Paraguay declares state of emergency of dengue

[Snowy Owl]

Paraguay declares state of emergency of dengue
www.chinaview.cn 2007-03-01 10:21:57

BUENOS AIRES, Feb. 28 (Xinhua) -- The Paraguayan government on Wednesday declared a 60-day state of emergency due to a major dengue outbreak, which has killed 10 people and infected 15,000 others since the beginning of this year.

Paraguayan President Nicanor Duarte signed a decree declaring a health and environmental emergency, said Aristides Gonzalez, the head of the country's national emergency secretariat, according to news from Asuncion.

He said he would meet cabinet members and prepare an action plan to raise money to curb the epidemic. A large part of the money would be allocated to brigades dispatched to eliminate stagnant ponds where the dengue-carrying Aedes Aegypti mosquito breeds.

On Tuesday, health authorities said they were on alert due to evidence of a more virulent strain of the disease.

Gonzalez said there were plenty of beds, medicines and doctors in state hospitals, and most of the dead died in private facilities.

A medical committee conducted autopsies on those who died of the disease, discovering evidence of so-called "gastric dengue," a variant of the disease that had not been seen in Paraguay before.

Gastric dengue, which is different from hemorrhagic dengue, killed six of the 10 victims by attacking the liver, heart, lungs and brain.

Dengue is caused by four closely-related viruses and is spread by the Aedes Aegypti mosquito, which breeds in still water. Its symptoms include high fever, nausea, rashes, backache and headaches

[Snowy Owl]

Re: Paraguay declares state of emergency of dengue

Dengue fever epidemic infects 13,000, prompts emergency declaration

http://www.ecanadanow.com/science/he...y-declaration/

Asuncion, Paraguay (eCandaNow) - A dengue fever epidemic that has infected more than 13,000 people in Paraguay prompted the country?s Senate to approve a 60-day state of emergency on Monday.

The measure, which had already been passed by the lower house of the legislature, clears government funds to fight the disease, whose symptoms include bad headaches, high fever, diarrhoea, vomiting and severe joint pain.

At least four people have died from the virus and 650 new cases have been reported recently. The disease is spread by mosquitoes, and there are no immunizations or medicines to fight the virus.

Critics have accused the government of ineffectiveness in handling the outbreak. They claim that deficient sanitation and open-air garbage dumps have provided ideal conditions for the insects that transmit the virus to reproduce.

Critics also allege official figures of infected people are too low. Unofficial estimates rise as high as 60,000, because many people have no access to doctors.

There are a total of four different types of the dengue virus. Exposure to more than one type can result in internal bleeding, if a person has already suffered from a previous case caused by a different variant of the virus.
In poor rural areas, up to 30 per cent of those infected die from dengue fever.

? 2007 dpa - Deutsche Presse-Agentur

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[Corn]

Re: Paraguay declares state of emergency of dengue

Dengue Kills Paraguayan Health Official
2:56 PM EST, March 2, 2007
By PEDRO SERVIN, Associated Press Writer ASUNCION, Paraguay -- One of Paraguay's top health officials died Friday of dengue fever, the latest casualty in an epidemic that has infected thousands of people.

Maria Catalina Roa, who oversaw registered nurses in all public hospitals, had been hospitalized two weeks ago after contracting the mosquito-borne illness.

In January and February alone, 15,000 people have been infected, compared to just 1,600 all last year, according to official figures. Ten people have died.

Some doctors say the actual toll is much higher, since many infected Paraguayans do not seek professional treatment. Opposition legislators say the actual number may be as high as 130,000.

Some 500 protesting hospital workers demanded the resignation of Health Minister Oscar Martinez.

"Our leaders are negligent, inept," said Carlos Cubas, one of the demonstrators. "Our comrade Maria Catalina, who fought to preserve the life of hundreds of people, has died today. This is a very sad day."

President Nicanor Duarte declared a two-month national state of emergency and allocated funds to fumigate breeding areas for disease-spreading aedes aegypti mosquitoes, which have flourished in unusually wet weather in central South America.

The government has asked for help from the United States and Argentina to determine what types of dengue are present in the current epidemic.

Four of those to die were among 40 cases of the more severe hemorrhagic form of dengue, which causes a sudden high fever, rash, aches, weakness, restlessness and even internal bleeding. Many others apparently have classic dengue -- also called bonebreak fever -- which causes fever, intense headaches, and joint and muscle pain.

The disease cannot be transmitted between people.

