Santo Domingo, RD

After the violent boom of dengue fever in Dominican territory, with more than 12,000 reports since its beginning and 11 human losses so far this year, private laboratories, such as “Referencia”, have had a high demand of patients who come to these centers for laboratory tests to determine whether or not they have the viral disease.

LISTÍN DIARIO, during a tour made yesterday, verified the increase of this type of test when visiting two branches of ‘Referencia Laboratorio Clínico,’ one located on Francia Avenue, on the corner of Rosa Duarte Street and the other on Ortega y Gasset Avenue.

A customer service staff of the latter branch told this newspaper that the test to detect dengue is called NS1, while the one for antibodies consists of other types of tests called “Dengue IgG and InG.”

“There is an increase in dengue testing,” the employee stated while explaining, “Doctors monitor the disease with the hemogram, which measures the level of platelets.”

These clinical analyses are usually completed within a maximum period of 24 hours, according to the person consulted.

At the branch on Francia Avenue, the customer service staff also assured the increase of these laboratory tests: “Yes, there has been an increase,” they indicated.

WHAT DO THESE TESTS WORK FOR?
This newspaper consulted a specialist on the subject, who explained that after questioning a patient with suspected dengue, they are sent for laboratory or complementary tests, such as hemogram or abdominal tomography, since, based on the results, the patient may or may not be diagnosed with the disease.

“In the hemogram we see white blood cells and platelets. The hemogram describes other things, but for dengue cases that is the most important thing,” said the physician, who preferred anonymity.

Regarding the CT scan, he said, “It is to see internal organs, but especially the liver, because dengue affects the liver.”

The expert also referred to the IgM test since it can indicate whether the patient has dengue or not.

“In case it is positive, it indicates the phase in which the patient is. But, it is not recommended to do it on the first day of symptoms, because nothing comes out, only the hemogram,” he explained.

HOSPITAL LABORATORIES
The high demand for tests on this disease, which is transmitted by mosquito bites of the Aedes aegypti species, has been similar in some hospital laboratories in the capital.

For example, the Hospital Materno Infantil Santo Socorro has registered “a packet” of laboratory tests, as stated to this newspaper by a medical staff member in the Sample Collection department.

Meanwhile, at the Robert Reid Cabral Children’s Hospital, the situation has been similar after the high attendance of suspicious patients. Estefania Cruz admitted her four-year-old niece to the emergency area of this health center for presenting symptoms of dengue fever since last Wednesday 18.

The campaign will cover the entire territory, but priority will be given to the capital, Santo Domingo, as well as to the provinces of Santiago, Puerto Plata, Monseñor Nouel, La Romana, Barahona, San Cristóbal, Montecristi and San Pedro de Macorís, which concentrate the most significant number of contagions, as explained at a press conference by the officials who make up the recently created Cabinet of Action Against Dengue.

The participants in this operation are part of the institutions that make up the Emergency Operations Center (COE), whose director, General Juan Manuel Méndez, called on the population to support the work “to fumigate and eliminate mosquito breeding sites in tanks, tires and other containers which can accumulate clean water so that together we can frequently eliminate the breeding sites” of the Aedes aegypti mosquito, transmitter of dengue and other diseases such as chikungunya and zika.

For his part, the Minister of Public Health, Daniel Rivera, guaranteed that the country has “all the supplies, medicines and a solid national response capacity to control this endemic disease” amidst criticism from the political opposition for the alleged lack of action to control the outbreak.

Along the same lines, the director of the National Health Service, Mario Lama, stated the reinforcement of “human resources, medicines and tests” to diagnose the disease in hospitals, many of which have been overwhelmed in recent months by the number of people affected.

Public Health maintained the epidemiological alert on 24 May for dengue, an acute viral disease characterized by high fever, intense headache, muscle pain, gastrointestinal disorders, and rashes.

Perez Duran asked President Abinader to pay attention to the growing 0epidemic, about which he indicated the figures do not correspond to reality, so he asked to declare a state of emergency in the country due to increased cases.

“I am making a call to you, Mr. President (…), I understand that within 24 hours you should decree a state of emergency, where a campaign of fumigation, orientation, protocolization of the dengue fever that we have in front of us,” said the doctor.

The doctor’s daughter died on Friday last week after remaining in intensive care and being diagnosed with the disease transmitted by the Aedes Aegypti mosquito after being hospitalized since Wednesday morning.

He explained that the teenager arrived at the hospital “in a critical condition,” so she was immediately referred to the Intensive Care Unit.

“We as parents spared neither resources nor efforts to facilitate everything that was asked of us,” said the grieving father in an interview with Martina Espinal on the program Al Punto.

