There is a lack of transparency in dengue management in Chennai which has resulted in the absence of an adequate response to the disease.
Last week, the Chennai Corporation stumbled upon evidence on what was being suspected for a long time in the health circles. They found cases of underreporting of dengue in some parts of the city, and conducted an enquiry. At the end of it, however, they went back to the original version of the number of cases of dengue in 2015 —93.
At the Chennai Corporation Council meeting this week, Mayor Saidai Duraisamy read a report compiled by zonal and regional officials, stating that just 93 cases of dengue were reported in 2015. But the Corporation is yet to start direct collection of data from hospitals by officials at Ripon Buildings. Meanwhile, senior officials of Chennai Corporation said one person has been suspended for deleting e-mails received from hospitals.
Even a casual enquiry at four city hospitals provided evidence for a different tale. The number of laboratory-confirmed dengue cases they saw in September alone was 294 — over 200 more than what the Chennai Corporation says it has recorded in the city for the entire year. All these hospitals swore that they had sent the details to the Corporation, as mandated. So where did the numbers vanish?
Explaining a mystery
As per the reporting system in Chennai, around 500 hospitals send data on notified diseases to the 15 zonal assistant health officials of Chennai Corporation on a daily basis. The zonal-level officers make decisions on sending teams to the residential areas affected by dengue or other vector-borne diseases or other notified diseases. They also report cases to the deputy commissioner, health. This report is then reviewed by Chennai corporation commissioner.
Insiders say that due to the “competition” among 15 zones and three regions to show fewer vector-borne disease cases during review meetings, the practice of underreporting of cases has reportedly been adopted by some zones.
Officials have reportedly deleted e-mails sent by hospitals, failing to send field staff for surveillance and mosquito control operations to residential areas. This is evident from copies of official records available with The Hindu. At a hospital in Mylapore, for instance, in September alone, 61 cases of dengue have been reported.
The question of testing methodology is also a point of contention, the government telling private hospitals to go by the more reliable Eliza test, rather than the rapid test that reportedly produces a number of false positives.
Dengue, the World Health Organization (WHO) says, is a viral infection transmitted by the bite of an infected female Aedes aegypti mosquito. There are four distinct stereotypes of the dengue virus. The flu-like illness can affect infants, young children and adults. At present, the only method to control or prevent the transmission of the dengue virus is to combat vector mosquitoes.
Former city health officer P. Guhanantham says the community should take 70 per cent of the responsibility on prevention with the remaining onus on civic agencies.
“About 80 per cent of mosquitoes that contribute to dengue breed in households. The remaining 20 per cent are found in public sector buildings, construction sites and vacant plots. One single agency cannot do the job of all the source reduction,” he said.
Every week, he said, each household must spend half-an-hour in clearing stagnant water from their terraces, in and around their houses and discarding any waste item such as tyres, coconut shells or containers that could potentially become breeding grounds for mosquitoes.
“People cannot push all responsibility on to the government. Any amount of fogging and spraying will only be temporary. Keeping one’s surroundings clean is essential,” he said.
There is one health worker for every 300 households, said a senior government official. He is responsible for regular inspections and clearing of potential breeding sites in urban areas. At the ward-level, breeding sources were being identified and eliminated. In rural areas, each block had been split into sectors that were visited every 15 days by a team of workers.
The WHO says early clinical diagnosis and management is crucial. There is no specific treatment for dengue. Severe dengue is potentially lethal and has become a leading cause of hospitalisation and death among children. State health officials say the government is working with the Indian Medical Association in order to ensure all private hospitals and practitioners follow WHO protocols in the management of the disease.
The official denied that there was under-reporting of cases and that there had only been one lapse at the Chennai Corporation which had later been rectified.
As per the National Vector Borne Disease Control Programme’s statistics, Tamil Nadu has recorded 2,965 dengue cases this year and six deaths as of October 25. While this higher than last year’s figure of 2,804 cases and three deaths, it is lower than 2013’s 6,122 cases.
Awareness and treatment
“Only about one per cent of dengue cases have the potential of developing complications. The goal is to follow evidence-based medicine, ensure adequate fluid intake and monitor the blood count. For the pain, symptomatic treatment should be given,” said T.V. Devarajan, head of the advanced fever clinic at Apollo First Med Hospital.
The level of awareness when it comes to dengue in the State is quite high, said L.N. Padmasini, professor of paediatric medicine at Sri Ramachandra University. “These days most doctors check for dengue on the first day of the illness and refer the patients for treatment. Dengue is very manageable. Even if patients test positive, we advise them on what to do and what to look out for and ask them to rest at home. They need to be admitted only if there are warning signs: abdominal pain, lethargy, vomiting or bleeding,” she said.
Over the past few days, the Chennai Corporation has started surveillance of all fever cases in each locality. But the civic body is yet to announce the actual number of dengue cases. Retrieving lost data on vector-borne diseases may be challenging, said an official. But the course for the future include transparency in reporting all confirmed positive cases.
Key facts
Transmission
a) Aedes aegypti mosquito is the primary vector. It lives in urban habitats and breeds mostly on man-made containers
b) Infected humans are the main carriers and multipliers of the virus, serving as a source for uninfected mosquitoes.
Characteristics
l Should be suspected when high fever is accompanied by two of these symptoms: severe headache, muscle and joint pains, nausea, vomiting, swollen glands or rash.
l Severe dengue is hazardous due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding, or organ impairment.
Treatment
No specific treatment for dengue fever. Maintenance of the patient's body fluid volume is critical to severe dengue care.
Source: WHO
