Dengue epidemic looms as Cambodian authorities scramble to prepare

PHNOM PENH, April 10 (Xinhua) -- Expert has warned that a dengue fever epidemic would soon sweep through Cambodia at a time when infections of the disease are usually at their lowest, the Mekong Times newspaper said Thursday.

Generally, dengue fever is most prevalent from early January till May in Cambodia, but this year the worst period will be from the end of April till July, claimed Ngan Chantha, vice director of National Center For Dengue and Malaria Control.

Ngan Chantha said the change has resulted from many factors such as the impact of the dengue epidemic in late 2007 and environmental changes that have altered the existing virus and irregular rainfall.

Other subordinate factors such as unsanitary conditions and migration exacerbate the problem, he said.

However, a combined Health Ministry and National Center Against Dengue Fever campaign dubbed "Abate", an insecticide used to kill mosquito larvae, should go some way towards reducing the risk, Ngan Chantha said.

Officials are distributing Abate to people in high risk areas for them to add to their water storage to kill the anopheles mosquito larvae that spread dengue fever when they reach adulthood.

Dengue Death Toll Highest in Nearly a Decade, Official Says

By Chun Sakada, VOA Khmer
Original report from Phnom Penh
04 January 2008

An early monsoon that encouraged mosquitoes led to the highest dengue fever death rate in nearly a decade, health officials said Friday.

Dengue hemorrhagic fever, or "bonecrusher disease," killed 407 Cambodians and infected more than 40,000 people in 2007, officials said. Health officials said Friday hospitals were ill equipped to handle the outbreak.

In 2006, 16,650 people were infected and 158 died. The death toll for 2007 was the highest since 1998, when the disease killed 474 people, the Associated Press reported.

The disease is characterized by headache, fever, exhaustion and severe joint and muscle pain. Health officials sought to curb the spread of dengue by encouraging Cambodians to cover water containers and treat standing water where mosquitoes breed.

Severe outbreaks of the disease in 2007 were also reported in Indonesia, Vietnam, Malaysia, Singapore and Thailand.

Cambodia suffers worst dengue epidemic, 407 dead

Fri Jan 4, 2008

PHNOM PENH (Reuters) - Cambodia suffered its worst ever outbreak of dengue fever last year and it killed 407 people, most of them children, the highest toll in nearly a decade.

Dengue, which causes fever, headaches and agonising muscle and joint pains, had infected nearly 40,000 people since the first outbreaks last May, Ngan Chantha, director of the Health Ministry's anti-dengue programme, said on Friday.

"It is the worst number of infectious cases ever in Cambodia," he said, noting the disease infected 16,000 people and killed 424 in 1998.

Thousands of sick children sought free treatment at four Swiss-funded hospitals last year, but doctors said they did not have enough resources to treat everyone.

The World Bank, the World Health Organization and the Red Cross have provided pesticides to kill mosquitoes, while the Asian Development Bank (ADB) gave $300,000 to the anti-dengue programme.
Cambodia, whose health care system was devastated in 30 years of civil war, spends about $3 per person on health a year, according to the World Bank.

Dengue No Longer Paediatric Says WHO

By Marwaan Macan-Markar

BANGKOK, Oct 31 (IPS) - As public health experts in South-east Asia come to grips with one of the worst outbreaks of dengue fever in years, they discern a disturbing pattern about the profile of patients who have died from the virus vectored by the aedes aegypti mosquito.

Indonesia, the region’s largest country and one that had a particularly bad year, offers a stark reminder of what the medical community is grappling with. ‘’Nearly 20 percent of the fatalities in Indonesia this year were adults,’’ says Dr. Chusak Prasittisuk, coordinator for communicable disease control at the South and East Asia office of the World Health Organisation (WHO). ‘’This is worrying, because it means the country has inadequate expertise to handle dengue haemorrhagic fever among adults.’’

Other countries that have been hit by record numbers of dengue cases this year are also showing a similar trend, said Chusak during a telephone interview from the WHO’s regional office in New Delhi. ‘’We have noticed this in Singapore, Thailand and Myanmar (or Burma).’’

Consequently, the medical community cannot view dengue fever as one that only affects children, which has traditionally been the case. ‘’Earlier the emphasis was to train paediatricians to deal with dengue since it was seen as a childhood disease,’’ adds Chusak. ‘’But now we have to shift our focus and concentrate on training the large medical community.’’

According to WHO, Indonesia has recorded over 123,000 cases and there have been 1,250 deaths this year. In 2006, by contrast, the archipelago had 114,000 cases. A similar picture has emerged in Vietnam, states the Geneva-based global health body, where there have been 80,000 cases this year -- which is twice the number recorded in 2006 -- and there have been 68 deaths.

