Dengue is fast off the blocks in Barbados this year, 2012

BARBADOS

The Barbados Ministry of Health has released its Dengue Fever scorecard for the first quarter of 2012 and the picture does not look rosy at all. In a press release published by Caribseek News, Melissa Rollock of the Government Information Service reports that Classic Dengue was up 15 percent from 2011 and hospitalisations by a factor of 60 percent, though not so much for the complication of Dengue Haemorrhagic Fever (DHF), which was down 50 percent over last year.

The release states that there were 53 Confirmed Cases for the period January to mid-March compared to 45 for the corresponding quarter in 2011. Doctors admitted 10 people to hospital, including 1 for the potentially deadly complication of DHF. At the same time a year ago, four hospital beds had been occupied, 2 for Classic Dengue, the other 2 for DHF.

It is to be expected that yet more persons will come down with DHF as the year progresses for unlike last year when the predominant serotype was Dengue-2, only Dengue-1 was seen in the first three months of 2012. DHF is manifest in patients experiencing their second infection caused by a different virus from the one that made them ill earlier in life. It would not be a stretch to say that  there are a number of naive persons in Barbados who are vulnerable because they had Dengue in the past.

There are four distinct Dengue viruses, Dengue 1, 2, 3 and 4. While a first infection confers lifelong immunity, that somehow paves the way for one to  come down with DHF and DSS (Dengue Shock Syndrome), which could prove fatal for the unlucky soul.

Barbados had a total of 206 Dengue Cases for 2011.

22

FDA gives go ahead to market Dengue test

Normally, you go to the doctor’s office with complaints of a flu-like illness.  Is it Dengue?  Is it not?  

The physician listens and compares what you relate with the observations made during your examination.  Is it Dengue?  Is is not?

To confirm the doctor’s suspicions, you are invariably sent to the laboratory across the hall, or maybe across town, to have your blood drawn for testing by a technician who must identify antibodies in the blood specific to the Dengue virus that would confirm you have actually succumbed to the illness.

Now, physicians are being armed with a new tool to help them hasten the diagnostic process for Dengue, one that uses the signs and symptoms of the disease as evidence. The DENV Detect IgM Capture ELISA test detects the antibodies to the Dengue virus, if it is circulating in your bloodstream, one step ahead of the confirmatory tests.   This is thought to be a boon for improved patient care and management.

This is a significantly important development considering the high rate of misdiagnosis that goes on in doctors’ offices resulting in patients being sent home not realising that they are incubating a potentially lethal disease.  No diagnosis does not necessarily mean no Dengue.

Complicating matters, even if doc makes a correct call and refers you to the lab to confirm Dengue before the onset of fever, there is a fifty-fifty chance that the Lab test would detect the IgM antibody response to the Dengue virus, which is more likely 3-5 days after the onset of the fever.  In other words, the test might come back negative but you could still have Dengue.

With the DENV Detect IgM Capture ELISA test, the hope is that physicians will be less likely to mistake Dengue for the common cold or the flu.

The test was approved for marketing by the U.S. Food and Drug Administration (FDA) in April 2011.  It is patented by the Centers for Disease Control (CDC) and is manufactured by Inbios Inc. based in Seattle, Washington.  Although the risk is low to moderate, the test is not recommended for persons who do not display clear signs and symptoms of Dengue.  If properly used, a positive test should be considered presumptive evidence of Dengue.

Source: U.S. Food and Drug Administration

15

Dengue Rapid Test in 15 minutes

It is almost two years since the announcement was made, but it is still worthy of note that Inverness Medical Inc. has put an Early Rapid Test for Dengue Fever on the market to help physicians diagnose Dengue from the very first day it shows up in the bloodstream.  As a matter of fact, the three-part test purports to facilitate a specific diagnosis of Dengue in 15 minutes thereby shortening the response time for patient therapy and monitoring to begin. 

The Panbio Dengue Early Rapid Test was developed, not as a standalone diagnostic tool by any means.  Rather, it acts as a cross-reference for other existing serology tests.

The Panbio test gives physicians the added advantage of reducing the risk of severe complications of Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) in patients for whom this is a second or subsequent Dengue infection.  Now, that can be fatal if not identified and treated early.

Continue reading →

Aside

A Comment on our civic responsibility in controlling Dengue

“Because the Aedes aegypti mosquito is peri-domestic by nature, the control of the Dengue mosquito is primarily the responsibility of the householder. You see, aegypti lives with us and depends on us for its survival.  We oblige by providing the stagnant water in odd containers around our places of abode and work for it to breed.  And when the adult mosquito emerges from the water, ready to feed and lay eggs, we offer it our blood and the Dengue virus in that blood if are infected. How generous! This is like knowingly leaving our front doors open for the thieves lurking in the shadows.

Now, who do we turn to for help when the mosquitoes begin to bite and spread disease?  The Government. But, so long as the Public Health Department is placed at the “forefront,” it simply means that we, the householders, are not pulling our weight. We are in effect reneging on our civic duty to conduct self-inspections of our properties for the proper and effective management of mosquito infestations.”

Want to know how to conduct a property inspection? Leave a Comment.  Let us know.  We’ll show  you how.

Aside

BAHAMAS

Neutralising the Dengue mosquito – Bahamas Tribune commentary

[The] talk in some quarters was that dengue fever had been banished forever from the Caymans. Of course, the next rumble was: If the Caymans can do it, why not the Bahamas?

That’s where we should slow down and do some thinking.

The Caymans is now undergoing a controlled scientific experiment that shows great promise — that is if there is no adverse fall-out from man’s attempt once again to tweak nature.

While the Bahamas had more than 1,500 persons with dengue-like symptoms this summer, last month the Caymans reported its first local case, explaining that it was “most probably imported from the Bahamas by a returning resident”.

Although the dengue carrying mosquito [Aedes aegypti] is in the Caymans, it has not been active. It is said that dengue fever is not endemic to those islands.

[A]ccording to the Pan American Health Organisation, Caribbean countries reported… confirmed dengue fever cases, with the Bahamas and Aruba on the very high-end of the scale.

According to a Wall Street Journal article researchers in 2010 released 3.3 million male mosquitoes that had been genetically altered so that they were born sterile. These mated with females in a small test area, passing on their defect. In turn, this killed their offspring at the larval stage. This, it was reported, triggered a population collapse.

However, scientists hailed the success with a great deal of caution. They are only too aware that every time an attempt is made to alter the natural state of the ecosystem there can be adverse reactions. This brings us to Newton’s third law of physics that states that for every action there is a reaction of equal magnitude, but in the opposite direction.

There is perfect balance in nature; when that balance is upset there are consequences. What if, say some scientists, the DNA from the genetically altered mosquito gets into other bugs – or even man, they could cause even more harm.

So this government when offered to be a part of the experiment took a wait-and-see attitude before exposing the Bahamas to the results of a test-tube experiment.

Environment Minister Dr Earl Deveaux said the company conducting the trial had approached the Bahamas government. However, at the time the Government was not convinced that it was a viable option as there were too many unknown factors associated with it. Wisely, the government declined, with the Minister continuing to hold a watching brief. [...]

Aside

Thing You Didn’t Know About Mosquitoes…

It would take 1,200,000 mosquitoes, each sucking once, to completely drain the average human of blood.

Sources: discovermagazine.comanannimos.blogspot.com

Additional Resources: Dengue/Malaria Woodbox – on Right Sidebar

Archived Dengue/Malaria Resources: Dengue|Malaria Chips

Aside

Comment: As an Aside – A chemical, not toxic to human beings?

“We have to get…control of plagues, it does not matter their type, as well as [decrease] pesticides’ use. In urban area[s], we recommend hygiene and…mosquito net[s]; but if there is no [other] way, you can use commercial insecticides, because they are not toxic for humans – they are pyrethroids…,” said Doctor Humberto Quiroz in buscador.uanl.mx.

Use commercial insecticides because they are not toxic for humans – they are pyrethroids? Really? A chemical, not toxic to human beings? Wrong!

Here is the deal. Insecticides, Pyrethroids included, are inherently toxic to mammals. Nevertheless, it is one the most effective classes of chemicals on the market today. But there are sensitivity-resistance issues with it that makes it highly doubtful it will remain as effective five, ten years from now. Why? Because overuse and misuse of these product is allowing disease-carrying and pest mosquitoes to mutate at a rapid pace, rendering them immune, if you will, to chemical attacks.

Regarding the safety of Pyrethroids, it all boils down to handling. In the hands of unskilled operators, the safest of products can be a lethal as the worst of them. Pyrethroids are no exceptions.

Rest assured though folks, Pyrethroids are still one of the better bets in fighting mosquitoes without endangering human life. Mind you, Organophosphates, like the other established compounds found in the inventories of Vector Control programmes, continue to hold sway and remain integral in the fight against vector-borne diseases.  That, in spite of the stiff challenges mounted by new classes of products.

We will simply have to wait and see how this plays out, won’t we?

Aside

Comment: As an Aside

A story entitled “Cuba on maximum alert over Aedes aegypti increase,” was posted in crofsblogs.typepad.com on September 08, 2011 caught my eye four days later.

It reads in part:

Epidemiological surveillance in Cuba is on “maximum alert” over the increase in August [2011], in the number of Aedes aegypti mosquitoes according to a Thursday [September 08, 2011] statement by the Ministry of Public Health…

Although it’s unknown how many persons have contracted the disease, doctors and nurses are roaming the neighbourhoods daily, thermometer in hand, seeking persons with possible dengue symptoms. The public campaign against the mosquito also includes fumigation of the houses and streets of Havana and other cities when deadly foci have been detected.”

