As winter looms and recent reports indicate an uptick in dengue fever cases in Miami and greater Dade County, Florida, people here in the states must start thinking about mosquito-borne illnesses. There have also been cases in California and Texas, which some scientists are attributing to climate change. No longer are we be able to ignore reports of dengue in the U.S. Virgin Islands, Puerto Rico, and Jamaica, just to name a few Caribbean current hot spots, and wave it off as an “over-there problem.”
This news is being reported as December, January, and February approach—peak time for tourist travel to the Caribbean, as folks in the global North seek to trade that local cold for a brief escape to a beachy paradise. And as the Associate Press notes, “the U.S. market drove more than 50% of arrivals to the region last year with 14.6 million U.S. tourists visiting.”
If you are planning a cruise, a resort stay, or you are visiting family in the Caribbean, you need to be aware of what’s happening and you need to take precautions. If you have family or friends in the affected areas, do make sure they have the necessary information on both precautions and treatment.
RELATED STORY: Dengue Fever in Florida. Locally transmitted.
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Growing up in New York City, I’d never heard of dengue fever. I did know a little about the U.S. history of the tropical diseases malaria and yellow fever, but those were wiped out (here, anyway) decades ago.
I didn’t learn about dengue till I went to Puerto Rico to work as a medical anthropologist in the late 1990s. It was then that I realized it was a major health issue across the Caribbean and the rest of the tropical Americas. Until the first vaccine, Dengvaxia, was developed for dengue in Mexico in 2015, killing the mosquito carriers, wearing insect repellent and treated clothing, and sleeping under nets were the only prevention options.
These days, we need to pay attention to not only dengue but also zika and chikungunya (which few people here know how to pronounce).
Please take five minutes to watch this dengue explainer from Medical Centric that explains dengue, and how serious the “breakbone fever” can be. It’s vicious.
From the YouTube notes:
Dengue fever is a mosquito-borne tropical disease caused by the dengue virus. Symptoms typically begin three to fourteen days after infection. This may include a high fever, headache, vomiting, muscle and joint pains, and a characteristic skin rash. Recovery generally takes two to seven days. In a small proportion of cases, the disease develops into the life-threatening dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood plasma leakage, or into dengue shock syndrome, where dangerously low blood pressure occurs.
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The virus has five different types; infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications.
I was shocked when I saw the infection numbers reported for the USVI by Nada Hassanein for USA Today in April.
Why children in US territories are 'bearing the burden' of neglected tropical disease
Dengue fever is on the rise in U.S. territories in the Caribbean, and a recent study estimates more than half of children in the U.S. Virgin Islands have had a prior infection.
Dengue is a mosquito-borne illness that can cause a fever and rash. Severe infections, particularly secondary ones, can be fatal.
The disease is endemic to tropical areas such as the U.S. Virgin Islands and Puerto Rico, two U.S. territories in the Caribbean Sea about 40 miles apart. A U.S. vaccine became available just last year.
Experts say the study calls attention to tropical diseases that have been neglected by global health initiatives and that are even more urgent amid climate change, which creates prime conditions for vector-borne diseases.
We on the mainland don’t pay enough attention to health issues in the “U.S. territories” colonies. And not just the so-called tropical illnesses are problematic. Consider that there’s a flu epidemic underway in Puerto Rico.
CBS News notes that, like with dengue in USVI, children are bearing the brunt of the epidemic.
Puerto Rico health officials on Thursday declared an influenza epidemic in the U.S. territory.
At least 25,900 cases have been reported since July, with 42 deaths and more than 900 hospitalizations on the island of 3.2 million people, Health Secretary Carlos Mellado said. Epidemiologist Melissa Marzán noted that officials have seen nearly six times more cases so far this year compared with the same period last year.
Those who are 0 to 19 years old have been most affected, with more than 13,600 cases reported in that population, Mellado said. Health officials said there were plenty of vaccines, tests and treatments available on the island.
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The island has struggled with a deteriorating health care system, which experts say was worsened by Hurricane Maria in 2017 and Hurricane Fiona last September.
As of last year, about half of the people living in Puerto Rico depend on the public health care system. Local officials have blamed federal funding gaps for causing staff shortages and long wait times for patients.
The deteriorating health care there should be a major issue, here. It isn’t.