Cambodia, one of the region’s poorest countries, has not escaped the current spread of dengue fever either. The health authorities report nearly 38,500 cases and nearly 390 deaths, which is double the number of both categories for the country last year. And its regional neighbours, Malaysia and Thailand, have also reported tens of thousands of cases, in addition to 85 deaths, in Malaysia, and 67 deaths, in Thailand.

In fact, the unconfirmed estimates for the region this year places it on par with the worst year recorded for dengue fever in South-east Asia in nearly two decades. So far, with two more months left for 2007, there have been 321,500 cases of dengue and 1,860 deaths due to the virus.

Till this year, the worst stretch for the region was in 1998, when 328,000 people fell ill from the virus and 1,484 people died, states the WHO. In 1991, there were 118,000 dengue cases. By contrast, in 1999, there were 46,000 cases reported.

Signs of a rise in dengue cases were apparent when health authorities surveyed the region in July, well after the year’s monsoon rains had begun. And the numbers in Singapore, the affluent city-state known for that the disease had reached epidemic levels.

At the time, Vietnam had recorded 24,255 cases during the first half of the year, in addition to 27 deaths from dengue, while Indonesia had accounted for 68,000 reported cases and 748 deaths by the end of June.

Yet there is little mystery as to why this virus has spread despite the region mounting a range of prevention campaigns, among which are efforts to educate the public about how to combat the Aedes aegypti mosquito. ‘’This is largely the result of unplanned urbanisation,’’ says Chusak. ‘’Dengue is an ecological disease created by humans.’’

‘’Nearly 80 to 90 percent of the breeding areas for the dengue mosquito are man made,’’ he adds. Among these are water stagnating in public areas due to poor drainage systems; water collecting in empty cans disposed on the streets; water in flower vases, pots and earthen jars; and water that collects in toilets.

As if that was bad enough, the region is also learning that its economic growth has, unwittingly, laid the foundation for dengue to change from being a largely urban disease to one that has spread to semi-urban and rural areas. This is the result of people moving in large numbers across the rural and urban divide for work.

In 2006, the WHO’s Western Pacific regional office warned that rural health systems in the region are facing a daunting challenge to deal with a disease that was increasingly becoming a ‘’disease of the poor in rural areas.’’

To that has been added another worrying factor -- global warming and climate change -- that could trigger a higher number of dengue cases in the future. Such a prospect was driven home by a new study of the world’s environment published last week by the United Nations Environment Programme (UNEP).

‘’Continued warming is expected to cause shifts in the geographic range (lattitude and altitude) and seasonality of certain infectious diseases, including vector-borne infections such as malaria and dengue fever,’’ revealed the 570-page fourth ‘Global Environment Outlook’.

‘’Because of increasing temperatures, mosquitoes are able to survive longer,’’ Surendra Shrestha, regional director for UNEP’s Asia-Pacific office, told IPS. ‘’Vector-borne diseases will move up in a few places and become increasingly widespread.’’

The region will also have to endure changes in the rainfall pattern due to climate change, ‘’which is already here,’’ added Shrestha. ‘’The eastern corners of Asia are receiving more rain now than parts in central Asia.’’

The concern about the spread of dengue in South-east Asia is understandable, since the region has recorded all four strains of the virus that is transmitted by the bite of the carrier mosquito. The virus, which causes pain in the joints, high fever, rash and nausea often requires hospital care, including regular testing of the patient’s blood. In severe cases, the patient suffers from internal bleeding, described as dengue haemorrhagic fever, which can be fatal.

Dengue fever hits Asia hard; experts question whether global warming to blame

Friday, October 26, 2007
The Associated Press

HANOI, Vietnam: The worst outbreak of dengue fever in years has hit Southeast Asia, prompting the World Health Organization to call for better prevention campaigns as experts question whether global warming is partly to blame.

Cambodia, Indonesia, Vietnam and Thailand have all experienced large outbreaks. Most of the victims are children who arrive at hospitals burning up with fever and crying from intense joint pain, a common symptom of the so-called "bone-breaker" disease.

There is no vaccine or cure for the four different varieties of the mosquito-borne virus spreading within the region. Even though outbreaks in several countries appear to be waning, many patients are still falling ill.

"We should really be in prevention mode, putting in place sound measures for suppressing the vector population so we can at least dampen down the epidemic," said Michael Nathan, a dengue expert at WHO in Geneva.

Every week for the past two months, some 350 patients have been admitted to hospitals in Vietnam's southern Ho Chi Minh City. That is double the number from the same period last year, said Nguyen Dac Tho, deputy director of the city's preventive medicine department

Nationwide, Vietnam has logged nearly 80,000 cases this year, including 68 deaths. That is a 50 percent increase over the same period in 2006, with the majority reported in the country's southern provinces where the monsoon season runs from June through December.