The writer ends the piece with this:

“I don’t find this story in the Cuban media, and dengue reports from Cuba have been notable by their absence.”
Source: crofsblogs.typepad.com

The way I see it, Dengue news from Cuba tends to be scanty indeed.  But I did find some sources recently. Since then, I posted a story at Woodshed Environment on the islandwide fogging campaign for Dengue mitigation that the Cuban Health authorities embarked upon. That campaign was scheduled to end on September 15, 2011.

As a Vector Control professional, I am faced with the everlasting dilemma, to fog or not to fog. One of the issues is that there are those persons who cannot get away during fogging, persons with various respiratory tract infections and allergies who cannot take the ‘smoke.’ And of course, there are the non-target species like bees and butterflies that are doubtless affected by the active ingredients in the chemicals being used.  Jorge Milanes Despaigne had something to say about this in an article he wrote on the subject “Mosquitos and Butterflies” in havanatimes.org (September 17, 2011).

The balance that we try to achieve in the British Virgin Islands for instance is fogging only when necessary. Environmental Health authorities in St. Kitts and Nevis have adopted this principle independently of us. Nevertheless, when there is a real threat of Dengue, we have a responsibility to pull out all the stops to protect human life and fog when required.

One of the ways that we can be more judicious though is by flagging the natural environment as vulnerable habitats in much the same way that swaths of land are set aside as national parks or put up for environmental protection. With the advent of GIS (Geographic Information System) technology, that is not hard to do. The frequency and intensity of fogging could then be regulated accordingly.

Obviously, this approach demands a multi-sectoral intervention.

The fogging technique is also critical. For example, fogging operators could walk through a High Risk community, fogging premises individually instead of fogging from a truck, street by street. If that is acceptable, there is the other issue of the availability of boots on the ground to do the ‘walk-throughs’ especially when there is a Dengue Outbreak and time is of the essence.

Aside

Comment: As an Aside

As much as the Dengue is driving you crazy, it is giving me a headache just trying to keep abreast of its spread in the Caribbean. From my blog reporting last year on the Dengue situation in the Bahamas especially, I grew more concerned than ever about the amount of fogging being done. You see, there is such a thing as “resistance.” Wanton fogging allows the Dengue mosquito to develop resistance to chemicals dispensed during fumigation. When that happens, you can fog all you want, it will be to no avail.

I wonder how much work is being done on the ground to empower our Caribbean people with information on how to eliminate the breeding places of the Aedes aegypti mosquito in and around our homes and places of work. The point I am making is that we must de-emphasize chemical control in favour of physical (destroying breeding places and barring mosquitoes from laying eggs) and biological control (using guppies, copepods, BTi). These are the only viable and sustainable ways  to control disease-carrying mosquitoes. Fogging without getting rid of the breeding places is of no use, much like counting sand.

…to antiguaobserver.com

Oh, the Dengue situation in the Bahamas was bad. Quoting the Woodshed Environment Collective blog, “With the rate of weekly infections not letting up, total cases were at 1,600 at mid-August [2011].” And at that time, up to 100 persons per week were known to seek medical attention fearing they had contracted the disease. 

Everyone in the Caribbean should add weekly self-inspections of private and business places to their regular cleaning schedules so that even if environmental sanitation is generally poor in their neighbourhood, with countless containers holding “clean” water in the open, the mosquito breeding cycle is bound to be disrupted.

The control of the Dengue mosquito is primarily the responsibility of the householder since the Aedes aegypti mosquito is peri-domestic by nature. In this regard, so long as Public Health agencies remain at the ‘forefront’ of intervention strategies and the people are sitting back waiting for help, the fight against Dengue Fever is essentially lost.

New Integrated Vector Management manual introduced in St. Kitts & Nevis

St. Kitts & Nevis flag

Environmental Health Officers are among a batch of Public Health workers from the Federation of St. Kitts and Nevis to be familiarised with a manual on Integrated Vector Management (IVM).  The manual was developed by Dr. Samuel Rawlins, Nobel Laureate and eminent Caribbean emeritus scientist with the Caribbean Epidemiology Centre (CAREC) and the Pan American Health Organization (PAHO).

Dr. Rawlins, himself a native of St. Kitts, ran a three-day workshop for the health workers from Monday, November 07  2011 in Charlestown, Nevis.  The workers modified and changed the generic manual Dr. Rawlins created for the East Caribbean region to suit the specific needs of the Federation.

The manual was the culmination of a series of consultations Dr. Rawlins had with Ministries of Health of member states.  It has seven modules that deal with mosquito vectors and mosquito-borne diseases of importance in the Eastern Caribbean; integrated vector management (control) measures and their application to Dengue Fever vectors and other common vectors in the Eastern Caribbean countries; the work of vector control operators; and issues of discipline/work etiquette.  Other selected arthropods and reservoirs of public health importance are also covered in the manual.  

So far, Dr. Rawlins has facilitated similar workshops in the islands of Barbados, Grenada, St Lucia, St Vincent and the Grenadines as well as Antigua and Barbuda.

Dr. Samuel Rawlins earned a Nobel Prize in 2007 for his expert work with the Joint Intergovernmental Panel on Climate Change (IPCC). 

Source: Caribbean News Now!

7

Researchers aim to predict emerging viruses and treat illnesses

Much research over the decades has been concentrated on the vexing issue of a lack of an effective Dengue vaccine. But what about being better able to predict how the Dengue virus is transmitted, how the disease is spread and its impact on public health measures designed to control it?

Well, these lines of research are to be advanced with the injection of a US$3 million grant from the National Institutes of Health (NIH) to researchers of the Louisiana State University (LSU), Tulane University and the University of New Mexico led by Associate Professor of the LSU Christopher Mores.

This money, to be disbursed over the next five years, paves the way for Dr. Mores and his consortium to join an NIH study that uses modelling techniques to understand the spread of contagion and measure how that impacts public health measures, namely community-based and international intervention strategies.

Dr. Mores’ particular goal in the context of the wider study will be to mature a set of tools that Vector Control practitioners can use to forecast the transmission of viral diseases, especially Dengue. To do so would be to learn more about the way infectious diseases spread both at the level of vector and human populations.

Given the financial burden Dengue has had on health services in tropical and sub-tropical regions around the world, we will take all the help we can get.

Source: Journal of the American Veterinary Medical Association (JAVMA)

This US$3 million dollar grant that the NIH has given to Dr. Mores’ consortium is, however, a drop in the bucket compared to the US$45 million the agency handed to Silver Spring biotech firm, United Therapeutics.

Working through their respective subsidiaries, United Therapeutics and National Institutes of Health signed a contract, the disbursement of whichi is pro-rated over five years, requiring Unither Virology to develop a treatment – not a vaccine – for Dengue.

In turn, UV has entered into a research agreement with Oxford Glycobiology Institute to undertake the studies as prescribed.

Source: Gazette.Net

6

What a difference a year has made in Puerto Rico

PUERTO RICO

What a difference a year makes.  Imagine that, one year ago, this month, Puerto Rico was on the downside of a Dengue epidemic that at the very height, in August 2010, was sickening between 900 and 1,000 people.  At that juncture, the historical average for the country (records taken between 1986 and 2010) was a few hairs below 200 infections per week.  The epidemic threshold, the stage at which an epidemic IS officially declared, was half that at 100.

Fast forward to 2011, Puerto Rico is once again in the stranglehold of another Dengue epidemic, although barely.  This year, the numbers are far less dramatic. When plotted on a graph, the curve, representing officially reported Suspected Cases, tracks along that for the epidemic threshold, slightly above it one week, under it the other.

One would expect that when the figures for the week, October 21-28 become available (the latest report we are privy to is for the week, September 17-23 2011), they will show that the epidemic in Puerto Rico would not have reached the historical peak, which is round about 300 cases.  Indeed the weekly average could be several scores short of that number.

Setting aside the modelling, what we do know for a fact is that PR actually saw 198 Suspected Dengue Cases at Week 38, 171 Dengue Cases the week before that, both totals a wee bit higher than the historical average for the same period.   The prevailing viruses in circulation then were DENV-1 and DENV-4.  DENV-2 and DENV-3 were detected in earlier months.

The accumulated totals for the year was at that time some 3,324 Suspected Cases, 886 of which were Laboratory Confirmed.  There were 15 cases of Dengue Hemorrhagic Fever (DHF) with 2 probable deaths.

Source: Dengue Surveillance Weekly Report for Week 38

Siparia Regional Corporation undertakes Dengue Eradication Programme

Trinidad and Tobago

This past September, the Siparia Regional Corporation (SRC) of Trinidad committed a sum of US$50, 000 (TT$500, ooo) to an ambitious Dengue Eradication Programme covering the Administrative Districts of Erin, La Brea, Siparia and Oropouche/Fyzabad.  This pronouncement came from business Leo Doodnath, Chairman of the SRC, on September 12  2011.

The plan, which was due to commence in mid-September, entails a massive clean-up campaign undertaken by small contractors with the assistance of householders of the so-called burgesses; a public education drive involving community meetings and seminars to sensitise the people living there about the need for a clean environment; the fumigation of said communities targeting the adult Aedes aegypti mosquito; the treatment of potable water receptacles to prevent wrigglers from developing into adults; an improvement in the lines of communication between the allied government agencies at the forefront of the exercise – and in so doing, to effectively reduce the mosquito population in the 510-square kilometre Siparia jurisdiction.  The measure of the success of the programme will be reflected by one of a number of Aedes Indices, presumably the House Index (the percentage of Premises found to be Positive for the Aedes aegypti mosquito).

An inter-sectoral team including the Chief Medical Officer and members of the Insect Vector Control Department has been set up in the County of St. Patrick to oversee the operations of its Dengue Action Team.

