Central American: Emergency Response to Dengue

There is a growing threat of a full-fledged epidemic of dengue fever and its more dangerous form, dengue hemorrhagic fever (DHF) in Central America. According to PAHO's Communicable Disease Program, some 24,000 dengue cases have been reported this year in Costa Rica, El Salvador, Guatemala Honduras, Nicaragua. and Panama. as well as 352 cases of hemorrhagic dengue. Cases have also been reported in Mexico, Brazil, Venezuela, and areas of the Caribbean.

Dengue and the potentially fatal DHF are transmitted by the bite of the Aedes aegypti mosquito. Dengue hemorrhagic fever begins with acute febrile symptoms, accompanied by hemorrhage and eventual shock. It predominates in children, and the case-fatality rate can be as high as 1520%. While no vaccine or specific treatment is available for dengue, simple sanitation measures can get rid of the mosquito's breeding places.

Rapid control of the current outbreak of dengue and DHF requires a different approach to that used thus far. Short-term emergency response is needed, using mechanisms normally organized for disasters. An example of such a response is that of Cuba, which was faced with a serious outbreak of DHF in 1981. The epidemic was brought under control with disaster relief measures that mobilized the nation's Civil Defense and launched emergency campaigns to eliminate mosquitoes and breeding sites.

Managing this and similar emergencies demands immediate response by the affected country and emergency humanitarian assistance from the international community and donors. Funding is now being sought to support national prevention and control programs, which include clean-up campaigns, community education, spraying, treatment of water containers with larvicide, and wide ranging surveillance activities. The United Kingdom has committed US$300,000 to PAHO for control measures in Central America. and special funds will be earmarked for different countries.

Hurricane season '95 ... relearning lessons

The 1995 hurricane season has been a frenetic and destructive one, testing response capacity at local and international levels. We've nearly run through the alphabet this year: Hurricanes Erin, Felix, Iris, Luis, Marilyn, Opal, Pablo, and Roxanne caused widespread destruction in the Caribbean and Gulf of Mexico.

From 4 to 6 September, Hurricane Luis caused serious damage in Antigua and Barbuda, St. Kitts and Nevis, Dominica, and the Netherlands Antilles islands of Anguilla and St. Maarten. Public water systems were knocked out. The most important hospitals and majority of health centers on Antigua and St. Kitts suffered extensive damage. With roofs blown off or damaged, their power and communications systems were disabled, and medical equipment and supplies ruined. It is unacceptable for health services to continue to be paralyzed in such situations; the damage to the hospitals and health centers was mostly preventable. How often do we have to relearn the same lessons drummed into us by Gilbert and Hugo'?

Following this year's hurricane season, the following steps should be taken:

· Enact legislation to enforce use of building and maintenance standards in health facilities such as those in the Caribbean Uniform Building Code (CUBIC) and others. CUBIC is praised by many but no one has made it law;

· Prepare case studies on the impact of recent storms on health facilities;

· Ensure strong Caribbean participation and presentation of these case studies on the impact of hurricanes at the International Conference on Disaster Mitigation in Health Facilities (Mexico City, 26-28 February 1996);

· Give urgent attention to coordination between the military and civilian sectors (see p. 1). An after-action meeting will by called by PAHO to discuss this matter among all players.

Hurricane Hugo underscored the importance of collective Caribbean response. The message of the PAHO video, "Facing Disasters in Small Countries" (available from this newsletter's editor), still holds true: no small-island health sector has the necessary critical mass to be self-sufficient in case of national disaster. There is no unaffected area to call for reinforcements; essential staff may not report to work, justifiably concerned with the security of their own homes and families. Positive examples of regional cooperation can be seen in the case of nurses mobilized by PAHO to Montserrat from neighboring islands to assist populations displaced by the eruption of the Soufriere volcano, and Caribbean SUMA volunteers who traveled to islands affected by Luis to sort and inventory relief supplies.