Dr.T.V.Rao MD
Department of Microbiology
Jubilee Mission Medical College and Research Centre
Trichur


Despite the success in control of many infectious diseases, a wide range of microbes still threatens the human health. Somehow Pandora box of infection is opened and continues to be a challenge. The unexpected emergence of Novel pathogens named as emerging and reemerging infectious diseases continue to strike any time, at any place. Before we learn about it, they disappear and make a dent on human health and social structure. Above all we live in an unpredictable nature - no rain, unwanted rain, and untimely cyclones - many attributed to global warming. Inspite of several scientific advances, we are controlled by nature. Recently we have experienced several communicable diseases like Chikungunya, Dengue, Leptospirosis, Hepatitis A and E. Chikungunya championed the list of microbes; produced fear, death, social unrest and political turbulence. Sudden emergence of epidemics exposed the facts that how vulnerable we are and how poorly we coordinate to overcome the problems. The world is rapidly changing, so are the microbes, as is the Chikungunya virus which originated in Africa, not a fatal disease to begin with a very few crippling complications. When the virus traveled to Kerala and other parts of India, became more vengeful, produced many cases of chronic morbidity and mortality. After 4 months of epidemic (October 2007) it subsided on its own. Today we do not know where it is hiding or when is the next date of reemergence.

In view of excessive urban migration narrow conditions of living initiates the epidemics. It is observed that we struggle to live and neglect the society. This remains the source of starting point. Epidemics frighten the society and infections attacking the young, old and pregnant women are a great concern to medical profession. In particular pregnant women have a changing physiology and immunity and are susceptible to or more prone to infectious diseases. The paradox of pregnancy may induce a state of increased susceptibility to certain virus, intracellular bacteria and parasites. One has to realize that any infection during pregnancy is a serious concern to preserve the health of mother and fetus and appropriate timely treatment must be provided. The ideal purpose of motherhood of giving love and wisdom has changed in the women infected with HIV/AIDS. And women transmit virus to their unborn babies. It is becoming the responsibility of the treating physician to screen the pregnant women for HIV antibodies to practice preventive and curative intervention to reduce perinatal HIV transmission.

To add to the existing epidemics, we have a serious challenge with Tuberculosis. At present several patients present with Tuberculosis in association with HIV/AIDS. Non compliance, irregular adherence to treatment regimen leads to multi drug resistant Tuberculosis (MDR - TB) strains. We have several medical colleges, reputed medical institutions but we have no up to date facilities to deal and diagnose drug resistant tuberculosis. If we do not wake up and control the multidrug resistant strains, it will be much difficult to control X MDR tuberculosis strains (X MDR- resistant to even second line of antibiotics). The Pandora box of infection is narrow and deep. The question to control the infections remains with health education, hygiene, political will and committed physicians. There is an emerging need to establish referral diagnostic centers committed to research to identify and notify on events of infectious diseases. But it is certain there are no short cut solutions or magical ideas to control epidemics. Are we united to control the Epidemics? Who will close the Pandora's box of infection?

The best solutions to control Epidemics are

1Coordinated scientific approaches
2Continuous monitoring of environment for prevalence of sub clinical infections
3Referral Virology laboratories to overcome all diagnostic problems and precise diagnosis to clarify all controversies
4Above all mass education on hygiene, simple social hand washing by all citizens.
5A simple commonsense to protect the environment.

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