Dengue Fever is Dangerous slideshow v.1.1

Slide through this fresh look at Dengue - from a Caribbean perspective.  Come on…slide.  Sorry, I should have said ’click’ on this link, Dengue Fever is Dangerous - v.1.1 courtesy of the Environmental Health Division, British Virgin Islands.

 

 

Get rid of tyres properly; think Dengue

    Tn’T

Old tyres can be seen everywhere.  They are thrown at the roadside, used to ignite fires at road protests or just left lying around.  But do we know the dangers of these modern wheels?

After all, they are kept in yards and at tyre repair shops for ages thus giving the Dengue mosquito countless opportunities to lay their eggs and thus breed and breed again.  Albon Scott, Executive Manager, Environmental Projects at the Solid Waste Management Company Limited (Swmcol) of Trinidad explains in the following article pulled and adapted from the Trinidad and Tobago Express with original reporting by Kristy Ramnarine.

________________________ 

“Burning tyres are very bad for health because the rubber is highly toxic,” he said.

“Tyres left lying around have the potential for harbouring mosquitoes, which carry Dengue Fever and also other vermin like rats.”

(Referring to Trinidad and Tobago) Scott explained that dumping tyres was illegal under the Litter Act.

“But there is a very small penalty which is not a deterrent,” he said.

For those choosing the legal path - like some tyre dealers with truck loads of old tyres - they pay SWMCOL to bury them at the Beetham Landfill.

“Our temporary measure is to put them in the landfill; at least we know where they are.  However, that poses a problem especially if there is a fire at the landfill site.”

The Environmental Project manager said Government needs to invest in a tyre shredder.

“There (have) been attempts to get that type of equipment but we have not gotten it as yet,” he explained.

“The wire could be taken out and sold through a steel factory and the rubber crumb of the tyre can be used in road material as part of aggregate, or it can be made into new tyres as well.”

Scott said Government could also work out an agreement with the rest of the Caribbean to shred their tyres.

“One of the biggest problems is that we bring in used tyres to be sold,” he said.

“That should be stopped; it is not good.  In Barbados and Jamaica they don’t allow them in the country but we still allow them in and they each end up as waste.”

 

____________

Editor’s Note: Used tyres have been major foci of mosquito breeding in the Caribbean.  They could not be more efficient in this regard.  There are good reasons for that:

• They are black in colour, which is attractive to mosquitoes.  Ever wondered why we are asked to avoid dark clothing in mosquito infested places?  
• The wells of the tyres are dark and cool.  The Dengue mosquito, Aedes aegypti, shies away from light sources with a passion.  Thus, they will not be seen in open sunlight.  Ever wondered why aegypti chooses the dark side of our legs, under the table and low to the ground when searching for a blood meal? 
• Aedes aegypti will not be disturbed during the aquatic stages of their development.  Tyres being useless, they are not likely to be moved around during the seven-day life cycle before the adult mosquito can fly off into our homes.
• Tyres tend to be discarded close to or around where we live and work.  The Dengue mosquito does not want to fly too far for a blood meal.  So what better place to breed than right there in our backyard?

Let us familiarise ourselves with our country’s regulations and get rid of tyres properly.

 

Brazil Dengue deaths breaks 2002 record

   Brazil

update 2 @ 04:40 p.m. E

The Dengue outbreak of 2002 in Brazil resulted in a record 91 deaths.  That number has now been bettered and threatens to rise even higher still.  According to Brazil’s government news agency, Agencia Brazil, the new record high of 92 Dengue fatalities was set in Rio de Janeiro in April. 

Citing the Rio state health department, the AB also says that there may be another 96 possible Dengue deaths.  This means that the death toll could possibly double when all the figures are finally in. 

The current mortality rate is one death for every 1,204 Dengue cases as compared to one per 3,167 in 2002.

The warning is already out that Dengue infections could triple this century.  The question to be asked, judging by Brazil’s extraordinary experience with Dengue this year, is whether or not Dengue infections could triple much more quickly than previously imagined.  All speculation now, but we shall see.

