Deadly Dengue

These are just two instances in the city whose underbelly is breeding Aedes aegypti mosquito,the carrier of dengue fever — at work places,residential societies,highrises and schools. Over the last few years,the city has noted a sharp rise in dengue cases — from a mere 115 recorded in 2010 to a whopping 1,275 (officially 660) recorded in just 10 months this year.

Dengue has also hit the nation hard. In October alone,the country witnessed over 100 deaths due to dengue. While Maharashtra recorded the maximum deaths at 31,Kerala saw the highest number of cases in the country — 7,000 — and 23 deaths.

While the civic authorities and residents indulge in blame game,dengue is steadily replacing malaria as the most dreaded disease. Till now,Maharashtra has recorded as many as 2,681 dengue cases and at least 31 deaths,with 12 deaths in Mumbai alone. The city marked an acute increase this month with 82 confirmed cases reported so far. While 660 cases were reported from various civic hospitals,615 suspected cases were reported at 38 private hospitals in the city.

Though malaria figures continue to exceed the total count of dengue cases,there has been a drastic slide in malaria cases in the past three years. From 76,755 cases and 145 deaths in 2010,the figure has plunged to of 8,000 cases and 17 deaths this year.

What has the BMC

done so far?

The Brihanmumbai Municipal Corporation (BMC) runs its campaigns on the lines of National Vector Borne Disease Control Programme (NVBDCP),a central nodal agency for vector-borne disease prevention and control. According to Manisha Mhaiskar,additional municipal commissioner,60 per cent cases of dengue are reported from residential areas while 40 per cent from slums,as opposed to the pattern for malaria,which observed more in open areas than residences or offices.

“Since Aedes mosquito breeds in fresh water,domestic areas are the most favourable place to multiply. We have,therefore,targeted not only societies but also offices and educational institutes to spread the word,” Mhaiskar said.

Of the Rs 2,000 crore health budget,BMC has spent close to Rs 1 crore on awareness campaigns for dengue and malaria — in the form of newspaper ads,radio,banners,posters and kiosks. Nearly 2.5 lakh posters have been pasted across the city.

Dr Mangala Gomare,deputy executive health officer,BMC,said 95 camps have been held since the onset of monsoon to screen public for various ailments. Under the BMC’s ‘Dengue Proof Your Home’ campaign launched on July 17,awareness camps have been conducted at 11,400 housing societies,6,080 work places,2,041 schools and 917 educational institutes. “These camps underline the general guidelines of preventive measures for mosquito breeding. In public schools alone,we have educated 1,627 principals and 1,994 teachers about dengue,” Gomare said.

The decision to include schools in campaigns,as Mhaiskar explained,was taken because children grasp the message quickly and help in propagating it further. As many as 5.7 lakh students have been sensitised through the awareness campaigns. “We have adhered to NVBDCP guidelines and taken all possible measures to ensure that no resident misses our awareness campaign. The responsibility of mosquitoes breeding at personal spaces lies on the owners. Therefore,even after repeated warnings,if we find indoor breeding spots,the individual can be fined by the metropolitan magistrate,” said Mhaiskar.

To bring perpetrators to book,BMC has started taking legal action against those who have ignored BMC’s warning. Those guilty have been prosecuted under section 381B of the BMC Act. “Fogging is done in every area once in three weeks. We have been insisting on prevention measures in all wards. An offender can be fined Rs 2,000-10,000,” said Rajan Naringrekar,insecticide officer,BMC.

Till now,BMC has served 537 notices to residents,offices and individuals.

Why has dengue breeding not been curbed?

According to Dr Avinash Supe,Dean,Sion Hospital,fogging should be done inside houses to achieve better results. “Currently,fogging is done in open spaces. However,it does not reach deep inside the domestic areas. Inter-residual spray can be used in flats and residences to kill mosquitoes. Although it will cause a greasy layer on walls,it will be far more effective,” he said. The inter-residual sprays are non-toxic and cannot be undertaken more than once in three weeks.

According to Naringrekar,dengue cannot be controlled by BMC alone and requires public participation. He claimed that during their expedition to wipe out breeding spots in Mulund,they found an astounding 37 spots at just one slum — Indira Nagar. Of these,28 were located indoors. In Indira Nagar,four suspected dengue cases and one confirmed case has been reported.

“People in all houses keep a water tank under the kitchen platform. These tanks facilitate mosquito breeding,” he said. Aedes mosquito breeds in water that has been stagnant for at least seven days. With a prolonged monsoon,water accumulation has only aided mosquito growth.

According to Naringrekar,five spots were located on tarpaulin sheets and four in ‘odd articles’. “The most common points are blue tarpaulin sheets,which retain water for a long duration. Regular cleaning of those sheets is the duty of the owner,” Naringrekar said.

Besides feng-shui plants,petri dishes and flower pots,identified by BMC as breeding spots,tarpaulin sheets on top of slum shanties have put paid to efforts to eliminate breeding spots.

Why BMC isn’t effective

While a little over a quarter of the revenue expenditure of the MCGM budget is spent on health,medical relief and education,non-availability of sufficient beds continues to pose a major problem. While diagnosis has improved tremendously,treatment has not.