Source: GuardianMEDIA

Cayman Islands imports Dengue every year since 2008

CAYMAN ISLANDS

Cayman Islands’ health authorities placed the country under a Dengue advisory in late September, mainly as a precautionary measure.  This was done in the face of outbreaks of the mosquito-borne disease in several countries across the Caribbean and the Americas and the unfortunate history of importing cases year after year.

Dengue Fever is not endemic in Cayman, according to health officials. However, the Dengue mosquito, namely Aedes aegypti, is very much present there.  And considering that the British Dependent Territory has a history of travellers introducing the Dengue virus into the country, as was the case from 2008 to 2010, causing sporadic localised outbreaks, medical personnel needed to be on high alert to prevent a recurrence in 2011.

But in spite of their best efforts, the first Confirmed Case of Dengue for the year was recorded in October.  It is believed that a female resident who had been to the Bahamas back in September was responsible for this.

Sources: caycompass.com ¹² 

16 

Dominica rocked back by Dengue; country scrambles

DOMINICA

COMMONWEALTH OF DOMINICA

Dominica health authorities declared a Dengue Outbreak on September 13, 2011. This, as 15 cases of Dengue Fever were confirmed in August with results for 9 more cases still pending.

The news came in a press release, which  omitted to give any justification such as the percentage of or numerical increase in Dengue infections from the previous month or months. Nor was the yearly total of Confirmed Dengue Cases revealed.  Chief Medical Officer, Dr. David Johnson did, however, go before the microphone on September 16 to reassure the public that none of the cases was of the severe Dengue Haemorrhagic Fever (DHF) form of the disease.  No deaths have been recorded.

By activating the National Dengue Emergency PlanNational Pest and Termite Control Ltd. – the company contracted to do routine baseline surveys for the Environmental Health Department – and the EHD itself have been given the mandate to investigate Suspected and Confirmed Dengue Cases and Dengue-related complaints and intensify mosquito surveillance and fogging operations.

The Ministry of Health through the Health Promotion Resource Center is required to conduct health information sessions with the public at health care facilities and exclusively with fishermen’s and community groups.

Educational materials like leaflets and flyers are to be distributed and posters put up, backed up by Public Service Announcements and discussions on radio and TV.

But most importantly, residents of the Roseau Health District (Roseau South, Roseau North, Roseau Valley and Roseau Central to the village of Mahaut) where the Dengue Outbreak is concentrated must do their part.  Unless they cover their drums, dispose of unwanted tires and practice environmental sanitation to deny the Dengue mosquito harbourage, Dominica has no chance of breaking the cycle of transmission in the near term.

Whether there was compliance or not, the Dengue situation in the Commonwealth of Dominica was on the decline by the end of September. The peak in weekly reported cases was during the week of August 22-28  2011.

Not only has the number of cases been on the decline since, so have the weekly hospitalizations. However, the Ministry of Health data do show a widening of the geographic spread of the disease from the Roseau Health District to all districts island-wide. The records also indicate that there were two cases of Dengue Haemorrhagic Fever (DHF). There are still no deaths to report.

The Ministry of Health has nevertheless not let up on its program of Health Education in the schools and the wider community and  its media campaign.  Regular surveillance to reduce the breeding sites of the Dengue mosquito and fogging to destroy the adult population has not ceased.

As a means of bolstering this approach, the Environmental Health Department proposes to enforce existing laws pertaining to the breeding of mosquitoes. Chief Environmental Health Officer Anthony Scotland is warning persons refusing to adhere to preventive measures that they stand a chance of being prosecuted.

There are people who are constantly found breeding mosquitoes and they are now being issued with notices. They will be prosecuted if the measures are not taken,” Scotland says.

Sources: dominicanewsonline.com ¹,²repeatingislands.com

14

Dengue Fever, Immune Homeostasis, Balance

Reprinted with permission of Author, Dr. Hellen Greenblatt

Dengue fever is caused by a virus that is carried by an infected female Aedes mosquito (called a vector) that injects the virus into a human while she is drawing her blood meal, a meal that she needs in order to reproduce. Over 50 million people, in over 100 countries, are infected every year with dengue. Until a report last week, there was still no way to control the disease. More on the study later.

The symptoms of Dengue Fever appear from a few days to two weeks after being bitten by an infected mosquito. The symptoms may be a sudden onset of high fever, nausea, vomiting, severe headache, muscle and joint pain, and pain behind the eyes, which worsens with eye movements.

The Response of the Immune System to Dengue

There are four genetically similar types of Dengue viruses (subtypes). When a person is exposed to the virus, specialized immune cells produce large proteins called antibodies, also known as immunoglobulins (Igs), that attach to the virus particles and mark them for destruction by incoming inflammatory immune cells.

Unfortunately, exposure to one of the four subtypes does not confer immunity against the other three types. Even more troublesome, because of the peculiarities of the immune response, if one has been previously exposed to one type of Dengue virus, exposure to another subtype may result in Dengue Hemorrhagic Fever. In this stage of the disease, there is a significant amount of bleeding and a person may go into shock. Unfortunately, this disease is frequently fatal especially in children or the elderly.

As in all immune responses, a controlled, well-modulated response is needed by the body when it is exposed to a pathogen like Dengue. When the immune system has a balanced inflammatory response to disease, when it is in immune homeostasis, a person is more likely to successfully fight infection and survive. The key is that the body has to generate enough of an inflammatory immune response to destroy the pathogen, but not so much inflammation that nearby healthy tissue is damaged.

Inflammatory Cytokine Storm

Too vigorous, inflammatory response to infection, for example to the Dengue virus during Dengue Hemorrhagic Fever, may result in destruction of the walls of blood vessels, bleeding, abnormal clotting, and loss of fluids (which can lead to severe dehydration).

This sort of extreme immune response is also reminiscent of what is seen in diseases such as SARS (Severe Acute Respiratory Syndrome), in which the body has an inflammatory or cytokine storm directed initially against the lungs, and goes on to destroy many different organs, resulting in death. [Cytokines are small immune molecules that trigger immune responses].

Decrease Mosquito Breeding Opportunities

Prevention- It Only Takes 15 Minutes:
There is no treatment for Dengue Fever, nor has vaccine development been successful. For now, the best way to avoid infection is to lower the risk of being bitten by an infected mosquito. Unfortunately, since the Aedes mosquito is active during daytime hours, nets around the bed are not an adequate solution.

However, all mosquitoes need water to complete their life cycle, so it is prudent to eliminate any standing water around the home. Think like a mosquito that is looking to lay eggs—it can be in any container imaginable, or a puddle that will not dry out within a few days.

Keep plant saucers, tarps, coolers, tanks, barrels, drums, bottles, tins, coconut shells, tires, buckets, and trenches, free of water.

Empty, cover them, or turn containers over when not in use, so water does not accumulate.

Keep containers of stored water covered at all times.

Empty refrigerator drip pans at least every other day.

Mr. Minchington Israel, Environmental Health Officer of the Government of the British Virgin Islands mantra is: “It only takes 15 minutes to go around the yard, … in search of stagnant bodies of water and do[ing] something about it.”

Mr. Israel also points out that since so many people have moved out of the countryside and crowded into urban areas, family and community-wide efforts are needed to slow mosquito population growth. In addition to the suggestions above, Mr. Israel strongly advocates:

  • Maintaining properties free of rubbish, junk, and overgrown vegetation.
  • Managing empty lots and abandoned properties.
  • Becoming knowledgeable as to where mosquitoes breed and eliminate these breeding areas.

Promising New Approach:
Last week the prestigious journal Nature, published results from an Australian research group reporting that they were able to stop the transmission of Dengue virus (ǂ). Researchers infected the Aedes mosquito with bacteria that “completely blocks the ability of the virus to grow in mosquitoes” (◊). The bacteria do not kill the mosquito, so the mosquito can continue to reproduce itself, and pass the bacteria to other mosquitoes. The infection is highly contagious so it spreads rapidly throughout the mosquito population. Successful testing in the wild supports its promise as a way to control vector populations. According to Flaminia Catteruccia, who works with malaria-carrying mosquitoes in London, “It’s an environmentally friendly approach that does not affect the mosquitoes, just the [growth of the] virus”(◊).

Personal Defenses:
If this concept works, it will take time for further studies to be completed and vector control to occur, so for now, taking personal responsibility is necessary. So in addition to the recommendations above:

  • Dengue carrying mosquitoes are active during the day, so netting around beds is not as helpful as in other mosquito-borne diseases.
  • Use mosquito repellents on your clothing and person.
  • Screen windows and doors against mosquitoes and use bed nets around ill, bed-ridden individuals.
  • Wear light-colored long-sleeves and slacks with thick socks.
  • A body in immune homeostasis, in immune balance, is better prepared to defend itself against infection.

To optimize one’s immune system: walk or be physically active in other ways for at least 150 minutes a week; eat in a nutritious manner; control your weight; eat darkly-pigmented fruits and vegetables on a daily basis; and consume fish or omega-3 supplements 2-3 times/week.

In addition, it is important to help the body achieve immune homeostasis, immune balance so that the body can battle illness and yet, control unchecked inflammation.

Hyperimmune egg contains a cocktail of antibodies and other active immune factors that help the body balance immune function. Consuming two or more servings/day of hyperimmune egg makes a major difference in your body’s ability to support immune health and heal itself.

ǂ Nature.com Journal
◊ Nature.com News

Nevis says, no fogging; reduce mosquito breeding instead

St. Kitts and Nevis

Faced with at least 2 Confirmed and 1 Suspected Case of DengueMr. Anthony Webbe, Principal Public Health Officer in the Nevis Ministry of Health’s Environmental Health Services is calling on Nevisians to help in the fight against mosquito borne diseases.  

