DENGUE: A GROWING PROBLEM IN BURMA

UNCLAS SECTION 01 OF 04 RANGOON 000810 SIPDIS SENSITIVE SIPDIS DEPT FOR EAP/EX; EAP/MLS; EAP/EP; EAP/PD DEPT FOR OES/STC/MGOLDBERG AND PBATES; OES/PCI/ASTEWART; OES/IHA/DSINGER AND NCOMELLA DEPT FOR CA/OCS/ACS/EAP DEPT PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL CDC ATLANTA FOR COGH SDOWELL and NCID/IB AMOEN HHS/OGHA/WSTEIGER AND MSTLOUIS USDA FOR OSEC AND APHIS USDA FOR FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG USDA/FAS FOR FAA/YOUNG, MOLSTAD, ICD/PETTRIE, ROSENBLUM DOD FOR OSD/ISA/AP FOR LEW STERN PARIS FOR FAS/AG MINISTER COUNSELOR/OIE ROME FOR FAO BANGKOK FOR REO OFFICE PACOM FOR FPA E.O. 12958:N/A TAGS: TBIO EAID SOCI PGOV AMED AMGT CASC ECON BM SUBJECT: DENGUE: A GROWING PROBLEM IN BURMA REF: BANGKOK 4603 RANGOON 00000810 001.2 OF 004 ¶1. (SBU) Summary. Dengue fever is a growing concern in Burma, with more than 9,500 reported cases and 117 deaths due to dengue in the first seven months of 2007. The number of cases reported, however, may not reflect the real situation, as the World Health Organization (WHO) believes that non-symptomatic or mild cases go unreported, and some of the reported cases may not actually be dengue. WHO continues to work with the Ministry of Health (MOH) to improve diagnosis of dengue cases and ensure that health officials have the equipment necessary to treat the disease. The under-funded Ministry of Health cannot afford to use insecticide to kill mosquitoes, and instead mobilizes local communities to help destroy mosquito breeding grounds and control the spread of the disease. End Summary. Dengue: The Facts -------------- ¶2. (SBU) We met with Dr. Leonard Ortega, World Health Organization (WHO) Medical Advisor for Malaria and other Mosquito Borne Diseases, on August 23 to discuss the current dengue situation in Burma. The dengue virus, Dr. Ortega noted, can be transmitted throughout the year, but is more prevalent during the rainy season (May-October). Additionally, as the dengue mosquito tends to breed in urban areas, cities rather than rural areas are more affected. There are four strains of dengue; in 2007, the Type 3 strain is most prevalent. Dengue experts consider the Type 2 strain to be the most deadly -- this is the strain that medical experts found in 2001 and 2005, when the most dengue-related deaths occurred (see chart below). A cyclical disease, dengue has a higher death rate every 2-3 years. The WHO, Dr. Ortega verified, believes that the rate of dengue-related deaths in Burma will increase dramatically compared to last year's figures, possibly exceeding 2001 levels. Outbreaks in Burma -------------- ¶3. (SBU) According to the Ministry of Health and WHO, as of August 11, there have been more than 9,500 reported dengue cases and 117 dengue-related deaths. The Ministry of Health claims that through July 2007, Burma has experienced a 29 percent increase in dengue cases compared to the same period in 2005. Dr. Ortega, however, is not as quick to cite these statistics. Instead, he explained that while the number of reported cases has increased compared to recent years, not all cases may actually be dengue. Mothers, concerned about the dengue virus, are quick to take their children to the hospital at the first sign of fever and chills, he clarified. Some of these cases, which may be the flu rather than dengue, are RANGOON 00000810 002.2 OF 004 reported as early-onset dengue, which distorts dengue statistics. -------------- -------------- Reported Dengue Cases and Deaths in Burma 2000-2007* -------------- -------------- Year Cases Percent Deaths Percent Mortality Change Change Rate -------------- -------------- 2000 1,884 -- 16 -- 0.85 2001 15,629 129.6 204 1175.0 1.33 2002 16,047 2.7 171 - 16.2 1.06 2003 7,117 - 55.6 81 - 52.6 1.13 2004 7,207 1.3 85 4.9 1.18 2005 17,360 140.9 170 100.0 0.98 2006 11,383 - 34.4 128 24.7 1.12 2007* 9,578 117 1.22 -------------- -------------- *Through August 11, 2007 Source: Ministry of Health, World Health Organization ¶4. (SBU) At the same time, Dr. Ortega is certain that there are more cases of dengue, either non-symptomatic or mild