. Make it a habit to look for the breeding places every day.

The innovative approach should be a war against indoor or outdoor mosquitoes; fresh stagnant or dirty water mosquitoes; in small containers like bottle caps or large containers like overhead tankers; made of mud or plastic; throughout the day (early morning fogging when pupa hatch for Aedes, late night for malaria); rub cleaning the utensils

Indian Medical Association (IMA) and Heart Care Foundation of India (HCFI) slogan is “Katwayega to nahi” i.e. whenever you someone ask “I hope your premises are mosquito free”. Also, when you invite somebody at home say, “You are invited at my home and I have checked there are no mosquitos”.

Remember the slogan: “Ghar ke andar or ghar ke bahar; din me or rat me, deewaron ke niche or upar, chote pani or bade pani ke collection me, eggs larve or mosquito, teeno ko maro.”

Disclaimer: The views expressed in this write up are entirely my own.

Platelet transfusion in dengue should not be done without proper assessment

Platelet transfusion in dengue should not be done without proper assessment It is imperative to carry out proper diagnosis to confirm dengue in patients with a low platelet count New Delhi, 09 August, 2017: Statistics indicate that India has recorded over 18,700 cases of dengue in 2017, thus far. Apart from other symptoms, dengue causes a drop in a person’s platelet count. However, as per international guidelines, unless the platelet count is below 10,000/or there is spontaneous active bleeding, no platelet transfusion is required in case of dengue patients. According to the IMA, the cause of death in dengue is capillary leakage, which causes blood deficiency in the intravascular compartment, leading to multiorgan failure. Many viral infections, which are not dangerous, can also lead to a drop in the platelet count. A proper diagnosis must be done to confirm whether it is dengue. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “At the first instance of plasma leakage from intravascular compartment to extra vascular compartment, 20 ml per kg body weight per hour of fluid replacement should be administered to the patient till the difference between upper and lower blood pressure is more than 40 mmHg or the patient passes adequate urine. Giving unnecessary platelet transfusion to the patient can harm the individual. The normal count of platelets is 1.5 lakh to 4.5 lakh per microlitre of blood. In dengue, this comes down to 20,000 or even lower, but reaches the normal once dengue is cured.” It is estimated that dengue causes about 50 to 100 million infections per year worldwide. It is a viral disease transmitted by mosquitoes. There is no vaccine for the disease yet and the most effective protective measure is to avoid mosquito bites. Adding further, Dr Aggarwal, said, “Family doctors should remember the ‘Formula of 20’ to understand the severity of dengue. Rise in pulse by 20,fall in upper blood pressure by 20 mmHg, pulse pressure lower than 20, hematocrit increase by 20%, platelet count less than 20,000, and more than 20 petechiae in the tourniquet test. Dengue takes on an epidemic form almost every year and creates panic among the public. It is a preventable disease and prevention is the first step in its management.” Human beings are primarily responsible for the presence of Aedes aegypti in their environment through poor sanitation practices; improper solid-waste disposal practices; unsafe water storage practices and poor pool management. The government cannot employ enough persons to search every backyard to identify and destroy breeding sites on a consistent basis to prevent this mosquito from breeding. At an individual level, the following measures can be taken to prevent dengue. • Avoid stagnation of water in and around the house to prevent mosquitoes from breeding. • Close all containers that have water stored in them. • Use mosquito screens, nets, meshes and insect repellent screens regularly. • Do not venture out immediately after dusk. If you need to go out, make sure to wear full-sleeved clothing and apply a mosquito repellant cream.

IMA supports insurance for death due to mosquito bite

IMA supports insurance for death due to mosquito bite Recommends an all-encompassing effort from the community as a whole to address this issue New Delhi, 15 May 2017: According to the South Delhi Municipal Corporation, 79 cases of chikungunya and 24 cases of dengue have been reported in Delhi just three months since 1 January 2017. Of these, 11 patients acquired the infection from neighboring states. It is a fact that we have collectively failed last year in controlling the mosquito menace and consequently, the mosquito menace is back this year. There is a need to over report and act in time and not only when the cases start appearing. Failure to act can be attributed collectively to Municipal Corporation, Delhi Government, Central Government, LG office, Medical Associations, CSR departments, Media, NGOs, and the private sector. It is time that last year's failure is converted into success this year. Speaking on this issue, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said "The mosquito menace requires a community approach which involves every component of the society. Every premise must display that it is mosquito-free. When you are invited to somebody’s place, you should ask 'I hope your premises are mosquito-free' and when you invite somebody, write 'Welcome to my house and it is mosquito-free. This should become a routine in a premises. Just like we do not clean our premises once in a week, it is important to look for and clean the breeding places daily." The fact that mosquito bites are a serious issue has been reiterated via a recent judgement by the National Consumer Disputes Redressal Commission (NCDRC) which ruled that the wife of a man who died due to a mosquito bite was eligible for claiming insurance. The commission ruled that 'It can hardly be disputed that a mosquito bite is something which no one expects and which happens all of a sudden without any act of omission on part of the victim'. It further said that death caused by mosquito bite is an accident, and directed the insurer to honor its policy to the widow. Adding further, Dr Aggarwal, said, "The need of the hour is a paradigm shift in the approach towards the dengue menace. We need to follow the formula of 20 to identify dengue fever: if there is a rise in pulse by 20; there is fall in upper blood pressure by 20; if there is a rise in hematocrit by 20%; there is a rapid fall in platelets to less than 20,000 with a rapid rise in hematocrit by 20%; if there is a petechial count of more than 20 in one inch after tourniquet test and a difference of less than 20 between the upper and lower blood pressure, then such patients should be given at least 20 ml of fluid per kg immediately followed by continuous fluids till they pass urine. This is one of the most immediate steps to combat the condition." IMA recommends the following approach to target the mosquito menace: Ghar ke ander maro aur ghar ke bahar maro; din me maro, sham me maro aur raat me maro; deewaron ke niche maro aur deewaron ke upar maro; chote pani ki collection me aur bade pani ke collection me maro; eggs ko maro, larve ko maro, pupa ko maro aur mosquito ko maro; chath me maro, kamre me maro, veranda me maro; container me pani ke niche maro aur container me pani ke upar maro, aedes ko maro, culex ko maro aur anopheles ko maro.

