Malaria to be made notifiable disease

Monsoons bring welcome relief from the scorching heat, but they also bring with them a host of illnesses, notably dengue, Chikungunya.

In a meeting held to review the preparedness for prevention and control of vector borne diseases (malaria, dengue, and chikungunya) in the national capital, the Union Health Minister, Dr Harsh Vardhan urged the state government and the Mayors to work towards making hospitals, schools and government buildings 'Vector-Free'.

He also suggested that Malaria should be made a notifiable disease, which was assured by the Delhi Health Minister.

In the meeting, it was also suggested that all hospitals, including the private ones, should appoint a nodal person for vector-borne diseases to ensure that the Government and private interventions and efforts to prevent/ cure vector-borne diseases are in tandem. The focus should be on active case finding of cases and reduction of vectors.

What each doctor can do

 ·         Ask every suspected case of dengue, chikungunya or malaria to trace the mosquito breeding site in the vicinity of 50 houses.

·         Surgical strikes on all the mosquitoes in the vicinity of identified cases can make the difference.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Dengue patients should defer blood donation for up to 6-12 months post-infection

Should screening for dengue be mandatory before blood transfusion?

I recently came across a story in The Muscat Daily (Jan. 23, 2019) which said “the Ministry of Health (MoH) and the Department of Blood Banks Services in Oman have announced on their Twitter accounts that “those affected by dengue virus will not be allowed to donate blood for six months”. Dengue cases are being reported in the country. The latest figures by the Ministry of Health revealed that until January 22, there were 52 recorded cases of dengue fever. In a statement, MoH said, “As a precautionary measure to prevent the spread of the infection, residents and citizens of the dengue-affected areas will also not be allowed to donate blood for 28 days.”  According to the Ministry, this is being put in place to help “prevent others from contracting the disease”.

Travel is a risk factor for spread of any infectious disease. With increasing travel, there is a chance of the disease appearing in another part of the country or the globe, where it did not occur previously. Consequently, the prevalence of dengue has increased several-folds across the world.

The dengue virus was recognized as a transfusion-transmitted pathogen in 2008 (World J Virol. 2015; 4(2):113-23). Chikungunya virus is also a transfusion-transmissible infection, as per the World Health Organization (WHO).

Since then, there has been concern about the risk of transmission of dengue via blood transfusion. Dengue virus becomes a blood-borne pathogen during the period of viremia, which coincides with the febrile period (World J Virol. 2015; 4(2):113-23).

 “In 2009, the American Association of Blood Banks placed dengue virus in the highest category of emerging infectious agents for their potential impact on transfusion recipient safety for the next years in North America” (World J Virol. 2015; 4(2):113-23).

Although rare, cases of transfusion-transmitted dengue fever have been reported. So far, five cases of transfusion-transmitted dengue, including one case of dengue hemorrhagic fever, have been formerly documented (World J Virol. 2015; 4(2):113-23).

Blood donors have been recognized as likely vehicles for transmission of the infection in endemic areas.

Dengue has become endemic in India, particularly in Delhi, where it has become a perennial infection.

In a study conducted to determine the prevalence of dengue virus infection in blood donors in a tertiary care centre, high seroprevalence (58%) of dengue infection in healthy asymptomatic blood donors was found; but, no active viremia was detected (J Clin Diagn Res. 2016;10(10): DC08–DC10). 

Seroprevalence is still a risk to blood safety and is a potential source for transfusion-transmitted infections.

NACO National Blood Transfusion Council “Guidelines for Blood donor selection and Blood Donor Referral 2017” recommend that blood donation should be deferred for 6 months following full recovery in case of history of dengue or Chikungunya. A person who has visited a Dengue and/or Chikungunya endemic area is deferred for 4 weeks following return from the endemic area if no febrile illness is noted.

In its 2012 “Guidelines on Assessing Donor Suitability for Blood Donation”, the WHO also recommends that individuals with a history of dengue or chikungunya virus in endemic areas should defer for 6 months following full recovery from infection. It further says that individuals who have visited an area endemic for dengue or chikungunya should defer for 28 days following return. And, those who have suffered a febrile illness during or following return from an endemic region should defer for 6 months following full recovery from infection

Dr NK Bhatia, Medical Director, Mission Jan Jagriti Blood Bank is a renowned name in blood banking with more than three decades of experience the field. According to Dr NK Bhatia, “Dengue patients are not allowed to donate blood for one year after treatment. If there is a history of blood/blood products transfusion, the same deferral period applies. This is also true for Chikungunya patients. Any person who has a ‘normal’ viral fever is not allowed to donate blood for 7 days after the active phase is over. Some extend this duration to one year.”

