The Aedes aegypti mosquito has had a great breeding season in Tamil Nadu. Surreptitiously proliferating in water cans and little pools of clear water within, and outside homes, it has this year put a dengue-endemic State into a low-level pandemic mode. At 8,482 cases (up to November 5, as per www.nvbdcp.org.in) and 54 deaths, Tamil Nadu remains at the top of the table, even as the numbers are rising in other States.
The outbreak peaked in two different phases — first in May, contributing to around 2,000 cases and 30 deaths, localised in the South. The second was in September-October, where the cases were dispersed across the State.
One of the key factors behind this year’s outbreak is, curiously, power cuts of long duration. Most parts of the State still reel under long hours of no electricity. As a result, when power is on, people collect and store water in containers for use during the rest of the day.
These cans, buckets, and barrels are breeding areas for the mosquito. An advertisement issued in public interest by the State government shows larvae on the sides of water containers and floating in stored water. So, much of the public health activity focuses on spreading awareness of the need to prevent breeding of mosquitoes in domestic and peri-domestic areas. Sanitary personnel go door to door, explaining the routine: water containers have to be covered, emptied out and scrubbed frequently.
Health authorities also had to tackle the phenomenon of a huge number of patients walking into hospitals with fever, and suspected dengue. Sifting dengue from common, seasonal, viral infections has been an overwhelming task, they say. It was only over time that protocols for managing and testing a patient sick from dengue have been laid down.
Health Secretary J. Radhakrishnan says the ‘Tirunelveli Protocol’ was set in place to handle both source reduction and case management. Except Madurai, the number of cases has come down to double digits in all other affected districts, he claims. Additionally, six IAS officers have been appointed to supervise dengue control in as many districts.
The challenge remains, he admits. Special strategies have been drawn up to reduce the burden of cases in Madurai. “The need to attack sources [of breeding] is acute. We’re hoping to convert the whole routine into a habit among the people,” Dr. Radhakrishnan adds.