Combatting Dengue in the Americas: Strategies, Prevention, and Updates from PAHO

2024-03-31 00:09:00
Brazil is the country with the most cases (81%), followed by Paraguay (6%), Argentina (3.4%), Peru (2.6%) and Colombia (2.2%), which concentrate 92% of cases and 87% of deaths

Dengue is advancing in America. In accordance withthe information provided by the Pan American Health Organization (PAHO)the year 2023 marked a historical maximum in the incidence of dengue in the region of the Americas, accounting for more than 4.5 million people affected, among which 7,665 high-severity cases were identified and 2,363 deaths were recorded due to this disease.

However, preliminary data through March 25, 2024 indicate that, with more than 3 million cases reported in just the first few months of the year, the region is on track to set a new record for the number of dengue cases.

“This is a cause for concern, since it represents three times more cases than those reported for this same date in 2023,”highlighted the director of PAHO, Jarbas Barbosa, on Thursday, March 28, during a press conference in which Infobae participated.

There, Barbosa reported that the vast majority of cases have been reported in Brazil (81%), followed by Paraguay (6%), Argentina (3,4%), Peru (2.6%) y Colombia (2.2%), which account for 92% of the cases and 87% of the deaths.

Jarbas Barbosa, director of PAHO, participated in a press conference on dengue with Latin American journalists

“I would like to highlight that our first priority at PAHO is to avoid deaths. It is the control of dengue mortality and we have been working for several years to keep that average below 0.05%. And at this moment the fatality on the continent is lower than that figure. It is a great ongoing challenge to avoid serious cases and deaths. And really that is at the center of the strategy promoted, integrated and encouraged by PAHO,” said Barbosa.

Likewise, he highlighted that this achievement has been achieved thanks to PAHO’s constant support for nations, through the implementation of a comprehensive approach to combat dengue and other pathologies spread by mosquitoes.

This methodology encompasses the improvement of monitoring systems, early diagnosis and timely administration of treatments, aspects that have played a crucial role in preserving thousands of lives.

PAHO emphasized three points:

• A call to action by urging intensified efforts to eliminate mosquito breeding sites and protect yourself from bites
• Prepare health services for early diagnosis and timely clinical management
• Educate the population regarding the symptoms of dengue so that they seek medical attention immediately.

“Tackling dengue is the task of all sectors of society,” said Dr. Barbosa and asked “to involve communities to be successful in our efforts.”

Since 2010, the Pan American Health Organization has been providing assistance to countries to deploy a comprehensive strategy aimed at managing arboviruses such as dengue, contributing significantly to safeguarding countless lives.

A health worker sprays once morest the dengue-carrying mosquito at the Nova Betania School, in Brasilia (REUTERS/Ueslei Marcelino)

This action plan focuses on strengthening integrated surveillance of vector-borne diseases, covering Dengue, Zika and chikungunya. Special attention is paid to optimizing diagnosis and treatment, prioritizing the early identification of risk indicators and ensuring a rapid medical response to prevent serious and fatal outcomes.

PAHO specialists attributed the rise in dengue cases to the most intense transmission season in the southern hemisphere, a time in which the spread of the Aedes aegypti mosquito is intensified due to climatic conditions of heat and precipitation. The spread of the mosquito carrier, as well as cases to previously unaffected territories, raises concerns that certain countries may not be equipped to handle an increase in disease transmission.

“We see an increase in dengue in countries such as Barbados, Costa Rica, Guadeloupe, Guatemala, Martinique and Mexico, where transmission is usually highest in the second half of the year,” Barbosa said.

Vaccination once morest dengue is a tool to protect once morest the spread of the disease. (Illustrative image Infobae)

“Several environmental and social factors promote the spread of dengue, such as extreme weather events, the El Niño phenomenon, rapid population growth and unplanned urbanization play a crucial role. Precarious housing conditions and insufficient water and sanitation services create breeding grounds in discarded objects and in others used to accumulate water,” she said.

“Under conditions of adequate temperature and humidity, discarded objects that can store water in any quantity serve as breeding grounds for mosquitoes,” said Barbosa.

“The great tool to control the transmission of dengue continues to be the elimination of mosquito breeding sites, whether in homes or public places, such as parks, shops, squares, etc., in order to reduce the mosquito population. and thus also reduce the transmission of the disease. In addition to the preparation of health services to adequately diagnose and treat cases that can become serious cases such as dengue,” Barbosa noted.

A health worker checks a patient suspected of dengue today, at the Dengue Care Center of the Rodolpho Rocco Policlínica, in the Del Castilho neighborhood, in Rio de Janeiro (Brazil). EFE/ André Coelho

“Our focus at PAHO includes strengthening integrated surveillance of all arboviral diseases, including Dengue, Zika and chikungunya. “Improvement in diagnosis and treatment, with emphasis on early detection of warning signs and timely care of patients to avoid serious and fatal complications,” he said.

