NREGP workers falling prey to rat fever?

 A sudden spurt in the incidence of leptospirosis (rat fever) in the district, especially from the suburbs and rural areas, has had the district health administration wondering about the need to generate more public awareness of this zoonotic disease, just as in the case of dengue fever.Nearly 140 leptospirosis cases have been reported in the district since January, with five reported deaths. Interestingly, public health experts point out that the figure has gone up because of the large clusters of cases reported from certain panchayats in the district where the National Rural Employment Guarantee Programme (NREGP) works are on."Scattered leptospirosis cases are being reported from all parts of the district but all the outbreaks we have had recently have all been in relation to the NREGP. This is not to give the scheme a bad name, but whenever manual labourers are engaged in a group for cleaning activities, there is always the possibility of a leptospirosis outbreak," a public health expert said. The clusters of leptospirosis cases that were reported in the district were all people who were engaged in cleaning or constructing canals as part of the NREGP. The district health administration officials said that though all panchayats have been issued clear guidelines as to the precautions to be adopted before engaging workers on a mass scale for cleaning activities, none of the local bodies has taken cognisance of these. Leptospirosis is contracted usually by people who come into contact with water contaminated by rat excreta or urine, usually farm labourers or manual workers. Early clinical symptoms include sudden onset of fever and chills, severe headache, muscular pain, skin rashes and reddened eyes. The workers have to take doxycycline as a prophylaxis; the area where cleaning is to be done should be sprayed with bleaching powder 24 hours in advance before workers are allowed to work; and gloves and gum boots have to be worn compulsorily."Engaging labourers on a large scale like this without adequate precautions put a large number of persons in a locality at risk of contracting leptospirosis. Our strategy has been to administer doxycycline to the entire group of workers, as soon as the first suspected leptospirosis symptoms are reported," a senior health official said.Public health experts point out that the lack of basic science research or data regarding the incidence of leptospirosis, the various strains of the bacteria (serovars), the predominant zoonotic carriers of the bacteria and other epidemiological factors are responsible for the haphazard manner in which leptospirosis outbreaks are handled by the health system."Dengue fever is fairly well-researched and we even have genetic studies being done on the various serotypes. But our basic research on leptospirosis is very poor. This is a zoonotic disease and different carriers spread different serovars, about which we have no information. Our prevention strategies are confined to rodent elimination alone, which is not enough," according to a public health expert.Early diagnosis and prompt treatment can reduce mortality. But early diagnosis is dependent on a combination of the knowledge of epidemiological factors, lab tests and clinical features. Blood tests do not give positive results until after a week after the onset of illness. However, a leptospirosis patient's condition can deteriorate rapidly, following multi-organ involvement and hence early institution of anti-microbial therapy is important rather than waiting for a definitive diagnosis to emerge.

 

The Hindu, 16th March 2009