MEETING REPORT
Contributed by: R. Sajith Kumar and Edited by Prathiksha
Emerging and re-emerging infectious diseases in Kerala
Emerging and reemerging infectious diseases pose a threat to the stability of nations worldwide due to their adverse effects on health and development. Factors for the emergence/re-emergence of infectious diseases are complex and interrelated. These include environmental changes, transformation of ecosystems, ongoing socioeconomic changes and the deterioration of public health systems in many countries. Worldwide explosion of infectious diseases, emerging diseases like the HIV/AIDS pandemic, or the re-emerging diseases such as cholera, tuberculosis, diphtheria, plague, yellow fever, dengue, or malaria are a major threat to several nations. More than 300 new pathogens (Bacteria, Parasites, Virus etc.) have been discovered in the last seventy years.
Kerala is considered as a model State for the health status and health care delivery systems all over the world. The ‘Kerala model’ has been appreciated, studied and analyzed extensively in various fields - scientific, economic, philosophical, historical and social. Even though the state has got a highly educated population with good sanitation conditions, it has been afflicted by a variety of infectious diseases in the form of epidemics in the last two decades. There are persistent issues like Leptospirosis and malaria. A few like dengue fever and Chikungunya are tending to become endemic, emerging disease such as H1N1, SARS typhus fever and Japanese Encephalitis are also becoming a major problem. The constant clusters of water borne illnesses like enteric fever and viral hepatitis pose a threat even to the casual visitors. There are diseases like HIV and Hepatitis B in the back ground, lurking as potential killers.
A symposium was organized with a view to take stock of the situation and recommend remedial or corrective measures which may help us to control these infectious diseases. It is a fact that we have a large amount of resource being unutilized. The parallel systems of modern medicine, Ayurveda, Homoeopathy and the backbone of nursing streams are all working at various levels aiming at the control of these epidemics and ensuring a healthier world; but they hardly ever work in tandem.
As the apex academic body, involved with the health sciences institutions in Kerala, KUHS organized this symposium aiming to bring together all disciplines of health sciences on a common platform in an effort to tackle the health issues and problems of the State in a concerted, collaborative and more effective manner.
The symposium first attempted to understand the emerging infectious diseases from a statistical point by taking stock of the present scenario, and then proceeded to critically analyze the origin of these problems. The participants were subsequently divided into four streams viz. Modern Medicine, Ayurveda, Homoeopathy and Nursing in parallel sessions, where each group explored extensively on the ways to combat the problem and generated ideas for sharing with the rest of the groups. The groups later re-assembled and listened to the concise presentations of the discussions from the four groups. Finally the symposium tried to bring about a convergence of these ideas with a view to develop a common academic document with recommendations for future action, which is to be placed before the public.
The current scenario
Our state Kerala has been witnessing an explosion of Emerging and Reemerging diseases in the past decade, particularly last 6 years. Emphasis and the need for a strong surveillance system got a foothold in Kerala with the advent of IDSP Programme in 2005.
Setting up of Regional Prevention of Epidemic and Infectious diseases Cell has promoted timely disease reporting by the different Clinical disciplines co-ordinated by Community Medicine departments of all 5 Government Medical colleges has been an important initiative in filling gaps in Disease surveillance activities.
The diseases that poses to be a challenge to the Health system in the Past 5 years are emerging disease like HIV,H1N1,Chickungunya,Dengue fever, scrub typhus and re-emerging diseases like Malaria, Measles, and other vaccine preventable diseases.
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In Kerala, 2009 and 2010 Disease surveillance reports show that we are under the threat of diseases like Leptospirosis, H1N1, Malaria and Scrub typhus. Rickettsial disease is another area of concern for which the clinicians need to be sensitized. Diphtheria and Tetanus is in the process of a comeback in Malappuram district. Unconfirmed reports of Epidemic Typhus too have appeared from Malappuram district which need to be investigated further. With the increasing interstate migration of labourers Leishmaniasis has also become a concern for the state in the near future. There is ample potential for spread of new disease like Congo Hemorrhagic Fever considering the globetrotting nature of Keralites with their intercontinental, inter-country and interstate migration.
There are various agencies working in the field of infectious diseases management in the state of Kerala. These include:-
- In the modern system, we have the Prevention of Epidemic and Infectious Diseases Units working in all five Govt. medical colleges collecting data on a regular basis. The data that is collected and coordinated by the State Disease Control Monitoring Cell plays a major role in the timely intervention activities across the State. The monthly evaluation systems also try to pick up early signals and act on the same.
- The Ayurveda hospitals and practitioners who see a large number of patients at different levels diagnose and treat these cases. The promotive effects of Ayurvedic way of living and environmental handling are very effective.
- The Homoeopathic practitioners also do a lot to cover the epidemic diseases, and are actively involved in organizing camps for the needy.
- The nursing service that forms the backbone of institutional care also undertakes many community oriented programmes as part of fulfilling their curricular needs. The word of mouth way of spreading awareness is very effectively promoted by many nursing colleges who also adopt communities for interventions and promotive care activities.
- The other stakeholders like the staff of the animal husbandry department, agriculture, education and local self-governments are also working at different levels/places with varying levels of efficiency. They are important considering the fact that more than 50% of pathogens have a link with fauna and can be classified as zoonosis
- The other organized health units like railway health system and the ESI dispensaries and hospitals attached to industrial and housing units also helps in identification and control at various levels.
The data related to the current epidemic burden and the changing trends were discussed in detail. It was realized that the data presented/available were merely the tip of the iceberg as many of the groups involved with infectious disease management are not in the line of communication with the higher surveillance centres.
- Surveillance being the complete collection of data for timely and efficient action, the lack of participation and regular communication adversely affects the efficiency of disease and epidemic management.
- Therefore proper feedback to the reporting units/surveillance centre is essential for effective monitoring and collaboration.
- The lack of coordination between the various units within and between the groups also affects the reality perception.
- A large pool of resources remains unutilized in the State such as those from the teaching institutions under various streams, whose faculty, staff and students are not part of the network.
- There is lack of training in the crucial aspects of surveillance and interventions.
- The lack of protocols in the management of patients and in community interventions is causing lack of uniformity in the effectiveness of programmes within the State.
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