Dengue and chikungunya hit the capital again

Dengue and chikungunya hit the capital again IMA warns of a possibly larger breakout unless immediate action is taken along with community participation New Delhi, April 13, 2017: A recent report by the South Delhi Municipal Corporation (SDMC) on vector-borne diseases has revealed about 79 cases of chikungunya in the national capital this year. In the last three months, 24 cases of dengue have been reported, of which 11 patients acquired the infection from one of the neighbouring states. According to the SDMC, there were 9 new cases of chikungunya this week. All these patients were from the neighbouring states. Although chikungunya and dengue cases had tapered off by the first week of December last year, this year has again brought back many such cases. Speaking about this Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "IMA had already indicated that the cases of vector-borne diseases in the capital will be as predicted last year. Dengue and chikungunya cases in Delhi so far have been a matter of great concern. Dengue cases create panic among the public every year. We must all agree that collectively we have failed in controlling the mosquito menace and consequently, Delhi today is in the midst of an increasing number of dengue and malaria patients. This is a collective failure of Municipal Corporation, Delhi Government, Central Government, LG office, Medical Associations, CSR departments, Media, NGOs, and the Private sector. Dengue is preventable and the very first step towards this is its management. However, to make this possible, community participation is a must." Both dengue and chikungunya are viral diseases transmitted by Aedes mosquitoes. The Aedes mosquito breeds in stagnant water anywhere inside or outside the house. Most of the symptoms associated with both diseases are the same, with some key differences. High fever is the primary symptom of dengue along with the at least two of the following: severe headache, severe eye pain, joint, muscle or bone pain, rash, mild bleeding from the nose or the gums, small spots caused by bleeding into the skin, and low white cell count. In severe cases, plasma leakage can lead to shock, hemorrhage (internal bleeding), and organ impairment. At this stage, the disease is potentially fatal. On the other hand, chikunguniya symptoms include high fever, severe joint pain, joint swellings, muscle pain, headaches, and rashes and this disease is mostly non-fatal. Highlighting the importance of community participation in taking action against vector-borne diseases, Dr K K Aggarwal added, "Individuals, families, and communities need to be more involved in the planning and conduct of local vector control activities. It is not possible for the government to employ enough people to search every backyard and identify and destroy breeding sites. At IMA, we are committed to raising awareness amongst the medical fraternity and the public in general about the prevention and management of vector-borne diseases.“ Some do's and dont's for the prevention and management of these diseases are as follows. Do's Take plenty of rest and avoid getting dehydrated if you have any of the above-mentioned symptoms. Get tested immediately. In case of high-grade fever for more than 24 hours, it is a must to go and visit the doctor. Use mosquito nets and cover yourself well to avoid being bitten by mosquitoes. Keep the surroundings clean, and dispose of waste and stagnant water regularly. Don'ts Aedes mosquitoes breed in clean water. Therefore, don't let water stagnate anywhere in or near your home. Don't use mosquito repellents on children below two months of age. Use insect repellents containing 10% DEET on children older than two months. Don't apply mosquito repellent on your palms, or near your eyes or mouth. Avoid dark-colored clothing as it attracts mosquitoes. Avoid wearing tight clothes as it is easier for the mosquitoes to bite through such garments.

Dengue and chikungunya hit the capital again

Dengue and chikungunya hit the capital again IMA warns of a possibly larger breakout unless immediate action is taken along with community participation New Delhi, April 13, 2017: A recent report by the South Delhi Municipal Corporation (SDMC) on vector-borne diseases has revealed about 79 cases of chikungunya in the national capital this year. In the last three months, 24 cases of dengue have been reported, of which 11 patients acquired the infection from one of the neighbouring states. According to the SDMC, there were 9 new cases of chikungunya this week. All these patients were from the neighbouring states. Although chikungunya and dengue cases had tapered off by the first week of December last year, this year has again brought back many such cases. Speaking about this Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "IMA had already indicated that the cases of vector-borne diseases in the capital will be as predicted last year. Dengue and chikungunya cases in Delhi so far have been a matter of great concern. Dengue cases create panic among the public every year. We must all agree that collectively we have failed in controlling the mosquito menace and consequently, Delhi today is in the midst of an increasing number of dengue and malaria patients. This is a collective failure of Municipal Corporation, Delhi Government, Central Government, LG office, Medical Associations, CSR departments, Media, NGOs, and the Private sector. Dengue is preventable and the very first step towards this is its management. However, to make this possible, community participation is a must." Both dengue and chikungunya are viral diseases transmitted by Aedes mosquitoes. The Aedes mosquito breeds in stagnant water anywhere inside or outside the house. Most of the symptoms associated with both diseases are the same, with some key differences. High fever is the primary symptom of dengue along with the at least two of the following: severe headache, severe eye pain, joint, muscle or bone pain, rash, mild bleeding from the nose or the gums, small spots caused by bleeding into the skin, and low white cell count. In severe cases, plasma leakage can lead to shock, hemorrhage (internal bleeding), and organ impairment. At this stage, the disease is potentially fatal. On the other hand, chikunguniya symptoms include high fever, severe joint pain, joint swellings, muscle pain, headaches, and rashes and this disease is mostly non-fatal. Highlighting the importance of community participation in taking action against vector-borne diseases, Dr K K Aggarwal added, "Individuals, families, and communities need to be more involved in the planning and conduct of local vector control activities. It is not possible for the government to employ enough people to search every backyard and identify and destroy breeding sites. At IMA, we are committed to raising awareness amongst the medical fraternity and the public in general about the prevention and management of vector-borne diseases.“ Some do's and dont's for the prevention and management of these diseases are as follows. Do's Take plenty of rest and avoid getting dehydrated if you have any of the above-mentioned symptoms. Get tested immediately. In case of high-grade fever for more than 24 hours, it is a must to go and visit the doctor. Use mosquito nets and cover yourself well to avoid being bitten by mosquitoes. Keep the surroundings clean, and dispose of waste and stagnant water regularly. Don'ts Aedes mosquitoes breed in clean water. Therefore, don't let water stagnate anywhere in or near your home. Don't use mosquito repellents on children below two months of age. Use insect repellents containing 10% DEET on children older than two months. Don't apply mosquito repellent on your palms, or near your eyes or mouth. Avoid dark-colored clothing as it attracts mosquitoes. Avoid wearing tight clothes as it is easier for the mosquitoes to bite through such garments.

