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.
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[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]
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[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>]
Date: Tue 31 Jul 2018
Source: elCaribe [in Spanish, machine trans., edited]
<https://www.elcaribe.com.do/2018/07/31/boletin-registra-33-casos-de-malaria-en-santo-domingo-oeste/>

The Santo Domingo Oeste municipality [Dominican Republic] has registered 66 percent of all malaria cases registered in the country so far this year [2018], according to the most recent epidemiological bulletin. In the week [8-14 Jul 2018], 8 cases were detected confirmed, of which, 7 are indigenous and one imported, this one a 35-year-old Venezuelan man in whom _Plasmodium vivax_ was detected.

The indigenous cases come from the transmission focus in the La Cienaga neighbourhood in Santo Domingo Oeste. During the last 4 weeks, 50 cases have been confirmed, of which 33 reside in the Santo Domingo Oeste municipality, for a total of 190 cases accumulated up to week 28 [week of 8 Jul 2018]. The highest frequency and accumulated incidence rate is registered in the Santo Domingo province.

Malaria is transmitted through the bite of anopheline mosquitoes infected, and cause high fevers, chills, flu-like symptoms, and anaemia. The health authorities consider that the resurgence of cases is related to the rains caused by the remnants of the storm Tropical Beryl [9 Jul 2018], which left the most rainfall in the District National, Santo Domingo, and San Cristobal.

In this regard, it is recommended to strengthen surveillance to detect outbreaks in these 3 territories. [Byline: Mar­a Teresa Morel]
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[Autochthonous malaria transmission has been described regularly in the Dominican Republic over the past 15 years.  The main explanation is that people with malaria from Haiti visit and work in the Dominican Republic, initiating local transmission. This has also resulted in visitors from North America and Europe returning with malaria from tourist resorts in the Dominican Republic.

The CDC recommends malaria chemoprophylaxis to the province of Santo Domingo
(<https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/yellow-fever-malaria-information-by-country/dominican-republic#seldyfm879>). - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Santo Domingo Oeste, Dominican Republic:
<http://healthmap.org/promed/p/40654>]
Date: Wed 21 Mar 2018
Source: CDN [in Spanish, trans. ProMED Sr.Tech.Ed.MJ, edited]
<http://www.cdn.com.do/2018/03/21/brote-difteria-haiti-alerta-autoridades-dominicanas-salud-publica-frontera-dajabon/>

Given the recent cases in Haiti of the dangerous acute infectious disease known as diphtheria, which has claimed the lives of several people in that nation, the Dominican Ministry of Public Health is carrying out a prevention campaign in the border area of [Dajabon] province. The ministry alerted the population about the existence of the contagious disease in the neighbouring country through the Provincial Directorate of Health in Dajabon.

The director of health in Dajabon, Percio Jiménez, confirmed that several deaths due to diphtheria have already been recorded in Haiti and added that, because of this, the Dominican authorities have initiated preventive operations in an attempt to prevent the disease from entering the Dominican territory again.

Diphtheria is an infectious disease that affects the respiratory, digestive, and other systems. It [affects the mucous membranes of the throat and nose] and is transmitted from person to person. Public Health said [on Wed 21 Mar 2018] that it has kept diphtheria under control through an immunization program with coverage of 85 per cent of the population, and that since 2014 cases have declined consistently. The director of the Expanded Program on Immunization, Zacarías Garib Arbaje, said that only one case was reported in 2015, 3 in 2016, and one in 2017. [byline: Ramón Medina, Elixandra Encarnación]
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[The Dominican Republic, with a population of about 10 million residents, occupies the eastern two thirds of the island of Hispaniola, in the Greater Antilles archipelago in the Caribbean region; the western third of Hispaniola is occupied by the country of Haiti (<https://en.wikipedia.org/wiki/Dominican_Republic>).

Dajabón, with a population of 42,661 residents, is a province located in the north western part of the Dominican Republic on the border with Haiti (<https://en.wikipedia.org/wiki/Dajabón_Province>). A map that shows the location of Dajabon province can be found at <https://www.google.com/maps/place/Dajabón+Province,+Dominican+Republic>.

A map of Haiti that shows the location of its provinces can be found at <http://www.nationsonline.org/oneworld/map/haiti_map.htm>. The Haitian province of Nord-Est abuts Dajabon province in the Dominican Republic. The other Haitian provinces that abut the Dominican Republic are Centre, Ouest, and Sud-Est.

