The National Dengue Control Unit has warned of an upsurge in dengue cases in the coming weeks. The biggest impact is in the Western Province, which accounts for almost half of all cases in the country at 34,396 (47.5%). Consultant Community Physician of the NDCU, Dr. Nimalka Pannila Hetti, revealed that up to the third [...]


Dengue patient count leaps past 63,500; 45 high risk areas identified


The National Dengue Control Unit has warned of an upsurge in dengue cases in the coming weeks.

The biggest impact is in the Western Province, which accounts for almost half of all cases in the country at 34,396 (47.5%).

Consultant Community Physician of the NDCU, Dr. Nimalka Pannila Hetti, revealed that up to the third week of November, dengue patients have risen to 63,540, and 44 have died. She said 3,844 cases were recorded in the last 18 days of November alone.

During the 45th week, 1,586 suspected dengue cases were disclosed in 24 districts, compared with 1,532 in the 44th week. The 45th week saw a 3.5% increase from the preceding week.

“A wider range of dengue cases in the WP has been discovered in Colombo District in line with the NDCU, and the number is 15,321 (21.2%). Besides, 14,509 (20.1%) dengue cases were reported from Gampaha District and 4,563 (6.3%) from Kalutara District,” Dr. Pannila Hetti said.

The NDCU says a lack of preventive measures has resulted in the spread of dengue in the Central Province (12%), the North-Western Province (8.5%), and Sabaragamuwa Province (8.2%).

Dengue response units of the Ministry of Health are conducting clean-up programmes in urban areas as the number of dengue-affected people has increased in recent months, particularly in six Medical Offices of Health areas, including G1, G2A, G2B, G3, G4, and G5, that fall under the Colombo Municipal Council, said NDCU director Dr. Nalin Ariyarathne.

“There is a clear seasonal trend in the Northern and Eastern Provinces, with the majority of cases occurring during the inter-monsoon season, especially from September onward. It is important to initiate feasible strategies to control and eradicate the menace,” Dr. Ariyarathne said.

With the ongoing rains, the ministry’s epidemiology unit has identified 45 high-risk MOH areas. Entomological surveys have found that the top most potential mosquito breeding sites are civic space areas.

The unit has further taken steps to start prevention and control efforts in Kandy, Batticaloa, and Trincomalee Districts at the end of November and in Jaffna District by mid-December. Schools, commercial premises, and state- and private-led institutions are encouraged to set up a health committee aimed at mitigating the spread of dengue.

In the meantime, medical experts and specialist consultants say pregnant mothers with fever should seek hospital admission. People have also been asked to seek prompt medical treatment for any type of fever without resorting to home remedies. Paracetamol (acetaminophen) is recommended for pain and fever. Aspirin Plus, other salicylates, and non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided.

The transmission of dengue is based on multiple factors, and those that strengthen the contact between vector and host possibly favour a growth in dengue transmission. The immune status of hosts, virus traits, and environmental variables could determine its transmission patterns. Rapid urbanisation leads to urban population growth, household crowding, inadequate water supply, and poor solid waste management systems, which may trigger the re-emergence of dengue fever.

“The urban environment is an essential but poorly understood contributor to disease transmission dynamics. Understanding the oscillation of dengue epidemics in urban areas is vital for designing and enforcing effective vector control activities and minimising the health risks of the urbanisation process,” Dr. Ariyarathne said.

The medical officer for vector-borne disease control (Western Province), Dr. Yudhisteera Wedisinghe, said: “The primary preventive measure to reduce dengue infections is the control of mosquito populations. Since the transmission of dengue calls for mosquitoes as vectors, the spread of dengue can be limited by reducing mosquito populations. The recommended environmental management strategy is source reduction to eliminate unnecessary container habitats that collect water in which Aedes aegypti can lay their eggs.”

Likewise, source reduction can be efficacious when carried out on a regular basis as it dissuades mosquitoes from developing through their aquatic life stages, mainly when community members are mobilised and in the picture about vector control.

Environmental management activities can also involve major changes in a community, such as installing water systems with direct connections to residences and replacing wells and other water-storage containers, which act as mosquito breeding grounds. Such efforts can reduce the number of mosquitoes in an area, Dr. Wedisinghe added.

Speaking to the Sunday Times, a senior professor in the department of civil engineering at the University of Moratuwa, Prof. Thishan Jayasinghe, explained how building materials can become an important driver of dengue transmission.

“Expanded polystyrene (EPS or rigifoam) is extensively used as a packaging material when various equipment is imported for factories in free trade zones. These packaging materials could become mosquito breeding locations unless disposed of carefully. However, due to its non-biodegradable nature, it is not easy to dispose of EPS-based waste,” said Prof. Jayasinghe.

“One possible solution is to crush the waste EPS to form beads and reuse the beads to manufacture lightweight concrete. These lightweight fresh concrete can be used to manufacture lightweight interlocking blocks or lightweight wall panels.”

To eradicate mosquito breeding grounds, it is ideal if the home gardens can be landscaped. One deterrent is the high cost. Cement-stabilised rammed earth can be a durable alternative for creating landscaped gardens that can be well maintained, thus preventing any possibility for stagnation of water, Prof. Jayasinghe recommended.

PHIs protest over allowances, lingering work issues
As the dengue incidence rises, Public Health Inspectors (PHIs) have withdrawn from dengue prevention duties as of Wednesday, citing several demands.

Speaking to the Sunday Times, secretary of the PHI Union of Sri Lanka Shanaka Bopitiyage said that PHIs have taken this collective action to seek solutions to several occupational issues, including a non-increase in transport allowances.

All dengue control activities, including surveillance and fogging, have been halted.

“As of 2016, a monthly conveyance allowance of Rs. 1,200 was provided per 600 km, which is not adequate. Therefore, over the years, failure to increase mileage and transport allowances for field duties has affected all PHIs as existing allowances are not in proportion with the rising cost of living and fuel prices,” Mr. Bopitiyage said.

In the meantime, it has been observed that additional medical officers of health in certain areas have been conferred the duties of medical officers of health, which often creates confusion. PHIs want this to be addressed.

Moreover, Mr. Bopitiyage stressed that the conduct of the Diploma in Public Health and Management has reached a standstill since 2016, posing challenges to internal promotions. They ask the government to re-implement the diploma programme.

PHIs were off duty on October 29, 30, and 31. On November 8, all reports provided by PHIs were suspended, and participation in all meetings, including progress reviews, was discontinued.

The PHI Union has further reached a decision to withdraw from all infectious disease control activities as of November 22. A resolution was adopted to withdraw from all field duties and remain in offices from November 1. If the issues remain unresolved, it was agreed to hold protests and marches at the provincial level on November 15 in front of the Ministry of Health.

PHIs, being on the frontlines of vector control and playing a pivotal role in creating and retaining a health system in the face of infectious diseases, call for a quick fix in correcting defects among them to prevent impending collapses in the healthcare system.

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