The Mosquito Menace: How to win over our collective failure

The Mosquito Menace: How to win over our collective failure

Dr K K Aggarwal
National President Elect and Honorary Secretary General IMA
President Heart Care Foundation of India
Napoleon Hill once said, “Most great people have attained their greatest success just one step beyond their greatest failure.” It’s time for all of us to convert our biggest failure of controlling the mosquito menace into success. We must all agree that collectively we have failed in controlling the mosquito menace and consequently, Delhi today is in the midst of an epidemic of Chikungunya with increasing numbers of dengue and malaria patients. This is a collective failure of Municipal Corporation, Delhi Government, Central Government, LG office, Medical Associations, CSR departments, Media, NGOs and Private sector. As per the current picture, the mosquito container index (the percentage of water-holding containers infested with larvae or pupae) in Delhi is over 40% and any index above 5% requires a community integrated cluster approach to reduce mosquito density together with effective anti-larval measures. But even today, 3 lakh mosquito repellent impregnated mosquito nets received by MCD as donations are not available to patients. Anti-larval measures, Temephos an organophosphate larvicide and/or mosquito fish or Gambusia, a freshwater fish are not available to a common man. What is the answer then? We need a paradigm shift in our thinking. We need to over report and act in time. There is no point acting when the cases have started. Often the civic bodies publically act in monsoon season. They may be planning ahead but public awareness and public involvement must start much ahead of time. Even the recent CAG report mentions that under reporting of dengue is disastrous to the society. We need to act against all the mosquitos, Aedes, Culex and Anopheles. Action against only the Aedes mosquito will not work. The campaign that Aedes mosquito is a day biter and only breeds in indoor fresh water will not work. Even if it is true, by killing Aedes you may end up in increasing the density of Culex and malaria causing Anopheles mosquitoes. Culex mosquito, which causes filarial and Japanese encephalitis is already rampant in the city. Even Aedes mosquito, which causes Chikungunya, West Nile, Zika and Dengue can spread by the bite of infected female indoor Aedes aegypti or outdoor Aedes albopictus mosquito. It is true that Aedes aegypti are more dangerous because they can fly up to 200 meters and only feed on human blood, whereas the Aedes albopictus that thrives outdoors can only fly as far as 80 meters and feed on animal blood other than human blood. The outdoor Aedes mosquito cannot be ignored. . The entire campaign up till now has been focused on a day biter, wearing long sleeves shirt and pants during the day and using night mosquito nets. But precautions needs to be taken throughout the day as the mosquitoes only recognize the light and not whether it is day or night. The fact that the mosquito only breeds in clear water also needs to be relearnt. The Aedes mosquito breeds in stagnant water anywhere inside or outside the house. Rain water is the most important source and can collect in any plastic container inside or outside the house. Even collected garbage in open areas can have left over plastic cups or tiny bottle caps with collected rain water collections providing an ideal atmosphere for mosquito breeding. It is true that disease spreading mosquitos do not make noise but the ‘noise-producing’ nuisance mosquitos unless addressed will not create a public movement. The law says that dengue or Chikungunya cases must be notified, but one can notify them within 7 days of diagnosis. Aedes mosquito takes up to three meals in a day and within 7 days will bite over 21 people in the vicinity. Municipal anti-mosquito and anti-larval actions must occur within hours of its detection. The very purpose of notification is lost if the disease is not notified within hours of even suspecting a diagnosis of Chikungunya. So, all suspected cases must be reported without waiting to confirm the diagnosis. We have failed because the government has been insisting that only ELISA-confirmed cases be notified. An SMS should be sent to all doctors practicing in that PIN code areas with a case so that they can become a part of the public health action chain. When the first case is suspected in a state, colony or house, all public health measure should start. An SMS should go to local councilor, MLA, MPs, all practicing doctors, local chemists, NGOs, RWAs, local IMA Branch, State IMA Branch, IMA Headquarters and other Specialty Organizations to join the public health chain efforts. It has taken over a decade for us doctors to understand that dengue 1 and 3 strains are not dangerous and cause only platelet deficiency with thinning of blood, while dengue 2 and 4 strains are dangerous as they destroy platelets and thicken blood due to capillary leakage and rise in hematocrit. Also, that platelet transfusion is not required in absence of active bleeding and it is the timely fluid resuscitation that is more important and not platelet resuscitation. Dengue becomes serious when the fever is subsiding. Earlier, dengue patients with high fever were hospitalized and there was always an urgency to discharge them when fever was subsiding. Now we know that the machine reading of platelet count can be defective. There can be an error of 20%. A platelet count of 10,000 by machine reading can mean it is actually 50,000. Hospital beds should be reserved only for severe dengue and severe Chikungunya cases. Just because one can claim reimbursement in Mediclaim or PSU, should not be the factor to decide on hospital admission. If it was US, Medicare by now would have come out with admission guidelines. The message has been going that fogging has no answer. But at this stage of container index of > 40, we need not only ground fogging but also aerial fogging. When Zika threat came up in Brazil they deployed the army to join and make it a public movement. All political parties reach every house during election process, then why can’t each one of them reach every house and make the anti-mosquito and anti-larval measures effective. Breeding checkers are only with Municipal Corporations and they also have regulatory powers to impose fine. We need breeding checker in private sector. The Skill development Ministry should start courses so that anyone can hire a breeding checker on weekly basis to check their premises. Community approach involves that 100% of the society talks about dengue. Every premise must write that their premises are mosquito-free. When you are invited to somebody’s place, you should ask “I hope your premises are mosquito-free” and when you invite somebody, write “Welcome to my house and it is mosquito-free”.’ Even today most hospitals do not provide mosquito nets to dengue or Chikungunya patients. While they may be having anti-larval mesh doors or mesh windows but for secondary prevention of dengue or Chikungunya, we need to ensure that medial establishments are certified mosquito-free. Many of us live in flats and the mosquitoes may be breeding on the roof top belonging to one of the owners of the flats and if he/she is out of station for a holiday, the anti-larval measures may remain deficient. RWAs should use their powers to check all unoccupied or closed premises including hostels, hotels and construction places in that premises. One of the five great vows of Jainism is Non-attachment/Non-possession or Aparigraha. It talks about not storing unwanted things. But in today’s era our roofs and verandahs are littered with left over tires, utensils, plastic utensils etc. We buy new car tires and keep the old ones on our roof top. We need to change this habit. We have forgotten to plant Tulsi and Peepal in our premises and stopped the daily Yagna, all of which have anti-mosquito properties. The new strategy has to focus on small collections of water such as bottle caps, finding mosquitoes lower in the room under the table or the bed, to look for them in all three parts of the house - roof tops, verandahs and inside the rooms including unused toilets accessories. Also the slogan “Check your house once a week” needs a change. One should be alert every day. It should be a part of your routine. You do not clean your premises once a week. Make it a habit to look for the breeding places. The new approach should be a war against indoor or outdoor mosquitoes; fresh stagnant or dirty water mosquitoes; small containers like bottle caps or large containers like overhead tankers; made of mud or plastic; throughout the day (early morning fogging when pupa hatch for Aedes, late night for malaria); scrubbing clean the utensils Slogan: Ghar ke ander or ghar ke bahar; din me or rat me, deewaron ke niche or upar, chote pani or bade pani ke collection me, eggs larve or mosquito, teeno ko maro.

