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Rats Feeding on Trash Increase Threat of Disease in Flood-Stricken Bangkok

Bangkok officials began paying residents to clear trash after doctors reported more cases of a potentially lethal rat-linked disease in flood-stricken areas.

The municipal government said it will pay 300 baht ($9.70) a day starting yesterday for 60 days to remove garbage in a city that normally produces 8,000 tons of waste daily. Concern that uncollected food scraps may be harboring vermin increased after Health Minister Wittaya Buranasiri said Nov. 9 seven people were being treated for leptospirosis, a bacterial infection spread in water contaminated with rat urine.

“We don’t want the rats to walk around finding food,” said Porntep Siriwanarangsun, director general of Thailand’s Department of Disease Control. “We have to take care of the garbage immediately.”

The specter of infectious epidemics is increasing as the battle to overcome the nation’s worst flood since 1942 stretches into the 15th week. Medical workers treated 4,684 people for influenza, 828 for diarrhea and 246 for conjunctivitis in 127 state shelters the past month in Ayutthaya, Nonthaburi and Pathum Thani provinces, the health ministry said this week.

“We are sending more mobile teams to cope with and combat infectious diseases,” Porntep said in a Nov. 8 interview.

Colds and skin diseases of the feet caused by contact with dirty water are the main complaints treated at evacuation shelters so far, he said, adding that leptospirosis is a key concern because the bacterium may persist in water for a month.

Anti-Garbage Campaign

“We are now in a campaign to get rid of garbage because this will attract rats, and the rat urine will leave the disease on small puddles of water on the ground,” Porntep said.

Humans become infected through direct contact with the urine of rats and other infected animals or with a urine- contaminated environment, according to the World Health Organization. The bacteria enter the body through cuts or abrasions on the skin, or through the mucous membranes of the mouth, nose and eyes.

In the early stages of the disease, symptoms include high fever, severe headache, muscle pain, chills, redness of the eyes, abdominal pain, jaundice, hemorrhages in the skin and mucous membranes, vomiting, diarrhea, and rash, the Geneva-based agency said.

Aid workers are delivering pre-prepared meals to displaced families to try to mitigate the risk, said Varabhorn Bhumiswasdi, director of the Priest Hospital in central Bangkok, who is leading a mobile medical team in Rangsit, a flooded area 20 kilometers (13 miles) north of the city center.

At a temporary shelter in Rangsit, villagers set up an outdoor kitchen, storing rice, raw fish and other food items in plastic bags. Trash was piled in a corner of the compound, which was shared with dogs and ducks.

No Cooking

“We tell people not to cook their own food at the shelters because we’re very worried about the garbage,” Varabhorn said. “We also warn them not to buy food from vendors because it may be unhygienic. That’s why we have to supply fresh cooked food three times a day, to prevent food poisoning and diarrhea.”

Varabhorn’s six-person team set up a makeshift clinic on a concrete bridge above the now-submerged village of Lak Hok. Patients are examined on an abandoned bed and dispensed medicines from the back of a truck.

“We’re mostly getting patients suffering from chronic diseases like diabetes and heart disease,” she said. “Hospitals are flooded so they need continuing care from us.”

Floods increase the risk of water-borne diseases, including typhoid fever, cholera and hepatitis A, according to the WHO. Stagnant water may also encourage mosquitoes that can spread malaria and dengue fever, the United Nations agency says.

Bed Nets

The UN Children’s Fund is providing 20,000 insecticide- treated mosquito nets to help protect families evacuated to temporary shelters and living in other flood-ravaged areas in Thailand from dengue fever, it said on Oct. 27.

More than 530 people have died because of the floods, which inundated parts of 64 of Thailand’s 77 provinces and affected more than 11 million people, the government said yesterday. Twenty-four provinces are still affected.

“This is an urban emergency in a mega-city of about 10 million people,” said William Aldis, an assistant professor of global health at Bangkok’s Thammasat University and a former WHO representative to Thailand. Aldis said cholera, a life- threatening diarrheal disease spread by Vibrio cholerae bacteria, posed a particular public health threat.

“It’ll just take one person with cholera excreting millions of Vibrio cholerae into the floodwater and potentially into the drinking water, and then you would end up with a serious outbreak,” Aldis said over the telephone from his home in Nonthaburi, on the outskirts of Bangkok.

Cholera Threat

“We’ve seen cholera in cities before, but cholera in the midst of massive flooding within a city -- and where the drinking water is compromised -- the conditions are ripe for a major urban cholera outbreak,” he said. “I don’t know if anybody is prepared for that.”

Water supplies may have already been compromised after flood barriers were torn down by residents angry at being caught behind them, allowing floodwater to flow into canals used to produce tap water.

“So far it’s not very bad because infectious diseases are under control,” said Porntep at the Disease Control Department. “We have not seen salmonella or Vibrio cholerae in any of the flooded areas, and there hasn’t been any serious bacterial infection in diarrhea cases, just from food poisoning.”

Residents without access to safe, potable water are advised to boil publicly supplied tap water to kill any pathogens, he said.

“The tap water may be safe now, but we don’t know if the tap water will stay safe,” Porntep said.

To contact the reporter on this story: Daryl Loo in Bangkok at dloo7@bloomberg.net

To contact the editor responsible for this story: Jason Gale at j.gale@bloomberg.net

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