As dengue outbreak looms, Cambodia families tremble

By Rafael D. Frankel, Globe Correspondent, 7/20/2003

SIEM REAP, Cambodia -- For the next three months, monsoons will push through Southeast Asia, drenching the region with the daily downpours that sustain this lush region.

With the rains come mosquitoes. And at such places as the Angkor Hospital for Children in this northwestern Cambodian town known for the nearby 1,000-year-old Angkor Wat temple complex, that means combating a growing wave of dengue fever -- including the potentially deadly hemorrhagic form.

''We obviously hope to do better this year,'' said Dr. Eugene Tragus, chief of medicine for the hospital, ''but they tell us it's going to be another bad year.''

Seven children there are being treated for dengue. And doctors are bracing for almost 200 cases -- a sharp increase over the same period last year -- by the time the monsoons subside.

Dengue fever, caused by four closely related viruses and found throughout the world's tropical zones, is spreading in Southeast Asia in ways never seen, health officials say. The disease, which is transmitted by mosquitoes that bite during the day, has begun to buck a trend of occurring in three- to five-year cycles and shows signs of becoming an annual problem.

Children have become the main victims in Southeast Asia. In particular, Type 4 dengue, which causes hemorrhagic fever and carries with it the highest instance of death, preys most commonly on children younger than 7.

Scientists do not know why children contract the Type 4 strain more often. The phenomenon has not been seen in Central America, another hot spot for dengue, according to Dr. Chang Moh Seng, the World Health Organization's regional point man for the illness.

And scientists have not pinpointed why the disease is occurring with more frequency, although weather patterns, increased population density, and virulent strains are among the possibilities.

Malaria is a more deadly threat in the region. For a country like Cambodia, which is struggling with myriad health issues, where about half its 12.2 million people are under 15, the prospect of dengue morphing from a cyclical epidemic to an annual crisis is daunting, said Chang, who works in Phnom Penh, Cambodia's capital.

''It's possible that dengue is moving to a highly endemic disease,'' he said. ''The signs from the first four months indicate this will be an especially bad year.''

Cambodia recorded almost 12,000 cases of dengue last year; the death rate was almost 2 percent. This year, cases of dengue are 50 percent higher than they were at the same time in 2002.

Lack of funding is among the chief hindrances for health workers in Cambodia.

For the past three years, the government received $150,000 annually from the US Agency for International Development to fight dengue. Half of that amount went toward large-scale larviciding -- spreading a chemical in city and town water supplies; the chemical is toxic enough to kill mosquito larvae without endangering people. This year, USAID has increased its annual contribution to $250,000.

Still, Chang said, ''We are facing a hopeless situation'' trying to keep down the breeding of mosquitoes. He said that again this year, due to lack of money, the government will only be able to spread larvicide in a few of the cities where dengue hits hardest.

Thailand, which is spending more than $3 million fighting dengue this year and will spend $3.4 million next year, is struggling to cope with the disease.

''With SARS winding down, it is the most urgent matter we are facing now,'' said Nitaya Chanruang Mahabhol, a spokeswoman for the Thai Public Health Department.

The Ministry of Public Health in Thailand reported 24,000 dengue cases by the end of May, 23 of them fatal. This accounting put the country on track to surpass the 108,905 cases recorded in 2002.

In contrast, in 2000, the last nonepidemic year, 18,617 cases were reported.

There is no cure. Although trials are underway to develop a vaccine, the Centers for Disease Control and Prevention says it could be at least 5 to 10 years before one is available.

Although the death rate from the disease is relatively low, dengue fever's toll on towns like Siem Reap is often worse than it would seem at first glance.

With so many children ill, schools in areas with outbreaks often lag behind, Chang said. And parents who earn little money are often forced to stay home from work to care for sick children.

''It's just a grossly unfair disease,'' Tragus said as he surveyed the board listing the conditions of the children at the Ankgor Hospital. ''Soon, most of these will say `dengue,' and all we can do is really hope for the best.''

©2003 Globe Newspaper Company