He indicated that, at first, they thought it was a classic dengue, but after she was intubated early Thursday morning, the infant became brain-dead at 5:00 p.m., indicating to her parents that it was too late.

The girl’s father said that the child’s platelets, which were at 266, reached 11 in just three days.

With a troubled expression, Perez narrated that they took the girl to receive medical attention since the first symptoms appeared on Sunday of that week. However, the pre-adolescent died days later.

“On Friday morning an attempt was made to connect her to a special dialysis machine, when the caveat was made that the girl was clinically dead, it was literally exploding her lungs, heart and kidneys. When she was connected to the machine, the girl died after two minutes, she went into irreversible arrest,” he said.

Relatives of affected children go from one center to another, searching for beds and locating the best doctors. According to official data, there is a slight decrease in hospitals that have been more saturated with patients, but the population indicates that they cannot find beds.

“I will ask for discharge from this clinic, if my daughter does not improve, will take her to another center,” said the mother of a teenager diagnosed with dengue.

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Situation
The Plaza de la Salud General Hospital had 29 patients admitted 12 hours ago; nine were waiting for beds in the emergency. This is the third hospital that has received the most patients with dengue fever. The Hugo Mendoza Pediatric Hospital has held first place. Yesterday afternoon, 82 minors were admitted; the emergency has a high demand. However, pediatricians insist that not everyone who comes to the emergency with a fever is dengue, as patients with influenza and other respiratory viruses have also increased.

The Robert Reid Cabral pediatric hospital had 58 minors admitted, while the Marcelino Velez Santana hospital reported 20. The Jaime Mota Hospital in Barahona had 20 admissions, and the Arturo Grullon Hospital had another 20 children. Dengue fever is also affected by the disease.

Warning signs
Firm and persistent abdominal pain; vomiting more than three in one hour, more than six in two hours; mucosal bleeding, mainly in the gums; edema; drowsy or irritable young children; hepatomegaly; hypotension (they stand up and get dizzy) and increased hematocrit, said Dr. Virgen Gomez, pediatric infectious disease specialist.

Symptoms
Dengue has symptoms that lead the family and the physician to think of dengue: the abrupt onset of fever, headache, body aches, vomiting and diarrhea, and rash.

Provinces
Some 25 provinces have presented more cases, with the municipality of Santo Domingo Norte having the highest incidence. This is why the Hugo Mendoza hospital authorities were forced to open more than 100 beds.

They have had up to 106 patients admitted. Santo Domingo, the National District, Barahona, La Vega, and San Cristobal have a high disease incidence.

The age groups that have been infected the most are 4 and 19 years old, but adults have also been infected, it has been proven.

It is an endemic disease. The virus is transmitted by the Aedes aegypti mosquito.

The Hugo Mendoza pediatric hospital beats its own record every day in the number of patients admitted with dengue fever; yesterday, it had 98 minors bedridden with the viral disease that affects children.

Meanwhile, the Roberto Reid Cabral Children’s Hospital registered 72 hospitalized patients.

The data were offered by the director of the National Health Service (SNS) hospital network, Yocasta Lara Hernandez.

Other hospitals maintain many occupied beds, which complicates the dynamics of these centers, which also attend to other children with various pathologies.

The Hospital General de la Plaza de la Salud is the third that attends the most patients; its authorities reported 18 admissions, and eight were waiting for beds in the emergency room.

The San Lorenzo de Los Mina hospital had 25 children hospitalized. Admissions are increasing, as this is where the disease outbreak is highest. Marcelino Velez Santana had 19 children in bed, and Jaime Mota de Barahona had 20. The Arturo Grullón in Santiago had 17,6, and the one in Boca Chica had 16.

Lara said that the Jacinto Mañon center has 11 children admitted with dengue, the Almirante,3 nine; Ciudad Juan Bosch, another nine; Felix2 Maria Goico, five and 15 at the Juan Pablo Pina.

Symptoms
Dengue has unique symptoms that can be confused with other diseases. Doctors and citizens should be alert to suspicions.

It produces sudden onset fever, headache, body aches, vomiting, diarrhea, nine, and rash. Doctors ask parents to be vigilant.

Santo Domingo.- The Vice Minister of Collective Health, Eladio Perez, has no fixed date for the dengue epidemic to decline. He thinks that the country is now facing a plateau. If there is no drop in cases, the disease affecting the Dominican Republic could continue its impact until the end of the year, according to infectologists.

The official has the perception that in the coming weeks if the current behavior continues, the disease could go down. He believes that there is a slight drop in patient admissions.

