A. Situation analysis
Description of the disaster
Timor-Leste has recorded an escalation of dengue fever cases from the start of 2022 with the death toll reaching 20 on 31 January 2022, making it the deadliest year in recent times. In the first week of 2022, there were 288 suspected cases of dengue in seven municipalities. In the second week of 2022, there were 56 additional dengue cases reported across Timor-Leste. Following a growing number of cases, the fatality rate from the start of 2022 and considering Timor-Leste Covid-19 pandemic situation, on 15 January 2022 the Government of Timor-Leste released a circular declaring that dengue had become a serious public health concern considered as an outbreak event. By the third week of January, the number of recorded cases across the country had more than doubled and healthcare capacities could not cope with the needs in the field.
Dengue remains an important public health problem in Timor-Leste, with several major epidemics occurring over the last 10 years. Dengue incidence in Timor-Leste is highly seasonal and spatially clustered, with positive associations with temperature, precipitation, and demographic factors. Despite the high costs and burden of the disease, there have been few epidemiological or clinical studies of dengue specifically in Timor-Leste. As a highly seasonal occurrence in Timor-Leste, dengue cases reach their peak during the wettest and hottest months of the year (December to April). The increase in dengue cases correspond with increases in mean temperature and precipitation and are likely to be associated with the vector dynamics. With the increase in temperature, the longevity of the Aedes mosquitoes increases, with the best survival temperatures occurring between 27 and 30 °C. Higher temperatures also shorten the extrinsic incubation period of the virus within mosquitoes. In places with water shortages, increased temperature leads to storage of water in containers, which in turn provides a breeding place for mosquitoes. Similarly, increased precipitation potentially facilitates vector population growth by providing water for mosquito breeding.
A report published by the Ministry of Health on 31 January 2022 confirmed that the 20 deaths recorded in the first month of this year had already surpassed the total number of deaths recorded in 2021 (11) and 2020 (10) respectively. The report also revealed that of the 20 deaths, 11 have occurred in the national capital Dili, four in the municipality of Ermera, two in the municipality of Covalima, and one each in the municipalities of Ainaro, Bobonaro, and Viqueque. The report also indicates that most of the patients have been children under 14 years.
The risk of dengue is present throughout Timor-Leste and year-round, with peak transmission from December to April. From graph 1 above, in the year 2021, dengue cases were relatively high between December to March and reached their peak in February 2021. The virus is transmitted through the bite of infected Aedes aegypti and Aedes albopictus female mosquitoes that feed both indoors and outdoors during the daytime (from dawn to dusk). These mosquitoes thrive in areas with standing water, including puddles, water tanks, containers, and old tires. Lack of reliable sanitation and regular garbage collection also contribute to the spread of mosquitoes. Dengue occurs in urban and suburban settings with higher transmission rates happening during the rainy season.
As shown in Table 1 above, in January 2022, dengue cases in Timor-Leste are seven times higher than recorded cases from the previous year. Dengue cases have also been reported in 12 out of 13 municipalities in Timor-Leste with Dili municipalities recording most of the cases. This is closely related to the fact that Dili municipality, the capital city of Timor-Leste, is a more densely populated urban area. As the above statistics indicate, as of 31 January there were 853 dengue cases in Dili representing 66% of the total cases reported. Of the total cases, 42% of cases have been identified in the 5-14-year-old age bracket; 36,5% identified from the group of 1-4 years old and less than 10% for the rest of the group.
The Ministry of Health’s report also conceded that apart from infrastructure problems, the country's health system is facing a shortage of doctors and other health professionals and that the situation could worsen in the coming months. The outbreak has forced authorities to use health facilities previously designated for isolation of Covid-19 patients, such as the Vera Cruz Health Care Center, as places to treat dengue fever patients after the state's main Guido Valadares National Hospital was overwhelmed.
Overview on COVID-19 pandemic situation in Timor-Leste
Apart from the dengue outbreak, Timor-Leste has documented 234 new cases of COVID-19 during 25 Jan - 1 Feb 2022. This represents a 117% increase compared to the preceding seven days. All the new cases were reported in the Dili municipality, and in general most of the cases have been reported in Dili. The weekly case incidence is 1.0 per 100, 000 population at the national level. The weekly Test Positivity Rate (TPR) is 0.5% at the national level and has slightly increased during the reporting period, compared to the preceding seven days. The country is therefore facing the double burden of tackling the third wave of COVID-19 alongside the surge in dengue cases which will place a great deal of stress on the already struggling health system in Timor-Leste in the coming months.
No new deaths have been reported from Timor-Leste during the same period, which is the thirteenth consecutive reporting period with no death reported. However, since the commencement of the global pandemic Timor-Leste has recorded a cumulative total of 122 deaths due to COVID-19.
As of 31 January 2022, the Ministry of Health in Timor-Leste has documented the administration of a total of 1,242,550 vaccine doses. In total, 84.0% of eligible people have received their first dose of COVID-19 vaccine, 70.4% of people over 18 years have completed the second dose, and 0.7% among the population aged 18 years and above have received booster doses.