Tag: dengue fever

Hundreds mobilized in campaign against dengue

Hundreds of volunteers and staff at state owned companies and government offices began walking door-to-door in the capital Malé this morning with a checklist of activities to eliminate mosquito-breeding sites. At least four people have died this year from dengue fever,a mosquito-borne disease.

The Health Protection Agency (HPA) is advising the public to empty stagnant water from containers, throw trash into dustbins, and keep containers sealed to prevent water from accumulating.

“We would like to appeal to the public to take up dengue control as an individual responsibility. We are taking measures to eliminate mosquito breeding sites in public spaces, but we do not have access to households,” said Asma Ibrahim, director at the HPA.

Of the 475 cases reported this year, some 180 cases were reported in Malé. Schools have been closed indefinitely to control the spread of dengue. Deaths include a pregnant woman and a migrant worker.

Dengue is now endemic in the Maldives. Prevention and control of the illness solely depends on effective mosquito control measures. Symptoms include high fever, headache, muscle and joint pain.

The HPA has also advised wearing clothes that hide the skin, using mosquito repellants, and keeping doors and windows closed during dawn and dusk.

The agency has stressed the importance of cleanliness and hygiene to prevent the spread of the disease and advised seeking medical assistance if a fever persists for more than three days

An outbreak typically lasts six weeks, Asma said.

The virus is transmitted to humans through the bites of infected female Aedes aegypti mosquito. It’s peak biting periods are early in the morning and in the evening before dusk.

The Housing Ministry is fogging public areas with insecticides and has requested construction companies to eliminate mosquito breeding sites from construction sites.

The HPA has meanwhile launched a 24-hour ‘dengue hotline’ and urged the public to call or text 7548221 for information.

A severe outbreak of dengue in 2011 saw a record high of 12 deaths. There were 2909 reported cases of dengue that year. In 2006, 10 people died of dengue.

There are four known types of the dengue virus, and the strains responsible for the illness wax and wane cyclically. In regions where dengue is common, one or two strains tend to dominate for two to three years at a time.

People in the region appear to acquire immunity for those strains and the number of cases will dip for a few years before another strain takes over and infections flare up again.

Dengue fever cases worldwide have climbed dramatically since the 1960s, with some 50 million people infected annually.

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Ministerial task force formed to combat dengue outbreak

A ministerial task force was convened today to formulate a national level response to a dengue outbreak across the Maldives.

An 18-year-old pregnant Maldivian woman and a migrant worker died of dengue fever in the past week while the Health Protection Agency (HPA) warned of an increase in the incidence of the mosquito-borne disease.

The government began mosquito fogging in Malé and the atolls this morning.

Some 374 cases of dengue has been reported so far this year, of which 125 were reported from Malé and 112 were reported in June.

Health minister Iruthisham Adam, home minister Umar Naseer, and defence minister Moosa Ali Jaleel attended the high-level meeting today along with a number of senior government officials, police officers, and officials from the Indira Gandhi Memorial Hospital (IGMH).

The health minister said mosquito fogging will take place in the capital and affected atolls for the next seven days. The ministry is also cleaning out mosquito breeding sites in collaboration with the housing ministry, environment ministry, home ministry, and the security services.

Last year, the health ministry said dengue fever has become endemic in the Maldives since 2004 with annual outbreaks.

A relatively severe outbreak of dengue in 2011 saw a record high 12 fatalities.

A total of 1,083 dengue cases were reported in the Maldives in 2012. The HPA has previously said that construction workers face an increased risk.

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Pregnant woman dies of dengue fever

An 18-year-old pregnant woman died of dengue fever at the Indira Gandhi Memorial Hospital last night in the second death from the mosquito-borne disease this year.

The woman died after going into shock around 2:20am, IGMH media official Zeenath Ali Habeeb told Minivan News. The patient was three months pregnant and was admitted on Thursday with a high fever, she said.

The hospital declined to provide personal information, but local media has identified the deceased as Hamdha Hassan, from Noonu Maalhendhoo.

A migrant worker had also died of dengue in Gaaf Alif Kooddoo last week as the Health Protection Agency (HPA) warned of the rapid spread of dengue across the Maldives.

Speaking at a press conference on Thursday, health minister Iruthisham Adam revealed that 374 cases of dengue has been reported so far this year, of which 125 were reported from Malé. Some 112 cases have been reported in June.

The incidence of dengue was “alarming,” she said, and appealed for public cooperation with mosquito control programmes.

Dr Ahmed Faisal from the IGMH said most patients admitted at hospitals with dengue were at a dangerous stage and expressed concern with the spread of dengue among migrant workers.

