Why we should worry more about the poor during extreme heat events?

The month of May is generally the hottest time of the year in India. This time it has been unbearable. Certain parts of India are suffering from extreme heat - soaring temperatures (40C to 50C) have been reported in Andhra Pradesh, Telangana, Delhi, and Maharashtra resulting in more than 1000 deaths in less than one week, and the numbers continue to rise. Alarmingly, this is not a rare occurrence. Higher peak temperatures and longer periods of heat waves are becoming increasingly common in many parts of the world  as it does in India where it seem  to be recurring with regularity.2014 witnessed high temperatures in Andhra Pradesh, Delhi and Odissa. Similarly in 2013, 2012, and 2011, heat wave gripped many parts of the country with  2014 the hottest year on record in India.

Records from the National Climatic Data Centre indicate that the average global temperature across land surfaces was 1.68°C (3.02°F) above the 20th century average of 3.2°C (37.8°F). The Earth's surface temperature has shown accelerated warming during the last two decades due to the cumulative effects of human activities in the past 50 years, which have altered the atmosphere’s chemical composition by the accumulation of greenhouse gasses that trap heat. Exploitation of our forests and unrestrained development have led to deforestation resulting in the removal of trees-our planet's  natural heat moderators. Rampant urbanisation has led to increased temperatures due to urban heat islands. When tree cover is replaced by concrete buildings that naturally absorbs heat and retains less water, temperatures rise concomitant with the rise of urban sprawls.

Consequently human activities lead to extreme heat events - weather that is different from the usual, is abnormally hot and humid, and sustained over longer periods. Extreme heat events are increasingly being reported in many parts of the world in recent years often resulting in heat-related illnesses and deaths and  disproportionately affects the poor in developing countries.

 The casualties in the ongoing  Indian heat wave are largely  construction workers, elderly and the homeless.

Why are the poor affected more?

Lack of access to drinking water

In developing countries, people living in poverty generally have poor access to clean drinking water. Extreme heat events often goes hand -in-hand with general water shortage which limits the amount of water available to the poor contributing to severe dehydration. 

Inadequate shelter from heat 

Often the poor live in dwellings that lack adequate protection from heat, with many urban poor living in makeshift houses in slums devoid of  heat alleviating devices such as electric fans.

Occupational exposure to heat 

Whilst the advice during extreme heat events is to stay indoors, away from the heat, many poor engage in outdoor manual work for sustenance, often in urban areas where temperatures are higher which makes them increasingly prone to sunstroke and dehydration. Regardless of the danger posed by outdoor work in extreme heat, they are forced to labour in potentially lethal conditions, ironically, to survive.

Limited access to healthcare

The poor lack access to healthcare for heat-related illnesses which sometimes leads to fatal consequences.

Vulnerable elderly

Increased age (65 and over)  is a primary risk factor for heat- related illnesses regardless of socio-economic status, but the elderly poor are adversely affected to the greatest extent. This is due to the restricted ability of the older people  to change their physical environment and  their limited ability to access facilities such as water, re-hydration drinks, and medical aid, that local authorities might provide during times of extreme heat events.Additionally the elderly poor may have untreated health conditions like cardiovascular diseases and kidney diseases which predisposes them  to heat-related illness and death 

Homeless marginalised

Homeless people are highly vulnerable to heat -related illnesses due to a plethora of reasons – Often there is a high prevalence of untreated physical and mental illnesses, substance dependence, and mental health issues all of which contributes to their susceptibility. They may be less likely to take effective precautions from heat and may have poor access to medical help . Further, they may have no place to take shelter during periods of extreme heat.

 How can we help the poor before and during an extreme heat event?

• The authorities must generate extreme heat event management plans far in advance, detailing how the poor would be taken care of during extreme heat events
• Alert the poor using awareness campaigns before an impending extreme heat event so that they are prepared, can take precautions, and know what to do to protect themselves.

The points below can be used as a guide in generating extreme heat event management plan.