Asked by Infobae regarding the new scientific techniques to combat the disease, Barbosa specified that PAHO seeks to work on new vector control strategies such as tests on the sterilization of mosquitoes, the use of the wolbachia bacteria that infects the mosquito and prevents it from being able to be a carrier of the dengue virus.

“They are promising strategies, but it will still take a couple of years until they are feasible for immediate use. But we already have strategies that are being used and can be expanded, such as risk stratification to identify areas in a large city where the most accelerated proliferation of the mosquito generally begins and efforts to reduce transmission are concentrated there,” he said. the official.

People clean garbage from the drain as health authorities are on high alert due to a rise in cases of dengue, a mosquito-borne disease, in Nemby, Paraguay, January 23, 2024. REUTERS/Cesar Olmedo

And he added: “What is also very important is to draw attention to eliminating the vast majority, around 80% of mosquito breeding sites, which are in people’s homes or near homes. In other words, the combination of a government activity, but also with important community participation, must be considered. I believe that it is key and it is a key tool so that the possibility of dengue outbreaks can be greatly reduced.”

The specialist highlighted that the coexistence of the four dengue serotypes in the region increases the risk of epidemics and severe manifestations of the disease, due to the simultaneous circulation of two or more serotypes, a situation that occurs in 21 countries and territories in the Americas. . Barbosa pointed out that dengue manifests intense transmission in the first half of the year, decreasing significantly in the second, generating an erroneous perception that the disease has been eradicated.

“Therefore, it is crucial that countries implement continuous programs that allow early identification of the beginning of transmission and even before it begins, when the proliferation of mosquitoes is observed,” said Barbosa. Furthermore, he highlighted: “Countries now face a significant challenge, because during a dengue epidemic, the circulation of the virus is so widespread that almost all people come into contact with some serotype of the virus.”

The Aedes aegypti mosquito is known as the “home” or “pet” mosquito due to its home habits / Graphic by Marcelo Regalado

Regarding the vaccine, the official said: “It is important to highlight that the vaccine is not a tool to control transmission at that time, but long-term studies show that in just eight years of application they might have a significant impact on the transmission of dengue,” said Barbosa regarding the immunization that is being carried out in several countries with the new Takeda vaccine.

“The producer Takeda has very limited capacity today for vaccine production. Brazil is currently the country that mostly uses the vaccine. Argentina is also applying them. This is important to occur in countries that have a good epidemiological surveillance system, a good registration system for vaccine adverse events. Therefore, they must be prepared or in a position to carry out studies on how this immunization behaves. It must also be remembered that it is a new vaccine that was developed at a time when dengue was practically not circulating, so efficacy data is very limited. Now with real-life use, we will have data on the effectiveness of the vaccines. A lot of new data is being generated,” added Barbosa.

The World Health Organization warns that a previous infection with the dengue virus increases the chances of suffering from a severe form of the disease.

Technician Marianela García Alba, 39, observes an Aedes aegypti mosquito under a microscope at the CNEA (National Atomic Energy Commission), in Ezeiza, on the outskirts of Buenos Aires, Argentina, April 12, 2023. REUTERS/Agustin Marcarian

It is also noted that individuals particularly at risk of contracting severe dengue include children under one year of age, pregnant women, and people over 65 years of age. Those who suffer from pre-existing diseases such as diabetes, obesity, high blood pressure, asthma, coagulation disorders, chronic liver disease, diseases of the blood system and kidney problems are also more vulnerable.

Severe dengue can manifest in patients in multiple ways, including extensive bleeding, dengue shock or severe damage to crucial organs, which can lead to severe complications such as myocarditis, encephalitis or hepatitis.

Pulmonologist Jorge Pascual, who practices at the Mayo Clinic and serves as executive medical director for the Americas region, shared in a exclusive interview with Infobae that “the most severe cases of dengue directly affect the blood vessels. The clinical picture typically begins with a slight fever, pain behind the eyes, general discomfort and joint and muscle pain, and there may even be skin rashes. However, the situation worsens with intense stomach, intestinal and nasal bleeding,” said Dr. Pascual.

Experts insist on taking preventive measures to avoid hospitalization with severe dengue Photo: Andina

Furthermore, the US Centers for Disease Control and Prevention (CDC) emphasizes that it is crucial to seek immediate medical attention if you experience warning signs of severe dengue, which usually appear within 24 to 48 hours. following the fever disappears. These symptoms include:

• Severe abdominal pain or tenderness
• Frequent vomiting (three or more times in a 24-hour period)
• Bleeding nose or gums
• Bloody vomiting or presence of blood in the stool
• Feeling extremely tired, agitated, or irritable

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