Update 7 on January 24, 2009 with news on Trinidad
(scroll down for the Dominican Republic, St. Kitts, St. Maarten/St. Martin, St. Lucia and Trinidad and Tobago stories)
As another year draws to a close, it is time to take stock of what Dengue has wrought to the countries of the Caribbean and the rest of the Americas. So for the next several weeks, the Coalition will seek to capture the final frames, albeit in synopsis, of the Dengue landscape of our region.
We would have liked to bring a first person perspective to all of the hard surveillance data compiled by the Health agencies of each and every of our countries. However, that is not possible since we were unable to attract in-country writers who were sufficiently motivated to keep a regular tab on Vector Control operations regarding Dengue and report on them here.
The Coalition will continue to work behind the scenes to give body to the “Coalition” as in Woodshed Environment Coalition. Our readers have followed the Dengue debate very closely, but simply do not feel the compulsion to become regular contributors to this forum. Maybe next year! (By the way the same applies to our sister site, Woodshed Entertainment Collective.)
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So here goes…
DOMINICAN REPUBLIC
The year 2008 ended with the death of six to seven more people to Dengue Fever in the DR. And that was just in the last fortnight of the year.
There are, however, conflicting reports casting serious doubt on the accuracy of these numbers: the Manager of the Robert Reid Cabral Hospital has claimed that there were only two deaths, not seven, while a doctor at the hospital affirmed that four children died from Dengue.
What is not in doubt are what the grand totals were prior to these latest deaths. The official 2008 Dengue death toll for the Dominican Republic stood at 34. 702, 354 diagnoses were made.
Previous Post: Dengue Fever spreads in Dominican Republic
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ST. KITTS & NEVIS
The St. Kitts and Nevis Ministry of Health has put any speculation of a Dengue Outbreak in the Federation to rest with the affirmation that more than two dozen Dengue Fever Cases have been laboratory confirmed by the Caribbean Epidemiology Center (CAREC) in Trinidad.
The Ministry’s statement of Wednesday, November 26, 2008, states that blood samples that were sent off to CAREC for laboratory confirmation have returned positive for the mosquito-borne disease.
The press release further contends that because of this, and the fact that notifications of clinical cases are still being logged by the Health Information Unit, means that “the mosquito that spreads Dengue viruses remains highly active.”
The population of St. Kitts & Nevis is, therefore, strongly encouraged to take the time to inspect their homes and surroundings for mosquito breeding sites, potential and real; to cover and protect such containers to make it impossible for the mosquitoes to lay their eggs; to drain and dispose of the useless or unwanted ones; and to contact the Environmental Health Department through the local Primary Health Care Clinics to request additional assistance.
In the meantime, public-environmental mosquito spraying will be conducted in the Federation to kill the adult mosquitoes, bearing in mind that the destruction of mosquito breeding sites is infinitely more effective if everyone gets involved in the control efforts.
Previous Post: Dengue may have reached SKB!
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DUTCH ST. MAARTEN/FRENCH ST. MARTIN
St. Maarten/St. Martin has made it to the top of the Front Page of this blog any number of times this year. The reason for this was the tremendous interest that the SM media adopted in this story. But the fuel that drove it were the residents of the island, especially Barbara Cannegieter, who fed the Coalition with stories often enough to keep it alive – and deservedly so.
The Dengue response in St. Maarten (Dutch) took a pause for the Christmas season on Friday, December 19, 2008. The last set of communities to be surveyed just prior to that were the Districts of Middle Region and Dutch Quarter, Dawn Beach, Oyster Pond and Red Pond. Earlier on, teams of Vector Control officers working four hour days starting at 08:00 o’clock each morning visited Point Blanche, Philipsburg, Fort William, Over the Bank and Sucker Gardens.
Fogging runs have already been completed in the Dutch Quarter, Middle Region and Sucker Garden as well as in Madame Estate, Arch Road, the Keys, Defiance, St. James Estate, A.T Illidge Road and Guana Bay. (Source: smn-news)
In addition to the ground surveillance activities geared towards the elimination of mosquito breeding containers in people’s homes and at their workplaces, inspectors gave talks at schools and to any organisation that would listen. The basic message advocated was that everyone needed to accept personal responsibility for the management of their premises. That responsibility would be to ensure that there is no standing water around that would allow mosquitoes to breed. The standard presentation dealt with Cause of the Dengue, the Signs and Symptoms of the disease, Treatment and Prevention. The programme will resume in January 2009.
As a lead up to Christmas hiatus, the Dengue Action Response Team (DART), the multidisciplinary committee charged with the responsibility of mounting a response to the country’s Dengue Outbreak, has released the last available figures for 2008. On Friday, December 12 DART reported that there were 36 Laboratory Confirmed Cases of Dengue in first week of November. (Source: smn-news.com)
By our calculation, we believe that another 90-odd test results are still pending. This deduction was based on a November 20 smn-news report, which put the number of Confirmed Dengue Cases for the first fortnight of November at 9 with 110 results still pending.
