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6/27/2014

Chikungunya

Filed under: caribbean,disease/health,dominica,dominican republic,usa — admin @ 3:55 pm

They suffer searing headaches, a burning fever and so much pain in their joints they can barely walk or use their hands. It’s like having a terrible flu combined with an abrupt case of arthritis.

Hospitals and clinics throughout the Caribbean are seeing thousands of people with the same symptoms, victims of a virus with a long and unfamiliar name that has been spread rapidly by mosquitoes across the islands after the first locally transmitted case was confirmed in December.

“You feel it in your bones, your fingers and your hands. It’s like everything is coming apart,” said 34-year-old Sahira Francisco as she and her daughter waited for treatment at a hospital in San Cristobal, a town in the southern Dominican Republic that has seen a surge of the cases in recent days.

The virus is chikungunya, derived from an African word that loosely translates as “contorted with pain.” People encountering it in the Caribbean for the first time say the description is fitting. While the virus is rarely fatal it is extremely debilitating.

“It is terrible, I have never in my life gotten such an illness,” said Maria Norde, a 66-year-old woman confined to bed at her home on the lush eastern Caribbean island of Dominica. “All my jointsare in pain.”

Outbreaks of the virus have long made people miserable in Africa and Asia. But it is new to the Caribbean, with the first locally transmitted case documented in December in French St. Martin, likely brought in by an infected air traveler. Health officials are now working feverishly to educate the public about the illness, knock down the mosquito population, and deal with an onslaught of cases.

Authorities are attempting to control mosquitoes throughout the Caribbean, from dense urban neighborhoods to beach resorts. There have been no confirmed cases of local transmission of chikungunya on the U.S. mainland, but experts say the high number of travelers to the region means that could change as early as this summer.

So far, there are no signs the virus is keeping visitors away though some Caribbean officials warn it might if it is not controlled. “We need to come together and deal with this disease,” said Dominica Tourism Minister Ian Douglas.

One thing is certain: The virus has found fertile ground in the Caribbean. The Pan American Health Organization reports more than 55,000 suspected and confirmed cases since December throughout the islands. It has also reached French Guiana, the first confirmed transmission on the South American mainland.

The Pan American Health Organization says seven people in the Caribbean with chikungunya have died during the outbreak but they had underlying health issues that likely contributed to their death.

“It’s building up like a snowball because of the constant movement of people,” said Jacqueline Medina, a specialist at the Instituto Technologico university in the Dominican Republic, where some hospitals report more than 100 new cases per day.

Chikungunya was identified in Africa in 1953 and is found throughout the tropics of the Eastern Hemisphere. It is spread by two species of mosquitoes, aedes aegypti and aedes albopictus. It’s also a traveler-borne virus under the right circumstances.

It can spread to a new area if someone has it circulating in their system during a relatively short period of time, roughly 2-3 days before the onset of symptoms to 5 days after, and then arrives to an area with the right kind of mosquitoes.

For years, there have been sporadic cases of travelers diagnosed with chikungunya but without local transmission. In 2007, there was an outbreak in northern Italy, so health authorities figured it was just a matter of time before it spread to the Western Hemisphere, said Dr. Roger Nasci, of the U.S. Centers for Disease Control and Prevention.

“With the increase in travelers the likelihood that something like this would happen goes up and eventually it did,” said Nasci, chief of a CDC branch that tracks insect-borne diseases. “We ended up with somebody at the right time and the right place infecting mosquitoes.” The two species of mosquitoes that spread chikungunya are found in the southern and eastern United States and the first local transmissions could occur this summer given the large number of U.S. travelers to the Caribbean, Nasci said. Already, the Florida Department of Health has reported at least four imported cases from travelers to Haiti, the Dominican Republic and Dominica.

“What we’re seeing now is an increase in the number of infected travelers coming from the Caribbean, which is expected because there’s a lot of U.S. travel, a lot of vacation travel, a lot of work travel,” he said.

Around the Caribbean, local authorities have been spraying fogs of pesticides and urging people to remove standing pools of water where mosquitoes breed.

An estimated 60-90 percent of those infected show symptoms, compared to around 20 percent for dengue, which is common in the region. There is no vaccine and the only cure is treatment for the pain and fluid loss.

One consolation for those suffering from the illness is that unlike dengue, which has several variants, people only seem to get chikungunya once.

“The evidence suggests that once you get it and recover, once your immune system clears the virus you are immune for life,” Nasci said.

