• PMA says chlorination of potable water by KWSB found to be inadequate
• People advised to drink boiled water, avoid washing face or bathe with polluted water

KARACHI: A day after the Sindh health department confirmed three deaths from Naegleria fowleri in a short span of one week in the metropolis, health experts associated with the Pakistan Medical Association (PMA) on Tuesday called upon the government to ensure supply of properly chlorinated water to citizens.

The experts are alarmed over the fact that none of the three victims of Naegleria fowleri, better known as brain-eating amoeba, had a history of swimming and it appeared that the infection occurred due to the use of contaminated, or non-chlorinated, tap water.

“The association is concerned over the fact that N. fowleri has been reported from Karachi’s municipal water supply, which is managed by Karachi Water & Sewerage Board (KWSB). We fear that unreported deaths will be higher than reported ones. Unfortunately, safe water is not available to the vast majority,” said Dr Abdul Ghafoor Shoro of the PMA.

He told Dawn that the KWSB’s filtration and chlorination of potable water were questionable. “Besides, the water distribution system is faulty, allowing seepage of sewage in the domestic water supply lines, which in turn gets contaminated and causes harmful diseases.”

According to the association, the general public in the city is forced to consume contaminated water, which exposes them to the grave risk of getting infections such as typhoid, gastroenteritis, cholera, hepatitis A and E, and primary amoebic meningoencephalitis (PAM), one of the most dangerous diseases.

Health experts belonging to the PMA also underscored the need for public awareness and efforts on the part of the government to ensure the supply of safe water.

“When water, contaminated with Naegleria, is sucked through the nose during bathing, rinsing the nose and ablution, it enters the body and rapidly destroys brain tissues, which causes severe meningoencephalitis within one to nine days after acquiring the infection,” explained Dr Shoro.

“It is fatal in 95 per cent of cases despite timely treatment. The initial symptoms of the disease are headache, body aches, high-grade fever, drowsiness, and fainting, and then the patient goes into a coma,” he said.

N. fowleri, a single-celled organism, is found in moist soil, freshwater bodies (lakes, ponds, and rivers), poorly chlorinated swimming pools, and water-supplying pipes.

In a statement, the PMA urged the general public to adopt measures to prevent the fatal infection. “Personal actions to reduce the risk of N. fowleri infection should focus on preventing water from going up the nose. Besides, always drink boiled water and do not wash your face or bathe with polluted water. Do not swim in non-chlorinated pools.”

“People are also requested to put chlorine in underground water tanks [one tablet in 1,000 gallons of water]. Water tanks at homes, hospitals, schools, shopping malls, and offices should be cleaned once a year,” it said.

The association requested that all the doctors, particularly the general practitioners and family physicians, take it seriously if a patient comes to them with symptoms of nausea, vomiting, headache, and a high fever.

“Such a patient should be tested for Naegleria. People should also visit their doctor immediately if they experience these symptoms,” the association said.

Earlier on Monday, the health department confirmed that the first case was reported on May 24, the second case on May 26 and the third case was reported on May 28 in the city. The deaths occurred at private and public sector hospitals where the patients presented with symptoms including high fever, vomiting, headache, and altered consciousness.

Published in Dawn, May 31st, 2023