The function was inaugurated by lighting the traditional lamp by Dr. Prem Nair. In the inaugural address, he commended the timely actions being taken by the public health authorities of the state in view of the perceived threat of Dengue and vouched the active participation and cooperation of AIMS in these activities.
The august gathering was welcomed by the joint organizer of the conclave Dr. K. N. Panicker. He hailed the public health team as the Commanders and Brigadiers in the battle against Dengue and wished them all success.
The function was presided by Dr. Hazeena Mohammed who reminded the audience about the World Health Day theme,2014, she said that small bites should no longer be allowed to cause big threats to the humanity. The involvement and positive attitude of the public will help keep a check on the vector borne diseases.
The Professor and Head of the Department of Community Medicine, Dr. K Leelamoni felicitated the meeting. She highlighted the fact that the joint organization of the Dengue Conclave by the National Health Mission and AIMS is an exemplary demonstration of Public Private Partnership and such associations would provide common ground for the exchange of information and experience.
The vote of thanks was proposed by Dr M. Sumayya. She called the attention of the audience to the fact that in the battle against Dengue, the Health Services alone cannot accomplish anything. But the help of public and other related departments will help to win the crusade against Dengue. The inaugural session was followed by ice breaking session during which all the delegates introduced themselves. Most of the participants were the Block Medical Officers from Ernakulam district, the District Malaria Officers, the state level program officers and the faculty from Community Medicine department, AIMS.
The Kerala scenario of vector borne diseases and the state level action plan called ‘Mazhakkilukkam’ was elaborated by Dr. A. S Pradeep Kumar. The statistics presented for the past 3 years clearly showed the rising trends of Dengue in the state. Thiruvananthapuram is the ‘hotspot’ for Dengue, while other districts barring Wyanad and Alapuzha have also reported a fairly high number of cases in 2013. In collaboration with the Total Sanitation Campaign, the state health services have launched an intense drive for sanitation mapping of the wards and cleaning the public places. Strategies for communicable disease control and the action plan for 2014 were presented. The highlights of the action plan were awareness cum action campaigns, dry container and key container elimination, clean water campaign, special focus on plantations and migrants and rapid response to outbreaks in the form of source reduction, indoor space spray and fogging within 48 hours if a dengue case is reported.
The profile of Dengue in the district was discuss by Dr. Suhita and the district level action plan was delineated. It mirrored the state level action plan, with the spotlight on the clean water campaign and clean public places campaign and migrant population. The field level activities are conducted by the Ward Health and Sanitation committees through Sanitation Squads. The Ernakulam district monsoon disease prevention programme has been termed as "Mazhameghangalil"
Dr. M G K Pillai laid out the protocol for the clinical management of Dengue. According to the WHO 2009 guidelines, the disease is now classified as Dengue with or without warning signs and Severe Dengue. He detailed the management of Dengue patients and the indications for hospitalization or urgent referral and stressed upon the importance of judicious fluid therapy.
The prevention aspects of Dengue was discoursed by Dr. K N Panicker. He drew attention to the fact that during the Chikungunya epidemic in Chennai in 1965, surveys revealed the entire Coromandel Coast to be infested with Aedes mosquito while the West coast showed presence of Aedes only in Kozhikode. But now Aedes mosquitoes are found ubiquitously in Kerala. Similarly till 1970s only 9 countries had reported Dengue positive cases while in 2000s more than 100 countries had confirmed Dengue cases. He attributed these phenomena to the strong adaptive aptitude of the mosquito Aedes albopictus. He recommended the Bombay Municipal Laws, which had very strict penal provisions, to the authorities for dealing with defaulters. With a story from Ethiopia he concluded the lecture with a warning that the overzealous actions should not be counterproductive.
The epidemiological perspectives of Dengue and the disease epidemiology was explained by Dr. Alexander John. He highlighted that attainment of PPI (pupae per person index) less than 50% is an effective strategy in Dengue control. The COMBI (communication for behavioural impact) approach among the masses should be stressed upon to translate information into responsive action.
Former Surveillance Medical Officer WHO-NPSP Dr. Paul T Francis discussed about Epidemic Preparedness in Dengue. He mentioned that no epidemic occurs without warning and the key step is to identify these warning signals at the earliest. Surveillance is an important step and sentinel surveillance can be tried in areas where notification is not done appropriately. Entomological surveillance is a must. Monitoring and evaluation are the cornerstones of all preparations.
An interesting presentation was made by Dr. T Dileep Kumar on the operational guidelines for mosquito control with focus on Dengue. He commented thar Aedes surveillance is now being introduced in the grass root level which is being conducted by Junior Health Inspectors in rural areas and District Vector Control Unit in urban areas. Weekly analysis of the data, categorization of areas based on risk and detection of warning signals are being instituted. Vector control by integration of biological, chemical methods and source reduction are being stressed upon.
Dr. K V Beena elaborated on the monitoring and implementation of the action plan being implemented. The pre-monsoon preparedness was done at the levels of Government of Kerala and the Local Self Governments and the implementers are the Directorate of Health Services and the Total Sanitation Campaign. The Block Medical Officer is responsible for the monitoring of the action plan. The Medical Officers were urged to develop their own check list, do analysis and take timely corrective actions to avert Dengue outbreaks.
Professor, of Community Medicine, Dr. Aswathi S focused on key areas such as diagnosis and case management, integrated surveillance, sustainable vector control, future vaccine development and basic operational and implementation research. The objectives of the global strategy for Dengue prevention and control by WHO are 25% reduction in morbidity by 2020, 50% reduction in mortality by 2020 and to estimate the true burden of disease by 2015. A study done in the Njarackal panchayath of Vypin block in Ernakulam district revealed the PPI to be 5.4% and House Index to be 13% during April 2014. Multisectoral collaboration is the need of the hour to tackle Dengue.
An open discussion followed these presentations in which the participants voiced their views and concerns. Dr Unnikrishnan, former District Malaria Officer, Thiruvananthapuram, reminded the participants about the importance of sanitation mapping and coordinating the activities of Ward Health and Sanitation committees. Ms M Sumayya, District Malaria Officer, Ernakulam spoke about the apathy shown by rubber plantation owners in source reduction activities and how the KSRTC garages are functioning as mosquito breeding sites. Mr Haridas, Biologist at the District Vector Control Unit told that shortage of staff in urban areas is an obstacle for the vector control activities. Mr Suresh, District Malaria Officer, Kollam raised the issue about inter sectoral collaboration.
Discussed the role played by media in disease outbreaks. He urged the health authorities to be media friendly. Developing a professional relationship would mutually benefit both the health authorities and the media.
Concluded the day’s proceedings by expressing the desire that these well formulated plans on the paper would actually be translated into field activities and the health sector and public will be able to triumph over Dengue.