Dengue: Ads only after outbreak

Dengue: Ads only after outbreak

Durgesh Nandan Jha| Sep 27, 2016, 12.30 AM IST

New Delhi: The under-reporting of dengue cases, highlighted in the CAG report—carried in TOI on Monday—is merely a symptom of the chronic illness Delhi's government and civic bodies suffer from. An analysis of the audit reveals a rot at all levels of planning and action as far as containment of mosquito-borne diseases by the corporations is concerned. The state, too, wakes up only when the crisis hits home.

The CAG report says that dengue cases peak from June to November every year and publicity campaigns relating to prevention of the disease have to be released before that. However, the Delhi government issued advertisements worth Rs 10.04 crore between September and November over the past three years (from 2013-14 to 2015-16) only after the outbreak of dengue. Thus, the very objective of spending to create awareness of the measures to prevent an outbreak was defeated.

This year, too, epidemiologists point out the issuing of advertisements has followed a similar trend. The publicity campaigns of municipal corporations also started in the month of October in the past three years. CAG says launching of a public awareness campaign after monsoon has little justification.

But the story doesn't end here. The federal auditor has criticised the corporations for lack of effective surveillance, first critical element of dengue prevention. According to the audit, none of the civic bodies has a standard operating procedure for this purpose and only 287 out of 967 private and public health institutions report on dengue patients. This undermines the objective of meaningful surveillance to provide early warning of an impending outbreak. In November 2012, the Delhi government constituted a dengue task force under the chairmanship of the state health secretary to formulate an action plan for containment of dengue and other vector-borne diseases in the city. However, the CAG audit has revealed this task force did not meet even once in 2014 and 2015.

The lack of manpower is another key concern voiced by the federal auditor. The malaria department was formed in the early fifties. Though the inhabited area and the population of Delhi have increased manifold since then, points out the CAG report, the sanctioned posts in the malaria department have not been reviewed.

The corporations suffer from shortage of supervisory staff, ranging from 46% to 97%, and in the workmen cadre, from 20% to 36%. In NDMC, there is no sanctioned post of entomologist (scientists who study insects) while the sanctioned posts of epidemiologist and sanitation officers are lying vacant as of January 2016. There is a 12% shortage of anti-malaria jamadaars. The CAG points out that despite this situation, many malaria inspectors, assistant malaria inspectors and field workers are still deployed on ministerial work.

Chemical control measures of vector management are undertaken with the help of various types of pumps. The audit noted 26% of the available pumps/machines in the corporations were not working while 65% of the available pumps/machines in NDMC were non-functional.

The federal auditor has suggested constituting an inter-agency coordinating mechanism, given the multiplicity of agencies dealing with dengue prevention and control in Delhi.

"The CAG report exposes civic agencies, the state and the centre that often get into a blame game over the cause of such a crisis. They should now act on the gaps in dengue prevention mechanism to ensure that more lives are not lost," said Dr K K Aggarwal, president-election, Indian Medical Association.