Dr Suleman Merchant from Sion hospital points out that dengue — just like other viral diseases — has no specific treatment. “While we have anti-malarial antibiotics to cure malaria,there is no prescribed medical treatment for dengue. A patient can only be given supportive treatment to build his immunity,” he said.

A person suffering from dengue is prone to rapid platelet decline,body pain and high fever. In the absence of immediate attention,the symptoms can aggravate to dengue haemorrhagic fever,which can cause death. Ruby Shaikh,who succumbed to dengue shock syndrome,was turned down from a nursing home and had to approach state-run JJ Hospital for treatment. The loss of a few days cost a precious life.

Absence of co-ordination between public and private hospitals is another deterrent. On record,BMC claims to have 660 confirmed dengue cases,which many say is just half the actual count. Thirty-eight private hospitals claim additional 615 cases. Gomare said these cases have been tagged as suspected in the absence of ELISA (enzyme linked immunosorbent assay) test.

An ELISA test is considered the final confirmatory test for dengue,as opposed to a rapid test,which is considered to be vague. However,many hospitals and private nursing homes first use rapid test because of its fast results. According to Dr Shubha Raul,member of health committee in BMC,dengue cases are underestimated. “In my ward (R North),BMC had claimed zero confirmed cases. However,I have found several cases,” she said. In her research,she found out that a single laboratory in Dahisar confirmed 250 cases of dengue through ELISA test in just one month. However these cases have not been acknowledged by BMC yet,she added.

The owner of the laboratory,Dr Ajay Shah,said,“BMC has not co-ordinated with us for the figures. This year,there has been an unusual rise in dengue but many cases go unreported.” In the absence of an actual count,it becomes difficult to zero in on the reasons for the spurt and consequent redressal also becomes tough.

On record,BMC has noted only six confirmed dengue deaths since the onset of monsoon. The ground reality is,however,different. At least 12 dengue deaths have been recorded since July — double the BMC claim.

The onus to curb dengue now has fallen on residents as well as the civic body. While residents claim a lackadaisical attitude by civic authorities,BMC alleges negligence on the residents’ part. Dhawal Shah,30,a resident of Goregaon West,the area that reported more than 50 dengue cases in September,said,“With a lot of construction going on nearby,water accumulates on the roadside. This is one of the reasons for mosquito breeding. BMC has never taken the responsibility of cleaning up this area,fogging or creating awareness.”

After reports of a rise in dengue surfaced in the media,BMC sent a three-member team to the Goregaon to examine the reasons. The findings confirmed only seven cases from the area as opposed to the high figures claimed by nearby hospitals.

Mutation and habitat changes

The behaviour of dengue and its carrier has undergone transformation over the last few years,with the disease hitting regions in the country in a cyclical manner. While experts blame pollution and weather change,newer strains of the virus may have come up. With the unprecedented rise in dengue cases,mutation in the virus is a high possibility.

Dr Om Shrivastava,director of infectious diseases in Jaslok Hospital,said with global warming,the vector cycle has undergone a change. “Vectors have a predictable pattern but with rapid urbanisation,we are getting rid of the green cover and the open spaces are reducing. If we add unhygienic lifestyle and improper garbage disposal to it,the life cycle of not only zoonosis,but also vectors can change,” he said.

While colder places have less scope for breeding,warmer regions encourage mosquito growth. The tropical wet climate — not just in Mumbai,but in most parts of the country — is conducive for mosquito breeding. “Also,with global warming,the average temperature is rising,which adds to the list of factors promoting Aedes. There can never be a single reason and even in the case of dengue,a combination of factors has led to the spurt,” Shrivastava noted.

While BMC is adamant that Aedes mosquitoes can breed only in domestic areas,doctors feel otherwise. According to experts,a mutation can cause the mosquito to breed in puddles and open spaces as well. If that is true,then the strategies underlined by the NVBDCP may have a loophole. While BMC has focused its energies on residential societies,offices and institutes,it has overlooked a major chunk of open spaces. According to Naringrekar,the destruction of breeding spots has been undertaken extensively in residential areas and dengue awareness campaigns have been focused on indoor breeding,not outdoor.

Steps ahead

With reports of new dengue cases coming in even after complete withdrawal of monsoon,BMC has now accepted the possibility of mutation. Generally,the disease peaks during monsoon and recedes with the withdrawal of rains. However,this year,the expected decline in cases was not seen in October.

BMC plans to set up NS1 antigen testing facility at 50 upgraded municipal dispensaries for dengue diagnosis.

Further,in an attempt to study the cause of a rise in Aedes mosquito and find solutions,the BMC has called in two teams to the city on Wednesday to study more than 100-odd blood samples. “A team from National Institute of Virology (NIV),Pune,and another team from NVBDCP,Delhi,are visiting the city to examine blood samples of dengue patients from various civic hospitals. The result will take about 10 days,” said Mhaiskar.

“We have carried out all steps required to curb the disease. We thought that prolonged monsoon may be one of the cause for the rise but that theory,too,has failed. Now with proper research,solid conclusions can be reached,” Mhaiskar said.

Following reports from NIV and NVBDCP,additional intervention strategies can be devised to approach the disease from a new angle.

tabassum.barnagarwala@expressindia.com