Prevention is the only bet for avoiding the onset of Lassa fever

Health Care, Heart Care Foundation of India, Medicine Comments Off

Be careful of rodents and avoid direct contact with infectious body fluids

New Delhi, 19 July 2018: Earlier this year, Nigeria fell under the grip of a viral infection called the Lassa fever. Many people succumbed to the symptoms and died. This fever comes under the list of priority diseases enlisted by the World Health Organization (WHO). Apart from Nigeria, the Lassa virus is endemic in Benin, Ghana, Guinea, Liberia, Mali, Sierra Leone, and other countries in West Africa.

Lassa fever is an acute viral hemorrhagic illness caused by Lassa virus, a member of the Arenavirus family of viruses. It is a zoonotic disease. Rodents (multimammate rats) are the animal reservoirs and shed the virus in their urine and feces.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, HCFI, said, “Humans acquire the infection from contact with infected rodents through rodent urine or feces, inhalation of aerosolized rodent excretions, or consumption of infected rodents as a food source. Person-to-person transmission can occur through direct contact with infectious body fluids (e. g., blood, urine, pharyngeal secretions, vomitus, or other body secretions), unprotected contact with potentially infectious material (e.g., touching vomitus) and mucosal exposure from splashes of body fluids. People with Lassa infection are not believed to be contagious prior to symptom onset. The incubation period of this fever is about 10 days (range 6-21 days).”

Initially, the symptoms are mild and include low-grade fever, general weakness, and malaise. This is followed by headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhea, cough, and abdominal pain. In severe disease, facial swelling, fluid in the lung cavity, bleeding from the mouth, nose, vagina or gastrointestinal tract and low blood pressure are present. Later stage may be characterized by shock, seizures, tremor, disorientation and coma.

Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “The overall case-fatality rate is 1%, while in hospitalized patients, the case-fatality rate is 15%. The diagnosis of this condition is usually supported by a relevant history of exposure along with suggestive signs and symptoms. It is possible to improve survival rates through early supportive care with rehydration and symptomatic treatment. However, there is currently no vaccine for this condition.”

Indian doctors need to update their knowledge in view of a large number of Nigerian patients coming to India for treatment.

Some tips from HCFI

  • Avoiding rodents (multimammate rats).
  • Consider all patients as infectious even if signs and symptoms are mild.
  • All standard, contact, and droplet precautions as well as correct use of appropriate personal protective equipment should be strictly adhered to.
  • Blood and body fluid specimens from patients with suspected Lassa fever infection should be considered highly infectious. Caution should be exercised when handling such material.
  • Postexposure prophylaxis with oral ribavirin for contacts with known or suspected Lassa fever infection with risk factors for transmission such as penetrating needle stick injury, exposure of mucous membranes or broken skin to blood or body fluids, and participation in procedures involving exposure to bodily fluids or respiratory secretions without use of personal protective equipment.

Homosexual relationships do not lead to STDs like AIDS: SC

Health Care Comments Off

Excerpts from TOI report

The Victorian-era morality, prohibitions, unsafe sex and living in denial have led to the spread of sexually transmitted diseases like AIDS and it cannot be blamed on homosexual relationships, the Supreme Court on Tuesday said while observing the sexual intercourse itself should not be seen as a crime. The apex court termed the prohibitions on acts like prostitution and homosexual relationships as one of the causes for the spread of STDs and said, “If you licence prostitution, you control it. If you shove it under the carpet, owing to some Victorian-era morality, it will only lead to health concerns”.A five-judge Constitution bench was not in agreement with the submissions of the lawyers favoring retention of section 377 in the IPC that the homosexual relationships have led to spread of AIDS.”The cause of sexually transmitted diseases is not sexual intercourse. But unprotected sexual intercourse. A village woman may get the disease from a husband who is a migrant worker,” the bench said. “This way you would want to make sexual intercourse itself a crime.”

“We would not wait for the majoritarian government to enact, amend or not to enact any law to deal with violations of fundamental rights,” the bench said and made clear that it may strike down a law if fundamental rights are infringed.“Sexual orientation is of abstract nature and such an abstract concept cannot be read into Article 15 and moreover, the term sexual orientation has not been defined either in the Constitution or in any other statute”.

The bench said its NALSA verdict recognized transgender as a gender besides male and female.The European Human Rights court has held that “the right to marry is not a conventional right”.The court reserved its verdict after lawyers concluded their arguments in the case.

The National Legal Services Authority (NALSA) v. Union of India is a landmark decision by the Supreme Court of India, which declared transgender people to be a third gender, affirmed that the fundamental rights granted under the Constitution of India will be equally applicable to transgender people, and gave them the right to self-identification of their gender as male, female or third-gender. The court also held that because transgender people were treated as socially and economically backward classes, they will be granted reservations in admissions to educational institutions and jobs.

MEDtalks

Sexual orientation is generally thought of as having three components: identity, behavior, and desire. “Gay” is generally used to describe how people identify themselves, while “men who have sex with men” (MSM) describes a behavior. MSM may identify themselves as gay, bisexual, queer, same-gender loving, or heterosexual. Some who are just beginning to come out may experience a desire to be intimate with other men, but may not yet have been sexually active with men or even identify as being gay. Some MSM do not even regard sex with other men as sexual activity, a term they reserve for sexual relations with women.

Gay men are at higher risk of human immunodeficiency virus (HIV) and other sexually transmitted infections. According to the CDC, 66% of new cases of HIV in the US in 2011 were in men who have sex with men (MSM), including MSM who use injectable drugs. They are more likely to attempt suicide and be homeless. Use of tobacco, alcohol, and other drugs are higher in them. Isolation and lack of supportive services are further barriers to health, especially in older gay men.

For effective HIV prevention, the CDC recommends that

  1. Sexually active MSM (patient or his sex partner[s] have more than one sex partner since the patients most recent HIV test) should be tested at least annually for HIV and other STIs.
  2. Sexually active MSM should practice safe sex by choosing less risky behaviors, using condoms consistently and correctly if they have vaginal or anal sex, reducing the number of sex partners, and, if HIV-positive, letting potential sex partners know their status.
  3. For some MSM at high risk, taking post-exposure prophylaxis (PEP) can reduce risk.
  4. For sexually active MSM at substantial risk, pre-exposure prophylaxis (PrEP) is recommended as one option.
  5. Health care providers and public health officials should ensure that:
  1. Sexually active, HIV-negative MSM are tested for HIV at least annually (more frequent testing may be recommended e.g., every 3 to 6 months)
  2. HIV-negative MSM who engage in unprotected sex receive risk-reduction interventions
  3. HIV-positive MSM receive HIV care, treatment, and prevention services

6. Universal screening: HIV screening has long been a core prevention strategy.

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA