PUERTO RICO
Dengue epidemic death toll reaches 7 in P.R. by CB Online Staff
The death toll from the dengue epidemic in Puerto Rico hit seven as cases of the mosquito-borne virus continue to mount at an “alarming” rate, the Health Department reported Friday.
“Much to our regret, we must inform you that the Centers for Disease Control (CDC) has confirmed a seventh death,” Assistant Health Secretary Concepción Quiñones de Longo said in a statement.
The deceased was an Arecibo area resident in his 40s. The region has accounted for half of the dengue deaths so far this year.
The number of hemorrhagic dengue cases, the most serious strain, held at 25 for the most recent week reported (July 16-22), according to Health Department statistics.
A total of 835 suspected dengue cases were reported to the CDC for the week, more than 700 above the epidemic threshold. The most affected municipalities were: Patillas, Arecibo, Aguadilla, Guaynabo, Hatillo, Quebradillas, Peñuelas, San Sebastián and Isabela.
“The numbers continue to show that we are facing a serious situation and that the people must do their part. Standing water must be eliminated and we must protect ourselves,” Quiñones de Longo said. “If people don’t treat this issue with the seriousness it warrants we are going to continue seeing this alarming rise in reported cases. We need a sense of urgency and real action.”
Puerto Rico’s dengue epidemic has continued to widen after weeks of wet weather that began soaking the island well ahead of the onset of the current rainy season this year.
The island Health Department has stepped up its public service campaign imploring Puerto Rico residents to take steps to stop the spread of dengue including getting rid of standing water that can serve as mosquito breeding grounds for the Aedes aegypti mosquito, the species that transmit dengue, and the importance of using bug repellent.
Health Secretary Lorenzo González has met with mayors of the most affected towns to fine-tune strategies to get the word out about dengue prevention and stamp out breeding grounds.
Another front was opened through the Education Department and the Puerto Rico Public Broadcasting Corp. as students headed back to class last week after the summer break.
Dengue fever is reaching epidemic stages across the Caribbean, with dozens of deaths reported and health authorities concerned it could get much worse as the rainy season advances.
The increase in cases is being blamed on warm weather and an unusually early rainy season, which has produced an explosion of mosquitoes.
González has warned the epidemic, which was declared in February well ahead of the normal high season, is shaping up as the worst in a decade.
The island’s worst dengue outbreak was registered in 1998. By the end of that year, the virus had sickened 17,000 and killed 19 people.
Notes from the Field: Dengue Epidemic — Puerto Rico, January–July 2010 | Weekly | July 23, 2010/59(28);878
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, compared with 2,711 cases reported during the same period in 2009. 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 (1). Although the timing of the current epidemic is unusually early (in Puerto Rico, increases in dengue cases typically occur during the June–November rainy season), the number of cases reported is large, and comparable to the 6,428 cases reported for the same period during a substantial epidemic in 1998.
Of the 6,321 suspected cases, 2,831 (45%) have been laboratory-confirmed. During January–July 2010, the incidence of confirmed dengue was 74.3 cases per 100,000 population, with 35% of patients hospitalized and five deaths reported, all in adults. Incidence of laboratory-confirmed cases was highest among children aged 10–14 years (165 cases per 100,000), 15–19 years (163), and 5–9 years (91), followed by infants (83), and adults aged 20–24 years (77). The epidemic is widespread; of 78 municipalities in Puerto Rico, 72 had confirmed cases in June. Of the 2,831 laboratory-confirmed cases, 2,001 cases (71%) were positive by dengue virus (DENV) real-time reverse transcription–polymerase chain reaction (RT-PCR); 830 were positive for anti-DENV immunoglobulin M. Among RT-PCR positive cases, DENV-1 serotype (1,505) and DENV-4 (344) were detected more frequently than DENV-2 (150) and DENV-3 (two).
Large, island-wide epidemics occur every 3–5 years in Puerto Rico; in the most recent (2007), 10,508 suspected cases were reported. Abnormally high ambient temperature might be a factor in the high incidence in 2010, and, more importantly, a large proportion of the population might be susceptible to the predominant DENV-1 and DENV-4 serotypes. PRDH and CDC Dengue Branch are working with municipal leadership to raise awareness about prevention measures and eliminate mosquito production sites, and are providing continuing medical education on dengue clinical management and educational materials for patients.
Third dengue death in Puerto Rico sparks fears by Ted Purlain onJuly 7, 2010
Puerto Rico’s health secretary issued a warning on July 5 that the island could potentially face its worst outbreak of dengue fever if action is not taken immediately.
The warning, as reported by the Associated Press, came after the third dengue related fatality of the year, and calls for the eradication of breeding areas for disease-spreading mosquitoes. Residents have been urged to drain pools of standing water near homes, sleep under mosquito netting and wear insect repellent in order to prevent what Health Secretary Lorenzo Gonzalez Feliciano calls, “A public health crisis.”
“If we do not act now, we will see a catastrophe in the months of August and September that could reach record numbers and would make it much more difficult to control,” Feliciano told the Associated Press.
To forestall the crisis, the government has ordered trucks to begin spraying neighborhoods and school areas to with a mosquito-killing mist and has asked people to report their neighbors to authorities should they have standing water on their properties. Gonzalez said that too many Puerto Rican residents had let their guard down against the disease.
The situation this summer in Puerto Rico may have been exacerbated by the unusually water-logged weather recorded in May and June, creating the damp conditions that mosquitoes use to breed. In 1998, dengue claimed 19 deaths and sickened approximately 17,000 people. It has no vaccine and typically causes fever, headaches and extreme pain in joints and muscles[...]
