these are the stories bubbling up from under the woodfloor…
Developing Stories
SURINAME/CUBA
Dengue outbreaks in the tropics normally subside by December/January. Not so in Cuba and Suriname where Dengue has been picking up.
In the case of Suriname, an outbreak has occurred near the heavily-trafficked Berbice border-crossing. This development has drawn the attention of the Guyana health authorities concerned about the impact this might have on its Dengue profile. In a press conference on Tuesday, January 31, Chief Medical Officer, Dr. Shamdeo Persaud, said that while there are reported cases of Dengue in Guyana, the situation is not alarming.
CMO Shamdeo also made it known that the Guyana health ministry was in discussion with the Port Health personnel at the Crabwood Creek border crossing to put in place a mechanism for the identification of travellers exhibiting flu-like signs and symptoms. Such persons are being asked to check-in to a health facility without delay.
Suriname has confirmed reports of a Dengue Fever outbreak saying there were more than 300 cases at the close of the month of January. There was no word about the strains of the Dengue virus in circulation there.
Dengue Fever is characterized by four virus types, Den-1, 2, 3 and Den-4. An infection with any one of these four serotypes offers lifelong immunity, but specific to that type only. Because no cross-immunity exists, a first bout of Dengue does not immunise someone from contracting Dengue by the other three viruses. In fact, by virtue of having had Dengue, a second infection could lead to the potentially-deadly complications known as Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). (Source: Kaieteur News online)
In Cuba, third, fourth and fifth year medical students of Cuba’s ELAM (Escuela Latinoamericana de Medicina, Latin American School of Medicine) assigned to the Salvadore Allende Hospital in Havana have had their classes suspended so they could go out into the city to look for people with symptoms of Dengue Fever and to check for standing water in which the Dengue mosquito breeds.
Like in Suriname, it is uncommon for a Dengue outbreak to occur this early in the year, let alone persist through February. Rightly, the incidence of Dengue increases in the second half of the year and the number usually dwindle by December.
Up until 2008/2009, I would not have imagined a Dengue outbreak continuing well into the first quarter of the new year. But the tell-tale signs have been there for a while. With climate change has come unseasonable patterns of rainfall and warming that have created favourable conditions for the Dengue mosquito to maintain their numbers into the traditionally dry season while extending their range further north.
The medical students are let loose in so-called Blocks of 135 homes. They visit the residents of all the premises daily, all the while keeping an eye out for signs of fever, joint and muscle pain, abdominal pain, headache, pain behind the eye sockets, purple blotches and bleeding from the gums.
Students have no trouble whatsoever gaining access to Cuban homes for the overwhelming majority of the Cuban people have accepted mobilization campaigns, in existence since the revolution, for disease prevention and control – among other interventions – as the norm and warranted. (Source: counterpunch.org)
T&T still faced with healthcare challenges
First published in GuardianMedia: Thursday, December 29, 2011 by Rhoda Krystal Rambally and excerpted by the WEC
A plethora of challenges continued to plague T&T’s healthcare this year. The deaths of eight-year-old Asia Archibald in August and 29-year-old Crystal Boodoo-Ramsoomair in March created public outcry. Dengue took the lives of Archibald and another female pupil, a teenager and a businesswoman, while scores of others were hospitalised. Government quickly implemented a five-year plan to deal with the eradication of the deadly virus. Local Government Minister Chandresh Sharma called on citizens to do their parts. He had said: “We will be starting with minor contracts to small business people to clean up the additional waterways as we seek to have an aggressive clean-up across the country.
“We are asking all truck-owners, all contractors to make available their trucks for two days and we will clean up the entire country.” He assured the population there was no need to worry since the Government was doing all that was necessary. Prime Minister Kamla Persad-Bissessar and her grandson, Kristiano, and Legal Affairs Minister Prakash Ramadhar’s daughter also were victims of dengue fever…
… In August the PM was diagnosed with dengue. However, she assured the population she would run the affairs of the country from her home in South…
While dengue plagued the country no one admitted there was an outbreak despite the high number of reported cases, especially among children. As at July, the Insect Vector Control Division said there were 1,885 reported cases.
World-wide news reports indicated that dengue cases were on the rise and a travel alert even warned of the virus in the Caribbean…
Expert questions dengue eradication strategy
… The Ministry of Health has advised that it is possible to reduce the conditions favourable for the breeding of the insect vector by cleaning up our environment, clearing weeds, emptying uncovered water tanks, cans, bottles, jars and vessels holding water, cleaning watercourses, and ensuring domestic hygiene. Our guest columnist in this two-part series is world expert on dengue, Professor Dave D. Chadee from the Department of Life Sciences, University of the West Indies who questions the dengue control strategies used in T&T.
One of the missions of the University of the West Indies is to conduct basic and applied research which serves to “explore solutions to priority national and regional problems and challenges; create significant new knowledge; elucidate important contemporary social issues; and provide a sound basis for public policy formulation and decision making”. This responsibility to conduct studies or research relevant to the needs of the Caribbean people is aptly demonstrated in the work being done on dengue fever: on the virus; the epidemiology of the disease and transmission dynamics as well as on the vector Aedes aegypti (population genetics, ecology, behaviour, insecticide resistance and control). Over the last seven years over 60 research studies have been conducted and published in international peer reviewed journals and most studies have been presented at local, regional, and international scientific meetings. Today the research findings from this UWI programme are being used in dengue and vector control programmes in Cairns, Australia, South East Asia, Peru and in Puerto Rico but not in Trinidad–a serious gap remains in translating knowledge into practice.
In Tobago as early as 2003 a switch in major mosquito breeding sites from water drums to small containers was reported because of the replacement of water drums by tranks, especially in the Central district. Why, for example, did Trinidad not adopt the strategy of replacing water storage drums with closed tanks? A more dramatic effect may have been expected in Trinidad where drums account for 70 per cent of mosquito breeding sites while, prior to replacement, only 35 per cent in Tobago. The Ministry of Health figures show over 1800 reported dengue cases in July 2011 and the current dengue programmes are being run by three different ministries–Local Government is conducting a source reduction programme or clean-up campaign but unfortunately this will remove less than 5 per cent of the mosquito breeding sites. This strategy was advocated in the 1980s by the Pan American Health Organization and was evaluated in 4 different geographical areas but they all failed to reduce the vector populations to below disease transmission levels. The education programme being run by the Ministry of External Affairs and Communication is targeting householders and is excellent but will have long term benefits rather than short term relief to householders.
This is one of the major drawbacks of health education messages—the population must read, understand the message, plan (intend to change their behaviour), implement the behaviour change, and maintain their enthusiasm for cleaning and maintaining a mosquito free environment. The Insect Vector Control Division is currently carrying out their normal Aedes aegypti control programme which is reactive to reports of dengue cases rather than proactive. This reactive approach cannot be criticized in the short term but its impact and value may be less than optimal. There is an urgent need to develop proactive approaches which involve early warning systems and better strategic planning. After 35 years of the Aedes aegypti eradication and control programme (1976-2011) no progress appears to have been made, though research has shown that with the same materials and manpower more strategically deployed, significant reductions in mosquito populations are possible.
FDA permits marketing of first test to help diagnose dengue fever
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 the 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 using the evidence of the signs and symptoms of Dengue.
More here…
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 would be 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.
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 at the time was 3,324 Suspected Cases, 886 of which were Laboratory Confirmed. There were 15 cases of Dengue Hemorrhagic Fever (DHF) with 2 probable deaths.
More here…
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; a public education drive; the fumigation of said communities; the treatment of potable water receptacles; an improvement in the lines of communication between the allied government agencies at the forefront of the exercise.
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.
More here…
CAYMAN ISLANDS
Cayman Islands health authorities have placed the country under a Dengue advisory. This precautionary measure, adopted in late September, was instituted in the face of outbreaks of the mosquito-borne disease in several countries across the Caribbean and the Americas.
Dengue Fever is not endemic in Cayman, according to health officials. However, the Dengue mosquito, namely Aedes aegypti, is very much present there.
But in spite of their best efforts, by early October, Cayman Islands had recorded their first Confirmed Case for 2011.
More here…
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 strangely enough, omitted to give justification such as the percentage of the numerical increase in Dengue infections from the previous month or months. Nor was the yearly total of Confirmed Dengue Cases revealed. No deaths have been recorded.
The National Dengue Emergency Plan has been activated for the purpose of conducting health information sessions with the public and residents of the Roseau Health District where the Dengue Outbreak is concentrated.
