The great dengue mess-up

By Dr. Pradeep Kariyawasam

It is pathetic to hear that health authorities are preventing the general public from knowing the numbers of hospitalisations and deaths due to dengue at a time when the Right To Information Bill has been passed by the Parliament. Giving prominence to this information itself will activate our citizens to detect and destroy the breeding sites of dengue mosquitoes. But we hardly see an advertisement on TV-the best media to propagate such a campaign to activate the people.

The lethargic attitude of health officials in most of the areas is unbelievable. In the early part of last decade we got the support of the Rotarians, other NGOs and the private sector to carry out the famous House-to-House inspection program which quickly spread to the suburbs of Colombo and then to the districts. The program was called the best program in the country and won an international award and was published as a Best Practice by the WHO and UNCHS.

Unfortunately, the program came to an end in 2014 calling it as an old method and internal spraying of houses was begun. This method quickly spread to other areas and officials were gloating of a so-called success. Unfortunately, there was no intensive program to control the breeding of dengue mosquitoes in the environment.

It is a known fact when a new type of virus enters the country epidemics start as the people have no immunity against the new entrant. Before 2004 most of the outbreaks were responsible due to DEN-3 virus. Then came DEN-1. Since the year 2005 DEN-2 virus has been circulating in our region especially in the neighbouring India and South East Asia perhaps imported from South America. 

Until the number of mosquitoes infected with DEN-2 virus were limited it didn’t create any havoc that we experience now. Most of the patients with DEN-2 virus would have traveled from mainland China, India, Singapore, Malaysia. Thailand etc., and helped to transmit to the local population. Most of them would have been in and around Colombo and later would have spread it to other areas. So actually the reason for this calamity is the stoppage of the normal inspection programs that were carried out for more than 15 years and the spraying and fogging programs. Over two hundreds deaths have been reported and the number of patients have reached over 75,000 according to reliable sources. Although piles of garbage is given as an excuse, the dengue epidemic started much before that.

It is time suitable experienced and committed medical officers are put in-charge of the prevention and control programmes in Colombo and the suburbs and other cities and also recall retired PHIs to help in this program before the whole country goes down with dengue fever. It is useless to use the Police and the Army as done now but may be each area could be given to separate units comprising of medical officers, PHIs, midwifes, Army and Police personnel who will with volunteers cover only a designated area. 

Each area should have a committee comprising health officials and the citizens. This will help them to understand the causes of breeding of that area thoroughly and they can change the situation by repeated actions and visits. Early morning spraying of BTi and limited fogging around the dwellings of infected patients is a must. Until that is done there is no hope of seeing an end to this dengue mess-up.