• Make provisions for water, re-hydration solutions, and food aid to reach the poor
• Provide emergency medical camps where the poor can seek medical aid. Additionally take  medical care to the point of need using mobile clinics- to the homeless and the elderly who may not visit the medical camps 
• Provide emergency heat refuges  where the poor can take relief from heat. In times of extreme heat events large public outdoor spaces like stadiums and parks could be adapted to provide shelter from the sweltering heat.
•  Provide financial relief that would help the poor to refrain from outdoor manual labour until the extreme heat events passes  .
•  Provide appropriate clothing, sun hats, umbrellas to provide shade etc.

With increase in global temperature, extreme heat events will continue to reappear regularly. Nevertheless, virtually all of the extreme heat- related illnesses and deaths can be prevented by taking appropriate measures to ensure that the public stays safe during an extreme heat event, and that absolutely should include the poor.

Authors of this post - Ruth Stephen and Tim Whallett

Plastic carrier bag tax in the UK- A step in the right direction

Plastic bag pollution is a grave issue  that threatens our environmental health . We have covered the potential damages inflicted by plastics in some of our earlier posts . Most plastic bags are non-biodegradable with an incredibly long life (approximately 300 -1000 years). Consequently they are ubiquitous. Discarded plastic bags often end up on trees or in the waterways where they affect wildlife. They have even been found in remote and pristine areas such as the Arctic and the Antarctic. 

Despite being  recyclable,  a large proportion of plastic bags end up in land fills. In the UK, plastic bags are not collected by the local authority for recycling, even though some supermarkets (especially the larger stores) have collection points. In the US only 12% of plastics belonging to the category including bags, sacks and wraps was recycled. Additionally, littering causes plastic bags to end up in places where they are a big menace.  In  aquatic environments where some discarded plastic bags end up,  they have been found to form dangerous bands around the necks of waterfowl and animals such as seals, dolphins, and turtles. Plastic bags are also often mistaken for food by fauna. Even the bio-degradable plastic bags that dissociate into pieces with time, are not truly degradable. During the decaying process , they are easily ingested by larger fauna causing morbidity and mortality. They can also be  eaten by smaller aquatic fauna including zooplankton; additionally, these bags degrade  in the water releasing toxic chemicals that leaches into the waterways- regardless of the means, they enter humans through  the food chain.

Last year the coalition government  in the UK confirmed plans  to levy  a 5 pence tax on single-use plastic carrier bags from 5 October 2015. The tax generated would be used to support charities. However, the charge on plastic bags would only apply to supermarkets and larger stores. A 5 pence tax has already been in use since 2011 and 2013 in other regions of the United Kingdom such as Wales and Northern Ireland respectively.A clear message from places all over the world where such taxes are implemented is the concomitant reduction in the usage of plastic bags upon tax introduction. In other words, whilst repeated messages to reduce use of plastic bags are ignored by us, taxes catch our attention. Simply put, we do not like to pay for the usage of plastic bags and will resort to other means when penalties are imposed.  In Northern Ireland, since the implementation of the 5 pence tax, plastic bag usage has declined by 80%.

With the advent of the 5p tax, more of us will be using reusable bags just like this eco-savvy shopper (Photo:R Stephen)

Figures published by the Waste and Resources Action Programme  show that 8.3 billions of plastic bags were  distributed in UK shops in 2013 which is an awful lot of plastic bags.
Many stores and supermarkets in the UK already have incentives for reducing the use of plastic bags. As early as 2007, Marks and Spencer started charging 5 pence for every standard food carrier bag (the store still gives away small plastic bags for free), with profits going to support charities such as the World Wildlife Fund, the Marine Conservation Society, and education projects in primary schools to promote marine life awareness. M&S also sells ‘Bag for Life’ bags, which are made of 100% recycled materials which would be replaced free charge  by the store when it wears out and would itself be  recycled. When the plan started M&S gave such bags for free. I have one of those still in use.

The legislation in England is a right step and  'every little counts',  but should also  be extended to cover other sources of plastic bag pollution such as retail stores currently exempted by the 5 pence tax. On a positive note, many shops have already started selling reusable bags and it is not uncommon to see customers using these for shopping.It is best to use reusable cloth/jute bags instead of reusable plastic bags.The damage inflicted by plastics is colossal and efforts should be made to eliminate the indiscriminate use of  these materials from all avenues as much as it is possible.

