Encountering outbreaks of Japanese Encephalitis, Influenza, Dengue, Chikungunia & Hand Foot and Mouth Disease at a time, Dakshin

hin Dinajpur, West Bengal, India, 2012

Location of The Study Area - I Dakshin Dinajpur fever outbreak

WEST BENGAL Uttar Dinajpur

Dakshin Dinajpur

Location of The Study Area - II Dakshin Dinajpur fever outbreak

Block - Khaspur

Block - Kumarganj

Introduction Dakshin Dinajpur fever outbreak

Dakshin Dinajpur, a remote and backward district covered by international border with Bangladesh from three sides Paddy, the main economic produce, is cultivated by flooding irrigation and jute is drenched in dirty cesspools for fibre breeding grounds of mosquitoes Crises in agriculture enhances massive migration of work force throughout India

Outbreaks of unknown fever, Dakshin Dinajpur, August 2012

Outbreaks of Acute Encephalitis Syndrome (AES) & influenza are common in North Bengal districts; kala-azar endemic Occasionally malaria, dengue & chikungunia are reported
Outbreaks are usually Not reported Not investigated

Clusters of cases at Kumarganj and Khaspur blocks, West Bengal, Aug 2012 (I)

25th August: 2012

Four children of Narayanpur, Chakjayanti, Kuchila & Kamarara villages suffered from acute onset of high fever, headache, convulsion & loss of sensorium They were admitted in District Hospital and then referred to North Bengal & Maldah Medical Colleges Several villagers from Narayanpur, Munglishpur, Madhavpur were suffered from fever, chill, malaise, anorexia, weakness, with or without severe joint pain and admitted to Kumarganj BPHC & Balurghat DH

Clusters of cases at Kumarganj and Khaspur blocks, West Bengal, Aug 2012 (II)

26th August to 25th September 2012: Total 384 fever cases from 15 and two villages of Kumargunj and Khaspur blocks were reported Few cases from adjacent Tapan and Gangarampur blocks & Balurghat municipality 33 patients were admitted in different hospitals Seven patients died Several guardians brought their children with fever and vesicular eruptions at different OPDs

Control Measures- I (Block Level): Dakshin Dinajpur fever outbreak

Local health authorities initiated control measures and sent Block RRT House to house visit, fever surveillance, line listing, symptomatic treatment, blood slide & sample collection, admission of serious patients and health education Outreach fever clinics, BCC, convergence with block administration, PRI, ICDS & schools, lab. investigation, daily reporting

Control Measures-II (District Level): Dakshin Dinajpur fever outbreak

District Rapid Response Team intervened Visited all affected villages Intensified and supervised control measure Coordinated with all line departments Prompt & extensive IEC - meeting, miking, leafleting, flex, television advertisement Opening of health facilities on holidays Arrangement of lab. investigation at NBMC

Control Measures-III (District & State): Dakshin Dinajpur fever outbreak

Treatment & critical care support to serious cases at District Hospital & NBMC&H Visit by State Level Team from Malda Medical College to affected villages Visit & collection of species by Central Level Entomological Team from ICMR (Madurai) IRS with focal spraying in affected villages ULV insecticide fogging in municipality area

Results of laboratory investigation: Dakshin Dinajpur fever outbreak

Blood samples of earlier cases not sent RDK & blood slides for malaria: - ve 208 blood samples were investigated JE: 3 + ve, 6 equivocal; Dengue: 4 + ve, 40 reactive; Chikungunia: 2 + ve Influenza & HFMD could not be tested Attack Rate: 0.76; Case Fatality Rate: 1.92

Conclusion: Dakshin Dinajpur fever outbreak

It was a mixed outbreaks of Japanese Enchephalitis (JE), Dengue, Chikungunia and suspected Influenza & Hand Foot and Mouth Disease (HFMD) at a time Influenza and HFMD were clinically diagnosed, not confirmed in laboratory

Problems and Limitations:

Dakshin Dinajpur fever outbreak

Continuation of lab tests at NBMC&H, a overnight journey Management of post AES complications Posts of BSI, MI & MTs in blocks and Epidemiologist, VBD consultant, AMO & DSI in the district are vacant Most of the spray workers are old and sick Existing agriculture & animal rearing pattern

Recommendations (I): Dakshin Dinajpur fever outbreak

Introduce use of impregnated bed nets Induce cleanliness, personal protection, source reduction, landscaping, proper water storage, increased treatment seeking Segregation of pets from living rooms and proper hand washing & hygiene practice Fogging with neem cake in the evening Special care and protection for children

Recommendations (II): Dakshin Dinajpur fever outbreak

Strengthen disease surveillance & IDSP Develop Fever Clinics and Drug Depots Perform RDK & rk 39 testing, blood slides & sample collection where indicated Availability of Mak Eliza kit at District Lab Introduction of JE vaccine in routine immunization Commissioning CCU/ITU at District Hospital

Director of Health Services, Government of West Bengal Acknowledgement DDHS (Malaria), Government of West Bengal State Nodal Officer, IDSP, West Bengal The Principal, Head & faculties, Pathology, NBMC&H Chief Medical Officer of Health, Dakshin Dinajpur Dy.Chief Medical Officer Health-I, Dakshin Dinajpur DMCHO, Dakshin Dinajpur ACMOH (Sadar), Dakshin Dinajpur Superintendent, Balurghat District Hospital, Dakshin Dinajpur Chairperson & Health Officer, Balurghat Municipality BMOHs, Kumarganj & Khaspur and all BPHC staff MO,Pathologist & his team, Balurghat District Hospital IDSP Data Manager, DEO IDSP, HS (M), NVBDCP file All staff, Public Health Wing, CMOH Office, Dakshin Dinajpur