Tag Archives: Dengue outbreak in St. Maarten/St. Martin

BVI Health Ministry records increase in cases of Dengue Fever

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Virgin Islands (Br.)

Dengue Fever has arrived in the British Virgin Islands in numbers.  This was inevitable considering that the virus has, over the past several months, jumped from country to island to island, finally encircling the British Overseas Territory from St. Kitts and St. Maarten to the south and Puerto Rico to the north.

This Vector Control Programme Manager, whose responsibility it is to track communicable diseases in the country and halt its spread, has  been tracing the run of Dengue on Tortola all along.  However, this information remained privileged, until now.  The decision to release the details of the investigatory work of the VC Programme Manager, the Surveillance Officer Athelene Linton and the Health Information Officer Tracia Smith,was the purview of the Surveillance Committee of the Ministry of Health.  The call to go public with an Outbreak Alert was made on December 04, 2008.

The VCP Manager and the Surveillance Officer were charged with the task of drafting of a press release.  The draft was subsequently edited by the Ministry’s Communications Officer Nadia James-Lord who submitted the story to the media under the GIS banner in two parts.

All radio and television outlets in the BVI carried them, but not necessarily in the same form.   The following is the story as it appears on BVIPLATINUM.COM, save for the bolded, bracketed and italicised words, which are those of the Coaltition.  It is a merger of the two parts, which were published unchanged in BVINEWSONLINE.COM (1, 2):

The Environmental Health Division (EHD) is urging the public to take preventative steps to combat the Aedes aegypti mosquito and reduce the spread of Dengue fever in the Territory.

This is following the Ministry of Health and Social Development’s announcement that it has seen an increase in the number of reported Dengue Cases in the Territory since late October.

 

An Aedes aegypti Inspector identifies a mosquito breeding site in rain water collected in an old tyre. 

Photo credit: Environmental Health Division/(Israel)

A Government Information Service (GIS) release stated that surveillance activities conducted by the ministry’s epidemiology unit have logged 36 Suspected Cases of Dengue Fever for the period mid-October to early December.

Of these, 32 samples were sent for testing at the Caribbean Epidemiology Centre (CAREC) in Trinidad and Tobago and to a private laboratory in Puerto Rico.  The remaining four samples are currently awaiting shipment.

To date, seven cases have been confirmed.  These comprise of six (6) cases contracted locally and one imported case (from St. Martin), with multi-serotypes or different strains of the virus having been identified for the for the positive cases.

Dengue cannot be transmitted from person to person and the Vector Control Unit is encouraging all residents to take the recommended measures to prevent the breeding of mosquitoes and the potential spread of the disease.

The fever is a flu-like illness that is transmitted by the bite of an infected female Aedes aegypti mosquito. Aedes is a domestic mosquito which breeds in clear or clean standing water in and around the home.

The classic signs and symptoms of Dengue include a very high fever, an intense frontal headache, pain behind the eyes or retro-orbital pain as well as muscle and joint pains.

Additionally, infected persons may also develop a rash.  If this occurs, persons are advised to seek immediate medical attention.

Preventative Measures

Vector Control Programme Manager Mr. Minchington Israel advises that certain preventative measures can be taken to eliminate the mosquito and its breeding sites.

- Flower vases and flower pots with saucers filled with water should be emptied and saucers wiped clean weekly since they are good breeding ground for mosquito larvae.

- Wet flower pots be replaced with dirt or alternatively, gravel or ornamental stones may be used with the water level below the stones.

- Cisterns should be sealed with concrete and downspouts covered with mosquito netting, cloth, plastic or another suitable cover.  Buckets, pails and other such containers used to store water indoors should be kept tightly covered to prevent the breeding of mosquitoes.

- Items such as old tyres should be disposed of at the incinerator plant, punctured or secured under shelter to prevent the collection of water.

Mr. Israel further suggests that any other items such as discarded laundry tanks, sinks, face basins, buckets, toilet bowls, bottles, tin cans, shoes and toys that can collect water, and become potential breeding sites, should be also properly disposed of at the incinerator plant, turned over or secured under shelter.

The Vector Control Unit also recommends that pet owners wash their pet dishes with a rag or a sponge weekly to destroy mosquito eggs.

