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.

Mosquito menace likely to be back

Mosquito menace likely to be back Time to learn from mistakes made last year and take steps to take preventive measures early on this year, including a community driven approach New Delhi, 25 April, 2017: According to statistics, the mosquito container index (the percentage of water-holding containers infested with larvae or pupae) in Delhi is over 5% and had crossed 40% last year. Any index above 5% requires a community integrated cluster approach to reduce mosquito density together with effective anti-larval measures. Cases of dengue and chikungunya have started in the capital already. Unfortunately, no alert has been issued and in sporadic cases, no surgical strikes have been attempted openly in selected breeding places. 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. Speaking on the 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 "There is a need for 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. However, even this year, cases have started without alerts and involvement of private sector. This is again a collective failure of Municipal Corporation, Delhi Government, Central Government, LG office, Medical Associations, CSR departments, Media, NGOs, and private sector. It’s time for all of us to convert last year's biggest failure of controlling the mosquito menace into success this year." Another point to consider is that last year, about 3 lakh mosquito repellent impregnated mosquito nets were distributed by MCD but most were not available to actual patients. The very purpose of notification is lost if the disease is not notified within hours of even suspecting a diagnosis of Chikungunya. Therefore, all suspected cases must be reported without waiting to confirm the diagnosis. Adding further, Dr K K Aggarwal, said, "This problem requires a community approach involving 100% of the society speaking 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. 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 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. However, precautions need 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 mosquitoes only breed in clear water also needs to be re-learnt. It is true that disease spreading mosquitoes do not make noise but the ‘noise-producing’ nuisance mosquitoes unless addressed will not create a public movement.

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.

Mosquitoes Can Infect Their Eggs With Dengue

Mosquitoes Can Infect Their Eggs With Dengue

Spraying not enough to eliminate dengue, prevention is key

The incidence of dengue will continue to exist this month and instead of creating unnecessary chaos and panic, it is essential that awareness is created about its prevention and timely steps are taken towards disease management.

The first step typically taken towards eliminating dengue is large scale spraying. What most people remain unaware of is that spraying affects adult mosquitoes, but it does not usually kill the immature forms — the eggs and larvae. Spraying only reduces transmission, but it may not eliminate the virus. The aedes mosquito can pass the virus to their offspring in their eggs making control harder.

Usually, it takes people plus mosquitoes to spread a virus. The mosquitoes bite actively infected people, incubate the virus for a while, and then bite other people to spread it. If no people in an area are infected, no virus spreads. Using mosquito nets, mosquito repellents with DEET and constantly checking for breeding in and outside one’s house are highly recommended.

Aedes are container breeders — they can lay their eggs in small containers and need just a tiny bit of water to hatch. They live in and around houses and like crowded urban areas where spraying is difficult. Spraying insecticides to kill adult mosquitoes cannot wipe out Aedes. They lay their eggs right above the water line in a small container, a discarded tire or some trash. So when that container is filled and the water covers the eggs, the eggs hatch. It is important that the inside of a container is scrubbed to kill the eggs. The eggs can survive being dried out, and they stick really well. They're impervious to insecticides or other chemicals. So simply emptying containers regularly does not necessarily get rid of the mosquitoes.

Speaking about the issue, Padma Shri Awardee KK Aggarwal – Honorary Secretary General IMA and President Heart Care Foundation of India said,” 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. It is important the formula of 20 to manage dengue fever - If there is a rise in pulse by 20, fall in upper blood pressure by 20, rise in hematocrit by 20 percent, rapid fall in platelets to less than 20,000, platelet count of more than 20 in one inch after tourniquet test and the difference between upper and lower blood pressure is less than 20, then such cases should be given 20 ml of fluid per kg immediately and then shifted to nearest medical center for medical assistance”,

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.

Mosquitoes Can Infect Their Eggs With Dengue

Mosquitoes Can Infect Their Eggs With Dengue

Dr K K Aggarwal


It’s hard to get rid of dengue as the mosquitoes can pass the virus to their offspring in their eggs. Mosquitoes infect their larvae with other viruses, too, including Zika virus.

It makes control harder. Spraying affects adults, but it does not usually kill the immature forms — the eggs and larvae. Spraying will reduce transmission, but it may not eliminate the virus.

Usually, it takes people plus mosquitoes to spread a virus. The mosquitoes bite actively infected people, incubate the virus for a while, and then bite other people to spread it. If no people in an area are infected, no virus spreads.

Sometimes an animal can act as a reservoir — birds can keep West Nile Virus spreading, for instance.

So-called vertical transmission allows the virus to spread even if all the adult mosquitoes in an area die out.

But that's not easy. Aedes are container breeders — they can lay their eggs in small containers and need just a tiny bit of water to hatch.

They live in and around houses and like crowded urban areas where spraying is difficult.

Spraying insecticides to kill adult mosquitoes cannot wipe out Aedes.

They lay their eggs right above the water line in a small container, a discarded tire or some trash.

So when that container is filled and the water covers the eggs, the eggs hatch.

YOU HAVE TO SCRUB THE INSIDE OF THE CONTAINER. THAT IS THE WAY TO GET RID OF THE EGGS.
The eggs can survive being dried out, and they stick really well. They're impervious to insecticides or other chemicals.

So simply emptying containers regularly does not necessarily get rid of the mosquitoes.

You have to scrub the inside of the container. That is the way to get rid of the eggs.

Aedes albopictus, the so-called Asian tiger mosquito that has a much broader ranges than Aedes aegypti, did not transmit Zika to its eggs. 

