Community involvement is vital to dengue prevention: Doctors

Despite the cyclical nature of dengue and its inevitable, clockwork-like emergence every year, research on the vector-borne disease in India is far behind similarly affected countries such as Singapore, Thailand, Indonesia, say health experts. Lesser research, a late start, a lack of proper implementation and a crucial shortage of specialists have hit India's programmes of dealing with dengue, and other vector-borne diseases hard.

Speaking to dna, Dr Sujata Sunil, research scientist with the Indian Council for Genetic Engineering and Biotechnology, said that there were two kinds of research when it came to vector-borne diseases. One was research for the sake of research, the hard science of looking into the disease, the vector and taking that apart; where India matched all global standards. It was the second kind, that could lead to new products or control/preventive measures in which the country was lacking. Echoing her words, Dr B N Nagpal, scientist with the National Institute of Malaria Research, said that the other Southeast Asian countries had sailed ahead in preventive research, with money pumped into the science and smaller controllable populations that were cooperating.  "For example, Indonesia has tapped into its population of housewives to thoroughly check breeding sites at home, preventing the spread of the aedes mosquito," he said. "Here, people won't let you inside the house for fogging." India's research, he said, only really took off after the 2006 all-India dengue outbreak.

Straight out of yet another meeting with the Director General (Health Services) -- happening everyday now in a ministry under pressure to show that it's proactive – Dr Nagpal said that he finally got the MCD officials to try fogging inside peoples' homes. "The mosquito breeds inside, there is not much use fogging outside just for show."

Both Dr Sunil and Dr Nagpal point out that there are very few institutes dedicated to research vector-borne diseases. National Institute of Virology in Pune is shouldering the major responsibility for dengue and NIMR for malaria. But what's more worrying is the decreasing number of entomologists, specialists who study insects. "Without entomologists, we cannot know the mosquito's types, its breeding patterns, when it comes out to bite. How are we then supposed to take preventive measures?" asks Nagpal. According to him, despite the health ministry's recruitment drives, students now choose to specialise in more lucrative fields that lead to jobs in private firms, such as biotechnology.

Prevention is key to virus-based diseases such as dengue, for which there is no cure as such. Though a Pune-based firm on Tuesday announced a vaccine that could cure dengue, it has met with scepticism from experts. Though Dr Sunil and Dr Nagpal did not comment on this specific vaccine, the latter did say that a disease caused by viruses cannot be cured by vaccine. Both stated that the govt research is geared towards a vaccine that can prevent the disease, a vaccine for each of the four serotypes. So far, there has not been much progress. "Delhi is hyper-endemic for dengue," explained Dr Sunil, "with all four strain in circulation. Though doctors need to test whether the patient is suffering a primary or a secondary attack, that is not possible with a deluge of patients." The second time one contracts dengue has a higher risk of complication, as the antibodies of the first attack aggravate the secondary infection. Delhi's problems also lie in implementation of preventive measures; a shoddy job here defeats any amount of path-breaking research. Prevention has to keep in mind that fogging needs to be done inside, where the mosquito breeds, one mosquito has 5-6 breeding sites, it never lays eggs on the surface of the water, but in the rim of the container, an infected mosquito breeds infected larvae.

"We did an experiment from 2010-2012, " said Nagpal. "In 20 localities in west Delhi, we eliminated breeding sites all year round. When the rains came there were no mosquitoes to spread to other spots. Till date, those sites are clean. It is possible to contain dengue, but the community has to cooperate. Prevention and community involvement can only go hand in hand."