The Hindu : Kerala / Thiruvananthapuram News : Special strategy sought for Valiathura

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Thursday, Jun 11, 2009
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Kerala

Kerala - Thiruvananthapuram

Special strategy sought for Valiathura

C. Maya

To prevent recurrence of malaria outbreak in the area

Introduction of second-line drugs mooted
Presence of asymptomatic carriers detected

Thiruvananthapuram: The district health administration has recommended to the Directorate of Health Services that a special strategy be evolved for Valiathura, including the introduction of second-line drugs, to prevent the annual recurrence of malaria outbreak in the area.

The recommendation was made after it was found that several persons with recurrent malaria infection were coming for treatment even though there had been no new cases in the Valiathura region after April.

Valiathura has been a hot spot for malaria since 1994 but almost all of the cases reported have been imported from other States.

‘Indigenous’ cases

This year, much to the consternation of the Health Department, a malaria outbreak occurred at Valiathura, of which 22 out of the 23 cases were found to be ‘indigenous’. This is also the first and the only instance of an indigenous malaria outbreak in the State in recent years.

Following this, the department found out through a mass blood smear survey and active surveillance that there were several asymptomatic malaria carriers in the community, who could be silently transmitting the infection.

Six persons from Joosa Street and Lizzie Road had been identified as carriers, even though health officials expect the actual number to be more. They have now been referred to Medical College Hospital for further treatment.

The traditional drugs administered for the two malaria strains found here - Plasmodium Vivax and P. Falciparum - are primaquine and chloroquine. It is not yet confirmed whether the treatment is being rendered ineffective due to drug resistance.

“The requirement of second-line drugs is unusual in our settings as we had almost achieved total control of malaria. Also, Kerala is one of the few States where chloroquine-resistance has not been recorded by the Directorate of National Vector-borne Diseases Control Programme. We seem to be having a peculiar situation at Valiathura where even though new cases have not been reported, the treatment seems to have been ineffective,” a senior health official said.

Incomplete treatment

“Incomplete treatment too can result in drug resistance. The persons who are now coming forward for treatment are those who have tested positive for malaria several times since February and had been treated too. Anti-malarial drugs do induce side effects like nausea or vomiting and some times people might not complete the 14-day treatment course,” he added.

Given the community behaviour at Valiathura, where most of residents are fisher folk, a person undergoing treatment for malaria is often back at work on the third or fourth day, when his symptoms would have subsided. They also travel frequently to Tamil Nadu and might come back with a fresh infection.

Officials are now convinced that the treatment of these asymptomatic carriers is necessary to break the cycle of recurrent malaria episodes at Valiathura.

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