Rajasthan govt's delayed response, lack of learning from previous Zika outbreaks, aggravating health scare in state

By Rangoli Agrawal

Jaipur: Several city-based hospitals, and the Department of Medical, Health, and Family Welfare (DMHFW) are on high alert as the Zika Virus spreads throughout Rajasthan. As per latest reports, the number of people who have tested positive, stands at 80.

A variety of measures are being carried out by concerned authorities, including the municipal corporation, to deal with the epidemic. These measures, however, are seen as a delayed response to an epidemic that broke about two weeks ago in Shastri Nagar, Jaipur. The source of the virus, whether from a person travelling to Jaipur or locally developed, still remains a mystery.

“The disease is spread if an already infected person is bitten by Aedes mosquito. The same has happened in this case. We have not found the source of the disease, but we are sure it is from a person who visited Jaipur after visiting an affected area. We are trying to ensure the disease does not spread further,” says Dr Narottam Sharma, Chief Medical and Health Officer, at the Jaipur DMHFW.

Several measures are being taken to spread awareness regarding the virus’ symptoms and prevention methods.

“As many as 150 private and government doctors have been sensitised during a workshop by the government. Under the programme, the doctors were given training on identification and treatment of the virus,” said Dr Leeneshwar Harshwardhan, professor of medicine, and medical superintendent at Kanwatia Hospital. These training sessions were conducted on October 8, while the first case of Zika was identified on September 22.

The state government, on Tuesday, October 16, increased the number of teams to 330, where each team comprises two members. These teams have been performing anti-larvae activities on a door-to-door basis, only across Zika-affected areas of the city. “If a positive case is found in one part of the city, a door-to-door survey of the larvae is conducted within a three-kilometre diameter. Nothing is being checked in the remaining city,” Sharma said.

Pamphlets are being distributed across the city that list out several precautions to be taken. These include usage of condoms for six months if one partner has suffered from Zika, usage of mosquito re-plants and nets during the day and at night, conducting Zika test before blood donations, wearing attire with full sleeves, avoiding collection of water in and around residential areas, among others.

Rallies are also being conducted, where information is given on open mic across schools and colleges. This aims to spread awareness about causes and symptoms of Zika and other weather-related diseases, and ways to avoid them.

Learnt nothing from other states

In 2016, the Union Health Ministry had issued guidelines regarding the Zika Virus, and had asked Kerala and Tamil Nadu to be extra careful. This had come as a response to increase in number of dengue cases in the state. Rajasthan is one of the top six states in India with the highest number of dengue cases, amounting to about 3,000 cases in 2018 so far. “Proper surveys are being conducted in schools on a regular basis for dengue but larvae can grow anywhere, especially in houses. Jaipur Municipal Corporation has not taken proper precautionary measures earlier to ensure removal of the mosquitoes,” informed an official from the health department.

Since Rajasthan is the third state to experience a sudden breakout of Zika, a team from the Central Department of Health is visiting Jaipur to ensure proper execution of ‘safety measures’ being taken to eradicate the disease, informed Sharma. “The team has members from Gujarat and Delhi. They are monitoring the manner in which presence of larvae is being checked in the houses. They also give us several other suggestions based on which the process is executed,” said Dr Sharma. The suggestions include checking locations like water tanks, refrigerators, water inside air coolers and others, where mosquito larvae could easily breathe, during the door-to-door survey.

Despite warnings from neighbouring states, effective measures against Zika were not taken in Rajasthan in 2017. Also, there is no initiative taken to identify areas at ‘high risk’, as the door-to-door surveys are conducted only in areas that have been found with positive cases.

Along with Rajasthan, Gujarat and Tamil Nadu were hit with the virus as well. According to reports, the three cases of Zika virus detected in Gujarat in early 2017, were actually reported to World Health Organisation in mid-2017, suggesting a cover-up.

Gujarat carried out mass communication campaigns to raise awareness among citizens, which was followed by action that included four rounds of door-to-door surveys. The state, with the help of panchayats, municipalities and municipal corporations, conducted vector indoor residual spraying across 41 lakh households. Families living in high-risk areas were identified and 3.3 lakh mosquito nets were distributed, said an official of the National Vector-Borne Disease Control Programme, Gujarat.

Tamil Nadu reported a singular case in 2017 - “Once the case was confirmed, all districts were pressed into preventing its spread. All district collectors and district health secretaries were alerted and asked to continually monitor government hospitals for any new cases. Anyone who came in with high fever had to be compulsorily tested for Zika. Patients deemed particularly vulnerable were given mosquitoes nets,” said J Radhakrishnan, Principal Secretary, Health and Family Welfare Department, Tamil Nadu.

Moreover, corporation officials instantly initiated cleanliness drives, regular inspections were carried out, and individuals and organisations found flouting the rules were fined. A 104 helpline was established for the public to report cases or address concerns. “Medical and awareness kiosks were set up at all airports in the state and passengers showing any symptoms were examined,” added Radhakrishnan.

About 40 supervisors were also trained in Tamil Nadu to conduct intensive surveillance and 75 engineers were trained as part of an ongoing process. As the symptoms of Zika are similar to that of Dengue and Chikungunya, the government’s focus was to ensure and minimize mosquito breeding, control mosquito population and increase anti-larvae activities.

According to a report by The Hindu, the WHO has warned that ‘new cases may occur in the future’, based on the local circulation of the virus, particularly because the Aedes Aegypti mosquito that transmits the virus thrives in India.

- with inputs from Mydeen Abdul Kadar, Tamil Nadu