Nicaragua versus Aedes Aegypti

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Tortilla con Sal, March 11th 2016


On February 1st this year the World Health Organization declared the Zika virus a global public health emergency. In South America, the countries grouped in the Union of South American Nations (UNASUR) have already declared that combating the Zika virus is a major priority for the region. The Zika virus is suspected of being linked both to cases of microcephaly affecting the foetus of pregnant women and to the rare Guillain-Barré syndrome causing non-traumatic paralysis in adults.


French researchers working established a possible connection while working on data from an outbreak of the Zika virus in French Polynesia in 2013. They estimate the risk of contracting Guillain-Barré from the Zika virus at around 2.4 cases per ten thousand. The reserchers reckon that regions affected by the virus should expect to a significant increase in neurological disorders.


In Central America, with its health model based on popular participation, Nicaragua is in the front line of the campaign against the Zika virus.  So far the number of positive cases of the disease is 93 (6 of whom are women in pregnancy). More than half o fthese positive cases are located in the capital, Managua. Nicaragua's figures compare well with its wealthier neighbors south of the border: Costa Rica reports only 8 confirmed locally transmitted cases (including one pregnant woman) whereas Panama has 118 confirmed cases (including two pregnant women).


These numbers come in stark contrast with those of the so-called Northern Triangle. Honduras has more than 13,000 cases, including 164 pregnant women. El Salvador has more than 7,000 suspected cases, including almost 200 pregnant women. Guatemala has almost 700 suspected cases of infection, including almost 200 pregnant women. Zika is just one three diseases transmitted by the mosquito aedes aegypti, the other two being Dengue and Chikungunya. Both Dengue and Chikungunya are both more dangerous in terms of mortality among affected patients.


The struggle against poverty-related diseases, especially those caused by the deadly vector of aedes aegypti has become a permanent trait of Nicaragua under the Sandinista government of President Daniel Ortega. Coordinating the efforts of the personnel of the Health Ministry with those of teachers, community leaders, youth, religious organizations and enterprises at all levels, this campaign has succeeded in mobilizing people nationwide in order to contain, control and roll back these devastating epidemics.


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[Photo: El 19/CCC/Jairo Cajina]


In recent months, national campaigns against Dengue, Chikungunya and Zika have intensified, especially during weekends in hours where people are most likely to be at home. They also address localized outbreaks of other diseases where they occur, such as cases of Hepatitis A recently detected in Leon (on Nicaragua's Pacific Coast) and Jinotega (in Central Northern Nicaragua).


These campaigns include routine monitoring of the occurrence of various infections involving too massive house-to-house fumigation of homes and neighborhoods, particularly in selected areas where an increase of cases of disease has been detected. A vital component of the campaign is house-to-house control of all water deposits like sinks, water tanks and even domestic basins and buckets where the government health authorities insist on the cleaning of all water containers and the application of a special insecticide, called abate in Nicaragua to kill mosquito larvae.


An integral and supremely important part of the campaigns is the communication of information to the population about mosquito borne diseases and other health-related issues. Above all the campaigns prioritize insistence on the importance of a clean environment as well as of adequately disposing of garbage. Mosquito larvae reproduce in tiny quantities of clean water, even in the water left in an upturned bottle top.


This massive house-to-house campaign model has been praised by authorities from the UN World Health Organization and the Pan-American Health Organization (WHO/PHO). At a meeting recently held with university students in Managua, WHO/PHO representative Socorro Gross, confirmed the success of this Community-Based Family Health Model.


“The Health Care Ministry (MINSA) and all Government Institutions are generating this initiative that attacks the hatcheries of the mosquitoes. The plan is to join all the wonderful forces this country has in order to combat the mosquito”, Gross said. At the end of February this year Dr Carlos Cruz, Director of health services nationally for Nicaragua's Health Ministry announced that in just the first two months of this year the mass cleaning campaign has eliminated around six million sources of reproduction for the aedes aegypti mosquito, an incredible community focused effort.


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[Photo: El 19 / CCC / César Pérez]


The effectiveness of this community-based model has also been acknowledged by the region's public health authorities. At a meeting held on February 18th in Tegucigalpa, Honduras, the Central American health ministers were informed about Nicaragua's efforts and general policy to combat mosquito borne diseases. Nicaragua's proposals to combat the Zika epidemic were incorporated into overall regional action plans, especially with respect to the handling of the epidemic, the training of health care personnel and the strengthening of internal diagnostic capabilities – a capability lacking in all the countries of Central America except Costa Rica and Panama.


“Finally, we insisted and got strong incidence in the decisions that were made, convinced as we are of the positive results achieved through popular participation”, said Nicaragua's representative and Risk Assessment Adviser, Dr Guillermo González who is also responsible for Nicaragua's Civil Defense coordination in cases of natural disasters in Nicaragua like earthquakes and volcanic eruptions.


Nicaragua's relative success in controlling the frightening regional outbreaks of mosquito borne diseases like Dengue, Chikungunya and Zika results directly from the country's community based health care system which prioritizes preventive care. Right now the focus is on mosquito borne diseases, but since 2007 the government has also dramatically improved its infant immunization programs which has significantly reduced the incidence of respiratory and other typical infections in young children.


In many ways the anti-mosquito campaigns are a natural development of the already highly developed community organization involved in the country's mass vaccination campaigns. Preventive, community-based care is very clearly a cost effective and efficient model capable of maximizing the general health of a country's population. So, given its track record since January 2007, it is no surprise that Nicaragua now has taken the lead in helping its fellow Central American countries make the best of scarce resources to protect their populations against the mortal threat posed by aggressive viral infections carried by the aedes aegypti mosquito.