Dengue Fever and Hemorrhagic Dengue Reported In The Caribbean Basin

Dengue Fever and Hemorrhagic Dengue Reported In The Caribbean Basin.
August 24/2006.

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

1. Cuba: Doctors imprisoned. The Lancet 1998; 441-442.
2. Cantelar N, Fernández A, Albert L, Pérez E. Circulación de
dengue
en Cuba 1978-1979. Rev Cubana Med Trop 1981;33:72-8.
3. Kourí G, Mas P, Guzmán MG, Soler M, Goyenechea A, Morier L.
Dengue hemorrhagic fever in Cuba, 1981: rapid diagnosis of the etiologic
agent. Bull Pan Am Health Org 1983;17:126-32.
4. Kourí G, Guzmán MG, Bravo J, Triana C. Dengue hemorrhagic
fever/dengue shock syndrome: lessons from the Cuban epidemic. Bull World
Health Organ 1989;67:375-80.
5. Dengue and dengue hemorraghic fever in the Americas: guidelines
for prevention and control. Washington: Pan American Health Organization;
1994. Scientific publication No. 548.
6. Guzmán MG, Deubel V, Pelegrino JL, Rosario D, Sariol C,
Kourí G.
Partial nucleotide and amino-acid sequences of the envelope and the
envelope/nonstructural protein-1 gene junction of four dengue 2 virus
strains isolated during the 1981 Cuban epidemic. Am J Trop Med Hyg
1995:52:241-6.
7. Ricco-Hesse R, Harrison LM, Salas RA, Tovar D, Nisalak A, Ramos
C, et al. Origins of dengue type 2 viruses associated with increased
pathogenicity in the Americas. Virology 1997;230:244-51.

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