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Graham Sowa: I've been living in Cuba for three years now. I would like to blame my obvious hair loss seen in this updated photo on the rigors of life here and medical school, but it is probably just genetic. I've made some of the strongest friendships during my time in Cuba from other writers on this website. The strength of those friendships has almost restored my faith that the online world can lead to offline and real life change. On that same note I've adjusted to using internet one or two hours a month. In the meantime I have rediscovered things like flipping through the pages of books, writing stuff down by hand, and having to admit that I don't know something instead of rapidly looking up the answer on Google while the teacher isn't looking.

What the Chikungunya Virus Means for Cuba

May 11, 2014 | Print Print |

Graham Sowa

graham-1HAVANA TIMES — After months of hopping from one Caribbean island to the next the Chikungunya virus has arrived within 50km of Cuban shores. With confirmed cases in neighboring Haiti this disease has implications for the Cuban public health system, vector control campaign, and tourist industry.

The Chikungunya virus is spread by the Aedes aegypti mosquito. This is the same vector that spreads the Dengue virus, endemic to Cuba, as well as Yellow Fever, which has been eradicated from the island.

A day or so after being bitten the victim develops fever and joint pain which can also include headache, rash, muscle pain and/or joint swelling. While rarely fatal, the symptoms are significant enough to ruin a 7 day Caribbean vacation or lose a week or more of work.

The clinical presentation and course of the disease are so similar to Dengue it is only possible to distinguish the two by using expensive laboratory tests such as viral isolation or polymerase chain reaction.

As a medical student in Havana´s epidemiological reference hospital, Hospital Salvador Allende, I’ve seen my share of Dengue…plus some.

A few weeks ago we were introduced to Chikungunya via a presentation at the Cerro Pediatric Hospital where I am currently rotating. An epidemiologist told us that we need to consider the virus on our differential diagnosis for suspected Dengue cases. Up to now there have been no confirmed cases of Chikungunya originating from Cuba.

When Chikungunya does show up the Ministry of Public Health is probably preparing for more hospital admits for acute fever.

Current policy dictates that all patients with suspected Dengue cases are admitted to the hospital until they complete serological studies on the 7th day of the clinical illness. Because the presentation of Chikungunya is so similar to Dengue that hospitals, especially urban ones, will have to contend with increased patient loads. Further complicating the situation is that there is no immunity to the Chikunguynya amongst the Cuban population, which means everyone has a theoretical chance to become infected.

Of course Cuba’s anti-vector campaign against the Aedes aegypti will continue to try to prevent disease spread and the related stress on the public health system.

graham-2As a first hand participant in the anti-vectoral campaign I have mixed feelings about how the campaign is run on the ground. It seems that every year no matter how many times we go out into neighborhoods and do public education, or knock on doors asking people if they have fever, or get chased out of houses, businesses, or even clinic rooms by the fumigation squad, Dengue still fills up our hospital.

I anticipate we will be expected to double our efforts once Chikungunya makes its presence known. However, short of major upgrades to Havana´s infrastructure to do away with standing water and increased quality of housing I don’t think eradication of Aedes is likely. And as long is Aedes is around so is Dengue, with Chikungunya soon to be added.

Waiting for the arrival of Chikungunya right along with the health service is the tourist sector.

Cuba counts on at least 2 billion dollars a year from tourism to keep up its barely positive economic growth. After the cholera scare last year Cuban tourism has proven to be pretty resilient to new health concerns. However any new disease, and subsequent travel alerts issued by other countries or the World Health Organization, will have a negative impact on the tourist industry.

At least Cuba won’t be alone in the suffering, as the entire Carribean region, and eventually all parts continental America were Aedes flies, will become host to Chikungunya. Hopefully the emergence of the disease in the Western world will spur research towards a vaccine, or at the very least invite more regional cooperation on public health.


What's your opinion?

  • Moses Patterson

    Why is it that the first public mention of this new potential threat is by way of a foreign medical student in an offshore blog? Worse yet, since Sowa is an American it kind of makes you wonder if the Castros wanted this to leak in this fashion while retaining deniability. I mean the Castros can always say that Graham is a paid CIA agent and this is a false story intended to put a chilling effect on tourism. Good thing I don’t believe in conspiracies, eh?

