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HEALTH-ARGENTINA: Dengue Haemorrhagic Fever Is Here

Marcela Valente

BUENOS AIRES, Apr 2 2009 (IPS) - While the authorities squabble over what or whom to blame, Argentina is suffering its worst epidemic of dengue fever since 1998 in terms of the number of people and the size of the area affected. And on top of that, the most dangerous form of the illness, never recorded here before, has made its appearance.

“There is a major breakout of the disease and it is more serious than in other years, because the number of infected people is larger and more provinces are involved,” Dr. Alfredo Seijo, a specialist in infectious diseases in charge of the Dengue Unit at the Muñiz Hospital in Buenos Aires, told IPS.

But official information about the epidemic is confusing. The figures mentioned so far by the national authorities are much lower than those communicated by local officials and other healthcare personnel.

After playing down the problem, Argentina’s Health Minister, Graciela Ocaña, finally admitted this week that the situation “is serious” and sent extra help to the northern province of Chaco, the most affected area, in spite of the provincial government’s reluctance to acknowledge the problem.

Ocaña said Monday that 4,147 people had contracted the dengue virus in six provinces, and that most of them had been infected on Argentine soil. Only about 400 are “imported” cases, that is, people who have acquired the virus in another country or region. However, a confidential report by the Chaco provincial emergency committee for dengue prevention and control stated that there were already 11,363 confirmed cases. In Charata alone, a town of 35,000 people in southwestern Chaco, the local authorities have recorded more than 4,000 dengue sufferers, but the provincial government denies this figure.

Dengue fever, an endemic disease in tropical areas, has spread like wildfire this year in Bolivia, where 45,000 cases were reported, 22 of which were fatal. It was, according to experts, the largest epidemic in the history of the country. Paraguay and Brazil have also notified cases of dengue fever.

In Argentina even the most conservative figures, such as those reported by the Health Ministry, lead to the conclusion that the epidemic is the worst since the virus reappeared in the country in the late 1990s. In the intervening period, the worst outbreaks occurred in 2004 and 2007, with nearly 2,000 cases reported on each occasion, according to the ministry’s Epidemiology Department.

So far the Health Ministry has not reported any fatal cases, but in Chaco, two women are said to have died from the illness, and another death has been reported in the adjacent province of Salta.

“During a dengue epidemic, the official numbers of people affected are lower than the real numbers because politicians tend to withhold information, and also because there are people with asymptomatic infections who are not recorded,” Seijo said.

Classical dengue or “breakbone” fever is a viral disease transmitted by the Aedes aegypti mosquito. The symptoms are fever, severe headache and muscle and joint pains; mild cases can be mistaken for the flu. It is usually treated with painkillers, but aspirin should be avoided as it tends to stimulate internal bleeding.

There are four serotypes of the virus, and although patients acquire immunity to the particular serotype that infected them, they can be infected a second time by a different serotype. A second infection with any other type of the virus carries a much higher risk of evolving into dengue hemorrhagic fever (DHF).

DHF is the most severe form of the disease, causing bleeding and shock, and it can be fatal. It appeared for the first time in Argentina this year.

The Health Ministry in Salta reported eight cases of DHF in March, but the national ministry only recognises three cases in Chaco, and none in Salta. Seijo warned that the expansion of classical dengue is creating a large pool of patients who are sensitised to the dengue virus and therefore vulnerable to contracting DHF.

“The longer the time period between the first and second infections, the greater the risk of getting the haemorrhagic form of dengue fever,” he warned, noting that in Cuba there have been cases of patients suffering from DHF 20 years after their first infection with classical dengue fever.

Saijo said the dengue fever epidemics are getting constantly worse because of the number of infected people, the number of countries where the virus is found and the increase in cases of DHF. Argentina is following the same pattern, and he predicted that the problem could get even worse during 2009.

Mass migration, poor standards of urbanisation, lack of clean water and badly managed sanitation are all factors that create a breeding ground for the mosquito, he said.

“There is no vaccine, so we need to control the mosquito population, and this is not being done effectively,” he said. “The strategies are designed by people behind desks who are ignorant of the reality on the ground.”

The situation in Chaco is a case in point.

Rolando Núñez, of the non-governmental Nelson Mandela Research and Study Centre, based in Resistencia, the provincial capital, told IPS that Chaco province combines several of the factors that can fuel the spread of dengue fever.

“Nearly 70 percent of the population lacks piped water,” the activist said. And at times of drought, the situation is even worse. Last July the Provincial Water Administration announced that it was building reservoirs to collect rainwater in the wet season.

“These reservoirs are dammed lakes open to the sky, sited all round the towns, and they are breeding grounds for mosquitoes,” complained Núñez. Meanwhile, the health authorities are encouraging people to get rid of the pots and containers they use to collect rainwater for their own consumption, in order to eliminate mosquitoes.

Núñez said that in Chaco solid waste is not disposed of properly and there has been an extraordinary increase in disposable packaging and containers. A demographic explosion is also under way in urban centres because the expansion of soy bean cultivation has forced the rural population to migrate to the cities.

In these circumstances, the provincial authorities “should implement strict epidemiological monitoring,” but instead “they down-graded the department in charge of surveillance and prevention” of the dengue outbreak, he said.

Then “they denied the truth, played it down and prohibited any reporting,” and it was only at the end of March that they began to act, when the epidemic was already full-blown, Núñez said.