By Fernando Gandarillas.Paraguay has the third highest incidence of dengue fever in the region. This is the third year in a row where there has been an intense outbreak of the disease. In 2020, the country has had the highest number of cases in its history (over 220,000 cases) and 73 people have died. The cities most affected are Asunción, Mariano, Limpio and Capiatá. The Paraguayan Red Cross has been working since the beginning of the year to support to the emergency in these locations; with the support of the IFRC they implemented  dengue response projects reaching 1,280 families. The actions focused on generating educational activities for prevention, hygiene and sanitation, as well as the delivery of protection and hygiene kits. These activities suffered serious complications for their implementation with the appearance of the COVID-19 in the country.The COVID-19 pandemic has complicated the dengue work."Due to mobility restrictions and social distancing measures, we were unable to continue with the activities we were carrying out in the communities," said Magali Paredes, Health Officer for Dengue and COVID-19 of the Paraguayan Red Cross.Much of the work with the community was done through community meetings, where workshops were used to share information. One of the most important tasks was the creation of community brigades to work on the prevention and response to dengue outbreaks at the local level.Some of the families living in affected areas work in garbage recycling. Many of the recycled items are stored by people in their backyards or in places close to where they live. This is where rainwater collects and where mosquito breeding takes place. Because of this direct link to people's ability to have income, the Red Cross projects were aimed at informing and training community members on how to prevent the spread of mosquito larvae without affecting economic activity."We felt that there was always an important involvement and interest from community members because they knew that we are aware of this and that we want to work with them to find solutions," said Magali.Another piece of the work that the Paraguayan Red Cross has been doing focused on 12 schools in these cities. They work with children to teach them about dengue prevention measures. But, when the isolation measures were adopted, the children stopped going to school. Due to these circumstances the Red Cross is working to generate a process of training teachers.The Red Cross included a COVID-19 component in community actions since the outbreak of the virus. The creation of community brigades has been key to disseminating information and promoting prevention actions for both dengue and the new coronavirus. In addition, community surveillance mechanisms were created that involve coordinated work between community members and the local Family Health Unit (local public health care point) so that people can report, without fear of being discriminated against, if they have been in contact with people who have tested positive for COVID-19 or if they have been seriously exposed to the virus."Many times people do not want to report their health condition, if they are showing symptoms or if they have been in contact with people with COVID-19 because they feel observed," said Magali.The Red Cross has worked as an intermediary between the community and this state entity to facilitate conditions that create security for informants.The National Society is working to share information around COVID-19 and dengue fever at the same time.The work carried out by the Paraguayan Red Cross has been sustained with the active participation of dozens of volunteers. One of the most important results of the project has been to achieve empowerment of the people in the affected communities.

Dhaka/Kuala Lumpur, 6 August 2020 – Monsoon floods are robbing millions of people of their homes and livelihoods, with mounting risk of more deadly disease outbreaks when health resources are stretched to breaking point by COVID-19. So far almost 17.5 million people have been affected and more than 630 killed by major floods in India, Bangladesh and Nepal according to government figures. Half of Bangladesh’s districts are underwater, leaving nearly 1 million families stranded and cut off in their villages. Flooding and landslides in Nepal have left almost 200 people dead or missing. In India, almost 12 million people are affected by the floods mainly in the northern states of Assam and Bihar. Feroz Salah Uddin, Secretary General, Bangladesh Red Crescent said: “This is one of the biggest monsoon floods we have faced in many years and the worst may be yet to come as we face growing risks of malaria, dengue, diarrhea as well as this worsening COVID-19 pandemic.” The monsoon season floods mean a high proportion of the population in South Asia is vulnerable to diseases such as dengue, malaria, leptospirosis and cholera. In 2019, Bangladesh experienced its deadliest outbreak of dengue with more than 101,000 cases and almost 180 deaths. India reported 136,000 people were infected with the disease and many were hospitalised. Previous years show how devastating these diseases can be for communities in South Asia, so Red Cross and Red Crescent teams in the region are urgently ramping up their flood response activities, which include distributing mosquito nets and working with communities to reduce their exposure to diseases like malaria and dengue. COVID-19 restrictions have hampered efforts to destroy mosquito-breeding sites and raise awareness in communities of how to prevent the spread of diseases like dengue and malaria, ahead of this year’s monsoon season. At the same time, restrictions on movement of people and increased screening for COVID-19 may be helping to keep other diseases from exploding for now. Dr Abhishek Rimal, Regional Emergency Health Coordinator, Asia Pacific, International Federation of Red Cross and Red Crescent Societies (IFRC) said: “Vast inland seas of stagnant water create an ideal breeding ground for mosquitos, with soaring risk of diseases like dengue and malaria. Millions of people are also gathered in confined spaces or sleeping in temporary shelters with limited access to food, safe water and protection from mosquitos, creating the perfect storm for the spread of mosquito and water-borne diseases.” The majority of limited hospital beds, doctors and health resources have been redirected to focus on COVID-19 response as India deals with more than 50,000 recorded cases a day. Bangladesh and Nepal have surpassed 240,000 and 20,700 confirmed cases respectively. South Asia now has more than 2.2 million cases of COVID-19 cases with fears that the total number of infections is much higher. Dr Rimal, said: “The critical focus on saving lives in this pandemic and preventing the further spread of COVID-19 has diverted their resources from prevention activities such as dengue and malaria are going untreated. We are seeing evidence that people are reluctant to go to health facilities because they fear catching COVID-19 and getting more sick.”

