Overwhelmed by the worst dengue outbreak in history, with a record number of people contracting the deadly disease so far, the Government has teamed up with the World Health Organization and Thai dengue experts to come up with a strategy to control the situation.
A four member WHO team from Thailand, a country having one of the best anti dengue campaigns, arrived in Colombo to join in the Government’s war against the deadly disease.
The team comprised an expert from the WHO Collaborating Centre for Case Management of Dengue, Queen Sirikit National Institute of Child Health (QSNICH) Thailand, a Senior Expert on vector control from the Thai Ministry of Public Health and a senior Epidemiologist and an Entomologist.
Overwhelming
The team of dengue experts visited highly affected regions since May, reviewed the current situation and provided hands on training and expert recommendations to control the outbreak.
In an email interview with the Sunday Observer, the Thai experts revealed their take on the current situation, especially, what made the cases to shoot up to such overwhelming numbers in 2017.
The Epidemiology Unit of the Health Ministry recorded 98,390 dengue cases and around 290 fatalities by Friday, July 21. According to WHO it is an over 4.3 fold increase compared to the average number of cases for the same period between 2010 and 2016.
An action plan was presented by the team to Health Minister, Dr.Rajitha Senaratne last week, outlining a mechanism to bring down the number of patients by 50% within four weeks. It has emphasized the importance of community mobilization in ending the crisis.
The excerpts of the email interview:
Q. Have you come up with findings that might explain the high numbers of deaths and dengue cases reported so far this year in Sri Lanka ?
Epidemiologist, Senior Expert to the Dengue Control Program in Thailand, Dr Jeeraphat Sirichaisinthop –
It is obvious that since 2009, the situation of dengue transmission in Sri Lanka has changed.
The baseline number of cases when there was no outbreak used to be thousands of cases, but now it has suddenly sprung up to more than 20,000 cases and has not come down since.
Additionally, dengue cases are now found throughout the year. This reflects that transmission exists throughout the year in Sri Lanka, with no effective interruption.
As dengue is a vector borne (mosquito borne) disease, it is likely that year round transmission through Aedes mosquitoes is a key factor and might not be effectively interrupted.
Q. What recommendations have you come up with, to control the current epidemic/ crisis?
Dr Jeeraphat Sirichaisinthop-
My recommendation is simple. As more cases are coming to hospitals, we need to stop cases before admission to hospitals. Stopping the transmission at household level will be critical to controlling the current outbreak.
This has to be done at community level, with direction and support from the Government. Community mobilization is key to stopping the transmission and ending this crisis.
Dr Bhupender Nagpal, Technical Officer (Entomologist), WHO South-East Asia Regional Office –
There are many potential breeding sites for the mosquito within the household, such as, uncovered tanks, old tyres, vases, roof gutters, discarded containers, etc.
House-to-house
The life cycle of the mosquito is 7-10 days, therefore, a household member should drain out the water from all containers in and outside the house on a weekly basis. When cleaning containers, one should remove the water from the container and scrub the inside of the container to remove all the mosquito eggs.
The community should also fully support the Government’s house-to-house inspections for potential mosquito breeding sites and fogging programs.
Q. The hospital staff and the health sector is overloaded with dengue patients, are we good at crowd management in hospitals or is there room for improvement?
Professor Siripen Kalayanarooj, World Authority on Clinical Management of Dengue –
The current case management is quite good, but due to a large number of patients being admitted to the hospitals, there is a greater requirement placed on the health services.
A few days after my arrival (May 6), I noticed much improvement in the services. The MOH has increased the number of extra beds, recruited and trained, both, doctors and nurses for dengue management, and opened a new High Dependency Unit (HDU) consisting of 40-50 beds for more severe dengue patients at the National Hospital.
Improving OPD triaging by having more screening parameters so that unnecessary admissions are markedly reduced will help improve crowd management at hospitals.
Recommendations
The message to the community is that the majority of dengue cases are not severe and there is no need for them to be admitted to hospital.
But, they have to come to the hospital for follow up according to the doctors’ recommendations.
In addition, the MOH has procured automated full blood count (FBC machine) for all hospitals in endemic areas to enable early diagnosis and proper IV fluid management.
Q. What is your message to the community?
A. The most important message to the community is that if at the end of the fever phase or when there is no fever and no clinical improvement (i.e. patients are still weak, have poor appetite, vomiting, abdominal pain), the patients have to be taken to the hospital immediately for they may be suffering from Dengue Hemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS). Almost all dengue shock syndrome patients still have good consciousness, they can walk and talk! So it is important to seek hospital admission in these conditions.
In conclusion, there have been major improvements in dengue case management. Through effective screening at OPDs, we hope to get fewer cases admitted so quality services will be provided for all dengue patients.