Forward planing underestimated dengue outbreak

Every year there are some registered dengue fever cases in El Salvador. In 1999, the number of cases was low, including only a few cases of Dengue Haemorrhagic Fever (DHF). Plans made by the Ministry of Health (MOH) for coverage this year were based on last years figures. Because of this, when the first cases appeared in May and June, the MOH underestimated the scale of the epidemic. But the number of cases increased rapidly, with a very high fatality rate for DHF (12%).

The epidemic exploded in the capital, San Salvador, and extended to all of the other departments in the region. El Salvador is divided into 14 depts and all have registered cases. Some are much more affected than others. As of October 9, there were 2,428 confirmed cases of classic dengue with 311 confirmed haemorraghic cases. In addition, there are a further 10,858 suspected classic dengue cases in the country.

The MOH declared a national emergency on September 12 and, two days later, made an international appeal for assistance. A delegation of experts from the region came as well as two large delegations from Cuba and Mexico - both countries having extensive experience in dengue epidemics.

Almost all of the assistance has focused on three aspects:

  • case management
  • vector control
  • community health education

    Case management involves active and early case finding, disease surveillance and reporting within the community, health centres and hospitals as well as training medical staff (including medical students in their last year).

    Vector control, which aims to reduce the number of mosquitoes and larvae, involves removing garbage, fumigation and putting powder in water to kill mosquito larvae.

    Community health education involves distributing information on the early signs and symptoms of dengue, the importance of seeking health care, and vector control within the household.

    MSF involvement

    As most of the international attention has focused on San Salvador, MSF chose to focus on three other departments: Sonsonate (pop: 450,000), San Vicente (pop: 175,000) and La Paz (pop: 300,000) MSF's work will only cover those municipalities that are most affected.

    These departments are among those worst hit after San Salvador. Also, MSF has been running a post-Mitch project in these departments, and this previous knowledge of the system and context eased the running of the programmes.

    MSF's work was planned to cover vector control, case management and community education.

    However, Initial assessments carried out by a doctor and nurse from MSF emergency team in Amsterdam, suggest that case management is well covered by the Mexican and Cuban delegations. Around 2,000 medical and paramedical from the entire country have received short training on case management by the Mexican and Cuban delegations

    From this first evaluation, there is no real need for MSF. However assessments are continuing, mainly in the three departments.

    Given the coverage already provided, MSF will therefore concentrate on vector control and health education activities, working in close collaboration with the MOH and the Cuban and Mexico delegations. This work has already started, and includes:

  • sanitation
  • water treatment to kill larvae
  • health education
  • active case finding.

    At present, the epidemic curve is dropping. But that does not mean everything under control. El Salvador is a densely populated country and there are frequent population movements from region to region, all of which can lead to increase in disease if the mosquito population is allowed to increase.

    The Dengue project is a four-month project funded by ECHO