The Telegraph
Monday , October 27 , 2014
 
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Gujarat fever fight yields Ebola lessons
Hope in quick response

New Delhi, Oct. 26: Sporadic cases of a deadly infection called Crimean-Congo haemorrhagic fever in Gujarat over the past three years hold lessons on the risks of and remedies for Ebola if it ever surfaces in India, health experts have said.

Ahmedabad hospitals have managed at least eight cases of CCHF — a viral infection spread by tick bites — since January 2011. Public health specialists say these cases indicate what might happen if Ebola emerges in India and how it may be rapidly stamped out.

India’s health ministry has put in place surveillance and tracking mechanisms, ordered all states to designate hospitals, and kept 12 diagnostic laboratories ready amid concerns that the world’s worst outbreak of Ebola virus disease (EVD) may enter India.

In an update released yesterday, the World Health Organisation (WHO) said that 10,141 patients had confirmed, probable or suspected EVD in Guinea, Liberia, Mali, Nigeria, Senegal, Sierra Leone, Spain and the US since the outbreak began in West Africa in February.

Over 4,900 patients have died. But Nigeria and Senegal have been declared free of EVD after rigorous hospital infection control and isolation of patients.

“The most important thing is quick detection of the earliest cases and good isolation and infection control,” said Manish Kakkar, a microbiologist and infectious disease specialist at the Public Health Foundation of India, New Delhi.

“There is an expectation that India should have been prepared by now. We’ve had many opportunities in the past to prepare ourselves for infections such as influenza that spread much more easily than Ebola,” Kakkar told The Telegraph.

Ebola can spread from person to person only through direct contact with body fluids or secretions of infected persons, or with materials contaminated with infected fluids such as clothes, bed linen or used needles. This makes doctors, nurses and the family members of infected patients the most vulnerable.

The key to preventing spread of the virus lies in appropriate use of personal protective gear such as gloves, masks and gowns, following disinfection procedures, and careful handling of infected material.

“The US is expected to have the best such procedures in place, yet two nurses who cared for an Ebola patient were infected in Texas. So, what might happen if Ebola comes into India is anyone’s guess,” said an infectious disease specialist who requested not to be identified.

But while routine infection-control practices in most government hospitals and even in some private hospitals in the country appear discouraging, senior health officials say, there are signals that India’s health system can respond appropriately during emergencies.

“Gujarat’s response to the CCHF is an example,” Vishwa Mohan Katoch, director-general of the Indian Council of Medical Research, told this newspaper. “A quick response prevented the cases from turning into outbreaks.”

Gujarat encountered India’s first case of CCHF in January 2011 when a woman in her 30s developed high fever, bleeding and symptoms similar to dengue fever.

“But it was not the dengue season,” said Harsh Toshniwal, an infectious disease specialist in Ahmedabad who managed some of the patients in Gujarat.

The National Institute of Virology diagnosed her illness as CCHF, with a fatality rate comparable to that of EVD (40 to 80 per cent).

Two health care workers who had treated the woman and come into contact with her secretions developed CCHF and died. Her husband too caught the infection, but survived.

However, Katoch said, strong infection control following the diagnoses prevented the virus from spreading.

During 2012 and 2013, two more doctors died of CCHF in two other hospitals in Ahmedabad. They had probably picked the infection up while treating undiagnosed patients. Again, Toshniwal said, quick infection control prevented the virus from spreading to more health care workers.

The Union health ministry announced earlier this week that it would deploy thermal scanners at all of India’s 18 international airports and seaports over the next few days to detect arriving passengers who have fever, one of the symptoms of Ebola.

In August this year, the ministry asked each state to identify a hospital with a dedicated isolation facility to admit suspected patients. In collaboration with state health authorities, a surveillance mechanism is tracking the health of each patient arriving from West Africa for up to a month, the maximum incubation period for EVD.

The incubation period refers to the time between exposure to the germ and the appearance of symptoms and signs.

So far, over 21,800 passengers have been tracked, mainly in Maharashtra, Kerala, Tamil Nadu, Gujarat, Bengal and Delhi. About 1,000 travellers had been identified as suspected cases but released after they tested negative for Ebola.

The health ministry has also asked the Indian Medical Association to disseminate guidelines among private practitioners about the appropriate methods of managing EVD.

“This is particularly important, because the private sector is what most patients first turn to when ill,” a senior public health specialist said.

The WHO has been providing technical assistance to the health ministry in training medical teams on surveillance and response measures in the states where the 18 international ports of entry are located.