Whether there was compliance or not, the Dengue situation in the Commonwealth of Dominica was on the decline by the end of September. 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.
As a means of bolstering its response, the Environmental Health Department proposes to enforce existing laws pertaining the breeding of mosquitoes.
More here…
Antigua
Extrapolating a separate report by the Antigua Observer, Andre 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.
Echoing his MOH, Dr. Edward urged residents of Antigua and Barbuda to take heed of Dengue advice given by their public health authorities.
Unfortunately, Antiguans do not seem to be following the well-publicized advice given to them on how to manage stagnant water.
Chief Health Inspector Lionel Michael did not clear the air on that when he issued a Public Notice on September 10.
One thing is certain, the Aedes aegypti mosquito is overwhelming residents of Antigua and Barbuda.
More here…
On the same wavelength with doctors Frederick and Edward is Mr. Anthony Webbe, Principal Public Health Officer in the Nevis Ministry of Health’s Environmental Health Services. Faced with at least 2 Confirmed and 1 Suspected Case of Dengue, Mr. Webbe is calling on Nevisians to help in the fight against mosquito borne diseases.
In an SKNVibes interview, Mr. Webbe is reminding the public that they have a duty to get rid of containers to prevent the breeding of the mosquitoes.
In explaining why no fogging was being done on Nevis, Mr. Webbe emphasizes that source reduction is the message he plans to disseminate.
But make no mistake, a vector control programme is in effect where the Dengue Cases have been identified.
St. Lucia
The Ministries of Health and Education have joined forces to enhance Dengue awareness among teachers and pupils of the island’s schools. This effort is, however, not confined to the school yards. Parents and guardians are being targeted in the ongoing intervention to curb the Dengue Outbreak that has resulted in the death of at least two persons this year.
In an OECS Newslink report, September 05, Chief Medical Officer, Dr. Merlyn Frederick said that the goals of the exercise is to eliminate the breeding grounds of the mosquito.
Prior to the commencement of the school year, vector assessments were conducted on school compounds and fogging was undertaken in school districts.
More here…
Cuba
Like the rest of the Caribbean, Cuba is highly vulnerable to theDengue virus. However, it must be noted that the country has a remarkable track record in pre-empting 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.
The Cuban health authorities have undertaken an island-wide sanitation and fogging campaign.
Turks and Caicos
Bahamas and St. Lucia implicated in TCI Dengue Outbreak
TCI’s Chief Medical Officer, Dr. Rufus Ewing has implicated The Bahamas and St. Lucia for the introduction of Dengue into the Turks and Caicos. CMO Ewing told the Turks and Caicos Weekly News that the three adult cases confirmed to date were all imported, two from The Bahamas and one from St. Lucia. Two of the three, all females by the way, were discharged from hospital; the other lady was still receiving intravenous fluids on Tuesday, August 09, 2011.
Additionally, 30 persons have been hospitalised since mid-July. Most were treated and discharged. Hundreds more have showed up at island hospitals with complaints of signs and symptoms of Dengue Fever.
More here…
St. Lucia/Trinidad
Unseasonable rains are not exclusive to the Cayman Islands this year. The rest of the Caribbean has had to put up with record-amounts of rainfall and in some cases uncharacteristic flooding and destruction of property and infrastructure.
This has made the health authorities of St. Lucia and Trinidad and Tobago quite wary.
In the case of St. Lucia, public health officials were worried over what they saw as “disturbing” levels of Dengue Fever on the island this year.
Speaking with the media on Wednesday, June 22, 2011, Chief Medical Officer, Dr. Merlin Frederick, blamed Hurricane Tomas for the sharp increase in Dengue infections. The numbers have far surpassed the average for this time of year.
The St. Lucia Department of Health has responded. And like the MRCU in Cayman, the health authorities in St. Lucia desperately need the public’s input.
We imagine that Trinidad’s Ministry of Health would say the same especially now that an eight-year old girl out of Arima, Trinidad is dead, presumably of neuro-dengue, a highly fatal complication of Dengue Fever caused by a “mutant” strain of Den-4 that has been in circulation in Trinidad and Tobago for three decades. Children are especially vulnerable to this new strain.
Dr. Ashvin Sharma, Chairman of the North Central Regional Authority North (NCRHA), which overseas the Eric Williams Medical Sciences Complex, Mount Hope, the Arima area hospital, was ordered by Minister of Health, Dr. Fuad Khan to conduct a thorough investigation into the circumstances of the Thursday, August 04, 2011 death on , deemed suspicious by the mother.
The young mother lamented during a television interview, aired on TV6 and carried by the Trinidad Express, that she pleaded with the hospital personnel to keep her daughter overnight for observation, but was turned away anyhow pending the test results. Now, a three-year old sibling of the deceased has also come down with Dengue. She tested positive when the whole family had their bloods pulled for screening.
A preliminary report submitted to Minister of Health Khan has since cleared the hospital of any wrongdoing in that no protocols were contravened when the patient was discharged into the care of the mother following her examination. It did concede that the medical staff ought to have kept the child as was requested by the parent.
Khan said on CNC that “…the doctors followed protocol. The only thing…is the early discharge. And, I want to see why.” Interestingly, this is the only question the Dengue victim’s mother wants answered.
At any rate, the decision has been made to re-educate doctors and nurses at Port of Spain General on the “manifestations” of Dengue; a clean-up campaign involving 30,000 person will be commenced shortly; and the Litter Act will be more aggressively enforced.
But as Public Health Inspector Kurt Ross put it, the real problem has to do with the “barrel areas…communities which do not have pipe- borne water, but store water in barrels.” People tend to throw out the water from the barrels whenever public health workers treat them with chemicals, Ross explained.
An official at the St. George District Insect Vector Control Division office, who chose to remain unnamed because he was not authorised to speak to the Trinidad Express, elaborated by saying that people “…need to change their behaviour and attitudes because they are the ones who are responsible for keeping their areas clean… Spraying can only do so much.”
In the meantime, three children of Point Fortin, Trinidad were diagnosed with Dengue recently. All three children, ranging in age from five months to two years were still in hospital as of August 09, 2011. This is the news coming from Trinidad’s i95.5FM via the Mayor of Point Fortin.
Head of Insect Vector Control Division (IVCD) of the ministry Dr Clive Teeluckharry has revealed to Newsday that 1,800 cases of Dengue have been reported for the year thus far. The counties of St. George East (445), Caroni (332), St. George Central (270), St. Andrews/St. David (226) and St. Patrick (207) are the areas most affected.
To date, TT has counted 1,800 Dengue Cases. In 2010, TT had 4,894 cases of Dengue.
As an aside, Prime Minister of Trinidad and Tobago, Kamla Persad-Bissessar has been struck down with Classic Dengue, the mild form of the disease. PM Persad-Bissessar was diagnosed on Tuesday, August 16, 2011. On the advice of her doctors, PM Persad-Bissessar is receiving medical attention at her private home in Philippine, South Trinidad. She is still in charge of the government at this time.
In other news, 15 children were admitted to the Paediatric Accident and Emergency Department of the Wendy Fitzwilliam Children’s Hospital at the Eric Williams Medical Sciences Complex, Mt Hope, on Monday, August 11 on suspicion of having Dengue.
More here…
Barbados
A “Meeting On Preventing The Reintroduction Of Malaria In Non-Endemic Countries” was held in Barbados, June 01-02, 2011.
The meeting was called by the PAHO Regional Program and Office of the Caribbean Program Coordination (OCPC).
More here…
>>>> Three months into the new year, Dengue reports from the islands of the Caribbean were far from flowing in. Whatever was available could have been called a trickle to a stop.
We know from the news of the deaths in St. Lucia, Sint Maarten and most recently Barbados that there is Dengue in our region already. It is just that the Ministries of Health have not yet shared all of their data with the Caribbean Epidemiological Center (CAREC), the agency responsible for gathering same from the English-speaking Caribbean and the Pan American Health Organization (PAHO), which takes care of the wider Hispanic Caribbean through the rest of the Americas.
Barbados
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.
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)
Reported Cases of Dengue in the Americas
For the Caribbean proper, the notable exception was Guyana, which had reported three weeks worth of Dengue info – 16 DF Cases, none serious. The rest of the Caribbean was not even off the mark at the time.
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.