Furthermore, the unit advocates that roof guttering should also be cleaned weekly to ensure that dirt and leaves do not trap rain water and allow mosquitoes to breed.  All gardening equipment such as watering pans, shovels and wheelbarrows should also be secured under shelter or turned over to prevent the collection of water.

(The weekly routine for managing mosquito breeding places is based on the roughly seven-day life cycle of the Dengue mosquito.)

 

More to come…

French St. Martin Dengue epidemic over

St. Barthélemy?  Not!

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St. Martin’s health authorities declared in a press conference on Tuesday, May 20, 2008 that the Dengue epidemic that occurred on the half of the island they share with Dutch St. Maarten is over.  Briefing the press were Préfet Délégué Dominqie Lacroix, Public Health Inspector Stéphane Barlerin and fourth vice-president Pierre Aliotti.

The epidemic, which struck in November 2007, resulted in 2,130 clinical infections through mid-April 2008.  22 persons (14 adults and 8 children) or one percent of all infections were hospitalised during that time.  9 of the adults who were admitted to hospital contracted a severe form of the disease, the St. Maarten Daily Herald reported.  Another adult has since been hospitalised – and remains so – with Dengue Hemorrhagic Fever (DHF).  The island of St. Barths does not have it nearly as bad as St. Martin, but still 500 infections is quite a number on a rock with a population of 8,450 (January 2007).

French St. Martin declared the Dengue epidemic under control based on the relatively low number of new infections recorded over the past eight weeks and a prolonged period of dryness.

The matter of how dry it has been in SM is an indictment of our people whose culpability it is in the persistence of the Aedes aegypti mosquito, the carrier of Dengue Fever.  The fact is that when it rains, the open containers we mindlessly insist on having on our premises become inundated; and because we never bother to check them for mosquito larvae once per week as we should, we thereby create the breeding grounds that proliferate the mosquito and trigger outbreaks of Dengue.

The five month battle against the Dengue outbreak in French SM involved no less than 80 fogging runs to knock down the adults, the fumigation of all arriving and departing airplanes from the Grand Case airport, an anti-Dengue awareness campaign which was waged in the print and broadcast media, the dissemination of posters and flyers, the removal and disposal of derelict vehicles and no doubt the actions of concerned individuals who rightly took personal responsibility in searching for and ridding their premises of mosquito breeding grounds.

All four types of Dengue (DEN-1 through 1v) are in circulation in the Caribbean.  DEN-1 is the prevalent serotype in St. Martin and St. Barths.

Previous Post: Vox pop Dengue: Barbara Talks! about St. Maarten/St. Martin

Vox pop Dengue: Barbara Talks! about St. Maarten/St. Martin

This St. Maarten blogger’s frustration over the scourge of Dengue in SXM is palpable as defined by this January 14 post on her blog, Barbara Talks! A St. Maarten Blog!
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Let’s talk about St. Maarten.  That’s where I live.  Dengue on St. Maarten is what I want to know about.  I want to know what the government is doing to combat these mosquitoes.  Ah, but that is what is hard to find out.  To say that the reporting on the Dutch side is less than reliable is putting it mildly.  And I am not sure about the French side either.

A recent article in The Daily Herald from October 01, 2007 states that we are still on “pre-dengue alert,” whatever that means.  It also states that as of the end of November, 18 lab cases of Dengue (were confirmed).  Eighteen?  Doesn’t sound like many, does it? 
Then on Saturday January 12, 2008, I read in the same paper that the French side had 110 Suspected Cases as of January but only 13 (were) confirmed.  Let me quote more from that…article:

“The number of clinically suspected dengue cases went down in the last weeks of December 2007 and the first week of January (2008), but there is no change to the current epidemic status on the French side, a report in St. Martin’s Week stated.
The figure is estimated at 110 suspected cases as of the first week in January and 750 since the beginning of the epidemic in the second week of November.
Since the beginning of December the number of hospitalised cases has increased by 4, bringing the total up to 13 biologically confirmed hospitalised cases.  The patients include 4 children and 9 adults, six of whom were in serious condition.
The predominant virus serotype since the rainy season has begun has been DEN-1. However, serotypes DEN-2 and DEN-4 are also circulating…
St. Barths has been in a pre-alert phase since mid-November and DEN-1 is the predominant serotype.  4 adults have been hospitalised there, 3 of whom were in serious condition, but no more biologically confirmed cases have been hospitalised since mid-December.  30 suspected cases were registered during the first week of January.
The committee of experts for infectious diseases plans to meet next week to assess the situation on both islands.”

