This week in health: all about Kyasanur Forest Disease, thepotential of CRISPR technology and some life-saving lessons in first aid.
(In the weekly Health Matters newsletter, Ramya Kannan writes about getting to good health, and staying there. You can subscribe here to get the newsletter in your inbox.)
It is highly unlikely that before 2024, any of us had heard of Kyasanur Forest Disease, unless of course one was a tropical diseases expert. But with the dawn of the new year, KFD, as it has come to be called. It was this year that we realised that this was no strange, new disease, but had first been noticed in the Kysanur Forest area of Sorab Taluk in Shivamogga district in 1956, and was named after the region. It is also known as monkey fever, as monkeys also get infected. In fact, the death of a monkey serves as a warning of a KFD outbreak. The scientists concluded that the virus must have been present right through in the forests of Malnad region. It stands to reason that it likely was reactivated due to ecological changes.
The disease spreads through ticks. Primates that come in contact with infective ticks contract the disease. Human beings who visit the forest area either for livelihood, to graze cattle, or to collect firewood contract the disease. Normally, the transmission begins from late November to June. It peaks between December and March, according to studies. A blood test is done to identify if someone has KFD. For more on the disease, do read this short explainer by Sathish G.T.: Kyasanur Forest Disease, the assault of the tick.
Since January 1, the State health department has conducted 2,567 tests and 68 people have been found positive in the Malenadu area: Shivamogga, Uttara Kannada and Chikkamagaluru: prompting the government to take action. Karnataka School Education minister Madhu Bangarappa instructed officials to spread awareness about the disease and issue a travel advisory to trekkers visiting the Malenadu region. Health minister Dinesh Gundurao also appealed to people in affected areas to be cautious, besides announcing that a new vaccine for KFD was likely to be ready by next year. He said that that with the concurrence of the Indian Council of Medical Research (ICMR), the Hyderabad-based Indian Immunologicals Ltd, has been asked to develop a vaccine to prevent KFD.
Naturally, with infectious diseases, border areas too have to be on the alert, and Tamil Nadu and Kerala which share the border with Karnataka, got their act together. The Kerala health department issued a KFD alert in Wayanad, while in Tamil Nadu, the health department issued guidelines for all its centres to identify, and tackle KFD viral infection.
With climate change playing a wrecking ball in the environment today, the reemergence of KFD is a reminder that we are not done yet. While we gear up to handle the looming threat from non communicable diseases, we do have to be on the lookout for remerging, and newly emerging strains of infection, and ready ourselves for two battles - prevention and later, treatment.
Since we are on the subject of infectious diseases, let’s quickly check for COVID-19 updates here. Bindu Shajan Perappadan quotes health Minister Mansukh Mandaviya speaking in Parliament: COVID-19 virus mutated 223 times, will continue to remain like influenza. This is something that is by now pretty much common knowledge. He further added: “When a virus mutates more than 100 times, its harmful effects are reduced. So far, the COVID virus has mutated 223 times and like influenza, which hits people once or twice every year COVID is with us and it will remain.”
Public health experts in Tamil Nadu followed it up with a genomic surveillance of the Omicron SARS-CoV-2 variant and its sub-lineages in the State to understand the mutational patterns of the virus between December 2021 and March 2023, when it was prevalent in the population. “Our findings suggest that continuous surveillance of viral variants at the global scenario is warranted to undertake intervention measures against potentially precarious SARS‐CoV‐2 variants and their evolution,” wrote the authors in the article Genomic surveillance of omicron B.1.1.529 SARS‐CoV‐2 and its variants between December 2021 and March 2023 in Tamil Nadu, India—A state‐wide prospective longitudinal study published in the latest edition of the Journal of Medical Virology. The researchers underscored the need to scale up surveillance measures to assess the vaccine’s temporal and geographic effectiveness.
Based on an RBI report titled, ‘Finances of Panchayati Raj Institutions’, The Hindu’s data team used data to prove that higher autonomy of panchayats leads to better health outcomes in rural India. Panchayats collaborate with health departments to maintain clinics and dispensaries in rural areas. By encouraging institutional deliveries and ensuring prenatal and postnatal checkups, they help reduce maternal and infant mortality rates (IMR). They also provide clean water and sanitation facilities, impacting on health outcomes. The RBI study uses two datasets to show that panchayats which scored high on the health, nutrition, and sanitation parameters also had lower rural Infant Mortality Rates. It uses the devolution index prepared by MoPR using independent agencies. The devolution index rates a State based on primarily three parameters - how many functions including drinking water, rural housing, family welfare, and women and child development are under the control of panchayats. Second, transfer of functionaries, that is, how many positions were filled by panchayats on their own. Third, transfer of finances, that is, what share of funds are raised by panchayats on their own and what share can they spend based on their decisions. To figure out which states did better, hit on the link above.