In the courtyard of a health centre in Managua, Nicaragua, a mother and daughter share a supportive smile. Their expressions convey joy and confidence. They have just shared with us a story of survival and empowerment. Having had a very hard personal experience with dengue fever, both are now community volunteers in a Nicaraguan Red Cross vector control operation. In 2019, the Central American region suffered the most extensive dengue epidemic of the decade. More than one million people have been affected by the outbreak, with the highest numbers of cases reported in Honduras and Nicaragua. The Red Cross is working in these two countries, as well as in Costa Rica, El Salvador and Guatemala, to empower local communities to cope with both the current crisis and possible future outbreaks. With the support of the International Federation of the Red Cross and Red Crescent (IFRC), National Societies are working alongside communities in the most affected areas to equip them with the information and materials necessary to control and mitigate the effects of the current outbreak, and prevent future ones. This community-based approach is known as Community-Based Epidemiological Surveillance (CBES), and has been used in the region before with positive results in other epidemic crises, such as zika in 2016. This strategy allows community members themselves to identify risks in their environment and take action to eliminate or mitigate them, empowering them to become active agents of change. The first step of CBES is to identify social leaders who, working together with National Societies, organize community groups. Once these groups are formed, the Red Cross provides them with information on the outbreak so that they can identify warning signs and know what referral routes to health care are available if a potential dengue case is identified, as well as what hygiene and sanitation measures should be taken to prevent and mitigate outbreaks. Based on this information, communities create risk maps and plans to implement preventive and mitigation measures. The final step of CBES is the implementation of these plans through breeding site identification and elimination campaigns, home visits in which they replicate the information learned about dengue prevention, and outreach activities in schools. A life-changing disease At a recent activity with community volunteers in Managua, Karen Rodriguez, a Nicaraguan Red Cross volunteer, shared her experience with dengue fever. Her daughter, Jade Gámez, had suffered from dengue three times, at the age of 11, 12 and 13. The last of those times, Jade had been diagnosed with severe dengue, and the girl suffered kidney and liver damage as well as a preinfarction. Children under the age of 15 are a particularly vulnerable group. In August 2019, 66% of the deaths reported in Honduras as part of the current outbreak were under 15 years of age, and in Guatemala, 52% of the severe dengue cases reported were also in this age group. Having survived such a serious illness, mother and daughter are now volunteers with the Nicaraguan Red Cross. As part of the current operation, their work consists on replicating the information received among their neighbors, as well as carrying out clean-up campaigns to eliminate breeding grounds in their community. "We both do the same thing - when one can't go to the clean-up activities, the other one goes," says Karen. For them, this is an opportunity to help their neighbors avoid going through the same experience they went through years ago. "Now that I am supporting the Red Cross and I can help people, I feel calm, I feel happy," says Karen. "More than anything, so that people don’t go through the same experience I went through," adds Jade. Dengue fever outbreaks are cyclical and peaks occur around the world every year during rainy seasons, with extensive epidemics occurring at a frequency of every four to five years. In 2019, the World Health Organization recognized dengue as one of the top ten threats to global health, with an estimated 40% of the world’s population currently at risk. Epidemics can have a devastating effect on the most vulnerable groups, such as children. That is why it is important for National Societies to work on advocacy and capacity building to continue to empower communities in preparing for and responding to dengue and other vector-borne diseases such as zika and chikungunya.