Dengue fever is common in Latin America. Recent outbreaks have been reported in Peru, Brazil, Mexico and even Easter Island, Chile's possession in the middle of the Pacific Ocean.

http://www.courant.com/news/health/ats-ap_health10mar02,0,4637107.story?coll=hc-utility-news-health

[Niko]

Re: Paraguay declares state of emergency of dengue

Paraguay's elite hit in worst dengue outbreak

Fri Mar 2, 2007 5:30PM EST
By Daniela Desantis

ASUNCION, March 2 (Reuters) - A Supreme Court justice, soccer players and a senator have all come down with dengue in Paraguay, as the worst outbreak in the country's history hit the well-off as well as its usual victims among the poor.

On Friday, a nurse who worked with the public health service died after being hospitalized for dengue.

Ten people have died and more than 15,000 have been infected in the last two months with the mosquito-born virus, which causes high fever, headache, severe muscle and joint pain and, in its worst form, potentially fatal internal bleeding.

Paraguay, which never had a dengue death before this outbreak, and neighboring Brazil and Bolivia have declared health alerts as they all fight major dengue outbreaks that could be linked to unusually hot and rainy weather.

"We're really scared. Everyone is sick. This is chaos," said Amalia Benitez, an herb vendor in Asuncion, capital of the landlocked South American nation.

Some stores in Asuncion have run out of mosquito repellents, citronella oil bracelets are all the rage and radios are full of a new song with lyrics about the dengue carrier: the Aedes aegypti mosquito.

Doctors and health workers protested on Friday in front of a government public health building, saying the government has failed to fight the epidemic properly despite assigning $3.8 million in emergency money.

Carrying signs with drawings of giant mosquitoes and photos of health officials, the protesters demanded Health Minister Oscar Martinez resign.

Dengue inflections have increased four-fold in the last three decades, according to the World Health Organization. Most dengue is in Southeast Asia and the Western Pacific, but incidence and severity is increasing rapidly in Latin America.

Dengue has expanded in the Americas since the 1970s, as the mosquito that carries it hugely expanded its territory after governments stopped large-scale eradication campaigns, according to the U.S. Centers for Disease Control.

http://www.reuters.com/article/homepageCrisis/idUSN02404537._CH_.2400

[Gert van der Hoek]

Re: Paraguay declares state of emergency of dengue

Dengue Affects 400,000 Paraguayans

Asuncion, Mar 15 (Prensa Latina) At least 400,000 are infected with dengue in the Central Department, home to the Paraguayan capital, Governor Francisco Franco said on Thursday.

According to Franco, 1.6 million people live in the Department, and 20 percent of adults contracted the viral disease in Jan-Mar this year.

Figures were released during a meeting with Health minister Oscar Martinez to coordinate joint actions to fight Aedes aegypti, the dengue-causing mosquito.

The Health Ministry, which has been strongly criticized for its handling of the situation, reported the deaths of 12 people so far.

http://www.plenglish.com/article.asp?ID=%7B2578BCE6-F4AB-4812-93FB-92EDD1D9A554%7D)&language=EN

[Gert van der Hoek]

Re: Paraguay declares state of emergency of dengue

Source: Pan American Health Organization (PAHO)

Date: 15 Mar 2007

Dengue outbreak in Paraguay: Follow-up

Summary of the Current Situation in Paraguay

The nationwide epidemiological alert in Paraguayan continues, as per information provided by the Ministry of Public Health and Social Welfare of Paraguay (MSPBS).

Up to 14 March of 2007 (Epidemiological Week / EW No. 11), following up on the February 9 update, official reports are as follows:

- 19,577 suspected cases of dengue

- 46 cases of dengue hemorrhagic

- 10 fatalities

- Case-fatality rate: 21.7%

- Serotype: DEN 3

- Affected areas: Asunci?n, Central Department, and other cities

Background

The current dengue outbreak in Paraguay caused by serotype DEN 3 was preceded by the circulation of the DEN 1 and DEN 2 serotypes in 2002. The disease reappeared in 2003, 2004, and 2006 with the DEN 3 serotype being the most prominent.

During the 2006 outbreak in Asunci?n, 4,271 cases of dengue serotype DEN 3 were reported. The country managed to control the outbreak and kept transmission at low levels until October, when the number of cases began to increase.

Current Situation

Up to Thursday, 14 March 2007, 19,577 recorded cases of dengue were reported, along with 46 cases of dengue hemorrhagic (DH) and 10 deaths: 3 from DH, 5 from atypical forms, and 2 from undetermined causes. The national average incidence rate is 325.8 per 100,000 inhabitants (Source: Mercosur and MSPBS).

