Why Viral Fever Epidemics are more in Kerala?

Facts and features of viral epidemics in Kerala 

Dr.Suja Pillai . Email : sujapillai8@gmail.com
Dr.Aji Punnen Email : ajipunnenkocheril@gmail.com
Dr.Rumsheed Necholi  Email : nrams3@gmail.com
PG Scholars, Govt. Homeopathic  Medical College. Calicut
Moderator : Dr.K.R.Mansoor Ali . Lecturer, GHMC. Calicut
Similima team presenting facts about the various epidemic viral fevers in Kerala.

In the last 3-5 years several viral fever epidemics occurred in Kerala, resulting in severe physical, financial and mental strain to the community and the Government.

This year also more than 1.5 lakh people affected from viral fever in North Kerala mainly caused by mosquito bite during monsoon season.

Till July 28,2009 the number of patients had crossed 11 lakh starting from January this year. Hundreds of people afflicted with fever and acute joint pains, belong mostly from hilly hamlets and tribal areas throng in huge numbers to nearby hospitals for faster relief. Patients’ complain of headache and joint pain and have not experienced such fever earlier.

In the last 2-3 years, homeopathic medicines were found to be more effective both as a preventive and curative in epidemic fevers of Kerala – like viral fever, chikungunya, dengue, hepatitis etc.

If chikungunya caused many deaths in Kerala, which it did not in most other places, the state had the unique opportunity to investigate the biology of the disease and reasons for death to contribute to medical science.

Obviously, medical science in Kerala is not prepared to investigate anything new.

Why should every ruling party go into a defensive mode when it is the collective problem of all political parties?
Why can’t all parties discuss this and make diseases the common enemy?
Why more deaths in Kerala compared to other states?
Was it mainly due to over medication at allopathic hospital?
Is homeopathy is effective as a preventive & curative?
Was the current upsurge of fever the unusual clustering of several diseases or was there a single cause for the outbreak?

Was there any hidden agenda by pharmaceuticals & media behind this panic?

KERALA-SOME BASIC FACTS

• Kerala, the “God’s own country”, is endowed with significant wealth of natural resources.
• The State contains more than 4600 species of flowering plants, 102 species of mammals, 476 species of birds, 169 species of reptiles, 89 species of amphibians and 202 species of fresh water fishes.
• Total area : 38,863 km2
• Districts : 14
• State Bird : Great Indian  Hornbill (Buceros bicornis)
• State Tree : Coconut
• State Flower : Golden Shower Tree (Cassia fistula)
• Rivers – 44
• Lakes – 34
• Backwaters – 53
• Springs – 236
• Kerala with the high density of population (~ 3.10% of the population in India) and low land availability (1.23% of the total land area in India) is vulnerable to various environmental problems.

Environment in the State is badly affected by issues such as scarcity of drinking water, pollution of various kinds and improper waste disposal, EPIDEMICS etc.

• The recent fever epidemics, which has gripped the State, is the disastrous outcome of the lack of proper garbage treatment coupled with society’s irresponsible attitude towards maintenance of hygiene.
• Most of the people are concerned only in personal hygiene than their environmental sanitation.
• It is due to their lack of awareness that, little pool of stagnant water can host lakhs of vectors of epidemic diseases.
• Unless implementing proper eco friendly technologies for waste management and way to generate less waste, the medical system will go to fail in front of these epidemic diseases.
• If our State continues with current system of vector control and garbage clearance, there could be an upsurge in vector-born and water-related diseases in the State in the near future.  

VIRAL FEVER

• Viral fever refers to a broad spectrum of conditions where viral infections are associated with elevation of body temperature.
• In medical terms, any fever caused as a result of viral infection is a viral fever.
• The term viral fever covers a wide variety of viral infections, some of which can be clearly identified by their signs and symptoms.
• Though these infections show some generalised symptoms, it may target specific organs.
• Viral fever may affect any age group and are seen world wide.
• It is normally not dangerous being self-limiting, but some viral infections can progress rapidly to complications.
• In many cases problems related to throat and lung get associated.
• Depending on the body’s immune system the intensities of fever and body ache may vary. 

TYPES ACCORDING TO TEMPERATURE

• Low-grade: 38 – 39 °C (99.5 – 102.2 °F)
• Moderate: 39 – 40 °C (102.2 – 104 °F)
• High-grade: > 40 °C (> 104 °F)
• Hyperpyrexia: > 42 °C (> 107.6 °F).
• Low grade fever is a normal response of the body to limit the infection getting multiplied. Adequate measures should be taken to limit the fever and in no case be allowed to exceed 104 °F.

The hyperpyrexia is clearly a medical emergency because it approaches the upper limit compatible with human life.

Spread

•    Most viral infections are spread by inhalation of aerosolised particles
•    by intake of contaminated water or food
•    by direct contact.
•    transmitted sexually
•    by direct inoculation into the blood stream.