Whenever Dengue or Chikungunya Case is suspected: Do the followings:

Whenever Dengue or Chikungunya Case is suspected: Do the followings:

Dr K K Aggarwal

• SMS to the RWAs President & Secretary who in turn should send SMS to all RWA Members.
• SMS to be sent to the local IMA Branch President & Secretary who in turn should send a SMS to all the doctors of that respective pin code area.
• SMS to be sent to all the Pathologists of that area.
• Local Councillor/MLA/MP should be informed about the outbreak of dengue in a particular Pin Code area so that necessary Vector Control Programme is under taken by the respective Municipal body.
• All the doctors should make it a point that whenever they see their patients, they do talk about Dengue prevention

All you need to know about Chikungunya and the management of arthritis while affected by the disease

All you need to know about Chikungunya and the management of arthritis while affected by the disease New Delhi August 11, 2016: Chikungunya fever is a debilitating, but non-fatal, viral illness that has got Delhi in its grip at the moment. The illness is spread by the bite of infected female Aedes aegypti mosquito. Common symptoms of Chikungunya that develop 3-7 days after being bitten by an infected mosquito include fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. “There is no need to panic since chikungunya is a non-fatal illness. Most patients suffering from it will feel better within a week. In some people however, the joint pain may persist for months. It is thus important to take necessary precautions against getting bitten by the Aedes mosquito known to cause both chikungunya and dengue fever. Those at high risk such as newborns infected around the time of birth, older adults (≥65 years), and people with medical conditions such as high blood pressure, diabetes, or heart disease need to be extra cautious since they can develop disease related complications, said Padma Shri Awardee Dr KK Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA. Said in a joint statements Dr N K Yadav, Training Coordinator GDD-CDC Project, NIHFW New Delhi & Dr V K Monga, IMACGP, the Aedes mosquito breeds in clean water collections making it imperative to regularly water containers and tanks and check discarded material such as buckets, utensils, tyres, flowerpots etc for breeding. While the peak biting times of the Aedes aegypti mosquito are early morning or late evening, however the mosquito can also bite in the night when in a well-lit room making the use of mosquito repellents essential. At present, there is no vaccine to prevent or medicine to treat chikungunya virus. Medicines can be used to ease symptoms. Patients are advised to get plenty of rest and drink fluids to prevent dehydration. It is important to note that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS) should not be taken until dengue is ruled out to reduce the risk of bleeding since both the ailments present similar symptoms. Given that joint pain is one of the primary symptoms of the disease, HCFI and IMA released a few points and tips on the management of arthritis in Chikenguniya: • The osteoarticular problems seen with Chikungunya fever usually subside in one to two weeks’ time. • In approximately 20% cases, they disappear after a gap of few weeks and in less than 10% cases, they tend to persist for months. • In about 10 % cases, the swelling disappears; the pain subsides, but only to 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. • Since an immunologic aetiology is suspected in chronic cases, a short course of steroids may be useful. • Care must be taken to monitor all adverse events and the drug should not be continued indefinitely to prevent adverse effects. • Even though NSAIDS produce symptomatic relief in majority of individuals, care should be taken to avoid renal, gastrointestinal, cardiac and bone marrow toxicity. • Cold compresses have been reported to lessen the joint symptoms. • Disability due to Chikungunya fever arthritis can be assessed and monitored using one of the standard scales. • Proper and timely physiotherapy will help patients with contractures and deformities. • Non weight bearing exercises may be suggested.; e. g. slowly touching the occiput (back of the head) with the palm, slow ankle exercises, pulley assisted exercises, milder forms of yoga etc. • Surgery may be indicated in severe and disabling contractures. • The management plan may be finalized in major hospitals, but the follow-up and long-term care must be done at a domiciliary or primary health centre level. • Occupational assistance after detailed disability assessment needs to be provided

Delhi is in a grip of Chikungunya

Delhi is in a grip of Chikungunya
 Symptoms, Diagnosis & Treatment of Chikungunya

Symptoms

• Most people infected with chikungunya virus will develop some symptoms.
• Symptoms usually begin 3 to 7 days after being bitten by an infected mosquito.
• The most common symptoms are high-grade fever and severe arthralgia (joint pain).
• Other symptoms may include headache, fatigue, throat discomfort, muscle pain, joint swelling, or skin rash.
• Chikungunya disease does not often result in death, but the symptoms can be severe and disabling.
• Symptoms usually resolve within a week. But, the joint pain may persist for months in some people.
• People at risk for more severe disease include newborns infected around the time of birth, adults aged 65 years or older and people with medical conditions such as high blood pressure, diabetes, or heart disease.
• Once a person has been infected, he or she is likely to be protected from future infections.

Diagnosis

• The symptoms of chikungunya are similar to those of dengue and Zika, diseases spread by the same mosquitoes that transmit chikungunya.
• A history of travel or residence in areas where chikungunya is found in a suspected case.
• Blood tests to look for virus specific antibodies for chikungunya or other similar viruses like dengue and Zika. 

Treatment

• There is no vaccine to prevent or medicine to treat the Chikungunya virus.
• Treatment is symptomatic and supportive.
• - Plenty of rest.
• - Adequate fluids to prevent dehydration.
• - Paracetamol to reduce fever and pain.
• -  Avoid aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) until dengue can be ruled out to reduce the risk of bleeding).
• - If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication. 
• Patients with Chikungunya should take precautions to prevent mosquito bites for the first week of the illness.
• - During the first week of infection, Chikungunya virus can be found in the blood and passed from an infected person to a mosquito through mosquito bites.
• - An infected mosquito can then spread the virus to other people