Santo Domingo.- The Vice Minister of Collective Health, Eladio Perez, has no fixed date for the dengue epidemic to decline. He thinks that the country is now facing a plateau. If there is no drop in cases, the disease affecting the Dominican Republic could continue its impact until the end of the year, according to infectologists.

The official has the perception that in the coming weeks if the current behavior continues, the disease could go down. He believes that there is a slight drop in patient admissions.

You can read Ariel Henry to the UN: “The Republic of Haiti is not at war with anyone.”

There will always be cases because the disease is endemic. The cessation of the high incidence will depend on the pattern; if it continues now, there will be fewer cases in the coming weeks, said the official who manages the country’s collective health.

“We need a little more time, if the disease continues to go down the country would be in improvement,” said the epidemiologist. In his opinion, the final phase of the disease cannot be determined by the behavior of a week.

Clinics to attend
The director of the National Health Service (SNS) hospital network, Yocasta Lara, asked the directors of the National Association of Private Clinics (Andeclip) to provide more beds.

In the public sector, the clinics refer patients to them, most of whom are under 19 years of age.

Almost all the cases are being attended by two large public hospitals and one of a patronage hospital.

The Hugo Mendoza pediatric hospital leads in admissions, followed by the Robert Reid Cabral and the General Hospital of the Plaza de la Salud in third place.

The Santiago Clinic, Unión Médica, and the Arturo Grullón hold the fourth place in the same city. The Jaime Mota de Barahona also has cases of children and adults.

Behavior
The end of this epidemic outbreak, as the authorities have called it, will depend on the behavior of the vector through which the disease is transmitted, the Aedes aegypti mosquito.

The hospitals
Dr. Yocasta Lara, director of the SNS hospital network, reported yesterday on the number of patients admitted with dengue fever.

She also reported that the Robert Reid Cabral hospital had 64 children admitted. Three children remain in intensive care at this center.

The Marcelino Vélez Santana hospital has 21 admissions, the Juan Pablo Pina, 10, the Arturo Grullón, 13, and 12 at the San Lorenzo de Los Mina. Lara indicated that the Jaime Mota hospital in Barahona has 26 patients admitted: Jacinto Mañón, seven; El Almirante, six; Boca Chica, 19; and Félix María Goico, three admissions.

Plaza de la Salud
At the Plaza de la Salud General Hospital (HGPS), where many patients, mostly children, have been treated, 17 patients were admitted yesterday and are still waiting.

Santiago, DR.- The number of patients affected by dengue fever has increased among children in the last few days here, while among adults, the cases are sporadic and isolated, according to reports from the three most important public hospitals in this province.

Reports also indicate that private clinics continue to receive patients with symptoms of the disease transmitted by the Aedes aegypti mosquito.

The director of the children’s hospital, Dr. Arturo Grullon, Dr. Mirna Lopez, reported that this health center handles an average of 15 to 20 patients affected by dengue daily, experiencing a slight increase in emergency and outpatient consultations of febrile patients.

Dr. Mirna López, director of the children’s hospital, Dr. Arturo Grullón.

She said that of the total number of children admitted, only one is in intensive care, and his health remains stable. So far this year, two patients have died from the disease.

López explained that most of those affected by dengue come from different sectors of Santiago, such as Pueblo Nuevo, Cienfuegos, Jacagua, San José de Las Matas, as well as Montecristi and other towns of the Cibao region.

Meanwhile, in the hospitals José María Cabral y Báez and Presidente Estrella Ureña, the cases of dengue fever are sporadic. For example, at the Cabral y Baez hospital, there have been six cases of dengue in the last 15 days; 4 of them were admitted and subsequently sent home, according to the medical director, Manasés Peña.

Only two patients had been admitted to the Presidente Estrella Ureña Hospital recently.

President Estrella Ureña Hospital
On the other hand, the provincial authorities of Public Health informed that they continue the fumigation and cleaning up of garbage in various sectors of Santiago as a prevention against dengue fever and other diseases transmitted by vectors.

The cleaning activities, orientation, and education to combat dengue are conducted in schools, colleges, and neighborhood councils.

Dengue mosquito (External source)

Dengue mosquito (External source)

Corominas Clinic

At the Corominas clinic, one of the traditional private health centers in Santiago, there are currently 16 hospitalized patients, 2 of whom are in the intensive care unit, none of whom have died.

