Maldives grapples with difficult dengue outbreak

The Maldives is battling a growing epidemic of dengue fever which is believed to have contributed to the deaths of at least five people this year.

More than 300 cases were reported in the first two months of 2011, compared with 737 cases and two fatalities reported last year. Many cases have been reported in Male’, although most of the fatalities have been islanders. One patient died during transit to Indira Gandhi Memorial Hospital (IGMH), and the more serious cases have disproportionately affected children.

Dr Ahmed Jamsheed, who until recently headed the Centre for Community Health and Disease Control (CCHDC), observed that 2011 had seen higher instances of dengue shock syndrome, where the mosquito-borne parasite causes blood pressure to drop so low that organs cannot function.

“Our initial theory was that this was a new strain of dengue,” he said. “There are four different strains, and strains one and three have been most prevalent. We took samples and sent them abroad but I had left the office by the time the results came back. I’m told out of the samples we sent a few tested positive for dengue one, which means no new strain.”

Instead of a new strain, Dr Jamsheed suggested that the growing number of dengue fatalities could be related to lapses in managing the disease, due to the high turnover of foreign doctors “particularly on the islands.”

“Usually dengue management in the Maldives is quite good, but new doctors are not very well orientated for dealing with dengue, and cases are being referred to Male’ quite late. It would be hard to say for sure at this point unless we did a case-by-case audit, to see where we’re going wrong,” he added.

IGMH Registrar Dr Fathimath Nadia noted that at least two of the fatalities this year involved children, “although these were quite complicated cases.”

Nadia said that health services had previously printed and issue a handbook on managing dengue to every incoming doctor and conducted briefings of incoming doctors, but was not sure if this was still carried out.

The CCHDC and the Maldives National Defence Force (MNDF) in February this year conducted spraying of mosquito breeding sites in Male’ and the surrounding islands, but reported difficulty obtaining access to residential and construction sites.

Minivan News also understands that a international mosquito expert brought in to exterminate breeding habitats at a resort had last month pinpointed the source of Male’s mosquito-breeding to pools of stagnant water in building sites across the city. However she was also reportedly unable to obtain the required permission to inspect the properties.

“The boom in the construction industry has created a huge number of mosquito breeding grounds,” Dr Jamsheed explained. “In Male’ when the Council gives planning permission it requires management of mosquito breeding grounds, but have so far failed to enforce it or conduct inspections. My experience in Male’ was that when our teams visited construction sites there was often nobody at the site to communicate with in Dhivehi or English.”

While the teams might be contact with the construction company responsible for the building, often those working at the site were employed under layers of subcontracting which made it difficult to place responsibility, he added.

Private and community rainwater tanks were also prime breeding grounds, he said, a particular problem on many islands.

“IGMH has a large underground water tank and we even found that full of mosquitoes,” he said. “They had not taken measures to make it airtight, although I think it’s been corrected now.”

Malaysia, which has had nearly 50,000 cases of dengue reported already this year, is currently working with France pharmaceutical company Sanofi-Aventis to develop a vaccine. The country has also launched a nationwide campaign to encourage people to destroy breeding grounds on their private property.

Early symptoms of dengue include fever, joint paint and a distinctive rash and headache, although it can be difficult to distinguish from the milder Chikungunya disease which can last for up to five days. However even healthy adults can be left immobile by dengue for several weeks while the disease runs its course.

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