Leptospirosis outbreak causes concern in Kerala after the floods

After the water receded from most of the flood affected areas of Kerala, the state has been facing threat over the outbreak of leptospirosis (rat fever), a zoonotic infection which is caused by the bacteria Leptospira. According to Kerala Directorate of Health Services (DHS) report 54 people have died of suspected leptospirosis among which 19 deaths were confirmed of this fever by September 3.

In the month of August there were 559 suspected leptospirosis cases among which 229 cases were confirmed. From September 1 to 3 there were reports of 283 cases, among which 143 are confirmed rat fever cases, the DHS informed.

The DHS issued an alert on outbreak of the rat fever on August 28. “There is a sudden increase of Leptospirosis from Thrissur, Palakkad, Kozhikode, Malappuram and Kannur districts. All of them had indirect contact with flood water. You may take this situation very seriously and alert the entire clinical team of your district. Any fever with myalgia to be taken as Leptospirosis and to be treated accordingly until further orders,” the statement from the additional director for public health said.

The highest number of cases were reported from Kozhikode district of Kerala, where the flood had hit badly. From September 1 to 3 more that 70 cases were reported from the district among which 6 died.

“During monsoon Kerala was always prone to this fever and this time it became more vulnerable due to the flood,” said K.J. Reena, additional director for public health. “Human contact with water that is contaminated with the urine of infected rats, dogs, cattle etc. leads to the spread of rat fever. So we expected an increase in the cases after flood. When we take the history of the people who died they haven’t taken the vaccine to prevent this disease. Department is all prepared to tackle the situation.”

Prevention is the best cure

The health department has strongly warned everyone who are engaged in cleaning mission after flood to take preventive medicines.

“We did not have a major outbreak of diseases after flood, but there were cases of rat fever reported from different parts of Kerala. The state is under threat of this disease so everyone who had a chance to get in contact with water during flood have to take preventive medicines. Health department is very much active after flood. We have started plenty of temporary health support centres in each district. Health department was well planned and prepared to face this situation. We have a special treatment protocol for the patients suffering from rat fever,” K.K. Shailaja, health minister of Kerala said.

The minister also pointed out that people’s hesitation to take the medicine is a worry for the health department.

A.P. Sugunan, senior scientist at the Indian Council of Medical Research’s Regional Research Centre, Andaman and Nicobar, who had visited Kerala to look in to the present situation told media in Thiruvananthapuram “Considering that hundreds of thousands were exposed to the flood waters, the number of reported cases are low. So present health services will be sufficient to tackle the situation. Among the 15 death cases, except one none of them had taken Doxycycline drug (preventive medicine). Any person who was exposed to flood waters should take this medicine.”

Though the health officials have informed that the situation is not alarming in Kerala, they are worried that health condition of the patients get worse within three or four days after the infection, sometimes even before the diagnosis. So DHS had informed the public that even a slight fever should be considered as leptospirosis and approach hospital immediately.

Earlier Kerala government had repeatedly warned about the outbreak of communicable diseases after the floods. Which is why the health department had immediately rolled out a 30-day health plan soon after the flood to prevent diseases. More than 70 people died in Kerala in August and September due to communicable diseases, including leptospirosis, fever and dengue fever.

Leptospirosis was always a major concern for Kerala

In 2015, 43 people had died of rat fever in Kerala. In 2016 and 2017 the death toll was 35 and 80 respectively.  In 2018, form January to July 31 (before the flood), 28 people died of leptospirosis. More than 1000 cases are reported every year. Among the communicable diseases in the state rat fever causes highest number of deaths. Before 2010 every year at least 100 people died of this disease. The state being vulnerable to this particular fever, this flood had caused a huge panic, but according to health officials, there had no major outbreak as expected.

C.K. Jagadeeshan, assistant director for public health said that Kerala’s ecological and environmental scenario is favourable for this disease. “In India leptospirosis is predominant in South India. Heavy monsoon seasons, intermittent rains, and water logging create a favourable environment for the spread of this disease in Kerala. Rodent population can easily contaminate stagnant water sources with their urine. Non-rodent hosts including cattle, rabbits and other various domestic animals are also the carriers of this disease. Preventive measures and early treatment is the best solution to this. Kerala has got an effective strategy for prevention, early diagnosis, early treatment and better awareness,” he added.

Kerala had witnessed its worst flood in last 100 years in the month of August this year, where 370 lives were lost. Though since August last week the water started receding thousands of people still live in rescue camps. A cleaning drive is still going on in the flood affected districts, where health officials have set up temporary health centres to prevent communicable diseases.

However, the health department as well as the officials claim that the situation is under control and outbreak was not as bad as they expected.