Fever cases spike, GHs get spl wards

CHENNAI: As many as 4,066 dengue cases and 3 fatalities have been reported in Tamil Nadu from January until September 14. With the incidence of fever cases rising, there’s a drastic surge in the number of cases of dengue and influenza.

With influenza, there are 1,072 AH1N1 cases and 203 H3N2 cases reported in the State. As many as 400 cases of influenza have been reported in the last two months alone, with 7 fatalities so far.

The recent death of a four-year-old boy due to dengue had alarmed the State Health Department and local bodies, as the parents alleged unhygienic living conditions in their residential area that caused mosquito breeding. Soon, the Greater Chennai Corporation swung into action and intensified cleaning and fogging activities in the city.

Doctors say that timely treatment is important and in the case of fever beyond 4 days, individuals should be taken to the hospital. “Late referrals can become a challenge, mainly in the case of children and people with co-morbid conditions,” opines Dr P Sampath, joint director of the Directorate of Public Health and Preventive Medicine (DPH). “Fatalities due to fever have been reported mainly among the elderly with co-morbid condition."

Fever ward at GHs

Meanwhile, government hospitals in the city have initiated exclusive fever wards as they comprise the majority of the cases being brought to the hospital.

“Though the spike in the number of dengue cases is common during the monsoon season, one-third of the cases that we see every day are among children. That’s alarming. We’ve instructed parents about the warning signs and encouraged them to follow up on the treatment. All cases are being monitored closely,” said the director of the Institute of Child Health, Dr. Rema Chandramohan. Kilpauk Medical College has also started the exclusive fever ward and sensitisation programme to spread awareness on prevention. Many control measures have been undertaken as well.

“We have two positive patients as of now, and the exclusive fever ward is ready to provide immediate treatment. The CME sensitisation programme (Continuing Medical Education) for healthcare providers has also started,” said Dr. R Muthuselvan, dean, Kilpauk Medical College, and Hospital.

While Rajiv Gandhi Government General Hospital has recorded 5 cases of dengue, fever cases are being reported from not just in Chennai, but also in Chengalpattu, Kancheepuram, and Tiruvallur. There are around 48 cases of fever admitted as inpatients at Stanley Medical College and Hospital currently, and 12 paediatric cases are also under admission, as on Friday.

Increase testing

Former director of public health Dr K Kolandaisamy said that there was a risk of an outbreak every 4-5 years based on the environmental cycle.

“The major outbreak we saw was in 2017. To prevent that, we need to intervene at all levels, beginning with intensifying the testing,” he pointed out. “Provide more lab equipment. Ensure there’s an adequate availability of reagents, cell counters, testing centres, and testing equipment for all types of fever including dengue, leptospirosis, malaria, typhoid and others, as these tests are expensive.”

He suggested that the local administration have adequate domestic breeding checkers – at least one person per 500 houses. “Construction debris from Metro Water, CMRL and storm water drains is piling up across the city, especially post COVID. Old abandoned vehicles, railway wards, transportation depots and other places where there isn’t much breathing space, and seized vehicles are all a potential source of Aedes mosquito-breeding,” added Dr Kolandaisamy.

More training, awareness

Public health experts also emphasise on training healthcare workers and the need to conduct awareness programmes in schools and colleges on prevention measures and controlling the spread of fever and dengue. Officials from the DPH have issued protocols for fever cases and influenza testing. Health Secretary Gagandeep Singh Bedi has also written to the health department officials to intensively monitor the cases and provide updates.

‘Health officers must follow guidelines on influenza prevention’

The Director of Public Health and Preventive Medicine (DPH) has instructed all the Deputy Directors of Health Services to follow the guidelines on prevention and control of influenza-like illness and seasonal flu. Stating that seasonal influenza may affect all age groups, Dr TS Selvavinayagam, DPH, added that the incidence is higher in children and elderly above 65 years and has an incubation period of 1-4 days.

“The sudden onset of fever peaking at 101 degrees can go up to 105, typically lasting 3 days, with symptoms of chills, body ache, sore throat, non-productive cough, runny nose, and headache,” he said.

