© 2006-2018 Kasturi & Sons Ltd. -vijay kumar [email protected] - EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE
THE HINDU CHENNAI SATURDAY, JANUARY 26, 2019 GROUND ZERO 15 EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE
dusty road that snakes through areca nut plantations and forests Aleads one to Jegala, a hamlet wedged between the Sharavathy hydel reservoir and the hills of the Western Ghats in Karnataka’s Shivamogga district. Late on Christmas eve, Shwetha J.S., 17, a student and resident of the neigh bouring town of Sagar, came up this road to spend the holidays with her fa mily. In the morning she was at their plantation, taking photographs with her father, Devaraj, 42, who was a farmer, and the farm help, who shimmied up the slender areca tree trunks to harvest nuts. There was also something more — the faint smell of rotting carcass, but this did not dampen her joy. Shwetha had her examinations com ing up in the next few months. She was aware that she could be the fi rst in the family to enrol in an undergraduate course. Her ambition was to get a docto rate degree in agriculture to help her father fi ght the diseases that often rav aged their plantation. After she left for Sagar on December 27, her family scoured the plantation and the nearby woods for the putrid odour that had by then become unbear able. Their search led to a highly de composed carcass of a monkey in a ditch nearby. State forest department and health offi cials then burnt it and doused the area with a strong insecti cide. By this time, however, nymphs, or young ticks , that had feasted on the monkey before its death had already spread. On December 28, Shweta was admit ted to a hospital in Sagar as she was run ning a high fever. She was diagnosed with Kyasanur Forest Disease (KFD), a viral haemorrhagic disease endemic to the region. Better known as ‘Monkey Fever’, KFD is primarily transmitted through ticks — in short, a tickborne zoonotic disease. Doctors treat only the symptoms, for KFD has no known cure. An epidemiological view: “Despite the threat of Kyasanur Forest Disease looming over the district for decades, offi cial responses have been purely reactive.” Picture shows an expert team drawing samples from a rat in
Shwetha’s mother Lata, 37, a tailor the Tirthahalli forest area of Shivamogga district. * VAIDYA and beautician, was trying hard to con trol her panic. Devraj had been diag nosed with KFD too, and was also suff er ing from bacterial l eptospirosis (rat fever). He was taken to Manipal hospi tal, 150 km away, while Lata devoted her Kyasanur’s ticking time bomb time tending to Shwetha, who seemed to be recovering. On January 2, Lata arrived in the hos Reckless human forays into eco-sensitive forest areas and lax public health monitoring have led to a deadly outbreak of Kyasanur Forest pital in the evening, planning to spend Disease, or Monkey Fever, in Karnataka’s Shivamogga district, disrupting normal life and the local plantation economy. Mohit M. Rao the night with her daughter. But, says Lata, choking on her words as she strug reports from Aralagodu, the epicentre of the outbreak gles to talk through uncontrollable sobs, “Shwetha looked at me, and said ‘Am their fi rst dose, while one had been ad Now, the demand is for 70,000 vials. plantations, harvested paddy fi elds, and were cut down for roads, mines and ma, you’re here’. Then she collapsed.” ministered the second dose. The demo But offi cials have only 16,000 vials at around homes. plantations. This brought people into Shwetha went into a coma. On Janu graphic group most vulnerable to KFD hand, with monkey deaths and new in Says Abhijit Kumar, a research assis closer contact with the virus that was #21659 ary 4, she was pronounced dead. are people more than 40 years old. But fection areas being reported daily. Says tant with the Bengalurubased Ashoka cycling naturally between wild animals A day after Shwetha’s visit to the three out of the seven dead are between Kiran, “We just can’t vaccinate a 5 km Trust for Research in Ecology and the and ticks in the forest.” plantation, the Aralagodu Gram Pan 17 and 31 years, suggesting an incredibly radius any more. We are instead focuss Environment (ATREE), “Monkeys are a Nearly every study on the disease so chayat, which encompasses multiple high viral load. ing on a core area of 2 km radius to pre good reservoir for the virus. But rodents far has highlighted the role of forest de hamlets including Jegala, registered its A State H ealth D epartment offi cial vent further outbreaks.” could be the maintenance hosts, ensur gradation in the spread of KFD. Kiran, fi rst case of Monkey Fever death. sums up the situation bluntly: “After the It was only in January that nearly one ing that the virus remains