Last year, the health ministry said dengue fever has become endemic in the Maldives since 2004 with annual outbreaks.

A relatively severe outbreak of dengue in 2011 saw a record high 12 fatalities.

A total of 1,083 dengue cases were reported in the Maldives in 2012. The HPA has previously said that construction workers face an increased risk.

Earlier this month, the HPA issued an alert warning of the spread of dengue and viral fever in Malé and the atolls and advised precautionary measures to control mosquito breeding during the rainy season.

The agency advised the public to empty stagnant water from containers, throw trash into dustbins, and keep containers sealed to prevent water from accumulating.

The HPA also advised wearing clothes that hide the skin, using mosquito repellants, and keeping doors and windows closed during dawn and dusk.

The agency has stressed the importance of cleanliness and hygiene to prevent the spread of the disease and advised seeking medical assistance if a fever persists for more than three days.

Symptoms of dengue fever include fever, headache, muscle and joint pains, and a characteristic skin rash.

Dr Faisal said the worst incidence of dengue has been reported from Alif Alif and Alif Dhaal atolls as well as Baa Thulhaadhoo and Malé.

The most dangerous stage of dengue is when the fever subsides after three days, he warned, and advised seeking medical attention if symptoms such as bleeding and fatigue persist.

He also advised drinking lots of liquid and resting to recover from the fever and warned against the use of unprescribed strong medicines.

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Health Protection Agency issues alert on spread of dengue and viral fever

The Health Protection Agency (HPA) has issued an alert warning of the spread of dengue and viral fever in Malé and the atolls.

The HPA said its statistics show an increase in the incidence of mosquito-borne dengue fever and advised precautionary measures to control mosquito breeding during the rainy season.

The agency also advised ensuring cleanliness and seeking medical assistance if a fever persists for more than three days.

Last year, the health ministry said dengue fever has become endemic in the Maldives since 2004 with annual outbreaks.

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Alert issued after migrant construction worker dies of dengue in Male’

The Maldives Health Protection Agency (HPA) has issued a dengue fever alert, following the death of a foreign migrant worker and the hospitalisation of two children for hemorrhagic dengue fever in Male’, with the HPA and World Health Organisation (WHO) emphasising that construction workers are particularly at risk.

Dengue is transmitted by the bite of an Aedes mosquito infected with any one of the four dengue viruses. It occurs in tropical and sub-tropical areas of the world, including the Maldives, which only has two strains of the virus. Though the Maldives holds South-East Asia’s record for being malaria-free, since 2004 the country has been battling a growing epidemic of dengue fever annually with nearly a 1000 reported cases and three deaths annually.

The year 2011 saw quite a severe outbreak of dengue in Maldives – though far below the 2788 cases recorded in 2006, the worst year ever for dengue in Maldives, according to the WHO. Fatalities reached 10 in 2006 and 12 in 2011 – a record high in the country’s history. While in 2012 there were a total of 1083 dengue cases in the Maldives.

Between January 1 and July 13 of this year, a total of 256 cases of dengue have been reported, with 90 in Male’ and 166 in the atolls, while dengue hemorrhagic fever accounts for 16 of those cases, the Health Ministry’s HPA has noted.

“The HPA issued a general alert – the first one for 2013 – regarding dengue fever to raise the level of public awareness a bit,” HPA Epidemiologist Dr Aishath Aroona Abdulla told Minivan News today (July 15). “Since it’s Ramazan it’s very difficult to conduct normal activities, so we wanted to alert people early.”

“We are beginning to see a rise in reported cases, but starting in May [the beginning of the south west monsoon season] this is to be expected,” said Dr Aroona. “Generally dengue peak season is June to early July, so this year its coming a little later, which could be because of changing rainfall patterns.”

She explained that while one of the dengue virus strains found in the Maldives is not fatal, the hemorrhagic strain is life threatening.

“The hemorrhagic variety is usually found in the Atolls, however people are getting sick from that strain of the virus in Male’,” explained Dr Aroona.

“Unfortunately one person, a foreign construction site worker, already died from the hemorrhagic strain [of dengue],” she continued. “He was in the country for about 15 days, according to the report we received.”

“Construction workers and people living near construction sites are at very high risk [for contracting dengue],” she noted.

Dr Aroona explained that when the sites are abandoned or the owner is not there, no one takes responsibility to ensure standing water or items that could collect water are removed.

“It’s important for the owners – the government or private businesses – to get rid of the [standing] water at the sites,” she said. “If removing all the water is not possible, large areas can be filled with sand as an alternative.”

