CONCERNS about nationwide dengue outbreaks, until now concentrated in coastal regions, came inland this week as a reported surge of cases in the Central Valley worried San José residents and sent health authorities into damage-control mode. They emphasize that while mosquito breeding pools have been spotted in western suburbs, few cases have been reported in San José itself.As in previous weeks, officials denied that the numbers represent a cause for panic but called for concerted nationwide efforts to reverse the alarming trend by eliminating standing water where dengue mosquitoes breed. The Public Health Ministry has announced plans for an information campaign designed to encourage citizen action.“We would like to continue the call we have made to the entire population, to check if each one of us has met the responsibility we have on an individual, family and community level,” Public Health Minister Rocío Sáenz said at President Abel Pacheco’s weekly Cabinet meeting on Tuesday, adding that people often forget dengue is not just just a passing illness but can also be fatal.Nationwide, 14,000 cases of classic dengue and 20 cases of hemorrhagic dengue fever – a more severe form of the illness – were reported by August 13, increasing by approximately 150% compared to last year, according to Willy Carrillo, director of health vigilance for the Public Health Ministry. By August 13, 2004, only 4,809 classic dengue and 8 hemorrhagic dengue cases had emerged throughout the country.HEALTH authorities attribute this year’s increase to inattentiveness from the public, which, according to the officials, has chosen to ignore warnings about cleaning out dengue breeding pools.Most of the classic dengue cases this year have emerged in coastal areas. While 43% were reported in the country’s central Pacific zone, 38% were reported in the Caribbean coastal region. The Social Security System (Caja), which oversees the nation’s public hospitals, has spent over $1 billion on dengue patient care so far this year.Of the 20 hemorrhagic dengue cases, 15 emerged in the central Pacific region, three in Guanacaste and two in the Caribbean zone, said Minister Sáenz.SÁENZ said most cases near the greater metropolitan area have been reported in the province of Alajuela and the western San José suburbs of Pavas and Santa Ana.While the daily La Nación’s lead story Tuesday informed readers that dengue is now “attacking the greater metropolitan area” with 1,300 cases reported through Aug. 7, director of health vigilance Carrillo told The Tico Times that dengue has not emerged in downtown San José.Dengue mosquito breeding pools have been spotted in Santa Ana, but no cases have emerged in that community, while the two dengue patients reported in Pavas actually contracted the disease in Orotina, Puntarenas, Carillo said.Alajuela and the province of Heredia, where dengue cases have emerged, have had problems with this viral infection historically, he added.“As years go by, (dengue) medical profiles become more serious,” said Anabelle Alfaro, coordinator of patient attention for the Social Security System (Caja), explaining that a person’s symptoms worsen each time he or she becomes infected. “Ten years ago in Puntarenas, dengue cases were not severe. Now, in Puntarenas, as well as Limón and (the northwestern province of) Guanacaste, they are.”DENGUE is a viral disease transmitted by infected aedes aegypti, or dengue mosquitoes, whose eggs can survive dryness for over a year but hatch during the rainy season in May-November, wherever water collects (TT, July 15, August 12).Among the symptoms of dengue are a fast-rising fever of more than 38 degrees Celsius that normally lasts from five to seven days, strong headaches, rashes and pain behind the eyes. Digestive symptoms may include diarrhea, vomiting and a bitter taste in the mouth.Hemorrhagic dengue may include liver enlargement and circulatory failure as well as all the symptoms of classic dengue.Hemorrhagic dengue may result in death within 12-24 hours if patients enter a state of shock following a drastic temperature drop.THE Social Security System (Caja) invests an estimated ¢80,000 (approximately $167) per day for the hospitalization costs of each dengue patient, which adds up to the ¢500 million ($1.04 billion) the Caja estimates it has spent so far on dengue hospitalizations this year.Health authorities are reluctant to fumigate as a strategy to combat dengue because it is a costly and ineffective procedure, according to Carrillo.“Fumigating is not the solution. The most effective practice is to destroy the dengue breeding pools in each house,” he said. Fumigating exterminates mosquitoes only, but the insecticide does not destroy dengue pupae or eggs laid in standing water, which will hatch seven days after being sprayed, Carrillo explained.A liter of dengue insecticide can cost approximately ¢20,000 ($42) and will only fumigate up to 20 homes, Carrillo said, adding that the insecticide has a low toxicity level, but will contaminate the environment just like any other agrochemical.THE Public Health Ministry launched a media campaign this week to get the anti-dengue message across the country, according to Carrillo. The campaign will involve diffusion of information through all forms of mass media, including print, radio and television, with no definite end date.Dengue Prevention Tips From the Public Health MinistrySteps to Avoid Dengue:•Eliminate potential breeding pools, including any objects in your home or garden that may accumulate water, including bottles, tires, empty cans and water-collecting plants such as bromeliads and knotted trees. Flush any unused toilets and empty pets’ water dishes daily.•Empty out barrels, buckets and any other containers used to store water for domestic use. Wash their interiors and cover them so they do not fill upwith water again.•Eliminate water in flower vases and place flowers or plants in pots filled with soil or sand instead.•Clean and repair your home’s drainage ditches.•Fill up holes in trees, walls and gates with sand or mud.•When visiting coastal areas, use mosquito nets, or stay in air-conditioned rooms and keep windows shut at all times. Use a mosquito repellent. If You Suspect You or Someone Else Has Dengue:•Report the case to health authorities or the nearest health center (hospital, clinic, EBAIS).•If the patient experiences muscular or bone aches, or if fever is very high, take acetaminophen (the main component of Tylenol).•Drink plenty of liquid and get lots of rest. Dengue patients can eat as they normally do; no special diet is required for this illness.Source: Public Health Ministry.