Still on the subject of reporting, the Hispanic Caribbean region – Cuba, the Dominican Republic and Puerto – was much more proactive than the Caribbean. Thus, we are aware that there were scores of Dengue infections in the DR and PR in the first five to six weeks of 2011. DR recorded 191 cases of Classic Dengue and 17 DHF (Dengue Haemorrhagic Fever) through Week 6. PR went further still. Not only did the Secretary of Health inform us that 389 DF Cases were logged in the first five weeks of the year, he gave details on the strains of the disease identified – Dengue -1, 2 and 3. As usual, Cuba has been mum. That was for the Spanish-speaking Caribbean.
Nine weeks after that last assessment, 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.
Do not, however, put the French Speaking Caribbean in the same column as Cuba. As usual, the Institut de Veille Sanitaire has made their figures available for scrutiny.
Let us go to St. Barths where, according to the INVS, the rate of Suspected Dengue and Laboratory Confirmed Dengue infections for the month of January was moderate at its worst. Suspected Dengue Cases ran between 0-5 Cases per week while Lab Confirmed Cases fell in the narrow 0-1 range. No one was hospitalised in January.
It can be safely concluded, therefore, that there was no evidence of an outbreak of Dengue in St. Barths.
Dengue activity in (French) St. Martin was more pronounced than in St. Barths. The good news may be that there was a steady decline of Dengue Cases diagnosed by General Practitioners from mid-December 2010. The 15 Cases recorded in Week 1, 2011 were 3 less than what obtained in Week 52, 2010.
The downward spiral of Laboratory Confirmed Dengue Cases was even more dramatic with the values for the three-week period leading to Week 1, 2011 well below the epidemic threshold. Visits to the emergency room was at most 2 per week. No beds were taken.
Upon reviewing these most recent data, The Committee of Experts declared the Dengue epidemic on the French Side, Saint Martin, officially over as of Week 50, 2010.
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, 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 Laboratory Confirmed Case of Classic Dengue Fever; the British Virgin Islands claimed to have 2.
The AmericasMore April updates for Bolivia, Brazil, Paraguay, Argentina, Maldives and USA her…
St. Lucia
One St. Lucian is dead, presumably due to complications of Dengue Fever. The Caribbean Epidemiological Centre (CAREC) is now collaborating with the St. Lucia Ministry of Health in investigating of this and two other suspicious deaths to determine if the cause was Dengue Haemorrhagic Fever (DHF). This is the news coming out of the Helen of the West Indies on Wednesday, January 26, 2011.
Chief Medical Officer of Health of St. Lucia, Dr. Merlene Frederick, has gone on record with a warning to St. Lucians not to let their guards down and to be extremely careful not to let clean water sit in uncovered containers of any kind.
Medical and Environmental Health personnel have been put on notice to step up surveillance and health education activities for a broad range of infectious diseases including Dengue.
Weather reports indicate that St. Lucia, the Commonwealth of Dominica and Barbados were rained on quite heavily this January. St. Lucia has had heavy rain showers almost daily this year.
More here…
Costa Rica
Not unlike the rest of the Caribbean and Latin America, Costa Rica succumbed to an unprecedented Dengue outbreak last year. Not unlike a number of other countries – Puerto Rico and the French Caribbean islands of Guadeloupe and Martinique being prime examples – new benchmarks were set, records were made, some were broken.
Costa Rica made its own mark at mid-year 2010 at which time, 21,000 Suspected Dengue Cases were recorded, surpassing the 2009 level by a multiple of four. The hardest hit Locality was Limon where 20 Cases were Confirmed.
The health authorities embarked on an intense fumigation campaign while imploring the population to support clean-up efforts, take care not to keep standing water in unprotected containers and allow Vector Control specialists to do their work. (Source: INSIDECOSTARICA)
Dengue activity – global update December to March 2010| nathnac.org
Central America and the Caribbean
As of 8 April 2010, 23,520 cases of dengue were reported from Central America, including El Salvador (7,711 cases), Honduras (3,899), Mexico (3,418) and Nicaragua (3,842). Numbers were higher than expected for that time of year.
In 2009, the Dominican Republic reported 6,418 cases (including 545 DHF). 1,894 cases of dengue were reported in the DR between January and April 08, 2010.
Puerto Rico had 1,880.
Cases have also been reported in other Caribbean countries.
The largest number of cases in Central America and the Caribbean usually occur in the second part of the year coinciding with the rainy season.
Central America and Caribbean: Dengue Fever, May 2010
In Guadeloupe, an outbreak of Dengue Fever was reported. About 40 to 60 cases were reported weekly.
In Guatemala, 313 cases of Dengue Fever were reported in Escuintla department.
In Managua, capital of Nicaragua, 2 784 cases of Dengue Fever were reported. (Source: ProMED-mail, 17 May 2010)
Puerto Rico, January to July 2010
During January 1–July 15, 2010, a total of 6,321 suspected dengue cases were reported to the Puerto Rico Department of Health (PRDH) and CDC’s Dengue Branch Passive Dengue Surveillance System[...] The increase in cases began in January. In late February, when the number of reported cases exceeded the epidemic threshold for 2 consecutive weeks, PRDH declared a dengue epidemic. Dengue has been endemic in Puerto Rico for 4 decades[...]
Trinidad and Tobago
The Pan American Health Organization (PAHO) said that deaths have also been recorded in Puerto Rico and Trinidad and Tobago. The Trinidad health authorities reported 1,200 cases up to August 10. However, the sobering reality is that the peak season for dengue transmission had not yet arrived. Based on historical records of the Caribbean Epidemiology Centre (CAREC), which were reviewed by Chief Medical Officer Dr. Anton Cumberbatch, the worst time for Dengue in the region is between September through November.
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.
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.
More here…
But this reduction in dengue is not true everywhere…
Puerto Rico/ Guadeloupe and Martinique
The BBC Caribbean Report of September 13 2010, citing the Centers for Disease Control (CDC), had it that a record 20 people died from Dengue Fever in Puerto Rico between January and Friday, September 10 this year. The report also revealed that PR health officials were investigating dozens of additional deaths and over 11,000 Suspected Cases of the mosquito-borne disease. There have been more than 80,000 Dengue Cases in the region altogether.
More here…
Guadeloupe and Martinique
According to JTV News in the British Virgin Islands, the French army concentrated its search and destroy operations around schools hoping to protect students by the time they returned to class on September 03. It was also hoped that Public Service Announcements would hit the airwaves in time for school.
More here…
Bahamas The Bahamas and Dengue Fever had hardly crossed paths this season when seemingly, out of the September blue, the disease was reportedly on the rise there with one suspected death, a 23 year-old Pharmacist. Bahamian health officials would neither confirm nor deny it to the Bahamas Press, but BP nevertheless published the news on September 23. What the officials did confirm though was an upturn in Suspected Dengue in the capital. The authorities were apparently taking no chances, continuing fogging throughout Grand Bahama while intensifying the promotion of Dengue prevention and the Signs and Symptoms of the fever. That very September 23, a Public Advisory on Dengue was released to the media by the Bahamas Department of Public Health and the Ministry of Health. More here… Turks and Caicos Islands The Environmental Health Department of the Turks and Caicos’ Public and Environmental Health Board announced recently that spray planes were in the air and a public awareness campaign was under way against Dengue Fever. These preventive measures were instituted in conjunction with a wider public health effort to prevent cholera from making a jump from Haiti. The Pan American Health Organization (PAHO) and the Caribbean Epidemiology Centre (CAREC) are helping. More here…
Guyana
What the people say about…The mosquito problem By Stabroek staff | June 7, 2010
Tiffny Rhodius…asked the man and the woman in the street if they are affected by mosquitoes in their area…
Why should we be surprised that unscrupulous medical practitioners, being aware of the tremendous publicity surrounding Dengue outbreaks around the Caribbean and Latin America, would take advantage of a population fearful of contracting Dengue by ordering opportunistic and unnecessary tests? Because the reverse is normally true: practitioners have a long history or being apathetic about Dengue to the extent of diagnosing patients over the telephone, not diagnosing at all for a lack interest and insensitivity to the implications, and refusing to report to their respective Ministries of Health even if they do.
So when it was brought to the attention of Guyana Minister of Health, Dr. Leslie Ramsammy that people were being charged thousands of dollars for useless tests, imagine the consternation.
But the major issue remains the lack of reporting by Guyana’s physicians. Minister of Health Leslie Ramsammy lamented that in spite of the fact it is written into law that physicians, whether in public or private practice, are required to follow set guidelines stipulating how a case is verified as having Dengue, many doctors renege on their Hippocratic responsibilities.