5/24/2014

Chikungunya outbreak

Filed under: caribbean,disease/health,dominica,dominican republic,haiti,usa — admin @ 4:14 am

They suffer searing headaches, a burning fever and so much pain in their joints they can barely walk or use their hands. It’s like having a terrible flu combined with an abrupt case of arthritis.

Hospitals and clinics throughout the Caribbean are seeing thousands of people with the same symptoms, victims of a virus with a long and unfamiliar name that has been spread rapidly by mosquitoes across the islands after the first locally transmitted case was confirmed in December.

“You feel it in your bones, your fingers and your hands. It’s like everything is coming apart,” said 34-year-old Sahira Francisco as she and her daughter waited for treatment at a hospital in San Cristobal, a town in the southern Dominican Republic that has seen a surge of the cases in recent days.

The virus is chikungunya, derived from an African word that loosely translates as “contorted with pain.” People encountering it in the Caribbean for the first time say the description is fitting. While the virus is rarely fatal it is extremely debilitating.

“It is terrible, I have never in my life gotten such an illness,” said Maria Norde, a 66-year-old woman confined to bed at her home on the lush eastern Caribbean island of Dominica. “All my jointsare in pain.”

Outbreaks of the virus have long made people miserable in Africa and Asia. But it is new to the Caribbean, with the first locally transmitted case documented in December in French St. Martin, likely brought in by an infected air traveler. Health officials are now working feverishly to educate the public about the illness, knock down the mosquito population, and deal with an onslaught of cases.

Authorities are attempting to control mosquitoes throughout the Caribbean, from dense urban neighborhoods to beach resorts. There have been no confirmed cases of local transmission of chikungunya on the U.S. mainland, but experts say the high number of travelers to the region means that could change as early as this summer.

So far, there are no signs the virus is keeping visitors away though some Caribbean officials warn it might if it is not controlled. “We need to come together and deal with this disease,” said Dominica Tourism Minister Ian Douglas.

One thing is certain: The virus has found fertile ground in the Caribbean. The Pan American Health Organization reports more than 55,000 suspected and confirmed cases since December throughout the islands. It has also reached French Guiana, the first confirmed transmission on the South American mainland.

The Pan American Health Organization says seven people in the Caribbean with chikungunya have died during the outbreak but they had underlying health issues that likely contributed to their death.

“It’s building up like a snowball because of the constant movement of people,” said Jacqueline Medina, a specialist at the Instituto Technologico university in the Dominican Republic, where some hospitals report more than 100 new cases per day.

Chikungunya was identified in Africa in 1953 and is found throughout the tropics of the Eastern Hemisphere. It is spread by two species of mosquitoes, aedes aegypti and aedes albopictus. It’s also a traveler-borne virus under the right circumstances.

It can spread to a new area if someone has it circulating in their system during a relatively short period of time, roughly 2-3 days before the onset of symptoms to 5 days after, and then arrives to an area with the right kind of mosquitoes.

For years, there have been sporadic cases of travelers diagnosed with chikungunya but without local transmission. In 2007, there was an outbreak in northern Italy, so health authorities figured it was just a matter of time before it spread to the Western Hemisphere, said Dr. Roger Nasci, of the U.S. Centers for Disease Control and Prevention.

“With the increase in travelers the likelihood that something like this would happen goes up and eventually it did,” said Nasci, chief of a CDC branch that tracks insect-borne diseases. “We ended up with somebody at the right time and the right place infecting mosquitoes.” The two species of mosquitoes that spread chikungunya are found in the southern and eastern United States and the first local transmissions could occur this summer given the large number of U.S. travelers to the Caribbean, Nasci said. Already, the Florida Department of Health has reported at least four imported cases from travelers to Haiti, the Dominican Republic and Dominica.

“What we’re seeing now is an increase in the number of infected travelers coming from the Caribbean, which is expected because there’s a lot of U.S. travel, a lot of vacation travel, a lot of work travel,” he said.

Around the Caribbean, local authorities have been spraying fogs of pesticides and urging people to remove standing pools of water where mosquitoes breed.

An estimated 60-90 percent of those infected show symptoms, compared to around 20 percent for dengue, which is common in the region. There is no vaccine and the only cure is treatment for the pain and fluid loss.

One consolation for those suffering from the illness is that unlike dengue, which has several variants, people only seem to get chikungunya once.

“The evidence suggests that once you get it and recover, once your immune system clears the virus you are immune for life,” Nasci said.

1/20/2014

Climate Change & Disease

Caribbean countries, struggling to emerge from a slump in exports and falling tourist arrivals brought on by the worldwide economic crisis that began five years ago, have one more thing to worry about in 2014.

