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Increased Efforts in Preparedness and Response Against Dengue are Necessary

Given the continued increase in cases of dengue in several countries of the Region, it is important to strengthen prevention and response strategies for these outbreaks. During the first semester of 2013, outbreaks have been reported in Brazil, Colombia, Costa Rica, El Salvador, Honduras, Mexico, Paraguay and the Dominican Republic, among others. In places like Peru, cases have been reported in places where the virus was previously not prevalent.

As of epidemiological week 23, 1,300,252 cases of dengue have been reported, of which 10,536 (1%) are cases of severe dengue; 51% more than in 2012. During the same period, mortality from dengue has been 0.03% (429 deaths), versus 0.07% (376 deaths) in 2012.

Cases in Central America have increased by 75.8% compared to 2012. Costa Rica, Nicaragua and Honduras have a higher incidence of cases. In Honduras a total of 8,380 dengue cases have been reported; 1,442 cases of severe dengue and 10 deaths as of epidemiological week 25. A red alert was declared in 28 municipalities and an early warning alert in 84 out the 298 municipalities.

Given the usual pattern of dengue in the Region, an increase in cases is expected in the coming months in Central America, Mexico and the Caribbean. This increase would coincide with the rainy season of those countries favoring the growth of the Aedes mosquito responsible for transmitting the virus.

The circulation of all four serotypes in the region increases the risk of severe forms of dengue and an additional burden for health services in the countries. PAHO/WHO is supporting national authorities in the process of organizing prevention and response actions for the outbreaks and is maintaining an ongoing monitoring of the disease behavior.

Dengue is a disease with different clinical presentations, ranging from benign conditions to a severe clinical course that may cause death. Symptoms can start with fever, joint pain, headache, skin lesions and overall sickness. Other warning signs of dengue are analyzed by doctors to establish the severity and define immediate treatment. It is important to consult a doctor to define the clinical management.

Dengue without warning signs: The disease can manifest as a "nonspecific febrile syndrome". The presence of other confirmed cases in the place where the patient lives is critical for the diagnosis of suspected dengue.

Dengue with warning signs: The patient may experience intense and continuous abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, altered state of consciousness, liver enlargement and progressive increase in hematocrit (percentage of red blood cell in the blood). Severe Dengue (formerly known as dengue hemorrhagic fever): Severe forms of dengue are defined by one or more of the following: plasma leaking, fluid accumulation with respiratory distress or both, bleeding that can be considered clinically significant by doctors, or severe organ impairment.

Recommendations

PAHO/WHO reiterates the recommendations emphasizing inter-sectoral coordination and actions to reduce morbidity and mortality. The following are the main recommendations:

Eliminate usual vector breeding sites through environmental cleaning activities, intensive sanitation campaigns, breeding site control and measures such as physical, biological and chemical methods that actively involve the community. See more information about Integrated Strategy to Manage Dengue.

Organize the health care services network to achieve the highest level of resolution at the primary care level and at other levels of care ensuring the supply of intravenous fluid, oral rehydration salts and other basic supplies.

Train medical personnel in charge of patient care, both at the primary care level as well as at other levels of care, to ensure early detection and identification of warning signs, and adequate and timely treatment.

Strengthen health information strategies for patients and family members in order for them to identify warning signs, and to seek medical care at the nearest health facility upon the onset of symptoms. Develop, adjust and implement plans for risk communication at national and local levels and conduct advocacy activities with policymakers and organized civil society (e.g. mayors, churches, NGOs, private enterprise) to raise awareness and promote a coordinated intersectoral response.

More information on the Epidemiological Alerts and Updates of PAHO/WHO:

http://new.paho.org/hq/index.php?option=com_content&view=article&id=8820%3A21-june-2013-dengue&catid=2103%3A--hsd0104d-most-recent-ea&Itemid=2291&lang=en

PAHO/WHO Epidemiological Alert related to Dengue (June 21, 2013): http://new.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=22101&Itemid=&lang=en

More information on Dengue: http://www.who.int/mediacentre/factsheets/fs117/en/index.html