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Trinidad: Dengue outbreak

Re: Trinidad: Dengue outbreak

Source: http://www.newsday.co.tt/news/0,92520.html

Year of dengue outbreaks
By LARA PICKFORD-GORDON Monday, December 29 2008

THE YEAR started with Health Minister Jerry Narace signalling his intention to make improvements in the sector. The Minister announced that the Regional Health Authorities and his Ministry would embark on 100-day plans which would tackle areas for priority action.

However, throughout the year members of the public and health workers had cause to show their anger with the failings of the service and system. This month there were vociferous calls from the Opposition benches for the Minister?s resignation.

There was some progress in health this year, but disease and death again stole the spotlight. People will remember 2008 as the year of the ?dengue outbreak?.

Dengue

From early January reports of persons contracting dengue fever began surfacing and continued consistently throughout the following months. To date the number of people who have contracted dengue is not known but there were many. Westmoorings, St Augustine, St Joseph, Caroni, Sangre Grande, Tabaquite and Freeport were among the areas hardest hit.

In January, 12 Chinese construction workers employed at the site of the multi-million dollar National Centre for the Performing Arts on Keate Street, Port-of-Spain, contracted dengue and there were fears that the disease would pose a threat for the Carnival season.

The workers were housed at Keate Street compound occupied by SCG International TT Ltd, contractor for the project. Six of them were hospitalised at St Clair Medical for treatment and the Keate Street area was subsequently sprayed a few times. The Port-of-Spain Corporation Public Health Department visited the site and made recommendations for cleaning.

On January 27, Mayor of Chaguanas Suruj Rambachan criticised the Health Ministry for failing to provide personnel to spray homes in the Borough to prevent dengue. He said there were ten confirmed cases and his office had to spend $13,000 to purchase chemicals to spray affected areas.

Reports of dengue deaths also made news throughout the year, with several cases receiving media attention. The death of eight-year-old Sasha Bickram on August 9 sparked outrage and Narace was severely criticised for saying her death was not due to dengue.

His view was reinforced at a media briefing chaired by Chief Medical Officer Dr Anton Cumberbatch who said ?a confirmed established cause of death can only be certified by a post mortem performed by a qualified pathologist and in this case blood investigation and report from that investigation must also be supporting the pathologist report with respect to dengue?. An autopsy was not done on Bickram.

There was more anger heaped on the Ministry when 11-month-old Josh Moonilal died at SFGH after being warded for dengue haemorrhagic fever.

At a post-cabinet media briefing on August 14, Narace said there was no dengue outbreak in the country. He said up to the middle of this year there were 120 cases and this figure was well below the mid-year national average 228 for the past three years. Narace also said there were no deaths this year from dengue and from 2003 to the present there were no confirmed deaths due to dengue haemorrhagic fever.

The Medical Professionals Association of TT subsequently responded to the Ministry?s data by stating that two deaths occurred in March and July this year.

In August the Ministry hosted an Inter-sectoral forum on dengue at Crowne Plaza in which Narace said two deaths did occur this year but provided no details. At the forum Narace said the Ministry was expecting an increase in dengue cases and had provided a $6 million allocation for goods and services to deal with dengue.

The CMO said there were 1,000 suspected dengue cases in the country and the last major outbreak was in 2002 when TT had 6,308 cases. Cumberbatch said the Ministry?s objective in 2008 was to prevent an increasing number of reported cases. However, the perceived dengue situation caused the UK Foreign and Commonwealth office to warn British citizens about ?increased activity? with dengue.

A team of experts from the Pan American Health Organisation (PAHO) came to TT in October to provide advice on dealing with dengue. The visit was at the request of Narace and the findings of their report are yet to be made known.

The death of 22-year-old UWI student Camille Ramcharan of Frederick Settlement, Caroni on December 9 prompted a series of protests against the Health Ministry and its Insect Vector Control Division (IVCD). Residents led by Ramcharan?s father Freddy have demanded action to deal with the conditions in the area (overgrown bush, dirty drains) which they believed were contributing to the mosquito infestation problem which caused approximately 50 residents to get dengue fever. The IVCD held a media briefing on December 22 to provide an update on the work done in Frederick Settlement outlining a series of spraying activities. But this has not placated the residents.

The Ministry has said a full update on the dengue situation will be given in January 2009 by the Chief Medical Officer. ...
 
Re: Trinidad: Dengue outbreak

Source: http://www.trinidadexpress.com/index.pl/article_news?id=161421588

Grande woman loses dengue battle
Aabida Allaham allaham@trinidadexpress.com

Wednesday, January 7th 2009

A 76-year-old woman became the first dengue victim for the year.

Camille Greenaway, of Coronation Road, Sangre Grande, died on Sunday after battling with dengue haemorrhagic fever at the Sangre Grande Hospital for several days.

One of her daughters, Patricia George, said while the hospital staff on ward five did everything they could to save her mother, they claimed that the staff in the emergency department "acted as if they could care less".


