Tag: dengue fever

Comment: Dengue fever, a problem for everyone

Although the MNDF has been drafted in to help combat the problem of dengue fever that is affecting Male and several other atolls, it is important that people don’t stand back and think that this action alone will solve the problem.

Experience in many other countries has shown that a ‘top-down’ or vertical campaign against dengue fever is only part of the solution to preventing outbreaks of the virus from getting worse.

Most people know that dengue fever is spread by a mosquito that takes the blood of an infected person. The blood contains a virus that causes dengue fever and this is passed on to a new person when they are bitten in turn by the mosquito. The mosquito seems fine – but people infected by the virus may become very seriously ill and a small proportion may die.

Most action to prevent the spread of dengue fever is aimed at the mosquito itself. If the mosquitoes are stopped from breeding then the transmission of the dengue virus from person to person will be interrupted and no new cases will occur. Often the strategy against the mosquito relies on spraying chemicals and treating water storage containers. But without having fully integrated community involvement, this strategy has failed almost everywhere in the world that it has been tried. The mosquitoes will always find ways to outwit their human adversaries unless locally tailored eradication programmes are implemented.

Community involvement is key to the success of the eradication programme and every member of the community should be involved in understanding the problem of controlling the mosquitoes (vector control). Within each community the local community leaders should be involved in forming a dedicated steering committee that can create formal task forces or community working groups that will undertake environmental management. The working groups will need to know in detail exactly what they are supposed to be doing and precise training sessions need to be organised. Every locality is different so each community task force needs to identify the exact local conditions in which their mosquitoes will be breeding. Precise local knowledge is the most important resource for beating the disease. In particular waste water needs to be evacuated efficiently; water pipelines and water storage containers must be protected and communal waste collection improved.

A research programme in Cuba compared the usual ‘top down’ ways of combating dengue fever with a community activist approach as described above. They found that the community based environmental strategy was much more effective that the usual eradication programme. You can read more about this research on:

http://www.bmj.com/content/338/bmj.b1959.full

Garbage: a special problem throughout the Maldives

The mosquitoes love little collections of water. When I was in the Maldives as a volunteer for the Friends of Maldives health programme I noticed that outside almost every house there is a little collection of garbage. This includes plastic drink containers, tins, discarded tyres, containers and invariably a pile of half coconuts. These are ideals breeding sites for the mosquitoes that carry dengue fever. Unless each and every one of these piles is cleaned up, dengue fever will continue to be a problem throughout the Maldives in urban and rural areas.

Mosquitoes love the little collections of water that form in garbage piles.

Dr Tom Heller is a Senior Lecturer in the Open University’s Faculty of Health and Social Welfare.  He has previously visited the country as a medical volunteer for the UK-based NGO, Friends of Maldives.

All comment pieces are the sole view of the author and do not reflect the editorial policy of Minivan News. If you would like to write an opinion piece, please send proposals to [email protected]

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Task force claims dengue “epidemic” under control despite coordination concerns

The task force appointed by the government to combat a dengue fever outbreak linked to the deaths of seven people has claimed it is beginning to bring the spread of the virus under control, despite initial difficulties in coordinating with local councils.

A spokesperson for the task force, which has been put in charge of coordinating the responses of government ministries, the Maldives National Defense Force (MNDF) and NGOs like the Red Crescent, has said it has overcome initial difficulties such as dealing with local councils in trying to curb virus infection rates.

In a week where authorities have labelled the latest outbreak of dengue fever across the country as an “epidemic“, opposition parties have been critical of both the speed and nature of the government’s response to these concerns, despite welcoming efforts to try and combat the virus.

The criticisms come after newspaper Haveeru reported that a four-year old boy, who had been brought to Male’ for treatment of dengue fever, had become the seventh person in the last week to have died from the virus.

Despite fears of the virus continuing to spread, for those charged with coordinating the country’s dengue control programme, “significant progress” is claimed to have been made over the last few days in collecting data and trying to understand the full scale of the current outbreak and how to contain it.