in the ecosys who has helmed multiple research pap Shwetha was the sixth victim in Aralago fi re has broken out, we’re now search lakh vials were procured from the Ben tem through the year.” ers on KFD, says that villagers living du. The toll has since risen to eight. ing for water to douse it.” Interviews galuru institute. Now they are being Five whitebellied rats and shrews are near highlyfragmented forests are with villagers, experts and government tested for potency at the Virus Diagnos trapped. An anaesthetic knocks out the more susceptible to the disease. He An old menace offi cials reveal that the infl ammable cin tic Laboratory in Shivamogga. The hope rodents providing the team a twomi says, “Tick densities remain high in In the current outbreak in the State, at ders of this ‘fi re’ were sighted nearly a and prayer is that the worst is over, as nute window to tabulate physical attri these forests, and with the presence of least 65 people have tested positive for year ago. these vaccines will be available only in butes, draw blood, and collect ticks. monkeys, peacocks, rodents and other KFD, but the number of suspected cases February. Kudige village, categorised by the reservoirs, there is always a chance of —awaiting confi rmation through blood Protocols that failed team as ‘severe’ (which denotes more the disease spilling over to the village. tests — has touched 204. At least 38 In April 2018, one person tested positive The genesis than 10 cases of KFD in fi ve years) for its This risk factor is not given its due in the monkeys have died in the plantations. for KFD, in Bidarur village. As in esta Barely 30 km as the crow fl ies from Ara recent trysts with KFD, is among the 42 health response to KFD.” Aralagodu is the epicentre of the out blished protocol, everyone within a 5 lagodu, a clump of houses separated by sites to be sampled in the region under Shivamogga district has a dismal re break, but infected areas are also being km radius needed to be vaccinated. Ho a road marks where Kyasanur is, which the IndoUK MonkeyFeverRisk project. cord when it comes to forest degrada reported in villages across four districts primary school here. Says Devendra wever, offi cials drove down 5 km from is well aware of its association with KFD. This collaborative initiative of 10 private tion. About 156 sq km of forests were of Karnataka (Shivamogga, Udupi, Naik, the school headmaster and who the infected spot, which, in the undulat As it happens, the village is not much ol and government research institutes and lost here between 2003 and 2017, ac Dakshina Kannada, and Uttara Kanna travels to work from a nearby town, ing landscape, led to the identifi cation der than the disease itself. Huchappa, the State H ealth D epartment seeks to cording to the Forest Survey of India . da) – and in Kerala (Wayanad) and Mah “We tried to convince the parents that of just 500 people. Bidarur was fortifi ed 77, was a boy of 10 when his father optimise forest benefi ts while minimis The district accounts for 70% of Karna arashtra (four cases). the school was safe. But how can we against the outbreak, but Aralagodu, on carved out a small piece of land from ing the impact of KFD. Microbiologists, taka’s denotifi ed forest land and a third KFD virus is no stranger to Shivamog convince them when we ourselves are the other side of the hillock, was left un the Kyasanur forests to set up a house entomologists, epidemiologists, animal of the regularisation applications seek ga, fi rst reported in Kyasanur village in scared to come to the village? ” When protected against a ticking time bomb. and a paddy fi eld. Says Huchappa, “Our health specialists, and social scientists ing the reclassifi cation of forest land as this district, about 30 km from Jegala , classes resumed from January 16, nine Despite the threat of KFD looming ov previous village had become crowded are working together for a better under agricultural land. Mass approval of such back in 1957. The virus belongs to the children showed up. er the district for decades, offi cial res and my father’s generation had no land standing of KFD. applications is a politically lucrative Flaviviridae family, whose other mem All the activity in the village is ponses have been purely reactive. The to till. We had to fi nd a new home. ” Says S.L. Hoti, Director, ICMRNation move that has made the careers of many bers are responsible for causing Yellow centred around the tworoom primary KFD fi eld station was set up in Sagar to Eventually, the hamlet grew in size as al Institute of Traditional Medicine, Be a politician. Fever, Zika and Dengue. Multiple spe health centres (PHC) which areperched monitor monkey deaths and to random the forests receded, giving way to paddy lagavi, and