“[However,] the Male’ City Council (MCC) or Local Government Authority (LGA) can be contacted to help control mosquitoes in these areas,” she added.

Foreign workers at risk

“While any reports of dengue are not good, comparatively, dengue cases in 2013 are not something to think of as an outbreak,” WHO Representative Dr Akjemal Magtymova told Minivan News today.

“However, there has been an unfortunate case of death and a few individuals in critical condition,” she noted.

While the children have subsequently been released from the hospital, the death of one foreign migrant worker has highlighted the risk foreign construction workers face due to their lack of social safety net support.

With an abundance of active construction sites in Male’ and the lack of inspection and control of these sites to prevent and control mosquito breeding places, it is expected that vector borne diseases will continue to persist in the capital, the WHO has noted.

“This [HPA alert] relates to foreign migrant workers. The individual who died was only here for about two weeks and must not have had a social safety net support,” said Dr Magtymova.

“While Maldivians are generally aware of dengue fever, migrant workers need more information and support because they may not know about dengue or have a support network if they fall ill,” she added.

“There should be more forceful promotion of awareness materials,” emphasised Dr Magtymova. “Everyone needs to be vigilant and aware, we don’t want people in critical condition.”

The WHO is working with the Health Ministry to leverage resources and extend dengue awareness. Additionally, the WHO in the Maldives has been an active partner in all aspects of dengue prevention, control and management – including training of doctors and nurses in clinical management of dengue, technical support in surveillance and situational analysis, provision of supplies and support in health promotion activities both at national and local levels.

Prevention

The Aedes mosquito breeds in small clean water collections in and around the home, places where people live (e.g. rainwater collections, pots, wells, tanks, tires, gutters, etc.). This is why controlling mosquitoes is everyone’s responsibility, noted the HPA.

“The dengue carrying mosquito bites in the early morning and in the evening close to sunset,” said HPA’s Dr Aroona.

There are two primary ways to prevent the spread of dengue, the most effective being to remove breeding areas and also to protect against bites.

“In addition to standing water at construction sites, garbage areas are also prime breeding grounds, especially since only a small amount of water is needed for mosquitoes to lay their eggs,” Dr Aroona said.

“It is very important for people to keep their gardens and homes clean, by collecting cups, cans, and other items that collect water,” she explained. “It takes seven days for mosquitoes to hatch after the eggs have been laid, so cleaning at least once a week is essential.”

The HPA has highlighted additional preventative measures individuals can take to protect themselves and their families from contracting the disease:

  • Keeping windows and doors shut in the early morning, as well as covering air vents.
  • Not littering, including throwing trash into air vents – which is particularly problematic in Male’.
  • Covering any open tanks or wells and putting fish that eat larvae into them.
  • Adding a little soap or salt to water to prevent eggs from being laid in planters, or they can be covered with cotton wool.
  • Wearing clothes that cover the arms and legs.
  • Using mosquito nets and screens.
  • Using sand to fill areas that collect standing water.

Seek medical attention

“Although individuals can develop a lifelong immunity after recovering from dengue, they are only immune to that particular strain and are still at risk of infection,” explained Dr Aroona.

Dengue symptoms appear three to 14 days after the infective bite.

The fever is typically high grade, above 38oC (101oF) and continuous. The fever may not disappear even after taking paracetamol, although paracetamol may reduce the fever to some extent, noted the HPA.

Other accompanying symptoms are headache, body aches, backache and joint pains, and sometimes a transient rash or reddening of skin.

Symptoms of simple viral fever generally last less than 3 days. Dengue fever, a more severe form of viral fever caused by the dengue virus may last slightly longer, between three to five days, and may be accompanied by more severe symptoms like vomiting and fatigue, particularly when the fever begins to subside, the HPA has highlighted.

If an individual has a fever, the HPA recommends rest, drinking coconut water, oral rehydration solution, fruit juices, milk or any home-based drinks, and only taking paracetamol – not other medication which can lead to bleeding.

“Fever is an important part of your immune reaction to the virus in your body, and helps to kill the virus. So you need not be alarmed, so long as you do not have any of the warning signs or danger signs,” stated the HPA.

The HPA has urged people to seek immediate medical attention if the fever lasts more than three days, or any warning signs of hemorrhagic dengue are present, which include:

  • Continuous vomiting and an inability to take fluids by mouth
  • Severe pain in the abdomen
  • Difficulty breathing
  • Not passing urine for more than six hours
  • Cold hands and feet
  • Bleeding from the nose or gums, vomiting blood, or black, tarry faeces
  • Changes in behaviour, such as lethargy or drowsiness, often with inability to stand, sit up or get up from the bed; Restlessness or irritability (excessive crying in children, adults may have behavioural changes and use foul language)

The Epidemiology and Surveillance Unit of the Health Protection Agency is conducting weekly monitoring of dengue nationwide and is issuing weekly reports.

