Via The Times of India: ‘Mumbai must learn from Andaman’s lepto triumph’.
MUMBAI: Once infamous for reporting one of the highest incidences of leptospirosis in the world, Andaman has fought a dramatic battle to turn things around.
So much so that, experts say, medical students can barely find acute cases of leptospirosis for academic purposes on the island now.
When a massive leptospirosis outbreak gripped the island in 1980s, the authorities made the departments of health, animal husbandry and agriculture join hands. People were aggressively treated at the first sign of infection, while animals were tested for harbouring the infection. Simultaneously, the veterinary and public health departments started conducting awareness programmes for farmers and animal handlers on taking care of their wounds and rearing animals in hygienic conditions.
The Andaman story is now part of several medical journals. After nearly a decade of coordinated efforts, the prevalence has dramatically dropped now.
As Mumbai grapples with the sudden emergence of the bacterial infection that has claimed 16 lives in quick succession, public health experts feel, the city may benefit from taking a leaf out of Andaman's book.
In Andaman, the bacteria leptospira was first isolated around 1931 but never studied further by local authorities. It erupted in the 1980s and was mistaken as Andaman haemorrhagic fever for nearly a decade. The incidence of 700 cases per 1 lakh population was probably the highest ever recorded incidence of leptospirosis.
"Morbidity and mortality were extremely high as local surveys started to point out then," said Dr P Vijayachari, director of National Leptospirosis Research Centre at Port Blair. This Indian Council of Medical Research laboratory is soon going to study the strain circulating in Mumbai.
Hospitals struggled with severe cases and a fatality rate of 30-40%. "People paid heavily for neglecting leptospirosis as a potential health hazard as there were several outbreaks and deaths," Vijayachari said. Authorities then woke up in the 90s and began sero surveillance in humans and animals to check for the presence of infection. The results started showing in the 2000s.
"The seroprevalence among animals was down threefold, which translated into a dip in infection among humans. In young individuals, it dropped to 8% in 2013 from 30% seen in 90s," Vijayachari said. "We aggressively promoted early detection and treatment in all clinically diagnosed patients. Simultaneously, we treated animals to reduce bacterial load in the environment and disease transmission," Vijayachari said.
The challenge was multiplied by the fact that the risk of leptospiral infection was embedded in the lifestyle of the people. "Working in rice fields or playing and fishing in water-logged fields was a common pastime for children. So we evolved a better animal-surveillance system for screening of healthy and sick," he said.
Vijayachari added that for a city like Mumbai early detection and rodent control could hold the key as leptospirosis transmission is difficult to contain.