June | 2017 | Pest Control India

H1N1 bigger killer than dengue and malaria in Maharashtra

Mumbai: The H1N1 influenza virus which entered the list of infectious diseases with a global pandemic in 2009, has overtaken dengue and malaria to become the biggest killer among seasonal ailments in Maharashtra.

Since its appearance, the viral infection has claimed nearly 2,500 lives in the state, about five times the fatalities caused by dengue and three times that of malaria in the same period. The viral infection is now next only to tuberculosis and AIDS in the state’s list of top contagious killer diseases. TB and AIDS together are responsible for more than 10,000 deaths in the state annually.

While annual death toll of dengue and malaria have reduced to double digits over the years, H1N1, initially called swine flu, has managed to spring a surprise almost every alternate year, killing hundreds. In the first half of 2017 alone, 247 people died of the airborne disease in Maharashtra, including 10 in Mumbai. Three deaths occurred in the last week, two of the victims being a pregnant woman and another a TB patient.

Dr A C Dhariwal, director of National Centre for Disease Control (NCDC), said HINI “has indeed changed the way we used to tackle viral fever in the country. Apart from Maharashtra, Gujarat and Kerala are also badly affected”.

In January-June this year, H1N1 claimed more lives in Maharashtra than malaria which has caused one fatality and dengue two.

The resurgence comes after a lull in 2016 when far fewer deaths (26) were reported. In 2015, the state had witnessed its worst outbreak with 905 deaths.

Experts say its mode of transmission—through infected droplets released into the air—makes control or prevention almost as challenging as in the case of tuberculosis. “In dengue and malaria, we can attack the vector and control the disease. But your combat tools are limited when the fight is against an airborne disease that provides a limited window to treat,” said Dr Satish Pawar, head of Directorate of Health Services (DHS), Maharashtra.

Pawar says tuberculosis, except the cerebral type, takes at least a few years to take a life-threatening form, whereas H1N1’s progression is exceptionally rapid. “Doctors often tend to wait for test reports, which is costing us lives,” he said, explaining why a viral disease is causing such a high number of casualties. In addition, he says, mostly people with underlying health problems are succumbing to the disease.

Infectious disease expert Dr Om Srivastava said clinical challenges of treating H1N1 are unique. “The antiviral oseltamivir works for most cases, but some patients who deteriorate despite treatment,” he said, adding dengue and malaria no longer pose the threat they did even a few years ago. “Dengue has less than 1% mortality and less than 3% hospitalisation rate if all basics of treatment are followed. In H1N1, however, mortality could go up to 20% if treatment has not been started in the first five days,” he said.

Epidemiologist Dr Pradeep Awate though feels much of the hype around H1N1 is because of enhanced surveillance. “We keep a count of every single case and death. In my personal opinion, TB is a much bigger public health problem, and if drug-resistant cases keep growing we may have to go back to the TB asylum era,” he said. “But of course it’s true that influenza surveillance began only after H1N1,” he added.

A senior physician from KEM Hospital said, “All these decades we lost countless lives to seasonal influenza, but didn’t know the magnitude. These numbers should force the government to design vaccination plans and build awareness campaigns around coughing etiquette or hand-washing,” the doctor said, adding the government needs to allocate more funds for influenza control.

Source: THE TIMES OF INDIA

Beware of repeated dengue afflictions

Docs Warn That Fatality Risk Increases Due To Reaction Between Antibodies Present In The Body From Primary & Secondary Infections
Even as dengue ravages Kerala, health experts are confused by the uncommon traits and complications that were recently observed in patients.

The pattern of dengue deaths also indicates that mortality rate was high among patients who were repeatedly diagnosed with the disease.

If a person gets dengue for the first time (type-I), proper rest and medication will help in combating fever and antibodies will be generated in the body that will give life-long immunity against the type-I variety. But, when the same person is exposed to mosquito bites and gets dengue (type-II or type-III), a new set of antibodies will be generated in the body. Antibodies generated in the primary infection and secondary infection react, resulting in grave complications that may even lead to the death of the patient.

Through virus uptake and replication, type-I antibodies will intensify and complicate the typeII virus by a process called antibody dependent immune enhancement. “When a person is tested positive for dengue, prescribed antibiotics will only treat the symptoms of fever and not the virus.Like any other viral fever, dengue virus will subside and antibodies will be generated in a week. When a person is affected by dengue twice or thrice, the reaction of subsequent antibodies will lead to internal bleeding and cause dengue haemorrhagic fever or dengue shock syndrome that may lead to death,” said associate professor of community medicine at Thiruvananthapuram medical college Dr Althaf A.