Hence, a medical history becomes very important when assessing eligibility of a prospective blood donor.

Always ask a history of dengue/Chikungunya, history of blood/blood product transfusion and history of any viral fever.

Dengue patients should defer blood donation for up to 6-12 months post-infection.

But, a question then arises “Should screening for dengue be mandatory before blood transfusion as is for hepatitis B virus, hepatitis C virus, HIV, syphilis, malaria” as many dengue patients go undetected in acute febrile illness?

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

On this World Malaria Day, let us pledge to "Test. Treat. Track" every malaria case

India is a malaria endemic country. The reported malaria cases in the country last year have declined by 23% compared to 2016, yet India still accounts for 87% of malaria cases in the South Asia region. Also, as per the World Malaria Report, India has among the weakest malaria surveillance systems globally, with only 8% of cases detected by the surveillance system.

The World Health Organization (WHO) Global Technical Strategy for Malaria has set a target of reducing malaria case incidence by at least 90%, reducing malaria mortality rates by at least 90%, eliminating malaria in at least 35 countries and preventing a resurgence of malaria in all countries that are malaria-free.

There is still a long road ahead before the goal of elimination of malaria throughout the country by 2030 is achieved.

Malaria is entirely a preventable disease. It is also a treatable disease provided it is diagnosed and treated in time. The symptoms of malaria are non specific and can be variable. So it may be mistaken for other diseases such as viral infections, typhoid and the diagnosis of malaria may be missed as a result.

It is important to remember here that malaria is not a clinical diagnosis; the diagnosis has to be confirmed by microscopy or a rapid diagnostic test (RDT).

The ‘T3’ initiative of the WHO Global Malaria Program supports malaria-endemic countries in their efforts to achieve universal coverage with diagnostic testing and antimalarial treatment, as well as in strengthening their malaria surveillance systems

T3 stands for Test. Treat. Track., which means:

· Every suspected malaria case should be tested

· Every confirmed case should be treated with a quality-assured antimalarial medicine

· The disease should be tracked through a timely and accurate surveillance system.

Adopting and implementing this initiative will be a step in the right direction in the efforts to control and eliminate malaria.

Every patient of fever must be investigated for malaria to either confirm the diagnosis or exclude it as a cause of fever.

Malaria

• Malaria is transmitted by the bite of a female anopheles mosquito.
• The mosquito bite occurs mainly between dusk and dawn.
• Malaria can also be transmitted through blood transfusion, or via sharing of contaminated needles.
• Bed nets are good against malaria as the major malarial vectors bite during the night.
• The behavior of the mosquitoes may differ. Some may prefer to rest indoors and feed indoors in the night. Some may prefer to rest and feed outdoors earlier in the day.
• Preventive therapy of malaria can be instituted during pregnancy in high risk areas.
• The malarial mosquito feeds every third day compared to the dengue mosquito, which feeds three times in a day.
• Unlike the malarial mosquito, the dengue mosquito bites during the day.
• Malarial fever presents with chills, especially during afternoon.
• Spraying of the indoor residential walls and ceiling is effective against mosquitos.
• DDT is widely used as indoor residential spraying.
• DDT should not be applied more than once or twice in a year on the walls.
• Mosquito contact with DDT surface would generally save from lethal exposure outside the house.
• Public must know that spray may require rearrangement of the furniture. Walls may become streaked with chemical treatment and residual odor from DDT.
• The other alternative is malathion spray.

#AskDrKK: Can HCQS be used as a first line of treatment for Malaria ?

#DrKKAnswers: Yes. But costly. In short run simple chloroquine is cheaper and as safe.

Emedinews: Dr Good Dr Bad : A patient on HCQS developed high fever.

Situation: A patient on HCQS developed high fever.

Dr Bad: Its classical malaria.

Dr Good: Rule out other causes.

Lesson: HCQS is hydroxychloroquine and effective against malaria.