DENGUE FEVER: SLOW DOMINICAN RESPONSE

C O N F I D E N T I A L SANTO DOMINGO 003141

SIPDIS

SENSITIVE
SIPDIS

DEPT FOR WHA/CAR, M/MED; DEPT PASS USAID/LAC; SOUTHCOM ALSO
FOR POLAD

E.O. 12958: DECL: 10/03/2016
TAGS: EAID AMED EAGR PREL PGOV SENV TBIO DR
SUBJECT: DENGUE FEVER: SLOW DOMINICAN RESPONSE


Classified By: EcoPol Counselor Michael Meigs. Reason: 1.4(b) and (d).


1. (SBU) Summary. Health authorities in the Dominican
Republic continue trying to deal with the widespread outbreak
of dengue fever that started in June, asserting at the same
time that that there is no epidemic. On September 24 the
Public Health Ministry announced that 3,933 cases of dengue
fever have been reported so far in 2006, including 150 of
dengue hemorrhagic fever (DHF) and a total of 37 deaths.
The official numbers do not include cases from private
clinics, hospitals or labs, sources which sum to indicate a
much higher incidence. In the USG community in the country
dengue has affected two Embassy officers, seven Peace Corps
volunteers and seventy family members of locally employed
staff. The government's sluggish response is typical of its
reactive approach to infectious diseases. End Summary.

Background
- - - - - -


2. (U) In July 2006, Dominican newspapers began reported
increases in the rate of dengue fever infections. Minister
of Public Health Dr. Bautista Rojas Gomez commented
officially many reported cases had been misdiagnosed. For
weeks, Dr. Rojas dismissed or minimized press reports of a
potential dengue outbreak in the country.


3. (U) Published statistics do not indicate how many deaths
had occurred before Rojas' public admission in September that
dengue had become a concern. The Heath Ministry organized a
campaign against mosquitoes and their breeding sites on
September 19 . Given the lack of government resources, the
Health Ministry enlisted masses numbers of volunteers from
schools, communities, faith-based organizations, to spray
with pesticides. In media announcements authorities urged
citizens to use household bleach to purify standing water.


4. (U) Ministry officials assert that the campaign has
visited visited 3.5 million residences and has eliminated 2.5
million breeding places. Members of the official American
community saw no activity in their own neighborhoods. The
Ministry has published healthcare guidelines, trained health
personnel in case management and has set up a dengue hotline
to counselt those who think they might have contracted the
fever.


5. (U) On September 24 the ministry provided official
statistics: 3,933 cases of dengue fever nationwide, including
150 of hemmoraghic dengue, and a total of 37 deaths. The
fatality rate for cases with hemorrhagic fever in the
Dominican Republic was 25 percent, compared to virtually nil
for all other countries in the region. Those most at risk
were the very young and the very old.


6. (C) Medical expert in infectious diseases Dr. Clemente
Terrero (protect) comments to Embassy staff that the Health
Ministry had simply reacted too late. Terrero believes that
the current dengue outbreak could last an additional two
months, depending on the amount of rain and the temperatures.
He expects that the disease will ebb naturally, with little
influence from government intervention.


7. (SBU) Epidemiological reports have shown a steady
increase in dengue fever in the period from July through
September, with a sharp spike in the first week of September.
Although the official numbers report close 4,000 cases, the
Embassy medical officer gauges this number to be seriously
inaccurate. Contacts in leading private clinics, labs and
public medical facilities suggest that the outbreak first hit
the capital in June. Since that time, one leading medical
laboratory has been processing between 40-50 exams for dengue
per day, finding positives for for acute dengue fever in 35
to 50 percent -- which is 100 to 175 new cases per week in
the capital alone, or 1700 to 3000 cases. These numbers come
from a single private lab generally serving only those who
can afford to pay. There may be an overlap with the official
figures, but it will be minimal -- these numbers reflects the
infection rate amongst the most affluent in town.


8. (U) Embassy personnel have been affected. Dengue fever
has afflicted two U.S. Embassy officers, resulting in
hospitalisations, seven teachers at the private school where
Embassy children study, nine Peace Corps volunteers, and 70
persons among locally employed staff and their families.


9. (U) On September 29th Health Minister Rojas told the
press that no one has died of dengue fever since September
23rd. He commented that the death of a five-year-old boy on
September 29th is under review to determine whether dengue or
pneumonia was the cause of death.


10. (C) Multiple sources indicate that senior Health
Ministry officials threatened to fire any ministry staff who
spoke to the press without authorization. The press reported
comments from the Minister that dengue had not affected
tourist locations. In fact, tourist locations include most
of the Dominican coastline and major cities including Santo
Domingo, which has experienced hundreds of Dengue fever cases.


10. (SBU) Plaza de Salud, the largest public/private
hospital in Santo Domingo, is just completing a study this
week of 1000 dengue patients the hospital recently processed
in just three days. This hospital cares for less affluent
Dominicans and has been "overrun" for the past six weeks with
dengue cases. Contacts indicate that the study puts the
number of dengue infections in the city and the country
substantially higher than the ministry figures.


11. (SBU) Press reports for early October relay the
ministry's line of a decrease in reports of dengue. In
contrast, they note the rise in cases of a new respiratory
virus, associated with bronchitis, pneumonia and chronic
asthma episodes. The Embassy sees these recent articles as
an effort to characterize dengue cases as misdiagnosed viral
illnesses.

Comment.


12. (C) Denial, managed information, and misdirection have
coupled with a lack of resources and training with which to
handle the outbreak of infection. A similar history occurred
with the malaria outbreak in 2005, which affected tourist
areas, among others. There is a pattern here, especially when
one joins these episodes with the authorities' poor response
to the 2005 incident of theinadvertent release from the
national refinery of toxic gas. A severe health emergency
such as fast-spreading Avian Flu or a catastrophe such as a
large earthquake would strain capabilities of the country to
their outer limits.
HERTELL