Influenza viruses are constantly changing; for this reason, every year, the composition of influenza vaccines is reviewed in the United States and updated as necessary to match as best as possible with the viruses, which, according to research, will be the most circulating in the season that is starting.

A detail
Dr. Jhan Gonzalez, a pulmonologist, indicates that the suggestions regarding the annual vaccination against influenza have some modifications, such as, for example, a change in the vaccination recommendations for people with egg allergy.

The specialist explains that the timing of influenza vaccination has not been modified; September and October are the best months for most people to get vaccinated. Vaccination is not recommended in July and August in most cases, but there are some considerations for certain groups of people in July and August.

Over 65 and pregnant women
For adults (especially those 65 years and older) and pregnant women in their first or second trimester, vaccination should be avoided in July and August unless they are not likely to be vaccinated in September or October.

Pregnant women in their third trimester can be vaccinated in July or August to ensure that their babies are protected against influenza at birth.

Children
Children who need two doses of influenza vaccine should receive their first dose as soon as it becomes available. The second dose should be given at least four weeks after the first dose. Vaccination in July or August may be considered for children who have medical appointments in these months if there will not be another opportunity. The physician from Centros de Diagnóstico y Medicina Avanzada y Telemedicina (CEDIMAT) assures that vaccination is still recommended as long as there is circulation of influenza viruses that pose a risk. In some seasons, this period may extend until the end of May or June. Gonzalez points out that the effectiveness of the influenza vaccine may depend in part on the coincidence between the vaccine’s viruses and those circulating.

Estimates
According to preliminary estimates, last season, people vaccinated against this disease had between 40% and 70% less risk of hospitalization due to influenza or its associated complications.

People with egg allergy
The significant change in influenza vaccination recommendations for 2023-2024 relates to administering the vaccine to egg-allergic persons. The physician says most current vaccines are still produced with an egg protein culture process and, therefore, contain a small amount of egg proteins, such as ovalbumin.

Recommendation
The CDC advises that the best way to reduce your risk of seasonal influenza and its potentially serious complications is to get vaccinated every year, this October.

Again, the Hugo Mendoza pediatric hospital had an admission of 92 children under 15 years of age, and the Robert Reid Cabral hospital had 65 admitted. This is happening while the flow through the emergencies is being maintained.

Dr. Yocasta Lara, director of the National Health Service hospital network, offered the information. She assures that most of the provinces are without admissions. As the authorities call it, the epidemic is concentrated in Greater Santo Domingo, the National District, La Vega, Santiago, and Barahona.

The Marcelino Velez hospital yesterday had 17 patients admitted for dengue fever, the Jacinto Mañon, 07,5, and the Arturo Grullon hospital in Santiago had 18 patients admitted.

Situation
More than 7,000 cases of the disease have been registered in the country, but a high underreporting suggests a higher number of people affected. Authorities are investigating ten deaths due to dengue, and six have been confirmed. The population is urged to avoid mosquito breeding sites.

The disease
Dengue is a viral disease transmitted by the bite of the Aedes aegypti mosquito.

The mosquito lays its eggs, which develop into larvae and reproduce. Entomologists study its behavior.

This is an epidemic year, so authorities have called the population to avoid mosquito breeding sites. They are asking people to clean gardens and areas with trees.

This week, Dr. Eladio Perez, Vice Minister of Collective Health, said that the indicators in the country remain well below those of other countries in the Americas region, thanks to the interventions being carried out.

He also presented the behavior of dengue to the 35th Epidemiological Week, where he detailed that currently, 3,123 cases were reported as suspected, and in the last week, they reported 1,093 six deaths.

Santo Domingo.- The clinical symptoms of dengue can be confused with other diseases ranging from leptospirosis to hepatitis, which is why it is important to perform a comprehensive medical evaluation of the patient and laboratory tests.

This is what the infectologist Elianet Castillo, from the Centro Médico de Diabetes, Obesidad y Especialidades (CEMDOE) warns when referring to the current epidemic outbreak of dengue that is affecting the country and that is leading to a high demand for medical attention.

The specialist explained that it is important to know that dengue is characterized by symptoms of fever, headache, retro ocular pain, general malaise, rash, joint pain and muscle pain.

These symptoms and signs, he said, can be confused with other diseases that are also part of the country’s local epidemiology, such as malaria, chikungunya, zika and leptospirosis,” he explained.

