24th November, 2020
The Caribbean is being advised to contain the spread of dengue, as 2.7 million cases, many of whom are children, have been recorded in the Caribbean, Latin America and North America thus far for 2020.
Dr. Yitades Gebre, PAHO/WHO Representative for Barbados and the ECC, recently stated: “We need to do it all – governments need to provide leadership, clear communication and strong public health measures and resources and partnerships.
“Individuals need to do their part in avoiding bites by mosquitoes, keeping homes free of the vector, personal protection and caring for most vulnerable in the family such as children and persons with chronic illness; and seeking medical attention early, when feeling sick.”
The PAHO/WHO Representative spoke during a webinar organized by the Barbados and ECC office, entitled “Dengue Response in the midst of the COVID-19 Pandemic”.
Dr. Gebre outlined several factors which may be contributing to the noted increase in dengue cases during the current COVID-19 pandemic in Barbados and the ECC.
- Possible underreporting of dengue.
- Delayed medical consultation of dengue cases with warning signs as a result of COVID-19 pandemic containment measures or as the result of fear of COVID-19 exposure in health care services by the population.
- Focus of the health care services on COVID-19 response.
- Interruption of fogging and other vector control activities
- Laboratory overload for confirmation of severe cases and lack of supplies for surveillance.
To date, PAHO has spent US$ 345,000 working with Barbados and ECC countries, especially those with the highest dengue cases, to accelerate the implementation of their integrated management strategies for dengue response plans.
Ms. Thais Dos Santos, PAHO Advisor, Surveillance and Control of Arbovirus Diseases, said of the four serotypes of dengue, serotypes 3 and 4 are currently in circulation in the Caribbean.
Comparing 2019 to 2020, Ms. Dos Santos described 2019 as having “the most dengue cases in the history of dengue in the Americas”, adding that “this year, 2020, we looked like we were heading in the same direction”. However, due to lockdowns resulting from the COVID-19 pandemic, Dos Santos said, “persons were not travelling around as much, thus resulting in a decrease in reported dengue cases.”
Dengue is a communicable disease which is spread from an infected person to another by the bite of an infected Aedes aegypti mosquito.
Participants in the webinar also received updates from three countries which are currently implementing strategies to address outbreaks of dengue while simultaneously addressing the COVID-19 pandemic. They heard reports on Clinical Management from Pediatrician Dr. Mishka Duncan of St. Vincent and the Grenadines; Laboratory Diagnosis and Surveillance from Acting Chief Medical Officer, Dr. Shawn Charles, Grenada; and Vector Control and Health Promotion from Environmental Health Officers, Ms. Cheryl St Romain and Ms. Charletta Charles, St. Lucia.
From January to October, 2020, St. Vincent reported 1,473 cases and 6 deaths; Grenada recorded 318 dengue fever cases and four cases of severe dengue; and St. Lucia recorded more than 1,000 dengue cases and three deaths.
Link to video Prevention and control of mosquito-borne diseases: https://www.youtube.com/watch?v=9yWChBCAkWk&feature=youtu.beRemarks by Dr. Yitades Gebre, PAHO/WHO Representative Barbados and ECC
Good morning to you all,
I am very pleased to welcome you all to this webinar on dengue fever to create special awareness and immediate action to address the double public health crisis in our Caribbean sub region.
In late July we issued an advisory to our member states that in the context of the current COVID-19 pandemic, the potential seasonal increase in dengue cases in endemic countries represents a challenge for both the population at large and health service providers who would be responding to concomitant emergencies.
This situation is especially worrisome in areas where highly vulnerable communities to dengue and other arboviruses and COVID-19 reside.
Factors that may influence the response capacity:
- Possible underreporting of dengue.
- Delayed medical consultation of dengue cases with warning signs as a result of COVID-19 pandemic containment measures or as the result of fear of COVID-19 exposure in health care services by the population.
- Focus of the health care services on COVID-19 response.
- Interruption of fumigation and other vector control activity
- Laboratory overload for confirmation of severe cases and lack of supplies for virologic surveillance.
This dengue outbreak which is concurrent with the COVID-19 pandemic has resulted in additional significant health burden and an increase in demand for resources required for an effective response.
