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HindustanTimes Sun,26 Oct 2014

A shot at prevention
Hindustan Times
October 10, 2012
First Published: 22:05 IST(10/10/2012)
Last Updated: 22:10 IST(10/10/2012)

Deadly monsoon diseases can be contained if the civic authorities perform their duties efficiently.

Disease outbreaks that follow the monsoons each year are far more predictable than the rains. Yet, the government and civic authorities wait for several hospitalisations and more than a few deaths before declaring that they are drawing up plans to tackle the problem on what is always described as a 'war-footing'. By the time the bureaucratic offensive even starts, the war against disease is lost, along with hundreds of lives.

Almost all these deaths are preventable. Among the most deadly monsoon diseases are dengue, malaria, Japanese encephalitis (JE) and chikungunya, all of which are spread by mosquitoes that multiply in fresh standing water. If the civic authorities would just do their job of cleaning up neighbourhoods and unclogging stagnating drains, people afflicted with mosquito-borne infections would be few and far between.

Simple civic measures such as not allowing rainwater to accumulate, using larvaecides to kill larvae and fumigation to kill adult mosquitoes bring down new infections drastically. Routine island-wide larviciding and DDT spraying in Mauritius - a mashy, tropical island that gets some amount of rain throughout the year - coupled with tracking each malarial case to ensure that there is no re-infection helped the country eliminate local infection in 1969, and again in 1998 after it re-emerged in 1975.

The fact that there is an inexpensive and effective vaccine against JE makes its containment even easier. Yet, despite the fact that the JE vaccine is included in the routine immunisation for 35 districts of eastern Uttar Pradesh, brain fever has claimed over 400 lives in the state.

This also points to the bigger healthcare lacunae of routine immunisation vaccines not reaching children. Measures such as rapid diagnostic tests for an early detection of the more deadly Plasmodium falciparum malaria, along with using the chloroquine, artesunate and sulphadoxinepyremethamine drug combination therapy in areas where the parasite is resistant to conventional anti-malarial medicines have saved lives, but prevention by far remains the most effective strategy of containing infection. For once infection starts - as the world's uncomfortably close encounters with H5N1 (bird flu) and H1N1 (swine flu) have shown - no one is safe from it.


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