- The dengue outbreak is concentrated in the capital city of Asunci?n and in four departments: Capital (incidence rate = 1166.6 x 100,000), Cordillera (392.3), Central (388.4), and Concepci?n (336.5). Other affected departments include Amambay and Paraguar?.

- The presence of serotype DEN 3 in Asunci?n could lead to an outbreak of massive proportions among populations groups susceptible to this serotype if response is not timely and if the necessary control measures are not taken.

- Climate in the form of continuous rainfall has played a major role in this outbreak.

Clinical Cases of Atypical Dengue

The National Commission of Physicians (Comisi?n Nacional de M?dicos de Cierre de Casos) has clinically diagnosed dengue with such severe unusual manifestations as serious visceral involvement, called "classic dengue with severe unusual manifestations." This has been well described in the literature and has become important now because most of the fatal cases have fit this condition. Classic dengue with severe unusual manifestations has affected patients who apparently have dengue but who developed severe cardiac involvement in the form of myocarditis, liver failure due to viral hepatitis, pulmonary involvement due to viral pneumonitis, and involvement of the nervous system resulting in unconsciousness.

Technical Collaboration Activities Effectively Carried Out and Facilitated by PAHO/WHO

- PAHO/WHO provided direct technical assistance in the areas of patient care, mass communication, and health services to strengthen capacities, timely diagnostic guidelines, adequate case management, and collaboration in "Dengue Day"(D?a D), among others.

- A mission from Argentina headed by Dr. Elena Pedroni, Director of Statistics and Health Information at the Ministry of Health, and Dr. Enrique V?squez, Consultant at PAHO-Argentina, and later by a high-level team from the Ministry, offered support for combatting the epidemic, namely by providing vehicles for chemical control agents, epidemiologists to operate the Situation Room (from their Epidemiology Division), and a specialist to work at the border area. Three Argentinian field epidemiologists have also been assigned to the country.

- A mission from Uruguay composed of communicators from their Ministry of Public Health and from PAHO-Uruguay is providing support for implementing the Mass Communication Plan for the dengue epidemic.

- Another mission from Peru consisted of a solid-waste expert who can analyze the situation vis-?-vis breeding sites.

Proposal for Immediate PAHO Technical Cooperation

- Visit by Dr. Roddy Camino, PAHO-Ecuador, to conduct an analysis of the current situation together with the MSPBS from 1 to 8 March 2007.

- Visit by Dr. Jos? Luis San Mart?n, Regional Advisor from the PAHO Regional Program on Dengue based in Panama, from 6 to 10 March 2007.

- Visits by patient-care expert Dr. Ernesto Pleites from Benjam?n Bloom Hospital in El Salvador for the period of one month, requested via ministerial letter; Dr. Pleites arrived on Monday, 5 March 2007.

- Deploying another expert in the clinical aspects of dengue, Dr. Eric Mart?nez from the Ministry of Public Health of Cuba, for a one-week period beginning 7 March 2007.

- Sending samples for diagnostic confirmation, sequencing, and viral genotyping to the National Reference Laboratories in Pergamino, Argentina (National Institute for Human Viral Diseases / Instituto Nacional de Enfermedades Virales Humanas / INEVH), or in Curitiba, Brazil (FIOCRUZ); in addition, technical staff members from Paraguay will receive hands-on training at these centers.

- Currently under negotiation with resources from the Inter-American Development Bank (IDB) is a a second stage of the above, sending a technician from INEVH in Pergamino with the goal of building capacity in Paraguay, including biosafety and training, once they are in the physical and technical condition to do so.

- Conducting a technical consultation on Organization of Health Service Networks for a two-month period beginning 12 March 2007, focusing on the most affected areas.

- Assessment with the Ministry of Health on the possibility of receiving support in entomology for vector control and epidemiology; other equipment and pesticide needs have not been reported yet and the country's current reserves need to be assessed.

- PAHO and the Ministry of Health collaboratively assessing vector control and epidemiology, equipment needs, and country reserves.

Source: Information obtained by the PAHO Regional Program on Dengue through the PAHO Country Office in Paraguay (PAHO-Paraguay), based on data from the central database Centro de C?mputos DiVET run by the Ministry of Public Health and Social Welfare (Ministerio de Salud P?blica y Bienestar Social / MSPBS) of Paraguay and MERCOSUR.

http://www.reliefweb.int/rw/RWB.NSF/db900SID/YZHG-6ZBSCD?OpenDocument

[Niko]

Re: Paraguay declares state of emergency of dengue

Why the disparity in the numbers being reported - 400,000 versus 19,577 cases (both per Mar 15th articles)? If the 19,577 were reported as confirmed and the 400,000 as suspected it would be more understandable. However, the 19,577 is reported as "suspected" cases.

