When Pedro Rodríguez fell ill with dengue in 2021, he felt like he was going to die. He was admitted to the Intensive Care Unit (ICU) in Nicaragua when his vital signs dropped in the so-called critical phase of the disease, which is when the fever disappears and some patients usually show warning signs. It occurs in the first 3 to 7 days.
According to Rodriguez, hospital authorities decided to admit him to the intensive care unit when he began to have fluid buildup in one of his lungs, making it difficult for him to breathe.
Rodriguez saw two people die who were with him, but he says he managed to recover completely and that experience marked him for life. Today he takes measures to not get sick again since he says he is susceptible to other types of illness. dengue serotype qwhich could be “catastrophic” for him.
In the last five years, cases of dengue have increased in Nicaragua and the rest of the Central American countries, according to figures from the Pan American Health Organization (PAHO), and the risk of dying has increased due to the spread of the four serotypes of dengue that circulate in the region.
Dengue cases in Nicaragua were caused by a single dengue serotype in 2020, but in 2021 two more serotypes were recorded, den 1 and den 2, until finally four serotypes of the disease were reported in 2022 and 2023.
And the pattern has been similar in other Central American countries over the past four years, with the reporting of just one serotype up to four.
Dr. José Luis San Martín, regional advisor on arboviral diseases at PAHO, explained to the Voice of America that the increase in dengue cases in most countries in the Americas is due, among other main causes, to climatic factors that play a crucial role in the distribution, behavior, survival and transmission of the vector mosquitoes.
“Climate change, which intensifies precipitation and raises temperatures, has favored the accelerated proliferation of vectors, shortening the development period of mosquitoes and the virus within them, and increasing the frequency of bites, which facilitates the spread of the virus,” the doctor told the VOA.
He said there have been other factors associated with the increase in cases, such as rapid unplanned urban expansion and population growth, combined with deficiencies in water and sanitation services, as well as insufficient community participation.
And Fabián Aragón, a general practitioner in Costa Rica with 20 years of experience, agreed with this.
“Settlements, complicated socioeconomic conditions, coupled with the lack of care in the handling of water containers, cause the dengue vector, Aedes aegypti, to spread,” Aragón lamented.
Complex panorama
PAHO specialist José Luis San Martín warned that when a person has had an infection with a serotype of dengue, he or she develops lifelong immunity against that specific serotype. However, if he or she is infected again with another serotype, this can trigger an immune reaction that increases the risk of developing a more severe form of the disease.
“For this reason, it is important to monitor the circulating serotypes, since the presence of multiple serotypes can increase the risk of epidemics, given that many people are still susceptible to at least one of the circulating serotypes. These conditions can also lead to an increase in the number of severe dengue cases,” said the specialist.
Severe dengue is a condition that could even lead to the death of a patient, either due to plasma extravasation, fluid accumulation with respiratory difficulty, or both. It could also be caused by profuse bleeding that is considered clinically important by the treating physicians or by alteration of consciousness.
In El Salvador, health authorities declared a red alert following three deaths of children from dengue in early July 2024.
Over the past five years, 57 cases of severe dengue have been reported in El Salvador, as well as more than 37,000 cases of suspected dengue, according to figures from the Pan American Health Organization.
The Salvadoran government has deployed not only the health corps but also the Armed Forces for inspection tasks, fumigation and delivery of supplies to prevent mosquito breeding grounds in stagnant water inside homes. In addition to other stagnation caused by the rains that have affected the region in recent weeks.
In Guatemala, the Ministry of Public Health and Social Assistance (MSPAS) declared a National Health Emergency, due to an early and pronounced increase in dengue cases at the end of June.
Authorities made the decision after reporting more than five times the typical number of cases last year, including severe cases of dengue (known as hemorrhagic fever) that left 50 dead, most of them children under 15.
To do?
The Pan American Health Organization is coordinating with countries in the region to implement comprehensive dengue prevention and control programs based on the PAHO Integrated Management Strategy for the Prevention and Control of Arboviruses.
These programs include coordinated actions between institutions, strengthening disease surveillance, improving timely and appropriate clinical care and management, control of the transmitting mosquito (Aedes aegypti), and promoting community participation.
However, many of the factors contributing to dengue transmission are socioeconomic and environmental in nature. Addressing underlying issues such as urbanization is also critical to mitigating and preventing future dengue epidemics, experts said.
[La periodista de la Voz de América en El Salvador, Karla Arévalo, contribuyó con este reporte]
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