By NewsDesk  @infectiousdiseasenews

Central American countries in 2019 have seen an increased incidence of dengue fever, in fact, the cumulative incidence rate of dengue in the Central America region is higher than in the previous five previous years, with an incidence of more than 100 people with dengue per 100,000 people, according to the International Federation of Red Cross and Red Crescent Societies . 

El Salvador map
Central America map/CIA

To date in Central America, close to 250,000 people in Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua have been reported to have dengue in 2019. Considering that dengue cases are typically underreported (with a 14 to 28 time ratio), the number of people who have been infected with dengue is likely much higher.

Three countries in Central America have declared an Epidemiological Alert for the current outbreak: Honduras (14 June 2019), Guatemala (29 July 2019) and Nicaragua (31 July 2019). El Salvador and Costa Rica are reporting an increase in dengue cases compared to previous years, and ministries of health of both countries are implementing response activities to reduce the incidence of cases.

Honduras, for example, is experiencing the worst dengue outbreak in its history, with 81,858 cases of dengue and 142 deaths.

The following factors and conditions contribute to the risk of a worsening outbreak exceeding endemic thresholds throughout the region:

• Increased rainfall leading to faster outbreak spread due to increased mosquito breeding sites.
• Typically, the highest incidence for dengue in Central America occurs from August through November and sometimes extends to January.
• Currently, the four dengue serotypes (DENV 1, DENV 2, DENV 3 and DENV 4) circulate simultaneously in Central America, which increases the risk of severe cases and the consequent burden of care for health services. Serotype 2 is one of the deadliest and is the one that is currently affecting children and adolescents in the region.

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• Children under 15 are the most affected group. In Honduras, they constitute 66% of all confirmed deaths, while in Guatemala, they represent 52% of the total cases of severe dengue. According to PAHO, this heightened risk is the result of low exposure, and therefore, low immunity among this age range.
• There has been inadequate environmental management and limited access to water services in impoverished areas.
• The Central American region is experiencing a series of political and social challenges (restructuring of the Ministry of Health in El Salvador; health sector strikes and social mobilizations in Honduras, Nicaragua and Guatemala; etc.) that are hindering access to health services for the population affected by dengue fever.
• Migrants and internally displaced people in the region may find accessing health services challenging.