Caribbean & Central America - December 2023

Data released in early November by Costa Rica’s health ministry put the number of cases of dengue, a mosquito-borne viral disease, at 18,194 in Costa Rica as of Epidemiological Week (EW) 42 this year, more than twice the total of 7,485 registered in the whole of 2022. This is in line with warnings from the Pan American Health Organization (PAHO) of a surge in dengue cases in Central America. An earlier report from the World Health Organization (WHO) noted in July that while dengue is endemic in most Central American countries, during the current season, a rise in dengue cases has been observed at levels above the average number of cases recorded in the last five years and beyond historical areas of transmission. Scientists have previously attributed outbreaks to warming temperatures and changing weather conditions, including more extreme weather.

According to PAHO data released on 15 September, the latest comprehensive update for the sub-region as a whole, between EW 1 and EW 35 there were 226,183 dengue cases reported in the Central American isthmus and Mexico, with a cumulative incidence rate of 123.6 cases per 100,000 people.

According to the PAHO, the highest cumulative incidence rates were reported in Nicaragua, with 1,346.7 cases per 100,000 population, Belize (1,009 per 100,000), Panama (162.2 per 100,000), and Honduras (114.6 per 100,000). This year, of the 226,183 reported dengue cases, 26,017 (11.5%) were laboratory confirmed and 577 (0.26%) were classified as severe dengue. The highest number of dengue cases were reported in Nicaragua with 90,258 cases, followed by Mexico (86,397) and Guatemala (14,299). As regards severe dengue cases reported in 2023, the highest number were reported in Mexico (443), Honduras (73), Guatemala (36), Panama (12), and Nicaragua (10).

In response to the rapid increase in cases, governments have taken measures. In the case of Nicaragua, which has registered the highest number of cases, the health ministry issued a series of recommendations at the end of July. These included house-to-house visits to raise awareness of the epidemic, as well as ensuring larvicide application in household water tanks and regular fumigations. Elsewhere, in Costa Rica, the health ministry declared a nationwide preventive health alert for dengue on 6 September while a report published on 20 October by the International Committee of the Red Cross (ICRC) notes that as well as actively seeking the support of the entire population and calling for a nationwide alliance to combat dengue, the ministry has implemented a series of strategies to prevent the spread of the disease-carrying mosquito. These strategies include the fumigation of residential properties and vacant lots, the treatment of water tanks, and the initiation of control and mitigation measures.

Meanwhile on 31 August Guatemala’s public health ministry declared a national health emergency after over 10,000 cases of dengue were reported in the country over the previous three months. Health Minister Francisco Coma said the measure would be in effect for three months and entails implementing fumigations to eradicate mosquitoes. It also provides for increased care in hospitals, among other actions involving various public and private institutions. In Honduras, international NGO Médecins Sans Frontières (MSF) announced it was partnering with the Honduran health ministry among others to implement innovative public health strategies that have proven effective in other countries with high levels of dengue. This includes releasing Aedes aegypti mosquitoes carrying the natural Wolbachia bacteria, which reduces mosquitoes’ ability to transmit arboviruses.

Criticism of measures taken in Nicaragua

A report published on 18 September by Nicaraguan investigative outlet Confidencial cites epidemiologists as criticising the measures taken by the Nicaraguan government in response to the surge in dengue cases. They blame the sustained increase in contagion on the health ministry’s failure to prevent and control the epidemic, and highlight a lack of collaboration with the Nicaraguan population, which is crucial to preventing transmission. They also highlight the need to education the public regarding the epidemic and criticise the lack of transparency regarding data – an accusation previously levied at President Daniel Ortega’s government in relation to the coronavirus (Covid-19) pandemic which struck in March 2020.