RMI dengue cases keep rising

Majuro Atoll Local Government heavy equipment has been in action around the capital clearing and cleaning areas to reduce mosquito breeding locations. Photo: Russell Langrine.


In response to the first laboratory-confirmed case of dengue fever in Majuro last Friday, the Ministry of Health and Human Services late Friday curtailed passenger travel to remote outer islands.

The government is attempting to prevent the spread of the virus to outer islands by halting air and ship passenger travel. “The goal of this advisory is to halt dengue fever transmission to the outer atolls/islands because of the limited resources available in their local health centers,” said Secretary of Health Jack Niedenthal in the travel advisory issued Friday. “These health centers are not equipped in any way to manage severe dengue cases.”

The number of confirmed and suspected cases reached 202 at Ebeye by August 27, and 46 suspected cases were reported in Majuro as the outbreak continued to multiply.

In early August, following a declaration of a national health emergency by President Hilda Heine, the ministry restricted travel from Ebeye to the outer islands. Now, with the spread to the capital atoll, the ministry has added Majuro to the outer island travel ban.

Before the Majuro travel ban was announced late Friday, the plan went through a process of review and approval that included the Ministry of Health’s Senior Leadership Team, the Public Health EPINET emergency response team, and the government’s National Disaster Committee, which includes membership from most government ministries and agencies. With all these entities supporting the measure, Niedenthal said he signed the order.

“All passenger air travel to the outer islands is now fully restricted,” said the new advisory. Outer island vessels conducting copra pickups and food deliveries are allowed to maintain service with numerous conditions, including that they take no passengers, ensure the vessels are fumigated 24-hours prior to departure, and crew members are screened by health authorities prior to departure.

The passenger air travel ban will virtually ground the national carrier Air Marshall Islands.

Health authorities are particularly worried about island residents getting re-infected with dengue because a 2011 outbreak resulted in over 1,600 cases of Type 4 dengue through the country. The Ministry of Health reported this week that one of the 95 Ebeye dengue patients who were treated in the hospital was “evacuated out of country” for treatment of dengue hemorrhagic fever — internal bleeding that occurs in severe dengue cases, including those who are infected a second time.

There have been no deaths to date.

“The Marshall Islands experienced one of the largest dengue outbreaks in history in 2011,” said the ministry. The current outbreak is dengue Type 3, the same strain now spreading in Palau, Yap, FSM, and the Philippines.

Health authorities issued a caution for people who were previously infected with dengue: “A past exposure to Dengue Type 4 and a re-infection by Dengue Type 3 can cause severe complications of excessive bleeding that could even lead to death.”

Read more about this in the August 30, 2019 edition of the Marshall Islands Journal.