At present, the taskforce overseeing this national response the to dengue fever has said that it expects the current outbreak to be fully under control within a week.  The claims have been backed by official figures supplied by the same coordination body that indicated that 11 suspected cases of dengue were reported today, compared to 16 cases recorded yesterday and 18 cases the day before.

Speaking to Minivan News today, the task force’s media spokesperson said that while dengue outbreaks were nothing new in the Maldives, the number of suspected cases of the virus that traditionally were expected dropped by this time of year had in fact spiked. The spokesperson added that this apparent spike in infections had created a number of coordination difficulties for a new system of local government put in place following the country’s first local council elections in February.

“Compared to last year, during these dates, figures usually go down. However, this month, there has been a spike [in numbers of dengue cases],” he said. “When the local councils took over [collecting data about the virus from the Health Ministry], the whole process was stalled, nothing was moving.”

The spokesperson said that there was insufficient research to identify the exact factors driving a suspected spike in infection numbers of late.  However, he claimed there had been “many internal and administrative problems” that when combined with the country’s wet season – resulting from the south west monsoon that runs from May to November – may have served to exacerbate the impacts of the outbreak.

According to the task force spokesperson, the decision to hand over the responsibility for detailing information on the spread of dengue from the Health Ministry to island councils had initially raised notable problems for the government; though these issues were now being resolved.

“There were some problems in getting councillors initially to work on weekends, but I think everyone has understood the severity of the outbreak,” he added.

While no “drastic” changes had been made in the methods used by authorities themselves to combat dengue fever infections, the taskforce representative said that the key focus for efforts both now and during any future “epidemics” would be in trying to ensure that the mechanisms for coordination were working efficiently.

“In the future, this task force will have helped with this, because we are getting important data and contacts,” the representative said.

With the task force currently budgeted to run for seven days, the body’s media spokesperson said that no decision had yet been made on whether similar initiatives would be used during future outbreaks, yet he was confident that important lessons could be learnt from the current system.

“I think the task force will help to administer preventative measures during outbreaks in the future. Building a fixed system out of this existing network will be very helpful,” he said. “There has been a change in how government works, so people have had difficulties in adjusting to this and awareness of requirements has been low. Councils also have to realise their responsibilities as well.”

The task force spokesperson claimed that preventative measures for dengue also needed to focus on members of the public in areas like education at schools, as well as improving hygiene in houses and carrying out inspections at construction sites to limit mosquito breeding grounds.

“I think the basic thing is to get this system in place, like in schools, things like education on personal hygiene and dealing with councils,” he said. “If these don’t work, then every time we can’t always go to the MNDF for assistance.”

“Bungled” response

Despite the task force representative’s claims, Ibrahim ‘Mavota’ Shareef, Spokesperson for the opposition Dhivehi Rayyithunge Party (DRP), saidthat he believed that the government had “bungled” their response to trying to control dengue fever. Shareef added that although the DRP welcomed and would cooperate with the government in efforts to try and limit the spread of the virus, he said that authorities had acted too slowly in trying to deal with the outbreak.

“From what we have seen the government is just not doing enough. We don’t believe they have been willfully negligent, but there has been negligence in their approach [to dengue outbreak],” he claimed. “They have not responded fast enough, which could be inexperience on their part. But I think this will be a wake-up call for them to change policy in dealing with these type of situations.”

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Education authorities halt extra-curricular activities as dengue fears escalate

Education authorities have stopped short of closing schools despite taking the decision to suspend extra-curricular activities over concerns about the further spread of dengue fever in the country, according to local media reports.

The government yesterday labelled an outbreak of the virus across Male’ and a number of islands as “an epidemic” after drafting the Maldives National Defense Force (MNDF) into efforts to try and combat the disease spreading.

Concerns have risen after the virus was linked to the death of four children over two days this week.

Amidst concerns about the further spread of the virus, education officials told local media today that they were suspending outdoor camps and other after-school activities in an attempt to minimize infection rates.