More shops have started selling reusable bags in the UK.(Photo-R Stephen)

This shopper is using a plastic bag  from elsewhere to shop in Tesco supermarket. (Photo-R Stephen) 

The question arises as to what to do with the plastic bags that we have lurking around in our houses. Firstly, reusing them as many times as possible is a good start. when it comes to the time, it can no longer be used, take it to your supermarket- many of  the larger stores have facilities for recycling not only plastic bags but also other  plastic packaging. If your store doesn't have a plastic bag recycling facility, request for one. you might be successful, especially as supermarkets have a commitment towards corporate social responsibility.

It is not uncommon to  find plastic bags littering  many of our streets, particularly our cities, where they are not only unsightly but dangerous due to the perils described above. Fixed Penalty Notices for littering exist in the UK , but it seems to be seldom enforced.Similar fines exist for owners of dogs who do not clean up the dog mess in public places. Signs like the one in the figure below are good deterrents, when coupled with the presence of dog wardens doing lightning -patrols in  the area .

 

Our streets should be provided with more signs that clearly convey the penalties of plastic bag littering . This could markedly help in our efforts towards curbing plastic bag litter. Awareness messages that encourage people to take their plastic bag litter home should be conveyed. The Tory party's election manifesto promises  to 'review the case for higher Fixed Penalty Notices for littering'.  It will be interesting to see whether the new government follows through with its promise in the coming days. Enforcing stricter penalties for plastic bag littering would be yet another step towards our goal of preventing plastic bags from being erroneously dispersed.

When it comes to plastic bags the following slogan is apt:
Replace, Reduce , Reuse and Recyle 
Replace plastic bags with Reusable bags ideally cloth/jute bags
Reduce  use of  plastic bags
Reuse plastic bags that you have as much as possible
Recycle plastic bags in appropriate collection points 

‘Water, water, everywhere, Nor any drop to drink’ – Safe drinking water and Adequate sanitation are indispensable for eradicating Cholera

What has Cholera to do with environment? Absolutely everything!  In this post, we look at why clean water and safe sanitation is essential for eradicating this dreadful disease from our planet.

Access to clean drinking water and safe sanitation could eradicate cholera. (Image - Sam Stephen)

Cholera, an acute intestinal infection caused by ingestion of food or liquids contaminated with the bacterium Vibrio cholerae, elicits the same fear today, as it did in the past. Although cholera has affected populations throughout history, the first recorded pandemic was in 1817 starting from South East Asia where it had been endemic. From there it spread globally. A dangerous disease, it affects children and adults, killing patients within hours. Malnourished children or HIV infected individuals are at a greater risk of death if infected. WHO figures indicate 3–5 million Cholera cases per year and 100000–120000 deaths.  

A big concern during the recent earthquake in Nepal was that cholera could strike as it remains endemic in that country today. Elsewhere in the world, an outbreak of cholera has been ongoing in Haiti since the earthquake in  2010 where  it has killed over 8000 Haitians, and  resulted in hospitalizing of over  600,000s and has also spread to the neighbouring country of Dominican Republic. Although epidemics such as this gains media coverage, in many parts of the developing world cholera cases continue to be reported occasionally but in smaller numbers and goes unnoticed globally often peaking during favourable conditions such as rainy seasons and drought seasons. In the rainy seasons, water and food often gets contaminated with wastes that spill out from faulty sanitation systems. The drought season  brings a different set of problems - people have to survive on very limited water which is often contaminated. Additionally, people are malnourished which makes them more prone to infectious disease including cholera.

Profuse watery diarrhoea is the main symptom of cholera. Diagnosis is made by the presence of V. cholerae-like organisms microscopically with a conclusive diagnosis by isolation and identification of V. cholerae from stool samples. Once infected by cholera, the patient requires immediate treatment as time is of the essence between life and death. Treatment primarily includes prompt rehydration through which lost fluids and electrolytes are  replaced using an Oral Rehydration Solution (ORS).  Approximately half of the cholera patients could die without rapid rehydration. Although most people can be helped with this treatment alone, severely dehydrated people may also need intravenous fluids. In children suffering from cholera, zinc supplementation can significantly reduce the duration and severity of diarrhoea. Antibiotics are also recommended for all patients who are hospitalized and the medication choice determined based on local antibiotic susceptibility patterns where it is used in parallel with aggressive rehydration therapy.

