SRI LANKA: DENGUE FEVER EPIDEMIC IN SRI

LANKA VS. STATE RESPONSIBILITY

Image: Anti- dengue campaign by school children.

by Sanjeewa
Weerawickwama.-12/06/2017

The population of Sri Lanka is 20.97 million (2015) people. Some 1.84 million are
migrant workers. The number of Dengue Fever affected individuals in 2015 was
29, 777. In 2016 it was 55, 154. Statistics for the first 5 months of 2017 show
affected individuals to be 56,887! And the total number of dengue affected
individuals is expected to rise to more than 136, 528. Following the above
mentioned statistics, the simple mathematical calculation gives an alarming figure
of the percentage of dengue affected individuals to date. It is approximately 1% of
the entire population for the period of three years, 2015-2017. [2] Local
Government Institutions play a major role in the Dengue Prevention Scheme. The
Governments failure to hold local elections means that the country is running
without functioning local government institutions. There is a severe outcry by the
people about the total collapse of the States mechanism on Dengue Fever
Prevention.

DENGUE FEVER BREAKDOWN

The female Aedes aegypti mosquito is the vector for the VIRAL infection of
Dengue. This is how it happens. The female mosquito bites a person with the
dengue virus in his/her blood. With this human bite a mosquito is then infected
with the dengue virus. After about one week, the next bites of the mosquito,
inject and spread the virus into healthy human beings. There is no transmission of
Dengue Fever from human to human. But, theoretically it is speculated that blood
transfusions, organ transplants and transmission to the baby from the mother are
possible [3]. Dengue mosquitoes are unable to survive easily in cold climates thus
confining the disease to tropical and sub-tropical areas. Interestingly, the dengue
mosquito is usually associated with human habitats making infection easier.

In other words, wherever human beings live, dengue mosquitoes are also there
as long as the other circumstances are favorable for them. Female mosquitoes
need additional human blood to produce eggs. Both male and female mosquitoes
consume plant nectar for their sugar requirements. Female mosquitoes feed on
humans both indoors and outdoors during the daytime (from dawn to dusk) but
more in the early morning and before dusk. The more vulnerable populations
reside in urban and suburban areas. Infected persons can spread the disease from
one country to another or from one area to another through travel.

The first confirmed dengue patient in Sri Lanka was diagnosed in 1962. The first
outbreak was reported in 1965- 1966. After that dengue was not that great a
threat in Sri Lanka, though isolated cases were reported from time to time. Sri
Lanka experienced its first Dengue Fever EPIDEMIC in 1989 1990. After that,
studies revealed that more progressive and devastating epidemics are surfacing at
regular intervals [4].
During the last 6 months of 2017, 56,887 suspected dengue cases have been
reported to the Epidemiology Unit from all over the island. Approximately 42.55%
of dengue cases were reported from the Western Province [5]. Other districts
more vulnerable are Gampaha, Kalutara, Galle, Kandy, Ratnapura, Jaffna and
Trincolmalee [6].

Let us consider figures related to dengue during the recent past. The number of
cases reported over the years is fluctuating but the overall TREND IS RISING. In
2015, the number was under 30,000. (2015: 29,777). In 2016 it was 55,150. In
2017, during the last 5 months, the reported number of cases is 56,887. This
figure is more than the total number in 2016 which was the highest number
recorded in our history [6].

To minimize Dengue Fever morbidity much effort has been expended from 2005-
2014. As described earlier, although the number of cases reported fluctuated, the
overall trend is increasing with a maximum in 2017. It indirectly tells a hidden
story. Measures adopted so far are not efficient enough to address this burning
issue in Sri Lanka. There may be several excuses for this allegation and I will name
two. The first is the type of virus which is active when a person is first bitten. It is
more virulent, causing more casualties than in earlier years. The second is climate
change including rising temperatures which favor the survival of the virus through
globalization and travel.

Whatever the highlighted facts, the seriousness of the problem in Sri Lanka is
getting worse, warranting urgent intervention. Can the State alone eradicate
dengue from our country? No again.
Individual responsibility is very much higher than the States. But the States
responsibility is considerable nevertheless. There are specific aspects that the
State should take care of in order to control this scourge.
 The dengue mosquito can fly
an average of 200 meters in order to find water to lay eggs. This is a long way. To
reduce the risks of infection, a responsible citizen is responsible for the
cleanliness of his own house and surroundings. An irresponsible citizen, far from
the first house, but with mosquitoes in his premises, will up the risk to the
responsible persons home area. The State has the major responsibility to look
after the vulnerable areas effectively. In the past there was a successful and
excellent HomeVisiting Program initiated by the Municipal Councils with the help
of the armed forces. A fine was imposed for not following official requirements
and an additional fine of Rs. 50,000 if a person continued to offend. With such
strict regulations, one would think that people would tend to be afraid of the fine
and the Courts, making them careful to maintain their environment up to
standard. But this is not the case. CLEAN UPS are hardly seen today.

