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, October 26, 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.