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There will always be cases because the disease is endemic. The cessation of the high incidence will depend on the pattern; if it continues now, there will be fewer cases in the coming weeks, said the official who manages the country’s collective health.

“We need a little more time, if the disease continues to go down the country would be in improvement,” said the epidemiologist. In his opinion, the final phase of the disease cannot be determined by the behavior of a week.

Clinics to attend
The director of the National Health Service (SNS) hospital network, Yocasta Lara, asked the directors of the National Association of Private Clinics (Andeclip) to provide more beds.

In the public sector, the clinics refer patients to them, most of whom are under 19 years of age.

Almost all the cases are being attended by two large public hospitals and one of a patronage hospital.

The Hugo Mendoza pediatric hospital leads in admissions, followed by the Robert Reid Cabral and the General Hospital of the Plaza de la Salud in third place.

The Santiago Clinic, Unión Médica, and the Arturo Grullón hold the fourth place in the same city. The Jaime Mota de Barahona also has cases of children and adults.

Behavior
The end of this epidemic outbreak, as the authorities have called it, will depend on the behavior of the vector through which the disease is transmitted, the Aedes aegypti mosquito.

The hospitals
Dr. Yocasta Lara, director of the SNS hospital network, reported yesterday on the number of patients admitted with dengue fever.

She also reported that the Robert Reid Cabral hospital had 64 children admitted. Three children remain in intensive care at this center.

The Marcelino Vélez Santana hospital has 21 admissions, the Juan Pablo Pina, 10, the Arturo Grullón, 13, and 12 at the San Lorenzo de Los Mina. Lara indicated that the Jaime Mota hospital in Barahona has 26 patients admitted: Jacinto Mañón, seven; El Almirante, six; Boca Chica, 19; and Félix María Goico, three admissions.

Plaza de la Salud
At the Plaza de la Salud General Hospital (HGPS), where many patients, mostly children, have been treated, 17 patients were admitted yesterday and are still waiting.

Santiago, DR.- The number of patients affected by dengue fever has increased among children in the last few days here, while among adults, the cases are sporadic and isolated, according to reports from the three most important public hospitals in this province.

Reports also indicate that private clinics continue to receive patients with symptoms of the disease transmitted by the Aedes aegypti mosquito.

The director of the children’s hospital, Dr. Arturo Grullon, Dr. Mirna Lopez, reported that this health center handles an average of 15 to 20 patients affected by dengue daily, experiencing a slight increase in emergency and outpatient consultations of febrile patients.

Dr. Mirna López, director of the children’s hospital, Dr. Arturo Grullón.

She said that of the total number of children admitted, only one is in intensive care, and his health remains stable. So far this year, two patients have died from the disease.

López explained that most of those affected by dengue come from different sectors of Santiago, such as Pueblo Nuevo, Cienfuegos, Jacagua, San José de Las Matas, as well as Montecristi and other towns of the Cibao region.

Meanwhile, in the hospitals José María Cabral y Báez and Presidente Estrella Ureña, the cases of dengue fever are sporadic. For example, at the Cabral y Baez hospital, there have been six cases of dengue in the last 15 days; 4 of them were admitted and subsequently sent home, according to the medical director, Manasés Peña.

Only two patients had been admitted to the Presidente Estrella Ureña Hospital recently.

President Estrella Ureña Hospital
On the other hand, the provincial authorities of Public Health informed that they continue the fumigation and cleaning up of garbage in various sectors of Santiago as a prevention against dengue fever and other diseases transmitted by vectors.

The cleaning activities, orientation, and education to combat dengue are conducted in schools, colleges, and neighborhood councils.

Dengue mosquito (External source)

Dengue mosquito (External source)

Corominas Clinic

At the Corominas clinic, one of the traditional private health centers in Santiago, there are currently 16 hospitalized patients, 2 of whom are in the intensive care unit, none of whom have died.

Influenza viruses are constantly changing; for this reason, every year, the composition of influenza vaccines is reviewed in the United States and updated as necessary to match as best as possible with the viruses, which, according to research, will be the most circulating in the season that is starting.

A detail
Dr. Jhan Gonzalez, a pulmonologist, indicates that the suggestions regarding the annual vaccination against influenza have some modifications, such as, for example, a change in the vaccination recommendations for people with egg allergy.

The specialist explains that the timing of influenza vaccination has not been modified; September and October are the best months for most people to get vaccinated. Vaccination is not recommended in July and August in most cases, but there are some considerations for certain groups of people in July and August.

Over 65 and pregnant women
For adults (especially those 65 years and older) and pregnant women in their first or second trimester, vaccination should be avoided in July and August unless they are not likely to be vaccinated in September or October.