The local authority of an area is responsible to clean the area in order to control
the epidemic. According to Dr. Pradeep Kariyawasam, Former Chief Medical
Officer of Health, Colombo in an article in The Island newspaper (May 2nd) was
of the following opinion. Dengue control and prevention is a duty of the local
authority. The Public Health Department of the Colombo Municipal Council has a
cadre of 1200: it should have around 55 Public Health Inspectors, 150 Midwives,
185 Health instructors, 55 Mosquito control Field Assistants, who could have been
used to inspect all the premises and land parcels in the city which number around
80,000. Unfortunately, instead of these 450 Field Officers, we had only around
180 to do this work. [7]. This data points out the inefficient work that a person is
able to deliver because of the tremendous workload taken on. It is the sole
responsibility of the State to employ people, even on a temporary basis, to get
the clean-up and inspection done during peak times of the monsoon of the
epidemic.

During the past there were organized control programs of fogging and spraying to
disrupt potential mosquito nesting sites. But, this is no more to be seen. Why it
cannot be implemented in an efficient and organized way, in order to cover both
internal and external environments where mosquitoes can breed, is the basic
question, needing an answer.

The inspection for mosquitoes should not be restricted to the Dengue control
week. It should be carried on regularly, routinely in an organized scheduled
manner. Dedicated Ministers and Authorities should periodically inspect the
work. Relevant Ministers or responsible Ministries are the people who can
address the problem facing the entire populace. They should develop sensitivity
to this on-going Public Health DANGER. A target/goal must emerge from the
Government to minimize mosquito breeding places.

Education on the disease is PRIMARY and the huge cost would be notable.
According to Dr. Pradeep Kariyawasam, Former Chief Medical Officer of Health,
Colombo, Our budget, does not allow us to communicate our educative
messages via electronic media and the press. TV companies charge Rs.20,000 per
15 seconds. A one-page newspaper advertisement costs Rs.100,000. Even in the
State-owned media we do not get a chance[8].

The privatization of the Cleaning Services by some local Councils is said to be a

strong factor negatively affecting the problem. These restricted Cleaning Services
come with many rules and regulations. Since there are no more functioning local
Councils and as elections are being postponed indefinitely, the situation has gone
from bad to worse. Now, no one is responsible for the routine, scheduled, clean
up functions in local areas.

The State should be directly responsible for the ever-increasing numbers and for
the variety of mosquito-breeding habitats. These are the results of rapid and
poorly planned urbanization, globalization, consumerism, poor solid waste and
water management and increasing population movements without adequate
measures to prevent vector breeding. Climate changes influence the eco-system.
It encourages vector breeding for which mankind is directly responsible.

It has to be mentioned that poverty, reduced access to health services, housing,

sanitation and clean water, should be considered by the State in order to address
this serious issue facing everyone [9].
The mass media highlighted how the recent flood was due to unplanned
constructions and land fillingsall politically biased. Is the State responsible for
these unplanned activities which are at times illegal?

There is no efficient method of waste disposal in Sri Lanka today. Such mundane,
yet common issues are not addressed with enough strength and attention.
Needed are strong leaders, to implement sustainable programs to implement
effective ways of waste disposal. Non bio-degradable tires, plastic containers and
tins are some of the most accessible objects where mosquitoes breed. However,
up to now, there is no OPERATIVE, effective way to dispose of them so they do
not pose a threat to the environment.

Following are international statistics that have to be considered: an estimated

50100 million Dengue infections occur annually in over 100 endemic countries.
Almost half of the worlds population is currently considered at risk of contracting
dengue. The South-East Asia Region contributes to more than half of the global
burden of dengue. About 52% of the worlds population is at risk as they are
residing in this Region [10].

To conclude, Dengue is a lethal disease which does not have a specific vaccination
or treatment protocol. The most important point that should be highlighted is
that Dengue Fever is a disease that can be controlled. Hong Kong has achieved
Dengue Fever control, so it is achievable goal. The individual and the States
responsibility is a two-pronged effort. It is urgent that the State put more
emphasis on the subject. They need to issue strategic, effective and sustainable
plans for the near future. Dengue is not a disease like AIDS where the individuals
responsibility is the answer. Dengue is a disease that can be controlled with
diligent mosquito control. To achieve this, State support is KEY as it is impossible
for individuals to do this alone. An individual can clean his home/garden
environs, but the threat remains unless the State takes overall responsibility for
all vulnerable areas in the entire country.

Footnotes

1. Rasika Sanjeewa Weerawickrama, LLB (Col), LLM (HK)), (Attorney-at-Law) is a

Legal Practitioner in the Supreme Court of Sri Lanka
2. Stop Press: Dengue Cases 2017: January May: 56,887, Dengue cases 2016:
54,945 (2015: 29,777) Click here to Read
3. Dengue, Dengue Fact Sheet. Click here to Read
4. Dengue Transmission. Click here to Read
5. Sri Lankan Situation. Click here to Read
6. Dengu update Click here to Read
7. Dengue Epidemic: Back to basics to prevent spread, The Island News Paper,
May 2, 2017, Internet link: Click here to read
8. General Health Risks: Dengue. Click here to Read
9. Dengue count Sri Lanka: 2017; the worst year on record? Click here to Read
10. Who spreads dengue and severe dengue? Click here to Read
Stop Press: Dengue Cases 2017: January May: 56,887
Posted by Thavam