Year : 2017 | Volume
: 6 | Issue : 2 | Page : 196--197
Chasing viruses feverishly
Public Health specialist, New Delhi, India
Dr. Chandrakant Lahariya
B-7/24/2, First Floor, Safdarjung Enclave Main, New Delhi - 110 029
A number of viral diseases have emerged and re-emerged in India and globally, in the last few years. Effective prevention and control of these diseases require, in addition to a functioning disease surveillance system, interventions both before and after disease occurrence, and a combination of personal and population services. However, the current efforts to control emerging viral diseases in India has major therapeutic focus (and attention on diagnostic and curative services) and there is limited attention on preventive and promotive components. It is proposed that for an effective and successful control, a systematic approach is adopted with an appropriate selection of personal and population health services, delivered by government through participation of private sector. This is possible through commitment and leadership of Government and other public health agencies, supplemented by multi agency coordination, sufficient funding and an accountability mechanism.
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Lahariya C. Chasing viruses feverishly.J Family Med Prim Care 2017;6:196-197
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Lahariya C. Chasing viruses feverishly. J Family Med Prim Care [serial online] 2017 [cited 2019 Sep 15 ];6:196-197
Available from: http://www.jfmpc.com/text.asp?2017/6/2/196/220019
Chikungunya virus fever was almost unheard in India till the year 2005, when it was first reported after a gap of 32 years. A dengue outbreak was first reported in 1996 in Delhi. Now, both of these viral diseases return almost every year, soon after arrival of monsoon. Chikungunya was considered a mild illness; however, things appear to have changed with deaths being reported due to complications.
For that matter, the emergence and reemergence of viral illnesses have become a common phenomenon at both global and regional level, and India cannot remain untouched and unaffected. In the recent years, we have heard of avian flu, swine flu, middle-east respiratory syndrome, Ebola, and Zika virus. Yellow fever, largely restricted to select African countries, has been reported from territories where it was unknown so far. India has had Crimean–Congo hemorrhagic fever virus being reported in 2011, in addition to many other viral illnesses which are endemic to the country.
The viral fevers pose challenges as these are often mild, have symptoms in a proportion of all those who are affected; the treatment is often symptomatic and no effective medication available, contrary to availability of antibiotics for bacterial infections. Moreover, viral illnesses spread rapidly and can affect large geographical areas and populations. The viral illnesses, though usually and not always, spread by some vectors which transfer these viruses from one person to another.
Completely stopping these viral illnesses is a difficult proposition and more realistically the countries focus on prevention and control of these illnesses, to minimize the impact on the population. The illnesses caused by chikungunya and dengue fall in this category. To prevent epidemics of chikungunya and dengue requires a combination of interventions, aimed at preventive (prevent breeding of mosquitos), promotive (adoption of appropriate behavior by the communities to reduce mosquito bites such as full sleeve clothing), curative level (to get early treatment to ensure that complications do not develop and diagnostic services). Many of these interventions need to start even before monsoon and need to continue during the rainy season as well. This requires acknowledgment of the existence of the problem, development of a plan, providing sufficient resources, and trained workforce.
The outbreak of dengue and chikungunya in India did not happen for the first time in the year 2016. The similar situation arose a year earlier as well. There were televised debates, newspaper pieces, charges and countercharges among governments and oppositions, and not much changed. It is pity that people keep suffering from these diseases which could be reduced if a few actions are taken.
Often, the attention is given to setting up of “fever clinics” or “dedicated beds in hospitals” for patients affected by these illnesses. This would definitely ensure better outcome for people who have already been affected. However, limited efforts are done to prevent the spread and control the diseases. The preventive efforts should start much before cases start getting reported in media. The disease surveillance system needs to be made more functional, so the early signals are picked up, the local health agencies need to devote more resources for community awareness and monitoring to prevent mosquito breeding sites and improve health seeking.
The reliance and focus on therapeutic care would be enough to treat cases but not to prevent people from becoming sick. It needs to be understood by key stakeholders (including policy makers) that to keep any population healthy, two broad categories of health services are required: Personal and nonpersonal (or population). Health services targeted at individuals are called personal health services, and those targeted at groups and society at large are called nonpersonal or population health services. Understandably, personal health services are delivered individually and are exclusive in nature (if someone uses those services, these are not available for the next person). The nonpersonal, or 'population' health services, are actions applied at collective level (mass health education) or to the nonhuman component of the environment (i.e., basic sanitation) and nonexclusive. The use of nonpersonal services does not lead to reduction in the availability of these services for next person. A combination of these services is needed for preventing and controlling diseases and keeping people healthy.
In a mix health-care system, such as India, the health services are provided by government and private sector. The personal health services, especially curative services, give visibility and immediate results. The private sector, for its very motive of profit, has interest in providing personal health services. However, nonpersonal health services are usually provided by government sector only and often available in limited quantity. The private sector has neither incentive nor interest in providing nonpersonal health services. Therefore, the responsibility lies with governments to take proactive interest and invest more on nonpersonal health services. It requires planning, finances, and commitment and measures to prevent outbreak next year should start a few months prior to monsoon.
Dengue was unheard 20 years ago and chikungunya 10 years ago, there are many new diseases emerged at global level in last few years and no one in India would like these emerging or new viral diseases to grapple the headlines, 10 years from now. To stop that, the actions have to be taken now and continued.
To conclude, effective prevention and control of emerging and re-emerging viral diseases in India, require concerted personal and population services, targeted at these diseases with engagement of private sector. This need a few interventions initiated much before the monsoon season when these diseases arrive. For population or the public health services, the governments have to take leadership, invest more financial resources, strengthen disease surveillance and work in coordinated manner with all agencies and a well defined accountability mechanism. The viral diseases are not likely to disappear completely but it is possible to prevent and control.
The opinions expressed in this article are solely of the author and should not be attributed to any institution/organization; he has been affiliated in the past or at present.