Platelet transfusion is not the solution to the increasing incidence of dengue

Platelet transfusion is not the solution to the increasing incidence of dengue in the Capital

HCFI & IMA hold a webcast on the dangers of unnecessary platelet transfusion

New Delhi, September 22, 2016: Dengue cases are at an all-time high causing immense panic and chaos in the city. Every family member of patients diagnosed with dengue is found to be worrying about how to arrange the necessary platelets for transfusion.

“It is crucial that the public is educated about the fact that platelet transfusion is not the only solution and is not required in most of the dengue cases”, said Padma Shri Awardee Dr KK Aggarwal - President Heart Care Foundation of India (HCFI) & President Elect IMA at a webcast held today.

“What most people are not aware of is that most dengue cases are preventable and manageable. The risk of complications is less than 1% of dengue cases and if the public knows warning signals, all deaths from dengue can be avoided. One must however always remember it is a myth that all dengue patients require platelet transfusion,” he added.

Addressing the webcast, Dr NK Bhatia Medical Director Mission Jan Jagruti Blood Bank said, “Unnecessary transfusion causes more harm and puts the patient at risk of complications such as sepsis, transfusion-related acute lung injury (TRALI), transfusion associated circulatory overload (TACO), alloimmunization and allergic and anaphylactic transfusion reactions. Transfusion must only be done if a person’s platelet count is less than 10,000, and he has active bleeding”.

It is also important to remember that platelet counts acquired by machine readings is not reliable, and a discrepancy of up to 40,000 can be found. Instead, the doctor must opt for a haematocrit test. Most dengue cases can be managed without testing by only measuring the difference between the upper and lower blood pressure. The pulse pressure should be kept over 40 mm Hg. The public must not pressurise the doctors to hospitalise patients whose illness can be managed at home. The beds should be made available for severe dengue patients instead.

The typical symptoms of dengue are fever, vomiting, headache, nausea, pain behind the eyes and severe joint and muscle pain.  Most dengue virus infections in adults are symptomatic  (86%) and in children under the age of 15 years are asymptomatic or minimally symptomatic. Classic dengue fever is an acute febrile illness accompanied by a headache, retro-orbital pain, and marked muscle and joint pains. Symptoms typically develop between 4 and seven days after the bite of an infected mosquito. The incubation period may range from 3 to 14 days. Fever typically lasts for five to seven days.  The febrile period may also be followed by a period of marked fatigue that can last for days to weeks, especially in adults. Joint pain, body aches, and rash are more common in females.

Because a virus causes dengue fever, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is directed toward relief of the symptoms. The acute phase of the illness with fever and myalgia lasts about one to two weeks.

In dengue, most complications occur within two days of the fever subsiding and most people are casual during this period. Dengue complications during this period are due to a shift of blood volume and patients require a rapid infusion of oral or intravenous fluids in large quantities during this time. 

Myths and facts about platelet transfusion

·      Right now there exists a platelet mania with the public demanding a platelet transfusion even when it is not required. People have a fear and they want to increase their platelet count either by unproved therapies or through transfusion. Both can cause more harm than good and awareness must be raised against this.

·      Platelet deficiency leads to thinning of blood, a condition that is not harmful as blood thinning is routine therapy for heart patients.

·      Risk of platelet shortage is when the blood becomes thick and that is a condition that needs to be managed by the treating doctor

·      Unnecessary transfusion may cause a resistance in the body and make a person’s platelets ineffective in a time of need, a situation called platelet refractoriness

·      Platelet transfusion is known to cause acute severe allergic reactions – a condition called anaphylaxis because of plasma proteins

·      Unnecessary transfusion can also cause platelet transfusion linked acute lung injury and confuse the doctor about whether lung involvement is due to platelets or dengue

·      When indicated, platelet transfusion (single donor) increases platelets by only 50,000 and they last in the body only for about 4-5 days

·      There are people whose baseline platelet counts may be permanently low and the panic may cause them to get an unnecessary platelet transfusion 

Differentiating Chikungunya from dengue

Differentiating Chikungunya from dengue New Delhi, September 06, 2016: Chikungunya and dengue are both acute febrile illnesses characterized by fever, myalgia and lethargy. Some patients may also have maculopapular rash, nausea, vomiting, and headache. Both the illness are caused by the bite of an infected Aedes Aegypti mosquito. Given the rise in the incidence of both the ailments in the city, IMA & HCFI raise awareness about the essential differences between the two, prevention and management. Speaking about the need for prevention Dr. SS Agarwal, National President IMA & Padma Shri Awardee Dr. K.K. Aggarwal, President HCFI and President Elect IMA said, “Community participation is vital to prevent and control the spread of diseases transmitted by the Aedes aegypti mosquito, which includes Zika, Chikungunya and yellow fever besides dengue. In community participation, individuals, families and communities are involved in the planning and conduct of local vector control activities. The Government cannot employ enough persons to search every backyard to identify and destroy breeding sites on a consistent basis to prevent this mosquito from breeding. We are committed to raising awareness amongst the medical fraternity as well as the public about the need for prevention and proper management of diseases caused due to the Aedes Aegypti.“ Distinguishing features of chikungunya include potentially debilitating bilateral polyarthralgia and, in some cases, arthritis. Although these signs and symptoms may assist in differentiating dengue and chikungunya, clinicians should include both illnesses in their differential diagnosis of patients with acute febrile illness. Dengue should be ruled out in patients with acute febrile illness and suspected of having dengue or Chikungunya. Evaluate patients for the warning signs of severe dengue such as persistent vomiting, severe abdominal pain, tachycardia, restlessness, hypotension, and narrow pulse pressure. If present, patients should be hospitalized for close monitoring and management. Ways to protect yourself from the bite of the Aedes Aegypti • Use Environmental Protection Agency-registered insect repellents that contain DEET, picaridin, oil of lemon eucalyptus or IR3535. • Use insect repellent with 20% to 35% of the chemical DEET; more than 35% of the chemical known as diethyltoluamide can irritate skin. • Make sure you apply it to all exposed skin. • Apply insect repellent correctly. Apply sunscreen before repellent, not on top of it. • Apply and let sunscreen dry before using insect repellent. You want the mosquito to land on the repellent, not your sunscreen. • Minimize exposed skin and wear light-colored long sleeved shirts and pants. Mosquitoes are drawn to dark colors, floral patterns and sweet perfumes. • Wear clothing treated with permethrin, a chemical used as an insecticide. • Treat your own clothes, shoes, tents, etc. with a permethrin spray. • Sleep under mosquito nets with windows and doors closed or securely screened if there is no air conditioning. • Make sure there's no standing water outside your lodging because mosquito eggs hatch in water. • Make yourself less appealing to mosquitoes by wearing deodorant and by avoiding drinking quite so much beer

