Date: 6 Jun 2019
Source: Washington Post [edited]
<https://www.washingtonpost.com/local/public-safety/dominican-republic-deaths-autopsies-show-similarities-for-all-three-us-victims/2019/06/06/508c179c-87ac-11e9-98c1-e945ae5db8fb_story.html?utm_term=.d51102bfb8ed&wpisrc=nl_evening&wpmm=1>

Dominican government officials released more-detailed autopsy results on Thursday [6 Jun 2019] for 3 American tourists who died at adjacent beach resorts owned by the same hotel company during the last week of May 2019.

All 3 victims experienced eerily similar symptoms and internal trauma before their deaths, according to a news release from Dominican authorities. Pathologists said autopsies showed the 3 had internal haemorrhaging, pulmonary oedema, and enlarged hearts.

Toxicology reports are pending [These are likely to be the most interesting. - ProMED Mod.TG].

A U.S. State Department official said authorities have not yet established a connection between the 30 May 2019 deaths of 49-year-old CAD, and 63-year-old NEH, both of Prince George's County, MD, and the death on 25 May 2019 of 41-year-old MSW of Pennsylvania.

The FBI is providing Dominican law enforcement with "technical assistance with the toxicology reports," the State Department official said.

MSW had just checked into the Luxury Bahia Principe Bouganville, in the town of San Pedro de Macoris, and was taking pictures from her room balcony when she started to feel ill.

Less than 2 hours later, she was dead, local authorities said.

The bodies of CAD and HEH were found inside their room at the Grand Bahia Principe La Romana after relatives grew concerned because they had not checked out of the resort.

The hotels are located next to each other on the island's southern coast, about 60 miles from the tourist-heavy Punta Cana area.

Dominican authorities initially did not run toxicology tests for MSW because there were no signs of violence, said Ramon Brito, a spokesman for the National Police's special tourism unit. After the Maryland couple was found, investigators ordered a set of tests to determine whether anything the 3 Americans consumed may have led to their deaths, Brito said.  [Byline: Arelis R. Hernandez]
Dominican Republic
18 Mar 2019

(Probable and conf.) 624 cases. Municipalities most affected: Santo Domingo Este, Santo Domingo de Guzman, Barahona, and Santo Domingo Norte.
<https://infosurhoy.com/cocoon/saii/xhtml/en_GB/health/cases-of-dengue-and-malaria-increase-in-302-and-179-in-the-first-2-months-of-the-year/>
Date: Mon 31 Dec 2018
Source: Outbreak News [edited]
<http://outbreaknewstoday.com/rabies-4th-human-death-recorded-dominican-republic-year-56961/>

A 5-year-old boy died Saturday [29 Dec 2018] in a Santo Domingo hospital from rabies, the 4th such case of the year [2018] in the Dominican Republic, according to an El Comercio report (computer translated).

The child, who entered the Robert Reid Cabral Children's Hospital 10 days ago, remained in an induced coma, and yesterday his condition began to worsen, presenting respiratory, cerebral, and cardiac failures, according to a hospital spokesman.

The boy was bitten by a dog on 19 Nov 2018 in Pedernales, in the southwest of the Dominican Republic, and 10 days later he was subjected to an anti-rabies vaccination scheme, receiving 4 doses.

This death follows a 6-year-old child who died on 14 Dec 2018.
====================
[We do not know what kind of wound care this child received prior to getting the post exposure prophylaxis (PEP). Neither does this article tell us the location of the bite on the body. This article also does not mention rabies immunoglobulin (RIG).

We are sorry for the family and the loss of this child. Sadly, this is an example of the urgency and necessity to get medical attention very quickly.

According to the US Center for Disease Control (CDC),

- The rabies virus is transmitted through saliva or brain/nervous system tissue. You can only get rabies by coming in contact with these specific bodily excretions and tissues.

- It's important to remember that rabies is a medical urgency but not an emergency. Decisions should not be delayed.

- Wash any wounds immediately. One of the most effective ways to decrease the chance for infection is to wash the wound thoroughly with soap and water.

- See your doctor for attention for any trauma due to an animal attack before considering the need for rabies vaccination.

- Your doctor, possibly in consultation with your state or local health department, will decide if you need a rabies vaccination. Decisions to start vaccination, known as post exposure prophylaxis (PEP), will be based on your type of exposure and the animal you were exposed to, as well as laboratory and surveillance information for the geographic area where the exposure occurred.

