One millimeter of water accumulated over three days is all the Aedes aegypti, or dengue mosquito, requires to deposit its eggs and perpetuate the species, according to doctor Julio César Quirós, director of the Public Health Ministry’s Santa Cruz division, in the northwestern province of Guanacaste. With abrupt increases from nine total reported cases of dengue from January through the end of June, to 131 by the end of July, the neighboring Guanacaste communities of Villareal and the popular beach destination of Tamarindo appear to have followed the one-millimeter recipe to perfection – much like the rest of the country, where the disease has continued to spread with alarming speed.Health authorities emphasize that the disease can be brought under control if citizens and visitors take precautions such as using mosquito repellents containing DEET and emptying standing water inside or outside the house, which can become dengue breeding pools.THE current number of reported cases throughout the country increased from 8,400 by mid-July (TT, July 15) to 12,692 to date, according to Teresita Solano, chief of the epidemiological vigilance unit of the Public Health Ministry.The communities of Atenas, in the province of Alajuela, and Jacó, a popular Pacific-coast tourist destination, have been particularly hard-hit by the virus, transmitted by infected female mosquitoes. Because more than 80 cases of dengue emerged in Atenas since June, the Atenas Municipality declared a state of emergency in the town last week that will last until the situation is stabilized, according to Federico Moreira, director of the local Health Ministry division.In Jacó, approximately 1,100 cases have been reported since the beginning of the year, including one case of hemorrhagic dengue fever, a more severe form of the disease, according to doctor Christian Esquivel from Jacó’s public health clinic.THE symptoms of dengue include a sudden fever of more than 38 degrees Celsius that may last anywhere from five to seven days, severe headaches, pain behind the eyes, rashes, diarrhea, vomiting and a bitter taste in the mouth. The nationwide incidence of hemorrhagic dengue – usually contracted only by patients who have already had dengue – has also risen, with eight reported cases from January through mid-July and 16 cases to date. It can include classic dengue symptoms as well as liver enlargement and circulatory failure. In severe cases, if patients enter a state of shock following a violent temperature drop, hemorrhagic dengue may result in death within 12-24 hours.The eggs of dengue mosquitoes may resist dryness for over a year, but hatch during the May-November rainy season wherever water collects.ACCORDING to María Luisa Avila, a child infectologist at the National Children’s Hospital, children are 16 times more likely to die of dengue than adults. “If a child’s mother has suffered from dengue, the child may inherit her antibodies, and if he or she contracts dengue during the first year of life, it may be hemorrhagic straight off,” she said.Solano, from the Health Ministry, recommends that parents take children to the doctor as soon as they exhibit dengue symptoms, because once they enter a state of shock, it may be too late.HEALTH authorities are calling for a change of attitude in the population, urging citizens to join in the effort to combat the disease, which has not induced death in Costa Rica since 1999, when two people died.“People are not responding. Dengue is a disaster we are all responsible for,” said Solano, referring to standing water people allow to collect inside and outside their homes.Quirós, stationed in Santa Cruz, agrees.“It is not the ministry’s obligation to (clean people’s homes). We (citizens) shouldn’t have to wait until people die to take action,” he said.According to Quirós, fumigation campaigns have been organized throughout the country all year, mostly on the Atlantic coast. In July, the Health Ministry, the Santa Cruz Municipality and members of the community organized a fumigation cycle in Villareal and Tamarindo, going house to house in each town.Although they planned to fumigate the area again this week, a countrywide shortage of dengue insecticide produced a delay until next week, when another fumigation cycle could begin after more insecticide arrives.ONE way to take action is by donating blood to help the Social Security System (Caja) National Blood Bank in Zapote, east of San José, stock up for blood transfusions in case hemorrhagic dengue continues to spread. For information on how to donate blood or to have the bank visit your company for corporate blood donations, call 280-9875 or 283-7321.Steps to Avoid Dengue The Tico Times published the following tips in our July 15 issue: •Use a mosquito repellent containing DEET. Generally, concentrations of up to 50% DEET give long-lasting protection.•Eliminate potential breeding pools, meaning any standing water in or around your house, daily. Check and drain gutters, planters, yard furniture or outdoor toys. Change pet bowl or flower vase water daily, and flush unused toilets.•Look around your neighborhood for standing water in gutters, barrels, or empty lots, and clear it out.•While the Aedes aegypti mosquito bites at all hours, take special care at night when visiting coastal areas. Use mosquito nets, or stay in rooms with air conditioning and keep windows shut.Source: U.S. Embassy in San José.