According to local newspaper Haveeru, the escalation of concerns about the prevalence of dengue has led to the formation of a makeshift ward at Male’s Indira Gandhi Memorial Hospital (IGMH) that consists of 19 beds specifically to treat suspected dengue cases.

The paper has also report added that a four-year old boy hospitalised at IGMH since June 28 was in too serious a condition to be moved abroad for treatment.

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MNDF drafted to aid government dengue response over “epidemic” fears

The Maldives National Defense Force (MNDF) has been drafted in to help with efforts to try and control an outbreak of dengue fever that the government has described as “an epidemic”.

President Mohamed Nasheed yesterday announced that he had requested the assistance of defense forces in collecting information about the virus from island and atoll health councils after four deaths linked to the affliction were recorded in the space of two days.

Speaking to Minivan News today, Major Abdul Raheem of the MNDF confirmed that the country’s armed forces would be working within a wider government task force to try and establish ways of better controlling the spread of the virus.

The Maldives has been battling a growing number of dengue fever cases in 2011, with 300 cases and five deaths reported in just the first two months of the year. There has been a reported spike in the number of cases of the virus reported in Male’; cases that were linked earlier this year by one health expert to a construction boom in the capital. However, most of the fatalities have been islanders who died in transit to regional hospitals, with many of the most serious cases having affected children.

Raheem did not specify what exact role the MNDF would take in efforts to combat the virus, but added that the defence force would be working as part of a taskforce based within a male’ school to try and coordinate a response to the outbreak.

“This is the first time we have been involved in efforts to help fight dengue fever,” he said. “But we have experience in working to control other [diseases].”

In addressing concerns about incidents of dengue across the Maldives, President Nasheed yesterday said that the MNDF would be used to obtain information about the virus from atoll health authorities in conjunction with councils and the Local Government Authority overseeing their work.

With the current outbreak now being treated as an epidemic by the government, the president called on members of the public and everyone involved in disease control to provide genuine information about the spread of the virus. Meanwhile, anyone found to be providing falsified information is said to risk facing possible prosecution from the authorities, Nasheed warned in a press release.

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

Government criticism

Despite announcing plans to take action against the disease, the government has come under some criticism this week within the Majlis for perceived failures in its handling of the local dengue situation.

Amongst the criticisms, People’s Alliance (PA) MP Abdul Raheem Abdulla asked Health Minister Dr Aminath Jameel if she was considering resignation “since based on what is being said here your sector has very much failed,” Dr Jameel replied that she did not believe that was the case.

The health minister, replying to another question from MDP MP Ali Waheed during Tuesday’s (June 28) parliamentary session, said the ministry was providing information to islands through teleconferencing and stressed that controlling mosquito breeding grounds was key to combating the rise in dengue fever across the country.

“Mosquitoes don’t travel very far,” she explained. “Therefore, it’s mosquitoes from nearby areas that are spreading it. Controlling mosquito [breeding] is needed from the public and individuals as well. We are working together with island councils and the Male’ City Council.”

Jameel claimed that the Addu City Council had also taken up initiatives and organised activities to try and combat dengue.

“An additional problem that we encounter is the quick turnover of doctors in the country’s hospitals and health centres,” she said. “So they are not very familiar with the protocol here. We are facing that problem as well. But as I’ve said, this can’t solved without controlling mosquito [breeding].”

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Four children dead in two days from dengue fever complications

A fourth dengue fever fatality in just two days has prompted meetings between Male’ City Council and the Ministry of Health to discuss “immediate steps” to reduce the number of mosquito breeding grounds in the capital.

The President’s Press Secretary Mohamed Zuhair said cabinet had also launched a program to counter the dengue outbreak and appointed a committee to oversee mosquito reduction efforts.

Haveeru reported that a four year old child from Muraidhoo in Haa Alif Atoll became the fourth death in two days, dying this morning while in transit to Kulhudhuffushi Regional Hospital.

The cause of the death was dengue hemorrhagic fever, the newspaper reported.