Using the right antibiotic/antibiotics is very important as bacterial strains that are resistant to drugs have been reported. In a recent study, researchers studied all available Vibrio cholerae  isolates collected from major outbreaks in the Democratic republic of Congo  during 1997–2012, and found loss of sensitivity to leading antibiotics over time. Additionally they found spread of fluoroquinolone-resistant strains. In a 2013 article in the New England Journal of Medicine, Waldman, Mintz and Papowitz  offered recommendations on how cholera can be effectively controlled. Whilst giving due credit to the current developments in cholera control in the medical arena - use of  antibiotics, treatment procedure, and  use of an improved two-dose oral cholera vaccine which had success in pilot trials, they importantly presented  a lasting solution for  prevention of the disease taken from the pages of the history books - Safe sanitation and clean drinking water eliminated cholera in North America and Northern Europe and this is the route for eradication of the disease, the authors proposed.

The  United Nations Committee on Economic, Social and Cultural Rights - General Comment 15, para.2. says "The human right to water entitles everyone to sufficient, safe, acceptable, physically accessible and affordable water for personal and domestic uses". However, the problem is that what  most of us take for granted-clean water and access to sanitation, is inaccessible to  an estimated 1.8 billion people world-wide who  are forced to drink water that is faecally contaminated,  and 2.4 billion people  who do not have access to any type of improved sanitation facility (WHO/UNICEF Joint Monitoring Programme forWater Supply and Sanitation figures). Sources of water in many parts of the world are tainted often by human activities- climate change effects, environmental pollution, and lack of sanitation.

Guaranteeing clean water, and improved sanitation is a difficult proposal complicated by a glut of hurdles which are technological, societal, behavioural, political and economical to name the main ones. Cholera, Waldman et al  said in their NEJM article  ‘is as much a symptom as a disease’. It is ‘a symptom of insufficient investment' by the global development community in offering access to safe water and improved sanitation for the marginalised.  'Safe drinking water and adequate sanitation are crucial for poverty reduction, crucial for sustainable development and crucial for achieving any and every one of the Millennium Development Goals', Ban Ki-moon, UN Secretary General said in2007 referring to the global targets to slash poverty, illiteracy, disease and other social ills by 2015 collectively known as the Millenium DevelopmentGoals. It appears that we still have miles to go.

Note: This is an updated version of an article that was first published in  http://zellula.blogspot.co.uk/ entitled -The long term solution for controlling cholera extends beyond antibiotics and vaccines : History books provide answers.

References:

The Rime of the Ancient Mariner (originally The Rime of the Ancyent Marinere) by the Samuel Taylor Coleridge

http://www.who.int/mediacentre/factsheets/fs107/en/index.html

http://www.who.int/water_sanitation_health/hygiene/en/

http://www.who.int/water_sanitation_health/mdg1/en/index.html

http://www.un.org/waterforlifedecade/pdf/human_right_to_water_and_sanitation_media_brief.pdf

http://www.undp.org/content/undp/en/home/mdgoverview.html

http://dailypioneer.com/nation/99107-Cholera-makes-a-comeback-in-kerala.html
http://allafrica.com/stories/201401140827.html
http://www.irinnews.org/fr/report/99273/drought-contributes-to-cholera-outbreak-in-southern-angola
http://uk.reuters.com/article/2015/04/17/us-haiti-cholera-idUKKBN0N82O220150417

Miwanda B, Moore S, Muyembe JJ, Nguefack-Tsague G, Kabangwa IK, Ndjakani DY, Mutreja A, Thomson N, Thefenne H, Garnotel E, Tshapenda G, Kakongo DK, Kalambayi G, & Piarroux R (2015). Antimicrobial Drug Resistance of Vibrio cholerae, Democratic Republic of the Congo. Emerging infectious diseases, 21 (5), 847-51 PMID: 25897570 Waldman RJ, Mintz ED, & Papowitz HE (2013). The cure for cholera--improving access to safe water and sanitation. The New England journal of medicine, 368 (7), 592-4 PMID: 23301693

Monkey Fever Disease in South India: Some recommendations for its management.