The scattered information and diagnoses are yet to be compiled and analysed by authorities. Sources in the health department said there was no proper database or research on such complexities.

“When autopsy was conducted in a suspected case of dengue death in 2013, we found that the person was suffering from West Nile fever, a mosquito-borne disease. Similarly , all reported deaths might not be due to dengue. We are unable to contain deaths as scientific analysis and research are lacking,” said Dr Althaf.

There are four different strains of dengue and for a person repeatedly afflicted with dengue, the risk factor goes up. “Severe internal bleeding or blood loss can occur due to the reaction of antibodies already present in hisher body . This is a matter we have to address through research,” said former state nodal officer (communicable diseases) Dr Amar Fettle.

Genetic mutation in disease causing virus is also suspected to be one of the major reasons for the increase in fatalities, said experts. “The spontaneous changes in genetic coding of dengue causing virus can be one of the reasons for the complications.Similar to the mutation seen in H1N1 virus, dengue causing virus is suspected to have undergone genetic mutation. H1N1 virus was seen only in animals at first, it later it was transmitted to humans and by 2008, due to mutation, H1N1 virus was transmitted from one human to another,” said Dr Althaf.

Doctors, who treat dengue, have also no ticed the change in symptoms. “Many patients who seek treatment for diarrhoea; throat pain and vomiting are later diagnosed with dengue. The symptoms were high fever, back and abdominal pain. It is not the same now,” said a doctor at the general hospital in the capital on condition of anonymity .

“The Aedes aegypti mosquitoes are responsible for the outbreak.These mosquitoes can cause chikungunya, yellow fever and Zika fever.Our environment is very receptive to these diseases and we are vulnerable,” he said.

Dengue cases have risen in Thiruvananthapuram, Kollam, Alappuzha, Palakkad, Malappuram and Kozhikode this year and the disease has become round-the-year problem over the past three years.

Source: THE TIMES OF INDIA

BMC inspects Govt. buildings,finds mosquito breeding in 1000+ water tanks

Mosquito breeding detection has reduced to eight per cent across government buildings in the city, the latest inspection conducted by the Brihanmumbai Municipal Corporation’s (BMC) insecticide department has found. Of the 6,232 government buildings inspected for breeding sites, 1,858 water tanks were found to be non-mosquito proof.

“Until last year, we saw that only 85 per cent institutions ensured that their tanks were mosquito proof. This is the first time that the compliance has reached 92 per cent,” said insecticide officer, Dr Rajan Naringrekar. The intensive drive comes ahead of monsoons, with which vector-borne diseases, specially malaria and dengue, record a spike.

According to a BMC report, maximum breeding was found in Public Works Department buildings with 536 non-mosquito proof spots, Central Railway with 446 such spots and the Central Public Works Department with 252 breeding spots. While the Western Railways owns 636 buildings, it has only 3.7 per cent tanks that have no mosquito proofing. On the other hand, Central Railway has 577 premises, of which 23.5 per cent had breeding spots.

In May, the BMC conducted inspections across 23,135 water tanks in government-owned premises. Of these, 21,277 had been mosquito-proofed, and 1,858 remained unprotected. “Not only government agencies, residential societies also need to routinely ensure that the premises are free from mosquito breeding. Since Aedes aegypti breeds indoors, our department cannot go everywhere to clean the breeding spots,” Naringrekar said.

According to civic officials, with detection of three Zika positive cases in Ahmedabad and frequent commute of residents between Ahmedabad and Mumbai, efforts to kill Aedes Aegypti mosquito and prevent its breeding have strengthened. Aedes aegypti is a common vector for both dengue and zika infections. While cases of dengue have steadily increased in the city since 2011, Zika is yet not considered a threat in Mumbai, officials claim.

Between January and April this year, the insecticide department inspected buildings of 65 government agencies. A notice was first served to government buildings in April where mosquito breeding sites were found with the Mumbai Metropolitan Region Development Authority (MMRDA), Maharashtra Housing and Development Authority (MHADA), Mumbai Port Trust, Bhabha Atomic Research Centre and airport jurisdiction owning maximum buildings in the city and recording maximum cases of mosquito breeding.