Myths and facts about the outbreak of Dengue in the National Capital

Myths and facts about the outbreak of Dengue in the National Capital New Delhi, August 29, 2016: Given the large-scale panic that the increasing incidence of dengue has created, it is essential that awareness is raised about the myths and facts of the disease. Clearing common misconceptions Padma Shri Awardee Dr. K K Aggarwal, President HCFI & Honorary Secretary General IMA said, “Dengue incidence will continue to exist in the coming one month and instead of creating unnecessary chaos and panic, it is essential that awareness is created about prevention and timely steps are taken towards disease management. One must remember that only 1% of the dengue cases are life-threatening. Most dengue cases can be handled on an outpatient basis and do not require hospitalization". Dengue Myths vs. Facts Myth: We are facing a dengue epidemic Fact: Delhi is at present going through a dengue outbreak, and it is not yet epidemic Myth: All dengue cases are the same and must be dealt with in the same manner Fact: Dengue can be classified as dengue fever and severe dengue. A person is said to be suffering from severe dengue when there is capillary leakage. Patients who have dengue fever do not have capillary leakage. Type 2 and type 4 dengue are more likely to cause capillary leakage. Myth: Everyone suffering from dengue must be hospitalized Fact: Dengue fever can be managed on an outpatient basis and patients who do not have severe abdominal pain or tenderness, persistent vomiting, abnormal mental status or extreme weakness, do not need hospitalization. Only patients suffering from severe dengue need hospitalization basis the discretion of their consulting doctor. One must always remember that 70% of the dengue fever cases can be cured just through the proper administration of oral fluids. Patients must be given 100-150 ml of safe water every hour, and it must be ensured that they must pass urine every 4-6 hours. Myth: Dengue can never re-occur if you have had it once in the past Fact: There are four types of dengue infections, which exist in our country. While dengue from the strain cannot re-occur, that from a different strain can. A second occurrence dengue (secondary) is more serious than first infection (primary). In the primary infection, IgM or NS1 will be positive and in secondary infection IgG will also be positive. Myth: Platelet transfusion is the primary treatment option for people suffering from dengue fever Fact: Platelet transfusion is only needed in cases where the patient's counts are less than 10,000, and there is active bleeding. Unnecessary platelet transfusion can cause more harm than good. The best treatment for dengue is to administer large amounts of oral fluids to patients. For patients who are unable to take oral fluids, intravenous administration may be necessary. Myth: Machine platelet count is accurate Fact: Machine platelet count reading may be less than the actual platelet count, and a difference of about 30,000 can occur Myth: Testing platelet levels alone accounts for complete and effective management of dengue Fact: A complete blood count (especially hematocrit) is needed to monitor prognosis and increased capillary permeability, which is the starting point of all complications. Falling platelet counts with rising hematocrit levels are most important

NCR is in the grip of Chikungunya

NCR is in the grip of Chikungunya New Delhi September 15, 2016: Chikungunya fever is a non-fatal debilitating viral illness, spreads by the bite of infected female Aedes aegypti / albipecto mosquito. Symptoms develop 3-7 days bite by an infected mosquito. Classical triad is skin rash, joint pains and high fever. Most patients will recover within 1-2 week. Cold compression may easy pain. “There is no vaccine to prevent or drugs to treat. One must take plenty of rest and drink fluids to prevent dehydration. Aspirin or NSAIDS should not be taken until dengue is ruled out. Both ailments may present with similar symptoms”, said Padma Shri Awardee Dr KK Aggarwal – President Elect IMA and President Heart Care Foundation of India. In 20%, joint involvement may persist for weeks and in 10% cases; they tend to persist for months. In 10 %, swelling disappears; pain subsides, but will reappear with every other febrile illness for many months. Each time the same joints get swollen, with mild effusion and symptoms persist for a week or two after subsidence of the fever. 92% have symmetric polyarthralgias, 67% arthritis, 75% skin rash. 89% have very good clinical response to NSAIDS. 27% require low-dose steroids & 5% methotrexate therapy. Non-weight bearing exercises may be suggested (slowly touching the occiput (back of the head) with the palm, slow ankle exercises, pulley assisted exercises, milder forms of yoga). Standard treatment is Paracetamol one gram up to four times a day for up to four weeks. At four weeks if pain persists four weeks course of oral steroids can be given. At eight weeks if pain persist specific disease modifying drugs like hydroxychloroquibe may need to be added. Chikungunya can unmask psoriasis arthritis of rheumatoid gathia arthritis in some cases. It can cause in some cases neuro and ocular manifestations (encephalitis, mono neuritis, optic neuritis).

