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HEALTH-PARAGUAY: Dengue Alert

David Vargas

ASUNCION, Feb 6 2008 (IPS) - As health authorities in Paraguay brace themselves to face another possible outbreak of dengue fever, critics are becoming more outspoken about the limited effectiveness of campaigns to prevent the disease, which affected over 28,000 people and caused 17 deaths in 2007.

Concern is rising with the mounting numbers of cases of suspected dengue, which in the space of a week multiplied from 40 to over 200.

However, so far the Health Ministry has officially confirmed only two dengue cases, while further results are awaited for another 15 blood samples which preliminary laboratory tests identified as positive.

The government of President Nicanor Duarte declared an epidemic alert and ordered the armed forces out to assist health brigades in eliminating containers of standing water and other possible breeding grounds for the mosquito that transmits the disease, the Aedes aegypti.

The efforts are focused on Asunción and the neighbouring Central province, where nearly 60 percent of Paraguay’s 6.7 million people live. Thirty-nine and 54 possible cases of dengue, respectively, were reported in these areas.

Another 22 suspected cases were notified in the province of Itapúa, in an area 400 kilometres southeast of Asunción, bordering on the Argentine province of Misiones, and 20 in the southeastern province of Alto Paraná, on the border with Brazil.

The head of the Dengue Victims Association, Olga de Fernández, told IPS that the epidemic this year could be as bad as, or worse than, last year’s, because “the Health Ministry isn’t carrying out the necessary awareness-raising and clean-up campaigns.”

“The minister came out into the streets supposedly to clean up but really in a bid to win votes, not out of concern for people’s health,” complained de Fernández, whose daughter died of dengue last year.

De Fernández blamed the authorities for what she considers was a “bad” prevention campaign. “This year they’re doing the same things, so it could be even worse,” she warned.

The head of the National Health Workers Federation, Abdón Villamayor, said all the health associations have sent concrete proposals in writing to the health minister and to President Duarte, but that these have not been acted on.

“There is a lack of coordination and not enough personnel, and we don’t think the authorities are being honest about the number of beds and ambulances available if mass hospital admissions are needed,” Villamayor told IPS.

The head of the Paraguayan Nurses Association (APE), María Concepción Chávez, said that her union condemns the lack of planning and of a serious policy on the part of the official institutions in charge of combating this viral disease, the symptoms of which are fever, headache and muscle pain.

Dengue or “breakbone fever” is transmitted by the Aedes aegypti mosquito, which is infected with the virus when feeding on an infected person’s blood, and passes it on when it bites a healthy person.

The authorities estimate that at least 600,000 people in Paraguay are susceptible to dengue haemorrhagic fever, the most serious and potentially fatal form of the illness, with additional symptoms including intense abdominal pain, nausea, and bleeding from the skin and mucous membranes.

This is the number of people who were infected by one of the four serotypes of the dengue virus during the epidemics of 1998, 1999, 2000, and 2006-2007.

People who have already been infected with one serotype of the virus are at much greater risk of dengue haemorrhagic fever if they suffer a second infection with a different serotype of the virus.

“The number of cases from 2001 and 2005 were insignificant, but adding up the total in other years, more than 600,000 people are now susceptible to dengue haemorrhagic fever,” the head of disease monitoring at the Health Ministry, Gualberto Piñánez, told IPS.

One of the main worries for the health authorities is the flow of people returning from holidays on the beaches of Brazil, where dengue is endemic.

“We have taken this preventive measure (of announcing an alert) in view of the great numbers of Paraguayans who vacation in Brazil, and the climate conditions of heat and frequent rains which favour mosquito breeding,” Health Minister Óscar Martínez said.

Climate is also a determining factor for a possible new dengue epidemic. The mosquito vector reproduces in still, clean water, and Paraguay’s humid warm climate offers ideal breeding conditions.

This is why the public are being urged to keep their homes clean and get rid of any receptacles that might serve as Aedes aegypti breeding grounds. The government also announced stiffer penalties for owners of empty houses and plots of land who do not keep their properties in good condition.

Environmental prosecutor José Luis Casaccia said that prison sentences of six to 18 months or fines of up to five million guaranís (just over 1,000 dollars) would be handed down to “those who refuse to cooperate to prevent violations of environmental regulations.”

In Asunción alone there are at least 12,000 empty plots of land and hundreds of unoccupied houses, where weeds flourish. Most of these sites are used as illegal rubbish dumps, and are highly suitable for mosquito proliferation.

Health Minister Martínez called on the population to cooperate with the work of dengue prevention. “We know how serious an epidemic can be and the consequences it can have. That’s why we’re taking this preventive measure, and asking people to support us, by ridding their homes of places where mosquitoes can breed,” he said.

Martínez also announced that health services all over the country are on the alert, in both the public and private sectors, and that hospitals are already setting beds aside for patients with dengue symptoms.