• With the spread of leptospirosis, cleaners and disaster recovery assisters note lack of precautions and awareness
• Farmers orgs. urge improved community-health services in farming villages to disseminate knowledge and distribute medicines

With a spate of fever cases being reported from Jaffna during the past few weeks and the health authorities’ warning about the spread of leptospirosis (commonly known as rat fever), Sri Lanka’s forgotten discussion on the prevalence and seriousness of rat fever has re-emerged. 

According to the health authorities, the recent rainy season has exacerbated the risk of the spread of rat fever in the country. They note that while certain groups such as farmers can be identified as at-risk groups, all persons that come into direct physical contact with contaminated water or soil should be careful. As the country has surpassed the total number of rat fever cases reported last year (2023), the health authorities have raised the importance of taking precautions and being vigilant about early symptoms of the disease.

Weather and rat fever

These concerns attracted national level attention in a context where the health authorities had cautioned that the prevailing weather has created a situation that is favourable for the spread of rat fever, noting that it calls for steps such as proper waste management and maintaining clean environments in order to reduce the spread of animals such as rats.

Last week, in the backdrop of the fever cases reported from Jaffna, the Health Ministry’s Epidemiology Unit’s Dr. Kumudu Weerakoon said that in a context where there are many groups whose professions involve coming into physical contact with soil and water contaminated by the bacteria that causes rat fever, both precautions and prompt responses to early symptoms are necessary. She pointed out the importance of taking seriously the early symptoms of the disease, which some may consider to be insignificant. 

Highlighting farmers as a key group that is facing the risk of contracting rat fever due to the nature of their profession, Dr. Weerakoon added that the recent rainy period has posed a threat to other groups including those working in flood affected areas and those engaged in jobs near water bodies and muddy areas. Preventing direct physical contact with water and mud was recommended. 

“It is not only those engaged in paddy cultivation who are in a high-risk situation,” she stressed, adding that regardless of one’s profession, if one is coming into direct contact with potentially contaminated water or soil, they should be vigilant.

According to the health authorities, around 10,000 rat fever cases have been reported thus far this year, and this number has already surpassed the number of cases reported last year which was around 9,000. In this context, they noted, it is crucial to take the prevailing increase in cases seriously. They advise the people to remain vigilant about early symptoms and to take precautionary measures.

High-risk groups’ experience

Several persons engaged in various activities that involve working in and near water bodies described to The Daily Morning how they are facing an increased risk of contracting rat fever and also how the nature of their activities impacts their ability to protect against rat fever.

A 40-year-old individual engaged in cleaning wells for a living, Narada (name changed on request) said that despite the abovementioned rat fever-related risks, it is essential to continue his job to make ends meet. Acknowledging the importance of being careful during work, he added that practical aspects of his job however require him to take risks. “My job involves coming into direct contact with water. In many cases, these wells have not been used for some time and they have stagnant water, which I think poses a higher risk. I understand that there are risks. But, this is not a job that can be conducted without taking that risk,” he said, adding that he will have to clean more wells in the coming few weeks due to the recent floods which has added mud to many wells. In response to the question as to whether he has been contacted by any healthcare workers or whether he is taking any medicines as a precautionary measure, Narada added: “I know that there are awareness raising programmes. I wanted to attend these, but I was unable to due to various reasons. I am not taking medicinal precautions. But, I refrain from getting into wells when I have a wound, and I make sure that I clean my body, especially hands and legs, with anti-bacterial soap once my job is done. I often drink a coriander seeds-based drink (koththamalli), which I am sure improves health against diseases. So far, these steps have protected me.” However, according to Narada, there are many people engaged in cleaning wells that do not adopt any of these precautions who he said should be educated about these risks.

Meanwhile, a 28-year-old person who joined a flood assistance programme during the recent floods, Sandaru Rathinda opined: “It is true that rat fever poses a considerable risk. But, when providing assistance during an emergency situation such as floods, there is little room to think about such. Floods require urgent action, and there are a plethora of activities that need to be coordinated even if our assistance is limited to something such as providing cooked food. In such a context, given also the fact that we are not trained professionals but are ordinary people, most of us don’t pay much attention to such health risks.”

Such concerns are prevalent among farmers as well, who have been identified by the health authorities as a high-risk group. According to the National Agrarian Unity organisation, farmers not paying adequate attention to and not having adequate knowledge about rat fever-related health risks is a major challenge. “They don’t understand the dangerous nature of this situation, and, as a result, many farmers are not adhering to the instructions pertaining to the prevention of rat fever,” its President Anuradha Thennakoon expressed concerns. “In areas where farming activities are conducted both in the Yala and Maha seasons, the spread of rat fever remains low because farming in both the seasons creates a situation unfavourable for rats. However, when it comes to paddy fields that are used for farming only in certain farming seasons, such as those located in the Gampaha, Kegalle, Matara, Galle, and Badulla areas, they are facing a higher risk of the spread of rat fever. In other words, low country paddy fields face a higher risk than those located in the dry zone. If more concrete solutions are not provided, even the areas in which farming activities take place in both the farming seasons may also be affected.” According to Thennakoon, although the authorities have taken certain steps, they should be expanded to reach the overall farming community. Adding that a medicinal pill is issued to help farmers protect against rat fever, he said that some farmers have not received this pill and that farmers in general are less likely to voluntarily visit the relevant Medical Officer of Health offices and obtain this pill. To address this situation, he proposed to improve community health services in farming villages, especially during farming seasons, in order to provide the relevant knowledge and medicines to farmers.

Precautions and symptoms

Adding that revealing to health professionals the risky conditions in which one functions is important for effective treatment, last week, Dr. Weerakoon advised the people to avoid bathing in unknown and potentially unclean bodies of water, and to avoid dirty and unclean water, especially if they have wounds.

Rat fever is a health concern globally as well. Among the internationally accepted precautions to protect against rat fever are wearing waterproof boots and gloves when working in potentially contaminated water or soil, avoiding direct contact with animal urine, disinfecting the equipment and clothing that come into contact with potentially contaminated water or soil, vaccinating animals (including livestock and pets) as recommended, keeping environments clean especially to destroy and prevent the creation of conditions that are favourable to rodents (rodents include rats, mice, squirrels, and hamsters), and not wading into unknown water bodies.

Among the most common symptoms of rat fever are fever, headaches, muscle and/or join aches, chills, vomiting, and swollen lymph nodes near the bite if an animal bite has occurred. Authorities advise that upon the detection of these symptoms, especially if the person has come into direct physical contact with water bodies, medical assistance should be sought immediately. At the same time, they raise the importance of providing accurate information about any underlying medical conditions to medical professionals as rat fever may have an impact on other medical conditions and various parts of a person’s body.