[Gert van der Hoek]

Re: Paraguay declares state of emergency of dengue

Dengue epidemic hits Paraguay

Critics say government too slow to act

By Pablo Amarilla and Patrick J. McDonnell
Los Angeles Times
Posted March 22 2007


ASUNCION, Paraguay ? An outbreak of dengue fever linked to a hot, wet South American summer has prompted charges here of a botched government response and spurred fears the disease is spreading to neighboring countries.

More than 18,000 people in Paraguay have contracted the mosquito-borne ailment, with at least a dozen fatalities, according to government statistics in this landlocked nation of 6.5 million.

An elevated incidence of dengue also has been reported across Paraguay's borders in Brazil and Bolivia.

An Argentine health official who visited Asuncion blamed the problem in part on global warming and the resulting "tropicalization" of the continent. Authorities in neighboring nations have stepped up fumigation of vehicles and cargo along the Paraguayan frontier.

The official number of dengue cases in Paraguay is widely viewed here as underestimating the extent of the outbreak. Most victims in the country are poor and never diagnosed, doctors say. Some medical experts have said the number of cases could be as much as 10 times the official figure, or close to 200,000.

"The government wanted to cover up the problem without admitting the error it committed," said Desiree Masi, who heads a physicians group critical of the official response.

President Nicanor Duarte, widely accused of reacting late and inadequately, has stepped up fumigation and other measures in recent weeks, and he has affirmed his determination to battle the disease. The president this month declared a 60-day state of emergency.

Health Minister Oscar Martinez Doldan has resisted calls to resign and recently insisted the outbreak was "controlled" amid an expanded effort to exterminate mosquitoes and get rid of their breeding pools. Critics say the measures come too late and long after the first cases were reported.

The revelation that expired chemicals had been used in fumigation efforts aimed at reducing dengue and malaria resulted in the sacking of Humberto Recalde, the Health Ministry official previously charged with overseeing the strategy.

The government's response to the crisis has dismayed many Paraguayans.

"This was an avoidable problem that spread, thanks to a lack of planning, which is something that characterizes this government," said Maria Jose Garcia, 23, expressing the frustrations of many interviewed here.

This largely tropical nation has experienced other dengue scares, but the death toll this time is higher than during an outbreak in 2001 and 2002. Experts have attributed the deaths in part to the appearance of more severe forms of the disease, including so-called hemorrhagic dengue, which can lead to bleeding and circulatory collapse.

Dengue fever, caused by one of four closely related viruses transmitted by infected mosquitoes, is a flu-like illness that is seldom fatal. Symptoms include fever, chills, headaches, muscle and joint pain, nausea and general malaise. There is no vaccine for dengue, which is endemic to much of the world's tropical regions. It cannot be spread from person to person.

Experts and donated equipment have arrived here from abroad in recent weeks to help tackle the outbreak. Physicians agree that dengue's spread here and elsewhere is related to unusually warm and damp weather, which has caused widespread flooding and favored the breeding of the Aedes aegypti mosquito, which spreads the disease.

"The problem of dengue is by no means solely an issue in Paraguay," Andres Leibovich, Argentina's under secretary for health, said during a visit to Asuncion aimed at providing technical assistance.

The Argentine official linked the problem to South America's "tropicalization" as temperatures rise, though the role of global warming remains theoretical. Even in Buenos Aires, the temperate Argentine capital, a mosquito infestation after recent downpours led to dengue alerts.

Dengue prevention efforts focus on fumigation and removing stagnant pools of water.

"The most important tool in the fight against dengue is the elimination of breeding grounds," said Walberto Pinanez, a Health Ministry official in Asuncion coordinating anti-dengue efforts.

Neighboring Brazil is also suffering a dengue outbreak, with some 85,000 cases reported as of this month, authorities say.

http://www.sun-sentinel.com/news/local/caribbean/sfl-hparadenguemar22,0,3399070.story?coll=sfla-news-caribbean

[Gert van der Hoek]

Re: Paraguay declares state of emergency of dengue

Update via ProMed Mail

1] Paraguay

Date: 23 Mar 2007
From: ProMED-mail <promed@promedmail.org>
Source: Infobae.com, Argentina [trans. Mod.TY, edited]

http://www.infobae.com/contenidos/307734-100799-0-Son-17-los-muertos-el-dengue-Paraguay

The country most affected [Paraguay] by this disease continues to
register additional fatal victims. Currently, there are 400 000
infected individuals, and the authorities are not promising that the
situation will improve.