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Maldives holds regional record as malaria-free zone

The Maldives holds South-East Asia’s record for being malaria-free. Meanwhile, the region is falling behind as one-third of affected countries show signs of eliminating the vector-borne disease over the next ten years.

Dr Robert Newman, director of the Global Malaria Program of World Health Organisation (WHO) said malaria control has improved significantly. “The world has made remarkable progress with malaria control. Better diagnostic testing and surveillance has shown that there are countries eliminating malaria in all endemic regions of the world.”

Malaria affects 40 percent of the world population. While the Maldives had a volatile track record in the 1970s, peaking at 1100 cases in 1976, virtually no cases of local origins have been reported since 1984.

Director General of Health Services Dr. Ibrahim Yasir said the only malaria cases have involved foreigners or Maldivians who have traveled to regions where the disease is endemic.

“A few times a year a foreigner might come who has been infected elsewhere, or in a recent case a Maldivian boat capsized near Africa and those on board contracted malaria and were treated here,” he said.

Yasir noted that the interiors of transport vehicles coming from malaria-infected locations are sprayed with a disinfectant to prevent accidental importing of the bug.

Certain countries that share regular traffic with the Maldives are showing worrisome resistance to malaria elimination.

According to an article published by Times of India today, Roll Back Malaria Partnership (RBM)’s latest report says that high rates in India, Indonesia and Myanmar have kept South East Asia’s malaria report rate stable while other regions see a declining report rate.

RBM’s report compares 5,200,000 probable and confirmed cases of malaria in 2000 in India against 5,000,000 in 2010. A WHO fact sheet, however, notes that 2 million fewer cases of death due to malaria were reported for the same time period.

Sri Lanka and Korea are in the pre-elimination phase.

Malaria elimination – the deliberate prevention of mosquito-borne malaria transmission resulting in zero incidence of infection in a defined geographical area – was first attempted at large scale during the Global Malaria Eradication Program from 1955 to 1972.

WHO certified 20 countries as malaria-free during this time, however in the 30 years that followed efforts to control the disease deteriorated and only four countries were certified.

During the 1970s, the Maldives successfully eliminated the malaria-carrying mosquito. It continues to combat the dengue-carrying mosquito, however, and several outbreaks have claimed 11 lives this year, making 2011 the worst year on record for dengue fatalities.

Among the factors that prevent the elimination of malaria, dengue and other viral diseases is the over-use of antibiotics. At the 64th meeting of the Regional Committee for South-East Asia in September, members suggested that overuse of antibiotics was making diseases harder to treat.

In 2010, WHO introduced a program combatting the reflexive practice of prescribing anti-malarials to any child with a fever. “Anti-malarial treatment without diagnostic confirmation means poor care for patients. It masks other deadly childhood illnesses, wastes precious medicines, hastens the inevitable emergence of drug-resistant parasites and makes it impossible to know the actual burden of malaria.”

In a previous interview with Minivan News, ADK Chief Operating Officer Ahmed Jamsheed called antibiotics “the most misused drug in the Maldives,” and warned that the trend could put Maldivians more at risk for dengue fever and chikungunya, as well as viral diseases.

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Dengue outbreak in Gaaf Alif Villigili under control

The rapid spread of dengue in Gaaf Alif Villigili last week that resulted in one death and 129 islanders struck with fever has been brought under control, according to the island hospital.

MNBC One reports that the ‘Villigili Dengue Task Force’ conducted a door-to-door awareness raising programme together with programmes to clean the island and spray fog to eradicate mosquito breeding grounds after three people were admitted to hospital on Saturday with dengue fever.

No new cases have been reported to the hospital in the past three days. Four people – three expatriates and a four year-old girl – are being treated at the hospital for dengue.

Nationwide some 1,900 cases of dengue have been recorded so far this year with 11 deaths compared to a total of 10 in 2006 out of 2,788 recorded cases.

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Dengue fever taskforce to disband if situation remains stable

The government’s dengue task force will be disbanded if incidents of dengue fever remain stable over the next few days, Haveeru has reported.

Speaking on behalf of the task force, Deputy Education Minister Dr Abdulla Nazeer said in the last 24 hours new cases had only been identified in four of the eight islands most affected by the mosquito-borne disease.

The work of the task force would be handed to the Health Ministry, Dr Nazeer said.

