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Medi snips

8 November, 2020

Beware of Rat Fever symptoms if in a high risk area – Health officials

Leptospirosis (Rat Fever) is on the rise following the monsoon rains, and all those in high risk areas should take extra precautions  to safeguard themselves from this disease that can have serious health complications, the Epidemiology Unit has warned. 

According to the latest figures reported to the Epidemiology Unit this year 6,784 cases of suspected Leptospirosis have been reported to the Unit from across the country.  Starting with 665 cases in February the numbers fell to 156 in April due to several intervening steps taken by the health authorities.  In May it peaked to 6,784 due to complacency on the part of the public and even health officers.

However, with vigorous awareness programs and education programs to those in high risk occupations, Health Ministry officials said they were able to bring down the numbers to 597 in August. In September the numbers rose to 974 and in October 514 cases were recorded.

Highest number

District wise the Galle district showed the highest number in October at 129 cases, while Kegalle had 58 cases and Ratnapura 56 cases. Colombo had 38 cases, Kalutara 38 and Gampaha, 10.

Explaining how the disease spread, a health spokesperson told the Sunday Observer on grounds of anonymity that rat fever (leptospirosis) is an infectious disease caused by pathogenic bacteria called leptospires, which are maintained in nature in the kidneys of certain animals such as rats, pigs, cattle, rodents, canines, wild mammals and livestock. These organisms are transmitted directly or indirectly from animals to humans the spokesman said. According to the Epidemiology Unit some animal species have a commensal relationship with certain types of leptospires (serovars), i.e. natural hosts for those serovars.

These animals continuously excrete leptospires in urine, though they do not suffer from the disease. If other animals including humans are infected by the same serovars, they often become ill. If a natural host for a particular serovar is infected with another serovar, it may also develop the disease. Serovars found in rats and bandicoots are often identified as the cause for serious illness in humans.

Sources said that exposure through water, soil, or foods contaminated by urine of affected animals are the most common route. A leptospire-contaminated environment caused by, for example, local agricultural practices (paddy cultivation) and poor housing and waste disposal gives rise to many sources of infection. Leptospires enter the body through abraded or traumatised (injured) skin or nasal, oral, or eye mucous membranes. The ingestion of contaminated water can also lead to infection. After infection, they enter the blood and invade practically all tissues and organs, they said.

Fatality rate

The diagnosis of leptospirosis should be considered in any patient presenting with an abrupt onset of fever, chills, conjunctival suffusion, headache, muscle tenderness (notable in calf and lumbar areas) and jaundice. The fatality rate is reported to range from less than five percent to 30 percent, and important causes of death include renal failure, heart failure and widespread haemorrhage. Liver failure is rare despite the presence of jaundice, sources warned.

They said Leptospirosis is a potentially serious but treatable disease. Treatment with effective antibiotics should be initiated as soon as the disease is suspected. Clinicians should never wait for the results of laboratory tests before starting treatment with antibiotics because serological tests do not become positive until about a week after the onset of the illness, and the culture may not become positive for several weeks. Supportive care with strict attention to fluid and electrolyte balance is essential. Dialysis is indicated in renal failure. Heart failure can occur if medical treatment is not given on time.

Asked about preventive measures, they said preventive measures must be based on knowledge of high-risk groups and local epidemiological factors. It is important to raise awareness about the disease among the risk groups, health care providers and general population, so that the disease can be recognised early and treated as soon as possible.

“If you are involved in occupations such as farming, mining, or cleaning drains and canals, please inform your area MOH or PHI. They will explain the specific precautions that can be taken to prevent contracting the disease” Epidemiologists have urged the public. 

They said there were adequate stocks of Doxyycycline for all patients needing them and warned that children under 12 years and pregnant women as well as those with kidney or liver disease should not be given the antibiotic.  

Dengue rises with monsoon rains

With 105,049 suspected dengue cases being reported across the country in 2019 and 28,449 this year up to October, the Dengue Control Unit and other stakeholders as well as the Ministry of Health has warned residents in areas that were environmentally friendly for the dengue breeding mosquito to promptly clean up their surroundings and get rid of all small containers that can attract the dengue carrying vector.

 According to the latest statistics reported to the Epidemiology Unit, approximately 28 per cent of dengue cases are from the Western Province.  

Starting with 11,608 cases in January, the number of cases fell to a new low in April at 511 but rose to 1,508 in August and 1,145 in September. Last month however, due to awareness raising campaigns and presentations as well as distribution of pamphlets in all three languages the numbers fell to 765 in October. District wise, Kandy registered the highest with 175 cases and was followed by Batticaloa with 146 and Colombo with 133 last month.  At least five districts  including Mannar, Vavuniya, Mulaitivu and Moneragala had zero cases, owing to vigorous Anti Dengue campaigns,  sources told the Sunday Observer. 

“However, the public needs to realise that without their cooperation no amount of cleaning or fogging on our part can succeed fully. We need their support to sustain our efforts to eradicate this menace,” a spokesperson from the Unit said.