India struggles to combat dengue fever

As dengue cases climb, solutions remain elusive
India struggles to combat dengue fever
Spraying to kill mosquito larvae; one method to try to prevent outbreaks

November 14, 2012
No matter that Bollywood film director Yash Chopra was 80 years old and suffering from kidney problems. When the official cause of his death on October 21 was confirmed as dengue fever it only served to heighten fears as cases of the disease have climbed in India this year. The Ministry of Health has recorded 12,470 cases up to October versus just over 10,000 for the whole of last year. So far in 2012, 92 people – including Chopra – have died. The National Vector Borne Disease Control Program, India’s front line against dengue fever which receives reports on the disease from every corner of the country, says the real figure is much higher; it estimates as many as 32,000 cases to date this year. But while statistics can be debated, nobody is denying that the disease is clearly on the rise. South India has been particularly badly hit with 4,949 cases and 39 deaths in Tamil Nadu alone in 2012. Health professionals are also pointing to a growing number of dengue reports from New Delhi. Last month, in a remote township of Dimapur in the far-flung northeastern state of Nagaland on the Myanmar border, two cases were reported. However, local health officials said both victims had traveled to the capital which has become increasingly at risk. “These were cases of dengue being imported from Delhi,” said F. Kikon, a local voluntary health worker in Nagaland. With one more person succumbing to the disease last week in the capital, the number of deaths attributed to dengue has risen to four and there is a probe into Chopra’s death to determine whether he acquired the disease in the capital or on a film shoot in Jammu and Kashmir. Recently the Delhi High Court served a notice to the federal government to submit a report on the implementation of a long-term plan to control the outbreak, but critics say the policy remains muddled and inadequate. A relative of a dengue patient in a government-run hospital in New Delhi said patients are sharing beds due to a lack of space, one of a handful of problems. “Authorities are showing apathy while hospital staff are virtually clueless. Everyone is languishing here and just trying to keep the faith,” he said. A recent health ministry report noted that "the implementation [of dengue precautions] at the ground level needs to be strengthened with focused monitoring by technical staff.” The problem is that the same health ministry admits that there is very little that can be done. “I am told there is no certain anti-dengue precautionary medicine. The only way left is prevention of mosquito breeding and bites,” Health Minister A.K. Walia said recently. Evidence suggests that dengue cases spike during the monsoon season in the second half of the year leading to anecdotal reports of people taking dengue medicines and antibiotics themselves as a precaution. Health professionals worry this only serves to promote super dengue strains while some have blamed the disease on Sri Lanka and even dieting in recent months. Meanwhile, precautionary measures are proving to be largely ineffective. “Mosquitoes bite in the day time but general precautions against mosquitoes (such as nets) are only usually used during the night,” said a health ministry spokesman. The main plan of attack has therefore been eradicating stagnant water and spraying to kill off larvae. In the northeastern state of Assam where about 525 dengue cases have been reported, the Director of Health Service Dhrubjyoti Hojai said state authorities will issue a fine to any household found with stagnating water in pots, ditches and tires. “Dengue mosquitoes breed in and around the house and office localities where there is often clean water,” said the health ministry spokesman. “We must ensure that there is no fresh water collecting.” Related reports State chiefs say dieting causes dengue fever
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