Country lacks the means to detect new diseases
Aug 18, 2014-
Dr Manas Banerjee is a former director of Epidemiology and Disease Control Division under the Department of Health Services. He has extensively worked for prevention and control of Malaria, Japanese Encephalitis and other vector-borne diseases. Currently, he is working as a Senior Epidemiologist of Patan Academy of Health Science Influenza Surveillance Project. Binod Ghimire caught up with Dr Banerjee to discuss on various facets of epidemic. Excerpts:
What kinds of epidemics are posing threat to our country?
First of all, we should understand what epidemic is. If we see high number of cases of a particular disease we term it as an epidemic, but it is not the reality. There is existence of communicable diseases round the year, and the number of patients fluctuate according to the season. However, if the number of the cases are reported beyond the estimation it is epidemic. For example, if we estimate five cases of malaria for July but 50 cases get reported then that it is epidemic. A single case of Ebola will be epidemic for us as it is unpredicted in Nepal. Poor sanitation and drinking water is the main factor behind epidemics in Nepal. Water and food borne diseases have high probability of transmission, mainly during the rainy season. But the water contamination is equally possible during the dry season. Based on the order of priority gastrointestinal, cholera and hepatitis, mainly A and E, have threat to a large extent. Similarly, vector- borne diseases like Malaria, Dengue and Japanese Encephalitis may also lead to epidemic.
What are the grounds for a disease to balloon into epidemic?
We have records of endemic diseases. There are surveillance mechanisms to study the cases of particular disease every week or every month. After studying the dynamics of the disease, we prepare its pattern. And based on this, a graph is prepared. We tally the present pattern of the disease from the past, and if any disease cross the threshold projected in the graph, we call it epidemic. Every year the preparation to curb the diseases is made studying the plot presented in the graph.
What about new diseases posing threat across the world?
We are also experiencing the emergence of new diseases. The scientists have predicted that zoonotic diseases will have share of 90 percent of the total outbreak of the diseases in the 21st century. It started with Severe Acute Respiratory Syndrome (SARS), Avian Influenza, H1H1, Middle East Respiratory Syndrome-corona virus (MERS-CoV) and now Ebola. There should be a serious study of zoonotic and human interface which is lacking in our country. For the new diseases there is no mechanism for the diagnosis in the country. Therefore, we have been depending upon the international community for diagnosis and treatment. The zoonotic diseases are firstly limited in a few humans just as an accidental host, but at time a human becomes reservoir, and there is human to human transmission which is very dangerous and can lead to a pandemic.
What should be done to control epidemic?
We need to have three phases of preparations: pre-epidemic, during epidemic and post-epidemic. First, the identification of cases, recording of cases and reporting of cases is done by the surveillance units. The action and preventive measures are taken accordingly. The skilled and trained human resource is the most important factors, followed by the facilities for the identification (diagnosis) of the diseases. There should also be stock of medicines, insecticides, and disinfectants for the actions.
How competent are we to fight the outbreak of an epidemic in the country?
Every country has epidemic preparedness plan, and heath facilities preparedness plan is its top priority. Firstly, we don’t have adequate human resource. Secondly, we cannot provide the technical facilities to the existing human resources. Every surveillance and treatment centre should be technically sound to give a needed output, which is seriously lacking in our country. Our system is more focused in an individual than in an institution. We should focus in strengthening our institutions. Our health structure remains the same it was two decades ago. The health structures were set up at the local level taking Village Development Committee as a unit, when the average population was just 5,000. Now the population has soared to over 10,000, but the number of health workers has not increased. Post creation should be as per the work load. Because of this, sometimes even surveillance fails to diagnose the disease before the epidemic is over.
What about new diseases like MERS-CoV and Ebola?
As thousands of Nepali are working in Middle East, MERS is more serious for us than Ebola. The International Health Regulations -2005 clearly envisions setting up surveillance level up to the peripheral level by 2012. We failed to meet the deadline then. We failed once again in 2014. It had envisioned putting quarantine facilities in major international crossings. Nepal had worked to set up nine quarantine centres at the Tribhuvan International Airport and the Indian bordering areas. However, the government has not provided adequate budget for it. It’s high time that we set up such check posts. We should start with TIA and Kodari in the first phase, if we cannot start in other places.
Published: 19-08-2014 09:10