A two year old infant died at 3:00am this morning while being treated in Indira Gandhi Memorial Hospital in Male’. Haveeru reported a relative as claiming that the infant had to be transferred from ADK due to lack of availability of a blood transfusion machine.

A six year-old girl and a nine month-old baby died yesterday after being transferred to Male’ from Meemu Atoll.

Health Minister Dr Aminath Jameel, replying to a question from MDP MP Ali Waheed during yesterday’s parliament session, said the ministry was providing information to islands through teleconferencing and stressed that controlling mosquito breeding grounds was key to combating the rise in dengue fever across the country.

“Mosquitoes don’t travel very far,” she explained. “Therefore, it’s mosquitoes from nearby areas that are spreading it. Controlling mosquito [breeding] is needed from the public and individuals as well. We are working together with island councils and the Male’ city council.”

She added that the Addu City council had taken initiative and organised activities to combat the spread of the disease.

“An additional problem that we encounter is the quick turnover of doctors in the country’s hospitals and health centres,” she said. “So they are not very familiar with the protocol here. We are facing that problem as well. But as I’ve said, this can’t solved without controlling mosquito [breeding].”

When People’s Alliance (PA) MP Abdul Raheem Abdulla asked if she was considering resignation “since based on what is being said here your sector has very much failed,” Dr Jameel replied that she did not believe that was the case.

The Maldives has been battling a growing epidemic of dengue fever this year, with 300 cases and five deaths reported in just the first two months of the year.

There has been a spike in the number of cases reported in Male’, however most of the fatalities have been islanders who died in transit to regional hospitals. Many of the most serious cases have affected children.

Early symptoms of virus 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. Even healthy adults can be left immobile by dengue for several weeks while the disease runs its course.

The government and health authorities have expressed concern about mosquito breeding grounds developing in stagnant water in the city’s many construction sites.

“The boom in the construction industry has created a huge number of mosquito breeding grounds,” former head of the Community Health and Disease Control (CCHDC), Dr Ahmed Jamsheed, told Minivan News in April.

“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.

Zuhair told Minivan News today that the problem was exacerbated by the large number of unfinished buildings where construction had ceased.

“For example, one proposed seven storey-building has [ceased construction] at four storeys, and has pools of stagnant water on top,” he said, adding that it was sometimes difficult to pinpoint who was responsible for the building site due to the layers of subcontractors involved.

Many islands had sought to combat the problem by borrowing fogging equipment and expertise from nearby resorts to kill their mosquito populations, but this also killed beneficial insects, he said.

“It is common for resorts to loan fogging equipment and technical assistance to local islands, but this has negative side effects: it kills all the other insects, which prevents pollination and impacts agricultural activity,” Zuhair explained, adding that human intervention and the elimination of breeding sites was the main priority.

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Comment: Spread of dengue fever should be alarming

Malaria still maintains its respect as the leading killer disease in sub-Saharan Africa, surpassing the 20th century wave of HIV infections that rocked the continent. Malaria is spread by a mosquito known as CULEX.

The Maldives and many other South East Asian countries are infested with a mosquito species known as AEDES AEGYPTI, the carrier of Dengue Fever and Chikungunya that have claimed lives of many young and old. In population comparison with neighboring countries, the deaths and spread of dengue in Maldives is and should be considered as alarming.

A visit to health centers or hospitals in islands and Male reveals panic among parents with infants or small kids. Four deaths in two days, the youngest being a nine month-old baby has sent shockwaves in many households and I hope the World Health Organisation (WHO) has intervened. It ultimately raises the suspicion and doubt on the management of public health in a country where health and health education is inadequate, and not an immediate priority in the eyes of the lawmakers.

I support the government health insurance policy which we have enrolled and I have seen benefits in the past year. But think of a person with similar insurance facility but lives in an island village 600 miles from Male’, which cannot provide urgent medical assistance. It’s not acceptable; it’s just immoral, and unfair.

