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