On to taking care of mental health, a subject that always gets significant play in The Hindu, despite the fact that mental health has traditionally had a much lower priority than physical health. This week we reported the NIMHANS director saying that it was only after COVID, did the world became acutely aware of mental health. Speaking during the convocation ceremony Pratima Murthy, Director, NIMHANS, explained: “It has also to some extent, helped in reducing the stigma around help-seeking for mental health conditions.” The rights-based Mental Health Care Act and initiatives like Tele Manas were some of the steps taken to improve mental health among people, she added. Also, she stressed that the emphasis on physical health versus mental health was somewhat misplaced, as one in 10 persons has a diagnosable mental condition as estimated by the National Mental Health Survey, 2016.
Afshan Yasmeen also brought us a couple of stories related to mental health. There is going to be a further update to that National Mental Health Survey, the second phase of the National Mental Health Survey will begin in a month, she reported. In 2014, concerned over the growing problem of mental health in India, the Union Ministry of Health and Family Welfare entrusted NIMHANS to study the mental health status in the country. Following that, the first National Mental Health Survey was undertaken during 2015-2016 in 12 States, covering nearly two-thirds of the population of the country. Karnataka was not part of the first survey, which indicated that around 150 million individuals had mental illnesses that required treatment in India. The survey used a structured diagnostic instrument which is equivalent to clinical assessment. “NMHS-2 is being planned across all 28 States and 8 Union Territories in the country,” Dr. Murthy said.
Not only is the need to prioritise mental healthcare poor among policymakers and doctors, but also among people who actually suffer. A recent study showed that self-reporting of mental disorders in India is lower than the actual burden. Well, appallingly low, in fact. The IIT Jodhpur study - based on the 75th Round National Sample Survey (NSS) 2017-2018 - revealed that the self-reporting of mental illness was less than 1% in India. It also threw light on the significant out-of-pocket expenses incurred by individuals seeking mental health services. This is largely due to reliance on the private sector.
In certain good news from the sector, the top-notch institution for mental health care in the country, NIMHANS, bagged the WHO’s Nelson Mandela award for Health Promotion. Richly deserved, indeed.
Moving on, modern medicine has come to rely much on genetic studies, and gene therapies. With gene editing made possible with CRISPR technology, recently licensed in the treatment of patients with sickle cell anaemia, CRISPR is the future, presented today.
Here, Soujanya Padikkal discusses that even as CRISPR is poised to revolutionise therapy, we need to take a pause to consider the ethical issues. “When you have such a blockbuster therapy, you also have to think about how you can make it accessible and many people around the world including us are working along those lines”, said Debojyoti Chakraborty, Principal Scientist at CSIR Institute of Genomics and Integrative Biology. Hit the link to read more.
Sneha Khedkar brings up the story of the untapped potential of stem cells in menstrual blood. Adult stem cells in the endometrium - endometrial stromal mesenchymal stem cells- are truly “multipotent,” with the ability to be coaxed into becoming fat cells, bone cells, or even the smooth muscle cells found in organs such as the heart. A biologist named Caroline Gargett who identified this class of stem cells in cell tissues removed during hysterectomies, was excited with the research that showed that some of these cells were found in menstrual blood. Rather than relying on an invasive surgical biopsy to obtain the elusive stem cells she’d identified in the endometrium, she could collect them via a menstrual cup. A handful of small but promising clinical trials have found that menstrual stem cells can be transplanted into humans without adverse side effects. Dr. Gargett’s team is also attempting to develop human therapies. Certainly, an area we will put on our radar.
After World Cancer Day in early February, here are some more stories on the subject. AIIMS unveiled indigenously developed technology for early detection of cancer, raising the hopes of oncologists across the country. AIIMS Delhi, in collaboration with the Centre for Development of Advanced Computing, Pune, has launched an Artificial Intelligence (AI) platform - iOncology.ai. - designed for the early detection of breast and ovarian cancer. It has already been deployed in five district government hospitals, including Mathura and Faridabad, for validation, and officials confirmed that in the future, the government would install the system in other medical centres with the assistance of National Information Centres and the Ministry of Information Technology.
If you remember, we discussed, last week, the impact of King Charles’ revelation on being diagnosed with cancer, might have on stigma surrounding the disease. This week, do read this piece on how he broke with the famed royal tradition of ‘mystery’ by sharing his cancer diagnosis.
