Opinion Sur Joven

Although the current catastrophic newspaper headings and TV reports mostly refer to the swine flu outbreak in Mexico and other countries, that problem (to the date this article was written) seems to be mostly affecting the northern hemisphere. Here in Argentina we are coping with yet another old epidemic: dengue.

More than 120,000 cases have been registered in Brazil, according to the World Health Organization (WHO), and more than 15,000 have been detected in Argentina. According to the Argentine Ministry of Health, this is the worst dengue epidemic in the country’s history, with already five fatal cases. The disease is also present in Bolivia and Paraguay. Are we supposed to get used to the idea that each summer will bring more victims? What’s the responsibility of the governments of the affected countries for its spread? Like with any other problem, let’s try to understand it first.

The enemy: Aedes Aegypti

Dengue is an infectious disease caused by a virus (Flavivirus) that is not transmitted from person to person, but through a vector. In this case, the vector is the infamous Aedes Aegypti mosquito.

“The most common symptom of the disease (classic dengue) is a sudden onset of fever, headache, eye pains, a sensation of extreme exhaustion, muscle and joint pains and the possible appearance of rash. Vomiting and abdominal pain may also be present in some patients”, Dr. Néstor Jacob explains to Opinión Sur Joven; he’s the head of the Infectology Department at Hospital Universitario Austral.

According to Jacob, this classic variety of dengue (also called dengue fever) lasts for about five to seven days and disappears spontaneously, since ―he says― there are still no effective medicines to fight the virus.

The treatment consists in something as simple as any granny’s advice: resting and taking an antipyretic (fever reducers) such as paracetamol, though not aspirin or its derivatives. “Aspirin and ibuprofen are avoided to reduce bleeding risks. And dengue may cause bleeding”, comments Hernán Barugel, a physician at Pirovano Hospital, in Buenos Aires city, who has treated several infected patients at the institution.

The best treatment, however, is to stay away from mosquitoes; otherwise, the sick person contributes to spread the disease by being bitten. Furthermore, Jacob adds that many people are infected with the virus but the disease never develops.

Things aren’t that simple, though. The disease may derive into more severe conditions: dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Although they occur in a lower proportion than the classic disease, they can cause death if not treated in time.

“These varieties are mainly characterized by the appearance of hemorrhagic spots (rash) on the skin, hemorrhage at the digestive tract, bleeding from mucosa, low blood pressure, intense abdominal pains and vomiting. Patients must be admitted to hospital in every case and assisted at the intensive care unit in most cases”, Jacob adds.

How to prevent it

Regarding these types of diseases, prevention is essential and it basically narrows down to avoiding infected mosquito bites. When the weather is hot and these little insects multiply exponentially, it’s not easy. But it’s possible.

“Avoiding mosquito bites is possible by controlling the proliferation of the vector, preventing its reproduction (by eliminating standing water sources where eggs are laid and larvae grow) and using personal protection methods to avoid the bites (proper clothing, repellent)”, says Jacob. He adds that there isn’t an effective vaccine yet, so prevention is the most important measure.

The Argentine Ministry of Health recommends ―apart from installing mosquito nets at home and using repellent― to eliminate all sorts of mosquito breeding grounds. This implies a tough battle against any water container, so it’s essential to remove all standing water sources at households, cover water deposits, get rid of old tires and unused cans and bottles, and turn upside down unused water recipients.

Besides, the water in drinking bowls for pets must be changed every three days, swimming pools must be emptied or maintained with chlorine, and clogged gutters must be cleared.

Prevention must continue even if we are already infected. Furthermore, although it may sound cruel, infected persons must be quarantined.

Barugel described to Opinión Sur Joven the experience of assisting a patient infected with dengue: “He was a professional football player who had been to Rosario; two days after that, he showed the symptoms. At first he was admitted as a suspected dengue case, but the blood tests later confirmed he was infected with dengue”.

“While he remained at the hospital as a suspected dengue case, he was placed at an isolated room. He was alone and surrounded by a mosquito net to avoid other Aedes Aegypti mosquitoes from biting him and thus transmitting the disease to other patients. The hospital staff had to go buy a mosquito net, and then they covered the patient’s body with a blanket”, he explains.

The other factors: weather and politics

The outbreak of the epidemic in Argentina triggered several discussions, mainly related to structural poverty. The government’s policy regarding the problem also generated doubts: Had the population been properly informed to face dengue? It is worth to mention that the disease has been getting stronger summer after summer.

“The current problem has been evolving since 1986, when the presence of Aedes mosquitoes was registered again after its eradication in 1965. Epidemic outbreaks and the pandemic behavior of the disease have been registered over the last decades in most South American and Caribbean countries, and the first Argentine cases were registered in 1997, in the northern region”, Jacob points out.

And he adds: “It’d be unfair to hold the current government entirely responsible for Argentina’s situation today, but it’s essential that health authorities define global and regional strategies to control the epidemic. The entire society must commit and enforce those actions. It is essential to render clear messages and conduct strong educational actions.

Some members of the Argentine government defended themselves from lack of foresight accusations, and argued that the situation is much worse in countries such as Brazil (as previously mentioned, with 120,000 confirmed cases).

Apart from attempting to avoid responsibility, this type of reaction is hard to believe. Taking into account the obviously larger number of cases in Brazil because its population is five times larger than Argentina’s, the Brazilian Ministry of Health has informed that their dengue cases have decreased by 28.6% in comparison with the same period of 2008, when more than 160,000 people were victims of the mosquito.

The Brazilians’ social and economic conditions aren’t likely to have improved so much so as to explain such a decrease. The reason can be nothing but prevention and State intervention to solve the problem.

And here’s another aspect: dengue doesn’t make a distinction between the poor and the rich, but it only takes some common sense to know the poor are in worse conditions and therefore more vulnerable to the epidemic, since many times they lack sewer systems and have no access to information, prevention or health assistance.

Global warming has a relevant role as well.

In previous articles of this section, such as Climate Change Diseases and Mosquito Invasion, we explained the close connection between global warming and the proliferation of infectious diseases such dengue.

The tropicalization of the upper half of Argentina, due to climate change, has carried several consequences; among them, dengue outbreaks. From now on, we should know temperature increase, structural poverty and negligent governments may combine into a dangerous cocktail that more than one Aedes would love to pose its little legs on.