With the onset of the much-awaited monsoon season, the melodies of the falling rain are often overshadowed by the monsoon maladies. The monsoon season is characterised by a higher incidence of viral, vector-borne, food-borne and skin infections among children, which lead to frequent visits to the pediatrician and absence from school, increasing the woes of parents and caretakers.

In an interview with HT Lifestyle, Dr Mahesh Hiranandani, MD, Head – Department of Paediatrics at Cloudnine Group of Hospitals in Chandigarh, highlighted the monsoon maladies to watch out for -

1. Viral infections:

Viral infection affect the respiratory and gastrointestinal systems leading to fever, cold, cough, throat irritation, vomiting, and diarrhoea. Though most of these infections are mild and self-limiting, they may cause complications like pneumonia and dehydration, especially in infants and newborn babies. Self-medication, especially the use of antibiotics should be strictly avoided for they lead to side effects and the development of antibiotic resistance, an emerging and serious problem worldwide. In case the child has a high fever for more than 3 days, persistent vomiting, profuse watery diarrhoea, scanty urination, rapid and laboured respiration, and difficulty in feeding, it is essential to visit the doctor for treatment. Most viral infections can be prevented by good hand and food/water hygiene. Immunization with the flu vaccine protects against four strains of the influenza virus that can cause severe respiratory infections, especially in children less than 5 years old and those suffering from asthma. It is recommended yearly for all children > 6 months and < 5 years of age.

2. Infective diarrhoea:

Infective diarrhoea strikes in monsoons with the child passing multiple watery, foul smelling and blood-stained stools. Some children can have high grade fever and vomiting too that can result in dehydration which is the main cause of increased mortality. This is one indication for treating the child with appropriate antibiotic along with probiotics and Zinc.

• Typhoid fever is a common water and food-borne bacterial infection in the monsoon months. Fever, abdominal pain, headache, and loss of appetite may last for weeks and be associated with complications involving all organ-systems, especially in unimmunized children. Two doses of the typhoid vaccine can decrease the severity of this infection.
• Hepatitis A and E are highly contagious, viral liver infections, affecting unimmunized children and leading to fever, vomiting, abdominal pain, and jaundice. They are transmitted through viral contamination of drinking water and uncooked food, especially unhygienically cut fruits and fresh fruit juices. Though self-limiting, they may occasionally lead to liver failure and coma. Two doses of Hepatitis A vaccine provide 100% protection. No vaccine is available for Hepatitis E.
• Malaria, transmitted by the bite of the female Anopheles mosquito, usually at night, leads to high fever with chills and rigors, usually 10-12 days after a mosquito bite. The fever can cause life-threatening complications affecting the liver, brain, and kidneys. Children living in endemic areas can have severe anaemia and failure to thrive. Research is ongoing for the development of a malarial vaccine, till then, avoiding mosquito bites and destruction of malarial larvae is the most important modality of malaria prevention. This can be accomplished using mosquito repellents, nets, and appropriate clothing for children. All collections of stagnant water should be drained or treated with oil to destroy the larvae.
• Dengue fever results from the bite of the Aedes mosquito, during the day. The predominant symptoms are high fever, body aches, headache, and pain behind the eyes. The rash may appear within 48-72 hours and there may be a fall in the platelet count. In children with a previous history of dengue fever, the illness may be biphasic with recurrence of fever, rapid pulse, low blood pressure, and bleeding in the skin, urine, stool, and gums due to a significant fall in platelet count. This is dengue haemorrhagic fever, a medical emergency requiring urgent hospital admission. Preventive measures are the same as for malaria. A dengue vaccine is in the pipeline and should be available soon, especially for those with a history of dengue fever.
• Japanese encephalitis (JE), as the name suggests is a brain fever due to a virus transmitted by the bite of the Culex mosquito, especially in the rural areas where pigs serve as an intermediate host. The illness is especially severe in young children leading to fever, convulsions, and coma. It may lead to death or severe neurological handicaps in those who survive. Two doses of JE vaccine between 1-15 years of age give life-long immunity against the disease.

Dr Mahesh Hiranandani revealed, “In areas prone to flooding, walking in water may lead to leptospirosis, due to exposure to the urine of infected animals like dogs and rodents. The symptoms include high fever with chills, headache, vomiting, diarrhea, and muscle pains. As the disease can be treated with antibiotics, it needs to be diagnosed early to prevent complications.”

The humidity in the monsoon season increases the incidence of bacterial and fungal skin infections. Dr Mahesh Hiranandani suggested, “Daily baths and loose cotton clothing help in keeping the skin healthy. Snake bites are common in areas with dense vegetation, as the snakes get flooded out of their holes. Avoiding bushy areas, wearing appropriate clothes and shoes while playing, and rushing to a hospital for early and appropriate treatment cannot be overemphasised.”

Suggesting to keep your children safe from monsoon maladies by taking appropriate preventive measures and immunising them against vaccine-preventable diseases, Dr Mahesh Hiranandani recommended the following preventive strategies for monsoon maladies -

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