The more present concern is that Dengue may well pose an even greater threat in 2009.  Already, a nationwide task force has been set up to look into this.  An estimate of the Aedes aegypti population in Brazil has shone the spotlight on two (Santa Catarina and Rio Grande do Sul) of the 17 states in the country where there have been no prior epidemics. 

A health ministry sanctioned report claims that the residents of these states are more susceptible to a future outbreak of the disease due to a lack of widespread immunity against any of the prevalent Dengue virus types.     The fear though is that local government authorities will ignore that risk after the current outbreak has been brought under control leaving their constituents as vulnerable as ever.

 

 

Sources USNews.com and ChinaDaily.com.cn

 

 

 

12 more Brazilians die from Dengue

Medindia.net has reported that there were 12 more Dengue fatalities in the eastern Brazilian state of Rio de Janiero up until two weeks ago.  This is in addition to the 67 deaths previosly recorded there in the first quarter.  The figure may well be much higher given that another 80 deaths are under investigation as possibly Dengue related.  On top of all that, a further 18,000 people have been infected with the fever. 

Rio’s Ministry of Health now puts the total number of deaths to Dengue at a conservative 79 and overall infections at 75,399.  The mortality rate, says StarTribune.com, is three times higher this year than what obtained during the 2002 Dengue outbreak, the worst in the country’s history thus far.  Young children have been hardest hit, making up most of the serious cases and fatalities.

The NationalTravelHealthNetworkandCentre (NaTHNaC) website in an April 07 Clinical Update revealed something that had not come through previously and that is Dengue Hemorrhagic Fever infections was at 245 on March 28.  The site also indicates that there is even more DHF in Amazonas, Rondonia, Sergipe, Bahia, Rio Grande do Norte and Para.   In all instances, the cost in lives and health surpasses the 2007 scenario for the same time period.  

 

Commentary: World Health Day 2008: Protecting health from climate change

Following is part of the ‘A World Health Day Message from Caricom/PAHO’ on the relationship between Climate Change and human health.  World Health Day was on April 07, 2008, but the message remains apropos today. 

Much of the emphasis in this piece published in Caribbean Net News on April 05 is on the potential for an increased incidence of Dengue Fever.  However, there are the associated costs to our people if we do not take heed and act accordingly to reduce this and other threats posed by Vector borne diseases such as Malaria and the other ills. 

We are referring here to the issues surrounding the flooding of low-lying areas and the destruction of valuable infrastructure including arable lands; the water-borne diseases that would occur as a result; the respiratory illnesses that people will suffer from due to air pollution; energy concerns that could breed more poverty; and on and on.

(The bolds and italics are all ours.)

The health of each man, woman and child in the Caribbean is being affected by climate change. In this, the first part of a series on the lead-up to World Health Day on April 7, the link between climate change and health is examined, and we look at what each individual can do to help combat this worrying trend.

Though one may not readily see a connection between climate change and health, the two are inextricably linked.

Studies from around the world show that climate and weather have a powerful impact on human life and health.  Already the effects are being seen in the region with the sharp increase in Dengue Fever cases in Caribbean countries in recent years.

Dengue is caused by a virus transmitted by the Aedes aegypti mosquito, and mosquitoes are sensitive to direct effects of climate such as temperature, humidity, rainfall patterns and wind.

It is thought that the warmer temperatures being experienced have accelerated the growth of mosquito populations, and hence the spread of this deadly virus.

As such, Dengue Haemorrhagic Fever and Dengue Shock Syndrome are forecast to increase in the tropics and sub-tropics as a result of climate change.

In the Caribbean, Dengue cases have climbed from a few hundred a year in the 1980s to as many as 8,000 a year since the early 1990s.

And, according to researchers on the Assessments of Impacts and Adaptations to Climate Change (AIACC) study which was released in Bali, Indonesia last year, cases could triple by the 2080s if there is an estimated two degree centigrade temperature rise in the Caribbean.

This would deal the region a double whammy.

That is, it could impact on the health of the local population, and the growing number of cases could strike the economically-important tourism industry which accounts for nearly 70 per cent of Gross Domestic Product in Antigua and more than 10 per cent in many other islands.

Because of such factors, the World Heath Organisation (WHO) has dedicated this year’s World Health Day on April 7 to focussing on the need to protect health from the adverse effects of climate change, given the threats it poses to global public health security.