Many of my friends and family frequently travel to Puerto Rico. They are not tourists. But there are tourists—whom I don’t begrudge! Tourism is a major source of the GDP of many nations in the Caribbean.
Statistica:
In Caribbean region, the travel and tourism sector contributed more than 60 billion U.S. dollars to the gross domestic product in 2022. Among all listed Caribbean territories, the Dominican Republic and Cuba registered the highest total contributions of this sector to the GDP
I’ve read numerous comments from people who are headed out on cruises who are oblivious to the hazards. Be aware and informed. Please.
And for all you cruise bugs out there, here’s what the Centers for Disease Control and Prevention (CDC) have to say about cruise ship travel and vectorborne diseases:
Some cruise ship ports of call include destinations where vectorborne diseases (e.g., dengue, Japanese encephalitis, malaria, yellow fever, Zika) are known to be endemic. In addition, new diseases can surface in unexpected locations; chikungunya was reported for the first time in the Caribbean in late 2013, with subsequent spread throughout the region and numerous other North, Central, and South American countries and territories. Zika was first reported in Brazil in 2015, and subsequently spread across the Caribbean and Latin America, sparking concern because of its association with microcephaly and other congenital abnormalities in the fetus. For disease-specific information, see the relevant chapters of Section 5.
For guidance on how to avoid bites from mosquitoes and other disease-transmitting arthropod vectors, both onboard and while on shore at ports of call, see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods. For specific details on yellow fever vaccination and malaria prevention, see Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country.
The CDC also notes that the very new dengue vaccine is not for travelers.
A new dengue vaccine is approved for use in children aged 9–16 years with laboratory-confirmed previous dengue virus infection and living in areas where dengue is endemic (occurs frequently or continuously). Endemic areas include some U.S. territories and freely associated states. The vaccine is not approved for use in U.S. travelers who are visiting but not living in an area where dengue is common.
And on Oct. 11, the U.S. Embassy in Jamaica rang the warning bell.
Jamaica’s Ministry of Health declared an outbreak of the dengue virus on September 23rd, 2023, due to an increase in cases throughout the island. Over the last three months several hundred cases of dengue have been reported, including of the more severe (often called hemorrhagic) cases.
To date, there have been 1,060 confirmed dengue infections in Jamaica. All parishes have recorded dengue cases, with Kingston and St. Andrew, St. Thomas, St. Catherine, Portland, and St. James recording the most confirmed cases.
This was from just last week.
Jamaican Prime Minister Andrew Holness has even held press conferences addressing mitigation measures.
Communities in Jamaica are mobilized to fight dengue. This video from the Jamaican Southern Regional Health Authority showcases the effort.
Parts of the mainland Caribbean basin, like Guyana, are also facing dengue issues. As Micaiah Morgan at Caribbean National Weekly reported in August:
Dengue claims lives of school children in Guyana
Guyana’s health minister Dr Frank Anthony has confirmed that two children succumbed to dengue infections.
The children were ages nine and 11.
As of the latest data, approximately 3,453 individuals in Guyana have contracted the mosquito-borne illness this year, with 2,169 of these cases still marked as active.
In response to the rising number of infections, local officials have increased efforts to mitigate the spread of the disease.
This includes fogging various areas to reduce the mosquito population and distributing agents that eliminate mosquito larvae.
Here’s a video report on the kids lost to dengue, from One Caribbean Television.
The impact of climate change on disease vectors is being explored, as this report from the Yale Center on Climate Change and Health details.
From the YouTube notes:
Introduction: Climate change impacts are not existential threats in the Caribbean but rather an unwelcomed norm to which public health systems are required to adapt. Their influence on transmission of infectious diseases continues to increase yet our understanding on the associations of climatic variables and arboviral diseases. Dengue is distributed worldwide causing diseases such as non-severe and severe dengue in tropical regions of Latin America and the Caribbean which are inherently vulnerable to climate change impacts, infectious disease outbreaks and disasters. Dengue endemicity is rife throughout the Caribbean as the dengue vector, Aedes aegypti, is ubiquitously present in Neo-tropical ecosystems present in the region.
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Results: In total, 85 studies were identified, with 17 selected studies meeting the inclusion criteria ranging from French-, Spanish-, Dutch- and English-speaking Caribbean. Various mathematical models were utilized in the selected studies with varying power to generate robust risk estimates of human dengue infections linked to climatic variables. Strong evidence of dengue disease association with rainfall/precipitation and temperature factors were observed but mixed evidence being observed based on local climatic conditions due to geographical locations.