This situation was brought to light in August as the incidence of Dengue increased in Guyana and despite the efforts – advisories disseminated by the Health Communication Department, posters, handouts and television programmes – made to keep the public informed on how to help control the spread Dengue.
Kaieteurnewsonline.com captured Minister Ramsammy taking the moral high ground in appealing to the country’s physicians. “If people are not reporting to us, they are doing a disservice to all the citizens of Guyana,” KNEWS reported in the online edition of August 24, 2010.
Physicians everywhere would be wise to heed this admonishment: Be vigilant in diagnosing and testing patients showing signs and symptoms mirroring those of Dengue and report all cases to the Ministry of Health for follow-up epidemiological surveillance.
We must also be proactive. We need to arm ourselves with the knowledge of how the disease behaves and what our doctors are mandated to do in terms of diagnosis, testing and reporting. If unsure whether a doctor has reported a case to the Ministry, we should do so ourselves so that an investigator can track and verify our. Most importantly, self-reporting allows for Vector Control Officers to protect the rest of our families, our friends and co-workers by searching and destroying mosquito breeding places where we live, work and play.
Nine months into the year, Collective Preventive Services (CPS) of Dutch St. Maarten was racking up the Dengue numbers. The Dengue situation on St. Maarten had worsened significantly in a two-month period. And the prospects of halting the spread of the disease were not all that good either.
More here…
Brazil
Brazil has been the worse for wear this 2010 Dengue season. The State Secretariat of Health of Mato Grosso, in a September 30 release covering Dengue transmission for the period January to September, stated that there were 50 deaths of the 41,651 reported cases on record. 10 more cases were still under investigation. Another 899 were of the serious kind, which could change the Dengue picture in Brazil in the last quarter of the year. (Source: ProMEDmail)
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In Jamaica, there was a slight increase in the weekly Confirmed Cases in August. Dengue Hemorrhagic Fever (DHF) Cases were also on the up in September. It also came to light that there had been one Dengue death, in Manchester, Jamaica.
As school children returned to the classroom in September, administrators were cautioned to teach the children how to search for and destroy mosquito breeding sites on their campuses.
Belize
August 24 2010
It has been a deadly year for Dengue in Belize. Beds have filled up at the Karl Heusner Memorial Hospital, Belize City. 3 patients died and by late August, with the peak season for Dengue yet to come, Belize had already confirmed 807 Classical Dengue Cases.
The total Confirmed Cases for last year was 1,400.
The worrying concern for the Belize health authorities are the densely populated areas of Belize City and Caio.
In terms of Dengue Hemorrhagic Fever, BC and Caio have produced all of 77 cases from January to Friday, August 13 2010, 64 in Belize City and 13 in Caio.
More here…
Dominican Republic/United States Virgin Islands
BBC Caribbean Report of August 27, 2010 alerted the Caribbean to the threat of the spread of Dengue Fever as the number of cases continued to rise region-wide. The United States Virgin Islands might well have been on the verge of an outbreak too, but nothing compared to that of the Dominican Republic. More here…
St. Vincent and the Grenadines
Sherry Anne Ash, Environmental Health Officer responsible for Vector Control in the Environmental Health Department of St. Vincent and the Grenadines, gave an interview to an NBC Radio programme on Sunday, August 22 2010 in which she disclosed the number of Dengue cases on record in St. Vincent and the reason for the increased Dengue risk to the country.
More here…
Grenada
BBC Caribbean Report, August 18 2010
Presumably because of public consternation over the lack of information about the true Dengue picture in the country, a press conference was called by the Ministry of Health of Grenada mid-August to address the situation. The reporters assembled were told what the Dengue toll in Grenada was up to that point and how the event had progressed from the tail end of the 2009/2010 Dengue season.
More here…
St. Lucia
The Health Ministry of St. Lucia is concerned about the Dengue epidemic that is spreading in the Caribbean and Latin America. Feeding off OECS Newsline radio reports dated July 28 and August 05, we hear that 17,000 cases were reported in the Caribbean alone up to early June.
Director of the St. Lucia Bureau of Health Promotion, Cyprian Yarde, said in the reports that the Ministry of Health is always on the alert because it is expected that Dengue could become a problem every year. The Ministry has, therefore, mounted a prevention and sensitization campaign in response to the threat being posed to the island.
More here…
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.
With one Dengue case confirmed at the time, Ag. Chief EHO Anthony Scotland implored his country to prevent the Aedes aegypti mosquito 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.
Chief EHO Anthony Scotland said that Source Reduction activities were also ongoing.
Dominica’s total was now at to 192 with the majority of cases concentrated in the capital Roseau. This was 15 cases less than the 207 cases from the last outbreak in 2007. CEHO Anthony Scotland, told BBC Caribbean Report that the situation is likely to escalate.
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.
More here…
Montserrat
July 26 2010, BBC Caribbean Report
Health officials in Montserrat have taken measures to avoid the spread of the Dengue Fever. Trevor Howe, the Head of the Environmental Health Department warned residents to take all necessary precautions to prevent mosquitoes from breeding. Howe alerted the public that it was up to them to continue doing self-inspections to curb the proliferation of the Dengue mosquito.
More here…
Martinique/Guadeloupe
Three months ago in May, Guadeloupe health officials were reporting 30 to 40 cases of Dengue every week. Then on Monday, June 07, a 10-year-old Martinique girl died from complications of Dengue Fever. Less than a week later, news broke in Martinique that there was an additional death due to Dengue.
Hardly past the one-month mark after the Dengue deaths of June 2010 and the number of “Clinically Suggestive” cases of Dengue had multiplied to an unfathomable 1,900 patients. That was just the beginning.
Cumulatively, Martinique racked up a whopping 18,100 cases from the last week of February to the first week of August.
Across in Guadeloupe, the Dengue situation was worse still. Over a roughly similar time as obtained in Martinique, that is July 21 to August 03, 2,900 cases “Clinically Suggestive” of Dengue were logged for a cumulative total of 25,200 from the beginning of the year.
The Dengue types circulating in Martinique up to that point were Dengue 1, 2 and 4. Guadeloupe was seeing only Dengue 1.
More here…
St. Maarten The lessons learned from the latter years of the 1990′s when Dengue raged through the Dutch side, the Department of Health, VSA and the Ministry of Health, Labor and Social Affairs started a two-month project of premises visits followed by a round of fogging just to get ahead of the disease. Being proactive, a team of eight was sent into areas of the highest concentrations of infections starting March 15 to conduct the survey and give advise. The inspectors found that St. Maarten had a House Index eight times over the internationally acceptable standard. One day after the outreach programme ended, the fogging began. More here… Guyana An unnamed, unofficial source surfaced on Kaieteur News online in February with a plea to the Guyana Ministry of Health asking for an intervention in Mahdia, Region Eight (Potaro/Siparuni) where all seemed to agree Malaria was running “rampant.” The Vector Control Unit of the Georgetown City Council began taking action to combat the problem with an anti-mosquito campaign starting March 15. Then in May, Dr. Bheri Ramsaran of the Ministry of Health had a meeting with the Regional Health Committee of Region Six to discuss the matter. Additionally, Professor Pamira Ventosilla, a vector control specialist from the University of Peru, was contracted by the Ministry of Health to help them tackle mosquito larvae using the bacteria, bacillus thuringiensis israelensis (Bti). However, the ministry official reiterated that it is imperative as always for all residents to adhere to the basic rules of sanitation. The Mayor of the Georgetown City Council, Hamilton Green and Chief Inspector of the Vector Control Unit, Karanchand Krishnalall, echoed these sentiments. As for the mosquito situation in Berbice, Lall revealed that it was finally under control and that there was nothing to be alarmed about. Meanwhile, the Mayor and City Council of Georgetown were gearing up to recommence fogging in early June with a proposed end date on June 15. More here… Trinidad and Tobago After a decline in 2009 that followed the 2008 Dengue outbreak, one of the worst Trinidad & Tobago ever went through, the Dengue numbers were once again on the up. At the half-year mark, 242 persons had already been hospitalised. Compared to the 1,295 hospitalizations in 2008 and 1,266 in 2009, T&T could well be on course to contain this year’s outbreak. The Ministry has refined its Integrated Pest Management (IPM) programme. Source reduction efforts are a part of the plan. The Public Health Inspectorate and Health Education Department were themselves engaged, but at the level of the region’s mosquito reduction and Dengue Fever prevention programme. These agencies were collaborating with the Insect Vector Control Division and the Sangre Grande and Mayaro/Rio Claro Regional Corporations. Meanwhile, Minister Therese Baptiste-Cornelis accepted a recommendation from Attorney General Anand Ramlogan asking her to appoint an independent medical panel of three to investigate the death of a nineteen year old male. Over in Trinidad’s sister island, Tobago, a Dengue Outbreak was declared in the wake of a resurgence in the number of dignosed cases in June. More here… Bahamas One case of Dengue Fever was picked up in the Bahamas in late March. This case was the first since October 2003. Medical alerts were promptly sent to all physicians asking them to be on the lookout for patients with signs and symptoms of Dengue. The Environmental Health Department was also notified. Speaking to bahamaslocal.com, Minister of Health Dr. Hubert Minnis said that his ministry was not taking this development lightly… More here… Cayman Islands Dengue cases not related to MRCU spraying (CNS) (The) appearance of the virus is not related to any reduction in aerial spraying by the MCRU. The mosquito which can carry the dengue fever is present in the Cayman Islands but generally breeds in urban areas and is therefore not controlled by the widespread spraying from the air but by targeted reduction of stagnant water sources in gardens and yards.