Panama/Geneva, 27 September 2019–-As dengue spreads rapidly across Central America, the International Federation of Red Cross and Red Crescent Societies (IFRC) is scaling up emergency assistance to help countries contain the mosquito borne viral disease. In Honduras, more than 71,200 people have been affected by the disease making it the worst outbreak in the country’s history. Nearly one quarter of the cases reported were classified as severe dengue and more than 65 percent of the 128 deaths so far are children under 15. Guatemala, Nicaragua, El Salvador and Costa Rica are also reporting massive increases in dengue cases compared to previous years. Dr Maria Franca Tallarico, Head of Health at IFRC’s Regional Office for the Americas said: “Dengue is endemic across the Americas, but what is very concerning in this outbreak is that the majority of the cases and deaths are occurring in children under 15. This is due to a lack of immunity in young people to the deadliest of the four strains of dengue currently circulating in the region.” A combination of seasonal rains and warming temperatures are being blamed for dengue’s rapid spread--creating more stagnant pools that are perfect breeding grounds for mosquitoes. There are rising concerns that this will make the outbreak will be harder to contain. According to the World Health Organization (WHO), rising global temperatures rainfall patterns linked to climate change could significantly modify vector-borne diseases and their effect on human populations—making epidemics more difficult to predict and control. Teams of Red Cross volunteers in affected Central American countries have been supporting government efforts to slow the outbreak—providing door to door awareness raising about the disease and how to prevent it. With their unique access to affected communities, the Red Cross volunteers are helping to clean up mosquito breeding sites or accompanying health workers to identify cases. Dr Tallarico said: “The size of this outbreak is unprecedented across Central America. Dengue is a disease that affects the most vulnerable--those who live in places where there is poor sanitation and where mosquitoes thrive. But the disease can be contained if governments and communities work together to raise awareness, access medical care and clean up the environment. This is what the Red Cross teams across affected countries are focused on doing.” The IFRC has launched a regional appeal seeking a total of 2.9 million Swiss francs to support the National Red Cross Societies in Central America to deliver assistance and support to 550,000 people for 12 months. The appeal will focus on community health, water and sanitation and promoting behaviours changes that prevent the decease. Dengue cases have increased 30-fold over the last 50 years, according to the World Health Organization. As one of the world’s fastest growing diseases, dengue is endemic in 100 countries infecting up to50-100 million people a year.

Manila/Kuala Lumpur/Geneva, 26 July 2019 – Urgent action is needed to contain a dengue outbreak in the Philippines as cases continue to soar and an unprecedented nationwide emergency alert is issued, the International Federation of Red Cross and Red Crescent Societies (IFRC) and Philippine Red Cross are warning. The Philippines is experiencing an alarming dengue outbreak with more than 115,000 cases reported since the beginning of the year – 85 per cent more than during the same period in 2018. To date, dengue has already led to 491 deaths, 30 per cent of them children between the ages of 5 and 9. The significant spike in dengue is particularly alarming as the monsoon season is only starting in the country. Dengue cases peak during and after monsoon rains, raising concerns that a severe epidemic may threaten the nation in the coming months. The Philippine Red Cross is supporting government efforts to stem the outbreak. Philippines Red Cross Chairman and CEO, Richard Gordon said: “Dengue is one of the fastest spreading viral diseases and children are particularly vulnerable. Tens of thousands of patients are streaming into overcrowded hospitals. Our 2 million volunteers across the country are in the communities raising awareness about preventing infections and when to seek treatment, organising clean-up drives for mosquito breeding sites and supporting overcrowded hospitals.” The IFRC has released nearly 150,000 Swiss francs (7.2 million Philippine peso) from its Disaster Relief Emergency Fund to support the Philippine Red Cross scale up dengue treatment tents at ten hospitals and provide volunteer nursing staff to care for up to 15,000 patients and their family members. The Red Cross is targeting 300,000 people in at-risk communities with critical information on getting early treatment. Chris Staines, the Head of IFRC’s Philippines office said: “We need to work together to save lives and contain the outbreak which we fear will worsen during the monsoon. Dengue can be stopped in its tracks, but families need to protect themselves from mosquito bites and seek medical treatment if they experience any symptoms such as high fever, headaches, nausea and joint pains.” The current spike in dengue infections comes at the same time as the Philippines continues to deal with a deadly measles outbreak that has stretched healthcare capacities across the country. Elsewhere in South-East Asia, Red Cross teams in Cambodia, Laos, Thailand and Vietnam are also responding to spiking dengue cases.