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Infectious Diseases Posing the Greatest Epidemiological Risk
Following Hurricane Mitch in Central America
7 December 1998

A Report of the PAHO Emergency Task Force on Hurricane Mitch Prepared by the Division of Disease Prevention and Control

The following summary is based on information received from the Ministries of Health of the Central American countries affected by Hurricane Mitch. It contrasts the pre- Mitch period (1 January-30 October 1998) and the post-Mitch period (November 1998, which includes Epidemiological Weeks 44-47).


Guatemala is the most affected. The country has reported suspected and confirmed cases of cholera during all of 1998. From 1 January through 30 October, 2,530 cases were reported. Of these, 1,174 were from October (before Mitch). The weekly average in this period was 59.

 Beginning in November, the problem of cholera increased notably, and during the four-week period 395, 530, 450 and 566 cases respectively were reported. A total of 1,941 cases were reported in November, a weekly average of 485. Of the 1,941 cases in November, 383 were confirmed (19.4%). Through 2 December, the Ministry of Public Health reported a total of 38 outbreaks and 33 deaths due to cholera. The source of infection in almost all outbreaks was contaminated food.

Nicaragua was the second most affected country, where like Guatemala, cholera had been reported during all of 1998. Through 30 October 1998, 675 cases had been reported; a weekly average of 16 cases. In the post-Mitch period (November), 84, 170, 87, and 39 cases were reported for Epidemiological Weeks 44-47 respectively. The weekly average following Mitch was 95 cases. As in Guatemala but to a lesser degree, there was an increase in the number of reported cases following Mitch. Contaminated food was also sited as the principal source of infection.

In other Central American countries affected by Mitch, Belize reported sporadic cases of cholera in 1998; a total of 12 cases through 30 October. Following Mitch, six cases and one death occurred from an outbreak in Saint Martin Village in the Cayo District. The source of infection in this outbreak was drinking water contaminated with the cholera virus.

In Honduras through 30 October, no cases of cholera were reported. Following Mitch, the Ministry of Health reported 18 suspected cases but only one of these was bacteriologically confirmed.

Similarly, in El Salvador, no cases of cholera had been reported during the first ten months of 1998. Following Mitch, and as a result of cases "imported" from Guatemala, eight cases were confirmed. The Ministry of Health recently reported that the one death was not caused by cholera.


In the pre-Mitch period, none of the five countries affected by the hurricane had reported suspected cases of this disease. Beginning in November, there were still no notifications, although some suspected cases were reported in Guatemala, Honduras, El Salvador and Belize. A very different situation occurred in Nicaragua, where epidemic outbreaks were reported in several regions. The most affected were Chinandega and Esteli. During November, a noticeable weekly increase in the number of reported cases occurred, with 450 cases reported in the four-week period (one in Week 44; 56 in Week 45; 161 in Week 46; and 232 in Week 47). During November, seven deaths were reported, a case fatality rate of 1.5%.


Through the end of October 1998, the countries of Central America had reported 34,166 cases of dengue and hemorrhagic dengue to PAHO. Honduras and Nicaragua reported 80% of the cases (51% and 29% respectively). These countries also had the highest rates per 100,000 inhabitants.

With the exception of Guatemala, which reported a moderate increase in the number of cases of dengue in the post-Mitch period, there was no evident increase in epidemic outbreaks in the other countries. However, this disease must remain under close surveillance.

In El Salvador, no noticeable increase was reported in the four-week period of November.

Guatemala reported 277 cases in Week 45, an increase of almost 200 cases over the previous week.

The Ministry of Health of Nicaragua reported an increase in reports of cases in the last two weeks, Weeks 46 and 47.

In Honduras, the Ministry of Health reported that through 4 December, 1,080 cases of classic dengue were reported. Of the 33 suspected cases of hemorrhagic dengue, 15 were confirmed and the rest are under analysis. The four deaths reported occurred before the hurricane.

There were no increased reports from Belize.


In comparison with the reported number of cases in the first ten months of 1998, the situation as reported by the five countries for the month of November does not show a great change in terms of the number of cases reported. This does not mean that the situation could not change in the near future, with the affected countries reporting an increase in cases.


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