Sometimes, we facilely assume that what we know, the world knows too. One of those myths in the health sector might be our assumption that the world is aware of the potent Oral Rehydration Salts solution to save lives in cases of acute diarrheal disease. But, nearly half of diarrhoeal cases around the world do not receive ORS, according to researchers. Why? Because of the most bizarre reason: Most healthcare providers in developing countries know that Oral Rehydration Salts (ORS) are a lifesaving and inexpensive treatment for diarrhoea in children, but few prescribe it. Taking a closer look at this know-do gap, a new study has found that healthcare providers assume that patients do not want ORS, and this, in fact, played a major role in under-prescribing ORS. Diarrhoea is a leading cause of death in children, and lives could be saved with this low-cost and widely available treatment. Do read on: Misconception drives under prescription of ORS.
What purpose does education serve if it fails to equip individuals with the skills to save lives in critical situations? asks Tharsni M. in our tailpiece for the week: Life-saving lessons. While this might be an apt topic for philosophical cogitations, this article is about that precious knowledge of administering first aid, a literal life-saving manoeuvre. According to the ‘Accidental Deaths and Suicides in India’ report by the National Crime Records Bureau (NCRB), a staggering 32,457 individuals succumbed to heart attacks in 2022, marking a significant increase from the 28,413 deaths recorded the previous year. Accidental deaths are on the rise in India, with snakebites alone claiming 45,000–50,000 lives annually, as reported by the Journal of the Association of Physicians of India (JAPI). She asks: With such alarming statistics, the question arises: isn’t it time to incorporate life-saving lessons into the school curriculum? Fair enough.
From the Health page
Employ those couple of extra minutes you have to also read:
Zubeda Hamid asks: Are cough syrups effective for children? in the In Focus podcast series.
Recruitment for 29,000 posts at various AIIMS has taken place in the last six months: Mansukh Mandaviya.
Government gets ready to include ASHA and Anganwadi workers/helpers in its Ayushman Bharat scheme.
Ecuador’s High Court decriminalises euthanasia, following lawsuit by terminally ill patient.
There’s been some opposition to this, but Ayush is being integrated with the new, upcoming AIIMS, we learn.
NExT should be brought in after meticulous due diligence: parliamentary panel.
From our Science newsletter: Arkatapa Basu explains the role of X chromosome in auto-immune diseases.
For more content on regional issues, read on:
Andhra Pradesh
ASHA workers in Vijayawada taken into custody, shifted to police stations.
Seven children fall sick after being administered with antibiotic injections in Government Hospital in Machilipatnam.
B. Madhu Gopal reports: Praja Arogya Vedika urges Chief Minister Jagan to bring out Right to Health Act in Andhra Pradesh.
Nellore Sravani follows up: Govt. responded positively to some demands of ASHAs, says union leader.
‘Raise awareness about childhood cancer and its diagnosis’, says expert.
Assam
Rise in HIV infections in Assam due to injecting of drugs, says Minister.
Delhi
AIIMS-Delhi to collaborate with Liverpool University for research on head and neck cancer.
AIIMS Delhi-SBI launch smart card for hassle-free payments.
Karnataka
Shilpa Anandraj writes about Bhangaar, a documentary about an aged couple seeking euthanasia, which is to be screened in Bengaluru.
Union government accords in-principle approval for opening CGHS wellness centre in Mangaluru.
School performance hit by poor eye health in exam season, say Karnataka doctors.
Union Health Minister Mansukh Mandaviya gives in-principle approval for CGHS wellness centre in Shivamogga.
Government giving priority to the overall improvement of the healthcare sector, says Dinesh Gundu Rao.
ASHA workers to stage two-day protest from February 13.
Project for improving digitisation in private health facilities launched.
Kerala
Thrust on housing, health, and sanitation in Alappuzha district panchayat Budget.
Panels set up in Kozhikode to plug antibiotic misuse.
Scientific research must be aimed at shaping a brighter future for humanity, a greener future for planet: Kerala CM Pinarayi Vijayan.
Maharashtra
Purnima Sah on: Maharashtra resident doctors beginning indefinite strike today; OPD services to be hit.
Puducherry
Government to set up public hospital to serve rural areas, says Puducherry CM.
M. Dinesh Varma reports: Junior residents accuse Jipmer HoD of harassment.
Tamil Nadu
Master Health check-up clinic, and payment kiosk launched at Christian Medical College in Ranipet.
Madras High Court appreciates T.N. govt. for deciding to absorb 977 nurses appointed during COVID-19.
2.69 crore persons to be covered under deworming campaign in Tamil Nadu.
Rela Hospital signs MoU with Bangladesh hospital to set up liver transplant programme.
S. Vijay Kumar follows up on an old case: Fresh investigation underway into irregularities in harvesting organs from brain-dead patient.
Sunitha Sekar reports: Early memories of Madras and beginning of geriatric care.
Telangana
Siddharth Kumar Singh finds Telangana’s health budget is down ₹661 crore from last year.
As always, do put us on your radar, as we bring more health content your way. Get more of The Hindu’s health coverage here.
