119 cases of Hand, foot, and mouth disease reported since January

A total 119 cases of hand, foot, and mouth disease has been reported across the country since January this year, the Health Protection Agency has said today.

According to the HPA, cases have been reported in the Malé area as well as Gaafu Dhaalu, Gaafu Alif, Baa, Haa Alif, and Haa Dhaalu atolls

An official from the HPA said that the disease has been seen more frequently in the Malé area lately in comparison with January, at which time it was concentrated more in the atolls.

The official also said exact figures on cases reported in Malé were unavailable due to some difficulties in acquiring the information from Indhira Gandhi Memorial Hospital (IGMH).

In a statement alerting the public to the situation, which requested greater caution, the agency said children between 1 – 5 years are most vulnerable to this disease, warning that is is likely to spread among students in preschool and primary grades 1- 2.

Hand, foot, and mouth disease – while not always serious – is contagious. According to the HPA, it can easily spread through close contact by means of saliva, nasal mucus, feces, and blister fluid.

Early signs of the disease include fever, reduced appetite, feeling tired, body aches, and sores in the mouth.

The HPA has requested all members of the public to take the following precautionary matters to control the disease:

  • Do not send children infected children to school
  • Keep infected children separate from others and do not taking them to public gatherings
  • Thoroughly clean objects such as plates, towels, and toys used by children with the disease before allowing other children to use them
  • Pay extra attention to hygiene of children and their surroundings, particularly toilets
  • Wash hands with soap before eating and after changing diapers, cleaning or going to toilet
  • If the disease is discovered at a school, suspend all activities involving the use of sand

Health Protection Agency warns of viral fever in Male’

In light of what it claims is a rapid spread of viral fever in Male’, the Maldives Health Protection Agency (HPA) issued a warning Sunday (June 16) urging the public to take precautionary measures.

Local media quoted HPA Epidemiologist Dr Aishath Aroona as saying that those who contract fever were advised to avoid crowded places, cover their mouth when coughing or sneezing, and consult a doctor if the fever persists for more than three days.

“Increasing viral fever is a sign of spread of dengue. Hence the best way to counteract dengue is to guard against breeding grounds for mosquitoes,” Aroona told Haveeru.

Amidst concerns about recent growth in the number of cases of viral fever and increase in patients at both ADK and Indira Gandhi Memorial Hospital (IGMH), the HPA has refused to label the current situation as an epidemic, according to local media.

“Such spread of fever is always common in June and July. Now only we’re starting to see it. So everyone must take precautionary measures,” said Aroona.


New drug-resistant strain of TB found in Maldives “quite serious”: HPA

The Health Protection Agency (HPA) has warned that a new drug-resistant strain of tuberculosis (TB) that has appeared in the Maldives poses “quite a serious threat” to people’s health.

The agency’s comments follow a report released by the Ministry of Health on Sunday (March 24), revealing that it faces new challenges in order to control the disease in the Maldives.

According to the World Health Organisation (WHO), TB is an infectious bacterial disease that can be transmitted via droplets in the throat and lungs of the infected.

WHO states that drug-resistant strains of TB have become a major public health problem that has resulted from patients not fully completing the recommended six-month course of treatment.

HPA Public Health Program Officer Shina Ahmed told Minivan News today (March 25) that although the new strain of TB is “quite serious”, the particular strain found in the Maldives is not resistant to every drug available to patients.

“We have had a few cases come in now with the new strain. The most important thing we have to do is to continue and complete the course of treatment.

“Most of these drug-resistant strains are caused by patients stopping the treatment. We have enough drug supplies to give to them, but because the course goes on for six months, patients tend to go off taking the treatment towards the end,” Shina said.

Local media reported that the Health Ministry had revealed that 10,563 people had been registered to receive treatment for TB since 1963, out of which 5,256 people were said to have infected lungs.

Shina claimed that the majority of cases within the Maldives have been reported on the islands as opposed to Male’, and that in order to prevent the spread of the disease the HPA will be undertaking awareness programs.

An official from Indira Gandhi Memorial Hospital (IGMH) in Male’ stated that there was no need for the public to be concerned in regard to the spread of the disease, adding that there may have been only “one or two” cases found to have contracted the new strain.

“When we find a patient who is not responding to the prescribed course of treatment, there is always a second course they can take instead,” the official told Minivan News.