In an SKNVibes interview, Mr. Webbe reminded the public that they have a duty to eliminate “tins and bottles…old tires, old washing machines, old refrigerators, old stovesWe want persons to get rid of those containers to prevent the breeding of the mosquitoes…”

In explaining why no fogging was being done on Nevis, Mr. Webbe emphasized that source reduction, essentially cleaning up the environment, is the message he plans to disseminate at churches and in public gatherings.  But make no mistake, a vector control programme is in effect where the Dengue Cases have been identified.   

Antiguans, step it up; Dengue is no joke

ANTIGUA

Extrapolating a report by the Antigua ObserverAndre Edward, a St. Lucian doctor employed by the Ministry of Health there, posited that the situation in his country would have been worse if the authorities were not proactive.  “The peak of the rainfall season in St. Lucia is September, October… If we did not take steps to curb the spread of Dengue Fever in September and October, it would have been worse for us,” said Dr. Edward.

Echoing his MOH, Dr. Edward urged residents of Antigua and Barbuda to take heed of Dengue advice given by their public health authorities to prevent an outbreak such as what has occurred in his home country and Trinidad.  His personal advice is to make weekly checks to uncover mosquito breeding places, and in so doing, cover water containers, empty coconut shells, tires and other utensils capable of holding water.

Unfortunately, Antiguans do not seem to be following the well-publicized advice given to them on how to manage stagnant water for it turns out that non-compliance on their part has caused alarm across Antigua and Barbuda as the number of Dengue cases begins to rise.  Various reports put the total for the first eight months of 2011 at 15 or more.  But when one physician can say that he has seen 15-20 cases in one month with 10 Confirmations, it would be reasonable to deduce that the figure is certainly several dozens at least.

Chief Health Inspector Lionel Michael did not clear the air on that when he issued a Public Notice on September 10 to warn the population that he had confirmation from CAREC (Caribbean Epidemiological Center) in Trinidad that their tests were showing that Dengue-4 is in circulation in Antigua and Barbuda. This news ups the ante for residents who were previously exposed to Dengue-2.  As has been documented in the literature, it could be fatal if any persons who had Dengue-2 in the past  are reinfected with Dengue-4.  That would place them at serious risk of getting Dengue Hemorrhagic Fever (DHF), the complication that could lead to death.

One thing is certain, the Aedes aegypti mosquito is overwhelming Antigua.  

This from CHI Michael on caribarena.com.  

Michael says he would like to see the communities of the south sections of the island, from Jennings to Old Road, but particularly from Bolans to Urlings as well as Freetown, Fitches Creek, Hodges Bay, Crosbies, Paradise View, McKinnon’s, Point, Villa Area, Gray’s Farm, Clare Hall, St Johnson’s Village, and Skerritt’s Pasture work together to combat the infestation.

6

The father of Tropical Medicine in Cuba dies

CUBA

CUBAHEADLINES, citing a Lancet report, announced that the father of Tropical Medicine in Cuba died in Havana on May 05, 2011, at the age of 75.

Gustavo Kourí Flores is credited with developing the field of biomedical research, shepherding Cuba’s formative generation of researchers and practitioners in the field and launching the study of tropical diseases and parasitology in his homeland.

The Institute of Tropical Medicine Pedro Kourí (IPK) in Havana, Cuba, which he headed for more than thirty years, bears the name of his father who founded the institute in 1937.

Notwithstanding the important hats that Kourí wore in his illustrious career – he served as Assistant Director of Research at Cuba’s National Scientific Research Center, Assistant Dean of the School of Medicine and Vice Rector of research and postgraduate studies at the University of Havana – his lasting legacy will be the yeoman contribution he made in the field of Dengue Fever research. This work was spurred by the record-making Dengue outbreak, which occurred in Cuba in 1981.

María G. “Lupe” Guzmán, Kourí’s wife of 31 years, says that Kourí’s team was successful  in determining the characteristics and micro-diagnostics of the epidemic as well as the risk factors for serious Dengue.  Always a hands-on microbiologist and virologist, Kourí was never far removed from the actual design of Dengue studies conducted by the IPK and personally participated in the discussions of the findings with his staff.

Adds Jeremy Farrar, Professor of Tropical Medicine at Oxford University and Director of Oxford’s Clinical Research Unit in Vietnam, Kourí’s approach was never scientifically aloof.  His approach to science, although hard-nosed, was patently community centred with a reverence for community values, community care and the workings of the community.

Gustavo Kourí Flores, dead at 75.

Source: cubaheadlines.com

22

Cuba goes on the offensive against Dengue

Cuba

Like the rest of the Caribbean, Cuba is highly vulnerable to the Dengue virus.  However, it must be noted that the country has a remarkable track record in preempting Dengue outbreaks, or at best mitigating them.

Similarly, Cuba shares the high temperatures and intense rainfall that the islands have experienced since May of this year.

Where Cuba deviates from its neighbours is in regards to the drought conditions that exist in the western territories.  (The heavy rainfall is in the eastern provinces.)

Taken together, Cuba could become prone to an epidemic risk since rain potentially means more unprotected containers holding water, breeding Aedes aegypti mosquitoes; and drought conditions result in people trapping and hoarding water in unprotected containers, breeding mosquitoes.

The Cuban health authorities are well aware of this.  Thus, every family is being called upon to conduct inspections of their premises at least once a week to help control the Dengue mosquito.

On the Government’s side, an island-wide sanitation and fogging campaign is concentrated in the cities of western Pinar del Rio, the Mariel municipality, the Artemisa province, Santa Clara, Camaguey, Santiago de Cuba, Guantanamo and all fifteen provinces of Havana for a start.  These locales are seen as the worst affected with high levels of the Aedes aegypti mosquito.  Presumably, doctors and nurses are out in those neighbourhoods trying to capture anyone with signs and symptoms of Dengue.  This is the kind of aggressive approach that other jurisdictions must emulate.

All things considered, what Cuba has going for it is a Dengue profile for the period June to July, 2011 that is better than it has ever been since 2006.

The sanitation and fumigation campaign will reach into every corner of the Cuban countryside by the end date, September 15 2011.

Source: caribbeannews.com

22

Aside

Over 3.5 million health workers urgently needed – say 250 organisations

“Over 250 organisations including Malaria No More UK, White Ribbon Alliance, Merlin, Every Mother Counts, ONE and Save the Children, have come together to call for urgent action for more health workers.

More health workers, better supported

For the next two months in the run up to the UN General Assembly meetings we will be joining other campaign partners to call on global leaders to deal with the health worker shortfall and make new commitments for supporting health workers…”

It is indeed unfortunate, but health programs are the first to get cut when governments seek to re-engineer their budgets in times of economic crises. I think this is so because there is insufficient understanding, or appreciation if you prefer, of the cost the community must bear if health services are not provided or withdrawn.

Correct me if I am wrong but it seems to me that budget planners do not want to go through the ‘trouble’ of determining the fiscal value of health services and thus they are more impressed by accounting officers’ records showing direct revenues from Customs departments, Port authorities and the like.

Be mindful too of the standing of health workers on the totem pole of ‘prestigious’ professions. How often does “Community Health Nurse” or “Environmental Health Officer” roll off the tongue of a high school graduate? There you go! Same with the policy-makers. Therefore, which professions are the first to get scholarships for training, vehicles for accessing remote villages, allocations for the purchase of supplies? There you go!

Cayman Islands launch pre-hurricane strike against the skeeters

CAYMAN ISLANDS

46 years ago, mosquitoes were so dense in the Cayman Islands, swarms of the pests could suffocate large animals like cows by completely shutting off their air supply.  Just imagine then how much of a nuisance they were for the residents.

This situation became so untenable that it prompted the establishment of the Cayman Islands’ Mosquito Research and Control Unit (MRCU). The MRCU has been successful in reducing mosquito density to a more manageable level than what existed decades ago.

But mosquitoes are not easily eradicated, not with international trade and travel being what it is.  In this regard, resistant Aedes eggs could enter the country in used tyres, for example.  And someone infected with the Dengue virus could so easily waltz into Grand Cayman and thereby become the focal point for an outbreak of the disease.  The Aedes aegypti mosquito is present in Cayman, having been reintroduced in 2002 after being previously gotten rid of by the MRCU.

It goes without saying that the MRCU has a never-ending fight on its hands to keep a grip on the gains they have made.  For this reason, MRCU’s planes took to the skies in the latter half of May to mount an assault against the Dengue-causing Aedes aegypti mosquito ahead of the start of the hurricane season on June 01.

MRCU concentrated its aerial bombardment in the main urban population centres of Georgetown and West Bay on Grand Cayman.  Assistant Director, Alan Wheeler told caycompass.com that more flights were scheduled.

With increased rainfall a certainty, a large population of adults could breed so profusely in yards and vacant lots as to carry the Dengue virus across the small island in no time, sickening people along the way and probably causing death in their wake.

It is a well-established fact though, that the Dengue mosquito cannot be successfully controlled without the active involvement of the community at large.

In a May 26 editorial in caycompass.com, captioned ‘MRCU needs our help,’ the agency went on the offensive, “…asking residents to survey their properties for any places of standing water and to empty any containers where they find it.” The argument was that “[reducing] the number of breeding places can go a long way in reducing the population of the Aedes aegypti mosquito, helping to ensure  Grand Cayman remains mostly free from the dangers of dengue fever.”

So far, so good.  Grand Cayman has been lucky thus far.

Source: caymancompass.com¹²

5

Mosquito Maths 1: Flower Vases

Little Johnny taught me some Mosquito Maths today.  Johnny put it this way:

Clean, stagnant Water + Aedes aegypti mosquito = Dengue Fever

Johnny says he is sure that the Flower Vase on the center table in the living room allows the mosquitoes inside to lay eggs and breed more mosquitoes.  His mom will not do away with the Flower Vase for she loves her plants.  And after all, they are pretty.

