GRBV UNDEREPORTS H1N1, DENGUE AND MALARIA ON THE RISE

C O N F I D E N T I A L SECTION 01 OF 02 CARACAS 001591

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E.O. 12958: DECL: 2019/12/23
TAGS: ECON VE KFLU KHIV AMED
SUBJECT: GRBV UNDEREPORTS H1N1, DENGUE AND MALARIA ON THE RISE

REF: CARACAS 1515; CARCAS 1367

CLASSIFIED BY: DUDDY, AMBASSADOR, DOS, AMB; REASON: 1.4(B),(D)


1. (C) SUMMARY: As of December 17, the Venezuelan Ministry of
Health has reported 2,697 laboratory-confirmed cases of H1N1 and
117 deaths associated with the virus. Many medical experts claim
that the Venezuelan Government (GBRV) has underreported the
prevalence of H1N1, based on the mortality rate of H1N1 worldwide
and the number of reported deaths. On December 18, the Director of
the Health Corporation of Miranda told Emboffs that the GBRV has no
contingency plan for an H1N1 outbreak, no supply of H1N1 vaccine,
and few intensive care units for patients with respiratory
problems. In a related development, dengue and malaria are on the
rise, and while the opposition media has blamed the GBRV's failed
policies for the spread of these diseases, it is equally plausible
that the increase is part of a wider regional phenomenon. END
SUMMARY.



GBRV UNDERREPORTS H1N1




2. (C) On December 18, Emboffs met with Doctor Gustavo Villasmil
(protect throughout),Director of the Health Corporation of
Miranda, the government entity responsible for managing the
opposition-governed Miranda state's medical network. Villasmil
said that while GBRV statistics on the number of H1N1-associated
deaths were credible, the GBRV dramatically underestimated the
prevalence of the virus (Note: According to the local press, eight
Yanomamis who died from the virus have not been included in
official statistics. End Note.).




3. (C) Villasmil estimated that there have been approximately
10,000 cases of H1N1-not 2,697 as reported by the GBRV. His
calculation was based on a comparison of the H1N1 mortality rate
worldwide and the number of reported deaths in Venezuela.
According to Villasmil, the H1N1 mortality rate is between one
percent and .5 percent worldwide. This mortality rate suggests
that the number of cases of H1N1 in Venezuela should be much higher
given the number of reported deaths (Note: Post's Regional Medical
Officer said that the worldwide H1N1 mortality rate is almost
certainly lower than .5 percent, but agreed that the GBRV has
probably underestimated the incidence of H1N1 since the official
GBRV statistics suggest that the mortality rate in Venezuela is 4.3
percent. End Note.). On September 28, the opposition daily "El
Universal" cited an epidemiological report that concluded that the
actual number of H1N1 cases could be seven times greater than the
number reported by the GBRV, a charge that Health Minister Carlos
Rotondaro has repeatedly denied.




4. (C) Villasmil characterized GBRV preparations for an H1N1
epidemic inadequate. There are only 50 Intensive Care Units (ICUs)
in Venezuela for patients with respiratory problems-who would be at
great risk in the event of a pandemic-and the Ministry of Health
has no organized plan for using the units during a crisis. "This
government has not written a single word to plan for a pandemic,"
Villasmil said. Clinics and hospitals have not been prepared for
an outbreak and the GBRV has not organized emergency triage
centers. At the moment, the GBRV has no supply of H1N1 vaccine.
On December 4, the press reported that the GBRV had ordered 3
million doses of H1N1 vaccine that were scheduled to arrive in
January 2010, but Villasmil said that the central government would
"probably not" share the vaccine with opposition-led Miranda state.
In preparation for a possible outbreak, Villasmil has made
arrangements to buy generic Tamiflu from India, over the objections
of Ministry of Health officials who argue that the Ministry of
Health is responsible for coordinating health policy throughout the
country.

CARACAS 00001591 002 OF 002


DENGUE AND MALARIA ON THE RISE, OPPOSITION MEDIA BLAMES GBRV




5. (C) As of December 5, the Ministry of Health has confirmed
59,138 cases of dengue, including 4,485 cases of hemorrhagic
dengue, a subtype with a higher mortality rate (Note: Post RMO said
that for a variety of reasons dengue is often unreported, while
hemorrhagic dengue is often over reported. As such, the GBRV's
estimate for the number of cases of dengue is probably too low,
while statistics for the number of cases of hemorrhagic dengue are
probably too high. End Note.). According to Villasmil, the GBRV
has facilitated the spread of dengue and malaria by allowing basic
infrastructure to deteriorate and neglecting effective prevention
programs. Delays in trash collection have left huge piles of
garbage along the streets of Caracas and contributed to unsanitary
conditions (Ref A). In response to government-imposed water
rationing (Ref B),Venezuelans have collected water in large tanks,
creating breeding grounds for mosquitoes (Note: Post RMO said that
while an increase in standing water may have contributed to the
spread of dengue, such a casual relationship is difficult to prove,
and that the increase in Venezuela is more likely part of a wider
regional phenomenon. End note.). The incidence of malaria, a
disease that was all but eradicated by a government fumigation
program in the 1940s, has increased to between 30,000 or 40,000
cases per year.




6. (C) COMMENT: Most medical experts accept the GBRV statistics on
the number of H1N1-associated deaths in Venezuela, but the general
consensus is that the Ministry of Health has underreported the
prevalence of H1N1 based on a comparison of the mortality rate of
H1N1 and the number of deaths. Health care professionals also seem
to agree that the GBRV has taken few substantive measures to
prepare for an H1N1 epidemic. Venezuela's medical infrastructure
would be quickly overwhelmed in the event of an outbreak, with
shortages of ICUs, H1N1 vaccines, and anti-viral medications
particularly likely. Although opposition media outlets have blamed
government inaction and ineptitude for the increase in dengue and
malaria, it is not clear that the GBRV bears full responsibility
for the spread of these diseases, which may be part of a wider
regional phenomenon. END COMMENT.
DUDDY