MRCU Director Dr William Petrie told CNS that although there are issues currently relating to the unit’s resources and its ability to spray, the Aedes aegypti…does not populate the islands’ swamp areas, where most other mosquitoes set up home and the areas targeted by the aerial spraying…
Public health officials have also confirmed that there have been no further cases reported since the three samples were sent for analysis…
Dengue cases confirmed by officials (CNS)
Some two months after tests were submitted to the Caribbean Epidemiology Centre (CAREC) in Trinidad, health officials have now confirmed three suspect cases of dengue fever…
More here…
Puerto Rico
As reported on the Front Page, the Dengue season started in the French Departments of the Caribbean with the turn of the decade – no waiting for the rainy season like before. But Dengue is raging in other parts of the Caribbean and the wider Americas too. Puerto Rico is one such country where the Dengue virus is spreading with a vengeance due to record levels of rainfall in December and January.
The situation in PR first came into focus at the Woodshed in early February when Health Secretary Lorenzo Gonzáles admitted to the Puerto Rico Daily Sun that the country was experiencing an epidemic and that the rate of infection was “significant.” Secretary Gonzáles singled out Arecibo, Bayamon, Caguas and San Juan metro where he said the highest numbers of Dengue cases were being recorded.
The total number of confirmed infections for the year up to that point (736) had already far exceeded that (415) for the same period last year. Of course, some patients experienced hemorrhagic complications of the disease, but none of them succumbed.
According to Caribbean Business PR via the St. John Source, Puerto Rico Health officials confirmed that the country was in the midst of a Dengue outbreak. However, the officials were not yet ready to declare an outbreak, preferring to keep the country on a Dengue alert instead. They did report nonetheless that 158 new cases were logged in the second week of the month of February, 10 less than the figure for the first week of that month. ProMed updated these figures on March 15 to reflect the situation during the first week of March. Four days later on Friday, March 19, Gonzáles was back in the news, with more bad news. The CDC had confirmed the death of a 43-year-old man to Dengue in the second week of March. Thus, at Week-6, total cases rose to 1, 490 with 627 testing positive, most of them from Dengue Type 1. A fogging and education campaign was well under way around the island. The PR situation has made US Virgin Islands health principals sit up and take notice fearing that Dengue could jump off from their neighbour’s shores to theirs. After all, PR had activated regional medical directors, environmental coordinators, hospitals, clinics and laboratories to tighten up on their early detection and treatment protocols. Anyway, referring to Epidemiologist of the VI Health Department, Eugene Tull, there has been no similar spike in Dengue cases in the US territory.
More here…
Over in…
More here…
Over in…
Jamaica, Dengue was not as acute as in Columbia and Puerto Rico. However, a real threat existed for the residents of Port Maria, Annotto Bay, Gayle and Highgate in St. Mary Parish that could not be ignored.
Inspections conducted in St. Mary since the beginning of the year uncovered a level of mosquito breeding that was almost four times higher than what is considered acceptable by the WHO (World Health Organization).
The Mountain View area of Kingston was also at risk in Week 6, but for another reason, Malaria. Word spread freely about the possibility of a Malaria outbreak after the disclosure that a Jacques Road man who was tested for the disease in January was hospitalized for it on Tuesday, February 09. Two days after that, on February 11, two bus loads full of public health officials were said to have converged on Mountain View to test the other residents an unidentified person told the Jamaica Observer. It is now understood why Vector Control fogging (spraying) operations were being conducted on a daily basis. But confirmation of the story will have to wait. Efforts by the Observer to reach either the Director of Health Promotion and Protection or Chief Medical Officer proved unsuccessful. More here… Over in… Cayman Islands, compasscayman.com has it that the three Suspected Dengue Cases from January have been Confirmed by the Centers for Disease Control in Puerto Rico. All three contracted Dengue-2, the most prevalent strain in the country. The test results were slow in coming due to the excessive pressures placed on the laboratory there. This was brought about by record levels of Dengue in Puerto Rico itself that led to the declaration of an epidemic in March. According to Director of the MRCU, Bill Petrie, no new cases of Dengue have been reported in Cayman since January. This was confirmed by Medical Officer of Health, Dr. Kiran Kumar. We also learn that the Mosquito Research and Control Unit (MRCU), having intensified efforts to manage the problem, declared success in the middle of March. More here…
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Cape Verde
Cape Verde Dengue poster
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Trinidad and Tobago
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)
More here…
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Who would have thought that the male Malaria mosquito, unlike any other, must seal its sperm inside a female to guarantee fertilisation? It is true. For the Anopheles gambiae to make sure fertilisation is successful, it produces a special “mating plug” to keep its sperm in.
Upon discovering this fact, that the male mosquito generates a coagulated mass of proteins and seminal fluids during copulation to lock the sperm in the female’s sperm storage organ, researchers at Imperial College London salivated at the prospect of preventing the male mosquito from creating this plug altogether, which would leave the female with sterile eggs and the mosquito population in the red.
Lead author of the Imperial College study, Dr. Flamina Catteruccia, explains that her team at Imperial’s Department of Life Sciences found a way to disarm the male’s coagulation enzyme.
Emboldened, the scientists are thinking that in the future, an insecticide spray that Vector Control staff could easily apply in the field, will be concocted to do just that.
More here…
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British Virgin Islands
An Environmental Officer (not an Environmental Health Officer) of the British Virgin Islands’ Conservation and Fisheries Department asked for my views on the impact of Climate Change on mosquito proliferation, Dengue Outbreaks and Mitigation.
The questions 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.
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Jonathan Kearney and fellow volunteers Stephen and Dan work at the Centro Buen Pastor en Caguas in Puerto Rico. Jon writes a blog to chronicle his work.
Caguas is a 20-25 minute drive south of San Juan into more of a foothills terrain. Over the past few years, a collective effort called Proyecto Siempre Verde (Project Always Green) developed. The idea of the project is to make the rain forest more of an ecotourism attraction. A lot has to happen before any of this is realized, though. Jonathan is in the midst of developing trails through the forest. That was when a bout of Dengue cut him down. Here is his First Person Account of that experience.
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Guyana
At 1000 new Dengue cases, Guyana has recorded twice as many cases this year as the last up to the end of September. It is no consolation that there was a decline in the third quarter for the mosquito population is on the rise again in the coastal areas of the country. This, Minister of Health Dr. Leslie Ramsammy, says will lead to an upsurge in Dengue cases in the last quarter of 2009. (Source: Stabroek News)
Dr. Ramsammy is …”urging all families to re-examine their environment and get rid of all tyres and containers that breed the Aedes aegypti mosquitoes.” Ramsammy continued, “…no matter how much we do, if you don’t do your part we will not succeed.” What the Guyana Ministry of Health is doing is distributing literature, conducting premises inspections, applying chemicals and handing out free supplies to residents.
However, there is an inbred resistance among Guyanese to having inspectors come into their yards and homes. That is the problem.
