San José, Costa Rica, since 1956

Diarrhea Outbreak Ravages Isthmus, Kills 68

WHILE a rotavirus outbreak has left astring of deadly cases of diarrhea in itswake through Central America, a bacterialinfection has triggered a spate of diarrheain Costa Rica that has afflicted thousandsof children and killed two.Since Jan. 1, at least 68 CentralAmericans have died of causes related tothe diarrhea epidemic. Nearly 110,000people, most of them children under fiveyears of age, have been affected by diarrhea,which can cause severe dehydrationand death if not treated.While the rotavirus is not the cause ofevery case of diarrhea, and in Costa Rica isblamed for only a few, it has spread quicklythrough El Salvador, causing at least 20deaths, and has also taken a toll onNicaragua, where 38 diarrhea-relateddeaths have been reported in less than amonth.THE virus causes intestinal infectionwith symptoms that can include diarrheafor three to eight days, vomiting, severedehydration, fever and abdominal pain.The U.S. Centers for Disease Control andPrevention (CDC) calls it the “most commoncause of severe diarrhea among children,resulting in the hospitalization ofapproximately 55,000 children each yearin the United States and the death of over600,000 children annually worldwide.”Teresita Solano, director of the PublicHealth Ministry’s EpidemiologicalVigilance Department, said Costa Rica’sincidence of diarrhea is not as drastic asthat of El Salvador and Nicaragua, but officialshave increased vigilance in the borderzones.Two Costa Ricans have died and nearly18,000 have come down with diarrheathis year, the Health Ministry reports.About 7,000 of those are children underage 5. Rotavirus did not cause the diarrheathat killed one of the two victims, an 8-year-old boy, while the other, an adulthomeless person who was not identified,died of diarrhea of unknown causes, theministry reported.“WE have a little outbreak ofrotavirus, but there’s no epidemic,” Solanotold The Tico Times this week.“We’re taking measures to prevent andcontrol and we’re on a vigilance alert, butwe don’t have the kind of outbreak that hasoccurred in other countries.”She pointed out that the numbers inCosta Rica, while slightly higher this yearthan during this time last year, are normal.More than 100,000 cases of diarrhea arereported in the country every year, shesaid.The nation’s public, nearly universalhealth-care system and public awarenessprograms have prevented an outbreak.“Here, there’s a higher level of healthand availability of services, and people areaccustomed to going quickly to the clinics,”Solano said.IN rural Nicaragua, where goodhygiene is difficult because access topotable water is a serious and growingproblem, there have been 40,374 reportedcases of diarrhea and 38 deaths in less thana month.Luisa Marenco, social communicationsdirector for Nicaragua’s Ministry of Health(MINSA), said half of the recent deathswere caused by rotavirus, which causesviral gastroenteritis, characterized byintense diarrhea, vomiting and high fevers.MINSA is reporting an alarming over saturationof Nicaraguan public healthclinics by parents bringing in infants andchildren with diarrhea, especially in thenorth of the country.The Ministry of Health has declared apublic-health emergency in the departmentsof Madriz and Estelí, where doctorsare attending an average of 300 cases ofrotavirus each day in its state-run clinics.The ministry, working in conjunctionwith various municipal governments, istaking steps to prevent the outbreak fromspreading by cleaning up polluted water runoffditches and launching a public awarenesscampaign on proper hygieneand treatment for dehydration.MARENCO said some of the deathscould have been prevented if the parentshad known how to respond when their childrenfirst started showing signs of illness.Still, as the number of cases continuesto grow, some health officials are claimingthey are underfunded and understaffed tocombat the problem.International aid organizations havealready provided Nicaragua with $25,000in assistance, and Managua’s NationalAutonomous University (UNAN) isresponding to the crisis by providing morethan 800 third- and fourth-year medicalstudents to act as an emergency healthbrigade.IN El Salvador, at least 20 have diedand more than 83,000 cases of diarrhea arereported, in a mostly rotavirus-inducedoutbreak, the Salvadoran Health Ministrytold the EFE newswire.The Salvadoran government hasdeclared a state of emergency, in effectsince Feb. 8.A ministry source told EFE the sicknessis “on the drop,” though officials willcarry out preventive campaigns beforeSemana Santa (Easter Holy Week) to fendoff another outbreak. The emergency alertremains in effect in the country’s capital,San Salvador, and outlying regions, wherethe most cases are reported.Social organizations point to the lackof potable water and the dirtiness of povertyin El Salvador as the main culprits forthe spread of the virus.ROTAVIRUS infections have claimedthe lives of eight children in Guatemala,where health officials report 700 suspectedcases and nearly 400 confirmed cases ofthe disease.In 2004, there were nearly 278,000cases of diarrhea in El Salvador, more than100,000 in Costa Rica, 237,000 inHonduras and nearly 30,000 in Nicaragua.Guatemala did not provide figures.The rotavirus and others that causediarrhea spread through close contact withinfected persons, by sharing water, food oreating utensils, or by ingesting contaminatedfoods or beverages.People can reduce their chances ofgetting infected by frequent hand washing,prompt disinfection of contaminated surfaceswith household bleach-based cleaners,and immediately washing soiled clothing.If food or water is suspected of beingcontaminated, it should be avoided.

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