Although the Governor of the central department [state or province
equivalent - Mod.TY] of Paraguay, Federico Franco, informed us that
there are 400 000 infected individuals, the Minister of Health
indicated that there are only 22 000 dengue cases registered officially.

The Europa Press Agency announced today [23 Mar 2007] that 17 persons
have died of DHF. The Paraguayan Minister of Health, Oscar Martinez,
affirmed that the authorities are not "lowering their guard" in their
fight against the epidemic.

"The technical brigades go out in the neighborhoods daily in Asuncion and other cities of the interior to fumigate with insecticides," said the official. "But the population must continue to clean up their houses and the surrounding areas. Water in containers are the principal breeding sites of the mosquito _Aedes aegypti_, the transmitter of the disease [virus]," he added.

--
ProMED-mail
<promed@promedmail.org>

[Apparently the epidemic continues out of control. Fogging with
adulticides will provide only short-term interruption of transmission
if the mosquito vectors continue to breed actively. It is not clear
what measures have been taken to educate the public that they are the
key actors in eliminating these breeding sites, upon which control
will eventually depend.

http://www.promedmail.org/pls/askus/f?p=2400:1001:78987::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,36927

[Gert van der Hoek]

Re: Paraguay declares state of emergency of dengue

HEALTH-PARAGUAY:

Hello Rome, Goodbye Dengue!

David Vargas

ASUNCI?N, Apr 20 (IPS) - The corridors in Paraguay's Hospital de Cl?nicas are crammed with dozens of patients with symptoms of dengue waiting for treatment, but in the nurses' station they are having a party. Mirian L?pez, a registered nurse with several years' experience in intensive care, has just found out that she has a job waiting for her in Italy.

L?pez will soon join the ranks of the nearly 400 Paraguayan nurses who have emigrated to Italy since 2000 to work in public and private hospitals.

They represent over 10 percent of the nursing work force in this South American country of six million, where the Public Health Ministry budget covers a total of only 3,500 posts for nurses, auxiliary nurses and technicians.

Of these, only 1,567 posts are for registered nurses. And according to law, health personnel may work in up to two posts in different services, so the actual number of professional nurses is even lower, ministry sources said.

What for L?pez is wonderful news is a source of increasing concern for health authorities, especially since the country is experiencing a fresh outbreak of dengue fever.

Emigration of trained healthcare personnel to Europe and the United States has exacerbated the already serious shortage of qualified staff in public hospitals.

According to official statistics, there are 1.2 nurses per 10,000 people in Paraguay, a much lower proportion than in other countries in the region, such as Argentina and Uruguay, which have 12 nurses per 10,000, slightly above the minimum ratio of 10 per 10,000 people recommended by the World Health Organisation (WHO).

The brain drain is affecting clinical medicine and intensive care services most of all, the president of the Paraguayan Nurses Association (APE), Mar?a Concepci?n Ch?vez, told IPS.

Nursing vacancies are filled at best by inexperienced auxiliary nurses or technicians with insufficient training. "The proper functioning of many services is under serious threat. Several of our intensive care units are closed because of staff shortages, and specialisation takes two to three years," she said.

Since the dengue epidemic was declared early this year, the Health Ministry has registered 25,856 cases of the classic form of the disease, and 52 of the much more deadly haemorrhagic dengue fever.

Fourteen people have died, and more than 3,535 patients have had to be hospitalised. Although the authorities insist that the situation is under control, there are 200 new cases a day.

Pan American Health Organisation (PAHO) Representative Carmen Serrano was one of the first to sound the alarm. She said the phenomenon of nurses' emigration was serious, though it was not unique to Paraguay. "There is a worldwide crisis, because nurses' value as human resources in healthcare isn't properly recognised in developing countries. In some countries, like Bolivia, the situation is much worse," she told IPS.

The WHO Assembly addressed the issue in 2006, and debated the need to make reparations to the poorest countries for the loss of their trained health staff to rich nations. Serrano said the ideal solution would be to restore "other service components and medical supplies to the countries that are losing health personnel."

According to the APE, a nurse's salary in Paraguay averages 300 dollars a month. Seventy percent of nurses in the public health service are contract workers, which means they have no medical insurance, pension contributions or job security, and their contracts have to be renewed every six months or every year.

In Italy L?pez has an initial contract for one year, which is renewable. Her salary will be 1,500 euros (2,000 dollars) a month and she will have medical insurance, 30 days paid vacation, and an end-of-year bonus.

"It's a unique opportunity," L?pez told IPS. As a requirement for the job, she took intensive Italian classes for a year. Applicants must also have their professional qualifications validated, and pass a stiff entrance examination set by the Italian nursing association.