More here…
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They’re back…by Freeman Rogers Editor, The BVI Beacon Well, okay, the mosquitoes never really went away. But they’ve been particularly awful recently, at least in my Road Town apartment. So I’ve decided to fight back.  Freeman Rogers
Every morning I get out of bed and grab one of those electric tennis rackets. Then I sit in my living room and cackle with glee as I take revenge on the insects whose buzzing tormented me throughout night. But that ritual is a little sick. And, anyway, I’ve swung my electric tennis racket so often I’ve developed tennis elbow. So I thought very hard and developed an ingenious plan. Or so I thought. During the days after I came to the Virgin Islands, I remembered, I seemed to lose several pints of blood to mosquitoes every night. Then, after a couple weeks, I noticed fewer and fewer bites. When I explained this to other residents, they said, “Oh, yeah, the mosquitoes here like fresh meat. They like to bite new people.” I’ve heard this theory several times since. If it were true, I realised, I could offer my living room couch to tourists for free. Then, all the mosquitoes would bite them and leave me alone. Since this seemed like a pretty big commitment — you can’t always trust a freeloading tourist — I decided to be sure. ‘Fresh meat’ theory So I called Dr. Dave Chadee, a senior lecturer at the University of the West Indies, who has been studying mosquitoes for more than 27 years. When I asked him about the “fresh meat” theory, he laughed. The Trinidad-based scientist had another explanation…. I called Minchington Israel, the programme manager for the Virgin Islands’ Vector Control Programme. To my relief, Mr. Israel assured me that his department’s 10 inspectors are on top of the situation. They spend their time collecting data on where the next mosquito outbreak might occur and trying to pre-empt it. But the real soldiers in the mosquito war, according to the programme manager, are you and me. More here… |
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There is an initiative afoot in Latin America and the Caribbean to tackle the problem of parasitic infectious diseases such as Dengue Fever. The International Development Bank (IDB) has teamed up with the PAHO (Pan American Health Organization) and the Global Network “to put an end to…preventable and controllable diseases” in our region. The funds for this initiative have come from the Bill and Melinda Gates Foundation. US2.5M of these monies will be turned over to the IDB by the Global Network and the Sabin Vaccine Institute by signed co-financing agreement. More here…
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Sanofi Pasteurhas taken yet another step forward in the development of its investigational, novel tetravalent Dengue vaccine candidate with advanced clinical studies among children and adults in Singapore and Vietnam. Part of a global clinical study programme being undertaken in endemic regions in Asia and Latin America, these studies mark the expansion of sanofi-aventis Group‘s Asia-Pacific Dengue vaccine programme from Thailand and the Philippines.
Clinical trials have been completed in a mix of non-endemic and endemic countries, namely the United States of America, Mexico and the Philippines.The initial results show that three doses of the vaccine are sufficient to elicit a balanced immunological response against the four Dengue serotypes. Sanofi Pasteur is working jointly with Singapore’s Communicable Disease Centre and Vietnam’s Pasteur Institute. More here…
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CUBA
Two Cuban epidemiologists were in Sri Lanka in mid-August to lend a helping hand to the Health Ministry there in its ongoing tug-o-war with a Dengue outbreak.
The Cuban experts first toured the country to assess the situation and presented the Sri Lanka Public Health Director with a detailed report. Colombo has pledged to study it before implementing the findings. More here…
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CAYMAN ISLANDS
There seems to be some truth to the story that spending cuts initiated by the Cayman Islands’ government have affected the operations of the Mosquito Research and Control Unit (MRCU), the agency responsible for mosquito control mosquitoes in the British Dependent Territory.
The first programme to be grounded by the cuts in overtime pay is the MRCU‘s fleet of airplanes.
With the hands of the MRCU having been somewhat tied by what another Cayman News Service report referred to as insolvency in the Cayman economy, MRCU Research Manager Fraser Allen is calling on residents, especially those in the Capital Georgetown and West Bay, to take up the slack.
More here…
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The Origins of Malaria decoded
What if I tell you that the mosquito is really not the source of the very first infection of Malaria? What if I say that a virus researcher has come to the much studied conclusion that a primate, not the mosquito, is to be implicated in the jump of the Malaria virus to humans, much like HIV virus did twenty or more years ago? Chicken and the egg you say? You might. But let me end the conjecture here. The fact is that virus researcher and hunter, Nathan Wolfe, has had a score to settle with Malaria especially after surviving a third bout with the disease in his ten years of leading expeditions to crack elusive virus codes, if you will, as head of a research institute called Global Viral Forecasting Initiative. The so-called virus hunter, a microbiologist by profession, says he cracked the riddle in large part through an agreement with the government of Cameroon. Wolfe published his findings on Monday, August 03, 2009 in the journal, Proceedings of National Academy of Sciences. CNN Medical Producer, Stephanie Smith, had a read of it and broke down the science into digestible bits in her article written for Anderson Cooper 360°.In it, Wolfe claims that his research supports an hypothesis of a single event as conceptualized by noted anthropologist Frank B. Livingstone.
The importance of these findings rests on the premise that the Malaria parasite mutates easily.
How about we let Nathan Wolfe tell his own story?
More here…
—————————- The thinking is that if it were possible to develop a suitable bio-pesticide such as one that unleashes fungal spores that could kill older mosquitoes only, then Malaria could be stopped in its tracks since most mosquitoes would not live long enough to begin transmitting the disease. As a direct consequence of this, late-acting insecticides would have a much longer useful life as compared to conventional insecticides. Professor of biology and entomology, Andrew Reed and professor of entomology, Matthew Thomas, both of Penn State and Penelope Lynch, a doctoral student from Open University in England, all make the argument in the April 7 issue of PLos Biology that this can be done very simply by, for example, diluting existing insecticides. In the case of fungi, the spores would take 10 to 12 days in the three-week lifespan of the mosquito to destroy it. Studies conducted in Africa and Papua New Guinea have generated data that show that the killing of aging mosquitoes have the potential to reduce biting by up to 95 percent. More here… ________________ There are growing fears that Malaria is in resurgence in the Caribbean. Countries in the region have been importing cases since the disease was eradicated most everywhere in the 1960′s, Haiti being the one exception. However, local transmission is now taking place again as seen most recently in the Jamaica outbreak of two years ago and to a lesser extent in the Bahamas before that. Indeed, the re-emergence of Malaria started in earnest in the 1970′s. To that extent, it is endemic in Guyana, Suriname and Belize today. In an article published in the West Indian Medical Journal in November 2008, JP Figueroa of the The University of the West Indies, Mona Campus sorts out the positions of Rawlins and others. Part of this threat comes from the island of Haiti whose people are known to legally migrate to other Caribbean countries in search of economic opportunities. In responding to this, Figueroa places some of the responsibility at the doorstep of clinicians.Figueroa, therefore, recommends that more Caribbean countries take the threat of re-emerging Malaria more seriously. More here… ___________ Barbados Underground, the blog, has exposed a problem with the sluice gates at Worthing Beach resulting in an infestation of the Malaria mosquito at the Graeme Hall Nature Sanctuary. Stuart Heaslet, Sanctuary representative, lamented to The Bajan that since the gates went into disrepair three years ago, it has been impossible to flood the Sanctuary when water levels there are low. The Sanctuary used to be able to flood and flush the Graeme Hall Ramsar wetland.Now that the gates are non-functional, the Sanctuary has had to resort to chemical treatment of the wetland to curb mosquito production. In light of the re-emergence of Malaria in the Caribbean, Barbados’ status as a major travel hub for the region and internationally, and the growing resistance of the Malaria parasite to anti-malarials worldwide, this is cause for grave concern.
___________ The rainy season seemed to have come early in the Caribbean this year. Dark, overhanging clouds are a constant reminder of that. But in the region, rainfall is equal to mosquitoes, the Aedes aegypti, the carrier of Dengue Fever. Why? Because we the home-owners and renters continue to ignore the basic rule of self-responsibility regarding mosquito control: to conduct weekly surveys of our premises for uncovered containers (cans, barrels, discarded, tyres, flower pots, ornamental fountains, trash and cisterns etc.) that collect rain water and either get rid of them or the water in them. In February, Puerto Ricans learned a hard lesson when 350 Dengue cases were recorded there, the largest number of new cases ever. More here…
BVI EHD embarks on new educational thrust
Government Information ServiceResidents of the Territory can expect to learn more about safer environmental health practices as the Environmental Health Division embarks on a formal strategic education and outreach program. Chief Environmental Health Officer, Carnel Smith stated that the EHD has significantly transformed its operating system and the public needs to be aware of the new standards that will be promoted and enforced by the Division. More here...
