Rhon­da Krys­tal Ram­bal­ly

T&T does not have a dengue out­break but a world trav­el health alert last week warned trav­ellers that they were at risk of dengue in the trop­ics. The Au­gust 10 ad­vi­so­ry said "new out­breaks" were oc­cur­ring in the Caribbean while sea­son­al rain in Asia was cre­at­ing ide­al con­di­tions for dengue and oth­er mos­qui­to-borne dis­eases. Trav­ellers were warned to cov­er up and reg­u­lar­ly ap­ply an in­sect re­pel­lent to ex­posed skin at all times when out­doors. (www.etrav­el­black­board.com/ar­ti­cle/121984/world-trav­el-health-alerts-au­gust-10-2011) For­eign Af­fairs and Com­mu­ni­ca­tions Min­is­ter Dr Su­ru­jrat­tan Ram­bachan told re­porters at the week­ly post-Cab­i­net news brief­ing on Thurs­day the dengue prob­lem "is be­ing well man­aged."

Pri­ma­ry care physi­cian and chair­man of the Com­mu­ni­ty Im­prove­ment Ser­vices Lim­it­ed Dr Rai Rag­bir said T&T did not have an out­break. Rag­bir said there were more cas­es be­cause of the rainy sea­son. He said dengue was en­dem­ic in this coun­try and in the trop­ics. In an in­ter­view on Thurs­day, Rag­bir said an out­break oc­curred when there was a sig­nif­i­cant in­crease in the num­ber of cas­es. Last year, there were 4,894 cas­es ac­cord­ing to In­sect Vec­tor Con­trol (IVC).

Rag­bir urged cit­i­zens to vis­it a med­ical fa­cil­i­ty if they have any symp­toms. On Wednes­day, Prime Min­is­ter Kam­la Per­sad-Bisses­sar is­sued a state­ment from the Of­fice of the Prime Min­is­ter stat­ing she was di­ag­nosed with a less se­vere strain of dengue. At a press con­fer­ence on Ju­ly 29, Health Min­is­ter Dr Fuad Khan said: "Any­thing that is more than nor­mal...it be­comes an out­break." On Au­gust 4, eight-year-old Asia Archibald from Ari­ma, died from dengue af­ter she was dis­charged the Er­ic Williams Med­ical Sci­ences Com­plex in Mt Hope.

On Au­gust 10, un­of­fi­cial sta­tis­tics from the IVC said up to Ju­ly there were 1,885 re­port­ed cas­es. A day lat­er, Khan said up to Ju­ly 30 there were 1,639 cas­es. The World Health Or­gan­i­sa­tion (WHO) de­fines a dis­ease out­break as the oc­cur­rence of cas­es of dis­ease in ex­cess of what would nor­mal­ly be ex­pect­ed in a de­fined com­mu­ni­ty, ge­o­graph­i­cal area or sea­son. Gov­ern­ment launched a na­tion­al clean-up cam­paign to erad­i­cate breed­ing aedes ae­gyp­ti mos­qui­toes which is re­spon­si­ble for the dead­ly dengue virus.

In­creased world­wide re­ports

Caribbean coun­tries such as Bar­ba­dos, St Lu­cia, Ba­hamas, Guyana, Do­mini­can Re­pub­lic and Cay­man Is­lands have re­port­ed cas­es of dengue for the year with some even record­ing deaths. In the Asia-Pa­cif­ic re­gion, coun­tries such as Cam­bo­dia, Sin­ga­pore, the Philip­pines, Viet­nam and Aus­tralia have al­so re­port­ed cas­es, some as low as 500 and as high as 34,000. Last week­end, an ar­ti­cle in the Nas­sau Guardian out of Ba­hamas said more than 1,600 peo­ple in New Prov­i­dence were af­fect­ed and that the is­land's med­ical re­sources were "stretched to its lim­it." Ba­hamas re­ceived an av­er­age of 100 cas­es a day last week.

