Battling Dengue in Argentina

Global Trends / by Carol Lloyd /

A writer reports from the dengue epidemic in Argentina, where locals are asking hard questions of government and exploring a wide-reaching approach to prevention.

When I traveled to Argentina in April to investigate the little-known Latin American Chagas disease, I was greeted at immigration by posters of super-sized mosquitoes hovering around the words, Dengue: Podemos Prevenirlo (Dengue: We can Prevent it.) In the days to come, my trip’s initial purpose was overshadowed by encounters with the worst dengue epidemic in the country’s history: By mid-May the National Ministry of Health put the total number of reported cases in Argentina at more than 23,000. Dengue teach-ins were being held at the University of Buenos Aires, tourist kiosks were passing out brochures warning against travel to the affected northern provinces, and each night the evening news chronicled the gruesome “firsts”—the country’s first cases of dengue passed from a mother to her unborn child, the first cases of the virulent hemorrhagic fever, the first deaths. 

The alarm was understandable. Dengue fever is a mosquito-borne infection that causes a severe flu-like illness with two potentially lethal complications: hemorrhagic fever and shock. It’s sometimes called “breakbone fever” for its excruciating pain. Although a new vaccine is being tested in Thailand and early medical attention can quicken recovery, there is no treatment or vaccine for dengue. And unlike many of its neighbors, Argentina has a mild climate and a robust public health infrastructure, which have largely spared the country from the disease. In 1998, for example, neighboring Brazil reported 535,388 cases of dengue, while Argentina had only 822. The country reported its worst outbreak before the current one, in 2004, with 3,284 cases.


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A poster reading We should all avoid dengue hangs at a road block outside Anatuya, where cars were fumigated.

Photographs by Catherine Carp


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Every car coming into Anatuya was stopped and sprayed, inside and out, with insecticide.


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A truck sprays insecticide in the streets in Anatuya.


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Anatuya’s public health officials hold a press conference regarding the outbreak.


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Open water tanks, often used by families in slums, can be sites for mosquito breeding.


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Densely populated slums outside downtown Buenos Aries are constructed from recycled and found objects.


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A poster hanging at a university in Buenos Aires promotes a debate on the politics of the dengue crisis.


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The resurgence of dengue in Argentina is part of a global story of infectious diseases shifting their ecologies and increasing their spread; many experts believe these changes are a result of globalization and climate change. According to Ignacio Llovet, a health sociologist at the Center for the Study of State and Society (CEDES) in Buenos Aires, increased global travel and urbanization transports the Aedes aegypti mosquito to new places, but it is global warming that lets the mosquitoes settle permanently in new locations, thereby enlarging “the geographical risk areas for disease transmission.”

To many, this explains why dengue’s reach has grown dramatically in the past few decades: While only nine countries were affected by dengue in the 1950s, the disease now affects 100 countries. This year, dengue epidemics have struck Australia, Thailand, Bolivia, the Phillipines, Vietnam, and Paraguay. With 50 million cases of dengue reported around the world each year, dengue has become a disease that the developed world can ill afford to neglect. And while little can be done to control the climate or travel, Argentina has experienced the ways outbreaks can result from flimsy public health policies, a lag in government reaction time, and public ignorance about how the disease is spread.

When I arrived in Argentina, I planned to travel to Chaco in northern Argentina, a Chagas hotspot, but the impoverished northern province had been all but crippled by dengue. In the town of Charata, officials were reporting that one in three people had contracted the disease, yet Chaco’s Health Minister Sandra Mendoza refused to call the outbreak an “epidemic” until late April, long after dengue had devastated the province. An epidemiologist told me enigmatically that, even if I went to Chaco saturated in DEET, I would not be able to get interviews about Chagas. “Chaco is very sensitive,” he said. In other words, the health ministry would not risk another PR crisis about an all-together different disease. Activists and opposition politicians demanded Mendoza’s resignation because of her mismanagement of the epidemic and finally got it in early May 7—no small feat considering that Chaco’s governor happens to be Mendoza’s husband.

