Investigation of Rodent Borne Diseases

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Investigation of Rodent Borne Diseases

• Dr. U V S Rana, Joint Director,
• NICD, Delhi

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Rodent borne diseases having potential to cause
outbreaks

• Leptospirosis
• Plague
• Scrub Typhus
• Hanta virus

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Hanta Virus

• Antibodies against Hanta virus were detected in
  1988 from Andaman Nicobar
• No human case has so far been reported from India

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Scrub Typhus

• Cases/outbreaks of Scrub Typhus are increasingly
  being reported from Himalayan terrain

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India
Plague Foci

• POPULATION OVER 1 BILLION
• LAND AREA 3.28 MILLION SQ. KM.
• SHARES BORDER WITH CHINA, PAKISTAN, BHUTAN,
  NEPAL,
• MYANMAR AND BANGLADESH
• 29 STATES AND 6 UTs
• PLAGUE ENDEMIC STATES 6

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Warning signals for high alert

• Report of rat fall is a warning signal. A
  suspected human case is a medical emergency and
  should be treated as a potential outbreak,
  warranting immediate investigations and follow-up
  action.

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Tetra indica
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Health facilities must report immediately any
case of fever with painful lymphadenitis (or
severe pain in the groin or axilla) for immediate
investigations and follow-up.
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Report of rat fall / cases of fever with painful
lymphadenitis

• To
• State health authorities
• NICD, Delhi
• NICD, PSU, Bangalore
• Immediately

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States reporting leptospirosis outbreaks
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Is leptospirosis an occupational disease?

• Occupational in rural setting

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Leptospirosis in urban setting

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Changing pattern of symptomatology

• 1997 - Predominantly hepato-renal
• 1999 Mostly hepato-renal, few cases of
  pulmonary involvement, and occasionally one or
  two case of multi organ failure
• 2003 Hepato-renal 70
• Pulmonary 20
• Multi organ failure 10

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Difficulties faced in management of cases due to
changing pattern of symptomatology

• Gujarat
• 1997 Predominantly hepato-renal
• Dialysis units installed in district
  hospitals
• 2004 More cases of pulmonary involvement
• Need of ventilators
• Similar situation existing in other states

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Differential Diagnosis

• Falciparum Malaria
• Dengue Haemorrhagic Fever
• Hanta virus
• Viral Hepatitis

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Co-existence
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Importance of Correct diagnosis

• Antimalarials for falciparum malaria
• Supportive treatment for dengue heamorrhagic
  fever and viral hepatitis
• Antibiotics for leptospirosis

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The supreme court ruling is disappointing and
will leave more patients at the mercy of ignorant
and arrogant doctors. In June 1996, doctors
diagnosed cancer in my fathers lungs. A day
before the operation where they planned to remove
one lung, my father, who is a veterinarian
insisted on an x-ray, which proved that his lungs
were fine. He only had pneumonia.
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In September 2002, my mother was admitted in a
Hyderabad nursing home with what was thought to
be viral hepatitis. The doctor said she was doing
fine. But she died after 12 days. She was only 47
years old. I was 17.Ten days later, I developed
the same symptoms that my mother had.
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The doctor in Tirupati we consulted insisted that
it was viral hepatitis. When I didnt get better,
a trainee nurse suggested a blood test for
Leptospirosis, which was confirmed at Tirupati
and Chennai labs.

• Alekhya Mandadi,Tirupati, Andhra Pradesh

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Epidemiology of leptospirosis

• The major factors responsible for transmission
  of leptospirosis -
• Reservoir/Carrier Hosts
• Alkaline Soil
• Wetness of soil

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• Comparison of agro-ecological factors in
  leptospira endemic and non-endemic states

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Leptospira Endemic State - Gujarat

• Affected Districts
• Surat,
• Navsari and
• Valsad

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Presence of reservoir/carrier hosts - Rodent
population is present in abundance -
Seropositivity in domestic animals.
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Conclusion

• The agro-ecological factors responsible for
  transmission and survival of leptospira present
• Reporting leptospira cases continuously from 1994

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Non-endemic State - Orissa

• Suspected outbreak of leptospirosis was reported
  by the Govt. of Orissa in 2001 from Jajpur and
  Keonjhar Districts
• The outbreak was investigated by NICD
• Out of 79 serum samples tested none was found
  positive

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Study of agro-ecological conditions

• Reservoir/carrier hosts
• Serological studies in cattle population were
  found negative

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Conclusion

• Suspected outbreak was not confirmed
• Seropositivity against hepatitis reported

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Control

• Public health engineering
• Waste management
• IEC activities
• Others

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Public Health Engineering

• Some facts about Kerala

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• All developmental projects are referred for
  environmental impact assessment
• Developmental projects are not assessed for
  public health impact in planning stage
• With the implementation of Public Health Act,
  public health issues may be addressed

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Waste Management

• Outbreak of leptospirosis
• Mysore Medical College 1999
• Chennai 1984

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IEC Activities

• General awareness about the disease to the
  masses

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Others

• Rodent control ?
• Inter-sectoral coordination
• Leptospirosis should be made notifiable in all
  the states

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Thank You