Each Maldivian citizen deserves the right to standard medical facilities, and I ask the Ministry of Health to explain why many atolls/islands still have inadequate facilities. Why a heart patient has to wait for two weeks to use a treadmill in IGMH, or cannot do ECG because the equipment is broken down, why desperate parents of sick children have to wait for days for an appointment, and why Maldivians have to depend on doctors who visit once every six weeks.

Ironically, Male’ is mushrooming with high tech clinics, specialty doctors, and a sequence of tests that leave you broke for a whole month. Most victims are from islands where basic medical facilities sometimes cease to exist.

In December of 2005, WHO Epidemiologist Dr Shalini Pooransingh and the Maldivian government had a fact finding, training and knowledge awareness program on Communicable Diseases, and dengue was well addressed.

Since then, many other workshops and programs followed partly sponsored by international organisations and the local health authorities. Looking at statistics (weekly dengue cases 2009-2011) published on line, it is appalling to see the magnitude of the spread especially in other islands all over the country. What happened to all the training and expertise?

It is nearly a year ago when an article by Aishath Shazra and A. R. Abdulla was published online: “Maldives hit by dengue fever in global epidemic”.

It is a simple straightforward report that is alarming to any parent who reads it, and at the same time it exposes loopholes which law makers and health ministry should look at.

Unbelievably, just 14 persons made comments, and as you can read them, most were abusive, political and out of context. Exactly at the same time of this dengue infestation last year, the streets of Male were crowded every night with demonstrations, ironically not concerned over the outbreak, but keen to unseat the then Education Minister [Dr Mustafa Luthfy] out of office… at which they succeeded.

These street scenarios were well documented and covered by most media outlets. The Maldives has not seen a meaningful demonstration against inadequate health services, deteriorating or lack of
equipment or lack of simple medicines. The Maldives has not demonstrated effectively against pedophiles, abuse of women and children, crime or the bleak and uncertain future of the youth.

But it’s a common thing to have live meetings, street demonstrations, and special TV and radio programs on topics that will not move the country one step forward but lead it to an uncivilised world. Why not use these funds to help the needy?

I do not need to bore you repeating facts and statistics on dengue that you can easily find from the Department of Public Health and WHO websites. My objective was to openly voice my personal concern based on day to day events and to answer the most disturbing simple question: “Who is to blame?”

In sequence, responsibility lies heavily with the Ministry of Health (in charge of public health), lawmakers (who decide laws), municipalities/councils (who manage day to day issues), politicians (who represent the people’s voices) and the public (for not focusing on life-threatening grievances).

I really hope that somewhere, a Good Samaritan in the authorities will seriously look at the four deaths in these two days, the daily grievances of desperate people far away in need of health facilities, and use it as a platform to start a campaign to try manage this outbreak.

The government alone cannot, we need a combined effort from everyone, or each day we would have a new headline of yet another death.

It is time the President, the Minister of Health, politicians and the media take time-off from the daily politics that have slowed our development and taken us nowhere. Better to concentrate on what is affecting the country right now. Public Health is at stake!

Not long ago Male’ had illicit drug problems which were visible on the streets. Boys and girls turned into zombies, but today I also salute the NGO Journey, the government (police, army, NGOs) for helping these kids off the street. It has been successful and many have been rehabilitated, and openly talked about it on TV. Why not temporarily close Majlis sessions, use all available resources and let MPs, health coordinators and doctors go out to the islands and help those in need? Thinaadhoo continues to suffer from a strange unexplainable fever, and sooner or later it will spread to other islands. By the time it reaches the concern of authorities, many will have buried their loved ones.

We had a great laugh last evening watching the match between MDP and the government. So much money was collected, some of it for charity. The night closed with a very tearful yet important program on MNBC (My Way). Hishko and her husband, my very good friends, have done so much in so short a time, for the health of many kids. 192 kids today who have had their Tiny Hearts examined, operated or diagnosed with heart cardio problems, will forever remember this couple for their entire lives. This is just an example of how simple people can make a change in the lives of many.

