Tag: outbreak

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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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.


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Task force claims dengue “epidemic” under control despite coordination concerns

The task force appointed by the government to combat a dengue fever outbreak linked to the deaths of seven people has claimed it is beginning to bring the spread of the virus under control, despite initial difficulties in coordinating with local councils.

A spokesperson for the task force, which has been put in charge of coordinating the responses of government ministries, the Maldives National Defense Force (MNDF) and NGOs like the Red Crescent, has said it has overcome initial difficulties such as dealing with local councils in trying to curb virus infection rates.

In a week where authorities have labelled the latest outbreak of dengue fever across the country as an “epidemic“, opposition parties have been critical of both the speed and nature of the government’s response to these concerns, despite welcoming efforts to try and combat the virus.

The criticisms come after newspaper Haveeru reported that a four-year old boy, who had been brought to Male’ for treatment of dengue fever, had become the seventh person in the last week to have died from the virus.

Despite fears of the virus continuing to spread, for those charged with coordinating the country’s dengue control programme, “significant progress” is claimed to have been made over the last few days in collecting data and trying to understand the full scale of the current outbreak and how to contain it.

At present, the taskforce overseeing this national response the to dengue fever has said that it expects the current outbreak to be fully under control within a week.  The claims have been backed by official figures supplied by the same coordination body that indicated that 11 suspected cases of dengue were reported today, compared to 16 cases recorded yesterday and 18 cases the day before.

Speaking to Minivan News today, the task force’s media spokesperson said that while dengue outbreaks were nothing new in the Maldives, the number of suspected cases of the virus that traditionally were expected dropped by this time of year had in fact spiked. The spokesperson added that this apparent spike in infections had created a number of coordination difficulties for a new system of local government put in place following the country’s first local council elections in February.

“Compared to last year, during these dates, figures usually go down. However, this month, there has been a spike [in numbers of dengue cases],” he said. “When the local councils took over [collecting data about the virus from the Health Ministry], the whole process was stalled, nothing was moving.”

The spokesperson said that there was insufficient research to identify the exact factors driving a suspected spike in infection numbers of late.  However, he claimed there had been “many internal and administrative problems” that when combined with the country’s wet season – resulting from the south west monsoon that runs from May to November – may have served to exacerbate the impacts of the outbreak.

According to the task force spokesperson, the decision to hand over the responsibility for detailing information on the spread of dengue from the Health Ministry to island councils had initially raised notable problems for the government; though these issues were now being resolved.

“There were some problems in getting councillors initially to work on weekends, but I think everyone has understood the severity of the outbreak,” he added.

While no “drastic” changes had been made in the methods used by authorities themselves to combat dengue fever infections, the taskforce representative said that the key focus for efforts both now and during any future “epidemics” would be in trying to ensure that the mechanisms for coordination were working efficiently.

“In the future, this task force will have helped with this, because we are getting important data and contacts,” the representative said.

With the task force currently budgeted to run for seven days, the body’s media spokesperson said that no decision had yet been made on whether similar initiatives would be used during future outbreaks, yet he was confident that important lessons could be learnt from the current system.

“I think the task force will help to administer preventative measures during outbreaks in the future. Building a fixed system out of this existing network will be very helpful,” he said. “There has been a change in how government works, so people have had difficulties in adjusting to this and awareness of requirements has been low. Councils also have to realise their responsibilities as well.”

The task force spokesperson claimed that preventative measures for dengue also needed to focus on members of the public in areas like education at schools, as well as improving hygiene in houses and carrying out inspections at construction sites to limit mosquito breeding grounds.

“I think the basic thing is to get this system in place, like in schools, things like education on personal hygiene and dealing with councils,” he said. “If these don’t work, then every time we can’t always go to the MNDF for assistance.”

“Bungled” response

Despite the task force representative’s claims, 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. Shareef added that although the DRP welcomed and would cooperate with the government in efforts to try and limit the spread of the virus, he said that authorities had acted too slowly in trying to deal with the outbreak.

“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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