As monsoon approaches, Kerala readies for familiar battle with disease outbreaks

Kerala is gearing up for heavy rains and disease outbreaks, which were a common phenomenon in the state until COVID happened. The state health department has issued high alert for various types of fevers like dengue, tomato fever and leptospirosis (rat fever), urging people as well as health workers to remain watchful.

According to the Kerala Directorate of Health Services, in May (till the 13th) 96 cases of Dengue and 67 cases of Rat fever have been reported. The occurrence of other communicable diseases such as Hepatitis B and Chicken Pox is also high which shows a sign of return to the pre-COVID times. Notably, there was a significant decline in the number of communicable diseases in the state after COVID outbreak, which was assumed to be an unintended achievement of implementation of preventive guidelines for the pandemic.

When people followed social distancing and used masks and sanitisation rules, the occurrence of other type of fevers too came down. However, as COVID guidelines were relaxed, Kerala is witnessing a reverse trend with instances of communicable diseases on the rise.

Rising cases

As per records, 3,251 cases of dengue fever were reported in 2021 with 27 deaths. In contrast, the number of cases in 2020, when the first lockdown was in place, 2,721 got infected with dengue and 22 died. In 2019, before COVID happened, the reported cases of Dengue fever were 4,651 with 14 deaths. Other communicable diseases such as chickungunia, leptospirosis and hepatitis B too have shown a consistently high occurrence in the state over the past few years.

“The climate and terrain of Kerala are favourable for high occurrence of communicable diseases, but the inability in controlling the same is a systemic failure. The lack of coordination between various departments is one of the reasons. The attitude of people who generally don’t follow protocols for preventing diseases is another factor for rise in communicable diseases,” says Dr B Iqbal, a public health expert, who is also the Chairman of the expert committee for COVID management.

Kerala being a state with high number of water bodies requires extra care for maintaining public hygiene. According to Dr Iqbal, the absence of a sustainable planning process makes Kerala vulnerable to communicable diseases.

Mosquito menace

Diseases caused by mosquitos like dengue and chickungunia, water-borne diseases such as rat fever and diarrhoea are most common communicable diseases reported in Kerala. According to health experts, the growth of Aedes Aegypti mosquito is uncontrolled and the reason for high incidence of diseases as dengue, chickungunia and zika.

For records, there are three categories of mosquitos — Aedes Aegypti, Anopheles and Culex. Anopheles mosquitos cause Malaria and Culex causes diseases like Japanese Encephalitis and West Nile Virus. However, Aedes Aegypti mosquitos breed in fresh water and causes Dengue. “This is a major cause of concern. It is not easy to control mosquitos that breed in fresh waters. People do not follow instructions such as observing dry day and keeping the surroundings unfriendly for mosquito breeding. The Aedes Aegypti mosquitos can breed even in trays inside the refrigerator,” says Dr Iqbal.

“There are not many successful models for eliminating Aedes mosquitos, going by the global experience. This type of mosquitos breed either inside or in the peripheries of our home. Even the interior plants provide enabling environment to Aedes Aegypti mosquitos,” says Dr K P Aravindan, a public health expert. “I fear Kerala may soon face the threat of spread of Yellow fever, if we are not able to eliminate the threat posed by Aedes Aegypti mosquitos,” says Dr Iqbal. The mortality rate of Yellow fever is high when compared with other communicable diseases.

Return of malaria

Another alarming factor about Kerala is the return of malaria which had been almost eradicated a decade ago. In 2021, 309 malaria cases were reported in Kerala. The reported number of Malaria is 656 in 2019 and 268 in 2020. In 1965, Kerala was recognised as the first state that had eradicated malaria. However, the glory of this achievement did not last long. The disease re-entered within a decade and several cases have been reported since 1980. Over a couple of decades back, Kerala could successfully control the occurrence of the disease again and very few cases were reported by 2000. Since 2013, Kerala again witnessed a slowdown in the number of malaria cases which were mostly found as ‘imported from other States. “More than 90% of the cases are found to be brought by interstate travellers or migrant workers. The occurrence of indigenous Malaria is still low,” says Dr Aravindan.

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Though the death toll is not high, the high occurrence of acute diarrhoeal disorder (ADD) is also a cause of worry. Three to five lakh cases of Diarrhoea are reported every year in the state, according to the data provided by the Directorate of Health Services. Kerala is a state with abundant water bodies, which is a reason for high occurrence of water-borne diseases. “Almost every household in Kerala has one toilet, at least. We have achieved almost hundred percent self-sufficiency in home-based toilet facility, but at the same time, this caused the contamination of water in wells which is the major source of drinking water,” says Dr Iqbal.

Water contamination

Successive governments paid little attention to the way toilets were constructed with no regard for rules and regulations,” says Dr Iqbal. The presence of Coliform bacteria is wide spread and highly prevalent across our drinking water sources. “However, the people of Kerala are generally aware of water contamination and follow the practice of boiling water before drinking,” observed Dr Iqbal.

Communicable diseases that are generally not very dangerous become fatal in Kerala. This is predominantly due to the high occurrence of NCDs (Non communicable diseases) such as hyper tension, diabetics and high level of cholesterol. “Even an ordinary fever could prove lethal to a person who is suffering from non-communicable diseases like diabetics or hyper tension. The high occurrence of NCDs is a result of the affluence that Kerala has achieved, but the same makes it very vulnerable too” says Dr Iqbal.