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Outbreaks and Updates Travel Health Tropical Medicine

Dengue fever and Yemen Outbreaks September 2015

Aedes_aegypti_E-A-Goeldi_1905
Aedes mosquito

A recent increase in dengue fever activity has become an serious outbreak concern in Yemen. A country that has been suffering from civil unrest and conflict, collapsed medical infrastructure and is now suffering from “an extreme spike” in dengue fever cases according to the World Health Organization (WHO) in August, 2015 means that the only winners in Yemen right now are the mosquitoes.

The epicenter of this Yemeni Dengue outbreak is the city of Taiz, located in central Yemen. The city of Taiz is on the civil war frontlines, in the middle of the conflict between the Houthi rebels from the north and the Saudi-backed fighters loyal to the exiled president Abbdu Mansour. The WHO reports 1,243 cases thus far in 2015 but on-ground intelligence estimates the number of actual cases to be almost 10 times higher.

Dengue Fever Basics

Dengue is a viral illness spread through the bite of infected mosquitoes (Aedes Aegypti). Typically a mild to moderate illness with flu-like symptoms of fever, malaise and myalgia (muscle aches), severe cases can have hemorrhagic manifestations and progress into Dengue Hemorrhagic Fever (DHF). Approx 75% of cases are asymptomatic.

Causative Agent: Dengue viruses are in the Flavavirus group and have four distinct sero-types numbered DENV-1, 2, 3 and 4. All types can cause DHF.

Prevention: Insect bite prevention with DEET and Permethrin treated clothing, bed nets and screens; destruction of mosquito breeding grounds (standing water) and control of insect vectors

Treatment: Supportive; fever control, rehydration, pain control and  blood/blood products as needed for severe cases

Political-map-of-Yemen

Looking at why the Dengue outbreak has become so severe will also show more about the damage that has been done to the country of Yemen with all the recent unrest. Dengue is spread through mosquitoes. Mosquitoes like to breed and incubate in standing water. Yemen is a country that has had its infrastructure destroyed and running water in homes is rare. Access to clean water is limited. Garbage collection services are non-existent. People are storing water in makeshift containers and water is collecting in tires, pots, canisters and cups left out as trash. This makes for a prime breeding ground to increase mosquito numbers.

Combining this increase in mosquito numbers with a loss of almost half of the medical services in the country means conditions are perfect for this outbreak. While death from Dengue or DHF is rare (approx 1%), good medical care is required to have these good outcomes.

For more information on Dengue:

http://www.who.int/tdr/publications/documents/dengue-diagnosis.pdf

Dengue in Yemen:

http://m.rwlabs.org/report/1166831/yemen/mosquitoes-winning-yemen-s-war

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