Macaca radiata

The Western Ghats is a mountain range that runs parallel to the western coast of the India starting near the border of the states of Gujarat and Maharashtra and running through Maharashtra, Goa, Karnataka, Kerala, and Tamil Nadu states ending at Kanya Kumari, the southern tip of India. The forests in the Western Ghats are unique in that they are some of the best representatives of non-equatorial tropical evergreen forests. With  an estimated 7,400 species of flowering plants, 139 mammal species, 508 bird species, 179 amphibian species and 288 freshwater fish species Western Ghats  is  one of the eight "hottest hotspots" of biological diversity in the world. Researchers suspect that even more unidentified species may exist in these forests. An estimated 325 globally threatened flora, fauna, bird, amphibian, reptile and fish species make their home in the forests of Western Ghats. I first saw the majestic Western Ghats as a nine year old when I accompanied my father Professor Joshua Stephen during his research visits to the forests. In the early nineties along with my father from whom we imbibed the enthusiasm for forest conservation, my siblings and I including my sister Sarah,  a contributor on Ecoratorio, conducted voluntary research on the biodiversity in the Western Ghats. Needless to say, the conservation of flora and the fauna of the Western Ghats is of much interest to me.

Western Ghats near Ponmudi Hills

Wayand , a district in the north-east of Kerala state, is bordered by the Western Ghats on the East and is part of the Nilgiri Biosphere reserve. An estimated 885.92 sq km of Wayanad is under forest cover, but the higher altitude allows the cultivation of cash crops and spices (Wayanad is one of the biggest foreign exchange earners of the state),which has led to  ongoing exploitation of the natural  resources, which scientists have warned could lead to environmental crises. One such crisis has now come from a rather unsuspecting angle - Monkey fever which has reared its head in Wayanad. First, in December 2014 more than 100 monkey deaths were reported in Wayand wildlife sactuary ;  this was followed by cases of Monkey Fever in humans in Wayanad.  Since January 2015  there have been  127 reported  cases including  seven deaths in humans. Most of the affected have been tribals,  the indigenous people  who live in the forest and  mountains of Western Ghats. An outbreak on a smaller scale has also been reported in Malapurram district of Kerala again affecting the tribals in that area.

What is Monkey Fever?

Monkey Fever   otherwise known as Kyasanur forest disease (KFD)   is caused by Kyasanur forest disease virus (KFDV), a member of the Flaviviridae family. Other infamous members of this family include the virus that causes yellow fever and dengue . The disease was first identified in 1957  by Work and Trapido , with the observation of deaths in monkeys  with heavy mortality in two species of monkeys namely  the black faced langur (Semnopithecus entellus) and the red faced bonnet monkey (Macaca radiata)  followed by  high incidence of illnesses characterised by acute fever and a few deaths among the villagers in the forested areas of Shimoga district, Karnataka State. Subsequently  the virus was isolated from monkeys , man, and ticks from the Kyasanur forest in Karnataka, India and hence the name.

The vector, the main hosts, and the reservoir hosts

The vector for Monkey Fever appears to be ticks. The virus-infested ticks seem to infest diverse areas such as forest (tropical evergreen, semi evergreen and moist deciduous forests,) cultivated clearings and grasslands. KFD virus has been isolated from several  species of ticks  found in the Western Ghats , however, Haemaphysalis spinigera  is  thought to be  the  major vector . The main hosts of Monkey fever are rats, shrews, squirrels and porcupines, but bats and monkeys also carry the virus. Larger mammals such as goats and cows can become infected with KFD, but current evidence does not seem to implicate transmission of the disease though pasteurised milk. Among animals, current evidence shows that only monkeys seem to die upon exposure to infected ticks.

Often the first clue for the prevalence of the disease in any area  is monkey deaths, a gruesome warning that human cases could soon follow. Humans get Monkey Fever from a tick bite or by contact with an infected animal either ill or recently dead. Human to human transmission has not been reported so far.

Interestingly, Monkey Fever in humans seems to follow a seasonal pattern and human cases are usually reported from November until June, when young ticks or nymphs become active in forests. This time coincides with the warmer months when humans venture into forests for clearing forests, herding and for gathering firewood.