The theme, “Protecting Health From Climate Change” puts health at the centre of the global dialogue about climate change.

In what other ways can climate change impact on heath?

• The increased incidence of mosquitoes and other vector-borne diseases like Malaria (as occurred in Jamaica last year) and Leptospirosis from rodents, as high temperatures favour the proliferation of mosquitoes and other disease carriers;
• A high occurrence of heat- and stress-related illnesses and conditions;
• An increase in water related diseases, especially water-borne diseases, including skin conditions like dermatitis, particularly following extreme rainfall;
• Contamination of potable water, particularly following extreme rainfall, and the seepage of contaminants from illegal dumping of solid and other waste into underground aquifers;
• Increased occurrence of respiratory ailments like asthma and allergies; and
• Loss of life as a result of flooding, contaminated water, unsanitary conditions and respiratory diseases.

That’s the bad news.

The good news is that through increased collaboration, the global community will be better prepared to cope with climate-related health challenges world-wide.  

 

Vox pop Malaria: World Malaria Day, April 25, 2008

The Coalition got a comment on the subject of Malaria in Africa, which we think deserves a front page post.  This in spite of our internal policy that would normally restrict our discourse on Vector Control matters to the Caribbean and Latin America. 

But Malaria in Africa is much too important not to make an exception.  And at any rate, we must bear in mind that our inter-connected world does not immunize us in this region against emerging and re-emerging diseases such as Malaria.  Take for instance that Jamaica had a recent outbreak that came out of nowhere; and that Barbados, apart from having the Anopheles mosquito, has at times been faced with the introduction of Malaria from Africa.

————————————————————–

Africa Fighting Malaria writes: World Malaria Day is April 25, 2008. Africa Fighting Malaria is issuing a Call to Action to support indoor residual spraying, a highly effective, World Health Organization-approved method of malaria control – check out our interactive Africa map: http://fightingmalaria.org/issues.aspx?issue=14

Also check out our new video and support AFM’s fight against malaria! http://fightingmalaria.org/AFMInAction/

We will go further by republishing the following Jasson Urbach article.

World Malaria Day - Just another PR swat at malaria?

Jasson Urbach | 17 Apr 2008
Africa Fighting Malaria

April 25 has this year been declared World Malaria Day. Since 2001, April 25 has been observed as Africa Malaria Day, commemorating the signing of the historic Abuja Declaration by 44 African malaria-endemic countries at the African Malaria Summit held in 2000.

The day has been set aside on the calendar as an opportunity for malaria-free countries to learn about this age-old disease that has plagued mankind for centuries. A day for malaria afflicted countries to learn from each other’s efforts about how to control the disease.

Despite all efforts, malaria continues to be a serious public health concern throughout the world. It affects over 100 countries and approximately 40 per cent of the world’s population. It causes between 300 and 500 million infections and approximately 1 million deaths each year, most of which occur in the poorest region of the world, sub-Saharan Africa. It is estimated that malaria claims a child’s life every thirty seconds and the ones who survive an episode of severe malaria are likely to suffer from learning impairment or brain damage. Pregnant women and their unborn children are also particularly vulnerable to malaria, which is a major cause of stillbirths, low birth weight and maternal anaemia.

The majority of people in this world will never experience the debilitating effects of malaria, thanks mainly to the eradication campaign adopted at the eighth annual World Health Assembly meeting in 1955. Despite the fact that the campaign was eventually abandoned and considered a failure, it registered resounding successes in wiping out malaria from large regions of the globe. Successful application of DDT as part of indoor residual spraying (IRS) programmes, coupled with the effectiveness of antimalarial treatments such as chloroquine formed cornerstones of the programme. Africa however, was largely overlooked in the global eradication effort because the continent lacked the necessary infrastructure to conduct a successful campaign.

African nations now have the tools to control the disease. Communities have effective insecticides for the targeted application on the inside of their household walls, insecticide treated bed nets, and drugs to clear the parasites from their bodies. But the obstacles to a successful control programme today are similar to those that existed during the eradication campaign — weak infrastructure, bureaucratic hurdles and the stark reality of millions of poor individuals who can barely sustain themselves, let alone spend money on personal measures to control and treat the disease.