He explained that when the patient with dengue presents alarm signs such as nausea, persistent vomiting and abdominal pain it could represent a challenge because it could also be confused with other infectious diseases affecting the gastrointestinal system such as hepatitis or inflammation of specific organs such as the gall bladder (cholecystitis) and the appendix (appendicitis).

Malaria and Leptospirosis

Castillo pointed out that in the case of malaria, chikungunya and zika, they also present with fever. “Generally, compared to dengue, they do not cause as many alterations at the hematological level and do not usually cause as much morbi-mortality.”

He said that leptospirosis, which usually increases its incidence after heavy rains and floods, can present symptoms very similar to dengue, and being a bacterial disease requires treatment with antibiotics to prevent progression to its terminal stage called Weil’s syndrome where severe kidney and liver damage occurs, reaching a 50% mortality rate.

This shows, added the specialist, the importance of a comprehensive medical evaluation and the performance of the necessary laboratories to reach an accurate diagnosis and thus speed up the appropriate treatment of the patient.

Santo Domingo.- The Minister of Public Health, Dr. Daniel Rivera, together with the provincial authorities of the ministry, led this Saturday a day of fumigation and decacharrización in various neighborhoods of the Gurabo sector, north of this municipality, as a prevention against dengue and other vector-borne diseases such as leptospirosis.

The activity, organized by the Provincial Directorate One, directed by Dr. Adalberto Peña, included the communities of Los Platanitos, La Chichigua, Los Cajuiles, streets 7, 19, 20, and a part of the Gurabo River, among others, where there have been some suspected cases of dengue.

Minister Rivera said that on instructions from President Luis Abinader and Vice President Raquel Peña, Public Health continues to work on the prevention and promotion of programs to combat diseases and that, thanks to this effort, in the country at this time there are no reports of cases of Zika and Chikungunya, while leptospirosis and cholera are controlled.

Rivera called on the population to cooperate with the authorities by covering their tanks at home by smearing chlorine to avoid breeding the Aedes aegypti mosquito that transmits dengue.

He also thanked the president of the Dominican Municipal League (LMD), Víctor D’Aza, the mayor of La Vega and president of the Dominican Federation of Municipalities (Fedomu), Kelvin Cruz, so that the municipalities are integrated into the conference and contribute to the cleaning, eliminating improvised landfills where water accumulates and the mosquito is produced.

Rivera also highlighted the work, dedication, dedication, and effort of doctors, nurses, and epidemiologists in each preventive day carried out by the Ministry of Health throughout the country.

“An uncovered water tank can produce up to 120 mosquitoes per day, which would be difficult to control,” said the official, who added that the epidemiological fence will be maintained for at least four more weeks until the temperature change occurs.

The minister and president of the Health Cabinet recalled that dengue is endemic in the country and the Americas. He said the disease had been declared a WHO and PAHO alert for the El Niño phenomenon and global warming, increasing the highest incidence of the disease in countries such as Brazil, Peru, Bolivia, and Ecuador, which have suffered remarkable historical elevations.

In addition to Minister Rivera and the provincial manager One, Adalberto Peña, the regional director of Health, Dr. Virgilio Gutiérrez, the person in charge of DPS 3, Dr. Carolina Núñez and the professional and technical team of DPS 2, representing Dr. Pedro Felipe, they participated in the day.

Lethality and suspected cases

The Minister of Public Health, Dr. Daniel Rivera, explained that the lethality of dengue cases in the country is currently 0.04%, a low proportion compared to last year for the same date. He said the most significant concern of detected issues is registered in Santo Domingo Norte. About Santiago, the official indicated that this province does not have a high incidence. He reported that until this Saturday, 26 cases had been said, that is, half that occurred last year about the disease.

Vulnerable population

Minister Rivera reported that the population most vulnerable to contracting dengue are people between 9 and 19 years old, especially those previously suffering from the disease.

He said that the mosquito that transmits the dengue virus attacks more in the lower limbs because it is always under the table and bed. He noted that the mosquito is more attracted to the person with type O blood.

Zero self-medication

Rivera urged people who present fever during this epidemiological alert not to self-medicate and go to public and private health centers, where he said there are specialists trained to provide service. He recalled that going to the doctor promptly prevents severe cases and deaths.

