El Salvador

El Salvador: Chikungunya and dengue fever outbreak Emergency Plan of Action (EPoA) Operation n° MDRSV007

Situation Report
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A. Situation Analysis

Description of the disaster

Chikungunya fever is an emergent disease transmitted by mosquitoes and caused by an alpha virus - the chikungunya virus - which is transmitted mainly by Aedes aegypti and Aedes albopictus mosquitoes (the same species involved in dengue fever transmission).

During the 1952-1953 epidemic in Tanzania, the chikungunya virus was isolated from human serum and from the mosquito. Subsequent outbreaks occurred in Africa and Asia mainly affecting small or rural communities.

Chikungunya virus strains were isolated in Asia during major urban outbreaks in Bangkok, Thailand in the 1960s, and in Calcutta and Vellore, India in the 1960s and 1970s.

Since 2004, the chikungunya virus has expanded its geographical distribution throughout the world, causing sustained epidemics in Asia and Africa where some areas are considered endemic for this disease. The virus has produced outbreaks in many new territories.

On 6 December 2013, PAHO/WHO received confirmation regarding the first cases of indigenous transmission of chikungunya in the American continent on the island of Saint Martin (French territory). Faced with this situation, the Pan-American Health Organization (PAHO) issued an epidemiological alert on 9 December 2013, recommending that countries establish measures to detect, confirm and manage cases and implement a communications strategy.

Subsequently, five other territories in the Caribbean had reported indigenous transmission by late January 2014: Guadeloupe, British Virgin Islands, Martinique, Saint Barts and Saint Martin (Dutch territory). Outbreaks have also been detected in recent months in Dominican Republic, Haiti and Venezuela. El Salvador is the first country in Central America with a chikungunya outbreak. Several cases of fever and particular clinical symptoms have appeared since early June 2014 in the municipality of Axutuxtepeque in the Department of San Salvador. Given the situation, the Ministry of Health determined that the clinical picture of patients corresponded to chikungunya virus.

According to Ministry of Health data to date, 1,300 suspected cases have been reported, distributed over 6 departments and 20 municipalities, with the possibility of spreading to the rest of the country due to the population's high susceptibility to this disease, as they have never come into contact before with the virus. Suspected cases are clinically established and samples were sent to the Center for Disease Control (CDC) in the United States, where samples studied have been confirmed as positive.

On 18 June, the Ministry of Health, through the Directorate-General for Civil Protection, established a stratified Yellow Alert due to the growing number of cases of chikungunya and dengue fever in the country.