Over the past few years, a number of large multilateral organisations have taken an interest in malaria and eradication efforts are now benefiting from more funding and more political interest. The US President’s Malaria Initiative (PMI) is set to devote $1.2 billion to malaria control in 15 African countries over 5 years, eventually benefiting an estimated 175 million people.

The Global Fund for AIDS, TB and Malaria (GFATM) provides hundreds of millions of dollars to malaria prevention and treatment programmes. The US Congress is currently negotiating and authorising a bill that will seek to devote up to $9 billion for malaria control over 5 years. This interest in raising the profile of malaria must be applauded but simply pouring more money into the problem may not be sufficient to control the disease.

Without the necessary checks and balances in place this additional funding will be wasted. If the required economic development does not take place in targeted countries and a domestic commitment made to a sustainable control programme, it’s difficult to envision how the problem will be solved. There is a long, hard road to travel and, if history is anything to go by, the successful implementation of an eradication programme will have more to do with African politics and economics than with specific technologies.

In the short run, countries must continue to strive towards implementing a comprehensive malaria control programme. This implies an acute understanding of the nature of the vectors as well as the measures needed to control the parasite most effectively within each unique setting. Baseline studies in malaria affected areas need to be conducted before any interventions are initiated. Ultimately, the success of the programme should be measured in terms of reductions in morbidity and mortality, as opposed to the simplistic notion of the amount of resources expended.

Research into new and essential tools to fight malaria in Africa must continue. Desperate attention must be given to the development of a new insecticide that can be used in those areas where resistance is building up or has already built up. Furthermore, we need to remain vigilant of the quality of drugs being used to treat malaria and this involves a clamp down on the production of fake and sub-standard drugs.

World Malaria Day once again provides the opportunity to raise the profile of the disease and provide answers to the question of what works in malaria control on the ground. Additional funding is necessary but is by no means sufficient to control malaria. The necessary checks and balances must be put into place or else funding will be wasted, and World Malaria Day will be just another public relations event.

Author:Jasson Urbach is a director of Africa Fighting Malaria. This article may be republished without prior consent but with acknowledgement to the author.

 

 

Guyana on High Alert for Dengue

  Guyana

________

Guyana is seeing a repeat of the circumstances that in 2007 threatened to prosecute a major outbreak of Dengue Fever there.  At the start of the month of April, the country had already recorded 103 cases of Dengue, 9 up from the same time a year ago.  This comes on the heels of a spike in Classic Dengue cases - and some Hemorrhagic Dengue - across the country two months ago that was not, however, sustained.

It is not clear at this stage as to whether all of this Dengue activity is as a result of the increased sensitivity and suspicion of doctors and the consequent doubling of the amount of testing they have initiated.

Dengue-2, the type known to be prevalent in Guyana, is predominantly what patients are turning up with.  However, a relatively small number of cases has been diagnosed with Dengue-3 and Dengue-4, which is why DHF is showing up uncharacteristically this year.   

The Lethem border is currently under heavy surveillance.  Teams of health personnel are visiting the homes of infected persons and testing the other occupants for the Dengue virus. 

Airlines have been requested to share their manifests with Port Health in cases where persons with high fever have boarded inbound flights.  

Additionally, the bed net programme is being rolled out in coastal communities to pregnant women and families with young children.  And Minister of Health, Dr. Leslie Ramsammy went to the media on Monday, April 07 to appeal to people living on the coast and in the hinterland to sleep under the long term impregnated mosquito bed nets.

He also said that the country’s Vector Control efforts against the Dengue mosquito have been intensified through fogging and other measures.

At around this time of year in 2007, all indications were that Guyana would have suffered a major Dengue Outbreak.  The Ministry of Health reacted swiftly then by orchestrating an onslaught on the disease by throwing Vector Control and allied health professionals at it.  Ports of entry were put under surveillance to curb the introduction of the Dengue virus into the country.  Bed nets were distributed in affected hinterland areas to stem the rate of infection.  Soon, it became clear that Guyana’s worse fears would not be realised as disease spread slowed and eventually became a non-issue.  400 cases of Dengue were still recorded in 2007.