The devastating economic losses brought on by COVID-19 presents can also insurmountable challenge for countries that already have limited resources and response capacity.
For example, in St. Vincent and the Grenadines, the unusually high number of children with severe dengue and clinical presentation has added to the resource demands at the hospital level of care.
There is an increased demand for Paediatric Nephrologists, dialysis nurses and technicians, critical care specialist and biomedical equipment for the critical care management of dengue patients.
The early recognition of persons with dengue at the first level of care and the prevention of the progression of the disease is paramount. To this end the capacity of the health workers at the first level of care in the diagnosis and appropriate clinical management of dengue needs to be enhanced through training.
PAHO has been working with the countries in the sub-region, especially those with the highest burden of the dengue disease, to accelerate the implementation of their integrated management strategies for dengue response plans.
In this regard, between August and October 2020 the following support were provided by PAHO/WHO on the request of the member states.
- Press release by ECC Office calling countries to take action and address the dengue disease and mitigate its impact.
- Capacity building for testing in St Lucia, St Vincent and the Grenadines, and Grenada by providing laboratory reagents for dengue testing and serotyping, and training of laboratory staff.
- Organization of a special session on dengue clinical management training for St Lucia health care professionals.
- A sub-regional webinar on clinical management extended to all OECS member states, including St Vincent and the Grenadines and Grenada.
- Electronic dissemination of clinical management guidelines to all countries and the printing of hard copies for the Ministry of Health of St Vincent and the Grenadines.
- collaboration to assist St Vincent and the Grenadines in the review and management of complicated cases in children.
- Procurement of a renal dialysis machine to increase capacity for the management of severe cases in St Vincent and the Grenadines.
- Procurement of insecticides, insecticide application equipment, entomological supplies and PPEs for St Lucia, St Vincent and the Grenadines, Grenada, Antigua and Barbuda, Barbados and St Kitts and Nevis to strengthen their vector control programmes.
- Production and dissemination of communications materials such as videos, posters and public service announcements by countries.
- PAHO-ECC Office has also produced a dengue prevention and control video and updated its website to include a ‘dengue page’ through which countries can access additional communications materials.
In monetary terms:
Vector control – US$225,000
Risk communication – US$ 30,000
Clinical management – US$ 55,000
Laboratory diagnosis – US$ 35,000
Total – US$345,000
- Despite the above-mentioned support by PAHO/WHO, countries continue to report cases on a weekly basis and to request PAHO/WHO’s technical assistance to help control the outbreak and minimize its impact. Hence the need for sustained efforts through to 2021.
Our goal is:
- To control the current dengue outbreak and reduce its impact in the population and save lives and livelihoods.
Our objectives are
- Achieve at least 50% coverage of key dengue preventive interventions in mostly affected communities.
- Reduce weekly dengue incidence rate by more than 50% at national level.
- Reduce the mortality attributable to dengue to 0 deaths in severe cases.
- Reduce population densities of Aedes aegypti mosquitoes
Dengue outbreak control requires a combination of interventions outlined in the IMS-Dengue strategy and relies on surveillance and clinical data to monitor the effectiveness of those interventions at community and health facility levels.
We need to do it all – governments need to provide leadership, clear communication and strong public health measures and resources and partnerships.
Combination of interventions outlined in the IMS-Dengue. Individuals need to do their part of avoiding bites by mosquitoes, keep homes free of the vector, personal protection and caring for most vulnerable in the family children and persons with chronic illness, testing when sick, surveillance, treatment etc.
- As we have an increase in Covid-19 disease as of October in Eastern Caribbean we must continue to use public health tools and measures that we know are effective in preventing the infection and breaking the chains of transmission SARS-CoV-2.
Due to the coexistence of COVID-19 with dengue and other arboviruses in various countries and territories in the Americas, the Pan American Health Organization calls on Member States to continue surveillance, diagnosis, and adequate treatment of COVID-19 while simultaneously increasing efforts to facilitate access of patients with dengue and/or other arboviruses to healthcare services, the adequate treatment of these cases, and ensuring appropriate triage of patients both for the timely detection of dengue warning signs, as well as, to determine if isolation is warranted and reduce the risk of infection by SARS-CoV-2 acquired in healthcare services.
Thank you,