Nguyen Huy Nga, director of the national Preventive Medicine Department, said the number of cases has dropped down to about 2,000 cases each week since early October, from nearly 3,000 new cases reported weekly in September.

"We are now concentrating our efforts to completely wipe out dengue outbreaks to prevent possible flare ups next year," he said.

Dengue infects up to 50 million people worldwide every year; WHO estimates 19,000 deaths occurred in 2002, according to its most recent data. It causes rashes, blistering headaches, nausea and excruciating joint aches. The most serious form of the disease can cause internal bleeding, liver enlargement and circulatory shut down.

"This is the first time I've ever been this sick. Blood formed under my skin," said Ngo Dinh Khoi, 33, while resting in a bed he was forced to share with another dengue patient. "It was like someone was putting needles into my joints."

Indonesia has also had a bad year with more than 123,500 cases and 1,250 deaths, already surpassing the 114,000 cases for all of 2006. WHO sent regional expert Chusak Prasittisuk to Jakarta this week to assess the situation and help ready hospitals and the public for the rainy months ahead, when most cases are typically reported.

"I've come here to urge them to prepare for the worst scenario," he said.

Cambodia also has been hit hard, logging some 38,500 cases and 389 deaths — more than double the same figures from 2006. The bulk of those sickened were children younger than 15, said Ngan Chantha, head of the national dengue center.

However, he said the situation has improved in recent weeks, following an intense public awareness campaign warning residents to keep water from collecting in containers around their houses where mosquitoes can breed.

Thailand and Malaysia have recorded a combined 80,000 cases, with 67 and 88 deaths, respectively.

"Experts say it's partly due to global warming because it's increased the amount of water, not only sea water, but fresh water where mosquitoes breed," said Dr. Thawat Suntrajarn, director of Thailand's Department of Communicable Diseases. Thailand's rainy season started earlier this usual this year.

Scientists fear rising temperatures and longer rainy seasons, as Thailand experienced this year, will allow more vector-borne diseases such as dengue and malaria to flourish.

Singapore, for instance, saw mean annual temperatures increase 1.5 degrees Celsius (2.7 degrees Fahrenheit) between 1978 and 1998, while the number of dengue fever cases jumped tenfold during the same period.

This year, the number of cases has tripled in the city state over last year. About 200 patients are still being admitted weekly, though only a handful have died.

The last major dengue outbreak to hit Southeast Asia was in 1998, when about 350,000 cases and nearly 1,500 deaths were reported. Indonesia and Thailand were not included in that tally.
___
Associated Press writers Tran Van Minh in Vietnam; Ker Munthit in Cambodia; Sean Yoong in Malaysia; Mick Elmore in Thailand; Gillian Wong in Singapore and Irwan Firdaus in Indonesia contributed to this report.

Spread of dengue fever down in Cambodia

PHNOM PENH, Sept. 8 (Xinhua) -- The recent spreading rate of dengue fever has been down by 60 to 70 percent in Cambodia, thanks to the multi-level anti-epidemic efforts carried out by the government and international organizations, local media said on Saturday.

Earlier this year when the disease maintained its peak of spread, some 1,000 people were contaminated on average each week, and recently the figure was brought down to 300 to 400, Chinese-language newspaper the Commercial Daily quoted health official as saying.

The progress came along, after the Cambodian government, in conjunction with the anti-epidemic staff members at various levels, made concerted efforts to help residents clean their living areas and kill mosquitoes in large quantities, the paper said.

Meanwhile, the World Health Organization, the World Bank and the Asia Development Bank extended huge aid to the country in the field of epidemic containment, which also resulted in the back-off of dengue fever.

According to the statistics from the Cambodian Ministry of Health, altogether 370 children died of the disease while 35,000 people were hospitalized for contamination so far this years.

Dengue toll in Cambodia rises above 300 this year

15 Aug 2007
REUTERS

PHNOM PENH: Dengue fever has killed at least 333 Cambodians this year, most of them children, and many more could die before the rainy season ends next month, senior health officials said on Wednesday. The disease, which killed 116 Cambodians in 2006, has spread across the impoverished nation and infected 31,136 people this year, most of them in the countryside where living conditions are poor and children are vulnerable, they said.

"Their parents do not have enough time to take care of them at home. They are poor, they are away from home to make a living," said Ngan Chantha, head of the country's anti-dengue programme.

More could die with the monsoon season, ideal breeding weather for the mosquitoes which carry the disease, not due to fade until the end of September, he said.

A publicity campaign against the disease, including admonitions to clean containers at home every 10 days to ensure mosquitoes cannot breed in them, has borne little fruit.

"The striking issue is villagers do not clean their containers frequently," said Duong Socheat, director of the National Malaria Centre.