The health authorities have repeated their pleas to the St. Maarten community - householders and business owners – to maintain vigilance during the next couple of weeks and not slack off because the Dengue response is in abeyance. This was actually the gist of a Government Information Service (GIS) interview with Acting Head of the Preventive Health Department, Maria Henry. (Source: smn-new.com)
A health inspector finds an abandoned tire during a yard inspection. This is an ideal breeding ground for mosquitoes. (Photo credit: smn-news.com)
Crossing over the invisible line that demarcates the Dutch from the French sides, we learn that the last time the French health authorities held a press conference, it was a joint affair with the Dutch side’s Dengue Action Response Team (DART). Representing the French was Health Inspector for the Northern Islands Stephane Barlenin and Dr. Rachel Ersel of DART.
Health Inspector Barlenin reports that 30 Suspected Dengue Cases have been recorded every week this year. By his own count, this brings the total number of Suspected Cases as at the end of November to over 1,000. The Dengue epidemic, which is how he put it, is concentrated in Orient Bay, Concordia and Marigot.
Because the Dutch and French sides are contiguous, it is to their mutual benefit that they pool their resources and consolidate their efforts in controlling the Dengue epidemic. In pursuit of this objective, their laboratories (SLS and Lepers) are already cooperating in regards to testing patients for the disease.
To supplement regular surveillance activities (house-to-house inspections and spraying), Public Service Announcements and fliers providing information on how to fight the Dengue epidemic are disseminated to the public in both French and English.
The next steps would be joint training exercises aimed at their physicians and for their labs to begin working together to type the Dengue viruses in circulation. This is a critical next step that will prove invaluable when the time comes to further assess the potential threat of the current event and all future events. (Source: Over 1000 Suspected Cases of Dengue on French Side—Intense Awareness Continues)
Previous Post: Dengue escalates in St. Maarten
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ST. LUCIA
updated on December 30, 2008
Health authorities in St. Lucia lamented the near doubling of Confirmed Dengue Cases in 2008 over the year before.
Chief Medical Officer, Dr. Josiah Rambally revealed to the CMC (Caribbean Media Corporation) that there were all of 92 Confirmed Dengue Cases at the end of November, 45 more than for the corresponding eleven-month period of 2007.
Worse still is the fact that up to mid-December, more than a dozen individuals were being treated for the potentially fatal form of the disease known as Dengue Hemorrhagic Fever (DHF). St. Lucia had not recorded a death due to Dengue up to that time.
“We suspect that the increase (last year was) the result of the additional rain we have had and an improved system of surveillance, where we have done a better job of detecting persons infected with the disease,” CMO, Dr. Rambally intimated as he urged St. Lucians to eliminate the breeding grounds of the Dengue mosquito from their premises. (Source: Jamaica Gleaner News)
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TRINIDAD AND TOBAGO
These are the signs of the times…
…a demonstration to protest Dengue. At any other point in time, Vector Control professionals probably could not pay anyone to go out into the backyard to turn over a water-bearing container, protect a water storage container, empty out a flower vase or go up on the roof to clear out a roof gutter. Now, these same people are going out on the street to make a call to action to deal with a Dengue Outbreak. After all, the situation in Trinidad and Tobago has become desperate. Now, they have gotten the message – to control the mosquitoes – they are willing to share it.
In fact, Trinidadians are now becoming advocates for the cause, even calling for the penalisation of persons who allow the Dengue mosquito to breed on their premises. Indeed, there are laws prohibiting this, if anyone were to ask. However, these laws are seldom, if ever, enforced.
One of these advocates is Dr. Neil Singh. He has made a pitch to the health authorities to invoke the Public Health legislation dealing with Yellow Fever. This law was enacted in 1970, he says, to curtail the spread of Yellow Fever, also spread by the Aedes aegypti, the Dengue mosquito. Trinidad & Tobago Newsday has since confirmed that County Medical Officers of Health have been authorised to have their Environmental Health Officers begin serving compliance notices to offenders.
Dr. Singh echoes the Coalition’s cry that “It is not the Government that is responsible for the spread and people need to understand this. The doctors cannot control Dengue and spraying (thermal fogging to kill the adult mosquitoes and perifocal spraying to destroy them in the aquatic stage) is not the answer…But if there are containers and mosquitoes, you can’t expect Government to come and spray every day. It is the responsibility of citizens to take action to prevent mosquitoes breeding.”
Singh concurs with the Coalition that we must become more community minded in our approach to mosquito control. Our interventions must, therefore, not be limited to the narrow spaces within our fences and walls, but should extend outside to the places where clean/clear water collects. Applying small quantities of oil such as kerosene, petrol and diesel (not old oil or bleach) to small water bodies will do the trick.