According to WHO, healthy individuals infected with TB are not often affected by any symptoms as the person’s immune system acts to “wall off” the bacteria.

The organisation states that symptoms of active TB are coughing, sometimes with blood, chest pains, weakness, weight loss, fever and night sweats.

The WHO Representative to the Maldives, Dr Akjemal Magtymova, Health Minister Dr Ahmed Jamsheed Mohamed and the Health Ministry were not responding to calls at time of press.


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.


Conflicting reports of dengue alert issued by Health Ministry

State Health Minister Abdul Bari Abdulla was unable to confirm whether the ministry had issued dengue alert today.

Earlier today, Haveeru reported that the Health ministry had issued a warning over a recurring dengue outbreak in the Maldives. Hospitals have seen an increase in the number of reported and admitted dengue cases over the last three weeks.

The report stated that heavy rains are sustaining mosquito breeding activities, and that Maldivians should be aware of the increased risk of contracting the illness.

An outbreak in July made 2011 the worst year for dengue fever on record with 11 fatalities since January.

A task force headed by Deputy Minister of Education, Dr. Abdullah Nazeer, was appointed to handle the outbreak. The Ministry of Health did not assume control of the situation for a week after the outbreak began.

At the time, Dr Nazeer told Minivan News that the government faced two obstacles in its response to the outbreak.

“Number one is a lack of proper communication between the Health Ministry and local councils,” he said. “The second was that they did not have the capacity to resolve the issues.”

In 2006, dengue claimed ten lives. This year’s earlier outbreak fatality rate surpassed that record when a 22-year old man died in late July. A 37-year old Indian national also died of dengue fever that month.

The ministry said 2421 cases were reported in August this year, Haveeru reports.


Antibiotics “most misused drug in the Maldives”: ADK COO

Over-prescription and sale of over-the-counter antibiotics is leading to a rise of resistant super-bugs, the World Health Organisation (WHO) has warned, with the Maldives no exception.

“Antibiotics are the most misused drugs in the country,” ADK Chief Operating Officer Ahmed Jamsheed told Minivan News today. “People are becoming resistant, and in certain cases they might not even need the antiobiotics.”

The WHO is discussing the overuse of antibiotics and growth of superbugs at the 64th meeting of the Regional Committee for South-East Asia, in Jaipur this week.

Director General Dr Margaret Chan said, “we have taken antibiotics and other antimicrobials for granted. And we have failed to handle these precious, yet fragile medicines with appropriate care. The message is clear. The world is on the brink of losing its miracle cures.”

Jamsheed said he has seen patients with headaches prescribed with powerful antibiotics, such as ciprofloxacin. He says a lack of systematic supervision allows pharmacists, who are not educated in medicine, to give antibiotics to anyone who asks regardless of a prescription.

“We have a very rudimentary diagnostic capacity in the Maldives,” said Jamsheed. “Hospitals and physicians are not properly monitored, and patients have a lot of independence to choose the drug they want. There are few national guidelines.”

According to Jamsheed, hospital diagnoses are compromised by inadequate facilities. He said that as organisms  mutate, doctors are not able to keep up. Bacteria samples are usually outsourced, and communication can take weeks. “In some cases, we may not be able to recognise and diagnose a disease until we’ve already lost a few patients,” he said.

Superbugs, or super bacterium, are bacteria that carry several resistant genes and are difficult to treat. When a disease is inappropriately or excessively treated with antibiotics, the body develops an immunity which encourages the bacteria to grow stronger.

Dr Chan said many non-communicable diseases, such as heart disease and cancers, are triggered by “population ageing, rapid unplanned urbanization, and the globalisation of unhealthy lifestyles.”

Chan also noted that “irrational and inappropriate use of antimicrobials is by far the biggest driver of drug resistance.” As communities become more drug resistant, treatments could become more complicated and costly.

ADK Managing Director Ahmed Affal said education was important. “There is an increasing number of antibiotics being prescribed in the Maldives, and we need to talk more. Research shows that there will be problems, as organisms become more resistant.”

Affal said that the majority of cases at ADK are fevers and infections, although heart disease, hypertension, and renal infections are on the rise. “Antibiotics are commonly used for lung infections, and sometimes are given as a preventative measure,” he said.