Question: What should Johnny do to prevent the Dengue mosquito from laying eggs in his mom’s vase without getting rid of the vase altogether?

Tell Johnny how to mosquito-proof this vase

Help me teach Little Johnny how to prevent the Dengue mosquito from making him sick.   Post a Comment showing us how.  If you have a photo demonstrating a solution, e-mail it to woodshedec@gmail.com and I will upload it to this page for Johnny.

7

A visual guide on how Dengue is transmitted (updated June 05)

With the hurricane season upon us, we can expect the number of rain days to increase exponentially. Mosquito breeding will surely increase between now and November, possibly into 2012. The Dengue mosquito (Aedes aegypti) especially is going to have a field day laying eggs and breeding in the drums, buckets and miscellaneous containers we have lying around our yards, perfect habitats for this vector of disease that sickens more and more people in our region year after year.

Can we depend on you to make your home and place of work inhabitable for the Dengue mosquito? Are you in? To start you off, here is A visual guide on how Dengue is transmitted. 

Additional ReSources: Dengue Tutorial: History, Current Trends, Future Outlook

Mosquito Control/Dengue Reduction Manual - download manual, print, locate on refrigerator, practice once a week.  It takes only 15 minutes to stop Dengue in its tracks.

 

 

Dengue in progress – the Caribbean scorecard

Nine weeks into the year and already there have been several deaths due to Dengue - in St. Lucia, St. Maarten and…Barbados. A press release by the Ministry of Health of Barbados on Monday, April 11, 2011 admitted to at least one death there.  

Could that phrase “at least” mean there were more deaths?  The source headline at caribbean360 does say “Dengue deaths in Barbados still concerning officials.”

Fact: 135 cases were laboratory confirmed during the same nine-week period. (Source: caribbean360)

By Week 4, Guyana had adjusted its figures to reflect a total of 38 Classic Dengue Cases.

At May 06, 2011, twice as much data had been submittted to PAHO from Jamaica, St. Lucia, Suriname, St. Kitts and Nevis and St. Vincent and the Grenadines.  Breaking it down, Jamaica acknowledged having 55 Clinical Dengue diagnoses (2 Severe), St. Lucia 39, Suriname 3 (1 Lab Confirmed Severe Dengue), St. Kitts 2 (both Lab Confirmed), St. Vincent 1.

The number of reported cases of Classic Dengue in the Dominican Republic more than doubled to 441 as at Week 15.  Severe Dengue cases in the DR inched to 23 for the same period.  In Puerto Rico, the percentage rise of Classic cases to 956 at Week 15 was in effect two and half times higher than the previous reading.

Dengue transmission in Guadeloupe, Guyane and Martinique was sporadic.  These countries maintained that status through to March with cases clinically suggestive of Dengue remaining well below average.

In Guyane for example, during the month of March, the number of cases diagnosed by general practitioners ranged from 27-114; in the decentralised focal points, there was a slight increase of 5-6 cases weekly. This was particularly evident in the municipalities of St. George and Maripasoula, Matoury and Cayenne with Dengue-1 and 4 in circulation. Cayenne and St. George were still in active Dengue outbreak mode.

The records for Martinique are not comparable with those of Guyane because what we have dates back to the end of February.  So what do we have for the two months of the year, January 01 – February 27?  165 Cases.  Averaged out, the estimated number of weekly cases was far below what was expected for this period.  However, the 49 Laboratory Confirmed Cases, distributed as they were over 15 to 34 municipalities,  were on par.

Guyane (French Guiana) summarised: since the end of the Dengue epidemic in Week 39, 2010 to Week 13, 2011 in, there was a total of 2,667 Clinical Cases, 426 Biologically Confirmed.  DENV-1 and DENV-4 were serotyped.  The number of deaths, 0.

Martinique summarised: since the beginning of 2011, 165 Dengue Cases have been logged, 49 Biologically Confirmed.  DENV-1 serotyped.

Meanwhile, the Bahamas and Bermuda noted that within the first five weeks of the year, they each had 1 (one) Laboratory Confirmed Case of Classic Dengue Fever.  The British Virgin Islands claimed to have 2.

Trackback to the comprehensive 2011 report in Developing Dengue Stories.

US Government takes scissors to Dengue funding

WEC |  March 07, 2011

While we slept last year, the government of the United States was busy cutting funding to the Division of Vector-Borne Infectious Diseases (DVBID) from US$39 to US$12 million. In the immediate firing line of the government’s red ink pen were the Centers for Disease Control‘s (CDC) Puerto Rico Dengue Branch and Colorado State University’s Division of Vector-Borne Diseases.  It so happens that the PR branch is the World Health Organization‘s (WHO) reference center for the Caribbean region.  Colorado State is responsible for researching, tracking and treating infectious diseases such as Dengue Haemorrhagic Fever.

The result of this would have been a loss of essential jobs, expertise, human capital and technical resources so crucial to maintaining a high enough level of surveillance of Vector-Borne diseases such as Dengue while researchers struggle to come up with a tetravalent vaccine, one that could subdue all four strains of Dengue.

Emory University‘s disease ecologist Gonzalo Vazquez-Prokopec and colleagues, Emory disease ecologists Uriel Kitron and Luis Chaves and S. Ritchie and J. Davis from the Cairns Tropical Public Health Unit, reaffirmed in PLoS Neglected Tropical Diseases that the costs to Caribbean countries of delayed Dengue outbreak response, infection-related deaths and disability could rise exponentially without adequately funded and executed disease surveillance, prevention and control programmes.  It stands to reason, therefore, that the withdrawal of any amount of laboratory and other support services by the CDC Dengue Branch in Puerto Rico could severely increase the financial burden of island states faced with a likely Dengue outbreak in 2011.

“Our analysis shows that halting mosquito surveillance can increase the management costs of epidemics by more than 300 times, in comparison with sustained surveillance and early case detection,” Vazquez-Prokopec says.

“This analysis provides scientific-based evidence of the need for more funding of mosquito surveillance, not less,” says Uriel Kitron, chair of Emory’s Department of Environmental Studies.

The Emory researchers drew their conclusions from studies of the 2003 and 2009 Dengue outbreaks in Cairns, Australia.  ScienceDaily.com reports that Vazquez-Prokopec and Kitron et al used the available data from the Cairns outbreaks to calculate what the economic impact might have been for Cairns under variable epidemic curves and corresponding outbreak response times.

They were able to show that the average cost of the Cairns outbreaks, in terms of Vector Control, case diagnosis, blood screening and sick days, would have sky-rocketed from US$650,000 to US$382 million, assuming that active disease and Vector surveillance regimes were not in place and would have taken four to six weeks to be activated.

The researchers correlated their findings to the May 2010 Florida Dengue outbreak saying that it would have wiped out the entire US budget allocation for mosquito surveillance had not the state of Florida been ready.

The Division of Vector-Borne Diseases of Colorado State has also been doing some really important work  in vector biology that could have been seriously affected by the government cuts.  For instance, Colorado State is responsible for ArboVirus, the national arbovirus surveillance system that “integrates human, equine, avian and insect monitoring reports from state health departments.”  This according to the Northern Colorado BUSINESS REPORT.

Then there is Inviragen, a spin-off company that licensed technology from Colorado State to bring a Dengue vaccine to human clinical trials.

As an aside, Inviragen is one of several companies rushing to bring a Dengue vaccine to market.

In November 2010, Sanofi Pasteur’s  Sanofi-Aventis promised to have a vaccine on the market in two years’ time, maybe four depending on what you read.  They say that their candidate is in the final phase – Phase III – of development in Australia.  Trials have already been concluded in Asia, Latin America and the United States.  Clinical Studies are ongoing in Colombia, Honduras, Mexico, Peru, the Philippines, Puerto Rico, Singapore, Thailand and Vietnam.  India is on the radar for a two-year trial.  With a 90% safety and efficacy profile during Phase II, this one looks quite promising indeed.

Two other companies with a stake in the horse race are GlaxoSmithKline and Brazil’s Instituto Butantan.  The US government’s National Institutes of Health and the University of Queensland is in there too.

Researchers at the UofQ, led by Professor S. O’Neill, having discovered that a bacterium called Wolbachia has some potential as a Dengue Fever vaccine, began testing their hypothesis January in a Cairns, Australia neighbourhood with a record of a thousand Dengue infections per year. O’Neill and his team think they will know exactly how much potential this vaccine has by April of this year.  If successful, the Wolbachia bacteria would infect the wild Aedes aegypti mosquito population, which would lead to the control of Dengue within 2-4 years from now.

Sources:

healthrelatedinfos.com,

npr.org,

theviraldiseases.com,

timesofindia)

Realising the reach and extent of thee consequences of cutting funding, the American Society of Tropical Medicine and Hygienethe Infectious Disease Society of America, the American Society for Microbiology, the American Red Cross and Senators pressured the Senate Appropriations Subcommittee on Labor, Health and Human Services and Education and House of Representatives to reverse the decision to withhold the US$26.7 million from the CDC.  The Senate and the Congress repented, the Senate in July 2010.

If this does not strike a nerve in the weaker Caribbean economies, I do not know what will.

(Sources: plosntds.orgsciencedaily.comncbr.com)

Trinidad proposes water barrel replacement programme

 

Trinidad and Tobago

 

On the recommendation of a Joint Select Committee of the Trinidad and Tobago parliament, which this past January concluded a forensic examination of the Insect Vector Control Division (IVCD), the Health and Public Utilities Ministries of Trinidad have agreed in principle to join forces in tackling the problem that barrels pose in the breeding of the Dengue mosquito.