Symptoms, diagnosis of the disease, and treatment

Like many viral diseases there is an incubation period of 3-8 days with the virus,  after which the symptoms of Monkey Fever Disease  manifest suddenly with fever, severe headache, severe muscle pain, cough , diarrhoea and  dehydration. Sometimes, bleeding from nasal cavity, throat, gums, and gastrointestinal tract may also occur. Patients often experience abnormally low blood  pressure, and low  blood counts.  A small fraction of   patients recovers after 1-2 weeks of symptoms without complications. However, most patients present a biphasic illnesses pattern and begin to experience second wave of symptoms at the beginning of the third week. These symptoms include fever and signs of encephalitis. Confirmatory diagnosis can be made by isolation of virus from blood by cell culture methods. Sensitive techniques such as PCR can also be used in the diagnosis in the early stages of the disease. In the later stages of the disease, enzyme-linked immunosorbent (ELISA) can be sensitive in detecting the disease.

Whilst there is no specific treatment for Monkey Fever so far, rapid and timely supportive therapy is very important for preventing complications, hastening  recovery, and for reducing mortality. Treatment depends on the symptoms of the patient and includes hydration, adequate nutrition, and the usual precautions for patients with other bleeding disorders. Patients with preexisting  diseases such as tuberculosis and liver cirrhosis maybe more prone to dying.  Mortality rate  upon infection ranges between 3-5%.

Who is at risk?

Tribals (Indigenous people) living in forest areas who may come across the ticks or infected and dead monkeys during food gathering in the forest ( the  reported cases  in Kerala have largely been from the tribal hamlets),  people who earn a living from working in  the forest  (cattle grazers, forest officials and health care workers serving the tribal areas),  and hikers in the forest are potentially at risk for infection by contact with infected ticks or infected monkeys. 

Monkey fever : Another example of human -animal conflict ?

It has been long argued that  clearing of forest area for cultivation causes changes in tick fauna and is considered as  very pertinent to outbreaks. Deforestation could also cause the reservoir hosts to relocate into human settlements. Additionally, deforestation causes monkeys to come to human settlements in search of food.  Livestock grazing in cleared forested areas and grasslands also cause the ticks to attach to livestock and herders which in turn are accidentally introduced to human settlements.

Prevalence:  Monkey Fever is spreading

Although Monkey Fever Disease  was thought to be endemic to specific districts in Karnataka state,  as early as the late eighties, an antibody survey indicated the possible existence of this disease in Kerala and Tamilnadu although there were no reported  human deaths or monkey deaths then. Since 2013, Monkey Fever cases has affected Wayanad (Kerala)  and Nilgiris ( Tamilnadu), which makes it plausible that infections in these areas may have been missed earlier due to the  lack of an organized surveillance system. The evidence of KFD virus circulation in three southern states of India presently raises serious concerns for human health.  

Whilst eliminating the disease is nearly impossible due to the ability of the virus to hide in the reservoir hosts in the impenetrable forests, it could be contained effectively. Here are some recommendations:

Recommendations for the management of Monkey Fever Disease

The need for creating awareness of Monkey Fever Disease:  There should be awareness programs on monkey fever through different communication channels. Tribal settlements in Western Ghats often do not have access to modern amenities such as TVs , radios etc.  Illiteracy could also be high, therefore awareness messages using modern modes of communication might  not reach the target groups. Therefore awareness of the disease has to be ensured through health workers visiting the areas and communicating orally highlighting the need to avoid high risk areas, contact with dead animals and encouraging people to seek health care promptly on being ill.

Health care centres/mobile health clinics  in tribal areas needed:  Tribal areas are notorious for having poor access to healthcare. Tribals are also the poorest citizens.  There is often lack of/ poor transportation to nearby towns where hospitals may be located due to lack of vehicular roads. Even upon reaching health care centres ,  tribals often  face discrimination and insensitivity  from health care officials. To circumvent this, tribal areas should be  provide with accessible health care centres with adequately trained health workers /doctors who could spot the disease quickly and give the appropriate treatment. Additionally mobile health clinics could also be employed that can bring health services to remote and isolated parts. Furthermore, these health care centres and mobile units could also collect data for  researchers who will be able to monitor , the prevalence, spread,  and changing patterns( if any) of the disease.