Plasma leakage is the most specific and life-threatening feature of dengue

Plasma leakage is the most specific and life-threatening feature of dengue

New Delhi, September 11, 2016: The increasing incidence of Dengue has city causing chaos and panic in the city. Every person struck by even a common fever due to the change in weather is seen rushing to hospitals to rule out the possibility of it being dengue. However what most people do not realise is that there is no need to panic since 99% of the dengue cases are non-fatal. The need of the hour is to raise mass awareness about the necessary prevention measures of dengue and risk factors. Dengue fever is a painful mosquito-borne disease. It is caused by any one of four types of dengue virus, which is transmitted by the bite of an infected female Aedes aegypti mosquito. Common symptoms of dengue include high fever, runny nose, a mild skin rash, cough, and pain behind the eyes and in the joints. However, some kids may develop a red and white patchy skin rash followed by loss of appetite, nausea, vomiting, etc. Patients suffering from dengue should seek medical advice, rest and drink plenty of fluids. Paracetamol can be taken to bring down fever and reduce joint pains. However, aspirin or ibuprofen should not be taken since they can increase the risk of bleeding. The risk of complications lies in less than 1% of dengue cases and, if warning signals are known to the public, all deaths from dengue can be avoided. A platelet transfusion is not needed if the platelet counts are more than 10,000. Unnecessary platelet transfusion can cause more harm than good Speaking about the issue, Padma Shri Awardee Dr KK Aggarwal, President Heart Care Foundation of India and National President Elect IMA said, “Dengue is both preventable and manageable, and people must not panic since fatality only occurs in 1% of the cases. Plasma leakage is the most specific and life-threatening feature of dengue which occurs three to seven days after the onset of the illness. The presence of intense abdominal pain, persistent vomiting, and marked restlessness or lethargy, especially coinciding with defervescence are the red flag symptoms and a chest radiography and chest/abdominal ultrasound are useful for detection of plasma leakage. Taking necessary precautions and acting in a timely fashion is key to eliminating fatality in dengue cases. For all patients, staying well hydrated is strongly advised”. In cases of plasma leakage, the increase in vascular permeability develops over a period of 24 to 48 hours. Shock may develop in patients with marked plasma leakage, especially if supportive treatment is delayed and is associated with a case-fatality rate of 12 percent. Abdominal pain is also reported to precede the onset of plasma leakage in approximately 60 percent of patients with dengue. Plasma leakage is important to manage with intravascular volume depletion to prevent or reverse hypovolemic shock. In mild cases, particularly when medical attention is received early, oral rehydration may be sufficient. However, in patients with established intravascular volume loss, an intravenous fluid administration is recommended. Blood transfusion is appropriate in patients with significant bleeding or those who have low hematocrit and fail to improve despite fluid resuscitation. Platelet transfusions have not been shown to be effective at preventing or controlling haemorrhage but may be warranted in patients with severe thrombocytopenia (<10,000/mm3) and active bleeding. Physicians should remember the ‘Formula of 20’ i.e. rise in pulse by more than 20; fall of BP by more than 20; difference between lower and upper BP less than 20 and presence of more than 20 hemorrhagic spots on the arm after a tourniquet test suggest a high-risk situation and the person needs immediate medical attention. The onus of preventing dengue lies with the public and not with the Government authorities. The dengue mosquitoes are found only in water collected outside the house and not in dirty water in the drains.

Dengue and Chikungunya are totally preventable diseases

Dengue and Chikungunya are totally preventable diseases Dengue, Chikungunya as well as Malaria and Filaria are mosquito-borne diseases and are totally preventable. Here are some salient points to remember about their prevention. • Malaria is transmitted via the bite of a female Anopheles spp mosquito, which occurs mainly between dusk and dawn. It may rarely spread as a congenitally-acquired disease or via blood transfusion, sharing of contaminated needles and organ transplantation. • The Dengue mosquito (Aedes aegypti) bites in the day time. • The Aedes Dengue mosquito has up to 3 meals in a day, while the malaria mosquito has 1 meal in three days. Malaria may infect only one person in the family; on the other hand, dengue mosquito will infect more than one member in the family in the same day. • Malaria fever often presents with chills and rigors. If fever presents with joint and muscle pains, suspect Chikungunya. • The Dengue mosquitoes may also breed inside houses in fresh collected water; hence, insecticide spraying, in response to dengue outbreaks, is not highly effective. Water should not be allowed to collect inside the house for more than a week. Mosquito cycle takes 7-12 days to complete and if any water collected utensils is scrubbed cleaned properly once in a week, there are no chances of mosquito breeding. • Collection of water in and around the house can occur in flower pots, uncovered water tanks on the terrace, bird drinking pots, broken tires, broken glasses, water coolers or any container where water can stay for 7 days. • Education of the public about discarding tires and other containers that accumulate standing water has shown promise in reducing breeding sites. • Using mosquito nets/repellents in the night may not prevent dengue the mosquito bites during day time. Wearing full sleeves shirt and trousers can prevent the mosquito from biting the body during the day. • Both malaria and dengue mosquito do not produce noise. Therefore, mosquitoes which produce noise do not cause diseases. • There are no vaccines for malaria and dengue. • Comprehensive community and governmental control strategy, including the seeding of water vessels with copepods that feed on mosquito larvae, is successful in eliminating A. aegypti and dengue transmission.

