A rise in dengue fever

BUENOS AIRES — The world over, swine flu is the illness du jour. But in Argentina, the illness of the year — one that some say is worse than the swine flu — has been dengue fever.

As the southern hemisphere’s winter sets in and kills off the mosquitos that transmit the virus, Argentina is just beginning to come off its worst dengue epidemic ever.

The government has recorded more than 23,000 confirmed cases of the illness, with mercifully fewer than 10 deaths so far. But non-govermental experts say that the actual numbers may be many times higher.

“Argentina is en route to becoming a dengue-endemic country — that much is clear,” said Hector Coto, executive director of the Healthy World Foundation. Although the outbreak began and has remained strongest in the semi-tropical north of the country, every province in the nation has now seen suspected infections.

Some of the reported illnesses, especially those in the frigid Patagonian states, are believed to have been contracted when people traveled to dengue-endemic regions. But health officials believe the vast majority of cases, including some of those in temperate Buenos Aires, came from mosquitos right in peoples’ backyards.

This is a rude awakening for a country that had eradicated the dengue-carrying mosquito from its territory decades ago. But after 81 years without dengue, a few cases were imported from neighboring countries in 1997. A major domestic outbreak occurred the following year, and in the past decade there have been five more outbreaks infecting almost 3,000 people.

Argentina seems not to have fully adjusted to this new health reality. Groups like the Argentine chapter of the international NGO Doctors of the World have accused the national and provincial governments of negligence in treating the disease, and of denying the extent of the problem. Indeed, the congressional debate over whether to declare a health emergency in the worst-affected areas was suddenly silenced last month when Senate Majority Leader Miguel Pichetto declared, “We shall not place Argentina in the red zone of the world,” citing concerns about hurting tourism in the country.

The debate here is likely about more than medicine.

“I think it has deep cultural roots,” said medical sociologist Ignacio Llovet of the Center of Studies of State and Society in Buenos Aires. “I think there’s a deep resistance to admit certain things” that might associate Argentina with tropical neighbors that have historically had more trouble with health and development challenges, Llovet said.

It’s true that the recent resurgence of dengue in Argentina leaked from bordering states, which have had much larger epidemics — Brazil saw hundreds of thousands of cases in its worst outbreak ever last year. And it’s also true that Argentina’s tens of thousands of dengue cases are a drop in the Americas’ bucket of more than 1 million a year, and the 50 million annual cases worldwide.

But Argentina’s share in this and other diseases has been growing in recent years, and now some of the country’s health indicators are worse than those of its neighbors, Llovet said. He cited chagas, a parasite that has been all but eradicated in Brazil, where it was first discovered, but still persists in Argentina and infects about 10 million people in the hemisphere.

Like chagas and many other infectious diseases, dengue is strongly associated with conditions of poverty — a stigma that might be another impediment to its acceptance as a fact of Argentine life. Because dengue-carrying mosquitos breed in standing water, the disease disproportionately affects poor communities without plumbing on the outskirts of cities.

There have been a few cases of more illustrious dengue victims — an ex-governor, for example, was the first person known to have contracted the disease in his province during this outbreak. But these are the exception rather than the rule.

In Chaco, the province that accounts for half of Argentina's dengue cases, then-Health Minister Sandra Mendoza recently pronounced that dengue "doesn't distinguish between social class, religion or political parties,” and she indignantly dismissed as a political attack the allegation that she herself was infected. In an epic 13-hour legislative hearing on that allegation and questions about whether she had taken enough action on the outbreak, Mendoza declared that “the responsibility for dengue lies with the mosquito.” She has since resigned under fire.

Dengue panic and polemics were muffled by fears over swine flu at the end of April. But a few weeks into that outbreak, Mexican president Felipe Calderon revived dengue-related politics when he criticized Argentina's efforts at disease prevention. He made the jab as he was bristling at an Argentine ban on flights from Mexico, a measure that a handful of Latin American countries adopted against the advice of the World Health Organization and the United Nations.

Meanwhile, politicians and commentators — from Argentina’s Mexico ambassador to Foreign Policy Magazine — maintained that Argentina is sicker from dengue than Mexico is from the flu. That might still be true (by 40 to one) in terms of the number of reported infections, but Mexico seems to have had a much higher mortality rate during its outbreak.

And while the future of swine flu is unclear, dengue fever in Argentina is winding down — for this year, anyway. Experts say that without rigorous intervention by the Argentine government, dengue outbreaks will become more widespread and more deadly in the future.

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