High fever, insufferable headache, pain in the eyes, intense muscle and joint pain, vomiting… the Dominican Republic is on high alert because of the illness these symptoms point to: dengue fever. Dengue is a viral infection transmitted by the Aedes aegypti mosquito, which lays its eggs in stagnant, clean water, usually in and around homes. There are several classes of dengue, and in people who have been infected once before, the illness can progress into a life-threatening hemorrhagic form. Characterized by a distinctive rash, bleeding into the abdominal and chest cavities, and bleeding from the eyes and pores of the skin, this form of dengue is almost always fatal. There is currently no vaccine and no cure.
More than 8,400 cases of dengue have been reported in the Dominican Republic over the last several months, and 27 individuals have died — an epidemic level not seen in over a decade. So far, the illness seems to be concentrated in the Santo Domingo and Santiago regions. The Ministry of Public Health has launched a nationwide campaign to slow the spread of illness and prevent new cases. The campaign includes educating individuals about dengue prevention, conducting home visits to eliminate receptacles that could hold standing water, and fumigation in certain high-risk areas.
Here in the Puerto Plata region, dengue has not hit epidemic levels — yet. The regional Ministry of Public Health is proactively working to mobilize volunteers to participate in its prevention campaign. With the oh-so-catchy slogan “Sin criaderos, no hay mosquitos. Sin mosquitos, no hay dengue” (“Without breeding places, there are no mosquitos. Without mosquitos, there is no dengue”), the Ministry hopes to avoid an epidemic.
HHI is collaborating with the Ministry to do our part in this nationwide public health priority. Dr. Elisa, an epidemiologist from the MSP, and Laura, a nurse and TB specialist, came to Montellano to do a special training for our cooperadores de salud on Saturday. They discussed dengue prevention, symptoms, and treatment, as well as the active steps our cooperadores could take to educate their communities and eliminate breeding places in their neighbors’ homes. We then made plans for each cooperador to conduct a workshop in their community. The room was buzzing with creative ideas and energy, so now it’s a matter of carrying them out. Listos?
Yikes. Besides plenty of netting and getting rid of standing water, what else can you do?
The recommendations are to clean cisterns and buckets with bleach twice a week to kill any eggs; get rid of any receptacles that could hold rainwater, like old tires, bottles, cans, etc; and to cover water tanks tightly. The mosquito has to bite a person already infected with dengue in order to transmit the virus to another person, so it’s also important to make sure patients avoid mosquitoes (using bednets, repellent, etc) during the course of their illness.
One of the more tragic cases I saw last week was a 4 year old boy who had encephalitis from a dengue infection he had two months ago. As of the visit he had minimal use of his left hand and walked very poorly when he walked at all. I suspect this will affect him the rest of his life. In investigating dengue online I’ve found that neurological manifestations are pretty rare, with long term sequelae even more so. Check out the “Prognosis” section of this article if you’re interested: http://www.eimjm.com/Vol1-No2/vo1-No2%20C2.html. What a tragic case, particularly since there’s practically no effective treatment. Prevention, prevention, prevention!