Milenko Kindl Cvrcko

SAN JUAN, Puerto Rico - Dengue fever is spreading across Latin America
and the Caribbean in one of the worst outbreaks in decades, causing
agonizing joint pain for hundreds of thousands of people and killing
nearly 200 so far this year.
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The mosquitoes that carry dengue are thriving in expanded urban slums
scattered with water-collecting trash and old tires. Experts say
dengue is approaching record levels this year as many countries enter
their wettest months.

"If we do not slow it down, it will intensify and take a greater
social and economic toll on these countries," said Dr. Jose Luis San
Martin, head of anti-dengue efforts for the Pan American Health
Organization, a regional public health agency.

The U.S. Centers for Disease Control and Prevention in Atlanta has
posted advisories this year for people visiting Latin American and
Caribbean destinations to use mosquito repellant and stay inside
screened areas whenever possible.

"The danger is that the doctors at home don't recognize the dengue,"
said Dr. Wellington Sun, the chief of the CDC's dengue branch in San
Juan. "The doctors need to raise their level of suspicion for any
traveler who returns with a fever."

Dengue has already damaged the economies of countries across the
region by driving away tourists, according to a document prepared for
a PAHO conference beginning Monday in Washington.

Some countries have focused mosquito eradication efforts on areas
popular with tourists. Mexico sent hundreds of workers to the resorts
of Puerto Vallarta, Cancun and Acapulco this year to try to avert
outbreaks.

Health ministers from across the region meet at the PAHO conference
and San Martin said he will urge them to devote more resources to
dengue fever.

The tropical virus was once thought to have been nearly eliminated
from Latin America, but it has steadily gained strength since the
early 1980s. Now, officials fear it could emerge as a pandemic similar
to one that became a leading killer of children in Southeast Asia
following World War II.

Officials say the virus is likely to grow deadlier in part because
tourism and migration are circulating four different strains across
the region. A person exposed to one strain may develop immunity to
that strain - but subsequent exposure to another strain makes it more
likely the person will develop the hemorrhagic form.

"The main concern is what's happening in the Americas will
recapitulate what has happened in Southeast Asia, and we will start
seeing more and more severe types of cases of dengue as time
progresses," Sun said.