Stop mosquito breeding – prevent dengue

Stop mosquito breeding – prevent dengue New Delhi, 08 September 2016: Dengue cases are on the rise, and it is important that each one of us works towards preventing the onset on the disease. However, to do so, we must know all about the disease carrying vector and the disease itself. Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. The symptoms include severe joint and muscle pain, swollen lymph nodes, headache, fever, exhaustion, and rashes. Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is directed toward relief of the symptoms. The acute phase of the illness with fever and myalgias lasts about one to two weeks. Speaking about this, Padma Shri Awardee Dr. K.K. Aggarwal, President Elect IMA and President HCFI said, “What most people do not realize is that the dengue mosquito breeds in fresh clean water as opposed to dirty drains. Thus, people living in clean urban surroundings are more at risk of acquiring the disease. People must ensure that they do not let water accumulate in their houses, wear full-sleeve clothing and use mosquito repellents during the monsoon season when the incidence of the disease is the highest. Prevention is always better than cure. In case of being diagnosed with dengue, people must not panic, consume ample amounts of fluids since the dangers of dengue lie in dehydration and must only get a platelet transfusion if their platelet counts are below 10,000 or there is active bleeding. Unnecessary transfusion can cause more harm than good." The dengue mosquito lays its eggs on the walls of water-filled containers in the house and patio. Eggs can survive for months. The eggs hatch when submerged in water. Female mosquitoes lay dozens of eggs up to 5 times during their lifetime. The life cycle of the mosquito from egg to larvae, pupae, and to an adult mosquito, is about eight days and occurs in water. Adult mosquitoes live for about one month and rest indoors in dark areas (closets, under beds, behind curtains). It is only the female mosquitoes, which bite humans. The dengue mosquito can fly several hundred yards looking for water-filled containers to lay their eggs. A few mosquitoes per household can produce large dengue outbreaks. The dengue mosquito does not lay eggs in ditches, drainages, canals, wetlands, rivers or lakes; pouring chlorine into these habitats is useless. Chlorine is harmful to aquatic life. The risk of complications is in less than 1% of dengue cases and, if warning signals are known to the public, all deaths from dengue can be avoided. The onus of prevention lies in the hands of each person. We must not let mosquitos breed around our houses, wear full sleeve clothes while going out and use mosquito repellent in the monsoon season.

Differentiating Chikungunya from dengue

Differentiating Chikungunya from dengue New Delhi, September 06, 2016: Chikungunya and dengue are both acute febrile illnesses characterized by fever, myalgia and lethargy. Some patients may also have maculopapular rash, nausea, vomiting, and headache. Both the illness are caused by the bite of an infected Aedes Aegypti mosquito. Given the rise in the incidence of both the ailments in the city, IMA & HCFI raise awareness about the essential differences between the two, prevention and management. Speaking about the need for prevention Dr. SS Agarwal, National President IMA & Padma Shri Awardee Dr. K.K. Aggarwal, President HCFI and President Elect IMA said, “Community participation is vital to prevent and control the spread of diseases transmitted by the Aedes aegypti mosquito, which includes Zika, Chikungunya and yellow fever besides dengue. In community participation, individuals, families and communities are involved in the planning and conduct of local vector control activities. The Government cannot employ enough persons to search every backyard to identify and destroy breeding sites on a consistent basis to prevent this mosquito from breeding. We are committed to raising awareness amongst the medical fraternity as well as the public about the need for prevention and proper management of diseases caused due to the Aedes Aegypti.“ Distinguishing features of chikungunya include potentially debilitating bilateral polyarthralgia and, in some cases, arthritis. Although these signs and symptoms may assist in differentiating dengue and chikungunya, clinicians should include both illnesses in their differential diagnosis of patients with acute febrile illness. Dengue should be ruled out in patients with acute febrile illness and suspected of having dengue or Chikungunya. Evaluate patients for the warning signs of severe dengue such as persistent vomiting, severe abdominal pain, tachycardia, restlessness, hypotension, and narrow pulse pressure. If present, patients should be hospitalized for close monitoring and management. Ways to protect yourself from the bite of the Aedes Aegypti • Use Environmental Protection Agency-registered insect repellents that contain DEET, picaridin, oil of lemon eucalyptus or IR3535. • Use insect repellent with 20% to 35% of the chemical DEET; more than 35% of the chemical known as diethyltoluamide can irritate skin. • Make sure you apply it to all exposed skin. • Apply insect repellent correctly. Apply sunscreen before repellent, not on top of it. • Apply and let sunscreen dry before using insect repellent. You want the mosquito to land on the repellent, not your sunscreen. • Minimize exposed skin and wear light-colored long sleeved shirts and pants. Mosquitoes are drawn to dark colors, floral patterns and sweet perfumes. • Wear clothing treated with permethrin, a chemical used as an insecticide. • Treat your own clothes, shoes, tents, etc. with a permethrin spray. • Sleep under mosquito nets with windows and doors closed or securely screened if there is no air conditioning. • Make sure there's no standing water outside your lodging because mosquito eggs hatch in water. • Make yourself less appealing to mosquitoes by wearing deodorant and by avoiding drinking quite so much beer

Differentiating Chikungunya from dengue

Differentiating Chikungunya from dengue

Dr K K Aggarwal

Chikungunya and dengue are both acute febrile illnesses characterized by fever, myalgia and lethargy. Some patients may also have maculopapular rash, nausea, vomiting, and headache.

Distinguishing features of chikungunya include potentially debilitating bilateral polyarthralgia and, in some cases, arthritis.

Although these signs and symptoms may assist in differentiating dengue and chikungunya, clinicians should include both illnesses in their differential diagnosis of patients with acute febrile illness.

Dengue should be ruled out in patients with acute febrile illness and suspected of having dengue or Chikungunya.

Evaluate patients for the warning signs of severe dengue such as persistent vomiting, severe abdominal pain, tachycardia, restlessness, hypotension, narrow pulse pressure. If present, patients should be hospitalized for close monitoring and management.

Such patients should also be evaluated for other serious conditions, such as malaria, leptospirosis, and other bacterial infections.

(Source: Medscape)