Public Health sector widening collaboration to ward off dengue outbreak

Aug 31, 2019 News

Dengue has been wreaking havoc in many countries including some in Latin America and the Caribbean. Among the countries affected are two neighbouring countries, Brazil and Venezuela, which have been plagued by severe cases in terms of new cases per 100,000 inhabitants.

An Aedes mosquito which can transmit dengue fever

Dr. Cassindra Alonzo-Ash

Although Guyana has not been so impacted, it is yet faced with the threat of imported cases.
However, with the proactive tactics being employed by the Ministry of Public Health, there is no need for panic.
At least this is the assurance of Dr. Cassindra Alonzo-Ash, who heads the Ministry’s Vector Control Services Unit’s Aedes Borne Diseases Programme. According to her, even with a dengue outbreak raging just outside Guyana’s borders, the country has managed to keep its number of recorded cases to just about 100 for the period January to August, 2019. None of these cases, she said, have been classified as severe.
Dr. Alonzo-Ash has responsibility for monitoring and putting measures in place to control the prevalence of diseases that are transmitted by the Aedes-type mosquito such as yellow fever, Chikungunya, Zika and of course dengue.
This type of mosquito is distinguished by white markings on its legs and a marking in the form of a lyre on the upper surface of its thorax [between the head and the abdomen]. These mosquitoes are especially prevalent on the coastland and, according to Dr. Alonzo-Ash, the majority of the reported cases were based in Region Four.
Although the Ministry, through its Vector Control Services department, has been engaging fogging activities to control the spread of the vector, Dr. Alonzo-Ash said that there is need for more hands on deck.
This is in light of the fact, she said, that “In Georgetown we are limited in terms of staff so what I am doing is working along with the Environmental Health Department [of the Public Health Ministry] because they also deal with vector control. They also have a presence in all of the regions, so they can help us be at the ports so that we can do testing whenever someone comes [arrives at the ports of entry] with symptoms such as fever and rash.”
In addition to fever and rash, dengue fever can present with vomiting, headache and muscle and joint pains. Some persons have been known to develop dengue haemorrhagic fever after the initial fever declines which is a more severe form of the illness that can cause organ damage, severe bleeding, dehydration even death.
Guyana has no reports of dengue haemorrhagic fever. This, however, does not mean that the potential does not exist. “Thank God we do not have any such cases,” said Dr. Alonzo-Ash as she revealed plans to widen collaboration to combat an outbreak here. This, she said, will not only see efforts being made to reach out to the Environmental Health Department but also the City Council and the Regional and Neighbourhood Democratic Councils.
As moves are made to advance the vector control efforts, there are plans for a training programme in the coming week with the Red Cross because, “they can assist us; they have the capacity for that [and] we need all the help we can get to decrease the burden of dengue,” said Dr. Alonzo-Ash.
Another crucial tactic to ward off a possible dengue outbreak here, the vector control professional said, is the removal of breeding sites – an undertaking which requires the input of residents, especially in areas where there is an increase of mosquitoes. “We don’t want to have an outbreak and we don’t want to be caught off guard…so we are trying to interact with many people, including residents because we don’t want to spray [fog] alone and then there are still breeding sites around,” Dr. Alonzo-Ash said.
Aside from Brazil and Venezuela, there are eight other countries that are battling the scourge of severe dengue. These are Nicaragua, Honduras, Belize, Colombia, El Salvador, Paraguay, Guatemala and Mexico. Honduras and Nicaragua, all of which have already declared national-level epidemiological alerts this year to expedite their response.
The Pan American Health Organisation [PAHO] reported earlier this month that a new epidemic cycle of dengue which has invaded Latin America and the Caribbean Region comes after a two-year period of low dengue fever rates. The state of affairs has been dubbed a “complex situation” by PAHO.
According to the latest PAHO epidemiological update, published on August 9, during the first seven months of 2019, more than two million people contracted the disease and 723 died across the 10 countries. The number of cases exceeded the total number reported in 2017 and 2018, although, up to early August, it remained lower than the number recorded during the 2015-2016 period.
“The Region is experiencing a new epidemic cycle of dengue, with a notable increase in cases,” said Dr. Marcos Espinal, Director of PAHO’s Department of Communicable Diseases and Environmental Determinants of Health who attributed this increase in complexity to the climate, environmental management and the mosquito’s [Aedes] capacity to adapt. Another characteristic of the current epidemic is that children under the age of 15 appear to be among the most affected.
Dengue, according to PAHO, is caused by a virus that has four different, but closely related serotypes: DEN-1, DEN-2, DEN-3 and DEN-4, all of which circulate in the Americas. When a person recovers from the infection, he acquires lifelong immunity against that particular serotype. However, subsequent infections caused by other serotypes increase the risk of acquiring more severe forms of dengue. Serotype two is one of the deadliest and is the one currently affecting children and adolescents, PAHO has reported.