Vaccination campaigns in people in the target area and beyond:   Current vaccination practice uses  formalin-inactivated tissue-culture vaccine which  has been the primary strategy for controlling KFD in Karnataka . This is a seemingly a good one. However  recently published  studies from Karnataka shows that the currently adopted vaccination strategy has its own pitfalls. Valuable lessons can be learned that could be used in the other states to control the disease. Firstly the strategy in Karnataka involved mass vaccination of  persons 7–65 years of age  in the high risk regions . But the study showed that persons outside this range were also infected suggesting vaccination programmes to include persons  outside this age group . The study also showed that vaccine coverage in villages selected for vaccination in 2013 was surprisingly low. Further, the uptake of the vaccine was poor ( the current vaccine is multi-dosed  due to the transiency of  the vaccine-induced immunity ,requiring   two vaccine doses  to be administered  with the first booster dose of vaccine recommended within 6–9 months after primary vaccination after which annual booster doses are recommended for 5 years after the last confirmed case in the area) . Only some of the vaccinated persons took the full dose. The study showed that effectiveness  for persons taking full dose was 82.9%, two doses ( 62.4%)  compared to non-vaccinated individuals. The study also  indicated that targeting vaccination to areas within a 5-km radius of reported KFD activity may not be effective in preventing KFDV transmission as there have been  occurrence of cases in areas >5 km away from vaccinated villages.

In a nutshell, increased vaccine coverage is needed with respect to age as well as area (It has to extend beyond the ages of 7-65 years and has to extend to all persons- pending adequate medical advice for use in pediatric and elderly persons in the target area,  and  has to extend beyond the current limit of 5 km radius
Although cumbersome, full doses of current vaccine might be the best option currently available until better vaccines are available

There is a need for production of newer vaccines that accounts for drifts and diversity of current strain, and that which does not require periodic boosters. It is believed that such a vaccine would  lead to increased effectiveness and increased uptake.

Carcasses of infected dead animals to be disposed appropriately: Forest officials should be trained adequately in following appropriate biosafety procedures while handling infected animals and should dispose carcasses appropriately and expediently. They should also be trained in decontaminating surrounding areas where infected and dead monkeys are found.

Initiating Monkey Fever Surveillance Units: There should be active surveillance for Monkey Fever by instituting Monkey Fever Surveillance Units.  Not only target areas, but also regions outside should be tested in a systematic manner for virus positivity in ticks  far in advance of the peak season. This is indispensable for  preventing disease emergence in new areas.  In addition, disease surveillance systems should be in place to monitor effectiveness of vaccination programmes and for detecting any hidden niches of infection. Incidences of unusual monkey deaths and human fever cases should be monitored by the Monkey Fever Surveillance Units and information rapidly communicated  to forest officials and health authorities so that they can take prompt action.

Use of Preventive clothing and Tick repellents: Persons living in forests and those  visiting forested areas should be provided with preventive clothing and tick repellents . Tick repellents are reported to provide significant protection against tick bites.

Cordoning off the area : During the peak  season, the target  areas and areas in a  wider radius  should be off limits  for outsiders (apart from health workers and forest officials dressed in protective clothing)  and  hikers should  prevented  from going to the infected areas and also high risk areas.

Tourists encounter Bonnet monkeys near Ponmudi Hills

Banning cattle grazing: In the target areas, livestock grazing must be prohibited. In this respect it has to be emphasized that tribals are not the culprits, as they have no agricultural practices but only gather food in the forest.

Stop deforestation and slash-burn agricultural practices: Deforestation and slash -and -burn practices for agriculture forces the vectors from their natural habitats into human populations. Curtailing deforestation and harmful agricultural practices in the forests will prevent the spread of Monkey fever   and other such diseases.

Monkey Fever Disease preparedness and response plans : Scientists  have reiterated  that often the official response to an outbreak is too late. By the time monkey deaths are noticed in an area, the ticks have already flooded the locality. Therefore, the best approach is to prepare ahead and to have all containment measures in place much in advance.

Increased research on Monkey Fever Disease : Increased research is needed on monkey fever especially on the drift and diversity of the virus, and efforts should be made towards producing better vaccines. There is also limited knowledge on the susceptibility and prevalence of monkey fever in other monkey species ( For example  whether  the critically endangered species Lion tailed macaque is susceptible to infection) .  A concerted effort on understanding the natural history of the disease will enhance the efforts to curtail it.

