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17 July, 2017 11:31:32 AM
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Chikungunya outbreak

Awareness and clinical knowledge are necessary to diagnose chikungunya infection properly. Its virus is transmitted to people by mosquitoes. The most common symptoms of chikungunya virus infection are fever and joint pain
MOHAMMED ABUL KALAM, PhD
Chikungunya outbreak

Bangladesh found the first case in 2008 in northern Rajshahi and Chapainawabganj districts. In Dhaka, IEDCR noticed the presence of the disease later in 2O11. Institute of Epidemiology Disease Control and Research (IEDCR) Director Prof Dr Meerjady Sabrina Flora said 196 cases of chikungunya have so far been confirmed from April to May 25 (bdnews24.com). IEDCR director Prof. Meerjady Sabrina Flora also said that the situation was not alarming. “From 30-35 people getting tested every day, 10-15 of them test positive for the CHIKV virus,” she said. The officials and experts, however, said that many more cases on Chikungunya were not reported to the institute or major hospitals (bdnews24.com). If this is the fact then when we will consider the situation alarming or epidemic?  Now we can define disease outbreak and epidemic. A disease outbreak happens when a disease occurs in greater numbers than expected in a community or region or during a season. An outbreak may occur in one community or even extend to several countries. It can last from days to years. Sometimes a single case of a contagious disease is considered an outbreak. This may be true if it is an unknown disease, is new to a community, or has been absent from a population for a long time. An epidemic occurs when an infectious disease spreads rapidly to many people. Epidemic refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area. Outbreak carries the same definition of epidemic, but is often used for a more limited geographic area (CDC, USA). But the problem with us that until or unless the  international community and/or WHO declare the present outbreak of Chikungunya as epidemic, the Government of Bangladesh (Ministry of Health and Family Welfare) will  not accept this situation as epidemic. And the IEDCR or Disease Control Unit of the DGHS are not liable or authorized to declare this situation as epidemic.

Chikungunya fever is not uncommon in Bangladesh. Most of the cases remain undiagnosed or misdiagnosed due to lack of awareness and diagnostic facilities, the self-limiting nature of the disease and, most importantly, the prevalence of another arthropod-borne disease, dengue fever, in Bangladesh. But the concomitant presence of other arthropod-borne infections with similar courses of illness makes most physicians less aware of this infection. Awareness and clinical knowledge are necessary to diagnose chikungunya infection properly. And the IEDCR is not in a position to tackle the Chikungunya epidemic or any epidemic/endemic/pandemic successfully. The Department of Medical Entomology is responsible for vector control activities but at the department of Medical Entomology have only one trained and qualified scientist who joined this Institute in the year of 1993 as Scientific Officer and got no promotion in  life as there is no recruitment rule for the IEDCR since its inception in 1976. Most of the officers working IEDCR are experienced in administration and not interested in research activities with a few exceptions. There are no senior officers at any departments with research backgrounds and like to stay there. The highest authority of the institute is not interested for this recruitment rules as they will not be able to be there. Some times IEDCR is called ‘dumping station’.  The Ministry of Health and Family Welfare accepted a conceptual framework under HNPSP to make IEDCR as an autonomous body a few years ago but no progress has been made so far. Every employee works in an organization looks for a career development which moves in the right direction. Career path taken by an employee determines the growth. Career should be planned in a way that it moves forward. Career development provides the framework with skills, goals, awareness, assessment and performance which helps an individual to move in the right direction and achieve the goals one has in one's career. Lessons from Zika and Ebola crisis Despite progress made since the Zika and Ebola crises, a report released by the International Working Group on Financing Preparedness (IWG), established by the World Bank, shows that most countries are not adequately prepared for a pandemic, and the world is still doing too little to finance recommended actions to strengthen pandemic preparedness. The 2014 Ebola epidemic in western Africa was the longest and deadliest Ebola outbreak in history, resulting in 28,616 cases and 11,310 deaths. At the time, little was known about how to best manage patients to improve survival. There were no approved med¬icines to treat or prevent Ebola, only a few potentially useful agents with limited study. Given the nature of the disease and its high mortality rate, it was not feasible to perform clinical trials to investigate safety or efficacy until a natural outbreak of sufficient size and duration took place. The 2014–2015 Ebola epidemics presented such a situation.

The three countries most affected by the Ebola epidemic—Guinea, Liberia, and Sierra Leone—were ill equipped to re¬spond to or support clinical research during an epidemic. Lack of clinical experience with Ebola and poor surveillance and laboratory capacity hindered attempts to control the out¬break. Collection of patient-level data, which provides critical clues to better patient management, also was a challenge, due to poor health infrastructure and a shortage of health care per¬sonnel. Stakeholders must work collaboratively to improve capacity to collect and share data before an epidemic begins. At the start of an outbreak, developed nations and research funders should provide resources to enable data collection.

Building capacity for research cannot—and should not—be separated from building health systems capacity in general; to be most effective, clinical research needs to be embedded within the health care system. Funders and development agencies should provide resources and assistance for the development of core capacities in low- and middle-income countries. Stakeholders also should work with these     coun¬tries to help them develop capacity to quickly negotiate legal agreements, complete ethics reviews, and develop clinical trial templates to better respond in an epidemic. Research systems should be incorporated into these countries’ emer¬gency preparedness and response systems.

Emerging infectious disease outbreaks can quickly become globalized, calling for a global solution. Better coordination of international research efforts taking place sooner could have led to a safe and effective medicine that might have been deployed during the epidemic—and at the outset of the next one.

A coalition of stakeholders should work during the inter-epidemic period to: advise on and invest in priority patho¬gens to target for research and development, develop generic clinical trial design templates, and identify teams of clinical research experts who could be deployed to assist with research during an outbreak. This international coalition could also discuss and agree on methods to address adminis¬trative requirements that would rapidly become high priority during an outbreak, such as the location and management of a central data repository.

Careful inter-epidemic planning and execution through a well-coordinated and collaborative effort from national, in¬ternational, and local representatives can help ensure that the global community is prepared to answer challenging questions through the conduct of research. Considerable, sustainable investments will be required to achieve this, though the options are to invest now or pay later, when an outbreak strikes. Preparation now will enable moving for¬ward with sound clinical trials that have the best chance of identifying new vaccines and therapies that will improve our ability to respond to infectious disease outbreaks and provide care for future populations. Countries and international development partners all need to recognize the seriousness of pandemics and do their part to pay for preparedness. If we don’t do this now, we will find ourselves losing decades of health and economic gains when we are hit with an infectious disease outbreak.

The ultimate goal of robust pandemic preparedness is universal health security, which means protecting all people from threats to their health. Universal health security is an essential component of universal health coverage--where everyone can obtain the quality health services they need, while not being pushed into poverty by having to pay out-of-pocket for health care costs. Universal health security contributes to and depends on stronger and more resilient health systems, and is critical to achievement of the sustainable development goals.

The writer is former head, department of Medical Sociology, Institute of Epidemiology, Disease Control & Research (IEDCR)

Dhaka, Bangladesh E-mail: med_sociology_iedcr@yahoo.com

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Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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