Pregnant women in their third trimester can be vaccinated in July or August to ensure that their babies are protected against influenza at birth.

Children
Children who need two doses of influenza vaccine should receive their first dose as soon as it becomes available. The second dose should be given at least four weeks after the first dose. Vaccination in July or August may be considered for children who have medical appointments in these months if there will not be another opportunity. The physician from Centros de Diagnóstico y Medicina Avanzada y Telemedicina (CEDIMAT) assures that vaccination is still recommended as long as there is circulation of influenza viruses that pose a risk. In some seasons, this period may extend until the end of May or June. Gonzalez points out that the effectiveness of the influenza vaccine may depend in part on the coincidence between the vaccine’s viruses and those circulating.

Estimates
According to preliminary estimates, last season, people vaccinated against this disease had between 40% and 70% less risk of hospitalization due to influenza or its associated complications.

People with egg allergy
The significant change in influenza vaccination recommendations for 2023-2024 relates to administering the vaccine to egg-allergic persons. The physician says most current vaccines are still produced with an egg protein culture process and, therefore, contain a small amount of egg proteins, such as ovalbumin.

Recommendation
The CDC advises that the best way to reduce your risk of seasonal influenza and its potentially serious complications is to get vaccinated every year, this October.

Again, the Hugo Mendoza pediatric hospital had an admission of 92 children under 15 years of age, and the Robert Reid Cabral hospital had 65 admitted. This is happening while the flow through the emergencies is being maintained.

Dr. Yocasta Lara, director of the National Health Service hospital network, offered the information. She assures that most of the provinces are without admissions. As the authorities call it, the epidemic is concentrated in Greater Santo Domingo, the National District, La Vega, Santiago, and Barahona.

The Marcelino Velez hospital yesterday had 17 patients admitted for dengue fever, the Jacinto Mañon, 07,5, and the Arturo Grullon hospital in Santiago had 18 patients admitted.

Situation
More than 7,000 cases of the disease have been registered in the country, but a high underreporting suggests a higher number of people affected. Authorities are investigating ten deaths due to dengue, and six have been confirmed. The population is urged to avoid mosquito breeding sites.

The disease
Dengue is a viral disease transmitted by the bite of the Aedes aegypti mosquito.

The mosquito lays its eggs, which develop into larvae and reproduce. Entomologists study its behavior.

This is an epidemic year, so authorities have called the population to avoid mosquito breeding sites. They are asking people to clean gardens and areas with trees.

This week, Dr. Eladio Perez, Vice Minister of Collective Health, said that the indicators in the country remain well below those of other countries in the Americas region, thanks to the interventions being carried out.

He also presented the behavior of dengue to the 35th Epidemiological Week, where he detailed that currently, 3,123 cases were reported as suspected, and in the last week, they reported 1,093 six deaths.

Santo Domingo.- The clinical symptoms of dengue can be confused with other diseases ranging from leptospirosis to hepatitis, which is why it is important to perform a comprehensive medical evaluation of the patient and laboratory tests.

This is what the infectologist Elianet Castillo, from the Centro Médico de Diabetes, Obesidad y Especialidades (CEMDOE) warns when referring to the current epidemic outbreak of dengue that is affecting the country and that is leading to a high demand for medical attention.

The specialist explained that it is important to know that dengue is characterized by symptoms of fever, headache, retro ocular pain, general malaise, rash, joint pain and muscle pain.

These symptoms and signs, he said, can be confused with other diseases that are also part of the country’s local epidemiology, such as malaria, chikungunya, zika and leptospirosis,” he explained.

He explained that when the patient with dengue presents alarm signs such as nausea, persistent vomiting and abdominal pain it could represent a challenge because it could also be confused with other infectious diseases affecting the gastrointestinal system such as hepatitis or inflammation of specific organs such as the gall bladder (cholecystitis) and the appendix (appendicitis).

Malaria and Leptospirosis

Castillo pointed out that in the case of malaria, chikungunya and zika, they also present with fever. “Generally, compared to dengue, they do not cause as many alterations at the hematological level and do not usually cause as much morbi-mortality.”

He said that leptospirosis, which usually increases its incidence after heavy rains and floods, can present symptoms very similar to dengue, and being a bacterial disease requires treatment with antibiotics to prevent progression to its terminal stage called Weil’s syndrome where severe kidney and liver damage occurs, reaching a 50% mortality rate.

This shows, added the specialist, the importance of a comprehensive medical evaluation and the performance of the necessary laboratories to reach an accurate diagnosis and thus speed up the appropriate treatment of the patient.