Thursday - April 03, 2008

Dengue Fever outbreak in Brazil

Dengue fever outbreak in Brazil, tens of thousands infected. This mosquito-borne virus is spreading across the state of Rio De Janiero, and the numbers have been climbing for the last few weeks. Early reports said 30,000 infected, then 47,000, now 67,000. Death tolls are small but climbing; latest reports say 67 dead. Owing to a lack of available doctors, Brazil has called out the Army to help treat the sick.

There is no cure for this hemorrhagic fever, though most people infected with it get better in a couple weeks. Treatment includes ensaids (pain relievers and fever reducers, ie aspirin) and IV drip to replace fluids lost.

US National Institute of Health describes the disease as

Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue viruses. This disease used to be called “break-bone” fever because it sometimes causes severe joint and muscle pain that feels like bones are breaking, hence the name. Health experts have known about dengue fever for more than 200 years.

Symptoms of typical uncomplicated (classic) dengue usually start with fever within 4 to 7 days after you have been bitten by an infected mosquito and include

* High fever, up to 105ºF
* Severe headache
* Retro-orbital (behind the eye) pain
* Severe joint and muscle pain
* Nausea and vomiting
* Rash

The rash may appear over most of your body 3 to 4 days after the fever begins, and then subsides after 1 to 2 days. You may get a second rash a few days later.

Symptoms of dengue hemorrhagic fever include all of the symptoms of classic dengue plus

* Marked damage to blood and lymph vessels
* Bleeding from the nose, gums, or under the skin, causing purplish bruises

This form of dengue disease can cause death.

Symptoms of dengue shock syndrome--the most severe form of dengue disease--include all of the symptoms of classic dengue and dengue hemorrhagic fever, plus

* Fluids leaking outside of blood vessels
* Massive bleeding
* Shock (very low blood pressure)

This form of the disease usually occurs in children (sometimes adults) experiencing their second dengue infection. It is sometimes fatal, especially in children and young adults.

CNN carries a short AP story that Brazil is considering appealing to Cuba for doctors, after the state of Rio got 154 doctors from other parts of the country. They need more.

I think this may be a case for a good spray of DDT, and damn the theoretical environmental reprocussions. This may actually already be taking place:

More than 57,000 people have been infected in a dengue fever outbreak in Brazil’s Rio de Janeiro state, with 67 fatalities recorded so far, regional health authorities say.

The tourist city of Rio was worst hit by mosquito-borne epidemic, with 44 of the deaths and 36,600 of the infections occurring there.  Another 58 deaths are being investigated to see if they were caused by dengue fever, whose symptoms are high temperatures and muscle aches.  In extreme cases, haemorrhage and death can follow. Children are especially at risk and no vaccine is yet commercially available.

Rio Governor Sergio Cabral says he may appeal to Cuba for doctors to help treat patients, many of whom have been sent to tent hospitals set-up by the army to cope with the large number of people affected.

Around 1,200 military personnel have joined health service staff in fumigating areas that may contain mosquito colonies. (AFP story)

As is to be expected, some people there are blaming the government, while others blame the poor people. Favelas, or shantytowns, are the unplanned, homemade jury rigged ghettos that surround most urban areas in Brazil. Living conditions there are utterly abhorent, with little or no running water, no sanitation, rampant crime, extreme fire risk, etc.

“I think that the state and municipal governments here were irresponsible in the way they handled this, because they didn’t do anything until the problem was already out of control,” said Isabel Belo, 35, whose ill 11-year-old daughter was hooked up to an IV bag. “Now, everyone is just trying to pass the blame around to someone else.”

According to dengue experts, the outbreak can be largely attributed to the rise of hundreds of unplanned, densely populated shantytowns in Rio.

Wellington Sun, chief of the dengue branch for the U.S. Centers for Disease Control and Prevention, said the demographic shifts that turned Latin America from mostly rural to predominantly urban in recent decades have given the dengue-carrying mosquito a perfect environment in which to thrive. The mosquito needs only a tiny amount of standing water to breed—even a piece of crumpled plastic garbage is enough, Sun said. Eliminating breeding pools is very difficult in areas where trash collection is infrequent and water and sewer services are lax.

“The mosquito—Aedes aegypti-- has found a very favorable environment in cities where there has been fast growth without the corresponding infrastructure,” said Jarbas Barbosa, a Brazilian doctor who is the head of health surveillance and disease management for the Pan-American Health Organization. “In a lot of neighborhoods in Rio, for example, they store water on their houses because they don’t have 24-hour, seven-days-a-week water service.”

Brazilian president Luiz Inacio Lula da Silva takes a unity approach and says the whole country has to pull together to fight the disease

“It’s the responsibility of the president, the governor, the mayor and each resident of this country,” Lula said. “If we don’t clean up the water in our home, our street, our city, our state, we will all be victims of irresponsibility.”

Dengue fever is not limited to the tropics. There are cases in the US every year, though few, and most are people who have just come back from other countries. But this story is a grim reminder to check your property for standing water and other skeeter breeder areas.

Posted by Drew458     on 04/03/2008 at 10:14 AM   
Filed Under: • Health-Medicine •  
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