Fever panic in Kerala: numbers and the reasons

The official data show 12,32,541 confirmed cases of fever up to June 20 — 84% of all cases of communicable diseases. Fevers had led to 25 deaths in the state until Tuesday.

The deadliest infection has been H1N1, with 806 confirmed cases, but as many as 53 deaths — nearly half of all deaths. There have been 7,335 confirmed cases of dengue, with 13 deaths; the numbers for lepto are 660 and nine; for chickenpox, 18,046 and six.

Five individuals have died of hepatitis A and B (confirmed cases together, 782); diarrhoea has seen 2,04,926 confirmed incidents and two deaths, and malaria, which has reportedly returned to Kerala, has claimed one life out of 295 confirmed cases. There have been 1,538, 233, 41 and 33 cases of mumps, typhoid, chikungunya and measles respectively. No deaths have been reported from these diseases.

Health Department officials said the actual numbers for all diseases, particularly fever, would likely be higher, as all private hospitals do not furnish data, except in cases where deaths have occurred. The available data also do not capture patients treated by government doctors at their private clinics.

Are these numbers unusual for Kerala? And are they unusually high this year, and for this time of the year?

The early onset of the monsoon has been accompanied by a rush of illnesses. On June 2 alone, 11,013 cases of fever were reported; on June 20, this number was 20,300. On June 2, 134 confirmed dengue cases were reported; on June 20, there were 933. The daily report of cases of diarrhoea went from 1,500 on June 2 to 2,598 on June 20. June 12 saw a high of 18,638 cases of fever; the daily dengue count on that day was 163, and the diarrhoea count, 2,512.

H1N1 and dengue have been the two biggest concerns. The number of H1N1 cases has gone up alarmingly this year — to 53 deaths in six months from zero in all of 2016, and from only 24 confirmed cases in 2016 to 806 cases so far this year. But 2015 was bad — 900 confirmed cases and 89 deaths.

According to Dr Amar Fettle, Chief Nodal Officer, H1N1 Control Programme, Kerala, cases of infections were high across South India this year. The flu virus typically returns after a gap or one or two years.

Dengue has grown into a major threat in recent years. In the five years from 2006 to 2010, only 6,431 confirmed cases and 42 deaths were reported in Kerala. In 2015 and 2016, by contrast, 4,114 and 7,210 cases respectively were reported, with 29 and 13 deaths. This year, 7,335 dengue cases and 13 deaths have already been reported until June 20.

Capital Thiruvananthapuram has been a hub of dengue. Out of the 6,431 cases between 2006 and 2010, the capital district accounted for 3,399 — or more than half. In 2011, when the state reported 1,304 confirmed dengue cases, Thiruvananthapuram district had 865. In 2015, the district accounted for 991 cases and nine deaths; in 2016, it saw 2,158 cases and seven deaths.

Fever deaths too are higher this year — 25, the count until June 20, is already higher than the one for the whole year in 2016 (20). In 2015, 2014 and 2013, 26, 29 and 23 deaths respectively occurred from fever. Through the period 2013 to 2016, the number of confirmed cases in a year hovered between 29 lakh and 25 lakh — it is 12 lakh so far this year, and on course to reach the recent mean.

So, why is the incidence of, and deaths from diseases high this year?

Dr R L Saritha, Director of State Health Services, said the monsoon sees a spike in cases of fever every year. This year, cases of dengue and H1N1 are higher. After a drought there was a short spell of rain, which was followed by a return of dry days. Such a situation led to waterlogging, creating the perfect ground for mosquitoes, which are dengue vectors, to breed.

Public health analyst Dr B Padma Kumar said local governing bodies had failed to take pre-monsoon cleaning drives. Local bodies could have taken steps on waterlogging and mosquito breeding. Thiruvananthapuram’s dengue is mainly due to poor waste management, he said.

“Kerala is seeing an increasing incidence of both communicable and non-communicable diseases, Dr Padma Kumar said. People with lifestyle diseases are more vulnerable; a person with hypertension, for example, is at higher risk of contracting communicable diseases. The state’s growing population of the aged also makes it susceptible to disease outbreaks. The increasing risk of disease threatens the state’s health indicators, which are on a par with developed nations, he said.

What is happening in this situation now?

Health Minister K K Shylaja has said fever is now under control and the death rate has come down. The Health Department is equipped to address the situation, the Minister has said, but has also asked the people to join hands in a cleaning drive. On Wednesday, Chief Minister Pinarayi Vijayan announced a three-day mass cleaning programme across the state starting June 27. Politicians, officials, students, NGOs and the public will together remove garbage and clean public premises. An all-party meeting would be convened on June 23, Vijayan said.