Breaking the Seasonal Disease Cycle

Fulbright-Nehru Senior Research Scholar Dr. Rajib Dasgupta discusses ways to deal with seasonal disease cycles and the role of U.S.-India collaborations in the public health sector.

Most of us are aware of the seasonal cycle of influenza outbreaks. Scientists claim that all infectious diseases have a seasonal element and seasonality occurs not just in acute infectious diseases like flu, but also in chronic infectious diseases like Hepatitis B which, depending on geography, flare up with greater regularity at certain times of the year.

To know more about this, SPAN spoke to Dr. Rajib Dasgupta, a professor at the Centre of Social Medicine and Community Health at Jawaharlal Nehru University’s School of Social Sciences, New Delhi. Dr. Dasgupta, who holds an MBBS degree from NRS Medical College, Kolkata, and a Ph.D. in community health from JNU, has worked with the epidemiology and public health divisions of the Municipal Corporation of Delhi.

He was also a Fulbright-Nehru Senior Research Scholar at Johns Hopkins Bloomberg School of Public Health, Maryland, where he worked on developing a social determinants framework for understanding child health programs, including those on nutrition and polio eradication.

Excerpts from an interview.


Please tell us about your work as an epidemiologist and a public health specialist in India and the United States.
I served in the epidemiology division of the Municipal Corporation of Delhi for a decade before joining the faculty at the Jawaharlal Nehru University, New Delhi. During my stint at the Municipal Corporation of Delhi, I was at the frontline of technical and managerial roles during outbreaks of Cholera O139, plague, dengue fever or dengue hemorrhagic fever and SARS.

I spent an academic year at the Global Disease Epidemiology and Control Program at Johns Hopkins Bloomberg School of Public Health during 2010-11 as a Fulbright-Nehru Senior Research Scholar. Additional support from the Occasional Lecturer Program, as part of the Council for International Exchange of Scholars, accorded a wonderful opportunity to share and learn with a number of minority-serving institutions in the United States. I continue to research the social epidemiology aspects of communicable diseases across India and in the South East Asia region of the World Health Organization.


What would be your advice to people to protect themselves and their families? 
The do’s and don’ts have been widely publicized. The challenge for Indians is to be able to practice some of the key messages, such as frequent handwashing or physical distancing, given our structural and societal constraints. The National Sample Survey (NSS) 76th round reported in 2019 that 25.3 percent rural households and 56 percent urban households washed hands with soap or detergent before a meal. Earlier, a 2015 report estimated that 150 million people lacked access to “at least basic” water, with a greater share in rural areas. Census 2011 reported that nearly 40 percent households of India lived in one-room houses; add to these the number of homeless. There are no easy answers and some of the local health authorities and voluntary organizations are doing wonderful work to negotiate these challenges.


What kind of cooperation do you think is possible between the United States and India  during the spread of diseases and pandemics like COVID-19?
India continues to have the classical double burden of both communicable and non-communicable diseases. Disease surveillance systems have been constantly improving and we know that acute respiratory infections account for almost 70 percent of morbidity from communicable diseases. There were 38,811 cases of H1N1 during 2017 with a case fatality rate of 6 percent. Japanese encephalitis and acute encephalitis syndrome are the communicable diseases with the highest case fatality rates–12 percent and 8 percent, respectively. The COVID-19 pandemic has brought back the much-needed focus on communicable diseases. While there is a declining trend in malaria, 842,095 cases were reported in 2017. Add to those 157,996 cases of dengue and 63,679 cases of chikungunya. The challenge is obviously enormous. This requires strengthening of health systems, particularly primary health care as well as specific disease control programs.

U.S.-India collaborations can considerably benefit the work to address these challenges. The collaborations should include a focus on public health education that addresses the requirements of both academicians and researchers as well as public health practice down to the frontlines. Appropriate technologies in disease surveillance and epidemiologic analyses will be important inputs.

The two countries have a lot to work together. A pandemic of this scale will require a lot of global cooperation. India has opened up the export of hydroxychloroquine to the United States. The United States can support India with technology-sharing on related emerging fields and discoveries.


What would you say about the intensity of seasonal influenza outbreaks in India? How can citizens better respond to this disease?
There is a much wider diagnosis of seasonal influenza in India and disease reporting systems are picking up a lot of cases, though we know that these do not represent the true burden, which is obviously higher. We do not yet have an awareness program on seasonal influenzas and COVID-19 will surely bring that into popular discourse. Though there are no national guidelines for adult vaccination, it is increasingly being discussed in policy circles. The Association of Physicians of India has come out with expert panel guidelines, for healthy adults and high-risk individuals.


How can India fight dengue and other mosquito-related outbreaks, which infect many people?
Dengue fever and other mosquito-borne diseases are endemic in most parts of the country now. These no longer remain problems of big cities, but have spread to peri-urban and rural areas. These are human resource-intensive programs and many local health authorities lack the resources to institutionalize robust programs. On the other hand, there are several good models available around the country. There is a lot of room for cross-learning and adapting to local contexts.