 

Main Sources: Stabroek News/Sunday Stabroek

                            Guyana Chronicle Blog

 

Fogging with Malathion: How safe is it? - Part 111

Environmental Health Officers take questions and queries from our clients practically every day on a wide range of subjects, Mosquito Control included.  One of the questions that reached the desk of the Coalition is timely for its relevance to the most recent string of posts (Part 11, Part 1) on Malathion usage in our region.  

————————————-

 

QUESTION: Fogging, the carrier is diesel.  Has there been any study about what breathing that in will do to the body?

 

ANSWER:  

     

Pesticides have always been a source of concern for trained and licensed operators, the scientific community and, of course, the general public whom we shall refer to as “residential/bystanders”.  Our fears have centered on the simple fact that since such products are designed to kill, albeit pests and vermin, they can also be harmful to the human population as well.  However, a review of the scientific literature would substantiate what we already know in the Vector Control Unit, that exposure by inhalation to chemicals used for fogging has little or no significant adverse health effects on residential bystanders, whether be they adults or children.

     

The Pest Management Regulatory Agency (PMRC) of Health Canada, referring to Malathion, explains it thus: “The droplets of pesticide are very small and do not drift or deposit like larger droplets.  Spray droplets may evaporate during this period of suspension in the air, and so, not deposit at all….  Thus, exposure is minimized and adverse effects are, as a result, limited.”  The ATSDR (Agency for Toxic Substances and Disease Registry put it this way, again speaking of Malathion: “(it) can be absorbed after inhalation, oral, or dermal exposure, but is readily excreted in the urine, and does not accumulate in organs or tissues.”  The National Library of Medicine and the National Institutes of Healthpublished a study on the subject of fogging using organophosphate insecticides. 

 

The study indicates that “…inhalation of spray mist was negligible.  No clinical signs or symptoms of intoxication were discovered in either study, nor were inhibitions of cholinesterase (ChE) activity of health significance established under the conditions of the studies.”

 

The Vector Control Unit of the British Virgin Islands’ Environmental Health Division has in the past fogged to control adult mosquitoes using chemical products from the Organophosphate (Malathion) and Synthetic Pyrethroid (Chemrez 25 S, Biomist) classes in addition to Diesel Oil, which serves as an accelerant.  The Diesel burns the chemicals to produce a white smoke that the wind can easily carry in and around our premises where the pest mosquitoes are most active. Understandably, residential bystanders tend to feel vulnerable when overcome by that “smoke.”

 

The Cholinesterase enzyme is inhibited by chemical exposure and thus is a good pointer to the ill effects of a pesticide on the human person.  The Vector Control inspectors employed by the Environmental Health Division were all tested for lowered Cholinesterase inhibition in 2005.  All of them were passed fit.  Some of the inspectors have worked in this field for many years, decades in some instances.

 

However, exposure to the ULV (ultra low volume) formulations employed by truck-mounted equipment is to be avoided during and immediately after a spray event in the same way that a house should be evacuated after spraying for mosquitoes with a household aerosol.

 

Vox pop Dengue: Fogging with Malathion: How safe is it? - Part 11

 Antigua

Following is the second of the two-part piece on the subject by Peter Roderick, writing in the Antigua Sun.

If you omitted to read the first part of the article and clicked straight to this one, you may be interested in backtracking to Part 1 after which you can come right back here to complete your read.

__________

Malathion fogging has been causing controversy…for years.  I did some research…and discovered that there are two very different points of view on the matter.  Through it all, I came to certain conclusions which appear not to be in dispute.

Malathion is classified as an organophosphate insecticide. It is the most widely used organophosphate insecticide in the United States.