Principal Investigator of the The scope of the MonkeyFeverRisk cies of ticks of the genus Haemaphysalis on a hill. The telephone rings every few ly test ticks. Started by the Rockfeller fi elds and plantations, and the deer project, “Diff erent angles are being project is ambitious: over 15,000 ticks are the principal vectors. Infections minutes and a steady stream of villagers Foundation and researchers of the In scampered away. The monkeys, howev looked at: from the eff ect of rodents and are to be sampled and tested, data from peak between November and March, make their way to meet Nitin Patel, the dian Council of Medical Research er, stayed. But by 1957, they were dying ticks on livestock to human behaviour hundreds of rodents collected, hun which coincides with the larvaenymph resident doctor, with complaints of fev (ICMR), immediately on discovery of in the hordes. in forests. It is a complex disease and dreds of pages of social surveys, and cycles of ticks. er and body pain. the disease, it transitioned from a re American and Indian scientists needs a multidisciplinary eff ort.” creation of landuse maps, microcli But little else can be said with certain The 24yearold doctor was posted search station to a surveillance station thronged the village, believing that The ‘tick team’ had fi rst carried out a mate data to be worked on, and so on, ty. Since 1957, it has fl ared up in sporad here six months ago as part of the year in the years since. But three posts in this these could be the fi rst cases of yellow ‘dragandfl ag’ operation in Kudige. This with each element contributing a piece ic outbreaks Post2013, it has even ex long rural stint which is mandated at the fi eld station have been lying vacant for fever in India. When vaccinated re involves research associates dragging in the complex jigsaw puzzle. panded its range, with fatal end of an MBBS course. nearly a year. The post of ‘District Epi searchers started contracting heamor white sheets of cloth over leaf litter and A preliminary risk map — a map of consequences in Maharashtra, Kerala Initially, things were a bit dull for demiologist’, who tracks diseases in rhagic fevers, it soon became clear that shrubs. Every 10 metres, they peer into the region where the risk of a KFD out and Goa. According to State data, in the him, with most villagers relying on an populations, is being fi lled only now. In the affl iction was something else. KFD the dirtcovered sheets to check for break is shaded diff erently depending past 15 years, KFD has infected 2,067 array of medicinal herbs to treat ail stead, junior offi cers — unvaccinated was discovered, and by 1958, 681 per ticks, which are then collected. They al on the various risk factors — has been people and killed 42. (The International ments. But early in November, Padma and untrained — have been pressed to sons were confi rmed to have been in so collect data on temperature, humidi prepared and is being verifi ed. As data Society for Infectious Disease estimates vathi, 35, from Nellimakki hamlet, came the front lines. fected. Studies estimate that between ty, habitat type, and the presence of in pour in, Purse hopes that they can de 3,836 infections and 98 deaths between down with a fever that refused to sub While vaccines provide only a certain 19572017, 9,594 persons were infected vasive plant species known to host ticks termine which communities are at risk 19992017 through the country.) The side. A few days later, her husband Kom level of protection, they are an impor in 16 districts along the Western Ghats in large numbers. when, where and why. horrifi c spike in the number of deaths in raju, 38, too developed similar symp tant preventive measure. The KFD vac in fi ve States. For now, each day presents a new one village/district in Karnataka, in the toms. They live on the fringes of the cine, which causes acute pain and is not Huchappa was infected in the early <> “It is a complex disease and challenge for those in charge of contain last one month, has taken the civic ad forest on the outskirts of the village. very effi cient, has not been improved outbreaks and spent more than a month needs a multidisciplinary ing the 2018 outbreak. At Aralagodu, vil ministration completely by surprise. Says Padmavathi, a scrawny areca nut upon since the 1990s. Its only manufac in the hospital. He says, “I had high fev eff ort.” lagers are advised to liberally apply in As uncertain as KFD’s spread may be, farmer, “None of the medicines given at turer is the Institute of Animal Health er, I was bleeding, I lost weight. I sect repellent oil on their bodies before S.L. Hoti, what is increasingly clear is that the out the PHC worked. It was a fever unlike and Veterinary Biologicals in Bengalu thought I was