Contacts with the Italian employers are provided by recruiting firms like Obiettivo Lavoro, an Italian consultancy which came to Paraguay two years ago and also has branches in Bolivia, Peru and Brazil.

The company researches employment opportunities in Italian hospitals, recruits and trains staff in Paraguay, and applies for the necessary visas and work permits.

"Paraguayan nurses have an excellent bedside manner and are popular with patients. Paraguayans are preferred among the South American nurses, and are highly sought after in hospitals and clinics for their professional skills," the company's representative in this country, Jorge Romero, told IPS.

The WHO reported that unfilled global demand for health workers amounted to more than four million. Industrialised countries have a greater shortage of nurses, mainly due to the ageing of their population, it said. Italy, for example, has an estimated shortfall of 50,000 nurses, Canada needs 60,000, and the United States 168,000.

This gap will grow as average life expectancy increases, the WHO warned.

The APE in Paraguay emphasises training as the solution. "We need more and better nursing staff, so that the profession as a whole does not become out of date," said Ch?vez. But it is a complex problem, especially in a country like this one, where the average number of professional nurses entering the labour market every year is under 200, according to official figures.

The four-year degree course in nursing at the National University of Asunci?n -- where education is free of cost -- costs the state approximately 14,000 dollars. Most of the nurses recruited to work abroad are graduates of this university, which in spite of its budgetary and infrastructure problems is the main professional training institution in this field.

Ch?vez said APE's main concern was that most of the nurses who emigrated were aged between 30 and 35. "In 10 to 15 years' time, these nurses will return to Paraguay, without job prospects, pensions, or social security, and this will create social instability," she said.

But such concerns are secondary for L?pez and 21 other aspirants who are on the Obiettivo Lavoro agency's waiting list to travel to a new life in Italy. "The salary I earn here isn't getting me anywhere, and although it's hard to leave my family and friends, the sacrifice is worth it," L?pez said.

The farewell party is soon over. The flood of dengue fever patients is not letting up, and the line grows as the morning goes on. On leaving, L?pez could not conceal her exhilaration: "Ciao Roma, arrivederci dengue!" (END/2007)

http://www.ipsnews.net/news.asp?idnews=37427

[Gert van der Hoek]

Re: Paraguay declares state of emergency of dengue

Summary of the Current Situation in Paraguay

The Paraguayan government has continued the epidemiological alert throughout the national territory, in light of recent cases of dengue and dengue hemorrhagic (DH).

Up to 9 April 2007 (Epidemiological Week/ EW No. 15), as a follow-up to the March 15 update, the Ministry of Health of Paraguay reports the following:

25,021 reported cases of dengue

52 cases of DH

13 deaths: 5 from atypical dengue, 6 from DH, and 2 from unconfirmed dengue

Case-fatality rate: 11.5&#37;

Affected departments: Capital, Cordillera, Amambay, Central, Concepci&#243;n, and Paraguar&#237;


Adverse Event: Dengue in Paraguay

Date of Occurrence: In October 2006, an increase of dengue cases appeared with the DEN-3 serotype.

Specific Area of Impact: Cases have been reported in 17 of the 18 departments in the country.


1. Brief Description of the Adverse Event

From 1 January to 9 April 2007, 25,021 cases have been reported nationally. To date, 52 cases of DH have been reported.

There have been 13 deaths: six from DH, five from atypical forms, and two from unknown causes.

The case-fatality rate for DH to date is 11.5%. Of all reported cases of DH, 55% have occurred among males.

The most affected age group are persons age 15 to 29 years (37% of the total), followed by those age 1 to 14 years (35%).

The behavior of this epidemic has varied throughout the country. The departments exceeding the average reporting rate for the country are, in order of frequency, Capital, Cordillera, Amambay, Central, and Concepci&#243;n, followed by Paraguar&#237;.Capital shows an incidence rate of 1,357.2 cases for every 100,000 inhabitants.

Reports indicate that the peak of the epidemic occurred between EWs 8 and 9; although Amambay and Concepci&#243;n Departments showed an increase in the incidence rate of reported cases during EWs 11 and 12. Toward EW 12, it became clear that rates were falling in all departments—with the exception of Amambay, Cordillera, and Paraguar&#237;, where they remained stable (see Map 1, attached ).

With regard to hospitalizations from dengue, 3,420 people were admitted to hospitals due to some warning sign for dengue. On 8 April, there were 25 hospital admissions. The curve since the month of February shows daily fluctuations with a declining trend (see Figure 1 below).



