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Chikungunya viral fever is prevalent in the central province, what kind of preventive measure can we adopt now?

Dr.V.W. Jagath Vasanthathilaka. Consultant Rheumatologist General Hospital Kandy, Sri Lanka .

Chikungunya virus is now prevalent in the central province, patients often present with fever and joint pains. Are we aware of the significance of mosquito born infections and the adverse sequences to the public through such diseases? What are the options available and what are the collective responsibilities of the public towards prevention of such disorders? We have now identified more than ten Chikungunya antibody test positive patients presented with fever and arthritis isolated from the area around the city of Kandy. In fact, this is a totally new disease, added to the list of infectious diseases prevent in the cities throughout the Island. It is extremely important for the public to be aware of the nature of these disorders, in order to adopt appropriate preventive measures to control the spread of viral infections in urban areas.

City of Kandy is comparatively cool and less humid than the other costal cities in Sri Lanka. Medical profession has come across thousands of patients infected with Chikungunya virus in the costal cities in Colombo, Jaffna, Galle and Batticalo where the density of mosquito population is much higher. Dengue and Chikungunya fever were largely prevalent in the other cities along the way to the hill capital that is in Kurunegala, Mawanella and Kagalle, from where we have received some patients who were transferred and seeking treatment at larger Hospitals in Kandy. Chikungunya as well as dengue fever is now prevalent in Kandy, however it is not spreading in epidemic proportions like in the Jaffna peninsula.

The mosquito density was relatively less three to four decades ago in the central hills, and Kandy was a city where there was less overcrowding and the buildings were constructed in the city according to strict regulations, and the authorities could easily maintain an environment with relatively less mosquito density in the past.

Present situation is slightly different where the average temperature in the city of Kandy is gradually increasing, that is partly due to the effects of global warming. Rapid expansion of the economy and uncontrolled urbanization with increasing population within the city limits may also be contributing to some of these unwelcome and adverse effects.

Unless we, all the citizens living in the cities are conscious, concerned and educated on the value of maintenance of proper standards of living without leaving any room for mosquito breading places to prevail in the urban areas, the price the people will have to pay with diseases and occasional death of an otherwise healthy and a young individual would be extremely high. Mosquito breading places in Kandy are often linked to the overcrowded housing conditions found in few identified areas within the city limits, improper and unauthorized construction of the shops and market places found in few locations closer to the city center, and due to congested transport conditions which is a major issue need to be addressed fairly soon, in order to prevent further outbreaks of diseases in the city of Kandy.

If we fail to address these issues now and for what ever the reason, and if we are faced with a much more serious infection in the near future in few years time with a very high mortality rate associated with a virulent form of a virus, the consequences for the citizens living in the city could be disastrous. These viruses can easily mutate in to more virulent forms, the consequences can be much worse than a natural disaster of the magnitude of a major earthquake under present conditions of uncontrolled urbanization prevailing in our cities. For example, highly infectious avian influenza virus of type A of subtype H5N1 is the causative agent of H5N1flu commonly known as bird flu. It is prevalent in many bird populations, especially in south Asia. One such strain of HPAI A is spreading globally after first appearing in Asia is a potential threat which cannot be under estimated.

The presence of the mosquito Aedes aegypti and the mosquito bone infections in the central hills is increasingly becoming a serious threat to the people living in the Hill capital, and the situation could become worse and uncontrollable in the future as it has been observed in the recent past, number of dengue patients identified in this year is higher than that of the number of dengue cases identified in the year 2005 and the death rate is also rising. 48 deaths due to dengue fever have been reported so far all over the Island this year, compared to 26 in the last year. Some of the deaths occurred in Kandy were tragic and the patients were related to the affluent society, and some them were also related to the medical profession, the valuable lives of these patients were not been able to rescue despite best medical treatment with intensive care facilities offered to them. All categories of the population, poor and the rich were equally affected without any discrimination. It is extremely important for the public to be aware of these facts as it is only through awareness, most of these disorders can be prevented effectively. That is the reson why we explain the public, the tragic nature of the problem related to viral infections now spreading through mosquitoes. Not many families are aware of the gravity of the problem until a tragic event takes place related to their own families. Not many people are bothered about this until they themselves are affected.

Prevention is important, especially, when there is no effective and specific treatment available for complicated patients with these viral infections, the only thing which would be effective will be appropriate and timely preventive measures adopted collectively by the society. We presume it is our primary responsibly is to educate the public on these crucial aspects of disease control, through what ever the possible means available for us on the media. There is no other option left for us under present circumstances, we all will have to face the situation intelligently. The medical profession presumes that, still it is not too late for us to plan and implement appropriate and effective measures in order to prevent occurrence of such disease in epidemic proportions in the cities within the Island and in the near future .


Dr. V. W. Jagath Vasanthathilaka
Consultant Rheumatologist
General Hospital Kandy



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