The country's four-Swiss funded hospitals have appealed for $7 million to fight a disease that reached epidemic proportions in wealthy Singapore as well as striking hard in Thailand, Malaysia, Vietnam and Indonesia.

The World Bank, the World Health Organization and the Red Cross have provided pesticide to kill mosquitoes and the Asian Development Bank (ADB) gave $300,000.

Cambodia, whose health care system was devastated in 30 years of civil war, spends about $3 per person on health a year, according to the World Bank.

Cambodia reports over 300 dengue deaths

August 03, 2007

Dengue fever has so far this year claimed the lives of 304 people in Cambodia, almost double the number of people who died from the disease in 2006, according to the latest figures from the Health Ministry.

As of July 29, there have been 27,265 cases of dengue in Cambodia and 304 deaths, Ngan Chantha, the Ministry's dengue program manager, was quoted Friday by the Cambodia Daily newspaper as saying.

The three provinces hardest hit by the outbreak have been Kompong Cham with 4,090 cases and 57 deaths, Kandal with 3,220 cases and 28 deaths, and Siem Reap with 3,619 cases and 29 deaths, Ngan Chantha said.

Takeo province is the next worst off with 2,935 cases and 33 deaths, and Phnom Penh is fifth on the list with 2,555 cases and 15 deaths, he said.

"The situation is much better, but we still need more help. Dengue season is not yet finished," Ngan Chantha said.

In 2006, 158 people died from the mosquito-borne virus, according to official statistics.

Source: Xinhua

Dengue Fever spreading in SE Asia

Wed, 01 Aug 2007
The Guardian (UK)

Dengue fever, which is a mosquito-borne viral disease, is threatening to become the worst epidemic in almost a decade in some parts of Asia.

The Outbreak of Dengue fever has touched almost all countries across the region from wealthy Singapore to the poorest Cambodia. Compared with a 2006 epidemic, the new outbreak might be seen as a disaster with the number of deaths due to the disease standing at 1500.

Hospitals are full with infected patients and the number of affected people is increasing.

The spread of the virus is believed to be the outcome of mass immigrations from poor countries to Singapore.

Indonesia is the worse hit country with a total number of 1,100 deaths. 56 people have been died of the disease in Malaysia and the death toll is increasing.

Dengue Fever Plagues Cambodia [mainly due to gov't neglect]

By Rory Byrne, Voice of America
Phnom Penh, Cambodia
27 July 2007

Like much of Southeast Asia, Cambodia is struggling with an epidemic of dengue fever, which has killed scores of children and is threatening to overwhelm the country's fragile health care system. Experts say that early monsoon rains and heavy migration are spreading the mosquito-borne virus, while some also blame the authorities for not acting quickly enough to control the outbreak. Rory Byrne reports from Phnom Penh.

Every day thousands of people arrive at Kantha Bopha Hospital in Phnom Penh seeking free treatment for dengue fever. They come from all over Cambodia. Almost all of the most serious dengue patients are children.

Most of Southeast Asia has seen a surge in dengue cases this year, in part because of heavy rains. Cambodia is one of the hardest hit countries, with new cases up 94 percent so far from last year.

Since January, about 200 people have died from dengue, which causes high fever and bleeding. There is no vaccine or cure.

Dengue is spread by a type of mosquito that breeds in urban areas. Phnom Penh is experiencing a building boom and construction sites make perfect breeding grounds for the mosquitoes in areas where water collects and stagnates.

Migration from the countryside to the city also helps spread the disease as people infected with the virus carry it into crowded neighborhoods with poor sanitation. The only way to prevent dengue is to destroy the mosquitoes' breeding grounds. Most patients are infected near their homes.

Dr. Beat Richner is the director of Kantha Bopha Hospital. He says the authorities did not act quickly enough to prevent the disease. "We give all addresses of all patients to the Ministry of Health so they could go, and they should go there, together with the WHO (World Health Organization) to neutralize the breeding places but unfortunately nothing was done until the month of June, and then I made announcements in the newspapers and outcries and now they start, but it's too late."

The government says it is doing all it can but it needs help from the public and aid donors. Dr. Ngan Chantha is the head of Cambodia's National Dengue Control Program. "I would like to say that even though the situation is very difficult, the Ministry of Health and the departments in the 24 provinces have tried their best to fight the disease and we are determined to act to keep the lives of the children safe."

Experts say that with the wettest months of the rainy season still ahead, the dengue epidemic will only get worse, and more children may die.

Asia braces for new dengue outbreak

23 July 2007
AFP

MANILA - From rich and squeaky-clean Singapore to impoverished Cambodia, public health officials are warning of a possible epidemic of dengue fever in Asia this year.

The World Health Organisation (WHO) believes 2007 could be on a par with 1998, when nearly 1,500 people died in Asia of the mosquito-borne disease.

