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Health Department Addresses Dengue Concerns

June 29, 2005 – The panic on St. Croix over whether dengue fever has become an epidemic, in a small way, might be helping health officials.
Dr. Marc A. Jerome, Health Department officer, said at a press conference at the Charles Harwood Medical Center Wednesday that "emergency room personnel have a heightened awareness of the disease and residents who once were willing to sit home and take their chances are now seeking professional care."
He said the heightened awareness is due to the death on June 18 of a fourteen-year-old student at St. Croix Educational Complex. However, he pointed out that the vast majority of cases of dengue, while being "very hurtful," generally are not fatal.
He said less than 10 percent of the reported cases are of the acute type, and less than 15 percent of the acute type lead to death.
One recurring theme at the conference — which featured Jerome, Health Commissioner Darlene A. Carty; and Health Department epidemiologist Dr. Eugene Tull — was that the department needed more information from the public, doctors and hospitals.
Carty pointed out that an epidemiologist was a new position in the Health Department. Tull said that when he came on board in February, the first thing he did was upgrade forms, so reports of diseases would be more readily filled out. He said that up to this point compliance by physicians and hospitals reporting diseases like dengue fever has been very poor. He said that lack of reporting has made it impossible to decide whether this year is actually worse than any other year, that no baseline has been established. He did add that what has been reported this year appears to be similar to what was reported last year.
The gap between suspected cases of dengue and confirmed cases remains wide. On St. Croix there have been 11 confirmed cases and 143 suspected cases this year. On St. Thomas there were nine confirmed cases and on St. John three.
Jerome pointed out that the present situation is complicated because there is also an outbreak of flu on the islands, and the symptoms of flu and dengue are similar.
A patient's blood samples must be sent to the Center for Disease Control in Puerto Rico to confirm Dengue. If a rush is put on, the results could be returned in four days. However, generally no speed is requested because diagnosis does not affect the treatment. Jerome said the treatment consists of telling the patient to get plenty of rest, drink plenty of fluids and take pain killers. Taking aspirin is not recommended.
The officials said there were "hot spots" on St. Croix — areas where more than half a dozen cases of dengue have been reported. Williams Delight appears to be the hottest hot spot. Also listed were Estate Whim, Glynn and Barren Spot. Housing projects are also becoming a problem. Health officials are making visits to those areas and making an effort to eradicate the mosquitoes. A fogging program was in effect earlier this year but has been discontinued. Carty said the fogging program would be restarted.
Tull said that fogging was one of the least effective ways to fight dengue. The mosquitoes that spread dengue are the type that live in houses. Jerome said, "They live behind your drapes. They come out in the morning and in the evening to feed."
The health officials recommended fixing holes in screens, keeping windows without screens closed, putting on insect repellent and spraying inside the house. Also, they gave the standard warning concerning any standing water – eliminate it.
Abandoned cars and tires remain a breeding spot for mosquitoes. St. Croix Administrator Gregory Francis, who attended the conference along with Sens. Terrence "Positive" Nelson and Juan Figueroa-Serville, said a task force on the island had picked up 3,000 abandoned cars on St. Croix in the last two years, and it plans to step up efforts in the coming months.
The officials also mentioned an effort to get guppies back in island ponds. According to Tull, guppies used to be in all island ponds when he grew up on St. Croix. He said guppies eat mosquito larvae.
Medical Examiner Dr. Michelle DuPre said in a June 24 statement that Kamarah Isaac, the 14-year-old student, died of a rare complication of dengue, called dengue shock syndrome.
(See "Health Department: St. Croix Girl Died of Dengue Shock Syndrome".)
Dengue Fever symptoms include severe headache, joint and muscle pain, nausea, vomiting; high fever and loss of appetite, in some cases a rash may also appear three to four days after the fever begins.
The incubation time for the disease is about a week, according to Jerome. The symptoms won't appear until six or seven days after the bite.
The officials said there are actually four different types of Dengue, and after a person is infected with one type, he or she will be immune to that type.
Tull said that 62 percent of the V.I. cases that were tested showed they were secondary infections. He said this showed, "Dengue has been around for a while."
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