2. Main Activities Being Carried Out in the Health Sector

The Ministry of Public Health and Social Welfare of Paraguay (Ministerio de Salud P&#250;blica y Bienestar Social / MSPBS) continues to coordinate door-to-door vector control activities to eliminate breeding sites, in coordination with the National Emergency System (Sistema Nacional de Emergencia / SISNE).

Regarding impact assessment of the vector control activities, entomological samples have been taken using the LIRA method (for its Spanish name, Levantamiento de &#205;ndice R&#225;pido de Aedes aegypti or 'Rapid Assessment of Aedes aegypti Index') in the Municipalities of Villa Elisa, San Antonio, and &#209;emby, yielding average infestation indices of 3.8%, 7%, and 5.5%, respectively.

These indices are above the expected 1% rate. The larvae collected were mainly third and fourth stage, which indicates that these breeding sites have been in place for at least seven days and thus were not eliminated in the vector control activities.

Regarding epidemiological surveillance reports received in the last three weeks, the number of suspected cases has increased in the Asunci&#243;n neighborhoods of Sajonia, Le Petit, Tacumb&#250;, and Barrio Obrero, all of which are in the process of undergoing door-to-door spraying with portable equipment operated by staff from the National Service for Malaria Elimination (Servicio Nacional de Eliminaci&#243;n del Paludismo / SENEPA).

The seventh spraying cycle using heavy-duty machinery is near completion in Asunci&#243;n and Central Departments. Due to an insufficient number of heavy-machinery teams and heavy rains over the last week, it has not been possible to reduce the cycle to less than seven days.

The Situation Room is still hard at work, run by professionals from the General Directorate of Health Epidemiology (Direcci&#243;n General de Vigilancia de la Salud / DGVS).

3. Main Activities Being Carried Out by PAHO

Involvement in SISNE meetings and providing technical support to their discussions.

Involvement in the disbursement of financial resources from projects funded by the Spanish Agency of International Cooperation (Agencia Espa&#241;ola de Cooperaci&#243;n Internacional / AECI) and by the Office of Foreign Disaster Assistance (OFDA) of the United States Agency for International Development (USAID). Developing processes for purchasing drugs, medical supplies, trituration equipment, as well as for developing consultations and training activities.

Active and broad involvement in discussions on field interventions and decision-making processes.

Reviewing and adjusting the Plan of Response of the PAHO/WHO Representation in Paraguay (PWR-PAR) to the Epidemic of Dengue and Dengue Hemorrhagic, Paraguay, 2007.

4. Main Activities Being Carried Out by Other Sectors

SISNE-operated vector control activities have been completed in Asunci&#243;n and Central Departments, pending a few remaining properties and closed-up dwellings that still need to be checked; this activity will continue until the end of April. Partial data on these activities show the following general results:

Of a total of 173,000 properties in Asunci&#243;n Department, 99,863 have been assigned to the National Directorate of Statistics, Surveys, and Censi (Direcci&#243;n General de Estad&#237;sticas, Encuestas y Censos / DGEEC). Of these, 58,291 were buildings free of breeding sites, 7,618 buildings had breeding sites eliminated, 4,362 had been treated but did not eliminate breeding sites, and 6,215 have not yet been addressed. A total of 13,678 dwellings are uninhabited. To the date of collection of this information (30 March 2007), 25,229 febrile patients have been identified in the dwellings covered.

For Central Department, 51,874 properties have been dealt with. A total of 27,318 had no breeding sites, 2,530 had eliminated breeding sites, 1,831 had treated their breeding sites, and 6,650 have breeding sites yet to be addressed. A total of 7,041 are uninhabited dwellings.

During the last two weeks of April and the beginning of May, one final activity will be carried out in Asunci&#243;n within the framework of the Plan, namely revisiting those blocks at greatest epidemiological risk.

The Technical Advisory Group is now in the process of compiling selection criteria for this. In Central Department, activities related to closed or uninhabited dwellings and to unwilling households will remain in the hands of the Government, with logistic support from SISNE.

5. Needs Identified

Forming fumigation teams in newly affected departments.

Strengthening training activities for medical staff and nurses in other affected departments.

Carrying out health promotion activities.

http://www.paho.org/english/AD/DPC/CD/eid-eer-2007-04-16.htm

[Gert van der Hoek]

Re: Paraguay declares state of emergency of dengue

Source: International Federation of Red Cross And Red Crescent Societies (IFRC)

Date: 26 Apr 2007



Paraguay: Dengue outbreak DREF Bulletin No. MDRPY001 Update No.3

The Federation?s mission is to improve the lives of vulnerable people by mobilizing the power of humanity. It is the world?s largest humanitarian organization and its millions of volunteers are active in 185 countries.

