An epidemic of dengue fever, a viral disease spread by mosquitoes, is now plaguing Cuba, according to local reports. Estimates of the number of cases range from 838, the last official government number, to as many as 30,000.
The epidemic is testimony to the perseverance of the mosquito that spreads dengue, Aedes aegypti, which virtually every country in the Western Hemisphere has tried to eliminate over the last 50 years, without success. After a devastating epidemic of dengue fever swept Cuba in 1981, claiming 158 lives, the government went after the mosquito with what public health experts describe as paramilitary zeal and soon claimed victory. But now the mosquito has signaled its return with the rising toll from dengue, a severe, flulike illness that can take a potentially fatal form known as dengue hemorrhagic fever. The number of deaths during the current epidemic has been reported variously from three to 20.
International experts say they know nothing more about the epidemic than what CubaPress, an independent news agency in Havana, has disseminated over the Web and the little the Cuban government has made officially available. But Duane Gubler, director of the Centers for Disease Control and Prevention's division of vector-borne diseases in Fort Collins, Colorado, says he and his colleagues had suspected for some time that a problem was building. As early as the winter of 1996, the Cuban government apparently contacted the international aid group Doctors Without Frontiers, asking for insecticide to kill larvae, plus backpack sprayers for killing adult mosquitoes indoors. By the spring of last year, travelers from Cuba were talking about dengue outbreaks, but until early this June there had been no official confirmation from the government.
Those familiar with dengue and Aedes aegypti aren't surprised by their resurgence. "The problem with the Cuban program," says Gubler, "and those that rely on a paramilitary-type of organizational structure is they have no sustainability. Once support and funds dry up, the program falls apart and the disease will come back with a vengeance." The only hope, he says, is a program in which individual communities take responsibility for clearing out the mosquito--but that has yet to succeed in Cuba or anywhere else.