DENGUE: A GROWING PROBLEM IN BURMA

Identifier: 
07RANGOON810

UNCLAS SECTION 01 OF 04 RANGOON 000810

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E.O. 12958:N/A
TAGS: TBIO, EAID, SOCI, PGOV, AMED, AMGT, CASC, ECON, BM
SUBJECT: DENGUE: A GROWING PROBLEM IN BURMA

REF: BANGKOK 4603

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1. (SBU) Summary. Dengue fever is a growing concern in Burma, with
more than 9,500 reported cases and 117 deaths due to dengue in the
first seven months of 2007. The number of cases reported, however,
may not reflect the real situation, as the World Health Organization
(WHO) believes that non-symptomatic or mild cases go unreported, and
some of the reported cases may not actually be dengue. WHO
continues to work with the Ministry of Health (MOH) to improve
diagnosis of dengue cases and ensure that health officials have the
equipment necessary to treat the disease. The under-funded Ministry
of Health cannot afford to use insecticide to kill mosquitoes, and
instead mobilizes local communities to help destroy mosquito
breeding grounds and control the spread of the disease. End
Summary.

Dengue: The Facts
------------------

2. (SBU) We met with Dr. Leonard Ortega, World Health Organization
(WHO) Medical Advisor for Malaria and other Mosquito Borne Diseases,
on August 23 to discuss the current dengue situation in Burma. The
dengue virus, Dr. Ortega noted, can be transmitted throughout the
year, but is more prevalent during the rainy season (May-October).
Additionally, as the dengue mosquito tends to breed in urban areas,
cities rather than rural areas are more affected. There are four
strains of dengue; in 2007, the Type 3 strain is most prevalent.
Dengue experts consider the Type 2 strain to be the most deadly --
this is the strain that medical experts found in 2001 and 2005, when
the most dengue-related deaths occurred (see chart below). A
cyclical disease, dengue has a higher death rate every 2-3 years.
The WHO, Dr. Ortega verified, believes that the rate of
dengue-related deaths in Burma will increase dramatically compared
to last year's figures, possibly exceeding 2001 levels.

Outbreaks in Burma
------------------

3. (SBU) According to the Ministry of Health and WHO, as of August
11, there have been more than 9,500 reported dengue cases and 117
dengue-related deaths. The Ministry of Health claims that through
July 2007, Burma has experienced a 29 percent increase in dengue
cases compared to the same period in 2005. Dr. Ortega, however, is
not as quick to cite these statistics. Instead, he explained that
while the number of reported cases has increased compared to recent
years, not all cases may actually be dengue. Mothers, concerned
about the dengue virus, are quick to take their children to the
hospital at the first sign of fever and chills, he clarified. Some
of these cases, which may be the flu rather than dengue, are

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reported as early-onset dengue, which distorts dengue statistics.

--------------------------------------------- ---------
Reported Dengue Cases and Deaths in Burma
2000-2007*
--------------------------------------------- ---------
Year Cases Percent Deaths Percent Mortality
Change Change Rate
--------------------------------------------- ---------
2000 1,884 -- 16 -- 0.85
2001 15,629 129.6 204 1175.0 1.33
2002 16,047 2.7 171 - 16.2 1.06
2003 7,117 - 55.6 81 - 52.6 1.13
2004 7,207 1.3 85 4.9 1.18
2005 17,360 140.9 170 100.0 0.98
2006 11,383 - 34.4 128 24.7 1.12
2007* 9,578 117 1.22
--------------------------------------------- ---------
*Through August 11, 2007
Source: Ministry of Health, World Health Organization

4. (SBU) At the same time, Dr. Ortega is certain that there are
more cases of dengue, either non-symptomatic or mild cases, that go
unreported annually. People who contract a mild dengue virus often
do not seek medical treatment; because the Ministry of Health
obtains dengue figures from medical practitioners, these cases are
not included in overall statistics. Thus, he explained, the overall
number of dengue cases may actually be higher than reported.

5. (U) Although the number of dengue cases in Burma is on the rise,
the mortality rate continues to hover around one percent. Dr.
Ortega, emphasizing that the number of dengue-related deaths
reported is accurate, does not believe that the mortality rate will
increase. The WHO attributes the mortality rate to a variety of
factors, including high awareness among the Burmese about the
disease and better case management by the Ministry of Health and
local doctors.

6. (SBU) In previous years, Mon State and Rangoon and Mandalay
Divisions, sites of three of Burma's largest cities, were home to 90
percent of Burma's dengue outbreaks, with an average of 50 percent
of cases occurring in Rangoon Division. This year, Dr. Ortega
observed, the majority of cases have been reported in Mon State,
Rangoon, and Irrawaddy Divisions, with 2,152, 2,053 and 1,697 cases
respectively. Of the 117 deaths in 2007, 88 have occurred in these
three areas. Dr. Ortega noted that MOH officials expect a dengue
outbreak in Mandalay Division in September and October due to
predicted heavy rains. To prepare for this outbreak, MOH and
Mandalay authorities, working with the WHO, continue to educate the

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local population about dengue and mobilize community support to
prevent the spread of the disease.

GOB Response to Dengue
----------------------

7. (SBU) Because of severe budget constraints, the MOH is working
with local and international NGOs to address the growing threat of
dengue. The WHO estimates that the GOB has allocated less than
$5,000 for dengue prevention and treatment in 2007. Prioritizing
its response to dengue, MOH officials have focused their efforts on
ensuring that health clinics and hospitals have the necessary
equipment to treat dengue, including IV fluids, blood for
transfusions, and plasma expanders. Dr. Ortega also highlighted
that the MOH continues its nation-wide education campaign to teach
the population how to avoid catching dengue, as well as how to spot
and treat the disease. The MOH is also mobilizing communities to
assist in destroying mosquito breeding grounds, such as open jars,
flower pots, and coconut shells. The biggest challenge, Dr. Ortega
opined, is how to encourage communities to take a proactive, rather
than reactive, approach to dengue. Only with community
participation in destroying breeding grounds will the GOB be able to
effectively control the spread of dengue, he asserted.

8. (SBU) Although the GOB has taken steps to address the dengue
outbreak, only with NGO assistance will the GOB be able to truly
address the problem, Dr. Ortega noted. Like many Southeast Asian
countries, the GOB cannot afford the insecticides needed to kill
mosquitoes. While the MOH does sporadic fogging in priority areas,
it does so once or twice a season, rather than 3-4 times a month.
Additionally, the GOB continues to request from international NGOs
key medical supplies, including rapid diagnostic tests, blood bags
for donations and IV fluids. While the WHO and UNICEF have provided
more than 4,000 rapid tests and blood bags this year, the GOB
continues to lack the medical supplies necessary to treat dengue.

Comment
-------

9. (SBU) Although tens of thousands of children could contract
dengue fever this year, the GOB allocates less than $5,000 for
dengue prevention and control, despite receiving $2 billion in
revenues from oil and gas exports. Instead, they apportion an
overwhelming majority of the GOB budget for the defense and
maintenance of the regime rather than for basic social services.
Their refusal to fund the most basic health services shows where the
Burmese Government's priorities lie: maintaining the good life for
senior generals, regardless of the cost to the people.

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VILLAROSA