Chiapas Mexico reports several Dengue fatalities during 2019

August 19th, 2019 – Severe Dengue cases in Central American countries, including Mexico, have reached 10,335 in 2019. According to the Pan American Health Organization (PAHO) data on August 10, 2019, this type of dengue fever has been related to 150 fatalities. In Mexico, the southern state of Chiapas has reported the most severe dengue fatalities (26) in this PAHO region during 2019. Chiapas is known officially as the Free and Sovereign State of Chiapas, one of the 32 federal entities of Mexico. Chiapas became a Mexican state in 1824, with over 5.2 million residents in 2017, reports Britannica. Chiapas is home to one of the largest indigenous populations in Mexico; about one-fourth speak Mayan related languages. Chiapas includes the ancient Mayan ruins of Yaxchilán, Bonampak, Chinkultic and Toniná. Previously, the US Department of State issued a Level 2: Exercise Increased Caution, for Chiapas state, on April 9, 2019. There are no restrictions on travel for U.S. government employees in Chiapas state, which includes tourist areas of Palenque, San Cristobal de las Casas, and Tuxtla Gutierrez. Regarding health alerts, as of June 20, 2019, the US Centers for Disease Control and Prevention (CDC) Travel Information page for visitors to Mexico, did not identify ‘Severe Dengue’ as a risk. Severe dengue (dengue haemorrhagic fever) was first recognized in the 1950s during dengue epidemics in the Philippines and Thailand, says the CDC. The full life cycle of dengue fever virus involves the role of the Aedes aegypti mosquito as a vector and humans as the main victim of an infection. Once infected, humans become the main carriers and multipliers of the virus, serving as a source of the virus for uninfected mosquitoes.  The virus circulates in the blood of an infected person for 2-7 days. Moreover, patients who are already infected with the dengue virus can transmit the infection through breast milk, says the CDC. The dengue virus (DEN) comprises 4 distinct serotypes (DEN-1, DEN-2, DEN-3, and DEN-4) which belong to the genus Flavivirus, family Flaviviridae. Distinct genotypes have been identified within each serotype, highlighting the extensive genetic variability of the dengue serotypes. Among them, “Asian” genotypes of DEN-2 and DEN-3 are frequently associated with severe disease accompanying secondary dengue infections. In humans recovery from infection by one dengue virus provides lifelong immunity against that particular virus serotype. However, this immunity confers only partial and transient protection against subsequent infection by the other three serotypes of the virus. International travelers requiring dengue treatments average a total out-of-pocket cost of US $992 per episode. As of August 7, 2019, the CDC has confirmed 215 travel-related dengue cases and 1 locally acquired case in Florida. Clinical evidence points to the fact that sequential infection increases the risk of developing severe dengue. The time interval between infections and the particular viral sequence of infections may also be of importance. There is a CDC approved preventive vaccine available for the dengue virus. On May 1, 2019, Dengvaxia became the first vaccine approved in the USA for the prevention of dengue disease in people ages 9 through 16, who have laboratory-confirmed previous dengue infection, and who live in endemic areas caused by all dengue virus serotypes. “The newly licensed dengue vaccine offers hope to previously infected adolescents. While each subsequent infection increases the risk of developing severe dengue disease, this vaccine offers protection with one dose,” said Aubren Emberton, Pharmacy Intern, for Brookshire’s Grocery Company. A blood test is the only way to confirm a dengue diagnosis. >>  Order confidential blood tests at Ulta Labs  << Dengvaxia is a live, attenuated vaccine that is administered as 3 separate injections, with the initial dose followed by 2 additional shots given six and twelve months later. The vaccine was determined to be approximately 76 percent effective in preventing symptomatic, laboratory-confirmed dengue disease in individuals 9 through 16 years of age who previously had laboratory-confirmed dengue disease. The CDC says before being vaccinated with Dengvaxia, inform your healthcare provider if you have dengue symptoms or live in or have recently traveled to an area with risk of dengue.

• Fact checked by Robert Carlson, MD

References:

• PAHO: Dengue and Sever Dengue Cases and Deaths
• PAHO: Dengue and Sever Dengue Cases and Deaths by State, Mexico
• Chiapas, State, Mexico
• US Department of State: Mexico – Level 2: Exercise Increased Caution
• CDC: Health Information for Travelers to Mexico
• CDC: Map of Dengue risk in the Americas and the Caribbean
• Governmnet of Canada: MEXICO – Exercise a high degree of caution

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