Thomas Kollars Jr. PHD, Director, Biodefense and Infectious Disease Laboratory at Georgia Southern University at Statesboro in the United States has come up with a mosquito trap, shaped as a flower and laced with a biological agent known as BTI (Bacillus thuringiensis). The BTIbacteria, known to destroy mosquitoes, is secured in a pad snapped into the center of the plastic device. The pad is shielded with a fine mesh with tiny holes that allow only the mosquitoes’ proboscis or mouthparts (the tube mosquitoes use to suck fluids and blood) through while keeping out non-target species like moths, flies and ants.
Kollars tested the flower trap in Puerto Rico, chosen for its high humidity. His hope was to reduce the mosquito population in and around a simulated ‘village’ in the space of six to seven months. The hillsides surrounding the village were used as controls for the experiment.
ProVector BT, as the trap is called, was installed in each of fourteen tents that recreated an African village. More here… Commonwealth of Dominica February 09, 2009 A very reliable Woodshed Warrior has informed the WEC that a Dominican child has died after contracting Dengue Hemorrhagic Fever (DHF). No other details are as yet available.
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Ever wondered about the day when you could carry your own personal Dengue or Malaria test kit in your wallet? I guess not! Who would ever think about such a thing? Why, some smart guys at the University of Washington of course. This is not a joke. UW researchers, led by bioengineering professor Paul Yager, have indeed come up with a disposable malaria test card.
This prototype mylar card uses a technology that offers the real possibility of adaptation and application to the so-called “fever panel” of six diseases namely Dengue Fever, influenza, Rickettsial diseases, typhoid and measles. And that is only the beginning says Yager.
The Malaria cards are designed to be read by a fully-automated portable reader, taking into account the issues of portability, automation and ease of storage.
The selling point for the test card is two-fold…
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There is something happening in Barbados in relation to Dengue. We just cannot put our finger on it as yet. How do we know that? Fogging! A lot of fogging has been done since before the Christmas season. And up until the week ending January 16, the trucks were up and down the neighbourhoods.
What we can report at this time is that huge swaths of Barbados have been fogged, suggesting that there is a serious mosquito problem, and even Dengue, there. An expatriate Barbadian Environmental Health Officer who was visiting home over the Christmas holidays told the WEC that one or the other of the Bajan newspapers even reported on a Dengue death some time late last year. Our checks have not resulted in any independent confirmation of this.
The Barbados Government Information Service issued a press release on January 05, 2009 announcing the resumption of a fogging campaign, which commenced prior to Christmas 2008.
More here…
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updated on December 30, 2008
Health authorities in St. Lucia are lamenting the near doubling of Confirmed Dengue Cases this year over the last.
Chief Medical Officer, Dr. Josiah Rambally has 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.
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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.
More here…
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Malathion and Bees
The BBC Morning Report of November 11 has brought to light the concerns of the Association of Caribbean Beekeepers’ Organizations meeting in Guyana (November 09-14) that Malathion, an insecticide used to fog the Dengue mosquito (Aedes aegypti), is killing off bees and harming the honey trade. The organizations’ President, Gladstone Solomon, believes the use of Malathion in mosquito control may be counter productive.
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Antigua and Barbuda
A Mr. Shenstone from Antigua commented thus about Dengue in Antigua and Barbuda, October 28, 2008:
Dengue Fever is rife in Antigua & Barbuda. We have lived here 14 years and aged 48. Recently went down with the Dengue Fever in September 08 (a dry month before the rains). I lost 19 lbs and couldn’t move for three weeks. The Government says no new cases have been disclosed which is Not Correct.
The Antigua Ministry of Health has a responsibility, like all other Ministries in the region, to report all incidences of Dengue to the Caribbean Epidemiological Centre (CAREC) and by extension to the Pan American Health Organization (PAHO). The PAHO database captioned ’2008: Number of Reported Cases of Dengue & Dengue Hemorrhagic Fever (DHF)’ for the Region of the Americas (by country and subregion) up to Epidemiological Week / EW 40 at 29 September 2008, shows that there were 16 cases of Dengue on Antigua up till the end of September. These were all Clinically diagnosed cases.
No numbers have been provided for the diagnoses that have since been Laboratory Confirmed. It would, however, be safe to say that the figures are reposed somewhere because it is known that Dengue 1 is in circulation on the island.
Therefore, if the Ministry of Health did not disclose more up to date information, as Mr. Shenstone intimated, it could be due to one of two things: that the island’s physicians had not yet reported the new cases to the Ministry; or that the data from the physicians and those coming out of the secondary care system were not collated and the results transmitted to CAREC/PAHO.
But clearly, the number of Dengue cases would probably be much higher than 16 by now, the precise factor notwithstanding.
Mr. Shenstone would testify to that. Here is how he models the situation in Antigua:
Mr Dr, a well known local GP, stated that he was seeing 8-9 new cases a week! Think about it for a sec…20 local GP’s x 8 cases / week = 160 wk = 640 / month…!!
The Coalition will keep a tab on Antigua’s reporting to CAREC/PAHO and will update the country’s Dengue numbers here as they become available.
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Tortola, British Virgin Islands
Dengue Forum heated up about Fogging
A major Fogging Campaign got under way on the main island of Tortola in the British Virgin Islands on Monday, September 22, 2008. A schedule to that effect was released to all media, Government Users, a mailing list comprising of all BVI public servants on connected computers, and a Vector e-List, community members who have submitted their e-mail addresses to receive Dengue alerts.
This has been done for several years without fail. However, this time around, news of the activity attracted a lively debate on two online forums, one more so than the other.
A poster on that forum, dissatisfied with the line of the discussion, called me at my office to inform me it. Naturally, I entered the forum to answer the burning questions being asked and to address the misconceptions that were being voiced.
The discussion thread has pretty much come to a close. But the information therein is of significant importance to the understanding of the issues surrounding Fogging in the Virgin Islands, the products being used and the hazards associated with the dispensing of chemicals for the purpose of mosquito control.
You are encouraged to read the discussions on B.V.I. Platinum News and BVI News online. Post your own Comments on the subject on the Woodshed Coalition’s Talk to me page.
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London, England
Mutant Malaria skeeters
British scientists from London’s Imperial College have laid claim to successfully modifying the genetic structure of mosquitoes, rendering them incapable of spreading killer diseases like Malaria.
Under the leadership of Andrea Crisanti, who in 2005 proved that it was in fact possible to genetically modify male mosquitoes by inserting a gene that glowed fluorescent green, the researchers recently modified hundreds in the hope that will be used to fight Malaria some day.
Using this technology, Crisanti and his team now plan to so sterilise male mosquitoes that when released into the wild would mate with females thereby stunting their population and breaking the transmission cycle of the disease. That is in addition to the possible engineering of a malaria-resistant mosquito.
Chrisanti is set to do some rigorous testing, which would involve a test release of the modified mosquitoes in Southern Italy to find out how they would interact with wild mosquitoes and how many (in the billions say the sceptics) would be needed to control Malaria, a disease that claims about three million lives each year, most of them in sub-Saharan Africa.
