Jaundice: The yellow peril

On September 30, Madhavrao Mule, former general secretary of the Rashtriya Swayamsevak Sangh (RSS) succumbed to a severe attack of jaundice in a Pune hospital. During the last ten months at least one member of every Bombay household has contracted jaundice and many others have had mild attacks without realizing it.And yet, as far as the Municipal Corporation is concerned, there has never been an epidemic ("spurt in incidence" is the official euphemism). And according to them, "the situation is now well under control". Media attention has now dwindled, and in the absence of any reliable figures for jaundice cases, newsmen feel obliged to accept the Corporation's version. The Mayor of Bombay has done his own little bit, and has cheerfully informed the city that it has nothing to worry about.But while this grim charade is being enacted, the epidemic has continued to rage, its fury undiminished by the public health department's whitewash. And there are now new developments that suggest that the existing epidemic will be overtaken by the higher incidence of a more serious and potentially fatal variety of jaundice.The Truth: Said Dr B.M. Amin, head of the pathology department at Bombay Hospital: "Who says the epidemic is over? The corporation has no real way of knowing. Ask the pathologists, ask the doctors, they tell you the truth." Most doctors interviewed by India Today supported Amin. According to Dr Ramik Parikh who practises in Bombay's posh Kamballa Hill area, "more and more cases are being brought in every day. And it is no longer just Hepatitis A, it is now Hepatitis B".Up till now, it had been assumed that the epidemic was caused by the relatively mild Hepatitis A virus. While Hepatitis A causes weakness, yellowing of pupils, difficulty in digestion and all the symptoms commonly associated with jaundice, the disease has a mortality rate of only 0-07 per cent and is not regarded as being unduly dangerous.Hepatitis B, on the other hand, is potentially fatal. "Make no mistake about it," says Dr Gaitonde of the Haffkine Institute, "the disease is a killer, the mortality rate can go up to 10 per cent, and has even been known to rise to 30 per cent. To make matters worse, there is no cross immunity between the two diseases: persons who suffer from Hepatitis A might be struck down by the B virus the next time."No Solution: As there is no treatment for jaundice and no satisfactory vaccine has ever been evolved, everything hinges on the preventive measures taken by the public health department. To begin with, the department ignored reports that jaundice was on the rise.The only figures they have access to are those from the Kasturba Hospital for Infectious Diseases, but these comprise only the tip of the iceberg. As there is no treatment for jaundice, most people do not bother to report to hospitals.Doctors should, in theory, notify the Municipal Corporation of all jaundice cases that they come across, but in practice, they simply do not bother. The public health department's figures usually claim that there are around 500 cases a month, when the real figure is approximately 25 times that number.According to Dr Amin, 25 per cent of people undergoing routine blood checks at Bombay Hospital suffer from jaundice - a staggering figure that suggests that one out of every four persons in Bombay suffers from the disease.Even when the Corporation was finally persuaded about what everyone else took for granted - that urgent measures were required to stamp out the disease - it responded with ineffectual, half-hearted steps. As the Hepatitis A virus is spread through the contamination of food and water by the excreta and faeces of infected persons, the first priority is to ensure that the water supply is kept clean.Polluted Water: The Corporation's attempts to do this were, by their very nature, doomed to failure. Bombay draws most of its water from the lakes on the city's outskirts. Before the water reaches its destination, it passes through miles of pipeline. Many of these pipelines were laid over 50 years ago, and have now rotted and corroded.Drainpipes adjoining the water pipes are also corroded with age. As the city receives water supply for only three hours a day, a vacuum exists in the pipes for the rest of the time. The action consequently draws in faeces from the drains. As a result, nearly all water in Bombay is contaminated by human excreta and is unfit for human consumption.The public health department's preventive measures consisted of asking people to "maintain personal hygiene and dispose of night-soil", and did not even touch the core of the problem. No large-scale overhauling of the city's pipelines has taken place, and the few pipes that the Corporation claims to have repaired represent a negligible fraction of the total problem.Lack Of Money: "What can we do," moans a Corporation employee. "We can only work within our budget. If the pipes are to be repaired, then the Government will have to sanction the money. But which of the politicians care?" Meanwhile, Bombay's upper middle-class also fails to realize the enormity of the problem. It is commonly believed that filtration makes water safe: in fact, it does no such thing. And while boiling does kill the virus, few households bother to boil the water with which the cooking utensils are washed, and rare is the person who brushes his teeth with boiled water. Yet, both are potential sources of infection. "Jaundice is here to stay," says a resigned Dr Amin. "Short of overhauling the pipes, nothing is going to make any difference."Amin's major worry, however, is the Hepatitis B virus, which the public health department is completely ignoring. Unlike the A strain, this is not spread by contaminated water. In most recorded outbreaks, the virus has been spread through the transfusion of infected blood, or through the use of unsterilized syringes.While Amin has traced the source of infection in many cases to injections of gamma-globulin intended, ironically, to be a preventive measure. He is still mystified by the fact that the disease seems to attack entire families at the same time. One plausible theory is that jaundice is spread by bed bugs, the virus being passed on to the bugs when they bite an infected person.Should further research bear him out, the prospects appear terrifying. With Hepatitis A threatening to contaminate the water supply and the seemingly innocent bed bug assuming a more sinister form, the yellow peril seems to have set itself up for a long and malevolent reign.Published By: AtMigration Published On: Mar 15, 2014 08:15 IST--- ENDS ---

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Jaundice: The yellow peril

On September 30, Madhavrao Mule, former general secretary of RSS succumbed to a severe attack of jaundice in a Pune hospital. During the last ten months at least one member of every Bombay household has contracted jaundice and many others have had mild attacks without realizing it.

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