In Brief

Period covered by this update: 24 March ? 26 April 2007

History of this Disaster Relief Emergency Fund (DREF)-funded operation:

- CHF 68,000 (USD 54,530 or EUR 42,060) was allocated from the Federation?s Disaster Relief Emergency Fund (DREF) to respond to the needs in this operation. Unearmarked funds to repay DREF are encouraged.

- This operation is expected to be implemented over a 3 month period, and will be completed by 29 April 2007; a Final Report will be made available three months after the end of the operation (by 29 July 2007).

This operation is aligned with the International Federation's Global Agenda, which sets out four broad goals to meet the Federation's mission to "improve the lives of vulnerable people by mobilizing the power of humanity".

Global Agenda Goals:

- Reduce the numbers of deaths, injuries and impact from disasters.

- Reduce the number of deaths, illnesses and impact from diseases and public health emergencies.

- Increase local community, civil society and Red Cross Red Crescent capacity to address the most urgent situations of vulnerability.

- Reduce intolerance, discrimination and social exclusion and promote respect for diversity and human dignity.

Background and current situation

As of 14 April 2007, the Ministry of Public Health and Social Welfare (MoH) recorded a total of 25,955 confirmed cases of classic dengue fever since the start of the year and throughout the current dengue fever outbreak. There are 52 cases of the hemorrhagic strain of the virus confirmed by laboratory to date, and an additional 43 suspected cases.(1) Thirteen deaths have been officially claimed by the virus, with six deaths attributed to hemorrhagic dengue/shock, five to classic dengue/visceral, and two with serotype unknown.

There are still doubts regarding the official number of cases of dengue fever in the country. Health workers continue to argue that official figures fall between 80-100 percent short of actual cases registered by the MoH and that the actual number of suspected cases may therefore be in the realm of at least 100,000. The results of a survey undertaken by authorities in the Central Department indicate that the 19.9 percent of the department?s population have been infected by the virus since the start of the year.(2) The MoH maintains that real figures are lower than this, and furthermore that more precise figures will only be recorded at the end of the outbreak with assistance provided by the Pan-American Health Organization (PAHO).

At the beginning of April, the Government recorded an overall decline in the number of consultations and new cases of dengue in the country, although there are significant variations across the country. According to the MoHs recent estimates, the number of dengue consultations has reduced by 70-80 percent in the capital, Asunci?n and in the Central Department, and is replaced by a rapid increase in the number of consultations due to high rates of Acute Respiratory Infections (ARIs) after heavy rains and abrupt fluctuations in temperature. However, whilst the Commission for the Closure of Cases reports that there has been a slow decline in the number of potential dengue cases in the cities of San Lorenzo, Luque and Fernando de la Mora, in other areas the rates of infection are still worryingly high, for example in Lambar?, where 50 new cases are still being reported per day.

Since the Government declared a state of national emergency due to the dengue outbreak, national and local authorities have carried out several actions: The Secretariat of National Emergencies (SEN), who is coordinating the national campaign and joint activities conducted by the Ministry of Environment and the MoH, mobilised teams of health promoters working on dengue prevention at community level, and teams of personnel conducting fumigations with insecticide. The MoH accepted the Central Department?s plan to jointly fumigate neighbourhoods to eliminate the mosquito vector starting in Villa Elisa, ?emby and It?, where it is hoped that more precise data (on morbidity and mortality rates, decline rates of the virus and of the adult mosquitoes following fumigation activities) will be recorded during the implementation of this departmental plan.

To illustrate the proportions that the issue is taking nation-wide, the authorities in the capital city of Asunci?n have identified and are set to prosecute 19 property-owners (under Law 716, which sanctions procedures against those who commit offences to the environment) who failed to comply with regulations to clean empty or abandoned plots that have been identified as prime locations where mosquito larvae are produced. These measures have been taken within the framework of the dengue prevention campaign and in the fight against the disease.

Notes:

(1) Ministry of Public Health & Social Welfare (MoH), Bolet?n Epidemiol?gico Semanal, (Epidemiological Week 15, 08-14/04/2007).

(2) Survey undertaken by the Health Council of the Central Department and executed by the Office of the Study of Public Opinion, in which among the 599 people interviewed, 19.9 percent had been infected by the dengue virus since January 2007. Central Department Survey, March 2007.

http://www.reliefweb.int/rw/RWB.NSF/db900SID/RMOI-72MUYR?OpenDocument