Those suffering from flu-like symptoms should be categorised under A, B, and C. Category A is for those with mild fever, cough, or sore throat with or without body ache, headache, diarrhoea and vomiting. “For this category, there is no need to test for influenza. Oseltamavir is not required for treatment. They should be managed under home isolation but symptomatic management needs to be done,” he pointed out.

Category B patients have Category A symptoms along with high-grade fever or severe sore throat. “This affects children less than 5 years, persons above 65 years, pregnant women, persons with co-morbidities, and those under long-term immuno-suppressants. “As per the protocol, there is no need to test for influenza but Oseltamavir can be given in addition to broad-spectrum antibiotics. It can be managed under home isolation, stated the DPH.

Category C patients have symptoms of Category A and/or B, and breathlessness, chest pain, drowsiness, fall in BP, sputum in blood, bluish discolouration of nails, etc. Category C patients need to be tested for Influenza with RT-PCR.

“Children in this category will have flu-like illness plus somnolence, high and persistent fever, inability to feed well, convulsions, shortness of breath, difficulty breathing, etc. Oseltamavir along with broad-spectrum antibiotics and immediate hospitalisation,” he said.

Policy dictates that adults can be discharged a week after symptoms subside and children discharged after 14 days. Medical personnel involved in any aerosol-generating procedures like suction, intubation, nebulisation, critical care facility, ambulance staff, laboratory, etc have to use N95 masks. DPH recommends vaccination for healthcare workers, including all medical and paramedical staff working in casualty, emergency department, ICU and isolation wards, screening centers and laboratory personnel, pregnant women, persons with chronic illnesses, and immunocompromised.

Woman dies after prolonged fever, not dengue, says dean of Tiruchy GH

A woman from Tiruchy died of a mysterious fever on Friday but health officials ruled out dengue. It is said that R Kanagavalli (38) from Nariyan Street near Tiruvanaikoil had a high fever for the past few days.

She was later admitted to a private hospital here. Since the fever did not subsidise, she was referred to the Tiruchy Medical College Hospital where she was undergoing treatment. However, on Thursday night, Kanagavalli succumbed to fever. When her blood samples were sent for detection, it tested negative for dengue.

According to the Dr Nehru, dean of Tiruchy GH, the woman who died was admitted with multi-organ failure. “She had already been undergoing treatment for her ailments in a few hospitals. Since she had fever in the later stage, we had sent the blood samples for detection and it tested negative,” he added.

On Friday, around 30 people visited the hospital with fever, and 8 were admitted but they had no dengue symptoms, the hospital sources said.

GUIDELINES

SYMPTOMS, TREATMENT

(Patients categorised under A, B, and C)

CATEGORY A

• Mild fever, cough, or sore throat with or without body ache, headache, diarrhoea, vomiting
  
• No need to test for influenza.
• To be managed under home isolation but symptomatic management important

CATEGORY B

• Symptoms of Category A along with high-grade fever or severe sore throat.
• Affects children less than 5 years, persons above 65 years, pregnant women, persons with co-morbidities, and those under long-term immuno-suppressants.
• No need to test for influenza. Oseltamavir and broad-spectrum antibiotics to be administered.
• To be managed under home isolation.

CATEGORY C

• Symptoms of Category A and/or B, along with breathlessness, chest pain, drowsiness, fall in BP, sputum in blood, bluish discolouration of nails, etc.
• Should be tested for Influenza with RT-PCR.
• Children will have flu-like illness plus somnolence, high and persistent fever, inability to feed well, convulsions, shortness of breath, difficulty in breathing etc.
• Oseltamavir and broad-spectrum antibiotics to be administered, along with immediate hospitalisation.

VACCINATION, MASK

• Those involved in any aerosol-generating procedures like suction, intubation, nebulisation, critical care facility, ambulance staff, laboratory, etc. have to use an N95 mask.
• Vaccination for influenza is non-negotiable for healthcare workers, including all medical and paramedical personnel in casualty, emergency department, ICU, isolation wards, screening centers, and lab personnel.
• Pregnant women, persons with chronic illnesses, and immuno-com- promised must get vaccine shots.

Discharge Policy

Adults – a week after symptoms subside

Children – 14 days after symptoms subside