Puerto Rico, Tuesday 22 June 2010 by promedmail.org
Dengue fever remains a health problem in Puerto Rico, Health Department Secretary Lorenzo Gonzalez Feliciano reported today [22 June 2010]. Up to 27 May [2010], 236 cases of dengue had been reported, 22 of which are DHF cases, which means 171 over the normal amount. Gonzales Feliciano stated that 2 people have died from the disease.
“I’ve been very clear that we must be at major risk, if compared with 1998, which is the pattern most similar to what we are seeing this year [2010], in the [epidemiological] weeks of 31-36,” said the Secretary.
“The adult mosquito tends to hide under beds and in closets, so it is very important that people who do not have screens use recommended [insecticidal] products that are already known be effective in control,” he recommended.
Gonzalez Feliciano said efforts to combat mosquitoes continue through spraying and training for primary care physicians to consider dengue in a differential diagnosis, when they get a patient with symptoms of a viral disease. He also emphasized the use of repellents, especially on a day at the beach, as after 5:00 pm, “mosquitoes begin to annoy.”
Dengue deaths in Puerto [Rico] so far in 2010 increased to 2 after confirmation of a new death, the Subsecretary of Health, Concepcion Quinones de Longo, announced today [6 Apr 2010]. This official stated also that according to data from the Center for Disease [Prevention and] Control (CDC), in the week of 5-11 Mar [2010], 189 cases of this disease were confirmed on this Caribbean island.
Quinones de Longo recalled that the reported cases exceeded the threshold for declaration of an epidemic and that the municipalities most affected are Naguabo, Humacao, Las Piedras, Yabucoa, Juncos, Arecibo, Hatillo and Santa Isabel.
She requested the collaboration of the citizens, businesses and schools to overcome this disease classified as endemic on this Caribbean island. The Puerto Rican health authorities this past March [2010] declared a dengue epidemic on this Caribbean island after the threshold number for the established number of registered cases of this disease for 2 consecutive weeks was exceeded.
The combination of high temperatures and rain during the past month of January [2010] favored massive reproduction of the Aedes aegypti mosquito, especially on the northern coasts and east of the country.
As the month of July 2010 drew to a close, the number of Suspected Dengue Cases rebounded after a brief dip, according to afludiary.blogspot.com. 904 Cases were reported in Week 31 compared to 756 the week before.
The majority of the cases being seen in Puerto Rico continued to be typed as Dengue-1. In fact, Type 1 accounted for 68% of all cases in July and August with Type 4 and Type 2 a distant second and third respectively at 22% and 10% of the cases.
The 1,600 cases reported in the second fortnight of August took the accumulated tally for the first eight months of the year to 9,719 Suspected Cases. Exactly half of that (4,811) was actually Laboratory Confirmed. 27 Cases were confirmed with Dengue Hemorrhagic Fever (DHF). There were 8 deaths in sum.
These figures are unsurprisingly alarming given the upward trending of Dengue in 2010. However, for the number of Suspected Cases in Puerto Rico to have been four to five times above the epidemic threshold and for the August 1998 target of 9,800 to be within shouting distance, is heart-stopping.
By the first week of September, the number of Dengue-related deaths in Puerto Rico had more than doubled from the last count. Health Department Secretary Lorenzo Gonzalez brought this to light during a Friday, September 03 press conference when he stated that the Centers for Disease Control had confirmed another 10 Dengue Cases. These brought the grand total for the year to 18, one shy of Puerto Rico’s worst Dengue outbreak back in 1998. As a breakdown, 17 of the deaths were adults between the ages of 20 and 78 years of age. The other was a five-month old infant. No geographical pattern could be detected.
A separate story by the Latin American Herald Tribune highlighted the fact that 14 more Suspected Dengue deaths were being investigated. If confirmed, that would surge the total death count to 32 handsomely surpassing the 1998 record by 19.
The overall number of Dengue infections had also risen, as would be expected. The records of the Emergency Plan for Dengue Control revised the afludiary number from 9,719 at the end of July to 11,356 at August. (However, it must be pointed out that Chief Health Department Epidemiologist Carmen de la Seda declined comment when Puerto Rico Daily Sun asked for a verification of the EPDC figure.) The Latin American Herald Tribune report upped the total to 2,112.
Finally, on September 12, 2010 Columbia Daily Tribune referenced a CDC statement, which established the new Puerto Rico record, 20 Dengue deaths in one year. According to the CDC, 2 of the 14 Suspected Cases that were under investigation had been confirmed.
Some of the difficulties experienced in managing Dengue in Puerto Rico has been the refusal of some sick people to get access to medical care. And when they did, they were sometimes denied emergency room care because certain insurance companies’ health plans did not provide it. An undetermined number of persons who were in fact offered care were, however, not taken from the emergency room to intensive care for monitoring and follow-up.
But this is not the whole story. Gonzalez told the press assembled on September 03 that many patients were known to have discharged themselves when their fever subsided. But that was when they were most at risk of getting even sicker. That kind of thing, Puerto Rico Association Chairman Jaime Plá would suggest, compromises the survivability of the patients affected.
Clearly, the health authorities were concerned enough about doctors who did not routinely follow-up on their patients. For this and other reasons, thousands of PR doctors were required to undergo re-training on how to prevent, detect, manage and treat Dengue. (Additional source: repeatingislands.com)
An awareness campaign was also being directed at the general population who are really the ones to search and destroy mosquito breeding places especially as the level of rainfall has been unprecedented.
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.