After hearing the reports from the northern provinces, I decided to stay in Buenos Aires, which is usually protected against mosquito-borne epidemics by a mild climate and strong medical system. Yet this April unseasonably balmy weather created ideal conditions for mosquitoes to continue breeding, and the impoverished squatter cities, villas miseries, that have sprung up at the edges of the city over the past decade, added the necessary ingredient for an outbreak. A few days after my arrival, I began hearing dengue stories. During a visit to Carcova, a shantytown outside the city where children drink water from the garbage-staunched canal nearby, public health caseworker Patricia Pierdominici informed me that dengue had been reported in a barrio nearby, and that the cases were indigenous, meaning spread by local mosquitoes. By mid-May the National Ministry of Health reported 102 confirmed cases in Buenos Aires (including imported cases) and 573 suspected cases. But news reports quoting unnamed officials reported more than 300 confirmed cases with another 1,080 suspected cases awaiting serologic confirmation.

Pan American Health Organization spokesperson Olivia Brathwaite-Dick attributes the conflicting numbers to underreporting. “A percentage of cases never receive medical attention either as a result of socioeconomic reasons or because milder dengue can pass without the patient recognizing it,” she says. But many suspect that the government in Argentina is concealing the numbers. “The grapevine says there have been more classic dengue cases in the metropolitan area,” one dengue expert told me. “They are just ‘frozen’ till further notice. We’re in election time!”

At the height of the epidemic in mid-April, the federal government bloc, led by Nestor Kirchner, former president and the husband of President Cristina Kirchner, declined to sign a measure declaring a national health emergency because, as one party leader told the press, it might damage its international reputation. While Brathwaite-Dick points out that the federal government did respond to the outbreak by mobilizing resources, engaging the help of international experts, and—in the case of some of the most affected provinces—declaring an emergency, the move to table the declaration was evidence to many that politics tainted the government’s response to the epidemic.

Now that Argentina is heading into Southern Hemisphere winter, dengue fever has subsided and most suspect it will lay low, at least until the return of warmer months. But if another outbreak occurs within the next few years, the results could be disastrous, says Ricardo Gurtler, an epidemiologist in the Laboratory of Eco Epidemiology at the University of Buenos Aires. “This time there were not many deaths,” he says. “But if there was a second wave with a different serotype, then you could have a higher incidence of hemhorragic fever, which has a far higher mortality rate.” Exposure to a single type of dengue virus is thought to confer immunity to future infections of that serotype, but exposure to a second serotype greatly increases the risk of the far more virulent dengue hemorrhagic fever. “This is a city of 13 million,” says Gurtler. “Can you imagine what this would mean?”

Yet like all the experts I interviewed, Gurtler does not believe that dengue is inevitable or uncontrollable. Treating standing water with insecticides, and educating the public about removing potential breeding sites around their homes such as discarded tires and other garbage that holds rainwater could radically curtail dengue’s reach. “Lack of control actions led to the current large infestation of most of Argentina by Aedes aegypti,” Gurtler says.  “Furthermore, the lag in undertaking effective actions did the rest in some of the most affected provinces.” Brathwaite-Dick agrees, telling me via an email that Argentina’s success in controlling dengue will result from all stakeholders—the government, the nonprofits, and the people—learning the lessons of this epidemic.

By late April, some regions of Argentina seemed to have gotten this message. In Anatuya, a dusty town of 30,000 people bordering the Chaco, news of dengue’s arrival had just broken the morning we arrived on an overnight bus. Maria Eugenia Coppede, director of Mundo Sano, a local nonprofit that teaches environmental health and farming skills to the town’s rural poor, had dropped her scheduled events for an emergency press conference. Amidst the peeling walls of the municipal offices, she sat with the mayor and a host of other officials to face one television camera and a half dozen radio reporters. The mayor announced that the city, taking no chances, would begin fumigating under Coppede’s direction immediately. Two hours later, the fumigation trucks rumbled along the streets pouring clouds of pesticides over stray dogs and bicycling elderly men alike. On the roads into town, technicians with pesticide-filled backpacks fumigated incoming cars inside and out.

But even then it was easy to see how the mosquitoes might get the upper hand. The people living outside the city in ranchos—shacks precariously constructed from foraged sticks, grass, and dirt without electricity or running water—were too isolated to be serviced by the fumigadores. There rainwater stood in open containers, waiting for the vectors to come.

Originally published May 28, 2009

Tags cities climate development medicine multilateralism politics water

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