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Viewing cable 07RANGOON810, DENGUE: A GROWING PROBLEM IN BURMA

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Reference ID Created Released Classification Origin
07RANGOON810 2007-08-29 09:07 2011-08-25 00:00 UNCLASSIFIED//FOR OFFICIAL USE ONLY Embassy Rangoon
VZCZCXRO2895
RR RUEHCHI RUEHDT RUEHHM RUEHLN RUEHMA RUEHNH RUEHPB RUEHPOD
DE RUEHGO #0810/01 2410907
ZNR UUUUU ZZH
R 290907Z AUG 07
FM AMEMBASSY RANGOON
TO RUEHC/SECSTATE WASHDC 6422
RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE COLLECTIVE
RUEHBJ/AMEMBASSY BEIJING 1499
RUEHBY/AMEMBASSY CANBERRA 0461
RUEHKA/AMEMBASSY DHAKA 4587
RUEHLO/AMEMBASSY LONDON 1983
RUEHNE/AMEMBASSY NEW DELHI 3996
RUEHUL/AMEMBASSY SEOUL 7551
RUEHTC/AMEMBASSY THE HAGUE 0645
RUEHKO/AMEMBASSY TOKYO 5107
RUEHRO/AMEMBASSY ROME 0137
RUEHFR/AMEMBASSY PARIS 0550
RUEHCN/AMCONSUL CHENGDU 1173
RUEHCHI/AMCONSUL CHIANG MAI 1054
RUEHCI/AMCONSUL KOLKATA 0036
RUEAUSA/DEPT OF HHS WASHDC
RHHMUNA/CDR USPACOM HONOLULU HI
RUEHPH/CDC ATLANTA GA
RUCLRFA/USDA WASHDC
RUEHRC/USDA FAS WASHDC
RHEHNSC/NSC WASHDC
RUCNDT/USMISSION USUN NEW YORK 0902
RUEKJCS/SECDEF WASHDC
RUEHBS/USEU BRUSSELS
RUEKJCS/JOINT STAFF WASHDC
UNCLAS SECTION 01 OF 04 RANGOON 000810 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
DEPT FOR EAP/EX; EAP/MLS; EAP/EP; EAP/PD 
DEPT FOR OES/STC/MGOLDBERG AND PBATES; OES/PCI/ASTEWART; 
OES/IHA/DSINGER AND NCOMELLA 
DEPT FOR CA/OCS/ACS/EAP 
DEPT PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL 
CDC ATLANTA FOR COGH SDOWELL and NCID/IB AMOEN 
HHS/OGHA/WSTEIGER AND MSTLOUIS 
USDA FOR OSEC AND APHIS 
USDA FOR FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG 
USDA/FAS FOR FAA/YOUNG, MOLSTAD, ICD/PETTRIE, ROSENBLUM 
DOD FOR OSD/ISA/AP FOR LEW STERN 
PARIS FOR FAS/AG MINISTER COUNSELOR/OIE 
ROME FOR FAO 
BANGKOK FOR REO OFFICE 
PACOM FOR FPA 
 
E.O. 12958:N/A 
TAGS: TBIO EAID SOCI PGOV AMED AMGT CASC ECON BM
SUBJECT: DENGUE: A GROWING PROBLEM IN BURMA 
 
REF:  BANGKOK 4603 
 
RANGOON 00000810  001.2 OF 004 
 
 
1. (SBU) Summary.  Dengue fever is a growing concern in Burma, with 
more than 9,500 reported cases and 117 deaths due to dengue in the 
first seven months of 2007.  The number of cases reported, however, 
may not reflect the real situation, as the World Health Organization 
(WHO) believes that non-symptomatic or mild cases go unreported, and 
some of the reported cases may not actually be dengue.  WHO 
continues to work with the Ministry of Health (MOH) to improve 
diagnosis of dengue cases and ensure that health officials have the 
equipment necessary to treat the disease.  The under-funded Ministry 
of Health cannot afford to use insecticide to kill mosquitoes, and 
instead mobilizes local communities to help destroy mosquito 
breeding grounds and control the spread of the disease.  End 
Summary. 
 
Dengue:  The Facts 
------------------ 
 
2.  (SBU)  We met with Dr. Leonard Ortega, World Health Organization 
(WHO) Medical Advisor for Malaria and other Mosquito Borne Diseases, 
on August 23 to discuss the current dengue situation in Burma.  The 
dengue virus, Dr. Ortega noted, can be transmitted throughout the 
year, but is more prevalent during the rainy season (May-October). 
Additionally, as the dengue mosquito tends to breed in urban areas, 
cities rather than rural areas are more affected.  There are four 
strains of dengue; in 2007, the Type 3 strain is most prevalent. 
Dengue experts consider the Type 2 strain to be the most deadly -- 
this is the strain that medical experts found in 2001 and 2005, when 
the most dengue-related deaths occurred (see chart below).  A 
cyclical disease, dengue has a higher death rate every 2-3 years. 
The WHO, Dr. Ortega verified, believes that the rate of 
dengue-related deaths in Burma will increase dramatically compared 
to last year's figures, possibly exceeding 2001 levels. 
 
