West Nile Virus

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What is West Nile Virus?
  • West Nile Virus is a viral infection which typically spread by mosquitoes and results in neurological disease as well as death in people.
  • The Virus is the member of the flavivirus genus and belongs to the Japanese encephalitis antigenic complex of the family Flaviviridae.
  • It was first detected in a woman in the West Nile district of Uganda in 1937 and was later identified in birds (crows and Columbiformes) in the Nile delta region in 1953.
Spread of Disease
  • The disease spreads through mosquito bites.
  • Mosquitoes are infected when they feed on infected birds.
  • The virus then circulates in blood and multiplies.
  • The virus also travels to salivary glands from where it is injected into humans as well as animals through mosquito bites.
  • There have been no reports of human-to-human transmission through casual contact till date.
  • But a small proportion of human infections have reported through organ transplant, blood transfusions and breast milk while one case of transplacental.
Symptoms
  • People infected with WNV suffer from fever, headache, fatigue, body aches, nausea, vomiting, occasionally with a skin rash (on the trunk of the body) and swollen lymph glands.
  • In case of severe West Nile disease, the patient suffers from headache, high fever, neck stiffness, disorientation, stupor, coma, tremors, convulsions, muscle weakness and paralysis.
  • One in 150 persons infected with the virus will develop a severe form of the disease, according to the World Health Organisation (WHO).
  • There are no vaccines to prevent or medications to treat the infection.

Dengue

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  • Dengue is a vector-borne disease transmitted by the bite of an infected female Aedes Aegypti mosquito.
  • The mosquito becomes infected when it feeds on the blood of a person infected with the virus. After about one week, the mosquito can then transmit the virus while biting a healthy person.
  • There are 4 serotypes of the virus that causes dengue. These are known as DEN-1, DEN-2, DEN-3, DEN-4.
  • Infection with one strain will provide life-time protection only against that particular strain. However, it is still possible to become infected by other strains and develop into severe dengue.
  • Dengue cannot be spread directly from person to person. However, a person infected and suffering from dengue fever can infect other mosquitoes.
  • Most cases occur in tropical areas of the world, including the Indian subcontinent, Southeast Asia, Southern China, Taiwan, the Pacific Islands, the Caribbean, Mexico, Africa, Central and South America.
  • Dengue causes flu-like symptoms and lasts for 2-7 days. Dengue fever usually occurs after an incubation period of 4-10 days after the bite of the infected mosquito.
  • High Fever (40°C/ 104°F) is usually accompanied by at least two of the following symptoms: headaches, pain behind eyes, nausea, vomiting, swollen glands, joint, bone or muscle pains and rash.
  • There is no vaccine or specific medication for dengue fever. Patients should seek medical advice, rest and drink plenty of fluids.
  • As a precautionary approach, patients can adopt measures to reduce transmission by sleeping under a treated net especially during the period of illness with fever.
  • Aedes aegypti is a daytime feeder. The peak biting periods are early in the morning and in the evening before dusk.
  • Aedes aegypti has evolved into an intermittent biter and prefers to bite more than one person during the feeding period. This mechanism has made Aedes aegypti a very highly efficient epidemic vector mosquit

Diphtheria

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  • Diphtheria is a severe communicable and bacterial infectious disease that causes inflammation of the mucous membranes by forming a false membrane in the throat which creates a problem while swallowing food and during breathing.
  • It can also damage nerves by a bacterial toxin present in the blood. Currently, this syndrome is rare in developed countries. This disease spreads easily from one person to another but can be prevented by the use of vaccines.
  • The signs of diphtheria appear in a short period of time within three to five days after the infection has occurred. Some people do not feel any symptoms, while others do feel slight symptoms of a common cold. The most common and visible symptom of diphtheria is gray, thick covering on the tonsils and throat.
  • The first step in treating diphtheria is an antitoxin injection. This is used to minimize the effect of toxin produced by the bacteria. The doctors also prescribe antibiotics, such as erythromycin and penicillin to clear the infection. During the treatment, patients are instructed to stay in the hospital in order to avoid the spread of infection to others.
  • Diphtheria can be prevented to an extent by the use of vaccines and antibiotics. The vaccines for diphtheria is called DTaP. It’s normally given in a single shot with vaccines for diphtheria, tetanus, and pertussis

 

