Dengue prevention strategy

Outbreak of dengue in Assam's Karbi Anglong hills, which reportedly claimed three lives and infected 344 people in less than a week, is a worrying development and a wake-up call for all other districts too. The primary challenge for the State Health Department is to prevent outbreak of the disease in epidemic form. Building awareness in the community on preventing breeding of Aedes aegypti mosquitoes that transmit dengue virus and protection from mosquito bite is the key strategy to prevent its surge. Declaration of closure of educational institutions in Diphu Municipal Board and greater Diphu town region for five days is a timely intervention by the administration. People following the advisories issued by the health department for prevention of the disease will be crucial. Dengue is preventable by ensuring that there is no water stagnating in and around a house, office compound, educational institution in open containers, unused tyres, flowerpots to prevent incubation of dengue vectors, using mosquito net while sleeping even during the day, and wearing long sleeved clothes to protect from mosquito bite. High fever, headache, joint pain, redness of the eyes, pain behind the eyes, muscular pain, rash on skin, bleeding from gums are symptoms of the disease and disease surveillance, therefore plays the most critical role in ensuring timely medical care and preventing fatalities in severe cases. Kamrup (Metropolitan) district reporting 11 cases in past five days with one case in an intensive care unit of Gauhati Medical College and Hospital should alert Guwahati Municipal Corporation, district administration and other authorities to undertake preventable measures at the administration and community level and intensify fever surveillance to prevent a surge in cases. Total dengue positive cases in the state has surged to 369, including 344 in Karbi Anglong in just six days from November 1 to 6, indicates that there is no space for any complacency in most districts which reported one or two cases during the period. According to the World Health Organization, dengue is found in tropical and sub-tropical climate in urban and semi-urban areas and global incidence of dengue has grown dramatically with about half of the world's population at risk. Although an estimated 100-400 million infections occur each year, over 80% are generally mild and asymptomatic, it says. Assam recoded the highest number of 5,024 dengue cases and one death in 2017 but in subsequent years the cases reduced significantly to 166 in 2018, 196 in 2019, the lowest number of 33 cases in 2020 (during COVID-19 pandemic) and 103 in 2021 and only 74 cases till September this year. Sudden surge this month calls for comprehensive review which should reveal the gaps and new challenges compared to significant achievement in preventing dengue spread over the past four years. Management of vector-borne diseases also requires municipal authorities, town committees and panchayat bodies to take pro-active measures for undertaking fogging or source reduction i.e. emptying water storages in the open that are potential breeding sites of Aedes aegypti mosquitoes operations to prevent mosquito incubation. The fact that such initiatives are often witnessed mostly after outbreak of diseases point towards the critical gap which needs to be addressed by putting in place an effective system that is pro-actively activated by the authorities concerned well in times. Official statement issued by the National Health Mission, Assam, indicates at the low level of community awareness on preventing the diseases. Ten teams that moved across Diphu town carried out 3568 source reduction during visit 1422 houses, and detected 74 fever cases which is a pointer of the community awareness level in the town, which is also the headquarters of the Karbi Anglong Autonomous Council. The level of awareness in most other areas of the state is also poor. Such realities also reflect on the effectiveness of current format of awareness drive on vector-borne diseases in which communities need to play the most crucial in prevention of these diseases. Unless that awareness is built into the community for taking the prevention measures such as preventing mosquito breeding and mosquito bite in respect of vector-borne diseases like dengue, malaria, the management once the outbreak has already occurred will continue to be a challenging task despite improvement in clinical management. Besides, COVID-19 pandemic had left lessons how loss of learning put some sections of students at disadvantages, reduced their competitiveness and triggered mental stress about their future career prospects. Fresh disruption of classes in this part of the state on account of dengue, which is preventable simply through effective vector control and awareness, may create mental stress for students who suffer learning loss due to closure of academic institutions. It is hoped that clinical management of the situation in Diphu by rushing Epidemiology teams from GMCH and nearby districts will produce desired results. Innovative community awareness is needed for effective prevention of dengue.