Discussion: The interaction of climate and human dengue disease in the Caribbean is likely complex and guided by variations in localised climate and multiple co-factor interactions including socio-economic, biotic and abiotic features. More detailed systematic research on the influence of climate on mosquito-borne disease dynamics is necessary in the Caribbean to better understand the complexity of vector-borne disease transmission, its impacts and facilitate more effective disease management.
Circling back to chikungunya, Washington Post health care reporter Sabrina Malhi brought news of a vaccine on Friday.
The vaccine, sold under the brand name Ixchiq, comes at a time when public health experts are increasingly worried about vector-borne illnesses spreading to new regions due to climate change, posing an increased risk to human health.
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“This is very much a vaccine for the future because chikungunya is not here in a big way yet, but it looks like it will be in the coming decades,” said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Texas Children’s Hospital Center for Vaccine Development.
Hotez says climate change and urbanization are the main culprits for the increasing prevalence of vector-borne illnesses such as chikungunya. He added that the approval of Ixchiq lays the groundwork for other vaccines to treat mosquito-related diseases.
And as Jen Christensen reported for CNN:
Chikungunya, a mosquito-borne disease whose name in the Makonde dialect of Africa means “bending over in pain,” has no specific treatment and can be debilitating and even deadly for newborns. Health experts consider it to be an emerging threat to global health made worse by climate change, with at least 5 million cases in the past 15 years, although deaths and severe illness are rare, according to the World Health Organization.
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Before 2006, the virus was rarely identified even in US travelers, the US Centers for Disease Control and Prevention says, but studies identified a couple dozen cases in the US travelers between 2006 and 2013. In late 2014, cases that stemmed from local transmission were reported in warmer parts of the US: Florida, Texas, Puerto Rico and the US Virgin Islands.
Last but not least, there’s zika. As the Pan-American Health Organization reported in January:
Zika: A silent virus requiring enhanced surveillance and control Situation in the Americas and control measures
Since its first detection in Brazil in March 2015, local transmission of Zika has been confirmed in all countries and territories of the Americas, with the exception of continental Chile, Uruguay, and Canada. Ten countries account for 89% of Zika cases recorded between 2014 and 2023, however, with Brazil, Colombia, and Venezuela leading the list.
Data from the Pan American Health Organization (PAHO) shows that, unlike other arboviruses such as dengue or chikungunya, which caused over 3 million and 324,000 cases respectively so far in 2023, Zika exhibits significantly lower incidence, with only 27,000 cases during the same period.
"It is essential to link surveillance for acute Zika infections and the manifestation of other neurological syndromes such as Guillain-Barre,” Thais dos Santos, Advisor on Surveillance and Control of Arboviral Neglected Diseases at PAHO said. “If we optimize this approach, we will be better prepared to fully understand the disease and take preventive measures," she added.
What looks like bad news is when zika meets dengue. Duke-NUS Medical School’s Federico Graciano reported this month that “research shows maternal dengue immunity worsens birth defects caused by zika virus.”
A first-of-its-kind study led by Duke-NUS Medical School has shown that prior maternal immunity to the dengue virus substantially increases the risk of severe birth defects induced by Zika virus infection during pregnancy.
The research, published in Science Translational Medicine, found that pre-existing dengue antibodies in pregnant mothers lead to severe microcephaly and brain damage in the fetus after Zika infection compared to Zika-infected fetuses from dengue antibody-naïve mothers. Microcephaly is a birth defect where a baby's head is smaller than expected and is one of the hallmark features of congenital Zika syndrome.
"This study provides compelling evidence that a mother's immune history with dengue virus can put her baby at greater risk if she contracts Zika virus during pregnancy," said senior author Associate Professor Ashley St John, from Duke-NUS' Emerging Infectious Diseases (EID) Program. "It highlights a complicated interplay between these two closely related viruses and may provide new insights into why some fetuses experience much more severe outcomes from Zika infection than others."
Wouldn’t it be nice if all the Republicans purporting to be “pro-life” and “pro-fetus” would up the funding for such research and prevention?
Join me in the comments below for more about these diseases—and for the weekly Caribbean news roundup.