    • CUBAQUS

      Moses, the Iniciativa Cubaverdad posted a warning as far back as November 2011.

      http://chikunguynyacuba.impela.net/

      • Moses Patterson

        Today, CNN, MSNBC, FOX and Bloomberg all reported the second reported case of the MERS virus to emerge in the US. In a nation of 350 million people, there are only 2 known cases of this virus believed to have come from Saudi Arabia by health care workers. It was nonetheless national news. The site you posted, like HavanaTimes, is another offshore blog to report the Chikungunya virus. My criticism is why hasn’t State-controlled media put citizens on alert? When I asked my father-in-law if he had heard or read anything about this virus in Guantanamo, he said no.

        • CUBAQUS

          Moses, as with the dengue (see the epidemic in Santiago de Cuba in 1997 and the cases of Dr. Desi Mendoza) and cholera (see the case of independent Calixto Martinez) the Cuban regime desperately wants to protect tourism. It has the bad habit of trying to hide the true extent of these epidemics.

          • Moses Patterson

            Bad habit? That’s an understatement. How much needless suffering, possibly even deaths, occur in Cuba because the general public has been largely kept uniformed by official Castro media of the spread of epidemics like cholera. To its credit, the Cuban people have learned to not rely on official pronouncements and allow word-of-mouth warnings to spread throughout the island.

          • CUBAQUS

            Bad habit is indeed a cynical understatement by which I in no way wanted to minimize the effects of the omission of data and the lack of information to both the Cuban people and visitors to Cuba about the risks they face.
            You are correct to say that often news about these problems surface first in the reports of independent journalists on dedicated sites about Cuba. I use the sites of the Iniciativa Cubaverdad as source. They have a lot of sites and archives on Cuba going back to 2000 aggregating – for research purposes – and indexing thousands of messages each year.

      • CUBAQUS

        Due to a misspelling the URL of the site has changed. It now contains data and warnings going back as far as 2009.

        The correct URL: http://chikungunyacuba.impela.net/
        The other has a “click to forward” on it.

    • grahamsowa

      Moses, chikungunya has been published about in the Granma newspaper (an article a couple of weeks ago), on Infomed. So I don´t think that the first public mention is coming from me….i learned about it in the Cuban hospital…

      • Moses Patterson

        If true, I stand corrected.

  • CUBAQUS

    We are a long way away from Fidel Castro’s false boasts that dengue had been eradicated in Cuba. Both in 2002 and 2009 he claimed that dengue was eradicated (1) while during that period dengue was rife in Cuba. Dengue in fact has been endemic in Cuba since the 1980’s.

    Since the Chikunguynya virus is transferred by the same vector it is clear that it is in Cuba to stay. Eradicating the vector is indeed the only way o stop these two diseases. It is, I am afraid, another endemic disease as cholera also seems to have become.

    News about dengue in Cuba:
    http://cubadengue.impela.net/

    News about cholera i Cuba:
    http://cubacolera.impela.net/

  • https://identify.us.com IdentifyUS

    Public health campaigns in Cuba in the last century made impressive strides to dramatically reduce risks from yellow fever. The military-like battles that were waged against the mosquito then, however, would not be accepted by communities anywhere today. At best, we might take a little of the edge off of the likely epidemics of dengue and Chikungunya by pursuing limited vector management efforts, and by trying to convince residents to eliminate man-made habitats in which many these mosquitoes develop. An effective vaccine would be most useful, but this does not appear likely in the foreseeable future.

    • CUBAQUS

      Castro claimed dengue was eradicated and it was a lie.

  • CUBAQUS

    For more on the virus (posts dating to 2011) see:
    http://chikunguynyacuba.impela.net/

  • CUBAQUS

    Note that the correct spelling is: Chikungunya

  • alex

    Hi there, my mother has the same symptoms. She has spent the last three weeks suffering from fever, joint pain, rash, red mouth, etc. She saw the family doctor who said it was a “virus que anda por ahi”. Finally, she went yesterday to the IPK (Institute for Tropical Medicine, spent 6 hours there since there was no a doctor available to take of her. They are busy with foreigners and people who can pay. Please, if you have any advice of a doctor with a bit of professionalism who be able to see her, I would really appreciate.
    Thanks,

    Alexandra (blasonalexandra@gmail.com)