The people who manufacture malathion normally sell their product in a very pure state when it leaves the factory.  It should contain less than five per cent of impurities.  Pure malathion is said to have a relatively low toxicity to humans.  We have the manufacturers’ solemn promise that their product will not harm us when used according to their instructions.  What instructions?  Here’s a sample -

Precautions: Keep out of reach of children.  Hazardous if swallowed, inhaled, or absorbed through the skin.  Avoid breathing spray mist or dust.  Avoid contact with skin, eyes or clothing.  Wash exposed skin areas thoroughly with soap and water after working with malathion.  Clean contaminated clothing before reuse.  Do not contaminate feed or foodstuffs.  Do not treat dairy barns.  Do not apply to pastures while occupied by dairy animals.  Do not treat any plants while in bloom.  Avoid contaminating any body of water.  Wash treated food before eating.  Do not apply to eyes or ears (except in ointment form) or nose of any animal.  Do not store product near food, feed, fertilisers, seed, and like commodities.  Highly toxic to fish and bees.  Emulsifiable concentrate formulations may cause injury to young cucurbits and ornamentals (crassula; holly; African violet; petunia; sabina and canaerti junipers; Boston, maidenhair and pteris ferns).

Malathion is approved by the Environmental Protection Agency (EPA) of the USA.

The EPA doesn’t actually test malathion.  It approves the product based on information supplied by the manufacturer.

Diluting malathion with diesel can result in a product which weakens mosquitoes but does not kill them. This can give rise to mosquitoes which become resistant to malathion.

While malathion itself is not considered toxic, it can and sometimes does contain impurities which are in fact highly toxic.

Malathion is highly toxic to bees.

Malathion is toxic to fish, aquatic invertebrates, and aquatic life stages of amphibians (I think this means tadpoles.  If you notice that there are less tree frogs around (Antigua); this might be the reason).

Some female rats which were fed high doses of malathion for two years developed higher incidences of liver tumours, i.e. cancer.  The males were apparently not affected.

Malathion should not be used on fruits or vegetables immediately before consumption.

Malathion should not be inhaled.

If malathion is absorbed into the body it is quickly metabolised into toxic chemicals.

Malathion should not be stored at temperatures exceeding 25 degrees Celsius or 77 degrees Fahrenheit.  Above this temperature it will progressively break down into highly toxic by-products.

People who work with malathion for long periods should have frequent blood tests to check the level of cholinesterase in their blood.

Malathion fogging should only be carried out by individuals who are properly trained and are fully conversant with the manufacturers instructions for use of the product.  Use of the product by untrained individuals may constitute a public health hazard.  It can also ruin the paint on your car. 

Here’s an excerpt from the Fyfanon directions for use –

Droplet size

1. The Mass Median Diameter (MMD) of the droplets should not exceed 17 microns.  The MMD is the drop diametre which divides the spray volume into two equal parts; i.e., 50 per cent of the volume are drop sizes below the MMD and 50 per cent are above the MMD.

2. Spray droplets should not exceed 32 microns in size.  Three per cent of the spray droplets (six droplets out of 200) can exceed 32 microns providing the MMD does not exceed 17 microns and no droplets exceed a maximum of 48 microns.  Larger droplets, when transported by natural air currents, impinge more readily on objects in their pathway and will permanently damage automobile-type paints.

3. More than one-half of the total spray mass must consist of droplets in the 6 to 18 micron range to achieve adequate dispersal of insecticide over a 300-foot swath.

4. A minimum of two-thirds, preferably four-fifths of the total spray must consist of droplets not exceeding 24 microns in range.

Fyfanon was sprayed widely in New York City and on Long Island in September 1999 to kill adult mosquitoes and combat a newly emerging public health threat, the West Nile virus.

Fyfanon’s active ingredient, malathion, is highly toxic to lobsters and after heavy rains washed the insecticide out to sea the lobster population was virtually wiped out.  The local lobstermen sued and reached a tentative settlement in a class-action suit against Cheminova, the maker of the Fyfanon. The company agreed to pay $12.5 million.

An article on the BBC news Web site dated 28 March 2008 cites a new study which found a strong link between long term exposure to pesticides and the development of Parkinson’s disease.  Parkinson’s is a progressive, degenerative, neurological condition which causes uncontrollable trembling of the arms and legs. There is currently no cure.

In summary, the benefits of widespread malathion fogging to prevent the outbreak of dengue should be carefully weighed against the possible risks to the general population and to the environment.

There is much that can be done by ensuring that all roadside drains are regularly cleared of debris to eliminate stagnant waters where mosquitoes abound.  Perhaps we should focus more on cleanliness than on another quick fix from the chemistry laboratories.

 

Submitted by Peter Roderick

 

 

Source:Antigua Sun