INDIA: Beware of a Meningitis Epidemic, Warns Health Expert

By Ranjit Devraj Reprint | | Print |

Ranjit Devraj

NEW DELHI, May 9 2005 (IPS) - An outbreak of bacterial meningitis that has already killed 15 people and hospitalised 200 others over the past week could be the precursor of a full-blown epidemic that might strike in the next six months, warns a leading public health expert.

”What we have is a focal outbreak which could die down on its own but going by past experience with this cyclical disease it would be wise to gear up for a full-blown epidemic in December or even in May 2006,” Krishan Kumar Aggarwal, President of the Delhi Medical Association told IPS in an interview.

Meningitis caused by the meningococcal bacteria affects the thin membrane that covers the brain and spinal fluid and symptoms include high fever, loss of consciousness and skin rashes.

An eminent physician with a record of service in public health, Aggarwal based his prognosis on a similar outbreak of what is popularly called ‘brain fever’ in May 1985, which was followed by an epidemic six months later.

The 1985 epidemic resulted in 8,000 cases and 800 fatalities with authorities blamed for laxity and poor preparedness. Another epidemic in 1999 resulted in more than 650 deaths, but spared the national capital.

Harish Khare, a senior doctor at the National Institute of Communicable Disease, said that the disease caused the ‘Neisseria meningitides’ bacterium was cyclical and that deaths in untreated patients usually occurred from multiple organ failure.

Besides India, this year has also seen meningococcal meningitis outbreaks in the other parts of Asia and Africa. The Philippines, Chad and Sudan, in order to fight the outbreak, have resorted to mass vaccinations. But India has ruled them out.

Aggarawal said he found that worrisome, and also showed great concern over what he claimed was the lackadaisical attitude of public health authorities in raising the alarm bells.

He said there were still no awareness campaigns and people, even, have not been told to cover their mouths with handkerchiefs while coughing.

”Meningococcal germs spread through droplets and is highly contagious within a radius of three feet (one meter) from a coughing or sneezing patient,” said Aggarwal pointing to the fact that most of the victims of the present outbreak were found to be living in crowded conditions in Delhi’s old quarter.

Most cases of meningococcal meningitis can be treated with antibiotics, but it is important to catch the disease early.

In its Jun. 3, 2004 edition, the ‘British Medical Journal’ reported the findings of a study which showed that the risk to household contacts of a patient could be reduced by 89 percent if antibiotics were given to eradicate meningococcal carriage.

Aggarwal stressed the importance of handing out controlled dosages of antibiotics to people living in the same household, in order to prevent them from overdosing and making the bacterium drug-resistant.

Drug stores around New Delhi reported over-the-counter panic buying of the antibiotic ‘Norflox’, which is known to be effective in combating the bacteria in patients or acting as a prophylactic.

Unlike in most other countries, drug stores in India do not insist on doctors’ prescriptions before dispensing medicines and self-medication is common – restricted only by the high cost of drugs themselves.

Vaccines are also reported to be in short supply despite their high cost at around 30 U.S. dollars a dose and beyond the reach of most ordinary people, since there are no provisions in the public health delivery system.

By Friday 30,000 vaccine doses had been snapped up in the affluent southern districts of the capital – which is a world apart from the crowded, walled, old quarter around the 17th century Red Fort and other well-known Mogul monuments.

”Most of the patients who have contracted the disease seem to be from poor socio-economic backgrounds and unable to afford treatment,” said Vinokumar Ramteke, a physician at a government-run hospital.

India’s Health Minister Anbumani Ramadoss told assured Parliament on Friday that the government was keeping a close watch on the situation ”and would not let things go out of control.”

But there were several new infections over the weekend with two cases being reported from Jaipur, the capital of neighbouring Rajasthan state and three others from adjoining Haryana indicating that the outbreak could be spilling over.

Steps taken by the local administration in Delhi include providing vaccines to doctors and staff at hospitals likely to come into contact with patients and creating isolation wards to receive patients diagnosed with the disease.

In 2003, India was spared from the SARS (severe acute respiratory syndrome) outbreak that swept through several Asian countries. Also, in the subcontinent there have not been any reports of bird flu – which has broken out, again, in South-east Asia.

India might have been plain lucky, and this doctors, say, has bred complacency.

Too easily forgotten, said Aggarwal, was the 1994 pneumonic plague which spread rapidly across several vastly separated Indian states and killed 55 of the 6,000-odd affected people. Like bacterial meningitis, it is spread through droplets from the nose and mouth.

”As summer progresses (when temperatures reach 45 degrees Celsius in north India) we can expect the meningococcal bacteria to perish but there could be a recurrence in December with the onset of winter – though the exact role of climatic factors is yet to be properly understood,” he pointed out.

But Aggarwal had a warning.

”One way or another the government cannot afford to go about it in a-business-as-usual manner because December is a time when many international conferences are held in the national capital and there is a greater influx of tourists into the capital.”