CONTINUITY: Bi-weekly press briefing - 22 December 2023
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Press Conferences | WHO

Bi-weekly press briefing - 22 December 2023

PRESS BRIEFING BY THE UNITED NATIONS INFORMATION SERVICE

22 December 2023

Global Dengue Situation

Dr. Diana Rojas Alvarez, Team Lead on Arboviruses, Epidemic and Pandemic Preparedness and Prevention Department, World Health Organization (WHO) Emergencies Programme, said dengue was the most common viral infection transmitted to humans through the bite of infected mosquitoes and was mostly found in urban areas within tropical and sub-tropical climates worldwide. However, because infected mosquitos could thrive in more countries because of increasing temperatures due to climate change, many more countries had been reporting cases this year.

About four billion people were at risk of becoming infected with the dengue virus. Most people who contracted dengue did not have symptoms. But for those who did, the most common symptoms were high fever, headache, body aches, nausea and rash. Most recovered in one to two weeks, but some could progress to severe illness. 

There was currently no specific treatment for dengue or severe dengue, but early detection and access to proper medical care lowered the probability of death due to severe dengue.

Since the beginning of this year, over five million cases and 5,000 deaths of dengue had been reported worldwide. So far in 2023, close to 80 per cent of the dengue cases, or 4.1 million, had been reported in the Americas, followed by South-East Asia and the Western Pacific.

The distribution of the mosquitoes had changed in the last few years due to several social and environmental factors and in 2023, El Nino phenomena had resulted in increased detection of dengue in previously dengue-free countries.

It was also concerning that dengue outbreaks were occurring in fragile and conflict-affected countries of the Eastern Mediterranean region such as Afghanistan, Pakistan, Sudan, Somalia and Yemen. These countries were facing simultaneously outbreaks of infectious diseases, mass population movements, poor water and sanitation infrastructure and recurring natural disasters. This was also the case in the African region, where evidence of dengue circulation had been detected in local populations and among travellers returning from more than 30 African countries.

Dengue was not endemic in Europe and the majority of cases were usually travel-related, yet this year, limited clusters of autochthonous dengue had also been reported in Italy, France and Spain.

Considering all these factors, WHO assessed the risk of dengue as high globally, which required maximal attention and response from all the levels of the organization. WHO would support countries around the world controlling the current outbreaks and prepare countries to respond to the upcoming dengue season. WHO was currently actively supporting the countries to plan and implement priority multisectoral interventions to control the spread of dengue. These interventions included strengthening surveillance and reporting of cases; conducting risk stratification of countries to prioritise actions; providing support through global expert networks; updating guidance and training for clinical management; strengthening environmental and mosquito surveillance to guide vector control activities and reduce the density of mosquitos; and reinforcing risk communications and community engagement.

WHO was leading the Global Arbovirus Initiative, an integrated strategic plan to tackle emerging and re-emerging arboviruses with epidemic and pandemic potential. The initiative focused on monitoring risk, pandemic prevention, preparedness, detection and response, and building a coalition of partners. 

Countries, partners and the international community needed to work together, be alert and prepared to detect transmission of dengue and other mosquito borne diseases such as Zika and Chikungunya in tropical areas globally and especially the southern hemisphere, where the dengue season was about to start. The general population could lower their risk of dengue by using mosquito repellent to prevent mosquito bites, especially during the day, and eliminating mosquito breeding sites in and around homes.

In response to questions, Dr. Rojas Alvarez said that in the African region, 170,000 cases had been reported this year and about 700 people passed away due to dengue. There had been 15 countries in Africa with reported outbreaks, including Benin, Capo Verde, Chad, Côte d'Ivoire, Ethiopia, Ghana, Guinea, Mali, Nigeria, but Burkina Faso was the most affected, with almost 150,000 cases. Africa had experience with battling mosquito borne diseases such as malaria, but the mosquito that transmitted dengue behaved differently to the one that transmitted malaria, so some methods used to control malaria were not effective in controlling dengue.

An integrated approach using both insecticides and larvicides in water sources was effective in controlling dengue. Mosquitoes lived in any containers that had clean water. Communities needed to be aware of where mosquitos bred and reduce such areas. There were many measures that could be taken to prevent further spread.