The most significant number of admissions is at the Hugo Mendoza pediatric hospital, with 93 children in bed, while the Robert Reid Cabral hospital had 51 as of yesterday afternoon. In the emergency rooms of public and private centers, cases of sick people are constantly arriving. Other hospitals with a high influx of patients are the General de la Plaza de la Salud, with 38 patients admitted, and the Ramon de Lara military hospital, with ten adults admitted.

According to health authorities, the country is going through an epidemic outbreak of dengue fever, which has registered more than six thousand cases. However, historically, the disease has been underreported by more than 50%.

Other hospitals with patients admitted for dengue are Rodolfo de la Cruz Lora, with 20 patients; Juan Bosch, with 15, Boca Chica, with 15 more, El Almirante, with 10 and 12 at Marcelino Velez Santana.

Interventions continue
The Ministry of Public Health reported that it continues to carry out an extensive operation against cases of dengue fever in Santo Domingo North. The highest incidence of the viral disease is felt in Santo Domingo, the National District, La Vega, San Cristóbal, and Barahona. For the past few weeks, fumigation and pest control operations have increased in the municipality of Santo Domingo Norte to mitigate the cases of dengue fever registered in this district and surrounding areas. Everyone’s participation is required.

The operation seeks to prevent the spread of dengue fever through the mosquito breeding sites that generate waste and debris accumulated in yards and plots of land. The process was carried out in the neighborhood of Las 5 Esquinas de Los Guaricanos, where it began with house by house, alleyways, and patios, followed by fumigation to combat the larvae and eggs produced by the mosquito (Aedes Aegypti), which transmits the disease.

This is the third intense operation carried out by the Ministry of Public Health through Area III of Health in this demarcation, where more than two thousand houses of Santo Domingo Norte have been intervened given the epidemic outbreak of dengue fever in the country, said the authorities.

At the national level, the health system reports more than 303 suspected cases of dengue fever. Still, most of them are concentrated in the National District and Santo Domingo province, mainly in Santo Domingo Norte, where the authorities are redoubling awareness campaigns to families to eliminate mosquito breeding sites that produce the disease.

The director of Area III of Health reported that so far this year in Santo Domingo North, there have been 700 cases of dengue fever.

Dr. Mabel Jones, director of the Robert Reid Cabral Children’s Hospital, reported that four patients have died from the disease. At the same time, seven are being investigated while specifying minimal suspected cases in the country’s interior.

He explained that yesterday, three cases were reported in the Valdesia region, one in the Jacinto Mañón hospital, 11 in the Arturo Grullón hospital, 4 in the San Vicente de Paúl hospital in San Francisco de Macorís, 2 cases in Samaná. Mothers of the children explain that they go to the centers after their children present febrile symptoms for more than three days, after suspecting that they could be affected by dengue fever.

Jenny Mojica, from San Cristobal, went to the Robert Reid Cabral hospital with her 10-year-old daughter yesterday because she had been suffering from a fever for six days.

Another, who is only identified as Banelia, is also waiting for attention from San Cristobal’s pediatric center with her four-month-old baby girl, who has been suffering from fever and vomiting for three days.

María Guerrero came to the Robert Reid Pediatric Center from Baní because her son has been feverish since last Tuesday. Walkiris Sanchez was waiting for her turn with two children at the Santo Socorro Children’s Hospital in Cristo Rey, from La Javilla, Villa Mella, Santo Domingo Norte, because they have had a fever and headache for the last three days.

Victoria Zabala arrived at Santo Socorro from La Mina de Los Guaricanos because her daughter had suffered from high fever for several days. She chose not to go to the Hugo Mendoza hospital, within the Ney Arias complex, because this center is full of patients.

At Hugo Mendoza, it was impossible to enter the consultation and emergency areas due to heavy restrictions for journalists. However, from outside, the emergency room was observed to be full of patients waiting to be attended. At San Lorenzo de Los Mina hospital, no cases were reported.

The presence of dengue serotype three is causing an increase in the number of disease cases in the country and a greater demand for medical care.

This serotype (DENV-3) has not circulated in the country for several years and, therefore, has found more susceptible people without contact with it.

This was revealed yesterday by the Vice-Minister of Collective Health, Dr. Eladio Perez, who recalled that in general in the country, the one that has circulated the most each year is serotype 2, which has always been present in recent years.

