Pradip Kharya: Delhi’s chikungunya outbreak

photo-1-1In 2006 India experienced one of its worse chikungunya outbreaks, when more than 1.5m cases were reported. The current outbreak in Delhi has claimed at least 15 lives so far, and the city’s hospitals are overloaded because of demand from neighbouring states such as Rajsthan, Uttar Pradesh, and Haryana.

This mosquito-transmitted alphavirus causes acute fever and acute and chronic musculoskeletal pain along with rashes in humans. The mosquito Aedes aegypti, (which also spreads dengue fever) breeds in clean stagnant water and takes eight to ten days to mature from larvae.

Last week the government announced an additional 1000 beds for fever patients and a helpline number. The beds will be provided in the three nodal hospitals for vector-borne diseases—Rajiv Gandhi Super Speciality Hospital, Janakpuri Super Speciality Hospital and Deep Chand Bandhu Hospital.

The outbreak in India’s capital is the worst in six years, with more than 1,000 people affected by September 10. The last time the number of affected people reached the three-figure mark was in 2011.

But hospitals still don’t have uniform guidelines for treating chikungunya, with patients being prescribed antibiotics without chikungunya being investigated. Cases are being under reported because there are not enough testing centres in Delhi.

The cost of lab tests is rising. Even private hospitals are  feeling the pressure with inadequate infrastructure to support growing numbers of patients, and the situation is made worse by a sudden rise in seasonal cases of both dengue and chikungunya. There is no uniform provision of health education about prevention and primary treatment.

Healthcare providers have told citizens to empty and clean all vessels which hold clean water at least once a week to break the life cycle of the mosquito.

Delhi’s municipal council has accused hospitals of reporting cases late. Why are its staff not checking homes to see if their advice is being followed?

Now, however, is not the time to turn this outbreak into a political debate. The government should focus its attention on trying to reach people to help prevent the situation that happened after the 2006 epidemic, where many chikungunya patients were left with residual joint pain.

Pradip Kharya MD is a lecturer in community medicine at the Government Medical College, Kannauj, India.

Competing interests: None declared.

 

  • Dr Harish Gupta

    The article by our colleague provides us a snapshot of the prevalent situation in national capital and elsewhere in north India. In first line of the write up, the author states that 1.5 Million cases were reported here a decade ago. I want to emphasize that honestly diagnosing and then reporting such cases is a very high -risk -job in the present era. Dengue epidemic is raging on for almost 2 decades in this region. Previously epidemic used to recur every 2 to 3 years, and now every year.

    When it was intermittent , usual government response used to be of denial or suppression of cases. Sometimes official machinery used to harass physicians for spreading panic. While it’s true that many a times, platelets- transfusions are made more for business/ profit than for sound logic, hiding an epidemic behind smokescreen of raids is equally shameful and even dangerous. In 2010, being a member of IMA , I was called by a meeting of district administration on the theme through an official circular in Kanpur , UP. The meeting , ostensibly was called for communication with them , but real purpose was found that one should be ready to face raids at one’s clinic if one reports too many dengue cases.

    This is the way our government prepares for an epidemic in its early stages. Only when family members of district administration themselves and kith and kins of politicians start to die, they notice of something bad. 1 year ago ,medical journal Lancet says that actual number of such cases may be 282 times than officially reported (1 ) .

    Then there is an unsettled matter of Chikungunya deaths. Government says that all such deaths occur due to comorbidities , and not due to the vector- borne- disease itself( 2 ) .
    References-

    ( 1 ) Editorial .Dengue challenges India’s health system .Lancet 26 Sep 2015 ;10000: 386 , available at http://thelancet.com/journals/lancet/article/PIIS0140-6736(15)00313-X/fulltext

    (2 ) Blame games as Chikungunya claims 5 lives in Delhi , The Hindu .14 Sep 2016, available at http://www.thehindu.com/news/cities/Delhi/three-more-chikungunya-deaths-in-delhi/article9103583.ece

    Both the webpages are accessed at the time of submission of this comment.

  • Pradip Kharya

    Thanks Dr. Harish…Very well said about epidemiology of Dengue