- In the USA, post exposure prophylaxis consists of a regimen of one dose of immune globulin and 4 doses of rabies vaccine over a 14-day period. Rabies immune globulin and the 1st dose of rabies vaccine should be given by your healthcare provider as soon as possible after exposure. Additional doses or rabies vaccine should be given on days 3, 7, and 14 after the 1st vaccination. Current vaccines are relatively painless and are given in your arm, like a flu or tetanus vaccine (<https://www.cdc.gov/rabies/exposure/index.html>). - ProMED Mod.TG]

[HealthMap/ProMED-mail map:
Pedernales, Pedernales, Dominican Republic:
<http://healthmap.org/promed/p/2198>]
Date: Sat 1 Dec 2018
Sources:  <http://outbreaknewstoday.com/dominican-republic-reports-increase-malaria-45684/>

Health officials in the Dominican Republic are reporting an increase in malaria cases in 2018.

According to a Diario Salud report [computer translated], 438 cases have been reported year to date compared to just 360 during the same period in 2017.

92 percent of the malaria cases were due to _Plasmodium falciparum_ and the remainder were _P. vivax_ or mixed infections.

One death has been reported.

In the last month, 31 cases of malaria have been reported, of these, 27 are indigenous and 4 are imported, 3 from Venezuela and one from Guyana.
========================
[Autochthonous malaria has been reported from the Dominican Republic over the past 15 years, documented especially by malaria in returning visitors. The main problem is the proximity to Haiti, where malaria is endemic, and asymptomatic carriers from Haiti start local transmission in the Dominican Republic. One solution could be screening upon arrival, or if that is not possible, a course of treatment for instance with artemether/lumefantrine upon arrival, ending with a single dose of primaquine to inactivate gametocytes, as recommended by WHO (Policy brief on single-dose primaquine as a gametocytocide in _Plasmodium falciparum_ malaria. WHO, Geneva January 2015; <https://www.who.int/malaria/publications/atoz/policy-brief-single-dose-primaquine-pf/en/>). - ProMED Mod.EP]

[HealthMap/ProMED map available at:
Dominican Republic: <http://healthmap.org/promed/p/24>]
Date: Sun 16 Sep 2018
Source: Listin Diario, Republica Dominicana [in Spanish, trans. ProMED Mod.MPP, edited]
<https://listindiario.com/la-republica/2018/09/16/533361/sistema-capta-63-casos-de-malaria-en-las-ultimas-cuatro-semanas>

At least 63 confirmed cases of malaria have been reported through the surveillance system in the last 4 weeks, with 75% corresponding to the localized focus in the neighbourhoods of Santa Domingo West.

Until the beginning of September 2018, 294 cases were reported in the entire country, with the neighbourhoods of La Cienaga, Hato Nuevo, Caballona, and Manoguayabo, in Santo Domingo Oeste, and Las Mercedes in Los Alcarrizos presenting the highest incidence of this febrile disease, transmitted by the bite of the _Anopheles_ mosquito, which breeds in standing and dirty water, especially where there is vegetation.

In the past week, the surveillance system detected 25 confirmed cases, all autochthonous, including 17 men and 8 women with ages ranging from 13 to 62 years, according to the data contained in the epidemiologic bulletin for week 35.  [Communicated by:  Jaime R. Torres torresj@email.com]
=======================
[This is a large outbreak of introduced malaria with an increasing number of local cases. It is important to apply vector control and early case detection and treatment. Treatment should include a single dose of primaquine to block transmission.

An outbreak of introduced _Plasmodium vivax_ malaria in Greece in 2011 to 2012 was terminated by applying mass drug administration to the migrant worker population from _P. vivax_ endemic countries (Tseroni M, Baka A, Kapizioni C, et al. Prevention of malaria resurgence in Greece through the association of mass drug administration (MDA) to immigrants from malaria-endemic regions and standard control measures. PLoS Negl Trop Dis. 2015; 9(11): e0004215. doi: 10.1371/journal.pntd.0004215;  <https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004215>).

The malaria in this outbreak is almost certainly introduced by migrants from Haiti, and a mass drug administration program similar to the program used in Greece would eliminate a reservoir of malaria in semi-immune and asymptomatic individuals. - ProMed Mod.EP]

[HealthMap/ProMED map available at:
Santo Domingo, Distrito Nacional, Dominican Republic:
<http://healthmap.org/promed/p/4842>]
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