Dengue fever – an epidemic inside a pandemic in Peru

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International Year of Volunteers: A volunteer ombudsman in Peru helps a local woman with her problem, 2001. Photo credit: UN photo

UNITED NATIONS, January 15, 2021 (IPS) – As the world grapples with the third wave of the COVID-19 pandemic, Peru is still grappling with an epidemic it has been unable to control – the mosquito-borne viral disease known as dengue fever.

With nearly 56,400 confirmed cases in December, Peru suffers from the worst dengue epidemic since 2017, when the virus infected over 68,000 people. The disease, coupled with the novel coronavirus crisis, has left thousands of people undernourished and exposed to water-borne diseases.

Although death rates in dengue cases are low, nutritious diets and immediate hygiene are required to fight the disease. Above all, prevention is key to managing future epidemics as the dengue mosquito, Aedes aegypti, expands into new areas in Peru. As informal settlement and urbanization increase, so too do Aedes larvae, which grow in stagnant water that accumulates in cans or pots.

“Dengue fever has become endemic in many regions of Peru, whereas previously it was mainly found in tropical ecosystem areas,” says a researcher with the Pan American Health Organization (PAHO) in Washington DC, referring to the Madre de Dios regions in Loreto. Ucayali and San Martin among others. “It’s normal to find dengue near the Amazon, but now we can find it in desert-like areas. It should be easier to control dengue, but it is difficult to control urbanization. “

The epidemic

The dengue crisis in Peru began in October 2019 when cases increased in the Madre de Dios region in the southeast of the country. The government soon sent the armed forces to fumigate people’s homes and kill the larvae while issuing recommendations on how to avoid the virus.

As a result, the spread of the virus slowed in November, and Health Minister Elizabeth Hinostroza said dengue cases in Madre de Dios had decreased by 30%, as reported by local outlets.

But the respite was short-lived. In February, the government declared dengue a health emergency and increased resources to fight the virus. By the time the coronavirus pandemic hit Peru, dengue fever had spread to 17 regions, including Junin and Ica.

Yet the country lacked the resources to face a pandemic and an epidemic at the same time.

At the beginning of March, protests broke out in the Loreto region in northeastern Peru as the infected people were not receiving medical care. With COVID-19 airborne attacking the country and mandatory lockdowns, it has become difficult, if not impossible, to conduct fumigations. Also, some of the coronavirus symptoms, such as a headache, were similar to those caused by dengue fever.

In October 2020, Peru warned again by “increasing the hygienic response to the control and prevention of dengue fever […]. “By the end of the year, the COVID-19 pandemic had claimed nearly 38,400 victims, high unemployment and a growing informal economy. (The underground economy could have increased from 70% to 80% or 90% since the pandemic in Peru, local outlets say.)

Dengue fever continued to spread in the background.

On December 9, the National Center for Epidemiology, Prevention and Disease Control, affiliated with the Department of Health, issued a warning warning that Peru was the third country in the Americas with the highest death rate from dengue fever. The Dominican Republic and Venezuela came first.

But what does dengue fever do?

Dengue is a mosquito-borne viral disease that is widespread in the tropics because it is “influenced by rainfall, temperature, relative humidity and unplanned rapid urbanization,” explains the World Health Organization (WHO). The species Aedes aegypti is also the vector for other viruses such as Chikungunya, yellow fever and Zika.

With increasing climate change and increasing urbanization, the mosquito is finding new breeding grounds. “When new areas get warmer, the Aedes vector will expand,” explains PAHO researcher IPS. “We can now find it at higher elevations than before.”

The consequences of the disease are different, the WHO states in a notice dated June 23, 2020. Symptoms can range from flu-like to “severe bleeding, organ disorders and / or plasma leakage”. In both cases, the virus can also disproportionately affect women and anemics.

“Dengue fever affects a person’s platelet count, which can be especially important for pregnant women,” said Angel Muñoz, climate variability researcher at the International Research Institute, part of Columbia University’s Earth Institute. “Anemics are more likely to get the disease.”

Malnutrition

Dengue patients usually suffer from severe dehydration and lack of nutrients, so water and nutrient intake is essential.

Recommended diets are rich in vegetables with vitamins A, C and K such as spinach and beetroot, fruits with the latter two vitamins such as citrus fruits and nuts with proteins.

In Peru, access to clean water can be difficult in certain regions and peripheral areas where stagnant water is abundant. In the Loreto region, for example, only 45.4% of the population consumed drinking water through public infrastructure in 2019, according to a 2020 report from the country’s National Institute of Statistics and Informatics (INEI).

This lack of access to drinking water increases the effects of dengue fever and leads to other malnutrition problems. The Food Sustainability Index, developed by the Barilla Center for Food & Nutrition and the Economist Intelligence Unit, states that “poor sanitation and a lack of clean water lead to malnutrition due to diarrhea”. In contrast, the index says: “Improved sanitation and better water supplies also help fight global hunger.”

In addition to these infrastructure problems, the Food and Agriculture Organization (FAO) warns in its latest report that malnutrition increased in 2020 due to the COVID-19 pandemic, deepening the spread of dengue fever. “In the past five years the situation has worsened, with an increase of 13.2 million people suffering from malnutrition,” says the FAO.

How to prevent dengue fever

Prevention is vital to the fight against dengue, both through forecasting and through awareness-raising campaigns by public institutions.

Research has shown a link between climate patterns and the mosquito life cycle, as illustrated in the next-generation environmental monitoring and forecasting system AeDES for the transmission of Aedes-borne diseases, authored by Muñoz and other researchers.

“There is a connection between environmental conditions such as temperature, precipitation and humidity and the mosquito life cycle,” he explains to IPS. “It is possible to make reliable climate predictions and predict the likelihood of the disease spreading.”

As a result of the paper, the IRI team has developed a tool for monitoring and forecasting Aedes-sponsored environmental suitability, which enables policy makers to predict the potential impact of dengue.

However, predicting the likelihood of dengue is not enough because the information must reach the population. Muñoz notes that awareness campaigns are essential to ensure the public knows how the disease is spreading. “Receivers with standing water or large landfills create the perfect habitat for the mosquito.”

In the past, the Peruvian government has launched awareness campaigns through the Ministry of Health, most recently “Dengue kills. Kill the mosquito! ”

This campaign emphasized the elimination of breeding grounds for the species, both through preventive measures and through fumigation. Some of his recommendations include:

    ● “If you have flower pots or aquatic plants, clean the recipients every two days […]. “You water the plants every day. “
    ● “Close the receivers in which you store water tightly […]. ”

However, fumigations and awareness campaigns require enormous resources. While the regions have exclusive budgets to control mosquito-borne diseases, some of this money has been used in recent months to fight the pandemic, report Jorge Carrillo and Alicia Tovar for Peru’s Ojo Público investigative agency.

As a result, populations with less access to information, health care, and lower socio-economic conditions continue to be at higher risk as they are more likely to conserve cans or planters to conserve water.

“We need tools to understand the impact of environmental factors on dengue seasonality. If we have a detailed system of who could be at higher risk and where and when dengue fever could spread, we could strengthen prevention strategies, ”concludes Muñoz.

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