This year dengue has already killed more than 1,000 people in Indonesia alone. In many other places the death and infection rates through June had already surpassed the totals for 2006.

“There is a strong possibility this year could be one of the worst,” said John Ehrenberg, advisor for malaria and other diseases at the WHO’s regional office in the Philippines.

“We are seeing major spikes in reported cases around the region,” he told AFP.

Dengue fever is nowhere near as deadly as malaria, which kills an estimated 2.7 million people around the world every year.

But there is no known cure or vaccine to fight dengue fever, which is transmitted by a bite of the white-spotted mosquito known as Aedes aegypti.

Most of those killed tend to be children and old people who have a weak resistance to the virus, and die as a result of internal bleeding.

Officials say the best way to fight the spread of dengue is to control the mosquito’s breeding grounds — areas where water collects and stagnates — but that can prove difficult once the annual rains begin.

The early arrival of the rainy season in much of Asia has been blamed for the upsurge in outbreaks this year, experts said.

“The Aedes aegypti mosquito thrives in the tropics with its rich mixture of warm weather and wet seasons. So you will see a close correlation between dengue spikes and a country’s rainy season,” Ehrenberg said.

“The warmer the temperature the greater the risk of a serious outbreak.”

Throughout Asia, cases of the disease are soaring. Thailand has recorded 19,000 cases and 18 deaths for the first six months of the year.

“This year is more serious than last year because of the earlier arrival of the rainy season, which brought forward the hatching period,” Vichai Stimai, of Thailand’s health ministry, told Bangkok’s Nation newspaper.

In Cambodia, deaths this year have already eclipsed fatalities in 2006 as the country battles one of the worst outbreaks of the disease in a decade.

Some 182 deaths have been recorded for the six months of the year out of nearly 15,000 cases, said Ngan Chantha, director of the health ministry’s dengue programme. Last year 152 deaths were reported.

Vietnam has reported almost 20,000 cases with 21 deaths, seven more than in the same period last year, the health ministry said.

Than Winn, a senior Myanmar health ministry official, told the Myanmar Times newspaper the number of cases in his country was also rising dramatically.

“In the first six months of this year there have been about 3,000 cases of the disease and 30 deaths. This is much higher than the first six months of 2006,” Than Winn said.

While poorer countries with less developed public health systems are prone to dengue outbreaks, rich countries like Singapore are not immune.

Dengue has now become a major health issue in Singapore and the government has stepped up its public awareness campaign and efforts to eradicate mosquito breeding grounds.

There have been nearly 3,600 cases of dengue infection reported so far this year in the city-state — more than double the number in the period in 2006.

“This was a disease we used to associate with overcrowding in major urban centres,” the WHO’s Ehrenberg said. “But today it is even finding its way into remote rural areas as well.”

In Malaysia the Health Ministry’s director of disease control, Hasan Abdul Rahman, said 44 people had died in the first four months of 2007 from 16,214 cases reported, compared to 21 deaths and 10,244 cases in the same period last year.

“We are concerned over the increase and we need everyone to cooperate with the authorities to fight the menace,” Hasan said.

One country bucking the regional trend is the Philippines, where deaths in the first half of the year are down from 139 last year to 81 this year.

But officials warn that dengue fever can spread quickly.

According to the WHO, only a handful of countries had experienced epidemics before 1970. But now the disease is endemic in more than 100 countries around the world.

“It has been a neglected disease relative to malaria, tuberculosis and now HIV/AIDS, all of which are major causes of fatalities worldwide,” Ehrenberg said.

“With viruses you never know which way they will go. They can change and can become mass killers.”

Dengue fever kills 182 in Cambodia this year

Sat Jul 14, 2007

PHNOM PENH (Reuters) - Dengue fever has and the killed 182 Cambodians so far this yearcrisis will continue to worsen unless concerted community action is taken, the government and World Health Organisation said on Saturday.

"This year is particularly severe and, if present trends continue, it will be the most serious to date," the WHO and the Health Ministry said in a joint statement.

"Community-based larval control and elimination of mosquito breeding sites are currently the only sustainable methods of outbreak prevention and the only effective method of reducing the risk of infection," the statement said.

Health officials had been working hard in anti-mosquito breeding campaigns in high risk areas since the outbreak, but the results were not very satisfying, Ngan Chantha, head of the country's anti-dengue program, told Reuters.

"It's hard to change our people's behavior. Health workers can't do all the work, and villagers have to help themselves, too," he said, telling Cambodians to clean containers every 10 days to stem mosquito breeding.

The virus was expected to reach its peak during the late August-September heavy rainy season, Ngan Chantha said.

"I am asking all to join hands to fight dengue. We must kill the mosquito-borne disease before it kills us," he said.