Incubation period

• Depending on the level of individual’s vital energy it may vary from days to several week.
• The clinical manifestation also varies, depending on the virus multiplication and the site.
• In some rare cases, virus continues to multiply even after the fever comes down and that causes persistent infection.
• Such cases will need careful case taking and management. 

Signs and symptoms

• It starts after incubation period, with fatigue and malaise.
• Body ache and muscle ache may follow and lead to the onset of fever.
• he fever may be low grade or high grade and remittent.
• Inflammation of pharynx, running nose, nasal congestion, headache, redness of eyes, cough, muscle and joint pains could be present
• he level of fever could be disproportionate to the fatigue and body pain.
• Later lymph glands may swell up.
• The illness is usually self-limited but the fatigue and cough may persist for a few weeks.
• Sometimes vomiting and diarrhoea, jaundice, symptoms similar to pneumonia or arthritis (joint swelling) may complicate the initial viral fever.
• Some viral fevers are spread by insects, for example, arbovirus, can cause a bleeding tendency, which results in bleeding from the skin and several other internal organs and can be fatal. 

Investigations

• Viral fever is based more on the clinical presentation than by laboratory investigations.
• Since these infections are commonly self-limited, investigations are usually not necessary.
• Diagnosis can be made with the clinical history of patient.
• Skin rash and lymph gland swellings have to be specifically looked for.
• In viral infections blood tests will not show any remarkable increase in the white blood cells, which typically occurs with bacterial infections.
• The numbers of lymphocytes may be increased.
• The Erythrocyte Sedimentation Rate (ESR) is not elevated.
• Confirmation if needed can be done by culture of virus from the relevant specimens such as nasal swabs, and skin rash or by increase in antibody levels in serial blood samples. 

General Management

• If the fever is mild and no other problems are present, patient can be advised to drink much fluids and to take rest.
• Avoid antibiotics
• Keeping the environment  comfortable and cool.
• Taking sponge bath may help to cool a person with  fever.
• Sponging with lukewarm water in the armpits, forehead, and in the groin in case of high temperature
• Drink as much water as is possible. Besides water, which may be admixed with sugar and lemon and salt, etc., to make it tasty since plain water is boring if taken too often.
• Fruit juices that have been freshly squeezed may be taken.
• Soups, particularly chicken soup, is highly recommended as they are tasty, provide enough water and nutrition, and are said to have beneficial effects in such cases.
• Rest, especially bed-rest during the fever,
• Avoidance of any strenuous work or exercise for around a week is to be followed.

Note : Antibiotics do not treat viral infections, and thus are ineffective against the viral fever. Treatment of viral fever with antibiotics can be counterproductive, as it can promote the production of drug resistant bacteria, and can even promote infections by killing off normal bodily flora.

There is absolutely NO place for any sort of corticosteriods in the treatment of viral fevers. It may even prove fatal which is particularly tragic under the circumstances since they are not indicated in the first place.

They compromise the body immune system even further, thereby increasing the risk of infections that may be almost impossible to cure even with the latest generation of antibiotics. Majority of the deaths in Kerala may be attributed to injudicious use of antibiotics and corticosteroids.

Prognosis
An untreated fever that lasts longer than 48 to 72 hours may lead to upper respiratory infections like sinusitis, pharyngitis, Sore throat, tonsillitis, and laryngitis.

Other complications are pneumonia, ear infections, gastroenteritis, etc. (these complications are as a result of impaired immunity)

Most viral fevers recover completely in a week although fatigue may persist for a few weeks.

Remember that any viral fever causes the body immune system to be severely tested.

Therefore, the more danger arises as a consequence of having the viral infection than from the specific infection itself.

Cough is usually not a good sign and chest infections caused by bacteria (like pneumonia) are quite commonespecially in the young and old.

In the weakened conditions, even the less harmful bacteria can cause havoc to the body.

Precautions

• Infecting virus spreads through sneezing, it is best if the patient is generally kept confined in a comfortable and airy place as much away from close contact with others.
• His clothes, particularly his handkerchiefs, are separately washed with good cleaning fluids. It is preferable if the patient uses disposable facial tissue paper which must be disposed off with care.

Post viral syndrome

• Syndrome typically follows an upper respiratory tract infection from which the sufferer fails to make a full recovery complaining a multitude of symptoms which may persist for months or even years.
• Cardinal symptom is profound muscle weakness often accompanied by pain in muscles,headache,paresthesia,dizziness etc.
• Other symptoms are poor memory,lack of concentration,sleep disturbance,hyperacusis and emotional liability.
• Clinical examination shows no abnormality nor do routine laboratory investigations.
• Females are affected more.

Epidemics in kerala

• Chikungunya
• Dengue
• Leptospirosis
• Swine flu
• Japanese encephalitis
• Cholera
• Malaria