No caution in Dhaka even as adenovirus runs rampant in Kolkata

Many people, including children and the elderly, are visiting the Dhaka hospitals with symptoms similar to those of adenovirus, a virus that recently ran rampant in the Indian city of Kolkata.

Following the coronavirus pandemic, Kolkata residents are now suffering from another respiratory disease caused by the adenovirus.

Most of the patients are children, and the death toll has already crossed 10.

Hospitals are full of adenovirus patients who require ventilation and also intensive care. Adenovirus is not a novel virus, but its prevalence has been 'severe' in Kolkata recently.

An infection of adenovirus manifests symptoms similar to those of COVID-19 -- runny nose, cough, fever and upset stomach. But the infected become sick quickly, and it may affect the respiratory system.

While the Kolkata health administration geared up to combat the virus, Bangladesh has yet to take any precautions despite many children visiting hospitals with symptoms similar to the adenovirus infection. The director of a children's hospital in the city said they lacked the facility for medical tests to determine adenovirus cases.

A director of the Institute of Epidemiology, Disease Control and Research (IEDCR) admitted they had no surveillance system for adenoviruses and were unaware of how the patients got infected or how many of them manifesting the symptoms actually contracted the pathogen.

It is essential to know whether those who have the symptoms contracted the adenovirus. Bangladesh faces a high risk if the pathogen has already spread in Kolkata, said Nazrul Islam, a virologist.

THE SITUATION IN KOLKATA

At least 16 of the 26 viral pneumonia patients at Kolkata Medical College were found infected with adenovirus, and four of them died.

In Kolkata, the adenovirus death toll stands at 11, including children. Hospitals are overloaded with cases, and two children are sharing a bed in some hospitals.

After a teenage girl died from adenovirus infections in Kharagpur, health service providers were given directives to manage adenovirus patients. Those suffering from fever, respiratory distress, or cold and cough, should be hospitalised soon, the authorities said. It is mandatory to run a PCR test on those showing symptoms of adenovirus.

Kolkata had previously experienced the virus earlier, but why is it so severe this time? Authorities are still trying to figure it out. Currently, there is no evidence of a new strain following a mutation. But a 'recombinant virus' could evolve after a mixture of two strains or serotypes, they said.

SAME SYMPTOMS, NO 'CONCERN' FOR BANGLADESHI PATIENTS

Children are crowding Dhaka Shishu Hospital with fever, cold and respiratory complaints.

Faisal Mahmud from Mohammadpur brought his son Junaid with a cough, cold and respiratory distress, to the Shishu Hospital on Monday. The doctors asked him to hospitalise the boy, but no bed was available. Junaid took his son to a private hospital and returned to Shishu Hospital on Wednesday.

His child had a high temperature ranging from 102 to 103 degrees Fahrenheit and then started having breathing trouble, Junaid said.

Tongi resident Sanjida Akter brought her one-and-a-half-year-old son Safayat Hossain to the hospital. "He's had a fever and cold for the past few days. That's why I brought him here. The doctor asked for an X-ray to investigate what's troubling him," she said.

Rowshan Ara was holding an oxygen mask on her grandson's mouth at the hospital's emergency department.

"My grandson got pneumonia after a fever. He needs the gas [oxygen] as he has trouble breathing,” said Rowshan from Kamrangir Char.

Patients with respiratory tract ailments come to the hospital mostly at the beginning and the end of winter, said Prof ASM Naushad Uddin Ahmed, acting director of the hospital. "It could be adenovirus or other viruses. But we don't have the facility to run a test to identify the virus at Shishu Hospital."

"To know how far the disease has spread in Bangladesh, we must run the vectorological and virological tests,' said IEDCR adviser Mushtuq Husain.

Prof Md Nazrul Islam, a virologist, also highlighted the need for medical tests. "It's important to know if they are the sub-variants of the virus that has spread in Kolkata. If we have patients with similar symptoms in Bangladesh, we must run tests on them,” said the former vice chancellor of the Bangabandhu Sheikh Mujib Medical University.

IEDCR Director Prof Tahmina Shirin said the institute had no 'surveillance' system for the adenovirus.

"Therefore, we can't say how people contracted the pathogen or how many people were infected with adenovirus in Bangladesh," she said.

Usually, the IEDCR or other research institutes inform the Directorate General of Health Services when there is a need for cautionary measures regarding any virus, and the directorate takes the necessary steps, said Prof Md Nazmul Islam, director of the infectious diseases department at DGHS.

"The DGHS follows the issue when an infectious disease occurs in a neighbouring country. It takes precautions if there's a chance for the disease to enter Bangladesh. Also, the doctors always inform them if they notice any symptom distinct from those previously seen in the country," he said.

When asked why there was no surveillance despite the symptoms of adenovirus prevalent in the country, the director replied that any new symptom would fall under the surveillance of someone. "When doctors inform us about any suspected new disease, we take all necessary measures to fight it."

'HIGH CHANCE OF SPREADING ACROSS BANGLADESH'

The Kolkata variant of the adenovirus may invade Bangladesh due to its close connectivity with India, especially West Bengal, according to Prof Nazrul Islam.

"We can't get away from it. Coronavirus cases have dropped after everyone got vaccinated, but people won't be spared from emerging diseases, especially viral ones."

Adenovirus is a worldwide pathogen, but Kolkata could be experiencing a new wave of it, said IEDCR adviser Mushtuq Husain. "This virus exists in Bangladesh but not on a large scale."

SYMPTOMS AND HOW THE VIRUS SPREADS

Adenovirus symptoms are similar to that of the coronavirus. Common symptoms include coughing and colds, fever, sore throat, intense bronchitis, pneumonia, and conjunctivitis, said doctors. Also, it affects the intestines, leading to diarrhoea, nausea, and stomach ache.

Urine infection and neurologic diseases like brain and spinal cord ailments may happen, but they are not common.

People contracting the virus may suffer from moderate to severe illness. Those with a compromised immune system or respiratory and cardiac diseases are part of the high-risk group. The elderly and children are more likely to catch it due to their lower levels of immunity.

The adenovirus can transfer from human to human. The US Centers for Disease Control and Prevention identified the following ways of virus transmission: physical contacts like touch and handshakes, coughs and sneezes that make the virus airborne, touching the mouth, nose and eyes without washing hands after touching a surface with adenoviruses on it, and coming in contact with faeces of infected children.

An adenovirus patient may spread the pathogen long after their recovery, according to the CDC. Patients with lower immunity and those who are asymptomatic may spread it further.

PREVENTION AND TREATMENT

The CDC highlighted some measures to prevent the disease.

• Wash hands for at least 20 seconds with soap and water.

• Do not touch the eyes, nose and mouth with dirty hands.

• Avoid infected people.

• Stay at home when infected.

• Cover your nose and mouth while coughing and sneezing.

• Refrain from using other's utensils like cups and plates.

• Do not kiss others when infected.

• Wash hands for 20 seconds with soap after using the toilet.

No dedicated treatment plan or antiviral medicine exists to treat the adenovirus and some patients may need hospitalisation and intensive care.

Most cases of adenovirus are mild, and the patients can recover with proper rest and care. Antipyretic drugs may help to reduce the symptoms but should be taken after consulting a doctor.

"This viral disease goes away in four days if a patient takes medicine. Otherwise, it may linger for a maximum of one week," said Mushtuq Husain.

Vaccines for adenovirus type 4 and type 7 are available in the US, but only those who have contracted both types before and the high-risk group in the army receive the vaccine.