Are you asking the same question as I am?  If they suspect 110 cases, how in the world are only 13 cases confirmed?  Is it that hard to confirm?  I may be wrong but doesn’t a simple blood test confirm Dengue?  So are people not being referred for blood tests?  Couldn’t the article (have) read something like…110 suspected cases, 97 were ruled out and 13 were confirmed?  Shouldn’t everyone be sent for a blood test if…Dengue (is) suspected?  I just don’t quite get it!The last article also stated that Suspected Cases were down but the epidemic is still on, which brings me to another question.  How can you have an epidemic on one side of the island but only a pre-epidemic on the other side?

I know.  I know…different governments…different ways of reporting and assessing.

I still wonder how much is really being done to fight off this damn mosquito.

Dengue forum has my adrenaline pumping hard

I was alerted by one of my WW’s (Woodshed Warrior), Barbara, to the existence of a Dengue Forum.  I went into the site two months ago for the first time and again earlier this week.

This time around, the questions and comments from the Travelers as they call themselves have created such a lively discussion that I could not be having more fun sharing with these folks.

I think I may have talked more Dengue on Traveltalkonline in the last few days than I have done since launching this blog.

Dengue kicks up in SM and St. Barths – again

     Following a meeting on 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.’

Meanwhile Health authorities on Dutch St. Maarten announced on November 27, 2007 that the country was on a ‘pre-alert phase for Dengue in the wake of lab confirmations of eighteen cases 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.

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French St. Martin health officials noted that the number of Suspected Clinical as well as Confirmed Biological Cases rose to and exceeded the pre-alert phase between September and the end of November.   They would not reveal the total number of Suspected Cases they now have.  But they did say that 9 (nine) cases, seven adults and two children, were hospitalized.

One of the Confirmed Cases may well have progressed to the Dengue Hemorrhagic (DHF) stage of the disease.  There was no word of a DHF confirmation for that case.

Based on the history of this Dengue event, it would be expected that all of the patients were stricken with the Dengue 1 virus serotype, the predominant virus type on St. Martin.

The Dengue situation on St. Barths has been even more dramatic with a sharp increase in Suspected Dengue in the last two weeks of November – weeks 47 and 48.   

By the very last week of that month, the best estimate of Suspected Dengue on St. Barths was 50 cases.  Several of them have been Confirmed biologically.  Two were reportedly in serious condition.  It was unclear as to which serotype is in circulation on St. Barths.  

At the beginning of the month, the country was in the pre-alert phase.  This profile could well change as French experts embark on a Dengue review.   

Five of the other adults with Classic Dengue were deemed to be severe, while the sixth was filed under serious.

Back on mainland SM, this time on the Dutch side, Health Commissioner Maria Buncamper-Molanus has acknowledged, in essence, that the Dengue outbreak there is worsening.  She has admitted that the 18 (eighteen) cases they have recorded in the past eleven months is the highest ever, even though slightly, since data has been collected and kept.  And the numbers are climbing still on account of the physician sentinel protocol already in place.  St. Maarten has a commitment from seven physicians who issue weekly reports on communicable diseases, including Dengue, to the Health Commissioner.   

According to the Commish, “Up to the week of October 28 to November 3, the Public Health Department has seen a slight increase in the number of reported suspected dengue cases through the physician-based surveillance sentinel system” as well as from data gathered from testing laboratories on both sides of the border that receive requests for Dengue and which are privy to Confirmed lab results.

A fogging exercise in conjunction with a public awareness campaign has since gotten off the ground on the Dutch side.  The focus of the awareness campaign is to provide the public with detailed information on what they should do to prevent the proliferation of the Dengue vector, the Aedes aegypti mosquito.

