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Brazil's Military Mobilizes Against Dengue

Outbreak Leaves 67 Dead, Sickens Tens of Thousands

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Washington Post Foreign Service
Thursday, April 3, 2008; Page A08

RIO DE JANEIRO -- Brazilian military troops joined public health workers this week to battle the deadliest outbreak of dengue fever to hit this city, which in recent years has been the epicenter of the disease's resurgence throughout Latin America.

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Officials confirmed Tuesday that 67 people have died here from the mosquito-borne virus. Tens of thousands of people have been sickened, and many of the most serious cases -- including the majority of the fatalities -- have been children.

More than 1,200 military personnel arrived in Rio this week to spray insecticide in hard-hit neighborhoods and erect emergency hospital tents. At some of those tents, Brazilians were expressing anger over the government's failure to take preventive action sooner.

"I think that the state and municipal governments here were irresponsible in the way they handled this, because they didn't do anything until the problem was already out of control," said Isabel Belo, 35, whose ill 11-year-old daughter was hooked up to an IV bag. "Now, everyone is just trying to pass the blame around to someone else."

According to dengue experts, the outbreak can be largely attributed to the rise of hundreds of unplanned, densely populated shantytowns in Rio.

Wellington Sun, chief of the dengue branch for the U.S. Centers for Disease Control and Prevention, said the demographic shifts that turned Latin America from mostly rural to predominantly urban in recent decades have given the dengue-carrying mosquito a perfect environment in which to thrive. The mosquito needs only a tiny amount of standing water to breed -- even a piece of crumpled plastic garbage is enough, Sun said. Eliminating breeding pools is very difficult in areas where trash collection is infrequent and water and sewer services are lax.

"The mosquito -- Aedes aegypti-- has found a very favorable environment in cities where there has been fast growth without the corresponding infrastructure," said Jarbas Barbosa, a Brazilian doctor who is the head of health surveillance and disease management for the Pan-American Health Organization. "In a lot of neighborhoods in Rio, for example, they store water on their houses because they don't have 24-hour, seven-days-a-week water service."

Between the 1950s and the 1980s, dengue was practically unknown throughout the Americas, as it had been successfully eradicated in many tropical countries through intensive insecticide efforts. But after those efforts were relaxed, the mosquito that carries dengue and yellow fever reappeared in most of the countries where it had been eliminated.

Rio de Janeiro has emerged as a main breeding ground. Serious dengue outbreaks hit the city in 1986, 1995 and 2002, but this year's has proved more lethal.

Children ages 5 to 12 are showing the most severe symptoms. They have accounted for about 40 of the confirmed deaths, according to officials.

At one emergency tent in a southern neighborhood of this city, about 500 people -- many of whom had been referred to the tent by overwhelmed hospitals -- arrived Sunday for blood count tests that can help detect the likelihood of dengue exposure. Maj. Wilson Braz, a fire department medic overseeing the tent, said most were children.

Like Belo, many parents of those children have criticized public officials for not acting until the fatalities began to multiply in recent weeks. Now the city is covered with advertisements reminding people to use repellent and eliminate standing water, and health officials are aggressively spraying neighborhoods and standing water pools.

Brazilian President Luiz In�cio Lula da Silva said Monday that all Brazilians, not just the local officials who are catching most of the criticism, share responsibility for the situation.

"It's the responsibility of the president, the governor, the mayor and each resident of this country," Lula said. "If we don't clean up the water in our home, our street, our city, our state, we will all be victims of irresponsibility."

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