REPORT ON THE EPIDEMIOLOGICAL SITUATION IN CENTRAL AMERICA
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A Report of the PAHO Emergency Task Force on Hurricane Mitch |
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Cholera:According to information received on 23 November, the epidemiological situation remains unchanged from that reported yesterday. A total of six cases of cholera have been reported with one death. With respect to the outbreak of diarrhea reported on 19 November in the San Juan de Dios Hospital (Santa Ana, on the Guatemala border), an investigation continues of the 15 cases that remain hospitalized. The Ministry of Health continues executing its plan of disease prevention and control.
GUATEMALA:
Cholera: Information received today from the Health Management Information System (SIGSA) updates the cholera situation before and after Hurricane Mitch. Up to Week 43 (31 October), 1,965 suspected cases had been reported nationally, 564 were confirmed, and 35 people died, a case-fatality rate of 1.8%. Up to Week 45 (14 November), 2,701 suspected cases were reported, 734 confirmed, and 38 people died, a case-fatality rate of 1.4%. Consequently, for the first two weeks following Hurricane Mitch (1-14 November), the number of suspected cases of cholera nationwide reached 736 (327 in the first week following Hurricane Mitch and 409 in the second week). Of these, 170 were confirmed (68 in the first week and 102 in the second week.) Three people died (two in the first week, and one in the second week.) The nationwide case-fatality rate for the first two weeks following Hurricane Mitch was 0.4%.
Leptospirosis: No change has been reported in the situation since 23 November. The total number of cases to date is six, of which five have been confirmed.
Dengue: No new information has been reported.
Malaria: Reports indicate the situation is stable.
NICARAGUA:
Cholera: No new information is available since 23 November. The Ministry of Health has reported the occurrence of 335 cases of cholera, of which 301 have been confirmed.
Leptospirosis: On 23 November 22 additional cases were reported, raising the Ministry of Health’s figures to 286 suspected cases of leptospirosos since 7 November, when they reported the first suspected case. 97.9% of the cases are in Chinandega and Esteli (149 and 131 cases respectively.) Of the 195 samples processed in laboratories through 23 November, 46 (33 in Chinandega, 12 in Esteli and one in Madriz) tested positive for Leptospira (23.6%). To date, a total of seven deaths have been reported (3 in Chinandega and four in Esteli). The latest death occurred on 17 November. The health authorities report that all suspected cases are hospitalized and there are no serious cases at the moment. The Ministry of Health is taking the following actions: strengthening medical services; household-level focal control; carrying out environmental health campaigns, using rodenticides; and identifying animals that are potential hosts. The health authorities consider that the decline in the number of reported cases in the last five days is the result of these activities.
Dengue: The Ministry of Health reports a rise in the number of reported cases in the last two weeks.
Malaria: According to information from the Ministry of Health, the situation is stable.
HONDURAS:
Cholera: There is no change in the situation as reported on 23 November. The Emergency Operations Center of the Ministry of Health reports irregularities detected in the daily reports of diseases under surveillance. This has led to a suspected under-reporting. Up to 21 November, the Ministry of Health had reported 3 confirmed cases of cholera and 11 suspected cases in Regions 1, 3 and 4.
Leptospirosis: On 23 November one suspected case of leptospirosis was reported in Choloma-La Lima, one of the affected areas in the Department of Cortes. The patient died and the samples collected are being processed. To date, the total number of reported cases is five, and four deaths have occurred.
Dengue: Up to 24 November, there is no new information. Up to 21 November, the Ministry of Health had reported 1,080 cases of classic dengue, and had confirmed 15 cases of hemorragic dengue, which resulted in the death of four people.
BELIZE:
There is no change in the situation, as reported on 23 November. To date, five cases of cholera have been confirmed, resulting in one death. The 52 contacts in the five reported cases and the six suspected cases received treatment. The authorities believe the outbreak has been controlled.
EPIDEMIOLOGICAL ANALYSIS NOVEMBER 24, 1998
Epidemic activity of cholera remains in the five affected countries; of leptospirosis in Nicaragua, Honduras and Guatemala; and of hemorragic dengue in Honduras, as reported on 23 November.
This report highlights three situations:
- The decline in case-fatality rate from cholera reported in Guatemala in Weeks 44 and 45 (1-14 November) with respect to the previous period (pre-Mitch), could be the result of earlier diagnosis and an improved level of care in diagnosed cases.
- The situation reported in Nicaragua with respect to the outbreak of leptospirosis in Chinandega and Esteli, with a decline in the number of suspected cases beginning 19 November and the absence of deaths due to this disease as of 17 November, suggests that the actions taken to control the outbreak could be associated to these results.
- The situation reported in Honduras regarding case-fatality rate from leptospirosis (4 deaths and 5 reported cases) suggests problems in the suspected diagnosis and/or the early diagnosis of these cases. These considerations should be confirmed by the health authorities.
PAHO considers that the recommendations put forth in the report of 23 November remain valid, and consequently reiterates the need to set them in motion.
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