The Dutch St. Maarten Hygiene and Veterinary Department is also charged with the responsibility of doing Contact Tracing, which entails the inspection of the living quarters and general premises of the persons diagnosed with the disease and their immediate neighbourhoods. 

Commish Buncamper-Molanus provided the rationale for this saying that the public awareness programme “will have a positive effect, as far as reducing the chances of further spreading, but the public has to take the necessary action. We cannot underestimate the importance of the public’s role in keeping this disease from spreading. It is we, the people of St. Maarten, who have the biggest positive effect in stopping the spread of this disease.”  I could not agree more! 

 

 

Previous Posts:

Dengue Alert: add St. Maarten/St. Martin and St. Barths to the list of countries with Dengue

What you should know about Dengue – on steroids

 

External ProMED-mail post: DENGUE/DHF UPDATE 2007 (50)  

STOP PRESS: St. Barths and French St. Martin on Dengue ‘Epidemic Alert’

Dutch St. Maarten on ‘Pre-Alert Phase’ for a Dengue epidemic…

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More on these stories around the corner…

No Dengue in Antigua and Barbuda but…

…update on Dengue on Dutch St. Maarten

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One voice from St. Kitts and Nevis cautioned his country’s Chief Medical Officer of Health in his opinion on Dengue in SKB that “…because something has not been drawn to one’s attention does not mean it is not so.” 

The writer was at the time referring to the CMO’s objection to a newspaper report of a Confirmed Case of Dengue in the federation.

The same scenario seems to have been at play in Antigua and Barbuda.  The Antigua Sun’s Alfeefa Beharry, in an October 24 report in her paper, revealed that it had come to their attention that tourists were cancelling reservations at some of the island’s hotels for fear they could become infected with the Dengue virus while in transit in Puerto Rico where some reports have put the number of Suspected Cases as high as 25,000 with 4 confirmed deaths.

However, Neil Forrester, General Manager of the Antigua Hotel & Tourist Association sounded quite comfortable with the notion that hoteliers affected had not lodged official complaints to his office concerning the cancellations.  Mr. Forrester further stressed to the Sun that there were no reported cases of anyone having fallen ill from the disease in Antigua and Barbuda.  He totally missed the point that it is not so much whether there is Dengue, but that the economic cost of the threat of Dengue could be just as devastating to fragile economies, dependent on tourism, as if there was in fact a Dengue outbreak.  You never know until you put yourself in the know!

This brings the debate full circle to Dutch St. Maarten where the initial attitude was that a few cases of Dengue were inconsequential.  It has since come to my attention that Dutch residents are known to cross the border into French St. Martin to have serology tests for Dengue, bypassing the ADC lab on the Dutch Side.  So for all I know, these persons, if positive for the disease would have returned home and the authorities on the Dutch side would not have had a clue – unless of course there is a sound protocol for information sharing between the two sides.

What this tells me though is that the Dengue scenario on Dutch St. Maarten is probably worse than what the official records might show.  How worse, I do not know at this point.  The question to be asked is how many individuals actually accessed laboratory facilities on the French Side.  The answer may lie in the admittance of Head of the Preventative Section of Sector Health Care Affairs in St. Maarten Dr. Rachel Eersel who acknowledged to the St. Maarten Daily Herald that the Dengue figures for 2006 did not include those for tests done on French St. Martin. 

I take it then that the same answer would apply to the 2007 figures for Eersel added that her office was working with French St. Martin to paint a complete picture for the whole island, Dutch and French.

Picture for the Netherlands Antilles at early-October 2007 

The Update Dengue Fever 2007 report compiled by the Curaçao-based Epidemiology and Research Unit shows that 269 lab tests were done for the period January to early October for the entire Netherlands Antilles excluding Saba and St. Eustatius.  Of that number, 53 were Confirmed to be Dengue Fever and 1 case was confirmed to be Dengue Hemorrhagic Fever (DHF), in Curaçao.