Dengue had killed 182 out of 14,986 infected so far this year compared with 116 deaths from 12,300 infected in the whole of 2006, Ngan Chantha said.

Last month, the four-Swiss funded hospitals appealed for $7 million from donors to fight a disease that has reached epidemic proportions in wealthy Singapore as well as striking hard in neighboring Thailand and in Malaysia.

Cambodia, still recovering from decades of civil war and the Khmer Rouge "Killing Fields," was seeking 90 tons of pesticide worth about $500,000 to contain mosquito breeding, Ngan Chantha said.

The Asian Development Bank had given $300,000 and the International Red Cross had offered 35 tons of pesticide, he said.

Cambodia's public health system remains rudimentary, with much of its funding coming from foreign aid.

According to the World Bank, annual government spending on health is about $3 per person.

Concerted community action urged to contain dengue in Cambodia

July 14, 2007

The Cambodian Ministry of Health and the World Health Organization (WHO) have issued a joint statement here calling for community action to contain the current spread of dengue fever, according to local media Saturday.

Cambodia's severe dengue break, which has killed 182 people, mostly children, in the first six months of this year, will further escalate unless "concerted community action" is taken to fight it, English-language newspaper the Cambodian Daily quoted the statement issued here late Friday as saying.

In order to combat the quickly spreading dengue virus, which will reach its annual peak at the end of July, individual efforts must be expanded nationwide, it said.

"Household jars containing stagnant water, discarded tires and small pots constitute potential breeding sites and a dengue risk that only households and the community itself can commit to eliminate," said the statement.

Such containers should be cleaned every 10 days to interrupt mosquito breeding, it added.

According to the ministry, the 182 death toll from the virus in the first six months of this year already surpassed that of the whole year of 2006, namely 158.

The reported cases of human contamination of the fever so far this year have reached some 15,000. There were 16,649 reported cases in the year of 2006.

Currently, WHO's regional office is leading the efforts of Cambodia to spray insecticide and train provincial teams to contain the epidemic.

Source: Xinhua

Dengue Deaths in Cambodia This Year Exceed 2006 Toll

July 13, 2007
AFP

Dengue fever deaths in Cambodia so far this year have eclipsed fatalities in 2006 as the country battles one of the worst outbreaks of the disease in a decade, medical officials said Thursday.

Some 182 fatalities have been recorded for the first half of this year out of 14,986 cases, said Ngan Chantha, director of the health ministry's dengue program. Last year 152 deaths were reported.

"The disease is continuing to spread, but it is a little bit better than before," he told AFP, adding that Siem Reap province, home to the Angkor temples, a tourist drawcard, was the worst affected.

Medical staff have been sent to the countryside to reinforce poorly equipped and staffed rural clinics.

But ignorance remains the biggest challenge in combating the outbreak, Ngan Chantha said.

"People are still ignoring the issue so we cannot tackle this problem. They need to take better care of sanitation in their homes," he said.

"Medical staff cannot clean their houses for them."

Dengue fever is on the rise around Southeast Asia with neighbouring Thailand recording 19,000 cases and 18 deaths so far this year. Wealthy Singapore has seen 4,029 cases and three deaths.

The mosquito-borne virus is usually associated with poorer tropical countries. The disease leads to a sudden onset of fever with severe headaches, muscle and joint pains, and rashes.

Dengue fever outbreak in Cambodia

A man sprays insecticide near a market to fight an onset of dengue fever in the outskirts of Phnom Penh July 3, 2007. Impoverished Cambodia is appealing for international help to fight a major outbreak of dengue fever, which has killed more children early in this year's wet season than in all of last year. REUTERS/Chor Sokunthea

A mother transports her child, who is suffering from dengue fever, to a hospital in Cambodia's Kandal province on July 4, 2007. Impoverished Cambodia is appealing for international help to fight a major outbreak of dengue fever, which has killed more children early in this year's wet season than in all of last year. REUTERS/Chor Sokunthea

Children suffering from dengue fever are held by their parents under a tree, outside a hospital which ran out of housing, in Cambodia's Kandal province on July 4, 2007. Impoverished Cambodia is appealing for international help to fight a major outbreak of dengue fever, which has killed more children early in this year's wet season than in all of last year. REUTERS/Chor Sokunthea

Patients, most suffering from dengue fever, crowd in a waiting area in Phnom Penh's Kantha Bopha VI hospital on July 4, 2007. Impoverished Cambodia is appealing for international help to fight a major outbreak of dengue fever, which has killed more children early in this year's wet season than in all of last year. REUTERS/Chor Sokunthea

A mother prays over her child, who is suffering from dengue fever, at Phnom Penh's Kantha Bopha VI hospital on July 4, 2007. Impoverished Cambodia is appealing for international help to fight a major outbreak of dengue fever, which has killed more children early in this year's wet season than in all of last year. REUTERS/Chor Sokunthea

As Dengue Spreads, Doctor Appears on 'Hello VOA'

Nuch Sarita, VOA Khmer
Washington
28/06/2007

With a dengue fever outbreak gripping Cambodia, Dr. Ngan Chantha, deputy director of the National Malaria Center, appeared on "Hello VOA" Thursday to discuss symptoms, diagnosis, treatment and prevention of the disease.

