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Focus on disease outbreaks, says Kerala health secretary Rajeev Sadanandan

Focus on disease outbreaks, says Kerala health secretary Rajeev Sadanandan

Focus on disease outbreaks, says Kerala health secretary Rajeev Sadanandan
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By Shereen Bhan  Aug 23, 2018 7:23:21 AM IST (Updated)

Torrential rain finally let up in flood-hit Kerala, giving some respite for thousands of marooned families. People are going to back their homes as the water recedes. While the focus will now shift to rehabilitation, the immediate concern was to provide medication for people dependant on drugs such as insulin and hypertension drugs as prolonged denial of such drugs could lead to further complications.

Kerala health Secretary Rajeev Sadanandan said all stranded citizens had been rescued and about 196,000 people were sheltered in the 3259 camps across the state.

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The state also had a surplus  of antibiotics, which would be ramped up to 100 percent efficiency, Sadanandan added.
Infections such as leptospirosis and chicken pox can spread rapidly, especially in congested habitations such as rescue camps.
Edited Excerpt:
Q: You have just concluded a review meeting with Chief Minister, give me a status check of what things are like on the ground?
A: The good news is that there are no more rescue efforts to be done. All the people who have been marooned in different places have been rescued and brought to the camp. There is no threat to life left but 3259 camps and about 1,96,000 odd families living there. Many of them find it difficult to go back because houses are inhabitable and there is threat of infectious diseases breaking out.
Q: On issue of the threat of infectious diseases, I am looking at statement that has been put out by Dr Shashi Tharoor – he has met with WHO officials and UN officials in the statement he says that WHO is in position to offer Kerala rapid diagnostic kits to test water, water filters and monitoring non-communicable diseases (NCD) patients on medication – Is there a requirement for WHO to step-in an provide this sort of assistance, is that what the state government is looking at?
A: We already have people of WHO working with us they are working with as surveillance medical officers and they are national officers who are working with us. I had a conversation with the Deputy Director General Dr Soumya Swaminathan and as of now we do not need anything more sophisticated because right now what we are doing is looking for infectious diseases and our diagnostic systems are quite capable of taking care of the possible threats that could come up.
In case there are case there are cases which needs looking at different panels the National Institute of Virology and the Manipur Virology Research Institute who worked with on managing the NEPA crisis are available to us. So right now we do not need any more support from the WHO, the national systems are quite capable of taking care of them.
Q: What about antibiotics, medicines, vaccines etc for the possibility of leptospirosis or any of the other critical issues that may crop up?
A: Our antibiotic stock is sufficient, in fact we are right now about 40 percent more than what we need, we intend to ramp up it up to 100 percent redundancy. Leptospirosis itself it is not something that needs advance antibiotics, a simple antibiotic like doxycycline is capable of taking care of it. We have also issued an advisory on prophylaxis against leptospirosis, using the antibiotic doxycycline.So lepto is not the major threat. In any of these diseases, the issue is not management, the issue what are you system that can pick this up immediately and how good is the response to contain the epidemic and that is what we are focusing on.
Q: So what have you been able to do in terms of putting the safeguards in place both in terms of management as well as anticipation?
A: The initial phase was rescue and at that time we were focusing on people who have been caught in, right now our focus even now on the camps because we are worried with so many people living together and having had before the floods came, we had an outbreak of leptospirosis and chicken pox. So we expect that many of the persons who went to the camps following the flood would have been carrying these microbes and could have infected others.
Right now our focus is on three areas, one is to see whether any residue of old chicken pox, lepto cases are remaining and whether they have caused infections and the other one is the worry after a flood which is acute diarrhea diseases, these are areas which we are currently watching for. While the surveillance takes care of all the three but these are areas of concern as of now.
Q: In terms of efforts on currently – as you said the rescue operations are now over and focus shifts to rehabilitation –what will be the priority areas from here on?
A: Rehabilitation will take some more time because right now there are lot of things to be done. There are houses to be cleaned and during the cleanup we expect a lot of snake bites that is one area that we are focusing on immediate attention to snake bite victims. The second part is going to be all the water sources have been contaminated, so cleaning up the water sources and ensuring that safe water is provided. People have been off medication for a few days, like people on insulin, anti-hypertension drugs and which could expose them to cardio vascular, neurological complications. That is the other area we are watching for.
Now once this part is over and the rehabilitation starts the focus is going to be - we have lost about 58 institutions of which 8 primary health centres, 4 community health centres and one sub-divisional hospital and some sub-centres have been lost. So first part is going to be finding accommodation for them and rebuilding them. We have lost our equipment in most of the flood infected areas, there was no time to evacuate the equipment, so they will have to be replaced. So that is going to be the first priority.
Building our infrastructure which Kerala is known for, brining is back to speed that is first part and it is also possible that we will have a lot of downstream complications – what I mentioned before the non-communicable diseases which have been off management for three-four days.
What we are doing with the non-communicable diseases as of now is taking our register that is made recently and checking back on all of them to see whether their hypertension, glycaemia levels are under control and if they are not then managing it.
The other area we are focusing on it – we were on route TB elimination within a few years, so the 27000 we had on treatment, we will go back an verify whether they are fine so that our movement towards TB elimination is maintained. So lot of work to be done.
Q: Coming back to the statement made by Dr Shashi Tharoor- he says that the state government should examine whether it requires a multi-sector assessment by UN agencies which include the WHO, the UNICEF and the OCHA and he also said that the state government could request to 2 million WHO stock of anti-cholera vaccines to minimise the risk of grave water borne diseases – do you feel at least on the second part you require the anti-cholera vaccine from the WHO or do you believe that you have enough.
A: We work very closely with India officers WHO, the South Asian Regional Office and the Geneva headquarters. We have been closely working with them for few years and we had discussion with Dr Soumya Swaminathan on vaccination. What we feel is that incidence of Cholera in Kerala is not very high and cholera vaccination what we have right now has 30 percent efficacy, and it will be better for us to focus on the surveillance system and effective management than on Cholera vaccination. WHO Geneva is also suggesting some other vaccine, which will be looking at but as of now that is not under consideration.
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