St. Maarten: 25 tests were done for Dengue Fever, including 14 Suspected Cases, 4 Confirmed Dengue Fever Cases with 7 negative results;

Curacao: 195 tests were done for Dengue, including 125 Suspected Cases, 1 Confirmed Dengue Hemorrhagic Fever with 32 negative results;

Bonaire: 49 tests were done for Dengue, including 26 Suspected Cases, 12 Confirmed Dengue Fever Cases with 11 negative results;

 

Previous Post: Dengue Alert: add St. Maarten/St. Martin and St. Barths to the list of countries with Dengue

Later Post: 3 Dengue Cases confirmed in Antigua

     

Dengue Alert: add St. Maarten/St. Martin and St. Barths to the list of countries with Dengue

…and the plot thickens in Guadeloupe and Martinique

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Health officials on Dutch St. Maarten have reported that their Surveillance Network filed only 11 Suspected Dengue Cases for three months of the year, the same as for last year.  And the Commissioner responsible for Health Maria Buncamper-Molanus has said that this was testament to SM’s “good fortune.”  I cannot help but be juvenile here: Duh!  We in the British Virgin Islands would consider 1 case to be a major misfortune.

The St. Maarten Daily Herald is equally happy though.  The paper says in its online edition that provided the “commissioner’s analysis and conclusions are correct, then St. Maarten is truly blessed.”  Well, I’ll be damned!

In the article “Keep Dengue at bay,” the writer goes on to say that “St. Maarten should not become too smug and complacent…for Aedes aegypti mosquitoes do not need passports…work or residence permits or health documents to operate…”  These sentiments were doubtless motivated by a comparison with French St. Martin, which had an outbreak of Dengue in 2006, one that resulted in 52 Suspected Dengue Cases in the three-month period from September to November.   

But I take the point that the Dengue situation on Dutch SM is far better than that on the French side of the island and on St. Barths.  Taking just this past week ending on Saturday, October 27, into consideration, no less than 20 persons out of a total of 42 Suspected Cases have turned out to be positive for Dengue.  A French epidemiologist, speaking at a press briefing at the Sous-Préfecture on Thursday, October 25 would only say that the figure for St. Barths was significantly higher.

French Dengue protocols demand that a Dengue epidemic be declared if the number of Suspected Cases reach 25 in any one week.  Consequently, it can be deduced that French St. Martin was at near-epidemic levels last week.  According to the Epidemiologist Philippe Quenel of Cellule Inter-Régionale d’Epidémiologie (CIRE) of Antilles-Guyane, the rate of Suspected and Confirmed Dengue infections on the French side were “just below the threshold for an epidemic,” as a gradual increase of Suspected Cases has been recorded during the past three weeks. 

The virus type identified in this event is Dengue 4.  There is no evidence that any of the other serotypes are in circulation, which is good news because it means that there is little chance of any of the patients developing the complication of Hemorrhagic Dengue. 

A 12-member special committe of experts comprising of doctors, laboratory technicians, biologists, pharmacists, and health service specialists from Guadeloupe has been set up by the Sous-Préfecture to tackle the Dengue Fever (and other infectious diseases, by the way) situation on French St. Martin.  Head of the Preventative Health Department on the Dutch side Dr. Rachel Eersel and a colleague were also invited to the committee meetings.

“We have decided to reinforce all the surveillance systems and to make a renewed effort in giving out information to the public…to create more awareness in the schools and public buildings, as well as advising on personal protection,” Quenel told the press. 

As an added precaution, planes from Guadeloupe and Martinique that land at the Princess Juliana International Airport are sprayed with an insecticide in a process called Port Disinsection.  This is even more critical in light of recent reports that the death toll to Dengue in Martinique has risen to 2.  Quenel puts the number of Suspected Dengue Cases in Martinique at 7,500.  The initial figure at the start of the outbreak was 1,300.

Over in Guadeloupe, the cases of Suspected Dengue has gone up 400% to 3,500.  Currently, 2 children have Dengue Hemorrhagic Fever there.

Setting aside the editorialising, the fact remains that there is Dengue on St. Maarten, but much more so on St. Martin.  This means that the circle of Dengue has been extended from Puerto to yet another international destination that has considerable air traffic ties to the BVI.

In the final analysis, if any country has to plead good fortune and offer praises that its people have been spared, it is not SM; it is the Virgin Islands.

To date, there are no official reports of Dengue in the BVI.

 

Next Post: update on Dengue on Dutch St. Maarten