Agence France-Presse reported Thursday that as many children were killed in the first six months of 2007 as died in 2006 from the mosquito-borne illness. Since January, an estimated 7,655 Cambodian children under the age of 15 have been hospitalized with dengue, AFP reported. Of those, 109 died.

Listeners asked whether dengue happened to adults as well, whether a skin test could diagnose the disease and what other symptoms accompanied the disease, also known as "bone-break fever."

Ngan Chantha said adults and children across Asia were being affected in higher number this year, but that sometimes a skin test failed to identify the disease because a victim had it for an extended period of time. He encouraged people to visit a hospital if a fever held for 24 to 48 hours without breaking.

Cambodia seeks help to fight dengue outbreak

PHNOM PENH, June 28 (Reuters) - Impoverished Cambodia is appealing for international help to fight a major outbreak of dengue fever, which has killed more children early in this year's wet season than in all of the last.

"Dengue is hitting almost all provinces nationwide. We cannot contain the virus with our limited resources," Ngan Chanta, head of the country's anti-dengue programme, said on Thursday.

"We need foreign help" to counter an outbreak that has killed 138 of the 12,700 children the mosquito-borne virus has infected this year, he said.

The virus, which generally strikes during the June-September wet season and in Cambodia appears to hit mostly children, killed 116 of the 12,300 who caught it last year.

Cambodia, still recovering from decades of civil war and the "Killing Fields" of the Khmer Rouge, needed $500,000 swiftly to buy larvicides for use on mosquito breeding grounds, Ngan Chanta said.

Lam Eng Hour said the four Swiss-funded hospitals of which he is deputy director were being swamped by dengue sufferers the facilities treat free.

"We just cannot manage if more and more patients come," he said.

The hospitals had appealed for $7 million from donors, he said, to fight a disease that has reached epidemic proportions in wealthy Singapore as well as striking hard in neighbouring Thailand and in Malaysia.

Lam Eng Hour said many children died of dengue because the hospitals were short of blood for transfusions, and he praised foreign tourists who had responded to appeals by donating blood.

"They are being more than just tourists, they are saving our childrens' lives," he said.

Cambodia's public health system remains rudimentary, with much of its funding coming from foreign aid.

According to the World Bank, annual government spending on health is about $3 per person.

Dengue deaths sweeping Cambodia highlight healthcare failures

Cambodian mothers carry their children into Kantha Bopha hospital in Phnom Penh, 19 June 2007. Since January some 7,655 Cambodian children under the age of 15 have been hospitalised with dengue fever. (Photo: AFP - Tang Chhin Sothy)

A nurse checks dengue fever patients at Krouch Chhmar health center in Kampong Cham province, 18 June 2007. Since January some 7,655 Cambodian children under the age of 15 have been hospitalised with dengue fever. (Photo: AFP - Tang Chhin Sothy)

28/06/07
By Seth Meixner
AFP

Saing Ratha lies semi-conscious, her thin body shaking with fever as her mother tries desperately to cool her by placing blocks of ice under her arms.

Her 10-year-old bother Saing Sokun lies curled around a block of ice next to her in this spartan rural clinic.

Both have been struck down by dengue fever that has killed almost as many children in the first six months of this year as during the whole of 2006 in an outbreak that is expected to worsen with an early monsoon.

"In my village every house has been afflicted by dengue -- in some homes all the children are sick," says the children's mother, Chhiv Thy, as she wipes down the 13-year-old girl's body with wet towels.

For five days they have lain on crude wooden beds in a small alcove off one of the clinic's wings. Saline drips are tied to metal posts and the windowsill next to their cots is piled high with cooking pots and dirty plates.

Chhiv Thy says she has not worked since bringing her children to hospital. The medical care is free, and good, but the beds cost 30,000 riels (7.50 US dollars) each.

Since January some 7,655 Cambodian children under the age of 15 have been hospitalised with dengue, with 109 of them succumbing to the mosquito born illness, which punishes its victims with fever, vomiting and crippling muscle pain.

The most serious cases result in heavy bleeding as blood vessels disintegrate, and can quickly kill children.

Compared to last year's total of 6,149 cases and 158 deaths, "this year is much worse," said Ngan Chantha, director in the health ministry's dengue programme.