cases, that go unreported annually. People who contract a mild dengue virus often do not seek medical treatment; because the Ministry of Health obtains dengue figures from medical practitioners, these cases are not included in overall statistics. Thus, he explained, the overall number of dengue cases may actually be higher than reported. ¶5. (U) Although the number of dengue cases in Burma is on the rise, the mortality rate continues to hover around one percent. Dr. Ortega, emphasizing that the number of dengue-related deaths reported is accurate, does not believe that the mortality rate will increase. The WHO attributes the mortality rate to a variety of factors, including high awareness among the Burmese about the disease and better case management by the Ministry of Health and local doctors. ¶6. (SBU) In previous years, Mon State and Rangoon and Mandalay Divisions, sites of three of Burma's largest cities, were home to 90 percent of Burma's dengue outbreaks, with an average of 50 percent of cases occurring in Rangoon Division. This year, Dr. Ortega observed, the majority of cases have been reported in Mon State, Rangoon, and Irrawaddy Divisions, with 2,152, 2,053 and 1,697 cases respectively. Of the 117 deaths in 2007, 88 have occurred in these three areas. Dr. Ortega noted that MOH officials expect a dengue outbreak in Mandalay Division in September and October due to predicted heavy rains. To prepare for this outbreak, MOH and Mandalay authorities, working with the WHO, continue to educate the RANGOON 00000810 003.2 OF 004 local population about dengue and mobilize community support to prevent the spread of the disease. GOB Response to Dengue -------------- ¶7. (SBU) Because of severe budget constraints, the MOH is working with local and international NGOs to address the growing threat of dengue. The WHO estimates that the GOB has allocated less than $5,000 for dengue prevention and treatment in 2007. Prioritizing its response to dengue, MOH officials have focused their efforts on ensuring that health clinics and hospitals have the necessary equipment to treat dengue, including IV fluids, blood for transfusions, and plasma expanders. Dr. Ortega also highlighted that the MOH continues its nation-wide education campaign to teach the population how to avoid catching dengue, as well as how to spot and treat the disease. The MOH is also mobilizing communities to assist in destroying mosquito breeding grounds, such as open jars, flower pots, and coconut shells. The biggest challenge, Dr. Ortega opined, is how to encourage communities to take a proactive, rather than reactive, approach to dengue. Only with community participation in destroying breeding grounds will the GOB be able to effectively control the spread of dengue, he asserted. ¶8. (SBU) Although the GOB has taken steps to address the dengue outbreak, only with NGO assistance will the GOB be able to truly address the problem, Dr. Ortega noted. Like many Southeast Asian countries, the GOB cannot afford the insecticides needed to kill mosquitoes. While the MOH does sporadic fogging in priority areas, it does so once or twice a season, rather than 3-4 times a month. Additionally, the GOB continues to request from international NGOs key medical supplies, including rapid diagnostic tests, blood bags for donations and IV fluids. While the WHO and UNICEF have provided more than 4,000 rapid tests and blood bags this year, the GOB continues to lack the medical supplies necessary to treat dengue. Comment -------------- ¶9. (SBU) Although tens of thousands of children could contract dengue fever this year, the GOB allocates less than $5,000 for dengue prevention and control, despite receiving $2 billion in revenues from oil and gas exports. Instead, they apportion an overwhelming majority of the GOB budget for the defense and maintenance of the regime rather than for basic social services. Their refusal to fund the most basic health services shows where the Burmese Government's priorities lie: maintaining the good life for senior generals, regardless of the cost to the people. RANGOON 00000810 004.2 OF 004 VILLAROSA