Outbreaks in Burma 
------------------ 
 
3.  (SBU)  According to the Ministry of Health and WHO, as of August 
11, there have been more than 9,500 reported dengue cases and 117 
dengue-related deaths.  The Ministry of Health claims that through 
July 2007, Burma has experienced a 29 percent increase in dengue 
cases compared to the same period in 2005.  Dr. Ortega, however, is 
not as quick to cite these statistics.  Instead, he explained that 
while the number of reported cases has increased compared to recent 
years, not all cases may actually be dengue.  Mothers, concerned 
about the dengue virus, are quick to take their children to the 
hospital at the first sign of fever and chills, he clarified.  Some 
of these cases, which may be the flu rather than dengue, are 
 
RANGOON 00000810  002.2 OF 004 
 
 
reported as early-onset dengue, which distorts dengue statistics. 
 
--------------------------------------------- --------- 
       Reported Dengue Cases and Deaths in Burma 
                      2000-2007* 
--------------------------------------------- --------- 
Year     Cases   Percent   Deaths   Percent  Mortality 
                 Change             Change   Rate 
--------------------------------------------- --------- 
2000    1,884      --       16         --     0.85 
2001   15,629     129.6    204      1175.0    1.33 
2002   16,047       2.7    171     -  16.2    1.06 
2003    7,117    - 55.6     81     -  52.6    1.13 
2004    7,207       1.3     85         4.9    1.18 
2005   17,360     140.9    170       100.0    0.98 
2006   11,383    - 34.4    128        24.7    1.12 
2007*   9,578              117                1.22 
--------------------------------------------- --------- 
*Through August 11, 2007 
Source:  Ministry of Health, World Health Organization 
 
4.  (SBU)  At the same time, Dr. Ortega is certain that there are 
more cases of dengue, either non-symptomatic or mild cases, that go 
unreported annually.  People who contract a mild dengue virus often 
do not seek medical treatment; because the Ministry of Health 
obtains dengue figures from medical practitioners, these cases are 
not included in overall statistics.  Thus, he explained, the overall 
number of dengue cases may actually be higher than reported. 
 
5.  (U) Although the number of dengue cases in Burma is on the rise, 
the mortality rate continues to hover around one percent.  Dr. 
Ortega, emphasizing that the number of dengue-related deaths 
reported is accurate, does not believe that the mortality rate will 
increase.  The WHO attributes the mortality rate to a variety of 
factors, including high awareness among the Burmese about the 
disease and better case management by the Ministry of Health and 
local doctors. 
 
6.  (SBU) In previous years, Mon State and Rangoon and Mandalay 
Divisions, sites of three of Burma's largest cities, were home to 90 
percent of Burma's dengue outbreaks, with an average of 50 percent 
of cases occurring in Rangoon Division.  This year, Dr. Ortega 
observed, the majority of cases have been reported in Mon State, 
Rangoon, and Irrawaddy Divisions, with 2,152, 2,053 and 1,697 cases 
respectively.  Of the 117 deaths in 2007, 88 have occurred in these 
three areas.  Dr. Ortega noted that MOH officials expect a dengue 
outbreak in Mandalay Division in September and October due to 
predicted heavy rains.   To prepare for this outbreak, MOH and 
Mandalay authorities, working with the WHO, continue to educate the 
 
RANGOON 00000810  003.2 OF 004 
 
 
local population about dengue and mobilize community support to 
prevent the spread of the disease. 
 
GOB Response to Dengue 
---------------------- 
 
7.  (SBU) Because of severe budget constraints, the MOH is working 
with local and international NGOs to address the growing threat of 
dengue.  The WHO estimates that the GOB has allocated less than 
$5,000 for dengue prevention and treatment in 2007.  Prioritizing 
its response to dengue, MOH officials have focused their efforts on 
ensuring that health clinics and hospitals have the necessary 
equipment to treat dengue, including IV fluids, blood for 
transfusions, and plasma expanders.  Dr. Ortega also highlighted 
that the MOH continues its nation-wide education campaign to teach 
the population how to avoid catching dengue, as well as how to spot 
and treat the disease.  The MOH is also mobilizing communities to 
assist in destroying mosquito breeding grounds, such as open jars, 
flower pots, and coconut shells.  The biggest challenge, Dr. Ortega 
opined, is how to encourage communities to take a proactive, rather 
than reactive, approach to dengue.  Only with community 
participation in destroying breeding grounds will the GOB be able to 
effectively control the spread of dengue, he asserted. 
 
8.  (SBU)  Although the GOB has taken steps to address the dengue 
outbreak, only with NGO assistance will the GOB be able to truly 
address the problem, Dr. Ortega noted.  Like many Southeast Asian 
countries, the GOB cannot afford the insecticides needed to kill 
mosquitoes.  While the MOH does sporadic fogging in priority areas, 
it does so once or twice a season, rather than 3-4 times a month. 
Additionally, the GOB continues to request from international NGOs 
key medical supplies, including rapid diagnostic tests, blood bags 
for donations and IV fluids.  While the WHO and UNICEF have provided 
more than 4,000 rapid tests and blood bags this year, the GOB 
continues to lack the medical supplies necessary to treat dengue. 
 
Comment 
------- 
 
9.  (SBU) Although tens of thousands of children could contract 
dengue fever this year, the GOB allocates less than $5,000 for 
dengue prevention and control, despite receiving $2 billion in 
revenues from oil and gas exports.  Instead, they apportion an 
overwhelming majority of the GOB budget for the defense and 
maintenance of the regime rather than for basic social services. 
Their refusal to fund the most basic health services shows where the 
Burmese Government's priorities lie: maintaining the good life for 
senior generals, regardless of the cost to the people. 
 
 
RANGOON 00000810  004.2 OF 004 
 
 
 
VILLAROSA