Doctor Un Sam Ath gestures up and down the bare hallways of the Krouch Chhmar clinic, saying that only a few days before they had been crowded end-to-end with beds and sick children.

Since May Krouch Chhmar referral hospital has received 20 dengue cases.

"Much more than 2006, when we had five cases total for the whole year," he says.

Two children have died. Un Sam Ath says he wanted to send them to the provincial hospital in Kompong Cham city, about three hours down a dirt road pitted with deep muddy holes.

"But their families were too poor to afford the trip. We have no ambulance and transport is a problem," he explains.

"We are so worried about the coming months -- parents are always waiting too long to bring their children to our hospital. By the time they arrive they have already fallen in a coma," Un Sam Ath says.

Those who can afford transportation to Kompong Cham will be okay, "but what about the poor?" he says.

The outbreak, which has stretched several hospitals in the capital Phnom Penh to capacity, highlights the many failures of Cambodia's health system, which like all of its public institutions is struggling after years of civil war and neglect.

"The total level of public financing for health is simply too low," the World Bank said in its 2007 equality and development report, which found that rural Cambodians still lacked significant access to healthcare.

The government spent only four dollars per person on health expenditures in 2006, the World Bank said, while Cambodian health officials admit that paediatric care is especially thin.

"We have not enough health care services for children -- it is still at a limited level," says Mam Bun Heng, a secretary of state with the health ministry.

A lack of basic health knowledge is also particularly deadly for uneducated rural Cambodians like many of those seeking help in Krouch Chhmar.

This combination has left Cambodia woefully unprepared for the current dengue outbreak.

"People's understanding of sanitation is still very low," Mam Bun Heng says. "We are educating them," but about three million dollars will be needed to fight yearly outbreaks of dengue.

Despite massive public education campaigns already warning people of dengue fever, Un Sam Ath said most people simply tune out the radio and television spots offering advice on how to combat the illnesses.

"People just want to watch the other programmes," he says.

"They need to understand more about this problem. Dengue fever outbreaks spread very quickly, and many people don't know how it spreads."

Dengue fever outbreak among children in Cambodia

Cambodian women and their children wait along a fence near a hospital in Phnom Penh June 18, 2007. Dengue fever has killed at least 109 children in Cambodia so far this year, a three-fold rise from the same period of 2006, due to early monsoon rains and increasing urbanisation, health officials said on Monday. REUTERS/Chor Sokunthea

A Cambodian woman holds her child as she walks to a hospital in Phnom Penh June 18, 2007. Dengue fever has killed at least 109 children in Cambodia so far this year, a three-fold rise from the same period of 2006, due to early monsoon rains and increasing urbanisation, health officials said on Monday. REUTERS/Chor Sokunthea

A Cambodian woman carries her child as she walks to a hospital in Phnom Penh June 18, 2007. Dengue fever has killed at least 109 children in Cambodia so far this year, a three-fold rise from the same period of 2006, due to early monsoon rains and increasing urbanisation, health officials said on Monday. REUTERS/Chor Sokunthea

Children suffering from Dengue fever lie on beds at Kantha Bopha hospital Phnom Penh June 18, 2007. Dengue fever has killed at least 109 children in Cambodia so far this year, a three-fold rise from the same period of 2006, due to early monsoon rains and increasing urbanisation, health officials said on Monday. REUTERS/Chor Sokunthea

A child suffering from Dengue fever is attended by doctors at Kantha Bopha hospital Phnom Penh June 18, 2007. Dengue fever has killed at least 109 children in Cambodia so far this year, a three-fold rise from the same period of 2006, due to early monsoon rains and increasing urbanisation, health officials said on Monday. REUTERS/Chor Sokunthea

Economic boom brings more dengue to Cambodia

PHNOM PENH, June 18 (Reuters) - Dengue fever has killed at least 109 children in Cambodia so far this year, a three-fold rise from the same period of 2006, due to early monsoon rains and increasing urbanisation, health officials said on Monday.

"We are worried that more children will get sick as a result of mosquito-borne diseases in the coming rainy season months," said Ngan Chantha, director of the Southeast Asian nation's dengue program.

Dengue infections in Cambodia tend to peak in July, August and September, the height of the rainy season, when the mosquitoes that carry the disease breed most rapidly in stagnant pools and ponds.

Construction sites around Phnom Penh, which is enjoying an economic boom, are contributing to the spread because they tend to be strewn with breeding spots such as discarded tyres and broken pots, Ngan Chantha said.

Cambodia's experience with dengue mirrors that of other countries in the region, where scientists are worried that climate change is making the mosquitoes more active.

Dengue typically causes high fever, nausea and intense joint pain. There is no real treatment, apart from rest and rehydration. In severe cases it can prove fatal.

The Indonesian capital saw a surge in dengue infections earlier this year after much of the Jakarta area was flooded.