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Dengue Study Confirms Ongoing Threat of Disease

On a fellowship for training in applied epidemiology, Valerie Mac conducted a dengue study in V.I. schools; here she works in another program, helping with Covid-19 testing. (Photo courtesy Valerie Mac)

Sun, sand, sea — and dengue. It’s been 10 years since the territory’s last outbreak, but a recent study among Virgin Islands school children finds the dengue virus is still very much a part of island life.

Based on a testing sample, health experts have estimated five in 10 V.I. elementary school-aged children have already had at least one case of dengue. Older residents obviously have more of a chance of having been exposed.

The results of the test mean the Virgin Islands qualifies for use of the recently developed dengue vaccine, Dengvaxia, which is FDA approved only for people aged 9 to 16 who have already had dengue at least once and who live in an area that has a proven prevalence of dengue. However, there are no immediate plans to introduce its use in the territory.

For now, the emphasis is still on education, prevention, treatment, and the control of mosquitoes that spread the disease.

Dengue is considered endemic in the territory, meaning it is regularly found in the islands.  The last outbreak was in 2012. And since 2016, there have been only 16 documented cases, but experts believe an outbreak is overdue.

In an interview with the Source Thursday, Territorial Epidemiologist Esther Ellis and Valerie Mac, who’s working in the territory on a fellowship through the Centers for Disease Control and Prevention, stressed the potential seriousness of the disease and the importance of staying vigilant to combat it.

Given the heavy rains this week, “it’s a perfect time to bring this up,” Mac said, referencing the fact that mosquitoes breed in water and tend to proliferate after rains.

Last spring, Mac headed up a small team conducting “a very, very large outreach effort” in private and public schools on St. Croix, St. Thomas and St. John, reaching 1,400 students in grades 3 to 7.

Of those, 372 students, with parental consent, took part in the testing, which required a finger-stick to draw a small bit of blood which was analyzed to determine whether dengue antigens were present. The presence of the antigens confirmed the child encountered the disease at some time, although it could not pinpoint exactly when.

A “Dengue Day” outreach school program taught children the basics about dengue and the Aedes Agypti mosquito that acts as a vector, transmitting the virus through its bite.

Mac said the program can be repeated if any school wants it. “It’s available if needed and if desired,” she said.

Dengue symptoms range from mild to severe and commonly include nausea, vomiting, body aches and pains, rash, joint and bone pain, and pain behind the eyes.

About one in 20 infected people may get serious complications such as hemorrhagic fever, associated with increased bleeding and can lead to dengue shock syndrome. Warning signs for a severe case are belly tenderness and pain, frequent vomiting and blood in vomit or stool or from the nose or gums. Restlessness, irritability and fatigue are also indications of a severe case.

“Persons with sickle cell may be especially at risk for complications,” Mac said.

At the other end of the spectrum, many people have dengue and don’t know it, because only one in four people infected with the virus actually develop symptoms. Many others may have mild symptoms that mimic those of other illnesses, such as the flu.

Less than one percent of parents whose children had dengue, as revealed by the test, were previously aware their child had had it.

But having escaped symptoms once is no guarantee a person won’t ever get symptoms. There are four strains of dengue, two of which have been identified in the Virgin Islands. No one has full immunity unless they have had all four strains.  And, the second time a person contracts dengue, it is more likely to be severe.

All that is a reason to work on prevention, according to health experts.

That starts with controlling the mosquito population and includes protecting against mosquito bites.

“It does really matter what you do in your community (and) around your home,” Mac said. People should clear debris and empty any standing water such as in flower pot saucers or buckets or old tires. It’s also important to scrub out water containers because dry mosquito eggs can survive for three months — possibly longer — in drought conditions and become viable with the next rainfall.

Other recommendations

· Wear light-colored clothing with long sleeves and long pants.
· Use mosquito repellant on exposed skin and on clothing, especially at dawn and dusk when Aedes Agypti mosquitoes are most active.
· Spread the word about the importance of controlling mosquitoes.

Currently, there is no dengue-specific medicine or other treatment for dengue; however, Mac had common-sense advice for dealing with the disease:

· “Staying hydrated is key” as it is in most illness that depletes the body’s water.
· Avoid aspirin and ibuprofen because of bleeding risk. Instead, use acetaminophen (aka Tylenol or paracetamol) for pain.
· Rest.
· Stay alert for signs of severe dengue, and don’t be lulled prematurely into a false sense of relief. The first signs typically occur 24 to 48 hours after a fever is resolved.
· Consult a physician.

The Health Department offers free testing through local health care providers, Mac said.

Ellis said the testing results do qualify the territory as a place where the Dengvaxia vaccine could be used.

“This is really the first test” in determining whether to use the vaccine, she said, but there are other factors to consider including how to set up a network for distribution. Right now, “We do not have the vaccine here.”

There’s also the question of whether the public wants the vaccine.

As part of the pilot program, parents filled out surveys that included a question asking whether they would vaccinate their child if a vaccine were available.

Mac said 25 percent of parents said they would and 27 percent said they wouldn’t. The remaining 48 percent responded that they were not sure. To Ellis and Mac, that adds up to nearly 75 percent of parents either in favor or open to the possibility.

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