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By Adrienne Loerzel

KOROR, Palau (December 6, 2000 - Pacific Daily News)---A public health education campaign may have helped stop the spread of a potentially deadly disease in Palau.

Since June, the island has seen 28 cases of mosquito-borne dengue fever, with 21 of those cases reported between September and early December.

But the number of cases seems to be dropping, said Dr. Caleb Otto, Palau’s chief public health officer.

"We actually think we're seeing it coming down, with the last week of November and first week of December having fewer cases," he said. "We’re hoping that it continues to go down."

Otto said public health workers have discussed safety precautions during house-to-house visits on the island of Koror and school visits in Airai and Koror states.

Residents are asked to get rid of old tires, cans and other debris that provide breeding grounds for mosquitoes, which spread the virus that causes dengue fever.

During a 1998 dengue outbreak in Palau, four people died of the disease, while a 1995 outbreak claimed one life. Otto said the islands have been fortunate during this epidemic, which has not led to any deaths.

He said health workers also have been surprised by the lack of dengue hemorrhagic fever. That form of the disease causes bleeding from capillaries, but officials are uncertain of the mechanism that triggers the bleeding.

"We’ve gotten some indications that we might have some of that type -- low platelets and low white blood cell counts," Otto said. "But very surprisingly, we haven’t had any hemorrhagic type."

Otto said repeated exposure to one of the four types of virus that cause dengue may lead to the hemorrhagic fever.

"The theory is that the more you get exposed to the different stereotypes, the more at risk you are (for hemorrhagic fever)," he said. "Since the public has no way of knowing which mosquito has bitten you, or which type you have been exposed to, it's best not to get bitten at all."

One problem in identifying dengue fever itself is the abundance of viral symptoms on the islands. Otto said 269 blood samples have been sent to the World Health Organization offices in Australia, but just 28 of those samples showed the dengue fever virus.

Otto said there is no set treatment for the virus, but residents should go to the hospital if they suspect they have dengue fever.

Otto said public health is still investigating the cause of the latest outbreak.

"We think that the virus is probably endemic, but why it has a five-year cycle, we’re not sure," he said.



Dengue Fever And Its Symptoms

Dengue is characterized by sudden-onset high fever, severe headache, joint and muscle pain and rash. Nausea and vomiting, loss of appetite and altered taste sensations are common.

A rash may appear three to four days after onset of fever and may spread from the torso to the arms, legs and face. The disease is usually benign and self-limiting after about seven days.

Dengue also may present as a severe and fatal hemorrhagic disease called dengue hemorrhagic fever, or DHF. There is no specific treatment for dengue infection.

What Causes It?

Dengue is a viral disease transmitted by urban Aedes mosquitoes, a species found living in close association with humans in most tropical urban areas. Mosquito-biting activity is greatest in the morning for several hours after daybreak and in the late afternoon for several hours before dark. Mosquitoes may feed all day indoors, in shady areas or when it is overcast.

This mosquito breeds in artificial water containers, such as discarded tires, cans, barrels, buckets, 55-gallon drums, flower vases and cisterns.

Since 1980, the incidence of dengue has increased dramatically in tropical countries worldwide.

Your risk for becoming infected with dengue is lower if you:

· Spend most of your time in air-conditioned buildings, hotels or other closed-circulation environments.

· Avoid highly populated residential areas.

· Spend time on beaches or in forested areas.

Source: Centers for Disease Control and Prevention

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