Concluding thoughts

With the Monkey Fever Disease  season seemingly coming to an end, the authorities could easily fall into the trap of complacency and lethargy until new Monkey fever cases hit  the headlines next year. However, the ease by which the disease is spreading should be a warning to the authorities that it is a major perennial problem.  It is not one of those rare diseases anymore. Timely measures need to be in place to ensure that the disease does not spread any further as this could threaten monkey survival as well as cause a major public health crisis, which with passage of  time might be too difficult to contain.

Addendum
Since publishing this post, I have been contacted by the MCVR Virology Lab , Manipal , India that the disease has now been detected in Goa state also. 

References:

Mourya, D., Yadav, P., Sandhya, K., & Reddy, S. (2013). Spread of Kyasanur Forest Disease, Bandipur Tiger Reserve, India, 2012–2013 Emerging Infectious Diseases, 19 (9) DOI: 10.3201/eid1909.121884http://dx.doi.org/10.3201/eid1909.121884">10.3201/eid1909.121884

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Kiran, S., Pasi, A., Kumar, S., Kasabi, G., Gujjarappa, P., Shrivastava, A., Mehendale, S., Chauhan, L., Laserson, K., & Murhekar, M. (2015). Kyasanur Forest Disease Outbreak and Vaccination Strategy, Shimoga District, India, 2013–2014 Emerging Infectious Diseases, 21 (1), 146-149 DOI: 10.3201/eid2101.141227http://dx.doi.org/10.3201/eid2101.141227">10.3201/eid2101.141227
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Blue meets Green – What does Conservative party’s win mean for UK's environment?

The results of the general election are in. David Cameron will continue to lead the country for the next 5 years. But how does the UK’s environmental issues fare in the 2015 election manifesto of the Conservative party? Of the several promises listed in it, these grabbed my attention.

Creation of Blue belts for protecting marine environments in the UK and UK ‘s 14 overseas territories: Following on from the work in the previous term, the manifesto promises to complete the network of Marine Conservation Zones to create a UK Blue Belt of protected sites. Last year the coalition government  instituted a  Marine Protected Area around the Pitcairn Islands in the South Pacific –the world’s largest contiguous ocean reserve  with 830,000 square kilometers (3.5 times the landmass of UK).  The manifesto promises to extend this programme around the UK’s 14 Overseas Territories, subject to local approval. 

 Planting 11 million trees: This promise is significant especially because public forests and woodland where supposedly the trees would  be planted are to be kept in trust for the nation.

Building new environmentally sensitive infrastructures: The conservative manifesto promises to build roads and railways with reduced environmental impact. It promises to cut light pollution from new roads, build better noise barriers, include more tunnelling, and help restore habitats lost during construction. A specific case mentioned is that of the construction of High Speed 2 - the planned railways connecting London Euston with the Midlands through to the North. The manifesto promises to ‘replenish locally any biodiversity lost in the construction’. How they are going to achieve this is not mentioned in the manifesto.  Importantly ‘biodiversity’ cannot be easily replenished. Yes trees can be planted, some animals introduced,  however ‘ biodiversity’   refers to the variety of living organisms in different ecosystems starting with microbes and is complex. Thus, ‘replenishing biodiversity’ is not easily achievable, at least not  in totality, though conservation is possible and must be pursued .Therefore the 25 years plan that the Conservatives will develop to restore UK’s biodiversity is commendable.

Pocket Parks in urban areas: The manifesto promises to launch a programme of ‘pocket parks’  - small green spaces that town and city dwellers can enjoy .This is an excellent idea. Here in Ecoratorio, we have repeatedly highlighted the need for more green spaces in the cities.

One omission in the manifesto is the lack of any mention of how they plan to tackle pesticide overuse in the crops, which has been blamed for declining bee numbers. This is a lapse as the manifesto says that they ‘will help our bees to thrive’.

In the days ahead, we will see whether the new government remains committed to its promises.But one fact is clear that  a green Britain will assuredly contribute to a ‘greater Britain’.

Reference: Conservative Party Manifesto 2015  https://www.conservatives.com/manifesto