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Puerto Rico As a rookie Environmental Health Officer many moons ago, my colleagues and I suspected that the Aedes aegypti mosquito, the Dengue mosquito, was already adapting its breeding habits to polluted waters. (The Dengue mosquito prefers clear water). One of the phenomena that grabbed my attention, quite strange at the time, was that aegypti was being identified in septic tanks. Septic tanks are highly polluted by nature so the question was, “how could that be? “Over the past decade, my staff and I have documented instances of what we call “Mixed Breeding” in which two or more species of Culicines – to which the Aedes and Culex belong – cohabit the same focus or breeding place.Scientists from the Dengue Branch of the Centres for Disease Control and Prevention, San Juan, Puerto Rico, sought to find out more. They proceeded to investigate this issue in a pointed study, the results of which have been published in the journal of Medical and Veterinary Entomology. The hypothesis was surely not just to prove that Aedes aegypti mosquitoes were given to sharing the same habitats with other species – no news here. Rather, they yearned to substantiate the degree to which aegypti had a propensity for intensive breeding in septic tanks.The CDC story, “Unusual productivity of Aedes aegypti mosquitoes in septic tanks and the implications for dengue control,” appeared in the March 2008 issue of Medical and Veterinary Entomology. It showed that large numbers of the Dengue mosquitoes were to be found breeding in septic tanks. The use of GIS (Geographic Information Systems) technology had led the researchers underground in the subject area. The basis for this were observations of exaggerated clusters of mosquitoes as revealed by GIS. Further investigations turned up unusually high densities of Aedes aegypti and Culex quinquefasciatus in the town’s septic tanks. The use of Septic tanks as the premier method of human waste disposal is becoming more widespread throughout urban and rural centres around the Caribbean, save of course for slums and remote communities. Consequently, if Caribbean Vector Control operators have to pursue Dengue mosquitoes into septic tanks (not literally of course), this could potentially double their work load and handicap efforts to control them. The equation does not change for Vector Control in the British Virgin Islands since it has been more than a decade since the Aedes aegyptiinspectors have routinely searched and destroyed mosquito breeding in septic tanks. As to whether other jurisdictions in the region employ similar modus operandi is unclear. Jamaica The Jamaica Ministry of Health has grown increasingly concerned that its Vector Control operators have become too heavily dependent on chemicals in mosquito control. Citing a study, ‘The Threat of Dengue Fever: Assessment of Impacts and Adaptation to Human Health in the Caribbean,’ by the University of the West Indies (UWI, Mona, Jamaica) and the Caribbean Epidemiology Centre (CAREC, Trinidad and Tobago), the ministry pledged to embark upon a “strategic shift” to biological control measures in order to nullify the potentially dangerous effects of these chemical products on human health and the environment. Minister of Health and Environment Rudyard Spencer made this commitment, to create a more environmentally friendly and sustainable Vector Control programme, during the 2008/2009 Sectoral Debate held on Tuesday, June 03, 2008.
Spencer also called for the strengthening of inter-agency collaboration between Government agencies, private sector organizations, non-Governmental Organizations and civil society in this effort.
The Coalition is now in the process of finding out what specific biological measures Minister Spencer has in mind.
Commonwealth of Dominica The Dengue picture in the Commonwealth of Dominica has become foggy since the initial reports of the disease surfaced in October, 2007. At that time, reliable sources could confirm that there were thirteen (13) Suspected Dengue Cases in the north of the island and one (1) Dengue Hemorrhagic Fever Case that was confirmed in the United States of America. Other pieces of anecdotal and partially substantiated information from observers on the island gave one sufficient reason then to believe that the incidence of the disease was much more widespread than that. For instance, as reported here back on October 14, 2007, there was evidence to suggest that Dengue had reached the southern village of Eggleston not too far up in the mountains overlooking the capital, Roseau. And just this week (January 09, 2008), in speaking with someone from the Giraudel/Eggleston area, it was revealed that a female relative was diagnosed with Dengue last year. Now, the Foreign and Commonwealth Office in its Travel Advice by Country report of December 18, 2007 (and “Still current at: January 10, 2008″) states that there are at present “…four confirmed cases of dengue in Dominica.”The overall impression, therefore, is that Dengue can be found all over the island. How widespread that is has to be left to conjecture. The Coalition is working tirelessly to clarify the situation as regards Dengue in Dominica. ____________________________ »»» DECEMBER STORIES
Jamaica
Dr. Derrick Ledford, Chief Medical Officer of the Parish of St. Elizabeth, Jamaica told a Parish Council meeting on Thursday, November 08, 2007 that Dengue had been implicated in the deaths of four (4) persons from the parish.Dr. Ledford seemed to say that two autopsies had already been done to determine whether Dengue was actually the cause of death in those cases. The results of those autopsies were still forthcoming at that time.He also said that he had received reports that over fifty (50) people from St. Elizabeth alone had come down with Dengue. However, only four confirmations had been made.Vector Control has since deployed in the parish to control the Aedes aegypti mosquito, the carrier of Dengue Fever. Source: RJR News__________________________
Cayman Islands
Further afield in the Cayman Islands, the Public Health Department has just reported that 8 (eight) people have been confirmed with Dengue Fever since October. Another person is also presumed to have contracted the disease during that time.The officials remain confident that there has been no local transmission of Dengue for all 9 (nine) cases were said to have traveled to foreign countries with Dengue. These countries were not specifically named. Moreon this story on the homepage __________________________
St. Barths
Following a meeting in St. Barths on December 3, 2007 to assess the Dengue situation there, the working committee of experts on infectious diseases and the Institut de Veille Sanitaire (IVS) of French St. Martin have declared St. Barths and St. Martin in an ‘epidemic alert phase.’
St. Maarten
Meanwhile Health authorities on Dutch St. Maarten announced a ‘pre-alert phase’on November 27, 2007 as eighteen lab-confirmed Dengue cases were attributed to St. Maarten on that day. The authorities put out a cautionary note that the situation could turn into an ‘epidemic phase’ if all criteria for observation and tests were met. __________________________ »»» NOVEMBER STORIES Authorities in the British Virgin Islands and St. Lucia have reported yet unconfirmed cases of Dengue in their jurisdictions. But whereas the Director of Health Services in the B.V.I. did not number the Suspected Cases being followed up there, St. Lucia’s Chief Medical Officer boldly put the number of Suspected Cases of Dengue in his Helen of the West at 13, one short of last year’s (2006) total of 14 cases. The St. Lucia CMO did not, however, indicate whether any of the cases, either from last year or this, was at all Confirmed. But in the B.V.I., there have certainly been no Confirmed Dengue Cases for 2007. In fact, the territory has not had any Dengue whatsoever for about three years. Contact Tracing – to track the movement of persons diagnosed with Dengue in order to mount precise control measures – are underway in the B.V.I and St. Lucia. As part of this process, fogging (for adult mosquitoes) and residual spraying (for larvae and pupae, the aquatic stages) are being conducted in areas where the Suspected Cases live, work and are known to “play” as well as where infestations of the Dengue mosquito exceeds 1%. In the Cayman Islands, the Public Health Department released an up to date profile of Dengue in that British Overseas Territory on Monday, November 12, 2007. The Cayman Medical Officer of Health says that at November 05, there were 31 Suspected Cases under investigation. 4 Imported Cases have already been checked out : 3 of them were Confirmed Positive and 1 Confirmed Negative. Five other Suspected Cases already came back negative. The Mosquito Research and Control Unit (MRCU) is on the case, so to speak. PS. There are a number of statistical measures used to determine mosquito density and prevalence. If a further explanation of Mosquito Indices is required, just ask.
Over in…
THING YOU DID NOT KNOW ABOUT MOSQUITOES.... It would take 1,200,000 mosquitoes, each sucking once, to completely drain the average human of blood. (Sources: discovermagazine.com / anannimos.blogspot.com) - Now you know.
What you probably do not know Gonenative is that I am loving the questions – whether be they on this site, on the telephone and by e-mail when at the office or while working out on the field.
To answer your question, Carec is the preferred laboratory for Caribbean governments that do not have the resources to set up their own. However, in this day and age, Caribbean Ministries of Health are ‘independent’ enough (and in some cases rich enough) I think to take advantage of any labs that are speedier than Carec, say in Puerto Rico or St. Thomas.
I recall Jamaica for instance using both Carec and the CDC in Atlanta to fast-track the backlog of blood specimens at the begining of their December 2006 Malaria outbreak.
Further, there are Rapid Test Kits now on the market. These kits can confirm Dengue in-country within a matter of hours. Then…then the regional or off-island labs can be used to determine the type of virus (Dengue 1,2,3 or 4).
Ironically, Rapid Test Kits are even being used in T&T prior to Dengue bloods being sent off to Carec for typing. Go figure!
A friend from St. Thomas told me you can get dengue test results in one day in St. Thomas. So I ask again, why do the blood samples have to go to Trinidad? This seems crazy if it can be done in the USVI much more expeditiously. ps Thanks for your many answers to my many questions. I appreciate your patience.
If all 100 female mosquitoes were to bite an infected Dengue patient, all 100, without exception, would become infected and could pass on the disease.
With so many uncontrollable variables that could be in play, it is impossible to provide any reliable odds as to what percentage of the adult female mosquitoes would be carrying the disease at any given time. One has to know how many Dengue cases there are in the community, where they are located, the places where mosquito density (percentage of infested premises) is 1% or higher…and the list goes on. Given the non-existence of any system that can even begin to predict these variables at a particular point in time, let alone quantify them, there is no way to tell what the odds are that the next mosquito that bites you is infected with the Dengue virus.
The only thing we can say with certainty is that the odds of you becoming infected with Dengue rises exponentially with every house that is infested with the Aedes aegypti mosquito from the threshold of 1 in a 100 infested premises.