On Tuesday the Ministry of Health hosted a press in Belize City to update on its efforts to fight three major diseases, one already making an impact and two others being monitored as a potential threat.
We start with Dengue, the fever spread by the Aedes Aegypti mosquito. It is endemic to Belize and the rainy season from June to November is at its height in terms of cases reported. But the 2014 season has raised some concerns, both in terms of the cluster location of the virus and its mutation to the deadly hemorrhagic fever.
According to Director of Health Services, Dr. Michael Pitts, of the over 700 cases reported, the majority are concentrated in vulnerable areas of Belize City’s Southside.
“In terms of what is happening in Belize District, most of the cases that we are seeing are in Belize City. For all public health purposes, we have divided Belize City into nine zones. We are seeing most of those cases in three zones, which are primarily on the Southside of Belize.
Over time we found that cases began increasing around June, and had reached a peak about two weeks ago. We continue to monitor aggressively the numbers. The number that we report are the numbers that we collect both from the public and the private sector.”
Dengue is best contained by the clean-up of areas where the Aedes mosquito breeds. The Ministry has put boots to the ground to spray and clean up vulnerable sections of Port Loyola, Collet, Lake Independence and Pickstock where the disease is catching.
“The last time we spoke, we said [in] the effort to deal with Dengue we had expected vehicles, etcetera. We indeed got those vehicles and those vehicles has been distributed around the country, we have also conducted training and we have conducted varying activities in different communities to try and control mosquito population.
As we said in June and in January, a lot of what we need to do in the country is based on community action, and the community action with respect to reducing sources for mosquito breeding, as we go around the different communities we see a lot of areas where we need to have extra effort, in particular the cases in Belize City are coming from areas where we continue to see a lot of risky activities and a lot of clutter and receptacles that allow for the breeding of the offending mosquitoes.
We have interacted, of course, with some community groups, and certainly with the City Council in Belize City. In fact, over last weekend we had a major clean-up activity in Belize City on the Southside, to try and mitigate some of the issues.”
According to Chief of Operations for the Vector Control Unit Kim Bautista, while the total number of dengue cases is actually down compared to last year, there is a worrying increase in the more virulent form of Dengue, known as dengue hemorrhagic fever. Although fatal, there have been no deaths reported, but not for lack of opportunity.
“If you compare over the past couple years or if you compare it to last year for example, the accumulative number of cases is 5% less.
The alarming figure is in terms of Hemorrhagic Dengue Fever, which we tend to see outbreaks every 2 to 3 years. The last recorded outbreak of Dengue was in 2010; late 2009 through to 2010. Back then you had 293 Dengue Hemorrhagic cases in 2010.
This year so far we’ve seen 109, so that was from 2010 to this point. So if you compare to last year for example, we only had 16. So you are looking at 85% increase over the past year.
So that is the alarming figure in terms of the number of Hemorrhagic cases and that is attributed to the various stereotypes circulating in the Americas during that 2 to 3 year period. So it’s almost a cycle that you could time it; the next 2 to 3 years we expect to see an increase in specifically Hemorrhagic cases.”
Meanwhile, a cousin of Dengue, known as Chikungunya, has marched across the Caribbean and south-eastern United States as well as Central America and Venezuela infecting thousands. Belize sits between several infected countries – Mexico to the north, Guatemala and El Salvador to the west and south and Jamaica to the east. But so far it has managed to remain uninfected. Director of Health Services
Dr. Michael Pitts provides an update.
Doctor Michael Pitts
While we don’t know of any case of Chikungunya in Belize, I must tell you that since we spoke the last time, Chikungunya has move through the whole Caribbean chain. It certainly has entered into Miami, Florida, area.
We have seen Chikungunya now in Salvador, in Guatemala, in fact over this last week at least 5 provinces of Guatemala have reported Chikungunya. Salvador has also reported. We haven’t seen any reports out of Honduras. For Belize, we have no known cases, but we are actively looking for cases.
We recall now that Chikungunya mimics Dengue, but the cardinal difference with Chikungunya is the fact that people show up with a lot of pains in the small joints of the limb, the hands and the feet, and at times the back, but allows people to [be] either in a cramped position, or crouched over position, in the classic bending position as the name implies.”
Chikungunya shares common symptoms with Dengue fever, a high fever, severe joint and muscle pain, headache, nausea, fatigue and rash. But there is a way to distinguish the two. Chik-V pains tend to affect smaller joints and last longer and the rash looks and spreads differently. The typical case of Chik-V lasts much longer, up to 6 months, and treatments are limited because it is a viral disease. Antibiotics do not work, there is no vaccination against it, and affected persons are advised to take non-aspirin painkillers and anti-inflammatory medicines to lessen pain.
One of the best ways to stop diseases spread by mosquitoes, like Chik-V and Dengue, is to ensure that breeding sites for mosquitoes are destroyed.
Finally, two separate outbreaks of the Ebola virus in Central and West Africa beginning earlier this year have claimed over 3,000 lives. Those on this side of the world are alarmed because there is one case reported in the United States and others suspected.
Director of Health Services Dr. Michael Pitts introduced Belizeans to Ebola.
“Ebola is one of those diseases that has high fatality. When you compare it to Chikungunya, Chikungunya has low fatality. So they are of importance for two different reasons.
Ebola is a disease that is transmitted by body fluids. It’s not transmitted by casual contact, but essentially body fluids that include blood, semen, saliva, urine and feces are the principle modes.
The pattern that is emerging is that care givers and health care workers seem to be the people most at risk.
How did Ebola get into the population? It got into the population through exposure to dead animals that were host for this virus or people eating uncooked game in those countries, and the game includes; monkeys, shrews and some other rodents.
Once it gets into the general population, we need to have certain fundamental public health approaches. These include isolation, voluntary isolation, or state-supported quarantine., as the level of threat increases or changes over time.
In addition there are some common-sense approaches that we need to take.Our population needs to know the high-risk areas where Ebola is, and it is advisable that unessential travel isn’t done to those areas.”
Symptoms of Ebola include high fever, bleeding and central nervous system damage and fatalities sit at about 70% for the current outbreak, but can reach as high as 90%. There is no proven vaccine or cure, but symptoms can be treated including rehydrating patients who have diarrhoea and vomiting.
Most worryingly, there is a 2 to 21 day incubation period for the disease, prompting the Ministry to begin establishing links with brother departments including the Department of Immigration and Nationality to scrutinize who is traveling to and from Belize and West Africa.
Doctor Michael Pitts
“We have to be in a preparation mode. The approach to Ebola is one that involves several sectors, but clearly we need to have the [Belize] Airports Authority on board with us. We believe if Ebola is to come to us it’s more than likely to come through that route. We also have to pay attention to the border points, because that is our frontier.
So we could see that we need to have the Airports Authority, Immigration [Department] on board with us and, of course, the tourism industry etcetera Why I say tourism industry is because to a large extent they would be very familiar with the itinerary of visitors to our country, and if they can be aware of the risky countries and could inform public health about those travellers who come from risky countries, then we could take appropriate steps.”
At this point, Belize, like other countries, is scrambling to get resources in place, notably isolation units for potential Ebola victims as they cannot be placed near the general population and protective personal equipment that will adequately protect from Ebola. The Ministry has scheduled a series of meetings with other Government agencies in the next few days as the country’s Ebola plan comes together.