Caribbean Health Experts Warn Of Fapidly Spreading Mosquito-Borne Virus

By Jacqueline Charles, Nester Phillip and Ezra Fieser, The Miami Herald

ROSEAU, Dominica — Caribbean health experts warned Thursday that they “cannot stop” a rapidly spreading mosquito-borne virus that has infected thousands and is associated with six deaths in the region.

The alert comes as the Dominican Republic’s health ministry became the 15th Caribbean nation to confirm cases of the chikungunya virus, and Haiti announced it was awaiting confirmation whether the debilitating viral disease had arrived on its already vulnerable shores.

So far, the World Health Organization has documented more than 4,000 confirmed cases in the Caribbean, with the French territories the hardest hit, and more than 31,000 suspected cases. The developments come as the tourist-dependent Caribbean prepares to usher in the summer travel season when hundreds of thousands of pleasure seekers are expected to flock to the region.

“At first I thought we could stop it. I have since revised that thinking, given the way it is spreading. We cannot stop it,” said Dr. James Hospedales, the executive director of the Trinidad-based Caribbean Public Health Agency, which is awaiting the arrival of 17 specimen from Haiti for testing. “All we can hope to do is slow it down.”

More commonly found in Asia and Africa, chikungunya was first detected in the Caribbean in December in the French territory of St. Martin. It’s spread to about one new country a week.

The virus is transmitted by the same nuisance daytime Aedes aegypti mosquito that transmits dengue, a much more fatal viral disease that the Caribbean region has struggled to control for years.

But unlike dengue fever, which has already killed 14 people in the Dominican Republic where 17 cases of chikungunya fever has been confirm, the newly arrived painful viral disease isn’t usually life-threatening, experts say. However, children under 1, those over 65 with diabetes and hypertension or individuals who are chronically ill, are at high risk for serious complications including death, said Leticia Linn, a regional spokeswoman with the WHO/Pan American Health Organization.

“It’s extremely difficult to attribute the death to chikungunya,” she said, “because of that we speak about related deaths.”

Still, chikungunya (pronounced chik-en-GUN-ya) can cause serious economic damage in the financially vulnerable Caribbean, similar to what a 2005-2006 outbreak did on the French island of Reunion, Hospedales said. It can also have ramifications such as in South Africa, where individuals reported suffering for years from chronic, arthritis-like symptoms after an outbreak.

“There’s a potential for temporary economic disruption if a high percentage of the population becomes ill,” Hospedales said. “Associated with that is overwhelming your health facilities, if large people have ‘arthritis’ in short time. That is acute.”

But the tourist-dependent Caribbean nations aren’t the only ones under threat. Because the Aedes aegypti mosquito is prevalent throughout the hemisphere, South and Central America and the United States are also at risk for an outbreak.

The Atlanta-based Centers for Disease Control and Prevention said it has been documenting an increase in returning U.S. travelers infected with the painful viral disease since 2006 when the large global expansion of the disease started to occur.

“We expect to see more chikungunya-infected travelers coming from the Caribbean as the virus spreads in the region and more people are exposed,” CDC spokeswoman Donda Hansen said, adding that the agency is working with state health departments to help them better detect the virus that causes a severe fever and joint pains.

On Tuesday, the CDC issued updated travel alerts for Dominica and the Dominican Republic, warning potential tourists that several Caribbean countries and territories had reported cases of chikungunya. The level 1, or lowest level, alert urged travelers to take precautions, including using repellant and permethrin-treated clothing.

The CDC and the Caribbean Public Health Agency say they have been preparing for chikungunya’s arrival for years. Still, the rapid spread is disconcerting, said Hospedales, whose agency has called on Caribbean public health experts and citizens to be more proactive in preventing the disease’s spread.

It was this improved surveillance, Haiti’s Health Minister Florence Duperval Guillaume said, that triggered concern “after 25 suspected cases tested negative for malaria.”

“We don’t yet have any confirmations,” she said.

But over in the Dominican Republic, they do. Officials this week confirmed 17 cases, including that of Maria Soler Gomez. The mother of two said she assumed she had contracted dengue fever after her arms and legs began to ache.

“It was extremely painful. It felt like I couldn’t walk,” said Gomez, 28, who lives in San Cristobal, a small city near the capital, Santo Domingo. “I never had dengue, but there are plenty of mosquitoes now so that’s what I thought it was.”

Soler’s temperature spiked and she developed a rash. She soon learned that she had contracted chikungunya.

“I had never even heard that word before,” said Soler, who with treatment recovered in less than a week.

Chikungunya is quickly becoming a household word in the Dominican Republic, which has documented 3,490 suspected cases in the San Cristobal area since the virus reached the country in late March after spreading rapidly through the eastern Caribbean, the ministry of public health said.

The ministry this week labeled the disease an “epidemic” and called on local governments to improve trash collection and eliminate breeding places for the Aedes aegypti mosquito.

“It’s a new disease and it has spread quickly,” said Eduardo Rosario, spokesman for the Dominican Republic’s health ministry. “Patients have been treated and released and then they return for follow-up treatments if necessary.”

More than 600 miles to the southeast in Dominica, authorities went into high alert after the virus was detected. There were 105 confirmed cases as of Tuesday, according to the Caribbean Public Health Agency.

Island officials have stepped up mosquito fumigation and trash collection, and rolled out radio and TV spots alerting everyone from adults to schoolchildren on how to prevent mosquito bites — from wearing long-sleeve shirts to using insect repellant — and what to do should they contract the virus.

Health Minister Julius Timothy said a war on mosquitoes must be declared.

“We have tried everything possible,” he said. “We have called on the Pan American Health Organization the Caribbean Public Health Agency and other partners in this fight. We have to understand that the best defense is keeping our environment clean or else we will have the issue of this infection.”

Recently, the country of Guyana shipped 2,000 mosquito nets to Dominica to assist. Also, a local pharmacy is selling citronella-laced bracelets that last up to a week, to ward off the annoying insects.

Security guard Craig Riviere said he at first dismissed the aching pains in his knees. Then the pain spread all over his body, and he lost his appetite. That’s when he became worried. Days earlier, his younger sister, 12-year-old Kerima Sayers, 12, had been diagnosed with chikungunya after experiencing similar symptoms.

“I would sleep a lot. My appetite was also gone, sometimes I would fall asleep with untouched food in front of me,” he said.

Both Riviere and Kerima live in the same house in a Roseau suburb. Next to their home is a gully that normally has stagnant water, a breeding ground for the mosquitoes. On Wednesday morning, the gully was finally fumigated.

“Dirty gullies add to the problem,” said Timothy, the health minister.

Gullies, however, are not the only culprit in the Caribbean where governments have struggled for years with trash collections. The warm weather also attracts mosquitoes.

“It’s fair to say that governments have spent a lot of money attempting to control mosquitoes,” Hospedales, the Caribbean epidemiologist said. “We have been unsuccessful.”


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