Honduras: MSF treats more than 5,000 people during dengue fever emergency

Following an increase in dengue fever cases across Honduras last year, Doctors Without Borders/Médecins Sans Frontières’ (MSF) began treating patients in the pediatric dengue unit at the National Hospital Mario Catarino Rivas (HNMCR) in February. A mosquito-borne viral disease, dengue causes fever, headache, muscle pain, and rashes—and can be fatal. MSF provided medical care to 5,734 people before ending its intervention in mid-October.

Here, Evelyn Zorrilla, MSF’s regional epidemiologist for Mexico and Central America, explains how we responded to the outbreak, how the disease behaved in an unusual way, and how the international medical humanitarian organization adapted its approach accordingly.

What happened during the dengue fever outbreak in Honduras?

Starting in August 2018, the number of dengue fever cases started to grow across Honduras and continued to rise at an alarming rate. The province of Cortes was the worst affected. In February 2019, the HNMCR asked us to intervene because the number of cases was very high. In January 2019, there were more than a thousand cases, and the HNMCR didn’t have the capacity to cope with this number.

How did MSF respond to the emergency?

In February, we began treating patients with dengue fever symptoms in the pediatric dengue unit at the HNMCR. We brought in eight physicians, four pediatricians, eight nurses, and four nursing assistants. At the same time, we hired 16 health promoters to support vector control—so the mosquitoes carrying dengue fever wouldn’t reproduce—and fumigation activities. These were conducted in collaboration with the Sanitary Department in Choloma, one of the most affected municipalities in Cortes. Our health promotion team reached 90,335 people.

How did the epidemic evolve?

Between February and April, the number of cases kept growing, which is why MSF decided to increase its support for the HNMCR by triaging patients who were running a temperature in the pediatric emergency room. In Choloma, we also started activities in four Ministry of Health primary health centers. We hired one doctor and nurse for each center to take care of patients that didn’t require hospitalization.

But the outbreak kept growing, so in July we restructured our health promotion activities focusing on the application of larvicides—insecticides that target the larval stage of an insect—in 10 neighborhoods in Choloma that had the greatest number of dengue fever cases. At the start of September, we began to see a decrease in the number of cases. Responding to these encouraging signs, MSF decided to gradually reduce our activities, eventually ending the intervention in the middle of October.

This outbreak was unusual because we didn’t see a clear trajectory in the number of new cases; one week they would increase and the next the number would go down. This epidemic didn’t respect dates or times.

Why didn’t the number of cases decrease as expected?

It was a mixture of factors. First, this part of Honduras is an endemic dengue fever zone, and it wasn’t prepared to respond to this situation. The alerts for a new outbreak were not activated in time.

MSF also evaluated the efficiency of the insecticide used for the fumigations of the mosquitos that spread dengue fever. This study found that there was a 60 percent resistance among mosquitos to the chemicals used in the fumigation activities.

What are MSF’s recommendations to prevent future outbreaks?

We need to reinforce the epidemiological surveillance and have regular and coordinated health promotion activities so people are aware of the disease and its consequences, which can be fatal.

We also need to continuously train our health staff so they can do early diagnosis and give timely treatment, which will be reflected in fewer cases needing to be hospitalized and fewer patients dying from dengue fever.

MSF dengue fever emergency figures for Cortes province: 

Total number of cases treated by MSF: 5,734
Total number of cases treated through in the HNMCR: 5,171
Total number of cases treated in the Choloma health centers: 563
Total number of people supported by the health promotion team: 90,335