Much like the rest of the Caribbean and Latin America where rural and semi-rural communities do not enjoy a reliable source of pipe-borne water, there are areas of Trinidad and Tobago where residents in depressed communities rely almost entirely on barrels for the storage of potable water.

However, the everlasting problem of folks not handling the breeding of mosquitoes in their drums, not heeding the advice and counsel of Aedes Inspectors to protect those containers from the invasion of disease-carrying mosquitoes, and their refusal to use the water when inspectors treat them to destroy wrigglers is where the real challenge lies.

Speaking to the subject, Chief Medical Officer of Health, Anton Cumberbatch makes it clear that his ministry supports the idea of introducing an alternate type of container to mitigate this problem and expresses his willingness to represent the Permanent Secretary in any discussions with the Ministry of the People – the equivalent to Local Government – to deal with this. The big island of Trinidad does not have far to go for an example of a successful water barrel replacement programme.  The sister island of Tobago has one that could be copied.

But the CMO is well aware that cost is an issue for the people.  When asked about it, Cumberbatch opened the door to the Government subsidising the cost of replacing people’s barrels.

With the prevalence of Dengue worsening and the cyclical peaks narrowing from an average of every five years to every two years, the public would be well advised to be on guard by inspecting and eliminating mosquito breeding places on their premises.  Insect Vector too should be given all the support warranted to promote this concept and thus facilitate the introduction and acceptance of a more suitable type of water storage container to replace the traditional oil drum.

The JSC report also cited a couple of other shortcomings regarding Dengue, that there is limited use of the media in promoting the anti-Dengue message outside of the peak season for the disease and the ever-present problem of physicians missing the classic signs and symptoms and misdiagnosing patients.

There were 450 cases of Dengue in Trinidad and Tobago in 2010. (Source: Trinidad and Tobago’s Newsd@y2)

8

 

2010: The Ghost of Dengue past (March 05, 2011 updates, indented)

First published on January 05, 2011; update 4 on April 27, 2011

The Woodshed bots have scoured all available Dengue data to summarise the year 2010 to give some perspective about what has gone down in history as an unprecedented and turbulent twelve-month period.

At the end of 2009 (Figures for 2009), the Hispanic Caribbean (Cuba, Dominican Republic and Puerto Rico) and the Caribbean (English, Dutch and French-speaking) regions had tabulated 34,686 Classic Dengue Fever (DF) Cases, 78 Dengue Hemorrhagic Fever (DHF) Cases and 5 deaths due to Dengue. (Prior to 1999, the Dutch Caribbean did not report to Pan American Health Organization, PAHO)

Meanwhile, the number of reported cases of Dengue Fever and Dengue Hemorrhagic Fever in the Americas as a whole topped a million to reach 1,662,296 DF, 48,951 DHF/DSS with 1,193 deaths.

In making the leap to December 2010, we face the daunting reality that Dengue in the wider Caribbean (Hispanic Caribbean included), soared by nearly 300% for a total of 131, 666 Classic Cases, 2, 226 Severe Dengue and 129 deaths.

The Caribbean region was largely responsible for this jump, contributing 98,849 Dengue Cases to the lot.  In so doing, an outstanding record, that of the worst Dengue epidemic in recorded history, was established.  In fact, no other year is even remotely comparable to 2010.

In reviewing the data for the past twelve years, from 1998 to 2010, we found that the closest annual tally to the 2010 figures was in 2006 when PAHO recorded 32,764 Dengue Cases and 303 deaths.  In that year, Cuba did not report at all, therefore, no totals were available for Hispanic Caribbean, the region in which Cuba was later placed in 2007 with the DR and PR.

The worst-hit Caribbean islands by far in 2010 were the twin French Departments of Guadeloupe and Martinique.  Dengue sickened 78,200 of their residents, 41,100 in Guadeloupe, 37,100 in Martinique; and the disease claimed 19 lives in all.  French Guiana was a distant third on the list, having treated a mere 4,350 by comparison. 

 

If we were to group the Caribbean with Hispanic Caribbean, French Guiana would drop to fifth place, making way for Puerto Rico and the Dominican Republic where the Dengue virus overcame 21,298 and 11,519 people respectively.  PAHO records show that 33 died in PR (Puerto Rico Health Secretary Lorenzo González says there were 31 deaths, 28 of which were of the DHF type) and 51 in the DR.

It would be premature to report on countries with no Dengue considering that not all have reported down to December 31, 2010. The most diligent of all were the Puerto Rico, Anguilla, Antigua and Barbuda, Cayman Islands, the Commonwealth of Dominica, Guyana, Montserrat, St. Lucia and (French) St. Martin (Week 52).

In the case of Puerto Rico, Health Secretary González, announced Saturday, December 30 that the worst outbreak of Dengue in the country was officially over. It pleases us to announce today that the dengue epidemic declared in February has come to an end,” González said.

In the weeks leading up to González’ declaration, the incidence of Dengue had fallen steadily so that by the Week of December 03-09 at which time the number of cases was 60 less than the epidemic threshold, the Centers for Disease Control expressed satisfaction that the end to the outbreak had come. Nevertheless, the 188 cases recorded in Week 48 was still over and above the historical average for that time of year. The outbreak began in February 2010, a year that was arguably one of the rainiest ever.  (Source: caribbeanbusinesspr.com)

Not surprisingly, Cuba had no more than a week’s worth of facts to share with PAHO.  The United States Virgin Islands, Haiti and St. Barths did not even bother to get off the mark with the organization.

The viruses that circulated the Caribbean and Hispanic Caribbean were Dengue-1, Dengue-2, Dengue-3 and Dengue-4. Considering that not all countries have reported to the end of 2010 and that no serotyping information was shared by several of them, it could not be said with every bit of certainty that Barbados was the only country to have circulated Dengue-3 in 2010 as the records indicate.

What does this say?  It means that it will be some time yet before the 2010 Dengue chapter is closed.  As time goes by, we will flesh out the numbers, country by country.

Current Trends, 2011

Mosquito-borne diseases – Worldwide
2010 saw an almost world-wide increase in mosquito-borne diseases, especially dengue fever.  For example, officials in Malaysia reported a 12 percent increase in dengue infections in 2010 over 2009, and officials in Singapore reported a 19 percent increase in 2010.  Dengue fever increases were even more drastic in Latin America, where officials in Puerto Rico reported a 50 percent increase in 2010, officials in Venezuela reported an 82 percent increase, and officials in Brazil reported a 90 percent increase.  Indigenous dengue fever infections were also reported in Florida, US, for the first time in decades.  As climate change continues to expand the territories of disease-bearing mosquitoes, we may continue to see increases in such mosquito-borne diseases as dengue fever, malaria, and West Nile virus.  (Source: ijet.com)

P.S.: In the state of Goiania, Brazil, there was a 190 percent increase in Dengue Cases for the period January to November 20, 2010 over the corresponding period the year before.  Translated into real numbers, this amounts to 102, 726 cases and 69 deaths in that one state.

The situation may not be as bad in Sao Paulo, but it is bad enough.  That state recorded 322 cases in all of 2009.  By comparison, the total as at November 10, 2010 was 5, 576 for an incidence rate of 51.6 cases per 100, 000 inhabitants of which there are 11 million.

15

A visual guide on how Dengue is transmitted

A visual guide on how Dengue is transmitted

 

Woodshed Environment Coalition blog health: 2010 in review

The stats helper monkeys at WordPress.com mulled over how this blog did in 2010, and here’s a high level summary of its overall blog health:

Healthy blog!

The Blog-Health-o-Meter™ reads Wow.

Crunchy numbers

Featured image

About 3 million people visit the Taj Mahal every year. This blog was viewed about 42,000 times in 2010.   If it were the Taj Mahal, it would take about 5 days for that many people to see it.

 

In 2010, there were 40 new Page posts, growing the total archive of this blog to 234 posts.  (Many more posts published on Pages other than the Front Page were not counted in this report.)  There were 29 pictures uploaded, taking up a total of 2mb.  That’s about 2 pictures per month.

The busiest day of the year was September 13th with 346 views.  The most popular post that day was Caribbean scientist Dr. Samuel Rawlins helps UN win Nobel Peace Prize.

Where did they come from?

The top referring sites in 2010 were search.conduit.com, en.wordpress.com, righthealth.com, search-results.com, and search.aol.com.

Some visitors came searching, mostly for dengue fever, dengue, caribbean scientist, can mosquitoes bite through clothes, and dengue mosquito.

Attractions in 2010

These are the posts and pages that got the most views in 2010.

1

Caribbean scientist Dr. Samuel Rawlins helps UN win Nobel Peace Prize January 2008
5 comments

2

‘Dengue Fever is Dangerous’ slideshow v.1.2 is here… May 2009
4 comments

3

Can mosquitoes bite you through your clothes? May 2008
4 comments

4

Pakistan Dengue Poster August 2008
4 comments

5

Dengue Tutorial: History, Current Trends, Future Outlook February 2008
1 comment

‘Dengue Fever is Dangerous’ slideshow, v.1.3 is here…

Version 1.1, originally published on May 7, 2008

Dengue Fever is Dangerous slideshow

ALERT! VERSION 1.3, REFLECTING THE summarised DENGUE DATA FOR the whole of 2009, IS HERE

For a retro perspective, Slide to Dengue Fever is Dangerous – v.1.1, 2007.

(Brought to you courtesy of the Environmental Health Division, British Virgin Islands)

 

Related Posts:

Guyana atop Dengue for Carifesta XDengue pummels VenezuelaDengue Totals Rising…

The attack of the mutant mosquitoes – in Cayman Islands (updated)

CAYMAN ISLANDS

A trial at the Cayman Islands’ Mosquito Research and Control Unit (MRCU) could help to get rid of the mosquito responsible for the spread of Dengue.  British based company Oxitec has released genetically modified mosquitoes (call them mutant mosquitoes) into the wild in Cayman in the hope that this will cause the Aedes aegypti mosquito population to drop by interfering with their ability to reproduce.