Ba­hamas' Min­is­ter of State for the En­vi­ron­ment Phen­ton Ney­mour said the cas­es were a bur­den on the so­ci­ety. He not­ed the in­creased med­ical costs as­so­ci­at­ed with the out­break and the threat the spread of the ill­ness had on the tourism in­dus­try. In Ju­ly, an Bar­ba­dos news re­port said there were 59 con­firmed cas­es record­ed be­tween Jan­u­ary and June. For that same pe­ri­od last year, there were 31 cas­es. For 2010, there had been close to 600 con­firmed cas­es and four record­ed deaths. The is­land's Chief Med­ical Of­fi­cer Dr Joy St John said the mos­qui­to in­dex was 1.3 which meant the chance of con­tract­ing dengue was low.

In Viet­nam, there had been 22 deaths and ap­prox­i­mate­ly 23,000 cas­es. The Gen­er­al De­part­ment of Pre­ven­tive Med­i­cine re­port­ed a to­tal of 5,000 cas­es and eight fa­tal­i­ties in Ju­ly. WHO fig­ures showed that in the two weeks to Ju­ly 24, 31 cas­es rose to 498. Fig­ures for the Philip­pines up to week 27 showed there were 34,090 cas­es with 198 deaths. In Malaysia there were 11,653 caus­es with 19 deaths up to Ju­ly 21. For that pe­ri­od last year the coun­try record­ed 27,415 cas­es. Up to Ju­ly 14, Cam­bo­dia had 5,401 cas­es and 29 deaths.

Dengue sta­tis­tics in the Caribbean

The first dengue haem­or­rhag­ic fever (DHF) epi­dem­ic in the Caribbean was in Cu­ba. Sig­nif­i­cant out­breaks of dengue were re­port­ed in 2005 and 2006 in Puer­to Ri­co, US Vir­gin Is­lands, Do­mini­can Re­pub­lic (DR), Bar­ba­dos, Cu­ra­cao, Guade­loupe ad Mar­tinique. The most re­cent is­land-wide epi­dem­ic oc­curred in 2007 when more than 10,00 cas­es were di­ag­nosed. Ac­cord­ing to a May news re­ports on Caribbean 360 said twice as much da­ta had been sub­mit­ted to the Pan Amer­i­can Health Or­gan­i­sa­tion from Ja­maica, St Lu­cia, Suri­name, St Kitts and Nevis and St Vin­cent and the Grenadines.

Ja­maica was list­ed as hav­ing 55 clin­i­cal dengue di­ag­noses and St Lu­cia, 39. The num­ber of re­port­ed cas­es of clas­sic dengue in the DR more than dou­bled to 441 at week 15. Se­vere dengue cas­es rose to 23 for the same pe­ri­od. The spread of dengue in Guade­loupe, Guyana and Mar­tinique was spo­radic. These coun­tries main­tained that sta­tus through to March with cas­es clin­i­cal­ly sug­ges­tive of dengue re­main­ing well be­low av­er­age, the re­port said.

WHO: In­sec­ti­cides are not enough

Ac­cord­ing to a March 2010 pub­lic health jour­nal, the bat­tle against the mos­qui­to which af­fect­ed around 50 mil­lion peo­ple year­ly, need­ed more than just in­sec­ti­cide. A study pub­lished in the Bul­letin of World Health Or­gan­i­sa­tion ex­plored the breed­ing pat­terns of the Aedes ae­gyp­ti and dis­cov­ered sig­nif­i­cant dif­fer­ences in breed­ing and dengue trans­mis­sion be­tween sites af­fect­ed by fac­tors such as house­hold habits, lo­cal en­vi­ron­men­tal con­di­tions and the ecol­o­gy and be­hav­iour of the mos­qui­to. The study was con­duct­ed in six Asian cities.

Dr Jo­hannes Som­mer­field of the Re­search and Train­ing in Trop­i­cal Dis­eases at the WHO in Gene­va said: "Tra­di­tion­al­ly, com­mu­ni­ties ex­pect pub­lic health ser­vices to car­ry out mos­qui­to con­trol, nor­mal­ly through in­sec­ti­cide fog­ging. "Large scale in­sec­ti­cide spray­ing, how­ev­er, is not ef­fec­tive in re­duc­ing im­ma­ture lar­val stages of the mos­qui­to. "These mos­qui­toes breed in var­i­ous wa­ter con­tain­ers in and around house­holds so in­di­vid­u­als, fam­i­lies and com­mu­ni­ties have an equal­ly im­por­tant role to play in re­duc­ing these breed­ing sites in their own back­yards."