- The Washington Times - Tuesday, March 5, 2002

RIO DE JANEIRO A sad collection of sick and melancholy people in search of relief, the line at Rio's Miguel Couto Hospital wound its way out the big emergency unit's doors and off down the street.

Some had crutches and bandages, and others sported cuts and bruises, while the only sign others were suffering was etched in faces as long as the line itself. Those with long faces the ones invariably suffering from sore heads and soaring temperatures had dengue fever, the new epidemic afflicting Brazil.

"Everybody has dengue right now," said Sonia Martines, the mother of a 14-month-old victim.

Rio has registered 51,963 cases of dengue in the first two months of the year, almost as many as it did all of last year, according to state health officials. Specialists fear that by the time the outbreak is over, as many as a million people could have had it.

The problem for doctors, however, is not just in Brazil.

Officials with the Pan American Health Organization (PAHO), the regional arm of the World Health Organization, fear that the current crisis may indicate the shape of things to come in Latin America. In addition to the Brazilian epidemic, Cuba is suffering its most serious dengue crisis since 1981, while Venezuela and Peru have also reported outbreaks. PAHO last week declared that dengue fever is "ravaging the Americas with a new vigor."

"The rapid expansion of dengue to new areas, especially in its most severe form dengue hemorrhagic fever (DHF) makes it likely that in coming years, the countries of the region will witness the highest levels ever seen of the disease," said Dr. Jorge Arias, PAHO's regional adviser on communicable diseases and one of the world's foremost experts on dengue.

The high number of DHF cases and the speed with which it has achieved a foothold in the Americas is of particular concern to regional and local health officials. Once a problem restricted primarily to Asia, DHF is now present in 27 Latin American countries, 22 more than in 1980. So far in Rio this year, at least 23 persons have died from DHF, 11 more than all of last year.

To the relief of doctors, most Brazilians falling ill are not contracting DHF but one of the four less-potent forms of dengue, a disease that causes severe flulike symptoms but is not usually fatal. The outbreak has caused widespread panic in Brazil, and especially in Rio, where soccer stars, television celebrities and politicians have all come down with the disease.

Sales of Tylenol and mosquito repellent have shot up, and special candles said to ward off the Aedes aegypti mosquito that transmits the disease are selling like hotcakes. Some trade associations estimate dengue has depleted their work forces by as much as 30 percent.

"I've seen epidemics, but nothing compared to this," said Dr. Gustavo Leao, chief of emergency operations at Miguel Couto hospital. "We have 1,800 people a day coming here. Some people are waiting five or six hours to be seen by a doctor."

Dr. Leao blamed the country's politicians for failing to prevent the outbreak, and is scornful of the efforts of health authorities he said have not done enough to take action or warn Brazilians about the threat of the coming plague.

Like many experts, Dr. Leao hinted at his contempt for Jose Serra, the man who resigned as health minister last month in order to run for president in October's election. Dr. Leao said Mr. Serra and others in the federal government did not invest either in prevention or education, or in hiring people to carry out vital fumigation tasks when the outbreak was still in its early stages.

The physician also echoed criticism of Mr. Serra's rival for the presidency, Rio Gov. Anthony Garotinho, for his lack of action as the disease spread so readily in his home state.

"The two of them are playing politics," said Dr. Leao. "They are more interested in protecting their presidential bids. The measures that should have been taken were not taken."


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