Speakers at the WHO conference suggested that climate change could accelerate the growth of superbugs. Jamsheed told Minivan News that Maldivians could be more at risk for dengue fever and chikungunya, as well as viral diseases. He predicted that if these diseases were to become more common, the misuse of antibiotics would increase as well and people would become more drug resistant.

“The Maldives is not isolated,” Jamsheed said. “We import almost everything, and any bacteria that is growing elsewhere in the region and the world will certainly be transmitted here.”


MNDF drafted to aid government dengue response over “epidemic” fears

The Maldives National Defense Force (MNDF) has been drafted in to help with efforts to try and control an outbreak of dengue fever that the government has described as “an epidemic”.

President Mohamed Nasheed yesterday announced that he had requested the assistance of defense forces in collecting information about the virus from island and atoll health councils after four deaths linked to the affliction were recorded in the space of two days.

Speaking to Minivan News today, Major Abdul Raheem of the MNDF confirmed that the country’s armed forces would be working within a wider government task force to try and establish ways of better controlling the spread of the virus.

The Maldives has been battling a growing number of dengue fever cases in 2011, with 300 cases and five deaths reported in just the first two months of the year. There has been a reported spike in the number of cases of the virus reported in Male’; cases that were linked earlier this year by one health expert to a construction boom in the capital. However, most of the fatalities have been islanders who died in transit to regional hospitals, with many of the most serious cases having affected children.

Raheem did not specify what exact role the MNDF would take in efforts to combat the virus, but added that the defence force would be working as part of a taskforce based within a male’ school to try and coordinate a response to the outbreak.

“This is the first time we have been involved in efforts to help fight dengue fever,” he said. “But we have experience in working to control other [diseases].”

In addressing concerns about incidents of dengue across the Maldives, President Nasheed yesterday said that the MNDF would be used to obtain information about the virus from atoll health authorities in conjunction with councils and the Local Government Authority overseeing their work.

With the current outbreak now being treated as an epidemic by the government, the president called on members of the public and everyone involved in disease control to provide genuine information about the spread of the virus. Meanwhile, anyone found to be providing falsified information is said to risk facing possible prosecution from the authorities, Nasheed warned in a press release.

Early symptoms of the virus include fever, joint paint and a distinctive rash and headache, although it can be difficult to distinguish from the milder Chikungunya disease that can last for up to five days. Even healthy adults can be left immobile by dengue for several weeks while the disease runs its course.

Government criticism

Despite announcing plans to take action against the disease, the government has come under some criticism this week within the Majlis for perceived failures in its handling of the local dengue situation.

Amongst the criticisms, People’s Alliance (PA) MP Abdul Raheem Abdulla asked Health Minister Dr Aminath Jameel if she was considering resignation “since based on what is being said here your sector has very much failed,” Dr Jameel replied that she did not believe that was the case.

The health minister, replying to another question from MDP MP Ali Waheed during Tuesday’s (June 28) parliamentary session, said the ministry was providing information to islands through teleconferencing and stressed that controlling mosquito breeding grounds was key to combating the rise in dengue fever across the country.

“Mosquitoes don’t travel very far,” she explained. “Therefore, it’s mosquitoes from nearby areas that are spreading it. Controlling mosquito [breeding] is needed from the public and individuals as well. We are working together with island councils and the Male’ City Council.”

Jameel claimed that the Addu City Council had also taken up initiatives and organised activities to try and combat dengue.

“An additional problem that we encounter is the quick turnover of doctors in the country’s hospitals and health centres,” she said. “So they are not very familiar with the protocol here. We are facing that problem as well. But as I’ve said, this can’t solved without controlling mosquito [breeding].”


Maldives grapples with difficult dengue outbreak

The Maldives is battling a growing epidemic of dengue fever which is believed to have contributed to the deaths of at least five people this year.

More than 300 cases were reported in the first two months of 2011, compared with 737 cases and two fatalities reported last year. Many cases have been reported in Male’, although most of the fatalities have been islanders. One patient died during transit to Indira Gandhi Memorial Hospital (IGMH), and the more serious cases have disproportionately affected children.

Dr Ahmed Jamsheed, who until recently headed the Centre for Community Health and Disease Control (CCHDC), observed that 2011 had seen higher instances of dengue shock syndrome, where the mosquito-borne parasite causes blood pressure to drop so low that organs cannot function.