Hepatitis E

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  • Hepatitis E is a liver disease caused by infection with a virus known as hepatitis E virus (HEV).
  • Every year, there are an estimated 20 million HEV infections worldwide, leading to an estimated 3.3 million symptomatic cases of hepatitis E.
  • WHO estimates that hepatitis E caused approximately 44 000 deaths in 2015 (accounting for 3.3% of the mortality due to viral hepatitis).
  • The virus is transmitted via the faecal-oral route, principally via contaminated water.
  • Hepatitis E is found worldwide, but the prevalence is highest in East and South Asia.
  • Two different patterns are observed, where hepatitis E is found in: resource-poor areas with frequent water contamination; and areas with safe drinking water supplies.
  • A vaccine to prevent hepatitis E virus infection has been developed and is licensed in China, but is not yet available elsewhere.
  • Prevention is the most effective approach against the disease. At the population level, transmission of HEV and hepatitis E disease can be reduced by:
    1. maintaining quality standards for public water supplies;
    2. establishing proper disposal systems for human feces.
  • On an individual level, infection risk can be reduced by:
    1. maintaining hygienic practices such as hand-washing with safe water, particularly before handling food;
    2. avoiding consumption of water and/or ice of unknown purity; and
    3. adhering to WHO safe food practices.

MCI : Ordinance to supersede MCI

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Context:

  • In a move to enhance governance and quality of medical education, an ordinance was issued dissolving the Medical Council of India (MCI) and replacing it with a seven-member Board of Governors led by NITI Aayog Member Dr. V.K. Paul.
  • The Ordinance supersedes the MCI and the powers of the Council have been vested in a Board of Governors (BoG).
  • The BoG will continue to perform till a council is constituted.

 

Why Ordinance was needed?

  • The National Medical Commission (NMC) Bill, 2017 to replace the MCI with a National Medical Commission is pending in Parliament.
  • The Bill was taken up for consideration in January this year and was referred to the Department-related PSC on Health and Family Welfare for examination.
  • The PSC presented its 109th Report on the Bill to the House in March, and the Ministry, after examining the recommendations, obtained approval of the Cabinet for moving official amendments.
  • Meanwhile, the Supreme Court, in its judgment in May 2016, issued directions to the Centre to constitute an oversight committee with the authority to oversee all statutory functions of the MCI till a new legislation comes in.

 

Features of the Bill

  • The Bill provides for simplification of procedures and was aimed at spurring rapid growth in the number of Under and Post Graduate medical seats in the country.
  • The NMC Bill provides for distribution of functions among four autonomous Boards, whose members would be persons of proven ability selected through a transparent process.

Ayushman Bharat : Analysis

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Context:

  • Universal health coverage is getting prioritised as a part of political reform with the launch of two pillars.

 

Current state of Healthcare:

  • Poor condition of healthcare in country; Lack of infrastructure;
  • Poor health services in government hospitals; Private hospitals out of reach of most people.
  • According to the Global Burden of Disease study, India is ranked low in the Healthcare index; India stands at a rank of 154.
  • But despite this, the budget allotment on healthcare services is extremely low. India spends less than 2% of her GDP on public healthcare.

 

Ayushman Bharat:

  • The National Health Protection Mission or Ayushman Bharat Yojana, launched by the Government is the first major step.
  • Ayushman Bharat Yojana is a program which aims to create a healthy, capable and content new India.
  • It will also focus on the poor and weaker sections of the society.
  • It aims to provide insurance of up to 5 lakh rupees to each family.
  • The new scheme also intends to improve secondary and tertiary healthcare services for crores of Indians.

 

There are two flagship initiatives under Ayushman Bharat:

  1. Pradhan Mantri Jan Arogya Yojana (PMJAY):
    • Under this scheme, 1.5 lakh health sub-centres are being converted into health and wellness centres.  
    • It will bring the healthcare system closer to the people.
    • The centres will provide comprehensive healthcare, including treatment for non-communicable diseases and maternal and child health services.
    • Besides this, they will also provide free essential drugs and diagnostic services;
    • Rs. 1200 crore have been allocated for this flagship programme. 
    • The scheme will cover more than 10 crore poor families, which is approximately 50 crore persons.
    • It will also setup wellness centres which will give poor people OPD facility near their homes. 
  2. National Health Protection Scheme:
    • The National Health Protection Scheme will cover over 10 crore poor and vulnerable families.
    • It will provide coverage up to 5 lakh rupees per family, per year for secondary and tertiary care hospitalization.

 

Best health care at the lowest possible cost should be:

  1. Inclusive
  2. make health-care providers accountable for cost and quality
  3. achieve a reduction in disease burden, and
  4. eliminate catastrophic health expenditures for the consumer.

 

Criticism of Ayushman Bharat:

  • Currently, the NHPM is pushing for hospitalisation at secondary,  and at tertiary-level private hospitals, while disregarding the need for eligible households to first access primary care, prior to becoming ‘a case for acute care’.
  • It is important to note that without the stepping stone of primary health care, direct hospitalisation is a high-cost solution.

