Med school classes cancelled in Havana.

• Author: Fitz, Don
• Position: Winter Dengue

"I'm on pesquizaje," my daughter Rebecca told me. "All of the third, fourth and fifth year medical students at Allende have our classes suspended. We are going door-to-door looking for symptoms of dengue fever and checking for standing water." (1)

As a fourth year medical student at Cuba's ELAM (Escuela Latinoamericana de Medicina, Latin American School of Medicine in Havana), she is assigned to Salvador Allende Hospital in Havana. It handles most of the city's dengue cases. Though she has done health canvassing before, this is the first time she has had classes cancelled to do it. It is very unusual for an outbreak of dengue, a mosquito-borne illness, to occur this late in the season. She remembers most outbreaks happening in the fall, being over before December, and certainly not going into January--February.

Groups of medical students are assigned to a block with about 135 homes, most having 2-7 residents. They try to check on every home daily, but don't see many working families until the weekend. The first dengue sign they look for is fever. The medical students also check for joint pain, muscle pain, abdominal pain, headache behind the eye sockets, purple splotches, and bleeding from the gums. What is unique about Cuban medical school is the way ELAM students are trained to make in-home evaluations that include potentially damaging life styles--such as having uncovered standing water where mosquitoes can breed.

Dengue is more common in the Cuban cities of Havana, Santiago, and Guantanamo than in rural areas. Irregular supply of water to the cities means that residents store it in cisterns. Cisterns with broken or absent lids and puddles from leaky ones are prime breeding sites for the Aedes aegypti mosquito, the primary vector (carrier) of dengue. (2)

DF and DHF

There is a significant difference between dengue fever (DF) and dengue hemorrhagic fever (DHF). DF is a virus which usually lasts a week or more and is uncomfortable but not deadly. (3) DF has four varieties (serotypes). If someone who has had one type of dengue contracts a different serotype of the disease, the person is at risk for DHF. Early DHF symptoms are similar to DF but the person can become irritable, restless, and sweaty, and go into a shock-like state and die. (4)

DF can be so mild that many people never know that they had it and that they are at risk for the far more serious DHF. This is why the Cuban public health model of reaching out to people is important in preventing a deadly epidemic. There are no known vaccines or cures for DF or DHF--the only treatment is treating the symptoms. With DHF, this includes dealing with dehydration and often blood transfusions in intensive care. (3), (4)

Each year, there are over 100 million cases of DF, largely in sub-Saharan Africa, the Caribbean, Latin America, Southwest Asia, and parts of Indonesia and Australia. (4) Between 250,000 and 500,000 cases of DHF occur annually and...