To MNBC: Congrats, My Way is the greatest program watched by over 80 percent of households and Maldivians abroad. Through such great ideas, I believe you could have similar programs on health, education, computer and drug addiction, career guidance, etc. Not to forget, you guys Minivan, continue publishing the truth. With information, we can partly control this outbreak that is claiming a child per day.

All comment pieces are the sole view of the author and do not reflect the editorial policy of Minivan News. If you would like to write an opinion piece, please send proposals to [email protected]

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Health authorities focus on mosquito controls as hospital confirms infant dengue fatality

Male’s Indira Gandhi Memorial Hospital (IGMH) has confirmed that a nine-month old child died today from dengue fever as health officials look to combat further spread of the virus through attempts to control mosquito numbers.

Hospital spokesperson Zeenath Ali confirmed that the child was pronounced dead at 12:27am after being admitted with suspected dengue fever two days earlier.  Ali added that she was unable to give any further details of the specific strain of the virus that the child was thought to have suffered from or any additional details about the death without the consent of the infant’s family.

According to figures supplied by the Male’ Health Services Corporation Limited, a total of 59 people have been admitted to hospital between June 1 and June 20 this year suffering from the virus. Of these cases, six were admitted on suspicion of catching dengue fever, 50 were hospitalised with the dengue hemorrhagic variant of the virus and three others were diagnosed with dengue shock syndrome – where blood pressure drops so low that organs cannot function properly. Over the same period, 25 people were diagnosed by the hospital of having dengue fever and were treated as outpatients.

Early symptoms of virus are said to 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.

More than 300 cases of dengue fever in the Maldives were reported during the first two months of 2011, compared with 737 cases and two fatalities reported over the course of last year. While many of these cases were reported in Male’, most of the fatalities have been islanders, with the more serious cases thought to have disproportionately affected children.

Amidst these concerns, health authorities in the country have claimed that they are committed to a programme of working to control mosquito populations to try and combat the spread of the virus, particularly in island areas.

Geela Ali, Permanent Secretary for the Health Ministry, told Minivan News that while officials had not received any official reports of recent fatalities linked to dengue as of yesterday, there was concern in the ministry about outbreaks of the virus across the country of late.

Ali claimed that under present government health strategies, clinicians were being put at the forefront of efforts to try and provide local people with the best means to prevent potential infection of the virus, particularly in its more prominent forms like the type 1 strain.

“The main challenge is working with clinicians to pass on case management strategies to local clinics,” she said. “One of things we are trying to do is control [mosquito populations] and we are consulting with local councils and even the media in trying to do this.”

According to Ali, the hones for trying to combat dengue in the country remained on encouraging the public to locate and destroy mosquito breeding areas as to reduce incidences of the virus as effectively as possible.

While accepting that additional chemical spraying around various islands was one possibility being considered by the government  to stem the problem, she added this was strictly to be used only after clean ups of breeding grounds particularly on private property had taken place to ensure long-term effectiveness.

Earlier this year, the Centre for Community Health and Disease Control (CCHDC) and the Maldives National Defence Force (MNDF) conducted spraying of mosquito breeding sites in Male’ and the surrounding islands, but reported difficulty obtaining access to residential and construction sites.

Virus management

Back in April, Minivan News reported that health experts believed fears over a growing number of dengue fatalities was potentially related to lapses in managing the disease, particularly due to the high turnover of foreign doctors on islands.

Dr Ahmed Jamsheed, a former head of the CCHDC, observed that January and February 2011 had seen higher instances of suspected dengue shock syndrome occurring in the country.

“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.”

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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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Race for Dengue vaccine intensifies as virus hits US for first time in 65 years

US drug companies are working hard to develop a vaccine for Dengue fever, which is endemic in Maldives. Sanofi Pasteur Inc. predicts the market for a vaccine is worth up to US$1 billion per year. Dengue has now re-emerged in Florida where 28 people have been diagnosed with the disease.

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