Dominica’s chief medical officer, Dr. David John, said climate change and its effects are taking a toll on the health of people in his homeland and elsewhere in the region. “A lot of diseases will essentially create havoc among people who are already poor.”

“You have seen what is happening [with] the effects of climate change in terms of our infrastructure, but there are also significant effects with regards to climate change on health,” John said, adding that “these effects relate to the spread of disease including dengue fever and certain respiratory illnesses.” John said the Dominica government would be seeking assistance from international agencies, including the World Meteorological Organisation (WMO), to mitigate “the effects of climate change on health as it relates to dengue, leptospirosis and viral disease.”

In late 2012, the Ministry of Health in Barbados alerted members of the public about a spike in leptospirosis cases. Senior Medical Officer of Health-North Dr. Karen Springer said then that five people had contracted the severe bacterial infection, bringing the number of cases for the year to 18.

Springer explained that the disease, which includes flu-like symptoms such as fever, headache, chills, nausea and vomiting, eye inflammation and muscle aches, could be contracted through contact with water, damp soil or vegetation contaminated with the urine of infected animals. Bacteria can also enter the body through broken skin and if the person swallows contaminated food or water.

In recent years, dengue has also been on the rise throughout the Caribbean with outbreaks in Dominica, Barbados, Trinidad and Tobago, Puerto Rico and the French islands of Martinique and Guadeloupe, among other places.

Professor of environmental health at the Trinidad campus of the University of the West Indies Dr. Dave Chadee said there is ample “evidence that climate-sensitive diseases are being tweaked and are having a more significant impact on the region”.

He said he co-authored a book with Anthony Chen and Sam Rawlins in 2006 which showed “very clearly” the association between the changes in the seasonal patterns of the weather and the onset and distribution of dengue fever.

“There is enough evidence, not only from the Caribbean region but worldwide, that these extreme events are going to have and going to play a significant role in the introduction and distribution of these sorts of diseases in the region,” Chadee, who previously served as an entomologist at the Insect Vector Control Division of the Ministry of Health in Trinidad and Tobago, said.

“If you look at the various factors that are associated with climate change, the first is heat waves. There has also been a reduction in air quality. You also see an increase in fires and the effects on people’s ability to breathe as well as the association between the Sahara dust and asthma which was demonstrated in Barbados and Trinidad recently.

“The Sahara dust which comes in from Africa brings in not only the sand but also other pathogenic agents within the sand, together with some insecticides which have been identified by people working at the University of the West Indies,” Chadee said.

Dr. Lystra Fletcher-Paul, the Food and Agriculture Organisation (FAO) representative for Guyana, said she has no doubt that climate change has contributed significantly to some of the issues related to diseases in the region.

“If you look at some of the impacts of climate change, for example drought, with drought you are going to increase the amount of irrigation that you are going to be applying to the crops. And irrigation water is a source of pesticides or even chemicals, depending on where that source of water is and that could lead to problems in health,” she said.

“Similarly with the extreme events, if you are talking about floods, there can be contamination of the fresh-water supply.”

The FAO representative is adamant that there is too much “talk” in the Caribbean and too little “implementation”.

“We have had the conversation, so what we need to do now is put the systems in place to mitigate and adapt to climate change,” she said. Using land-use planning as an example, Fletcher-Paul said, “A lot of what we see happening in St. Vincent and St. Lucia may not necessarily have taken place if we had proper land-use planning.”

A slow-moving, low-level trough on Dec. 24 dumped hundreds of millimetres of rain on St. Vincent and the Grenadines, St. Lucia and Dominica, killing at least 13 people. The islands are still trying to recover.

“So we need to take some hard decisions in terms of where we would allow development to take place or not,” Fletcher-Paul said.

Chadee said the poor would always be at a disadvantage in climate change scenarios and they will suffer the most from sea level rise when you have salt water intrusion into fertile agricultural land, rendering them unsuitable for food production. “A lot of diseases will essentially create havoc to people who are already poor. The adaptability of the poor versus the rich within the Caribbean region will be tested because if the poor are no longer able to produce some of their food, this would then lead to health problems.”

He explained that if the poor are no longer able to have a particular diet this would make them susceptible to a number of diseases.

“With the Caribbean region having developing states, and especially Small Island Developing States, we do have a unique situation where the resources have to be put in place, especially for adaptation,” Chadee said.

“It’s almost like the wall of the reservoir has been breached and you know that the water is coming. You don’t know how high the water level is going to be but you know it’s coming, so what do you do? And that essentially is the scenario in which we have found ourselves in the Caribbean,” Chadee added.

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