Dec. 6, 2007 — Puerto Rico is currently dealing with a wide outbreak of dengue fever, an official with the U.S. Centers for Disease Control and Prevention (CDC) told health professionals gathered for a seminar at Juan F. Luis Hospital Thursday.
The outbreak is the dengue 3 strain of the virus, said Dr. Kay Tomashek.
"Dengue 3 is a concern in the territory, because most people in the Virgin Islands would be susceptible, since it has not caused disease here before," said Dr. Eugene Tull, epidemiologist at the Department of Health. "We need a proactive approach. Dengue could sneak in and we could have a full-blown epidemic."
Almost 50 public health-care providers gathered at the seminar to learn strategies on how to handle a dengue outbreak. Seminar participants expressed concern about the close proximity to Puerto Rico and inter-island travel.
The clinical and laboratory spectrum of the seminar was given by Tomashek, commander of the U.S. Public Health Service and chief of epidemiology activity at the CDC Dengue Branch in Puerto Rico. By the end of this year, CDC will be looking at just under 12,000 cases of dengue for 2007, Tomashek said. By law clinicians must report cases and submit samples. From the reports and samples, the CDC can track, monitor and give assistance where necessary.
A virus transmitted by the female Aedes aegypti mosquito causes dengue fever. Symptoms include high fever, rashes, severe headache, and joint and muscle pain. The incubation period is four to seven days after the bite. The fever may start one to two days later. A rash may appear two to six days after the fever begins. Nausea, vomiting and loss of appetite are also common, Tomashek said.
No medications are available to treat the symptoms, she said. The only thing a patient with dengue fever can do is to stay hydrated and take acetaminophen. The management of dengue hemorrhagic fever and dengue shock syndrome — rare complications of the disease — are treated more aggressively.
Dengue can lead to death on rare occasions. In June 2005, a 14-year-old St. Croix girl died from dengue shock syndrome.
An infected patient should avoid being bitten by mosquitoes to prevent the spread of dengue, experts told caregivers at Thursday's seminar. The patient should be kept in a screened room and covered by a mosquito net.
"Tell the mamas to go kill all the mosquitoes in their house," Tomashek said.
Prevention is the best cure.
"Preventing the epidemic from even occurring is the ideal primary prevention," said D. Fermin Arguello, MD, MPH, deputy chief of epidemiology and surveillance activity at the CDC. "Primarily there is no vaccine and no complete control of mosquitoes."
Spraying outside for mosquitoes has no impact on eradicating them, he said.
"They live in houses, close to humans, their source of protein," Arguello said. Dr. Richard Olans asked if there are methods other than spraying that can be used. Tomashek told the group they are testing a trap in Puerto Rico.
Arguello gave strategies for handling a dengue epidemic. Dengue epidemics can be like hurricanes: They are recurrent and seasonal, and there are alarm signals. Before an epidemic occurs, Arguello told the group, health-care professionals need to have an emergency plan and integrated action teams in place. There must be communication between clinicians, labs and public health departments.
To minimize the impact of an epidemic, there needs to be early recognition, mosquito control, patient care, lab diagnosis and transparency in media.
"The CDC is available to help coordinate and do whatever is necessary," Arguello said.
The seminar was coordinated by the Health Department's Office of Public Health, Bureau of Health Education, Territorial Epidemiologist, and the Luis Hospital and Schneider Regional Medical Center.
Medical agencies, clinics and private physicians territory wide are urged to report any dengue cases to the Health Department by calling 773-1311, ext. 3241.
"I will take all of the information I got here today and practice it," Dr. Jeffrey Inniss said. "The information was very up to date."
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