Amoebic meningoencephalitis: Is this vigilance enough?

Kerala is a state that has successfully fought the Nipah and pandemic virus. No one will have forgotten the Nipah outbreak of 2018. When the Nipah virus, which has been reported only rarely worldwide, was first confirmed in Kerala, it was effectively contained using the systems already in place. Even developed countries at the forefront of the health sector were amazed that the outbreak was brought under control within three weeks, though it claimed 17 lives. Kerala also faced the coronavirus in almost the same way. This was possible because of the well-established, systematic and scientific protocols and action plans in place. However, we often witness instances where we lose sight of the accuracy and efficiency of this health model. Take the monsoon season in Kerala. For the past few years, the rainy season in Kerala has also been the season of fever. During this period, about 200 people died in the state due to diseases such as jaundice, fever, dengue fever and leptospirosis. Eighteen lakh people sought treatment for fever alone. The same situation prevailed in previous years. Now, unlike before, another disease threat has emerged: amoebic meningoencephalitis. Sixteen people have died from the disease this year. The fact that six of these deaths have occurred in the last eleven days increases the seriousness of the issue. Although the vigilance exercised during the Nipah and pandemic periods is equally necessary now, the lack of significant action from the authorities has, in fact, heightened current concerns.

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Amoebic meningoencephalitis is a disease with a mortality rate of over 90 per cent once a person is affected. It is caused by pathogens belonging to the free-living amoeba group, such as Naegleria, Acanthamoeba and Vermamoeba, which are found in water. The pathogens enter the brain through the nose. Such amoebae are likely to be present in various water sources. Therefore, immersion in polluted warm water bodies such as rivers, ponds and canals can cause infection. This was the general medical understanding of amoebic meningoencephalitis. When the disease was first reported in Kerala in 2016, preventive measures were adopted according to this belief. However, the situation changed slightly last year. As more cases started being reported than in the past, the government decided to revise the treatment protocol. This time, meningoencephalitis is being reported at an alarming rate, despite the new protocol. As of the 10th of this month, about 60 people have been confirmed with the disease. Although a few patients have survived, concerns remain.

Also Read:Kerala reports seventh death from amoebic meningoencephalitis, another patient critical

The amoebic meningoencephalitis reported this year is different from previous years in many ways. Earlier, it was believed that the amoeba called Naegleria fowleri was the one that devoured the human brain and caused death. However, this year the presence of several variants of the amoeba has been identified. Generally, warm weather is favourable for the survival of these amoebae. Some believe that the high temperatures linked to global warming may be behind the increased density of the amoeba. This may also explain the wider spread of the disease this time. Therefore, along with providing the necessary treatment facilities, a comprehensive study is required. Unfortunately, it is doubtful whether the health department is showing sufficient urgency in this matter. Despite such a grave situation, the government does not even have a clear figure of how many people have been infected in the state. Although 16 people have died, the government has confirmed only two of these deaths. The rest remain only suspected cases. The same ‘doubt’ applies to the number of patients. In other words, the government has failed to collect even the basic information needed for disease prevention and research. This was not the case with Nipah and Covid. At that time, our health systems paid great attention to preparing accurate dashboards. Disease prevention systems are also inefficient. There is only one centre for the lab testing required to confirm the disease. Amoebic meningoencephalitis is officially confirmed only if the PCR result of the cerebrospinal fluid taken from the patient’s spine is positive. However, there are objections that the PCR results of many samples sent months ago from Kozhikode Government Medical College to the Thiruvananthapuram lab are still pending. Delays in testing also affect confirmation in other ways. The solution is to set up more testing laboratories. The demand to start a PCR lab at Kozhikode Medical College, where the largest number of people sought treatment, remains unfulfilled. All these matters need urgent reconsideration. On the other hand, water vigilance is crucial to prevent the spread of the disease. We must ensure that all our water bodies and drinking water tanks are free from pathogens. The government must also take the necessary steps in this regard. If the changing climate in Kerala has contributed to the spread of the disease, a comprehensive study in that field is urgently needed. Otherwise, we will face another health emergency.

Also Read:Experts state climate, temperature, water stagnation behind Kerala’s amoeba infections