In the Americas, the largest number of cases were reported in Brazil, Peru and Mexico, whereas the highest percentages of cases were reported in Caribbean islands. Usually for dengue control, house-to-house visits were conducted by public health officers, who checked for reservoirs where mosquitoes could breed. Such checks could not be carried out during the COVID-19 pandemic. Reduced health care services had impacted the response to several infectious diseases during the pandemic. However, diagnosis techniques developed during the pandemic could be used to better identify dengue cases.

During 2023, Italy reported 82 cases, France 43 and Spain three cases of dengue. This year, there were limited cases of autochthonous transmission, that is, transmission from local mosquitoes, in Europe. This was due to summers getting hotter. The aedes aegypti breed of mosquito that transmitted the virus was established in many areas including Cyprus, Madeira and other regions of Portugal since 2022. Mosquito eggs could hibernate during winter and then hatch when the temperature rose. The current winter was a golden opportunity for Europe to start controlling mosquitoes before dengue could become a real threat.

Climate change increased rainfall and humidity, which created better conditions for mosquitoes carrying the infection to breed and spread. This had led to mosquitoes becoming established in countries where they previously could not, such as in Europe, southern North America and southern areas of Latin America such as Uruguay and Buenos Aires in Argentina. They were now being seen up to 2,000 metres above sea level. Unusual rainfalls had increased mosquito densities in Bangladesh, Oman and Saudi Arabia. Countries like Colombia were seeing mosquitos for the first time in mountain areas, and previously unexposed populations were at risk. There was still a large percentage of the population in African countries like Burkina Faso that might be susceptible, so WHO was conducting prevalence surveys to understand better the real burden of dengue in the African region. This would help it develop better targeted interventions.

Mexico had been hyperendemic for dengue for a few decades. People could be infected with dengue up to four times, and the second infection might lead to severe dengue. This year, there had been almost 230,000 reported cases in Mexico, around 180 cases per 100,000 people. The Pan American Health Organization was coordinating with the WHO country office and the Ministry of Health in Mexico to address the situation with a multi-sectoral plan. Floods and hurricanes were leading to higher mosquito density and transmission.

In North America, there were cases reported in Florida and Puerto Rico, and there was a risk for introduction of dengue in other southern states of the United States, as the aedes aegypti mosquito was already present in some states such as Texas. Action needed to be taken to reduce mosquito densities and the risk of transmission in these states.

About 10 per cent of patients could develop severe symptoms such as bleeding and organ impairment, which could lead to death. Usually, severe symptoms came after fevers came down. It was important to detect warning signs such as intense abdominal pain, persistent vomiting, bleeding in the gums and in the gastrointestinal system, fluid accumulation and drowsiness. Populations needed to be aware to the symptoms and seek medical care when needed. Fluid intake was the main treatment for dengue. Proper fluid intake could prevent dengue symptoms from becoming severe.

There were about 390 million dengue infections per year. Dengue had a less than one per cent case fatality rate, but if there was an outbreak of five million cases, health facilities would become packed and it would be very difficult to provide care for patients. WHO was working to strengthen surveillance of cases to get a better view of the real burden of dengue.

 

Announcements

Alessandra Vellucci, Director of the United Nations Information Service (UNIS) in Geneva, said this was the last briefing for 2023. UNIS would continue to post updates on news from the United Nations System, and the first briefing for 2024 would be held in hybrid format on 5 January.

The United Nations Secretary-General António Guterres would hold a stakeout briefing at 12:30 p.m. New York time, at which he would address topics including the situation in the Middle East. The briefing could be watched live on UN Web TV.

Some changes were made to access to the Palais des Nations during the closure period of 20 December 2023 to 7 January 2024. During this period, the Palais was accessible from 8 a.m. to 5 p.m. through the Pregny Gate by foot, bike or car, and from 5 p.m. to 8 a.m. and on weekends and official holidays through the Nations Gate by foot (located to the right of the Peace Gate) and the Pregny Gate by car or bike.

Ms. Vellucci wished all a restful holiday period. This was not a time for celebrating as the news was so dire in many parts of the world, but she expressed hope for a brighter and more peaceful 2024.

