Smoke clears on a Cuban epidemic

Smoke clears on a Cuban epidemic

Spraying has curbed dengue fever, which has killed up to 100. State
secrecy slowed initial response, doctor says.
This story was written by a correspondent who was not authorized to
report in Cuba.
November 14, 2006

HAVANA — An epidemic of dengue fever that flooded hospitals and may have
killed as many as 100 Cubans has been brought under control by a
fumigation campaign involving 300,000 students, pensioners and
healthcare workers.

The outbreak of the mosquito-borne virus here was the worst in a quarter
of a century and appears to have afflicted thousands during its peak in
September and October. The infection rate has slowed to only a few dozen
new cases this month, said a senior doctor familiar with the scope of
the epidemic, who added that the response was initially slowed by
government secrecy.

Caused by a mosquito-borne virus, dengue produces flu-like symptoms,
including fever. It occurs in most tropical areas of the world and is
widespread in the Caribbean basin.

The physician complained bitterly about the veil initially imposed by
Communist Party officials. The ostensible purpose was to avoid panicking
the public, but the demand that the epidemic be treated as a
confidential security matter was strongest in early September, when
preparations were underway for the 14th summit of the Non-Aligned
Movement, to be held in Havana. That gathering of Third World leaders
brought 3,000 foreign visitors from more than 100 countries to the
capital Sept. 11-16, including about 50 heads of state and government.

The doctor spoke on condition of anonymity because of the possibility of
dismissal from his job or arrest for discussing the matter with a reporter.

"We were forbidden even to refer to it as dengue fever, because the
official position is that dengue was eradicated in the 1980s," said the
doctor, who has nearly three decades of experience in Havana hospitals.
"We were compelled to call it 'fever syndrome.' "

Cuba's Public Health Ministry later confirmed the outbreak, telling the
Pan American Health Organization representative in Havana on Oct. 13
that the country was suffering "a classic dengue outbreak" and that
about 10% of the cases involved children.

The ministry gave no count of the afflicted and said that an unspecified
number of deaths were "associated with preexisting chronic conditions."

But dengue deaths here and in at least four other provinces have been
reported to relatives abroad, providing anecdotal support for the
doctor's estimate of 100 deaths nationwide.

A Havana pediatrician, Angel Arturo Aballi, told a Web-based dissident
news agency that more than 1,000 children were hospitalized with dengue
fever in mid-September, when new admissions were coming at the rate of
50 a day.

The government report to the health organization also gave no details of
the epidemic's scope but asserted that Cuba "has the necessary
resources, materials and trained staff to deal with this event, in
addition to political will and integrated activities" of government
agencies and the population.

"Cuba is the only country in the world that can control for considerable
periods of time the insect-transmitter and its terrible effects," Vice
President Carlos Lage Davila, a physician thought to be No. 3 in the
party hierarchy behind President Fidel Castro and his brother Raul, said
in late October in a televised discussion of the "fever syndrome."

The first cases came to doctors' attention in July, and by September the
numbers had exploded. Hospitals discharged other patients and canceled
surgeries to accommodate the dengue sufferers, the doctor said.

Exacerbating the situation, he said, were renovation projects that have
made as many as 70% of the capital's hospital beds unavailable for the
last few years.

Havana residents report that a public education campaign to combat
mosquito breeding got underway in earnest after the summit, when the
government marshaled all available healthcare resources to deploy
"Brigades in the Battle Against Aedes Aegypti," the day-biting mosquito
that carries dengue.

Squads of khaki-clad troops in the "Army of Youth Workers" from Havana
universities and Communist Party federations comb the capital street by
street, training their portable insecticide bazookas along curbs,
building foundations, fences and potholes. Tanker trucks blast the
narrow streets of densely populated areas such as Old Havana, sending up
acrid clouds between the buildings where glassless windows are protected
only by wooden slats.

"The crisis has been lessening in recent days," a young veterinarian
said as he cast his flashlight over the water in rooftop cisterns at an
apartment building in the Vedado neighborhood. He inquired at each
household whether anyone had been ill with rash, headache, fever or
joint and muscle aches. He checked the bathrooms and balconies for
standing water, then signed and dated the inspection records taped to
each apartment door.

Asked how many cases of dengue fever had been fatal, the veterinarian
lifted his hands in a defensive gesture. "We don't know about deaths,"
he said. "That may be considered strategic information."

Maria del Carmen Marquetti, a specialist at the Pedro Kouri Institute of
Tropical Medicine, reminded Cubans who keep a glass of water on a shelf
or counter as an offering to Afro-Cuban deities that it should be
changed frequently to prevent mosquito larvae from forming.

Residents found to have open water sources with mosquito larvae can be
fined for failing to do their part in combating the epidemic, Havana
residents said. Despite official efforts to keep the name of the disease
out of public discourse, most know about it from friends and neighbors
who have been sick.

"People here are skilled at reading between the lines. They know what
goes on, even if the authorities won't tell them," said an intellectual
whose wife weathered the fever.

Cuba suffered its last major outbreak of dengue in 1981, when 158 died,
two-thirds of the victims children. A concerted spraying effort ended
the epidemic, and advances in healthcare and sanitation had enabled the
country to stay relatively free of the virus, which kills 20,000
worldwide every year.

This year's epidemic and an accelerating decline in public sanitation
have doctors worried about recurrence once the current campaign subsides.

"There are now fears that it is endemic in Cuba too," the senior doctor
said. "It will recur after the cool winter months, when everyone again
lets his guard down."

http://www.latimes.com/news/nationworld/world/la-fg-dengue14nov14,1,2595281.story?coll=la-headlines-world