"For three consecutive days we took her to casualty (department), but the doctors there ignored her and refused to admit her, even though she was in pain," she said.

Already unable to walk, Greenaway's family pleaded with several different doctors on the third day to admit their mother, whose health was already failing.

"They finally admitted her, but she did not last long after that," George added.

However, it was not the fact that she died of the fever that bothered her 11 children; it is simply because they have been unable to get the Insect Vector Control Division (IVCD) to spray the area in which Greenaway lived.

"Since she died on Sunday we have been calling on the Ministry of Health's Dammarie Hill office, in Sangre Grande to come and spray the area, but they said they need to investigate. Meanwhile, it have a whole set of mosquitoes making more people sick," George alleged.

Officials at the Sangre Grande Regional Corporation said they working on the mosquito problem. Meanwhile, an official from the IVCD has promised this newspaper that they will spray the area today in light of the circumstances.
 
Re: Trinidad: Dengue outbreak

Source: http://www.i955fm.com/News.aspx?id=5700

No Dengue Outbreak Says Health Report.

January 20th 2009.
8:05am

Only six dengue deaths last year say the Ministry of Health.

The Ministry yesterday issued a report saying that only six persons died from the disease.

This conflicts with some reports which have put the number of deaths as high as fifteen.

According to the report on dengue in Trinidad and Tobago there were 3,832 reported cases last year.

However, the Ministry says only 100 were confirmed by the public health lab with six deaths in total.

According to the report the majority of cases occurred in the under 18 age group.

The report did not classify the situation as an outbreak but noted that the rate of infection was similar to other paho member countries.


According to the Ministry barrels were responsible for 70 percent of the breeding areas found for the aedes egypti mosquito which carries the disease.

It says water tanks, buckets, tubs and basins, tyres, guttering and bottles account for the other breeding grounds.
 
Re: Trinidad: Dengue outbreak

Source: http://www.newsday.co.tt/news/0,93771.html

Puzzling dengue statistics

By LARA PICKFORD-GORDON Thursday, January 22 2009

Although the Health Ministry?s 2008 end of year dengue report stated that there were 100 cases of dengue confirmed by the Trinidad Public Health Laboratory (PHL), the Pan American Health Organisation data on dengue for 2008 lists 206 ?lab confirmed? cases up to week 37?September.

The data at the site was updated October 26, 2008.

According to the ?Number of Reported Cases of Dengue and Dengue Haemorrhagic Fever in the Americas by Country: Figures for 2008 (to week noted by each country)? on PAHO?s website TT had 2,366 clinical cases of dengue, eight cases of Dengue Haemorrhagic Fever and Dengue Shock Syndrome and three deaths. The incidence rate on the PAHO site was the same figure provided by the Ministry of 182/100,000 population. Dengue Type II and III were circulating last year.

The figures for the English speaking Caribbean were provided to PAHO by the Caribbean Epidemiology Centre (CAREC).

Health Minister Jerry Narace was asked to comment on the discrepancy yesterday after the formal opening of the La Romaine Health Centre.

He said whatever information was given in the report was compiled by the Chief Medical Officer Dr Anton Cumberbatch. Narace directed Newsday to Cumberbatch for comment.

However, on Wednesday Newsday sent an e-mail to the Health Ministry via its communications department with questions on the issue but comment was not immediately available and there was no response yesterday.

The Ministry?s statistics have raised questions from some quarters and one medical practitioner questioned how the Ministry could rely only on confirmatory testing from the PHL.

?Only 100 samples reached the PHL??

The doctor said the Ministry provided test kits for dengue and hospital laboratories verified the tests.

He said a positive IGM indicated antibodies against dengue and was used for diagnosis and treatment while the positive IGG test indicated exposure to dengue in the past.

?For the positive cases we only count the positive IGM, regardless of the IGG.?

The doctor said the PHL took between six and eight weeks to send back the results from tests.

Another doctor who saw the report described it as ?superficial? and lacking analysis.

He referred to the Health Minister Jerry Narace?s statement last year that there were no deaths and this view was later revised.


The doctor noted that the Ministry?s comparison of six-year cycle periods provided a percentage for confirmed reports but not a percentage for the deaths.

He said if the Ministry had provided percentage of deaths it would indicate that for 1997-2002 of the reported deaths ?95 or 23 percent (22) were confirmed while for 2003-2008 of the 11 reported deaths, 54 percent (6) were confirmed.

The report stated that for 1997-2002 there were 17,233 reported dengue fever cases and 1,308 or 7.59 percent confirmed.

Between 2003-2008 there were 8,534 reported dengue fever cases and 333 or 3.90 percent were confirmed.
 
Re: Trinidad: Dengue outbreak

Source: http://www.trinidadexpress.com/index.pl/article_news?id=161428585

Gopeesingh: Ministry's dengue figures bogus
Louis B Homer South Bureau

Thursday, January 22nd 2009



Recent figures supplied by the Ministry of Health on dengue fever and dengue haemorrhagic fever (DHF) are bogus and misleading, Caroni East Member of Parliament Dr Tim Gopeesingh has alleged.