***

The webcast for this briefing is available here: https://bit.ly/unog22122023

The audio for this briefing is available here: https://bit.ly/UNOG22122023

Teleprompter
if I come
and see.
So good morning.
Welcome to this, uh, press briefing of the information service, Uh, in Geneva.
Uh, today is Friday.
Um, the 22nd of December. We have a quite a straightforward agenda today.
Um, and I will start immediately with our colleagues of WHO. Tariq
is here with us today, and he has brought up, uh,
doctor Diana
Rojas. Alvarez was the team leader on
arbo
viruses
at
the WHO.
So Dr
Rojas or Tariq,
who would like to start? Thank you. Thank you, Alexandra Ju.
Just a quick a quick note. Before we give the flow to Dr
Rojas, we have, uh, sent uh
uh, What we call disease outbreak news or our update on, uh,
on a global dengue situation this morning.
So journalists already
got this.
Uh, this, uh this note has a detailed description of, uh,
of the current situation with dengue, but, uh,
it's it's always good to hear from our experts
and give opportunity to reporters to ask questions.
Uh, remarks, uh, made by Dr
Rojas will also be sent shortly to
to report. So it is. Um, Doctor
Rojas, please, uh,
deploys yours.
Thank you very much. Tarik and good morning, everybody.
So let me start with having a a brief description of what dengue is So.
Dengue is the most common viral infection transmitted to
humans through bite of infected mosquitoes and is mostly found
in urban areas within tropical and subtropical climates worldwide.
However,
because mosquitoes can thrive in
more countries because of increasing temperatures
due to climate change, many more countries are reporting cases.
About 4 billion people are at risk of becoming infected with dengue
virus,
but most of the people won't get any symptoms, but for those who do,
they will recover within 1 to 2 weeks.
There is currently no specific treatment for dengue
and severe dengue,
so the early detection and the access to proper medical care
will lower the probability to die due to severe dengue.
Since the beginning of this year,
over 5 million cases and about 5000 deaths
of dengue have been reported worldwide,
and close to 80% of those cases have been reported in the Americas,
followed by Southeast Asia and the Western Pacific.
The distribution of the mosquitoes that transmit dengue
and other mosquito borne viruses have changed in the last few years,
due to several social and environmental factors
and in 2023
Nino phenomenon have resulted in more detection
of dengue in previously dengue free countries.
It is also concerning that dengue
outbreaks are occurring in fragile and conflict
affected countries in the eastern Mediterranean region
such as Afghanistan,
Pakistan, Sudan, Somalia,
Yemen because these countries are facing simultaneously sorry
outbreaks
of infectious diseases, mass population movements,
pool, water and sanitation, infrastructure and recurring natural disasters.
This is also the case for the African region
where the evidence of dengue circulation has been detected in
local populations and also among travellers from about 30 African countries
in the in Europe, dengue is not endemic
and the majority of the cases are usually travel related.
But this year,
limited clusters of
atonal dengue transmission have been reported in Europe, in France,
in Italy and Spain.
So considering all these factors and this current situation, who
has assessed the risk of tender
as high globally,
which what it means is that it requires
the maximum attention and response from all levels
of the organisation to support countries around the world,
controlling the current dengue outbreaks and also preparing for
the countries to respond to the upcoming dengue season.
WHO is currently actively supporting the countries
to plan and implement priority multisectoral interventions because this
is a complex disease that requires a multisectoral approach
to control the spread of dengue
through strengthening surveillance of cases or strengthening their reporting
and an early reporting of detection and reporting of
cases conducting a certification of countries to be able
to prioritise the actions where the transmission is occurring.
Providing support through our global expert networks,
we are updating guidance and also supporting training for
clinical early detection and clinical management of dengue cases.
Strengthening environmental and mosquito surveillance to guide vector
control and reducing the densities of these mosquitoes.
Reinforcing risk communications and also engaging the
community will play a very important role
in dengue control.
WHO is also leading the Global Arbovirus Initiative,
which is an integrated strategic plan to tackle emerging and re emerging arbo
viruses with epidemic and pandemic potential. Well, dengue is part of
so for
advice for the country's partners in the community.
Let's all work together, be alert and prepared to detect transmission of dengue
and other mosquito borne viruses such as Zika chikungunya,
which are transmitted by the same mosquito on tropical areas,
uh, globally.
And now, especially in the southern Hemisphere,
where the summer is starting and the dengue seasons are also about to start.
And for the general population,