He explained that although the severity of this dengue serogroup is not more significant, there is a lot of vulnerable population that does not have the immunity it has against serogroup 2, which has always been the most present in the Dominican territory.

Dr. Perez was interviewed while participating in the opening ceremony of the third Annual Meeting of Epistemic Communities 2023 held in the country with the theme Emerging Technologies and Community Empowerment, organized by Two Oceans In Health (2OIH).

Santo Domingo and Santiago

He reported that the presence of dengue serotype three was identified in Greater Santo Domingo and Santiago, among other locations in the country, but that, nevertheless, the endemic corridor has exceeded the number of cases expected to date. Still, it has not yet entered an unmanageable stage.

He informed that currently, the highest number of dengue cases is in Santo Domingo Norte, where interventions are being carried out by the Ministry of Public Health together with the Mayor’s Office and the National Health Service, with the removal of garbage, fumigation, and awareness and education.

He said that there is a greater affluence of patients coming to the health facilities’ consultation services but that the parameters of hospitalization remain within the expected.

In the region

“We have in the country a serogroup of dengue in the country the three, which had been found previously, but had already several years that was not present, in that sense there is a lot of vulnerable population,” said the deputy minister of collective health.

He pointed out that dengue is on the rise throughout the region, and data from the World Health Organization indicate that the Dominican Republic is the country with the best indicators.

In 2023, noted the Vice Minister of Public Health, the region of the Americas has experienced a significant increase in dengue cases. So far, more than 3 million new infections have been recorded, surpassing the figures for 2019, the year with the highest recorded incidence of this disease in the region with 3.1 million cases, including 28,203 severe cases and 1,823 deaths.

Four serotypes

The four dengue serotypes are DENV-1, DENV-2, DENV-3, and DENV-4, which circulate in the different countries of the Americas, and there may be cases where all of them circulate simultaneously.

According to experts, infection with one serotype followed by another condition with a different serotype increases a person’s risk of severe dengue fever and even death.

Dengue is transmitted to people by the bite of the Aedes aegyptis mosquito that breeds in clean water, especially that which accumulates in or around homes. The recommendations for its control are to eliminate containers that become breeding places, cover water used for domestic use, and go to the doctor at the first symptoms of the disease, which begins with sudden fever, pain behind the eyes and head, and general malaise.

Scientific meeting

The meeting of Epistemic Communities held yesterday in the country brought together renowned researchers who discussed different topics related to artificial intelligence and the role of technology and science in the face of future pandemics.

The renowned researcher Dr. Jeffrey V Lazarus, PhD, MIH, MA. Director of the Health Systems Research Group at ISGlobal, University of Barcelona, Spain, was in charge of the Inaugural Conference of the event, with the theme “Delphi Method as a catalyst of epistemic communities: international approach for the response to COVID-19 and future pandemics”.

The activity was organized by Two Oceans In Health (2OIH), which is a health research center dedicated to building knowledge that empowers communities in the Dominican Republic through Health Research, Data Management, and Academic Initiatives, led by researchers Eddy Perez Then and Marija Miric.

“The problem is the hepatitis B treatment, which we demand also be assumed by the program,” asked Luisa Paradas, president of Funpaheinm, who also requested that the ARSs include the treatments in their coverage, as she had told journalist Olga Vergés, of Hoy newspaper.

Paradas explained to the reporter that, although the treatments for hepatitis B and C virus are low in comparison with other diseases, not all patients have the resources to afford them.

He reiterated that health authorities should disseminate more information about the need for hepatitis testing to identify infected people through hepatitis screening days.

More lethal than malaria
The World Health Organization (WHO) recommends preventing new infections and deaths from hepatitis B and C, facilitating access to treatment for all pregnant women living with hepatitis B, or providing vaccines against this disease for newborns.

It also sets desirable objectives to diagnose 90% of people living with hepatitis B and C and ensure treatment for 80% of those diagnosed.
In the case of hepatitis B, mother-to-child transmission during pregnancy is the most common. It occurs primarily in the Western Pacific, Africa, and Southeast Asia, where screening pregnant women with hepatitis B testing is crucial in curbing transmission.

However, a new WHO report shows that only 78% of the countries surveyed (64 out of 82) reported having a national policy on hepatitis B testing during pregnancy.

Of these, only half (32 out of 64) reported finally implementing these measures in antenatal clinics.