Sri Lanka Braces For Further Dengue Outbreaks
By Dinouk Colombage
Sri Lanka is bracing itself for “a massive outbreak of dengue in the coming months” according to Dr. Pradeep Kariyawasam, Chief Medical Officer at the Colombo Municipal Council.
The country has seen over 9,300 cases of dengue reported in the last three months, a threefold increase compared to the same time last year which stood at 3,103 cases. There have also been 38 deaths in the first three months of this year due to the dengue virus. Dr. Kariyawasam has warned, however, that this figure will increase dramatically in the next two months with the impending rains.
“With the country having experienced heavy rainfall in the last few weeks, and further rains predicted, Sri Lanka is looking at a sharp rise in the number of dengue cases”, Dr. Kariyawasam told The Sunday Leader.
He explained that “if the public is vigilant and aware of their surroundings, the outbreak can be controlled.” He further stated that the particular mosquito which transmits the virus only flies in a 150 yard radius. “The mosquito carries the virus, but it is the people who help the spread of the disease”, he said.
Dr. Kariyawasam added that people must be aware of their neighbours’ conditions “if your neighbour has dengue than it is very likely that the mosquito is nearby, you must take added precautions to destroy any possible breeding grounds.”
Sri Lankans now have the opportunity to undergo early testing for the dengue disease at the Genetech Sri Lanka laboratories or Lanka Hospital.
Nandika Perera, Senior Scientist at Genetech, told The Sunday Leader that his laboratory is in possession of the Polymerace Chain Reaction (PRC) machine, while would allow the doctors to carry out a “dengue genome detection” test on suspected dengue patients.
Perera added that other hospitals currently use anti-body tests through “Elisa”, and this is often too late. “For a patient to be tested with this method, he or she will have to wait three days after first exhibiting the symptoms. The PRC testing can be done in the first 24 hours of exhibiting the symptoms”, he explained.
Perera added that currently only Genetech and Lanka Hospital is in possession of the PRC machine, meaning that patients would be forced to carry out the tests at private medical institutes. According to Perera a single test costs Rs. 2,500/- and so far over 5000 patients have been tested with the PRC. “Of the total number of patients tested over 50% of them have tested positive, because of the early detection we were able to treat them quickly and they made full recoveries”, he said.
Dr. Kariyawasam explained that the public hospitals do not have the PRC machine as “it currently costs over Rs. 8 million and there are added expenses with every test. This is not to say that there is a price on human lives, but at this point in time it is difficult to outfit every public hospital with the machine.”
The Ministry of Health was unavailable for comment on the issue.
Dr. Kariyawasam went on to state that the Colombo Municipal Council would be conducting an awareness campaign starting on May 12. “The CMC can only do so much to slow the spread of the disease, unless people also take action the number of reported cases will continue to rise”, he said.
“Only 10 per cent of those affected with dengue can be detected, this is because many people will suffer from the disease but not exhibit the symptoms”, he said. Dr. Kariyawasam called on the public to be vigilant of their surroundings and to take precautions in public places.
“The public must be aware that even hospitals are a high risk zone for the spread of dengue, dengue patients gather at hospitals allowing the disease to be transmitted to other patients. Hospitals must be better equipped to keep the dengue patients away from the rest”, he said.
Dr. Kariyawasam stressed that the CMC is carrying out eradication campaigns around the city, but unless the public assists them it will be ineffective. “Chemically spraying the city is not the answer, we must manage our environment and destroy all breeding grounds. All it takes is a tablespoon of water for this mosquito to breed”, he said.
Ravi Fernando, a local university student, explained that he was diagnosed with dengue two weeks ago. “I suffered from high fever and exhibited most of the symptoms, despite the doctors being convinced it was dengue they could not confirm it until the third day”, he said.
Fernando added that his surroundings at home were continually monitored, and any possible breeding grounds were destroyed. “Despite all the precautions I took one of my neighbours was infected, it spread quickly and within a week there were seven of us on the same road that were infected” he added. Fernando’s case is one of thousands which shows both the rapidly growing cases of dengue, and the necessity for the easy availability of tests such as the “dengue genome detection” to the public.