An inspection across residential societies and private corporate offices found Aedes aegypti mosquito breeding in 1,997 spots from where the BMC insecticide department collected fine of Rs 14.3 lakh after serving 4,746 notices. While government buildings were initially served a notice, the BMC is now set to serve final notices under Section 381(B) of the Mumbai Metropolitan Act to those who defaulted in making water tanks mosquito proof. Fine under the act starts at Rs 2,000 and extends up to Rs 10,000.

Source: The Indian Express

FILE – In this Jan. 18, 2016, file photo, a female Aedes aegypti mosquito, known to be a carrier of the Zika virus, acquires a blood meal on the arm of a researcher at the Biomedical Sciences Institute of Sao Paulo University in Sao Paulo, Brazil. A Utah man who mysteriously contracted Zika from his infected father may have got it by touching his dad’s tears or sweat with his bare hands, according to new research unveiled Wednesday, Sept. 28, 2016, that found the unusual transmission method was likely caused by his dying father having 100,000 times the normal level of the virus. (AP Photo/Andre Penner, File)

Mumbai:53 year old woman dies of lung infection from fungi in pigeon droppings

Last year, when 26-year-old Naitik Zota took his mother Jayshri (53) to a pulmonologist following a severe about of breathlessness, the doctor confronted him with a bizarre question: Do you have pigeons in the vicinity of your home? When Zota told him about the presence of a kabutarkhana next door, the doctor advised him to place nets on the windows of his home, and move Jayshri to a room that wouldn’t be frequented by the birds. The advice, unfortunately, came late.

A few weeks later, Jayshri died of a lung infection, which the doctor alleges was the result of harmful fungi present in pigeon droppings.

Several residents of Neelkamal Cooperative Society in Borivli East, where Jayshri lived, say they too have been victims of ill health for the last eight years since the kabutarkhana came up close to their homes. They have complained of lung infection, breathing problems and asthma. After repeated complaints to local bodies fell on deaf ears, the society members filed a complaint with the BMC health department last month, demanding immediate action against the growing menace. But, the BMC is yet to act on their complaint.

Last year, when 26-year-old Naitik Zota took his mother Jayshri (53) to a pulmonologist following a severe bout of breathlessness, the doctor confronted him with a bizarre question: Do you have pigeons in the vicinity of your home? When Zota told him about the presence of a kabutarkhana next door, the doctor advised him to place nets on the windows of his home, and move Jayshri to a room that wouldn’t be frequented by the birds. The advice, unfortunately, came late.

A few weeks later, Jayshri died of a lung infection, which the doctor alleges was the result of harmful fungi present in pigeon droppings.

At Jaslok, Dr JR Shah, consultant pulmonologist, attribute her illness to pigeon droppings. “But, by then, my mother’s lung capacity had decreased by 40 per cent,” said Zota of his mum, who succumbed a few weeks later. “In severe cases, patients develop interstitial fibrosis that causes irreversible scarring of the lungs, like it happened with Jayshri. It affects the exit and entry of air to the lungs. This happens when a person lives in close proximity to pigeons or hens. I get five to six such cases every year,” said Dr Shah, referring to what’s probably a city-wide menace.

Residents at risk
“The kabutarkhana is causing health problems and many people are suffering from respiratory diseases. The physicians to whom these people consulted have opined to get rid of the pigeon feeding that starts every morning (sic),” reads the complaint copy. More than 40 residents have also submitted a petition.

Hitesh Upadhayay, a resident of the society, said that around three months ago, his wife suddenly developed trouble breathing. “There is a Jain temple inside the society where devotees come and feed the pigeons. The feeding continues till late evening,” said Upadhayay.

Medical experts recommend that patients with low immunity or history of respiratory problems should stay away from pigeon breeding grounds.

Dr Balwant Samant, a retired professor with KEM Hospital, explained that the problem is caused due to exposure to the soil, where the pigeons leave their droppings. When the droppings dry and scatter in the soil, microscopic fragments from it break away and become airborne. “These particles contain dormant fungi and bacteria that people around end up inhaling. It gets inside the lungs and becomes a breeding ground for infectious agents.”

BMC clueless
In 2016, when the issue raised in a BMC meeting, authorities had proposed to add fertility control pills in pigeon food to control the population. There has been no progress so far.

A senior health officer from the BMC, said, “People consider feeding pigeons a religious act. Most kabutarkhanas in the city are illegal, and usually near places of worship. We have been dissuading residents from feeding pigeons.”

When mid-day reached out to Dr Padmaja Keskar, health officer, BMC, she said she would look into the matter.

Source: MidDay