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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