Oxitec’s co-founder Luke Alphey explained how the trials of his ground-breaking Sterile Insect Technique (SIT) works to the BBC Caribbean Report in its November 11 edition.  For the past two years, he says, engineered sterile males have been released over 16 hectares, which is roughly 40 acres, of land to mate with females in the wild. Unfortunately for the pests, their sexual exploits have been fruitless since the offspring do not survive thus suppressing the numbers of the next generation of mosquitoes and so on and so forth.

The Oxitec scientists claim that upon releasing 3 million (roughly ten times the wild population, enough to overwhelm the local males and mate with all available females)  of these special mosquitoes, they cut the target species population on Grand Cayman down by 80% in the space of six months – or two weeks according to Sky News.  Oxitec accounts for the other 20% saying that they flew into the trial zone from untreated areas.

Oxitec and the MRCU think that in time, there will just not be enough mosquitoes to spread the Dengue virus to sustain an outbreak of the disease in Cayman.

The results of this small trial is encouraging, Alphey told BBC Caribbean Report.  He said the population of the target species has already been reduced, which augers well for other countries with a history of Dengue Fever.

As for potential negative impacts, Alfey assures us that the sterile males, being exquisite invasive species, designed to target only the Aedes aegypti mosquito, pose no threats to the rest of the ecosystem.

So environmentalists can rest easy.  Or can they?  Some groups and individuals are of the view that the release of the laboratory-bred mosquitoes into the wild is reckless.  This, in spite of Alphey’s assertion that unlike chemical treatments that have a broader spectrum, “The sterile males will only mate with females of the target species. “They won’t mate with other kinds of mosquito, let alone other insects that might be in the environment, like butterflies or bees.”

Someone who has made it a mission of his to sober up the debate on the Genetically Modified Mosquitoes is Malaysian immunologist Dr. Lim Thuang Sung.  Dr. Sung has appealed to the Malaysian government not to follow in the footsteps of the Cayman Islands because, in his view, the GM mosquitoes will not solve the Aedes aegypti problem in Malaysia.  His argument, made in Malaysiakini on November 19, was that since, according to Oxitec, the GM mosquitoes will die in a few days, it means that the mutants must be released continuously and indefinitely.

For Dr. Sung, the issue is not whether GM mosquitoes will mate with females in the wild and produce non-viable progeny or how long the released males will survive.  The more important questions ought to be, what if the native species of Dengue mosquitoes undergo genetic changes that in turn require genetic adjustments by the GM mosquitoes? Would there be any unpredictable consequences?

Dr. Sung also expresses concern that there is really no guarantee from Oxitec that their GM mosquitoes would not live the normal three-week lifespan of natural mosquitoes; and that their offspring will in no way develop beyond the larval stage to the adult stage.

This kind of advocacy presumably tangled up Oxitec’s Malaysia trials in red tape, delaying it for so long that the company looked to the Cayman Islands where opposition to the project was non-existent, according to Angela Harris of the MRCU. (Source: FT Magazine)

The UK Non-Profit public interest group GeneWatch has also taken Oxitec to task for the Cayman trials.  Not only did Oxitec fail to conduct any public consultations, said GeneWatch Director Dr. Helen Wallace, there was no public oversight prior to the release of the mutant mosquitoes.

In a Cayman News Service article published on December 14, 2010, GeneWatch accuses Oxitec of being heavily indebted to a venture capitalist whose loan to the company becomes due in 2013. The article also describes how Oxitec is losing money and has become increasingly desperate to commercialise the mutant mosquitoes to meet its financial obligations to the Boston venture capitalist.

GeneWatch goes on to make an implausible claim that the targeted Aedes aegypti mosquito, once eradicated, would be replaced by the sister Aedes albopictus mosquito, purportedly a more efficient transmitter of the Dengue viruses.

But the viability of the albopictus has not been satisfactorily demonstrated in the Caribbean.  For that matter, the twenty year-old albopictus hype, that it would invade the region, is yet to be fulfilled. Further, the Cayman reality has been that aegypti was wiped out in the past and albopictus did not fill the vacuum that was left. These facts alone are sufficient to debunk the GeneWatch albopictus propaganda.

GeneWatch does, however, make a valid point in questioning how the interactions of Oxitec’s mutant mosquitoes with wild female Aedes aegypti mosquitoes on Grand Cayman might affect the four Dengue viruses.

These contrary opinions aside, the fact remains that Dengue Fever needs to be controlled.  A viable vaccine that could target all four strains of the virus is years in the making and many more away.  The ease of movement of people from one place to the other – by air, sea and land – and the Global warming phenomenon are acting in concert to widen the geographic range of the Aedes aegypti mosquito.  Consequently, a greater percentage of the world’s population will become more and more vulnerable to Dengue Fever with each passing decade.

Genetically Modified Aedes aegypti mosquitoes is one of many approaches being pursued to reign in the spread of the Dengue virus. They are under trial on a very small, Caribbean island with a superior mosquito control and research programme as well as a substantial body of experience in the use of modern technologies to fight pest mosquitoes. So far, the prospects for GM mosquitoes appear to be good.  However, we hope that reservations like those of Dr. Sung will not go unheeded.

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Dengue in Dominica nears 2007 high

Commonwealth of Dominica

Acting Chief Environmental Health Officer, Anthony Scotland, voiced alarm on July 27 2010 about the encroachment of Dengue into the Caribbean region. In response, Dominica was put on a Dengue Alert in July, but merely as a precautionary measure for a start.

With one Dengue case confirmed at the time, Acting Chief Environmental Health Officer Scotland implored his country folk to do their best to prevent the Dengue mosquito, Aedes aegypti - the insect implicated in the transmission of the disease – from breeding on their premises.

Surveillance around all ports of entry in Dominica was stepped up and Health Alert Cards handed out to arriving passengers at airports and sea ports. The point of this was to ask people to refer themselves to the closest health clinics if they experienced any of the unique signs and symptoms of Dengue as listed.

Acting Chief EHO Scotland said this intervention was necessary because arriving passengers needed to understand that even though they were feeling fine, they could have incubated Dengue. He indicated that Source Reduction activities were also being undertaken to remove open containers, unwanted or otherwise, from the environment and in so doing to lessen the potential breeding places of the mosquito.

Dominica’s total was now at to 192 – 15 cases less than the 207 cases from the last outbreak in 2007 – with most cases concentrated in the capital Roseau. Ag. CEHO Scotland told BBC Caribbean Report that the situation was likely to escalate if persons did not take all necessary precautions to stem the breeding of the Dengue mosquito and, at the same time, to halt the importation of the disease from the neighbouring islands of Guadeloupe and Martinique.

Following up, Chief Medical Officer, Dr. David Johnson of the Commonwealth of Dominica, was reported by the OECS Newslink on Friday, September 17 2010 as saying that Dengue Fever was still posing a threat and challenge to health authorities there. Dr. Johnson told Newslink that the number of cases of Dengue rose in early September to 440 with 28 hospitalizations.

In his statement, Dr. Johnson revised and expanded the geographic spread of the disease in Dominica from the capital Roseau and the Roseau Health Districts to the west coast village of St. Joseph and the town of Portsmouth to the north-west of the island.

However, the good news was that for the first time since the start of the Dengue outbreak, there was an overall drop in the weekly rate of infections.

That information came across on the Friday, September 17th, 2010 edition of Dominica News Online courtesy of Dr. Shalandin Ahmeed of the Health Information Unit who presented the official position that there was a sharp decrease of over 30 percent in Dengue cases by week 2 of September over a notable increase in late August. According to Dr. Ahmeed, the number of Dengue cases reached a record high of 117 during the week of August 22-28 but that by mid-September, this number stood at 76.  Since then, there has been a marked decline in reported cases and weekly hospitalizations.

As of Saturday, September 11, 447 cases of Dengue were recorded and investigated by the Dominica health department. All patients admitted to hospital for treatment and observation were kept for roughly 2-3 days before being discharged.

The Health Information Unit reiterates its call for persons to take heed of the dangers of contracting the disease called Dengue and to do something about it.

For its part, the Ministry of Health continued its anti-Dengue campaign – media publicity, school visits, community meetings, surveillance and fogging of high risk areas – into October.

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THE SUSCEPTIBILITY OF AEDES AEGYPTI, ANOPHELES AND CULEX MOSQUITO LARVAE TO AQUATAIN AMF

 

Aquatain Products Pty Ltd. of Victoria, Australia has begun worldwide marketing of its flagship mosquito control product, Aquatain AMF.  The Caribbean distributor for this product is Avanzato Ricco Ltd. based in Kingston, Jamaica.

The company claims that Aquatain is not a chemical in that it is not designed, for instance, to disable the central nervous system of the aquatic stages of pest and disease-carrying mosquitoes like the typical insecticide. Rather, Aquatain is a physical acting product that reduces the surface tension of water thereby making it impossible for adult mosquitoes to rest on it and lay eggs.  Hence adults that land on water treated with Aquatain will drown; so too the larvae and pupae that would have hatched from eggs laid prior to treatment since they would not be able to penetrate the water’s surface to breathe.

Company literature and test results obtained by Woodshed Environment describe Aquatain AMF as a natural product with the main ingredients being silicone, citronella and eucalyptus oils.  This almost clear and slightly odourless liquid can also be added to drinking water to stop evaporation without any harm to humans, animals and the environment.

Tests on the safety of Aquatain to humans, animals and the environment have been done in the United States of America, Australia, Malaysia, Mexico, Singapore and Sri Lanka, and recently at the Government Analytical Laboratory of the Republic of Uganda.

