Nagaland: Transovarial transmission most problematic in controlling dengue

Public leaders urged to mobilise community to beat dengue 

Dimapur, August 9 (MExN): Two-day dengue awareness campaign with the theme “Beat Dengue: Our Health Our Responsibility” a public private partnership organised by National Vector Borne Disease Control Program (NVBDCP) and Christian Institute of Health Sciences and Research (CIHSR) with ULB members and village councils of Dimapur, Chümoukedima and Niuland was held at LG Hall, CIHSR on August 8 and 9. 

A detailed report on the campaign was released by IEC Consultant, NVBDCP, Directorate of Health & Family Welfare, Kohima. It stated that speaking as the special guest, Dr Neisakho Kere, State Programme Officer NVBDCP, DH&FW said that last year Nagaland had dengue Serotype 1 and type 2 and “this year which type will come again is unknown.” He cautioned that Serotype 2 is relatively more severe than the other three. 

Dr Kere said that the most problematic in controlling dengue is because of their transovarial transmission, meaning, the infected mosquito eggs will also be infected with the virus and when it lays its eggs the hatched young mosquito will fly out as infected mosquito and will infect any person getting its bite. He said, therefore, “even if we do fogging the adult mosquitoes will be knocked down or killed but the infected eggs in the water bodies will come out after a few days to bite us and infect us with the dengue virus.”

Dr Kere stressed that since there is no proper vaccine, the best preventive method is to remove their breeding places and avoid getting the bite – use long sleeves and pants, use repellant, sleep under mosquito net etc.

Highlighting the need to inform colony members to prevent mosquito breeding places, he urged to keep their surroundings dry as far as possible by observing one dry day every seven days. Dr Kere said that by observing one dry day not only reduces dengue causing mosquitoes but also many other vector borne diseases. He said that once mosquito population is reduced the different diseases spread by them will reduce, like malaria where the primary vector is not found or found very little in the town. 

‘Dengue vectors rising up again’
Cautioning that dengue vectors are rising up again, Dr Kere said that the house index and container index are going up to the level of outbreak again and unless we empty the containers and water bodies around our houses, the Aedesaegypti which cause dengue disease are found plenty showing the public are not cleaning or removing the breeding places. 

Recalling last year’s dengue outbreak, Dr Kere said that there were struggle and hard work to treat the disease. He said that many patients were admitted to hospital and some expired despite best effort. 

Reflecting on the experience from 2023, Dr Kere highlighted several key issues that hampered efforts to control the outbreak. Firstly, the inability to prevent people from visiting patients led to an increase in infections. Despite efforts, authorities could not stop people from visiting the outbreak colony, further complicating containment measures. Additionally, there were difficulties in restricting the movement of individuals who tested positive, which contributed to the spread of the disease. He said that hospitals, reliant on Rapid Diagnostic Tests (RDT) for identifying probable dengue cases, faced significant challenges due to a high number of false positives. This reliance on RDTs caused confusion and added to the strain on medical facilities. Furthermore, the limited number of sentinel testing laboratories led to a backlog of samples awaiting confirmation, delaying accurate diagnoses.

Dr Kere pointed out that hospitals struggled to separate dengue patients from others, particularly in districts overwhelmed by the number of cases. Compounding these issues was the inadequate blood storage in hospitals, a problem exacerbated by a decline in public blood donations and substandard storage facilities. Dr Kere emphasised the need for improvements in these areas to better prepare for future outbreaks.

He highlighted that this prompted to create a lot of awareness in the form of

 newspaper releases, through TV news, plays in YouTube, radio interviews and radio jingles. 

Dr Kere further advised to discuss with colony members to enforce some preventive measures like whoever is not removing mosquito breeding places shall be penalized or whoever is rearing mosquitoes within their house shall be penalized by asking them to clean their compound the day itself. 

Another updated from the IEC Section, Office of Chief Medical Officer Dimapur stated that Dr Nokchur Imchen, Consultant, General Medicine, CIHSR presented an overview of dengue; its clinical symptoms, complication and public health importance. According to Dr Imchen, most people seek medical intervention only when the illness has reached a critical phase, which is a major concern. 

He emphasised that late detection and treatment are primary causes of dengue-related deaths. Furthermore, patients with co-morbidities have a lower chance of recovery in critical conditions, making early detection and treatment even more crucial. 

Some warning signs of dengue fever include pain behind the eye, rashes, vomiting, severe abdominal pain, muscle and joint pains, difficulty in breathing, restlessness, blood in urine, stool, and vomit, etc. He underscored the importance of prompt medical attention and early detection in preventing severe dengue case and reducing mortality rates.

Kikolul Khieya, Assistant Director, Urban Vector-borne Disease Scheme (UVBDS) highlighted the dengue vector, its breeding sites and the control measures. 

Dr Atsung Aier, Senior Consultant, Community Health, CIHSR discussed the checklist for anti-dengue action plan with the trainees. He said similar checklist was used last year with teachers and it proved to be very successful. He hoped that the local leaders present in the training will take home not only the anti-dengue messages but also mobilize their respective communities to take action and responsibilities of their own health.

There were questions raised by the gathering and clarified by Dr Limatula Aier, Chief Medical Officer, Dimapur and Dr Imchen. Group discussion and anti-dengue action plan was moderated by Dr. Atsung Aier, Senior Consultant Community Health Department, CIHSR. Earlier opening address was delivered by Medical Superintendent, CIHSR and Laishram Vidyalakshmi, Quality Officer CIHSR chaired the programme.