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Dengue Fever and Hemorrhagic Dengue
Reported In The Caribbean Basin. Since the second week of August 2006 reports of dengue fever (DF) and hemorrhagic dengue DHF have been received from Havana. The official newspaper Granma reported an outbreak of dengue (DF) and hemorrhagic dengue (DHF) in El Salvador. Other reports, unconfirmed at this time have suggested that there is increasing evidence on the population of mosquito vectors in Cuba. It will be remembered that at one point in time in the early phase of previous Cuban dengue epidemics official recognition and campaigns to deal with this public health emergency have been lagging. Some reports from the isolated, independent journalists claim that up to 20 deaths in one Havana hospital have been documented. Reports are sketchy because of the governmental controls currently in place on free communication from the island, but medical personnel fully trustworthy have volunteered these reports. It should be noted that in the past, reports of dengue infection have been deemed by the Cuban revolutionary government as “spreading enemy propaganda.” Dr. Desi Rivero Mendoza was jailed and expelled form he island in 1997 when he reported dengue independently from the Province of Santiago de Cuba. (1) Dengue is endemic in Cuba but serious epidemics have resurfaced in the past from time to time. In the late seventies and early eighties Cuba introduced DHF in the Americas resulting in more than 150 deaths in the first bout. The epidemic began in1977; it was not recognized as such and by 1981 more than 500,000 cases had been reported. (2) A second dengue epidemic in 1981, caused by dengue-2 virus (3), was unusually severe and widespread affecting more than 300,000. 10,312 cases were diagnosed with dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). Altogether, 158 persons (101 children and 57 adults) died (4). While before 1981, only 60 suspected or confirmed DHF sporadic cases had been reported in the region (5). The Dengue-2 virus isolated during the 1981 epidemic in Cuba was classified in the same genotype as New Guinea 1944 (6). This strain of dengue was not previously known to circulate in the Americas. The high number of people involved in the Cuban migrations of the internationalistic duties since the 1960’s was likely the socio-political processes that facilitated the spread of the Asian dengue in the Americas. This genotype was not isolated again in the region until 1994 in Venezuela and again in 1995 in Mexico (7). Dengue is epidemiologically controlled by controlling its vector, the Aedes aegypti mosquito. Since 1981 a passive dengue surveillance system was said to have been established in Cuba. In January 1997, coincidentally with the discovery and report of dengue by Dr. Rivero Mendoza (1), the Institute of Tropical Medicine "Pedro Kourí" (IPK) established an active surveillance system for dengue in Santiago de Cuba municipality. It was confirmed by viral isolation and other microbiological methods that four dengue serotypes were prevalent in the area. It is this mix of serotypes that had been associated with the emergence in the population, particularly in children, of DHF with a high In this epidemic, 1997, 60,000 cases were reported to have DF. The breakdown of the vector control campaign in this municipality interfered with our efforts to abort the epidemic, despite the early detection of the first dengue cases; however, the partial vector control measures implemented once the outbreak was detected prevented its extension to the other 30 Cuban municipalities infested with the Ae. aegypti mosquito. The 1997 Cuban dengue outbreak demonstrated once again that dengue reappears where Ae. aegypti control is deficient. The current epidemic, if confirmed, occurs at a critical time in the island considering the recent transfer of power on a provisional basis to Raul Castro. Taking into account these facts, Cuba must maintain vector control and eradication in order to the dangerous DHF from spreading to other subregions in the Americas. There is evidence of at this time that the Ae. Aegypti is being detected in Pinar del Río province. The official report of the Cuban Communist Party newspaper on dengue in El Salvador is worrisome since Cuban authorities may be delaying the recognition of the epidemic outbreak thus placing the population at higher risk of serious morbidity and mortality since DHF has been reported. References
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