In March, Outbreak Thursday wrote about the global rise of dengue cases and outbreaks in 2019. Nearly 800 localized cases of severe dengue were recorded in Honduras at the time. Now, the outbreak in Honduras has grown with some health authorities even calling it the worst dengue fever epidemic in the last half century. In this week’s Outbreak Thursday post, we will be providing an update on the worsening Honduras epidemic and outline related local, national and international response activities. 

The Situation in Honduras

In the past, Honduras has had annual dengue case counts as high as 44,000, but in 2017, there were only 5,217 cases, and in 2018, there were only 7,942 cases. This year, Honduras has recorded over 28,000 dengue fever cases as of July 28, 2019 with the potential to have an even higher annual case count by the end of the year. According to PAHO, 8,662, or approximately 30% of the total cases this year so far, have been dengue hemorrhagic fever, a more severe form of the disease. This is the highest proportion of dengue hemorrhagic fever compared to total dengue cases in the country in the last five years. The second highest proportion of dengue hemorrhagic fever cases was 14% in 2018. There have been 58 deaths associated with the outbreak, and approximately half of the deaths reported have been children.

Out of the 32 public hospitals in Honduras, 26 are now over capacity with patients needing to be treated for dengue symptoms such as bone and joint pain, high fever, vomiting and dehydration. The departments that are most strongly affected by the epidemic are Cortés, Yoro, Olancho and Santa Bárbara. This marks an increase in geographic dispersion of cases since March, when the most affected department was Cortés. As of July 24, 2019, 75% of cases have originated from northwestern Honduras. Concerningly, the country’s three-month-long rainy season is about to begin, which may lead to mosquito proliferation, potentially worsening the epidemic even further.

Coping with the Caseload

In response to the epidemic, the government of Honduras declared a state of emergency in mid-June. On July 23, 2019, President Juan Orlando Hernández met with majority of Honduras’s mayors, the National Risk Management System authorities, Permanent Commission of Contingencies authorities and Scientific Technical Committee authorities to discuss the situation. The president outlined a risk-stratified plan where each municipality would employ an appropriate combination of vector control tactics depending upon the severity of the epidemic in that area as well as its potential for worsening. These tactics include fumigation as well as addressing stagnant water, which is a breeding ground for mosquitoes. Use of the dengue vaccine, Dengvaxia, has not been mentioned. Use of the vaccine in other settings has caused controversy in the past. National emergency funding mechanisms are also being explored in order to bolster the response. The Ministry of Health has decided to open 15 additional treatment centres and hire additional health personnel devoted to addressing the dengue outbreak in order to reduce strain on the healthcare system. 

The International Response & Humanitarian Actors

The international community has taken note of the growing, severe epidemic. The US Embassy in Honduras and CDC have issued travel alerts to inform tourists and others planning to visit Honduras regarding the risk of dengue infection and disease. The Honduran Red Cross, the International Federation of the Red Cross, MSF, PAHO, the WHO and other humanitarian actors have joined in on response activities, providing personnel, supplies and funding to boster the national-level and municipality-level response efforts. The International Federation of the Red Cross has collaborated with other organizations and agencies to create an emergency fund of approximately $218,000 to combat the epidemic. 

Conclusions

The Honduras epidemic has expanded considerably since our update in March with an increase in cases, geographic spread and strain on the healthcare system. Now, as Honduras is about to enter the rainy season, it is vital that the Honduras government is supported in their vector control activities. The international community must step up to recognize the threat of this epidemic and further assist in controlling it.


Outbreak Observatory aims to collect information on challenges and solutions associated with outbreak response and share it broadly to allow others to learn from these experiences in order to improve global outbreak response capabilities.    

Photo courtesy of CDC/James Gathany (https://phil.cdc.gov/Details.aspx?pid=4489)