Dengue Zika Chikungunya Cuba
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    Mosquito Guns and Heavy Fines: How Cuba Kept Zika at Bay for So Long
    It is one of the last Caribbean countries to get hit
    By Sara Reardon, Nature magazine on August 17, 2016

    As soon as the rain stops, mosquitoes flood the guard house of an
    upscale tourist resort near Cuba’s Bay of Pigs. Without hesitation, one
    of the guards reaches under his desk to pull out a device that looks
    like a very large hair dryer. “Mosquito gun,” he says. He walks around,
    spraying a thick, white cloud of fumigant that engulfs the booth.
    Slowly, the mosquitoes disappear.
    It’s not uncommon to see clouds of pesticide wafting through Cuba’s
    houses and neighbour­hoods. It is largely because of such intensive
    measures by ordinary citizens that the country has been among the last
    in the Caribbean to succumb to local transmission of Zika. As of Augus
    11t, Cuba has recorded three people who were infected by local
    mosquitoes rather than contracting the illness abroad, compared with
    8,766 confirmed cases in nearby Puerto Rico (see ‘Zika in the Caribbean’).
    Although scientists and public-health officials are disappointed that
    Zika has finally arrived in Cuba, they are not surprised. “It’s not easy
    to avoid an introduction, because a lot of people are coming to Cuba
    from a lot of places,” says Maria Guzmán, head of virology at the Pedro
    Kourí Tropical Medicine Institute in Havana. The country has recorded
    about 30 confirmed imported cases.
    Zika is especially insidious because most people who have it show either
    no symptoms or only common ones such as fevers, which could be
    attributed to other illnesses. Yet, with the exception of one locally
    acquired case in March, Cuba mostly managed to keep Zika out until this


    That success was the result of its excellent health-care system and an
    extensive surveillance programme for vector-borne diseases that the
    government set up 35 years ago, says Ileana Morales, director of science
    and technology at Cuba’s public-health ministry.
    In 1981, Cuba saw the first outbreak of haemorrhagic dengue fever in the
    Americas, with more than 344,000 infections. “We turned that
    epidemiological event into an opportunity,” says Morales. The country
    sent medical workers to affected areas and began intensively spraying
    pesticides to eradicate the Aedes aegypti mosquito that carries the disease.
    It also created a national reporting system, as well as a framework for
    cooperation between government agencies and public-education campaigns
    to encourage spraying and self-monitoring for mosquito bites, even among
    children. One of the most effective measures was a heavy fine for people
    found to have mosquitoes breeding on their property, says Duane Gubler,
    an infectious-disease researcher at Duke–NUS Medical School in
    Singapore. With all these measures in place, Cuba eliminated the dengue
    outbreak in four months.
    Now, when another outbreak threatens, “it’s no problem for us to
    reinforce our system” and intensify such efforts, says Morales.
    In February, before any Zika cases had been detected in Cuba, the
    government dispatched 9,000 soldiers to spray homes and other buildings,
    while workers killed mosquito larvae in habitats such as waterways.
    Airport officials screened visitors arriving from Zika-infected
    countries and medical workers went from door to door looking for people
    with symptoms. The health-care system already conducts extensive
    prenatal examinations, so it is primed to detect Zika-caused birth
    defects such as microcephaly.
    Cristian Morales, head of the Cuba office of the Pan American Health
    Organization (PAHO), says that it is probably unrealistic for other
    countries to simply copy Cuba’s mosquito-control programmes. The
    country’s health-care network is one of the best in the developing
    world, and the decades-long stability of its government has ensured
    policy continuity and enforcement of measures such as fines. He adds
    that the most important aspects of a response, for any country, include
    collaboration between government sectors and increased surveillance.


    “Cuba probably does a better job of controlling mosquitoes than any
    other country in the Americas, but it hasn’t been totally effective,”
    says Gubler. This is partly due to dips in funding. A resurgence of
    dengue in 1997 was probably exacerbated by the fall of the Soviet Union,
    Cuba’s major trading partner, which decimated the economy and weakened
    health funding.
    Another disadvantage stems from the 56-year-old US trade embargo, which
    prevents Cuba from acquiring drugs and medical supplies that include
    components made in the United States. It must instead buy them from
    other countries, such as China, often at higher cost.
    Yet success has come despite these issues. According to PAHO, health
    workers have intensified efforts to spray pesticides and eradicate
    standing water—where mosquitoes can breed—within 150 metres of the homes
    of each of the two most recent people to get Zika, in the southeastern
    province of Holguin. Workers are also searching houses for infected
    people and collecting mosquitoes for study. Guzmán adds that Cuban
    researchers have begun to plan work on a Zika vaccine.
    She says that international cooperation will be important in helping
    Cuba and others to address Zika. “It’s a problem of everybody. It’s a
    new challenge for the world.”
    This article is reproduced with permission and was first published on
    August 17, 2016.

    Source: Mosquito Guns and Heavy Fines: How Cuba Kept Zika at Bay for So
    Long – Scientific American –

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