A. Situation analysis
Description of the disaster
Dengue is an endemic disease in the Americas, and dengue outbreaks have occurred every three to five years over the past decades. In 2019, in several countries, the number of cases before peak season was already equal or above the total number of cases in previous years. Additionally, potentially deadly severe dengue cases are on the rise, with children being the demographic most at risk.
In the Americas, between epidemiological week (EW) 1 and EW 52 of 2019, a total of 3,139,335 cases of dengue were reported (321.58 cases per 100,000 population), including 1,538 deaths. Of the total cases, 1,367,353 (43.6%) were laboratory-confirmed and 28,169 (0.9%) were classified as severe dengue. The case-fatality rate was 0.049%.
The number of cases reported in 2019 through EW 52 (3,139,335) is the largest recorded in the history of dengue in the Americas, exceeding the number of cases reported in the 2015-2016 epidemic period by 30% (Figure 1). In 2019, the proportion of severe dengue (0.9%) has exceeded that observed in the previous four years; however, it is below that observed between 2010-2014 (ranging 1.35% to 3.05%).
A comparison of accumulated incidence rates by subregion between 2019 (EW 52) and the previous epidemic period (2015-2016, EW 52) shows that, except for the Andean subregion, incidence rates in the other subregions are higher than in the previous epidemic cycle (Figure 2).
A total of 2,074,348 cases of dengue (incidence of 212.48 cases per 100,000 inhabitants) were reported in the Americas between EW 1 and EW 40. The highest cumulative incidence rates were observed in the Southern Cone (589.43 cases per 100,000 inhabitants), the Non-Latin Caribbean (203.38 cases per 100,000 inhabitants), the Andean Subregion (146.44 cases per 100,000 inhabitants), and the Central American Isthmus and Mexico (88.70 cases per 100,000 inhabitants).
Of the total number of reported cases in the region as of EW 40, 943,147 (45 per cent) were laboratory-confirmed and 4,608 (0.22 per cent) were classified as severe dengue (Figure 3). The highest number of severe dengue cases were reported in Honduras (1502 cases), Brazil (773 cases) and Colombia (772 cases), and 810 deaths were reported in the region during that same period (fatality rate of 0.039 per cent).
Three Central American countries declared an Epidemiological Alert for the current outbreak: Honduras (14 June 2019), Guatemala (29 July 2019) and Nicaragua (31 July 2019). No formal alerts have been declared in El Salvador and Costa Rica, but the number of cases there have been notably higher than in previous years and continue to rise as of the drafting of this report.
In Costa Rica, the number of suspected cases of dengue in 2019/2020 is considerably higher than the number of cases in 2018 and 2017. A total of 9,400 cases were reported in 2019, and 8,859 cases have been reported as of EW 40 2020, for a cumulative total of 18,259 cases of dengue in the country - a 33 per cent increase (8,859 vs. 6,642) compared to 2019. The most affected areas are Huetar Caribe, Brunca, Pacífico Central, Huetar Norte, Central Norte, Chorotega, Central Este, Central Sur and Occidente.
Given the increase in cases, the Costa Rican Social Security Fund (CCSS) has made a call to the population and has activated an emergency protocol5, which seeks to mobilize health teams and serve the population, through the following actions:
Reinforce continuing education on dengue, chikungunya, zika and malaria care protocols.
Update data every two weeks to know the types of circulating viruses according to the mapping of areas.
Implement the dengue consultation and the dengue care unit, in accordance with the “Guide for the organization of care and management of patients with dengue and severe dengue” that has been in force for emergency cases since 2013.