Red Cross Appeals For $2.9 Million To Confront Central America’s Dengue Outbreaks

The International Federation of Red Cross and Red Crescent Societies (IFRC) has issued a global appeal to raise funds to combat the ongoing Dengue Fever virus outbreak in Central America.

On November 1, 2019, the Red Cross announced an effort to raise $2.9 million dollars to fund Dengue vaccination efforts in 5 Central American countries through September 2020.

"The size of these outbreaks is unprecedented across Central America," said Dr. Maria Frana Tallarico, head of health of IFRC's regional office for the Americas, in a statement.

The IFRC has previously supported community health outreach and used their unique access to cover gaps in service provision.

So far in 2019, the cumulative incidence rate of Dengue in the Central America region is higher than in the previous 5 previous years, with about 250,000 people in Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua being reported to have dengue in 2019.

Typically, the highest incidence for Dengue in Central America occurs from August through November but has previously extended into the month of January.

Considering that Dengue cases are typically underreported (14 to 28 time ratio), the number of people who have been infected with Dengue is likely much higher. 

Dengue’s serotype #2 is one of the deadliest and is the one that is currently affecting children and adolescents in the region.

Furthermore, Severe Dengue cases, which can result in fatalities are on the rise, says the Red Cross.

Unfortunately, those under 15 years of age are the most affected group. 

As an example, 66 percent of all confirmed deaths in in Honduras, while in Guatemala, they represent 52 percent of the total cases of Severe Dengue during 2019.

According to PAHO, this heightened risk is the result of low exposure, and therefore, low immunity among this age range.

Three countries in Central America have declared an Epidemiological Alerts: Honduras (14 June 2019), Guatemala (29 July 2019) and Nicaragua (31 July 2019). 

El Salvador and Costa Rica are reporting an increase in Dengue cases compared to previous years, and ministries of health of both countries are implementing response activities to reduce the incidence of cases.

Country specific information follows:

• In Costa Rica, the number of people with suspected dengue in 2019 is considerably higher than the incidence of cases compared to 2018 and 2017. As of EW 39, a total of 5,878 cases have been reported. The most affected areas are in the North Central and Caribbean regions in Sarapiquí, Guácimo, Pococí, and Turrialba. The Costa Rican Ministry of Health is actively seeking to reduce the presence of the mosquito vector using insecticides and partnering with Honduras on related activities.
• In El Salvador, 21,377 dengue cases have been reported as of EW 39, including 11 deaths for severe dengue. According to the Salvadorean Ministry of Health, the most affected departments are Santa Ana, Ahuachapán, Sonsonate and Cabañas. The Salvadorean Red Cross Society (SRCS) has developed a strong relationship with the Ministry of Health over the last few years and constant coordination is ensured with regards to the ongoing dengue outbreak in the country.
• In Guatemala, according to the latest information available, a total of 45 deaths out of 30,221 cases (67 severe dengue) have been reported as of EW 37. Among the deaths reported, over half were of children younger than 15 years, and most of those occurred in children aged 5 to 9 years. According to the Guatemalan Ministry of Health, the most affected departments are Huehuetenango, Quetzaltenango, Petén, Suroriente, Guatemala, and Las Verapaces. Though the trend of cases is now appearing to decline, it is unclear if this will be a sustained trend. The rainy season in Guatemala continues, and cases have remained higher than previous epidemic years, with 2014 reaching a peak of cases in EW 49 after an initial drop.
• Honduras is experiencing the worst dengue outbreak in its history, with 142 deaths and a case fatality rate (CFR) of 0.18%. The country has reported 81,858 cases of dengue as of epidemiological week 38. Nearly one-quarter of the cases reported were classified as severe dengue. The Honduran Ministry of Health indicates that the most significant number of dengue cases are in the departments of Cortes, Santa Barbara, and Comayagua. However, all 20 health regions in the country have reported dengue cases. In Guatemala, deaths are concentrated in the younger population, with children between 5 to 9 years most severely impacted.
• In Nicaragua, 130,243 dengue cases have been reported as of EW 38, including 19 deaths due to severe dengue. The government of Nicaragua has reported that the most affected departments are Leon, Carazo, Esteli, Chinandega, Masaya and Managua. The outbreak is primarily affecting children with the highest incidence rates among children 10 to 14 years old and 5 to 9 years old. There is an increasing risk of dengue infections since Central America is in its rainy season and this risk increases in more impoverished areas where improper waste disposal and water and sanitation systems generate stagnant water that is a breeding site for the Aedes aegypti mosquito. 

On August 15th, the Pan American Health Organization (PAHO) issued a report clarifying: 

• Dengue is caused by a virus that has 4 different but closely-related serotypes. When a person recovers from the infection, he acquires lifelong immunity against that particular serotype.
• Dengue is defined by a combination of at least 2 clinical findings in a febrile person, such as a positive tourniquet test, leukopenia, and the following warning signs: persistent vomiting, clinical fluid accumulation, mucosal bleeding, lethargy, restlessness, and liver enlargement.
• Dengue can become severe within a few hours. 
• Severe dengue is a medical emergency requiring immediate medical attention and usually requiring hospitalization. An estimated 500 000 people with severe dengue require hospitalization each year, and with an estimated 2.5 percent case fatality, annually. However, many countries have reduced the case fatality rate to less than 1 percent and globally.

A blood test is the only way to confirm a dengue diagnosis.

>  Order confidential blood tests  <

To notify international visitors to Central America, a Level 1 Travel Alert was published by the US Centers for Disease Control and Prevention (CDC) in early September 2019, saying ‘Dengue is an ongoing risk in many parts of Central America.’

In the USA, as of November 6, 2019, there were 865 Dengue cases confirmed by the CDC. The states of Florida (286), California (140) and New York (67) have reported the most dengue cases during 2019.

Regarding prevention, there is an approved vaccine available for the dengue virus. 

On May 1, 2019, Dengvaxia became the first vaccine approved in the USA for the prevention of dengue disease in people ages 9 through 16, who have laboratory-confirmed previous dengue infection, and who live in endemic areas caused by all dengue virus serotypes.

And just recently, on November 7th, a phase 3 clinical trial reported a Dengue Fever virus tetravalent vaccine candidate was found effective and appeared safe when tested with children and adolescents.

Takeda's TAK-003 vaccine is based on a live-attenuated dengue serotype 2 virus, which provides the genetic “backbone” for all 4 Dengue virus types.

The CDC says before being vaccinated, inform your healthcare provider if you have dengue symptoms or live in or have recently traveled to an area with risk of dengue.

Pre-travel vaccination counseling sessions can be scheduled at local pharmacies by Vax-Before-Travel.

Dengue vaccine news published by Vax Before Travel

Note: The CDC says any vaccine can cause side effects, which should be reported to a healthcare provider.