Puerto Rico Declares Dengue Epidemic

Oct 18, 2012 | Steven Purcell | Outbreak News

Health Secretary Lorenzo Gonzalez Feliciano announced Monday, Oct. 8 that Puerto Rico is in the grips of a dengue epidemic. At least six people have reportedly died, two of them children under 10 years old in the San Juan area. As of Monday, a total 4,816 individuals have reportedly suffered, with 21 possible cases of potentially fatal hemorrhagic dengue. While the 4,816 number represents a total 2012 cases through Oct. 5, 274 cases were reported in the first week of September, followed by 342 cases Sept. 9 through Sept. 15. When suspected cases pass the 75th percentile based on historical data between 1986 and 2008, the CDC declares epidemic status. Both of September’s case counts represent a breach of the threshold used to determine epidemic levels of disease, according to Gonzalez Feliciano. He noted that over half of the cases have been confirmed by a laboratory.

Dengue, also known as ‘breakbone’ fever, is spread when an infected mosquito transmits the virus to humans. Symptoms generally aren’t seen until four to seven days post-infection. The victim is first hit by sudden high fever, often followed two to five days later by a flat red rash over most the body. Later in the disease progression, individuals experience another rash resembling measles. A distinction is made between dengue and ‘dengue hemorrhagic fever’ which is caused by the same virus but exhibits much more severe symptoms and is potentially fatal. Early symptoms are similar to dengue fever, but escalate after a couple of days to include irritability, restlessness, and sweatiness. These develop into the acute phase to include bruises, generalized rash, and petechiae (spots on the skin caused by broken blood vessels), before the patient enters a ‘shock-like’ state.

Dengue is endemic to Puerto Rico, which sees 3,000 to 9,000 cases in non-epidemic years. The worst epidemics since 1990 saw 24,700 cases in 1994, 17,000 in 1998, and 10,508 in 2007. During the most recent epidemic in 2007, half of the cases were hospitalized, and one third were reportedly hemorrhagic.

The Health Secretary has asked the department’s epidemiologist to implement the latest CDC guidelines for dengue case management in addition to ensuring the Health Department’s latest procedures and guidelines are up to date. In addition, the department has discussed rolling out a call center to follow-up with dengue patients in addition to fielding calls concerning potential mosquito breeding hot spots.

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