going to die.” For reasons Director, ICMRNational Institute of Traditional Medicine, venturing out. There is a ₹ 500 reward break in Aralagodu was aggravated by anything I had experienced.” ru, which otherwise specialises in lives unknown, the disease vanished from Belagavi for anyone off ering information on systemic failures and lax monitoring of A bewildered Patel sent her to a hos tock vaccines. Until September, only the hamlet three decades ago and found monkey deaths. a disease that has lurked in Shivamog pital in Sagar for further tests. On No 35,000 vials had been procured by the pastures elsewhere. He adds, And yet, K.S. Manjappa, 55 looks on at the pro But anger is rising and protests for ga’s fragmented forests for over six vember 24, it was confi rmed to be a case district administration. Junior offi cials people think this is the village that start cess with some curiosity. A decade ago compensation erupt each day. The State decades. of KFD, a disease which had not been assumed that Bidarur’s infection had ed this scourge.” he cleared out a halfacre of forests for government has formed an expert com detected in Aralagudu for 12 years. been dealt with. Now, containing the Until 2013, the disease was largely his acre plantations, while the forests mittee to investigate lapses and offi cials Back after 12 years Says Patel, “It’s been a scramble outbreak is the responsibility of Kiran confi ned to Shivamogga and its neigh themselves remains part of his daily have been suspended. Village leaders Visitors to Aralagodu village are since,” recollecting that his medical col S.K., a Taluk Health Offi cer in neigh bourhood. Since then, it has broken out routine. Like most villagers, his planta have submitted petitions demanding greeted by posters that warn them lege textbooks had just a single para bouring Thirthahalli, who was recently in Wayanad (Kerala), North Goa, and tion is technically considered forest the culling of monkeys. about Monkey Fever. A habitation of graph about KFD. A small group of offi put in charge of the KFD fi eld station in Sindhudurg in Maharashtra. While the land. He says, “We’ve applied to regu Agriculture, their mainstay, has come barely 3,000 people, located a few kilo cials now help him oversee the stream Sagar. His mobile phone rings inces ‘how’ and the ‘why’ remain unclear, larise the land. We’ve been given assu to a halt and vast swathes of plantations metres from the Jog falls, it has been hit of patients. Says Patel, “The outbreak is santly as local leaders who are clearly can the future be predicted? rances from politicians, but nothing has remain unharvested. Says Mahabala Gi hard by the disease. Ambulances ferry diffi cult to contain as forest patches and panicky, demand that their villages be happened so far.” ri, 58, “People are scared to enter plan those with persistent fevers every day to a large number of monkeys create a con vaccinated on priority. “We don’t have Tapping the virus reservoir tations, and we do not want to take the hospitals 150 km away. Government ducive atmosphere for ticks to breed.” enough vaccines to do this,” says the The fi rst rays of the day penetrate the Praying for the rain risk either,” He estimates that he stands vans zip around, reaching out to villag Though a vaccination programme softspoken offi cer. dense canopy of forests that surround At the heart of the Monkey Fever story is to lose about ₹ 3 lakh on account of the ers in remote hamlets to identify and began on November 30, it was too late Last year, when Thirthahalli was the Kudige village, a hamlet close to Thir a cautionary tale of repeated human in unharvested areca nut on his 5 acre test fevers that could potentially be for Aralagodu. The fi rst dose hardly pro focus of a minor outbreak, about thahalli town. The ‘rodent team’ sets cursions into ecosensitive, ecologically farm. He does no t know why KFD has KFD. vides protection, while the effi ciency of 23,000 vials that are needed for a boos out on the chilly morning along a forest rich areas. Says Bethan Purse, Principal taken Aralagodu hostage this year. But Such is the fear that between January the second dose (administered after a ter dose (it bumps up immunity to 82%) path where metal boxes laced with Investigator and scientist at the Centre he knows when it will end. “We will 5 and 15, none of the 49 schoolgoing month) is only of 63% effi cacy. Of the se were procured. But the KFD spectre at sweets serve as baitandcage. The vil for Ecology & Hydrology, Wallingford, pray for early rains. If it pours, the ticks children showed up at the government ven dead, two persons had received Bidarur was lost in paperwork. lage has 60 such traps spread across U.K., “KFD emerged when the forests go away.”
CM M CH-CHE YK