By Talavou Alailima
Founder and Chairman of Power World Gyms
In the early hours of the April 19, 2012, the doctors of the Lady Ridgeway Hospital (LRH) Medical Intensive care (MICU) were fighting to save the life of my 5 month baby son Jason, after having been diagnosed with a severe attack of dengue. It was the first time LRH-MICU had dealt with such a badly managed dengue case of a baby in its history, and the job of not only dealing with this severe dengue attack, but also undoing the damage done due to the bad management of Jason’s dengue, fell into the hands of a brilliant young pediatrician Dr. Daham de S,ilva who was a senior registrar at the hospital. If not for his ‘out of the box’, bold and aggressive treatment of Jason, with the support of Dr. Srilal de Silva and Dr. Nalin Kithulwaththa the head consultants of the MICU, and God’s direct intervention of making the impossible, possible, Jason my son would have been lost.
Such a disaster deserves reflection on where I failed as a father and what I could have done better as a parent to have protected my 5 month baby from this dreadful disease. This write up is about sharing with you the lessons I learnt and what all of us should know and understand about what can and must be done, to beat dengue!
1. If your child is under the age of one year and gets fever, show the child to a board certified pediatrician immediately. Ideally, one who is also linked to a government hospital. Board certified means that their credentials are in order. The fact that they are also linked with a government hospital further confirms their qualification and also, if the situation goes terribly wrong, the government’s emergency setup is the best way to deal with life and death situations.
2. If your child has fever and you are concerned that it could be dengue, get a blood test called “Dengue Antigen”, as it tells you whether you have dengue or not even after one day of fever, unlike the standard “Dengue Antibody” blood test that needs several days of having fever before you can get a positive test for dengue. This delay in time of knowing whether your child has dengue or not, gives the virus more time to succeed in weakening your child’s ability to fight it.
3. Beating dengue is about knowing as early as possible whether you or your child has it, because at such an early stage you or your child’s platelet count may even be within the normal range and you can win the fight with ease from that position of strength.
This was the case with my three year old second son Jonathan who got fever just a day after my 5 month baby Jason, and was warded in the hospital for dengue as well. The Dengue Antigen blood test showed he was positive for dengue but the platelet count was at 160,000 just above the lower end of the normal range. Because we were able to react early with this information, the lowest the platelet count was able to go was 80,000 before it turned around.
4. Even though it is said that there is no treatment for dengue, the indirect treatment for dengue does save lives. Balancing the intake and outflow of fluids is critical and at the heart of the solution. Roughly 50% of deaths are due to the mismanagement of dengue and 50% is due to a delay in providing treatment for dengue. Many hospitals and doctors are getting this balancing act wrong, more times than we are willing to believe. So, please don’t take your eyes off the ball, believing that the doctor or hospital will not get it wrong and everything will be fine.
5. The dengue virus’ goal is to create a deficiency of vital nutrients to other life sustaining cells while it attacks important organs. The virus however, has only a maximum of a 6 day window to do this, from the day that the fever first appears. If it fails to overcome us within that window of time, we win! The proper management of dengue is to keep supplying the vital nutrients etc., to the body to support its ability to fight. The Full Blood Count test and a few others taken every 6 to 12 hours help us to know the direction of the attack, so that we can counter attack it by knowing how to support the body. This kind of support and management of dengue is the only way to beat it. Therefore, who the doctor is and where this support is provided is absolutely critical and central to the battle.
6. When you have fever, only take Panadol as a principle! Do not take any other fever reducing medicine such as Dolor, Brufen etc. If you do, and you or your child has dengue, and the fight goes down to the wire, this will tip the balance against you. The simple reason being that most other fever reducing medication has the ability to increase the leaking of blood from vessels and organs which begins to take place in dengue patients when the platelet counts go below 100,000.
7. What drove me to cycle in a fever medication, in between the 6 hourly Panadol dose when my second son Jonathan of three got fever, was the fear of him getting a fit if the fever rose too high which, I feared could lead to brain damage or so I thought. I believe I am not alone in this line of thinking and that is why I am addressing this issue as well.
I am told that such fear is misplaced and that brain damage does not take place if your child gets a fit as a result of high fever. If a fit does take place, turn the child on to his/her left and within 5 minutes the fit will end. However, if the fit extends beyond 10 minutes, show the child to a doctor to confirm that all is fine.
If the fever rises between Panadol doses, tepid sponge the child to bring comfort. Tepid sponging also does not guarantee that a fit will not take place in a child that may have a history of having fits because of fever or has a family history of such fits taking place.
If we follow the above instructions diligently, beating the dengue virus will be a walk in the park!