“Our initial theory was that this was a new strain of dengue,” he said. “There are four different strains, and strains one and three have been most prevalent. We took samples and sent them abroad but I had left the office by the time the results came back. I’m told out of the samples we sent a few tested positive for dengue one, which means no new strain.”

Instead of a new strain, Dr Jamsheed suggested that the growing number of dengue fatalities could be related to lapses in managing the disease, due to the high turnover of foreign doctors “particularly on the islands.”

“Usually dengue management in the Maldives is quite good, but new doctors are not very well orientated for dealing with dengue, and cases are being referred to Male’ quite late. It would be hard to say for sure at this point unless we did a case-by-case audit, to see where we’re going wrong,” he added.

IGMH Registrar Dr Fathimath Nadia noted that at least two of the fatalities this year involved children, “although these were quite complicated cases.”

Nadia said that health services had previously printed and issue a handbook on managing dengue to every incoming doctor and conducted briefings of incoming doctors, but was not sure if this was still carried out.

The CCHDC and the Maldives National Defence Force (MNDF) in February this year conducted spraying of mosquito breeding sites in Male’ and the surrounding islands, but reported difficulty obtaining access to residential and construction sites.

Minivan News also understands that a international mosquito expert brought in to exterminate breeding habitats at a resort had last month pinpointed the source of Male’s mosquito-breeding to pools of stagnant water in building sites across the city. However she was also reportedly unable to obtain the required permission to inspect the properties.

“The boom in the construction industry has created a huge number of mosquito breeding grounds,” Dr Jamsheed explained. “In Male’ when the Council gives planning permission it requires management of mosquito breeding grounds, but have so far failed to enforce it or conduct inspections. My experience in Male’ was that when our teams visited construction sites there was often nobody at the site to communicate with in Dhivehi or English.”

While the teams might be contact with the construction company responsible for the building, often those working at the site were employed under layers of subcontracting which made it difficult to place responsibility, he added.

Private and community rainwater tanks were also prime breeding grounds, he said, a particular problem on many islands.

“IGMH has a large underground water tank and we even found that full of mosquitoes,” he said. “They had not taken measures to make it airtight, although I think it’s been corrected now.”

Malaysia, which has had nearly 50,000 cases of dengue reported already this year, is currently working with France pharmaceutical company Sanofi-Aventis to develop a vaccine. The country has also launched a nationwide campaign to encourage people to destroy breeding grounds on their private property.

Early symptoms of dengue include fever, joint paint and a distinctive rash and headache, although it can be difficult to distinguish from the milder Chikungunya disease which can last for up to five days. However even healthy adults can be left immobile by dengue for several weeks while the disease runs its course.


No calls for Sri Lanka travel ban despite “Influenza Pandemic” caution, says CCHDC

The Maldives Centre for Community Health and Disease Control (CCHDC) has said it is not advising people against travelling to Sri Lanka amidst concerns about a recent rise in cases of the H1N1 influenza virus in the country, adding that no cases of the disease have been confirmed in the Maldives of late.

According to the CCHDC, data from the Sri Lankan Ministry of Healthcare and Nutrition’s Epidemiology Unit has recorded 342 cases of the disease, which in turn has been linked to 22 deaths in the country. Sri Lankan authorities have said that the country, particularly around the city of Colombo, is undergoing an “epidemic of Pandemic Influenza”, with 65 cases of H1N1 occurring just last week – between December 13 to December 19 – resulting in nine deaths across the country.

An official from the CCHDC told Minivan News that it was not calling for any travel restrictions as a result of the influenza report, but added that the centre did urge any travellers to be cautious when visiting the country.

In terms of caution, the centre urges travellers to maintain basic hygiene measures like washing hands, particularly among those most susceptible to the disease such as pregnant women, children and the elderly.

“The disease is spread by the respiratory routes, so we recommend avoiding crowded areas as much as possible, particularly as measures like wearing masks will not really help,” said a spokesperson for the centre.

Regular washing of the hands with soap was strongly recommended by the CCHCD, which said it had not had any confirmed cases of the virus recently in the Maldives, thought the centre claimed it would continue to keep the public informed.

However, beyond precautionary measures, the CCHCD has said that anyone developing a fever, a cold or a cough upon returning from Sri Lanka or being in contact with other travellers should try and obtain medical advice as soon as possible.

More information for those concerned about the virus is available by calling 3315334.