The Pan American Health organization reports (<https://reliefweb.int/report/venezuela-bolivarian-republic/epidemiological-update-diphtheria-28-february-2018>):
"In 2017, there were 4 countries in the Region of the Americas -- Brazil, the Dominican Republic, Haiti, and the Bolivarian Republic of Venezuela -- that reported confirmed diphtheria cases. As of epidemiological week (EW) 8 of 2018, 4 countries in the Region--Brazil, Colombia, Haiti, and Venezuela -- have reported suspected and confirmed diphtheria cases.

"Following is a summary of the situation in each country with reported suspected and confirmed cases in 2018. "In Haiti, since the beginning of the outbreak at the end of 2014 up to EW 6 of 2018, there have been 410 probable cases of diphtheria reported, including 75 deaths. Reported case fatality rates were 22.3 per cent in 2015, 27 per cent in 2016 and 10.7 per cent in 2017 and 2018.

During the 1st 4 epidemiological weeks of 2018, 2 to 5 probable cases per EW were reported similar to that observed during the last 4 weeks of 2017. "Females accounted for 57 per cent of the total probable cases in 2015, 50 per cent in 2016, 60 per cent in 2017, and 47 per cent in 2018 (up to EW 6). With respect to vaccination coverage, between 2015 and 2018 the unvaccinated cases accounted for 17 per cent (2018) to 38 per cent (2015) of the total cases.

Children less than 10 years of age accounted for 64 per cent of the probable cases reported between 2017 to EW 4 of 2018. "Since the beginning of the outbreak the departments reporting the highest number of probable cases are Artibonite, Centre, and Ouest."

PAHO reported in 2017 for the Dominican Republic (<https://reliefweb.int/sites/reliefweb.int/files/resources/2017-dec-15-phe-epi-update-diphtheria.pdf>):
"In the Dominican Republic, there were 3 confirmed diphtheria cases reported in the last diphtheria epidemiological update of 15 November 2017; however, the Ministry of Public Health and Social Assistance has since reported that only one was confirmed for diphtheria as the other 2 cases were discarded by clinical criteria (1) and by laboratory (1). No fatal case was reported."

A map of Dajabon, Dajabon, Dominican Republic:
<http://healthmap.org/promed/p/15113>. - ProMED Mod.ML]
Date: Wed 13 Dec 2017
Source: 7Dias [in Spanish, machine trans. edited]
<http://www.7dias.com.do/portada/2017/12/13/i237922_suman-las-muertes-por-leptospirosis-este-ano-republica-dominicana.html#.WjKXi0ribIU>

Some 62 people have died so far this year [2017] in the Dominican Republic because of leptospirosis, 7 more than in the same period of the previous year, the Ministry of Public Health reported today [13 Dec 2017].

A report from the General Directorate of Epidemiology of the Ministry of Health stated that in the last registered epidemiological week, from 19 to 25 Nov 2017, 14 suspected cases of leptospirosis were reported, for a total of 59 cases in the last 4 weeks, including 9 deaths.

In total, up to that period, 695 cases of leptospirosis have been reported in the country, with a [case fatality rate] of 10% (62 deaths) [62 deaths out of 695 cases gives a case fatality rate of 8.9%], compared to 540 cases and 55 deaths in the same period of 2016, the report said.

Leptospirosis is an acute bacterial disease that affects both humans as animals and is acquired through contact with standing water and soils contaminated with urine from reservoir animals, such as rats and others of the canine, porcine and caprine species.
====================
[Leptospirosis in the Dominican Republic has been reported previously by ProMED-mail (see archives). In 2006, it was attributed to "sanitary problems and to deficiencies in municipal garbage collection." Inadequate disposal of trash and debris provides a suitable habitat for rat infestation in urban settings. Outbreaks of leptospirosis in the Dominican Republic, as elsewhere, has also follow heavy rainfall and the ensuing contaminated fresh water flooding.

Also, the Dominican Republic is the 2nd-largest Caribbean producer of sugarcane, the nation's most important crop (<https://en.wikipedia.org/wiki/Economy_of_the_Dominican_Republic>), and sugar cane workers may be exposed to soil and vegetation contaminated by the urine of chronically infected rats living in the cane fields. However, the news report above fails to delineate the types of exposure that placed the most recent cases at risk for leptospirosis in the Dominican Republic. - ProMED Mod.ML]

[HealthMap/ProMED-mail map:
Dominican Republic: <http://healthmap.org/promed/p/24>]
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