Leptospirosis, a bacterial disease, has killed 42 people of 389 cases reported in different parts of the country. The disease has reached epidemic proportions in many parts of Mumbai, Gujarat and Delhi. "We are not geared up for disaster management,' says Vinay Aggarwal, honorary joint secretary, Indian Medical Association. With everyone banking on the National Institute of Communicable Diseases ( nicd ) for confirmation of the disease, the focus is once again on the pathetic state of the public health services and civic services. In Kochi, for example, food thrown into the drains is said to be the main reason for the increasing number of rats in sewers. "No guidelines are given to doctors regarding what has to be done when a leptospirosis patient is admitted,' says Aggarwal.

The disease is caused by a bacteria called Leptospira interrogans and is present in the urine of rats and cattle. The symptoms of the disease include fever, vomiting, diarrhoea, jaundice and kidney failure. "None of the symptoms are specific to the disease and this causes problems in its diagnosis,' says T K Mathur, a pathologist in east Delhi.

The disease is more prevalent in coastal areas and infects people who work in a dirty environment. Heavy rains and choked drains are also responsible for spreading the disease. The bacteria enter the body through cuts and grazes on the skin when a person comes in contact with contaminated water. Says Arun Bal of the Mumbai-based Association for Consumer Action in Safety and Health: "What is the point in plugging 6,000 rat holes in a city like Mumbai. Had the civic authorities prevented drains from clogging, we would not have had to combat the disease today.'