 

Problem of constraints:

  • Public sector health capacities are constrained at all levels.
  • Further, forward movement is feasible only through partnerships and coalitions with private sector providers.
  • It is important to note that these partnerships are credible only if made accountable.
  • It has been suggested that Health-care providers (public/private) should be accredited without any upper limit on the number of service providers in a given district.

 

Need of a holistic approach:

It is believed that one must bring together all relevant inter-sectoral action, linking health and development, so as to universalise the availability of:

  1. clean drinking water,
  2. sanitation,
  3. garbage disposal,
  4. waste management,
  5. food security,
  6. nutrition and
  7. vector control.

Further, the Swachh Bharat programme must be incorporated in the PMJAY.  These steps put together will reduce the disease burden.

 

Way Forward

  • A public education media campaign could highlight the merits of personal hygiene and healthy living.
  • The States of Kerala and Tamil Nadu have demonstrated that high-performing, primary health-care systems do address a majority of community/individual health needs.
  • The health and wellness clinics must connect with early detection and treatment.
  • It is believed that robust delivery of preventive, clinical and diagnostic health-care services will result in early detection of cancers, diabetes and chronic conditions, mostly needing long-term treatment and home care.
  • This would further minimise the demand for hospitalisation.
  • In conclusion, investment in primary care would very quickly reduce the overall cost of health care for the state and for the consumer. Technology and innovation are further reducing costs. AI-powered mobile applications will soon provide high-quality, low-cost, patient-centric, smart wellness solutions. Currently, the scaleable and inter-operable IT platform being readied for the Ayushman Bharat is encouraging.

Rabies

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  • Rabies is viral disease that causes inflammation of brain (acute encephalitis) in warm-blooded animals.
  • It is zoonotic disease i.e. transmitted from one species to another, commonly by bite or scratch from infected animal such as dogs to humans.
  • The rabies virus infects central nervous system (CNS) and ultimately causes disease in brain and death.
  • Domestic dogs are most common reservoir of rabies virus.
  • Dog-mediated rabies accounts for more than 95% of human deaths.
  • Its symptoms include neurological problems and a fear of light and water.
  • Vaccination of pets helps to prevent and control rabies.

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Ischaemic heart disease

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  • Ischaemic (or ischemic) heart disease is a disease characterized by reduced blood supply to the heart.
  • It is the most common cause of death in most western countries.
  • Ischaemia means a “reduced blood supply”.
  • The coronary arteries supply blood to the heart muscle and no alternative blood supply exists, so a blockage in the coronary arteries reduces the supply of blood to heart muscle.

Non Communicable Disease

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  • A non-communicable disease is a non-infectious health condition that cannot be spread from person to person. It also lasts for a long period of time. This is also known as a chronic disease.
  • A combination of genetic, physiological, lifestyle, and environmental factors can cause these diseases. Some risk factors include:
    1. unhealthy diets
    2. lack of physical activity
    3. smoking and second hand smoke
    4. excessive use of alcohol
  • Noncommunicable diseases kill around 40 million people each year. This is about 70 percent of all deaths worldwide.
  • Noncommunicable diseases affect people belonging to all age groups, religions, and countries.
  • Noncommunicable diseases are often associated with older people. However, 15 million annual deaths from noncommunicable diseases occur among people aged 30 to 69.
  • More than 85 percent of these deaths occur in low- and middle-income countries and in vulnerable communities where access to preventative healthcare is lacking.
  • Some noncommunicable diseases are more common than others. The four main types of noncommunicable diseases include cardiovascular disease, cancer, chronic respiratory disease, and diabetes.

 

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e-cigarettes and ENDS

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  • ENDS are devices that heat solution to create aerosol, which also frequently contains flavours, usually dissolved into propylene glycolor and glycerin.
  • e-cigarettes (electronic cigarettes) are most common prototype of ENDS.
  • These devices do not burn or use tobacco leaves but instead vaporise solution, which user then inhales.
  • ENDS solutions and emissions contain other chemicals, some of them considered to be toxicants.
  • They contain nicotine, addictive component of tobacco products.
  • In addition they contain metals, including lead, chromium and nickel and chemicals like formaldehyde with concentrations equal to or greater than traditional cigarettes.
  • Use of ENDS may affect development of foetus during pregnancy.
  • It may contribute to cardiovascular disease to people who use ENDS.
  • Moreover, nicotine may function as ‘tumour promoter’ and seems to be involved in biology of malignant diseases.
  • Foetal and adolescent nicotine exposure have long-term consequences for brain development, potentially leading to learning and anxiety disorders.
  • Why in news?
    • Union Ministry of Health and Family Welfare issued advisory to all states and Union Territories to not allow manufacture, sale and advertisement of e-cigarettes and other Electronic Nicotine Delivery Systems (ENDS).
    • It also has issued warning that use e-cigarettes and other ENDS devices pose great health risk to public at large, especially to children and pregnant women.

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