Most recently, in February of this year, efficacy tests were conducted in laboratories and at various water breeding sites in select districts of the Republic of Uganda leading to a 100% kill within the first forty-eight hours following application.

Field tests were concluded in December 2009 in Aluthkade, Sri Lanka with similarly impressive results. That study also showed that Aquatain retained its efficacy for up to a month after initial treatment.

The Aquatain AMF is being used successfully in many parts of the world including Singapore, Australia, Malaysia, Mexico and on Necker Island, an exclusive resort owned by Richard Branson in the British Virgin Islands.  It has been extensively tested otherwise than in Uganda and Sri Lanka.

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Trinidadian animator Ansar Sattar stamps on the mosquito

Trinidad

 

  

At Piarco Airport in Trini toonland, a bored Immigration officer casts heavy eyebrows over a weighty volume on The Art of Stamping.  An annoying flying insect interrupts him, proffering a passport from The Republic of Stagnant Water, whose cover bears the motto: Together We Go Bite Yuh Together We Go Bleed.  

The officer’s eyebrows rise in a combo of suspicion and scorn, before his highly informed stamp pounds into officious action with a red “Entry Denied” exit visa; swiftly followed by horror on the face of the reject and summary squashing with his own passport.  This three-minute “unofficial message from the Ministry of Health” (of Trinidad and Tobago) alerting audiences to the threat of dengue fever borne by the Aedes aegypti mosquito, won young Princes Town-born animator Ansar Sattar, the 2008 Animae Caribe award for Most Promising Newcomer. (Abstract: guardian.co.tt

 

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Impact of Climate Change on Mosquito Proliferation, Dengue Outbreaks and Mitigation

British Virgin Islands

An Environmental Officer (not an Environmental Health Officer) of the British Virgin Islands’ Conservation and Fisheries Department asked me for my views on The Impact of Climate Change on Mosquito Proliferation, Dengue Outbreaks and Mitigation.

The thoughts that question generated swirled like a hurricane through my head.  Being the person that I am, I put fingers to keyboard right away to capture everything firing between the synapses.  This is what I came up with, raw and unfiltered.

VULNERABLE POPULATIONS AND CONDITIONS
All things being equal, older teenagers and young adults are most vulnerable to Classic Dengue Fever (a first encounter with the disease); then infants and the elderly for obvious reasons of either underdeveloped or compromised natural immunity.  However, the fact remains that everyone in the British Virgin Islands can potentially succumb to infection. And indeed, Dengue cases dot the complete age spectrum from the very young infant to the middle-aged.

That being the case, more precise variables for determining vulnerability need be examined, namely location and mobility.  In regards to location, records show that on Tortola, the majority of Dengue Cases fall within a precise swath from East End/Long Look along the Blackburn Highway – through Baughers Bay, Purcell Estate, Pasea, the Greater Road Town area to include Lower Estate and Huntum’s Ghut – to Harbours.  Of course, sporadic cases turn up in other parts of Tortola, but still generally in coastal communities to West End and on the North Shore.  Very few cases occur at higher elevations.

The suggestion I would put forward to explain this phenomenon is two-fold.  The coastal communities are more urbanized and thus heavily populated by day – when the Dengue mosquito is most active – in comparison with the those on the Ridge Road, for example. Hence, by the law of averages, it is reasonable to expect that closer human contact and activity make it easier for the Aedes aegypti mosquito to successfully transmit the Dengue virus around.

However, there is the issue of the socioeconomic structure, and more specifically water management, in the Virgin Islands.  Persons residing at the highest elevations are not consumers of pipe-borne water and have no expectation of such.  Consequently, they depend strictly on cisterns.  They have no need to hoard water in arbitrary containers like drums, pails, tubs and the like as a backup supply.  The reverse is true for persons living in the low-lying communities.  They depend primarily on the pipe-borne, municipal supply and use the odd containers as backups.

It is this tendency that invariably leads to the over-abundance of open containers in a community, containers that contribute to the high mosquito Indices that are found in densely populated areas.  This in turn, predisposes the Aedes aegypti to carry a sufficiently high viral load that serves to trigger a Dengue outbreak in those very communities.

TRENDS AND ISSUES OF CONTROLLING DENGUE
Over the past five years, there has been a rapid growth in housing activity in already heavily populated coastal communities on Tortola, British Virgin Islands.  This trend places such a burden on water consumption patterns that the hoarding of water has increased and with it mosquito density.  As much as the Vector Control Unit of the Environmental Health Division has succeeded in keeping down mosquito breeding in those critical spots, all it takes to reverse those gains is a rainfall event.

Rainfall in excess of 2 inches over a few days causes results in a dramatic upsurge in Aedes aegypti (and other species) mosquito breeding due to an abundance of containers that householders make available to them.  With between 80-90 percent of containers found on private premises being left open to receive rainfall and the apathy and lack of knowledge on the part of community members in handling them, the likelihood of a Dengue outbreak occurring today as compared to five years ago has improved substantially.

It does not help either that rising global temperatures are speeding up the larval and pupal stages of the mosquito’s development.  Indeed, accounting for things like turbidity, alkalinity, availability of particulate matter and predation, the warmer the water, the faster the aquatic stages will be.  This drastically cuts into the response time for the curbing of a mosquito infestation following a rainfall event.

For these reasons, Dengue infections have trended upwards over time so much so that 2007/2008 were some of the worst years on record.  This trend closely mirrors the situation in the Caribbean and the rest of the Americas on a whole.

POSSIBLE INTERVENTIONS AND AVAILABLE ACTIONS
The crux of the matter of controlling Dengue is not just one of Climate Change actions in terms of reducing global temperatures, dampening the intensity and frequency of storms, and mitigating the encroachment and intrusion of sea water unto arable lands and into aquifers with the attending side effects of desertification and threats on food security and human survivability.  What would matter more are the social communication methodologies geared towards engendering mass community awareness of and direct involvement in the activities to curb the prevalence of Aedes aegypti.

The basic community actions called for are…

1. Source Reduction through country-wide clean up campaigns (removing all open containers, wanted and unwanted, from the environment)

2. Motivation of householders to conduct their own weekly premises inspections and to maintain good sanitation

The Vector Control Unit will continue to…

1. Conduct daily premises inspections to teach householders how to do self-inspections

2. Monitor the human environment and to search for and destroy mosquito breeding places

3. Manage breeding places identified using Physical, Biological and Chemical Control methods

4. Disseminate mosquito control information to the public through close community interactions (meetings, demonstrations) and the media

5. seek to bring all four variables above to bear in a Social Communication strategy that will eventually make the householder more responsible for Dengue management in the Territory

6. expand this concept to the sister islands on a full-time basis, unlike what obtains at present

The Climate Change debate is of course so much broader than Vector Control.  Explore the expanded issues for now at takepart.com where Danny Jensen speaks the Inconvenient Truth about the extent to which The Caribbean is One of the Most Vulnerable Regions to Climate Change.

As part of his argument, Jensen cites the two-part video Islands on the Edge –  A Look at Climate Change in the Caribbean.  These videos draw on the expert opinion of some of the most prominent of Caribbean Scientists alive today, scientists like Dr. Sam Rawlins.

CDC asks, What if a credible Dengue vaccine candidate emerges?

What if a credible Dengue vaccine candidate emerges in the not too distant future? After all, a number of research units are hard at work in a spirited race to be the first to market one. Some teams are getting close too. They have even begun human trials so this is not exactly a pipe dream. 

When happens then when a vaccine is eventually approved? No doubt, the question of availability will arise: Will those who need it most be able to get it?

The Centers for Disease Control (CDC) and Dengue experts have their eyes on this issue. Recently, they had a meeting in Puerto Rico during which they sought to develop a slate of guidelines to govern the introduction of licensed Dengue vaccines unto the market.

According to the CDC website, the objectives of the Dengue v2V (Vaccine to Vaccination) international meeting was the documentation of “…the human and economic impact of dengue; providing guidance regarding vaccine adoption strategies based on clinical, epidemiologic, other technical data; and making recommendations about the introduction of a dengue vaccine for routine and catch-up immunization.”

The CDC had better hurry because a credible vaccine candidate will most likely become available this decade.

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Caribbean Dengue Alert Initiative takes hold in Westmoreland, Jamaica

JAMAICA

If I had my way, I would recruit a cadre of Woodshed Warriors (call them what you will), from the school system and the community at large with a minimum high school education and a command of the local language. I would train them in the basics of mosquito control with a heavy emphasis on how to share such information with community members in a way that empowers them to take personal responsibility for managing mosquito-borne diseases starting with their premises and neighbourhoods. Once they have mastered the fundamentals and can impart that knowledge in easily digestible bite sizes, I would throw them at High Risk areas to help the Vector Control professionals in curbing mosquito infestations already measured and quantified.

Mosquito Alert! The Westmoreland Parish Council and its Public Health Department, late last year, recruited 73 students as part of a Caribbean Dengue Alert Initiative to promote preventive measures for the control of mosquitoes in select communities of Westmoreland, Jamaica. An announcement to that effect was made by Major Bertel Moore of Savanna-la-Mar and Chairman of the Parish Council on January 12, 2012.

Westmoreland Parish

The Jamaica Information Service (JIS) reported on January 17 that the young men and women, who in the Westmoreland model will earn an income on the bargain, are out and about in their respective communities speaking with householders on this important health issue.  

Chief Public Health Inspector of Westmoreland Parish, Steve Morris, in an interview with JIS reporter Glennis Rose, was very clear: “We are not under any dengue outbreak in Jamaica, but just to be on alert, we get our public education initiative in action.” 

If I had my way, that is exactly how I would go about things.

Source: JIS

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