The official dengue death toll is eight this year, including seven children. A 41 year-old man died on Thursday while a 62 year-old man admitted to hospital with dengue died yesterday.

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Dengue hospital situation “stable”, despite high patient demand

Hospitals in the capital have said they continue to screen significant numbers of patients for dengue fever, yet claim that the situation remains “stable” as authorities raise fears that an ongoing outbreak of the virus may be more persistent than originally thought.

As officials today confirmed that a 41 year old man from Addu Atoll had become the eighth person to have died during the latest dengue outbreak, health care representatives in the capital have said that they remain “busy” dealing with cases and had not yet seen significant declines in patients coming through their doors suspected of contracting the virus.

After declaring this week that the current outbreak of the virus around Male’ and several islands was being treated as an “epidemic”, the government has since established a task force to try and coordinate its ministries, the military and NGOs in preventing further spreads of dengue. The task force was originally budgeted to run for seven days, by which time the situation was expected to be under control.

However, upon admitting yesterday that the suspected number of dengue cases in the country had slightly risen after a perceived fall in infection rates earlier during the week, a media spokesperson for the task force suggested that the operations were now likely to run beyond the original seven day time-frame.

Meanwhile, for hospitals on the front-line of dealing with the “epidemic,” the Clinic, a Male’-based private hospital, has said it has been busy collaborating with the task force in trying to identify infection cases.

A spokesperson for the Clinic, which begun offering free dengue fever screening services on Tuesday (July 5), said it was continuing to receive a steady number of patients looking for dengue testing and had been working to the emergency protocols recently imposed by the government.

“At the moment I don’t think we are seeing the number of patients [with suspected dengue] going down,” she said. “From the first day [of the screening service], we have received large number of pediatric enquiries regarding dengue infections among children, though adults are coming for testing now in large numbers.“

Panic fears

The Clinic spokesperson revealed that the medical centre remained concerned about the impact panic was having on the general public.  She said this this concern reflected the limited amount of knowledge about the symptoms and severity of dengue fever within Maldivian society as a whole.

“Trying to create knowledge [about dengue] among the public is one of the main challenges we are facing. People who may have symptoms are sometimes sitting at home and relaxing trying to overcome the fever, which means that some cases of the virus are being missed,” she said.

“Dengue fever has to be better managed by people. Members of the public with the virus need to take more fluids, but they are lacking awareness of this.”

The spokesperson added that the Clinic was currently working to put together a leaflet that she said would try and provide more details about the virus.  During the current panic over dengue infections, the Clinic spokesperson suggested that some members of the public were staying at home instead of coming to be checked.

Despite concerns that the public may begin inundating hospitals beyond their capacity as a result of panic over the virus, Cathy Waters, Chief Executive of Male’s Indira Gandhi Memorial Hospital (IGMH) said that increased patient numbers were to be expected during an outbreak like that presently taking place in the country.

“We have seen a lot of children being bought in by relatives because of the virus. I think that some panic is to be expected as people are concerned about dengue, but the situation is definitely stable here at the hospital,” she said. “I think the message has got out about the virus and its symptoms and people are responding to this.”

In trying to treat patients found to be suffering from the effects of dengue, Waters said that the hospital had moved to adapt additional wards and services to dealing specifically on trying to deal with the ongoing dengue outbreak, yet she added that the overall situation was under control.

“At the moment we would describe the situation as relatively stable, but definitely very busy here,” said the hospital chief executive. “We have set up an additional fever clinic, which means people can be seen relatively quickly for testing and then be given the necessary treatment.”

Waters added that the current dengue situation had required the hospital to develop contingency plans to allow for the provision of increased bed capacity as well as bringing in additional nurses to cope with demand.

The hospital chief executive said that this had in certain cases meant that some surgeries had to be cancelled to accommodate dengue testing and treatment, a situation that would continue to be reviewed regularly to ensure patient demands were being met as best fitted the situation.

The government taskforce has said that it is expecting to address members of the media concerning the latest developments later this evening.

While pledging to support efforts to try and cut dengue infection rates in the country, opposition politicians have been critical of the speed by which the government has responded to the present outbreak.

Ibrahim ‘Mavota’ Shareef, Spokesperson for the opposition Dhivehi Rayyithunge Party (DRP), saidthat he believed that the government had “bungled” their response to trying to control dengue fever.

“From what we have seen the government is just not doing enough. We don’t believe they have been willfully negligent, but there has been negligence in their approach [to dengue outbreak],” he claimed. “They have not responded fast enough, which could be inexperience on their part. But I think this will be a wake-up call for them to change policy in dealing with these type of situations.”

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