In reviewing media reports of the Dengue Outbreak in Trinidad, it appears that Trinidadians are not sufficiently aware that the Dengue mosquito breeds more so on their premises than out their in the open environment. They seem to be looking too far outside rather than within.
Residents of Frederick Settlement, Caroni, display placards for passing motorists during their protest on Tuesday, December 23 at Southern Main Road, Caroni (Photo: Roberto Codallo/T&T Newsday)
Demonstrations like these ought not to be directed only at the the Insect Vector Control Division (IVCD) of T&T, but also at fellow residents who are the ones largely responsible for the breeding of the Dengue mosquito. This is simply because the mosquito prefers shaded and undisturbed grounds for laying eggs, which it is more likely to find in the drums, barrels, buckets, pails and all such containers that can hold rain water and rules out drains and temporary pools in empty lots for the most part.
According to Specialist Medical Officer Dr. Clive Tilluckdharry, the IVCD has been conducting mosquito surveillance activities, including fogging and spraying, in Caroni since October. This disclosure was made at a press conference given at the Division’s, Queen Street, St Joseph offices in response to the protests.
SMO Dr. Tilluckharry went on to detail these interventions saying that the IVCD had mounted a “blitz programme” in cycles from October 13 to December 19, 2008 with the assistance of an entomologist. This comprised of ‘perifocal’ and residual spraying using the insecticide propuxur during premises inspections as well as ULV (ultra low volume) and thermal fogging.
After the first cycle in October, the blitz resulted in the reduction of the mosquito Indices - the statistical measure of a mosquito infestation - in the East/West Corridor and the The Frederick Settlement by an average of 6.00% . The final Indices were 6.00% and 1.10% respectively. The goal for any Vector Control programme is 1.00% or 5.00% depending on which specific Indices are used to gauge the success of a programme.
Dr Rohit Doon, advisor to the Health Ministry (and former Chief Medical Officer), capped the dialogue with the conclusion that the response of the IVCD was “on time, targeted, focused and very detailed. All the elements that constitute good vector control management are contained in this response.” Hence, less mosquitoes.
But do not tell that to the protesters; or the families of the Dengue victims, like that of the 22-year-old university student and the 22 year-old daughter of Freddy Ramcharan, both from Caroni who died from Dengue Haemorrhagic Fever on December 9 and Jassodra Nanan who died of cardiac failure due to DHF on November 14; or the Dengue Cases like the two Canadians who were visiting with relatives in Ellerslie Park, St. Clair and the French woman who survived a bout with the disease.
The official line is that Dengue is on the decline in Trinidad and Tobago. But this is disputed by, for example, the Penal/Debe Regional Corporation who claim that they are still receiving Dengue patients on a daily basis and that there are cases all over the district. On the other side of the equation, sources at the San Fernando General Hospital are adamant that admissions at the institution are down. This position is bolstered by a Public Health Inspector who noted that complaints to Vector Control are going down also. (Source: Is Dengue up or down?)
The last officially available Dengue figures date back to Week 28, July when the Ministry of Health listed a total of 120 Dengue Cases. It is obvious that there have been many more cases in the ensuing months, especially in San Fernando, Sangre Grande, Caroni and Couva. However, it is hard to tell to what extent the Dengue Outbreak has escalated between July and December.
What we do know is that there were at least ten (10) Dengue deaths and over a 1,000 Suspected Cases in Trinidad & Tobago in September, the last month for which we had any kind of reliable figures. The number of Confirmed Cases were thought to be well above 280 at that time. A source at the Ministry now puts the total number of reported Dengue deaths at 35 in 2008. The same source adds that 2,500 individuals were diagnosed with Dengue in that twelve month period, with 65 of them progressing to the potentially deadly complication of Dengue Haemorrhagic Fever.
These though would not be the final figures for T&T because private doctors do not regularly report their Dengue diagnoses and treatment records to the country’s Ministry of Health. (Source: caribbeannetnews.com)
The Ministry of Health has now released its year end report, which has it that the Trinidad Public Health Laboratory (PHL) confirmed 100 cases of Dengue in 2008. However, the Trinidad Newsday cross-checked these data with those of the Pan American Health Organisation (PAHO) and found 3 Dengue deaths, 206 “lab confirmed” cases, 2, 366 clinical cases, 8 DHF/DSS at the end of week 37 (September).
Newsday also consulted with a couple of medical practitioners who read the report. One officer expressed puzzlement that the Ministry of Health would rely only on the PHL for overall Dengue statistics. (It is a well-know fact that many victims of Dengue have resorted to private labs to have their tests done.) The other officer described the report as “superficial.”
Health Minister Jerry Narace and Medical Officer of Health Dr. Anton Cumberbatch were both solicited by the newspaper for a clarification of the discrepancy between the official country statistics and the figures provided to PAHO by the Caribbean Epidemiological Centre (CAREC), but none was forthcoming.
Therefore, the jury is still out on the final Dengue numbers for Trinidad and Tobago.
More to come….