Gopeesingh yesterday called on the Ministry to "investigate the figures produced by the Chief Medical Officer, because... a report submitted by the Pan American Health Organisation shows 100 per cent increase in confirmed dengue fever cases up to October 2008".

Gopeesingh said "the report submitted by the Ministry was clearly an attempt to cover up the real position".

When Health Minister, Jerry Narace was approached yesterday at the opening of the La Romaine Health Centre for an explanation on the difference in the figures, he said, "Check with the Chief Medical Officer. He is the one who provided the figures."

Efforts to reach Dr Cumberbatch, the Chief Medical Officer, were, however, fruitless. The Express was told that he was engaged in meetings.

Two weeks ago, the Express asked the Minister to provide up-to-date statistics on the dengue outbreak, and last week the Ministry submitted statistics for 2008.

PAHO's figures were updated to October 26, 2008. Gopeesingh said the figures submitted by the Ministry do not include the hundreds who received treatment in the ten nursing homes around the country.

Gopeesingh said "dengue related illnesses are not reportable to the Ministry, so that the figures supplied by the Ministry would obviously be less than the number of cases recorded at the health institutions".

The Ministry reported that the number of reported cases for 2008 was 3832, while the PAHO report stated for 37 weeks the number reported was 2366. There was a high incidence of dengue from October to December which is not recorded by PAHO.

PAHO reported 206 confirmed cases up to October while the Ministry stated that the figure was 100 for 2008.

The Ministry reported six deaths, while PAHO up to the end of October reported three deaths. In November and December 2008, over ten deaths were reported through death certificates issued to patients who had died of DHF.
 
Re: Trinidad: Dengue outbreak

Source: http://www.trinidadexpress.com/index.pl/article_news?id=161429334

Call for dengue fever cases to be reported by law

Louis B Homer South Bureau
Saturday, January 24th 2009

Pressure is mounting from medical practitioners to make dengue and dengue-related illnesses a notifiable disease in view of the number of deaths that are reportedly occurring in various parts of the country.

At present there is no obligation on the part of medical practitioners to report those illnesses to the Ministry of Health.

Dr Neil Singh, Secretary of the Medical Board, said yesterday that it is time to include dengue and dengue-related illness as notifiable diseases.


Singh said under the Medical Board Act, "certain diseases like tuberculosis, leptospirosis, yellow fever, and malaria are included in the list of illnesses that medical practitioners are legally bound to report to the Ministry, but this is not so in the case of dengue".

He said "with the increase in dengue and other related illnesses that cannot be contracted from person to person the population needs to know the extent of these illnesses."

Singh said "there is a need to amend the act in light of new diseases that hitherto was not in the schedule."

Singh's comments came in the wake of conflicting data regarding dengue illnesses.

The Ministry of Health figures and those given by the Pan American Health Organisation differ.

Dr Tim Gopeesingh, MP for Caroni East, said recently, "The Ministry of Health and its surveillance section reports illnesses that occur at public institutions, while many people die at private institutions and those are not reported to the Ministry, and therein lies the difference in the figures."

He said the public is not interested in the semantics or systems. "What they want is the truth", said Gopeesingh.

Singh agreed that the reporting system by hospitals is poor. He said "the reporting system is poor, and the surveillance system needs to be revamped or improved."


Singh said the Private Hospital Board has a legal responsibility to meet regularly to ensure that all aspects of the Act are adhered to.

He said he has been a member of the board for the last four years "and we have met only once".

He explained that according to the law "post mortems have to be carried out on patients who died within 24-hours after entering a hospital".

In the case of private health institutions doctors can issue a death certificate "without a post mortem so long as they are satisfied with the cause of death."

At present the Ministry of Health does not have a system in place to track down all deaths occurring in private institutions. The only time the information becomes available to them is when the Registrar of Births and Deaths submit their annual reports."
 
Re: Trinidad: Dengue outbreak

Source: http://www.trinidadexpress.com/index.pl/article_news?id=161530372


Teen died from dengue
South Bureau

Saturday, September 12th 2009



The teenager who was found dead in his bed after being treated for gastroenteritis died from dengue haemorrhagic fever, an autopsy revealed yesterday.

Moonilal Toolsie Singh, 15, was found dead by his parents when they went to check on him on Thursday morning.

Relatives said the Penal Secondary School pupil was examined by a private doctor and sent home for bed rest. They said Singh went to bed with a fever and could not understand how it could have led to his death.

A post-mortem was performed on his body yesterday.

Singh lived at SS Erin Road, Penal.

The number of suspected dengue fever cases so far for 2009, according to the Ministry of Health, was 880. The statistics do not give the number of people who were confirmed as having the disease or how many people died from the illness.

The Express has reported on the deaths of two people this year whose death certificates gave the cause of death as dengue haemorrhagic fever -Barrackpore taxi-driver, Persad Backarally, who died in March, and 12-year-old Sydney Boodhan of Princes Town in June. -CK
 
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