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Public Health Worries Increase

THE spread of the dengue virus into San José and the threat of an influenza pandemic looming over the world have led health authorities here to raise warning signals, urging the population to remain alert and take cautionary measures to stay healthy – while the nation’s public hospitals, many already overcrowded, face the prospect of still more patients with nowhere to go.Public Health Minister María del Rocío Sáenz said this week it is important to remember that both dengue and avian flu – the virus worrying authorities worldwide are deadly.“What nature is trying to tell us is that we have to take care of ourselves,” Sáenz told The Tico Times, urging the public to avoid responding to the avian flu threat with the same apathy authorities blame for dengue’s rapid spread through the country.With 20 confirmed cases of classic dengue reported to date in the greater metropolitan area, the risk of transmission of the virus increases, according to Teresita Solano, chief of the Epidemiological Vigilance Unit of the Public Health Ministry.Solano said the urban dengue spurt – part of the approximately 29,700 classic dengue cases reported so far this year in Costa Rica – emerged in Los Guidos, Desamparados, a southern suburb of San José.Dengue mosquito breeding pools were spotted months ago in Santa Ana, west of San José (TT, Aug. 19), where 97 cases later emerged, according to Ivette Solano, representative of COOPESANA, a union of Santa Ana’s seven Basic Health Care Clinics (EBAIS).However, Solano explained the epidemic has struck the entire country, and people should be alert in all regions. The doctor explained that San José’s high population density could lead to an even faster spread of the virus, which has already claimed the lives of two victims in Costa Rica this year.THE families of Guiselle Umaña, 29, and Christian Rodríguez, 24, who died of hemorrhagic dengue in recent months, are pursuing legal action against the Social Security System (Caja) for alleged medical malpractice in treating the patients, the daily La Nación reported.Umaña, who died at Hospital San Juan de Dios in downtown San José on Oct. 2, and Rodríguez, who died at Hospital Monseñor Sanabria in the Pacific port city of Puntarenas in August, became the first dengue fatalities in Costa Rica since 1999, when two dengue deaths were reported. Umaña’s husband, Alexis Mora, told La Nación doctors cut an incision in Umaña’s stomach to determine what ailed her, and she died a few hours after entering the San Juan de Dios emergency unit.In Rodríguez’s case, his family may file a complaint against the Caja for neglect while he was hospitalized, claiming that a blood transfusion the night before his death might have saved his life (TT, Aug. 26).The Tico Times contacted the Caja for comments but had not received a response by press time.ALTHOUGH no vaccine exists for dengue, transmitted by female infected aedes aegypti mosquitoes, experts are seeking ways to stop the disease from spreading.Researchers from the University of Kentucky, in the United States, have taken steps to create a breed of genetically modified dengue mosquitoes incapable oftransmitting the virus, according to La Nación.By introducing a gene into a pool of male dengue mosquitoes to make them resistant to the virus, researchers predict that by the seventh generation of mosquitoes, 100% of the population would carry the gene, the daily reported. Researchers are planning to introduce the genes in dengue mosquitoes as their investigation continues.Costa Rican researchers are entering the third year of an investigation to identify a method of eliminating dengue larvae with two microfungi (TT, Sept. 2). DENGUE larvae, deposited wherever water is accumulated, can survive dryness for more than a year, but hatch during the rainy season in May-November. This year’s heavy rains have worsened the problem.Dengue symptoms include digestive disorders such as diarrhea and vomiting, a sudden, fast-rising fever of more than 38 degrees Celsius that can last five to seven days, pain behind the eyes, rashes and strong headaches (TT, July 15).Hemorrhagic dengue, a more severe form of the illness, includes all the classic dengue symptoms but may result in death.This type of dengue usually only occurs in people who have had dengue before.To avoid contracting the disease, health authorities recommend eliminating standing water in and around the home and using insect repellent.AVIAN flu, which has only affected humans in four countries so far this year, is deadlier than dengue, presenting a 52% mortality rate in the total number of cases worldwide, according to Daniel Salas from the Public Health Ministry’s Health Vigilance Unit.Of the 117 cases of avian flu that emerged this year in Indonesia, Thailand, Cambodia and Vietnam, 60 have resulted in death, Salas said.According to Health Minister Sáenz, the risk of this flu turning into a pandemic (worldwide epidemic) exists, but no one knows when it might happen.“(A pandemic) could happen in two years, two months or two days,” she told The Tico Times.The World Health Organization has detected five phases of transmission of this virus, starting from bird to bird at phase one, and ending as a pandemic at phase five.The virus now stands at phase three – a pre-pandemic alert phase in which the virus is being transmitted from birds to humans, Sáenz said. If human-to-human transmission begins, it will enter a more severe phase four.SALAS said avian flu presents similar symptoms to a common respiratory infection, and can only be identified as avian flu over time. Symptoms can include a fever of more than 38 degrees Celsius, sore throat, coughing and breathing difficulties, he said.To prepare for a possible pandemic such as the one that struck in 1918 as the Spanish flu took the lives of almost 40 million people around the world, the World Health Organization has urged countries to create national plans to respond to a worldwide health crisis, according to Sáenz.In Costa Rica, members of the Health Ministry, the Ministry of Agriculture and Livestock (MAG), the National Emergency Commission (CNE) and public hospitals, among other institutions, started working on a national plan four months ago, Salas said.The plan is almost 85% complete and should be finished in the following months, according to Salas. He added that the group may soon become an official commission within the Ministry of Health for preparation for a pandemic.ACCORDING to Minister Sáenz, in the face of a global health crisis, Costa Ricans need to stay alert and healthy, taking every possible precaution not to catch cold. Although the virus is now contracted through continued exposure to infected birds, human-to-human transmission would make it spread as a common cold does.Experts agree the disease cannot be transmitted by eating poultry, unless it is consumed raw and in large quantities.Like dengue, avian flu has no known cure, but Tamiflu, an antiviral medicine from Roche pharmaceutical company that reduces chances of contracting the virus by 89%, will soon be available in the country, the daily La República reported.Because of the high demand that exists for this medicine, Roche will distribute it in Costa Rica only through the Caja, according to Salas.He said a vaccine for the pandemic could only become accessible five to six months after it strikes – the estimated time it could take experts to create the vaccine and distribute it commercially.ALTHOUGH Salas said the country’s hospitals do not have the capacity to handle a pandemic, the national plan aims to prepare them for one.The plan includes a recommendation for the Caja to create a contingency plan for its hospitals, said Salas, who affirmed that a pandemic can be expected with certainty.Many of San José’s public hospitals, including Hospital Calderón Guardia, decimated by a fire in July (TT, July 15), are already full, according to La Nación.Officials from Hospital San Juan de Dios recently admitted an increased number of emergency cases that has caused the hospital’s capacity for attention to collapse, the daily reported – and last month, Hospital San Vicente de Paul in the province of Heredia became so overcrowded with dengue patients that it was forced to recondition its chapel to hold them.In the Caribbean province of Limón last month, 40 beds had to be placed in an auditorium in one hospital, while dengue patients crowded in he hallways of the emergency unit of another. The situation led Caja Medical Manager Marco Antonio Salazar to tell the daily the hospital overcrowding is an “emergency.”


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