you can lower your risk and your family's risk of
dengue by avoiding mosquito bites by using mosquito repellent,
especially during the day, because these mosquitoes bite mostly during the day
and supporting the communities to reduce
the risk by eliminating the mosquito breeding sites in and around the homes.
So that's it from my side. Happy to answer any questions over to you, Tarek.
Thank you very much. Uh, doctor, And, uh uh, I see there are, um, in the chats,
um, and and Tariq has answered about your note. So,
um, let's see who would like to ask.
The first question is from Peter Kenny, our correspondent of all Africa media.
Peter, you have the floor.
Yeah. Thanks for the briefing,
Rogers.
I was just wondering,
uh, could you elaborate on the African countries that are affected, uh, by dengue?
And also,
uh, is the rise of dengue?
Can this be partly attributable to the
non use of the former deadly pesticides that we use to eliminate mosquitoes.
Thank you very much for your question.
So in the African region we had about 100 and 70,000 dengue cases reported this year
and about 700 people passed away due to dengue. Uh,
there were reported outbreaks in 15 countries of the 47 of the African region,
including Benin,
Cape Verde,
Chad, Cote d'Ivoire, Ethiopia, Ghana, Guinea, Mali,
Nigeria.
But the the country that was most affected was Burkina Faso,
with almost 100 and 50,000 cases.
And
I think the African region has a lots of
experience in battling malaria and other vector borne diseases,
and
the as this is a mosquito that lives inside the house. So it it the
the
anopheles mosquito are the ones that transmit malaria.
And this is a different type of mosquito and they behave differently. So
some of the
activities that are used to tackle malaria transmission
might not be useful to tackle a dengue transmission or a A is aedes mosquito per SE,
so they but what we can
learn from what what has been used for several
decades in malaria control is the integrated approach,
because here
you need not just the infected
sites. But also
you need to control the
the water form of the mosquito,
which are the larvae and that's used with with larvae sites.
Or there are many other uh, strategies to control the larvae.
Also,
the adult mosquitoes that there are those are the
ones that usually are targeted by the insecticide,
then the community.
Because, as as these,
these mosquitoes lives inside the household in the
water pots in the flower pots in any
artificial container that has clean water. So we know where the mosquito lives.
So the community and everybody should be, uh,
putting effort in eliminating those breeding sites where so
we can we can control the mosquito densities.
So the the African region is, well, we the the real burden of disease in the region
is not really well understood.
But we are working with with partners to try to establish which is the
the set of prevalence or the level of exposure to dengue in the in the region.
So there are there are many,
many things that we can do right now to prevent
further spread and also further outbreaks in in this region.
Thank you. Over.
Thank you very much. Paula
Dupraz, uh, from Geneva. Solution.
Yes. Well, actually, I have, uh, one, couple of questions regarding dengue.
But then, uh, regarding, uh, another
issue that I was wondering, um, whether WH a could respond to
Why don't we start with dengue
so that we can ask
the doctor and then eventually I come back to you for for the other questions?
Maybe Tariq can pick them up. Go ahead.
Ok, um, first of all, uh, I'm sorry, I.
I signed in perhaps a minute or so after you started,
but just wondering what the most affected, uh, countries are, uh,
you mentioned that
80% of those cases are in the Americas.
So, uh, would you have, um, some data that you could share?
Uh, regarding, uh, the worst affected in terms of population.
And then also, uh, in terms of response, uh, just wondering,
uh, what, uh, Whether efforts to combat dengue
may have been affected by, uh, the
the the impact that, uh, health, uh,
health, the health services,
uh, were hit with, you know, regard during, um
uh, COVID-19. Whether that may affect the,
uh, the response, uh, to, uh, dengue to this outbreak,
Doctor,
thank you very much for your questions. So the the DA
that was distributed early in the morning has very detailed
information on the on all the countries and with the
with the highest burden is
But in the in the Americas, the largest number of cases is reported from Brazil,
Peru and Mexico, which are also very highly populated areas.
And the highest incidents which are, um,
um based on the population are mostly in the
islands in the Caribbean because they have low populations.
And they also had
they had they were hit during the the second semester due to due to dengue.
the about the impact of health services during the COVID-19 pandemic. Absolutely.
So people were locked down in their households. Usually for them get control.
There is a house to house visit where the the
the public health officers, they go to the to each of the house,
they knock on the door and they check if there are reservoirs and how much, uh,
larvae and mosquitoes
are available.
So all that all all those actions were not able to be performed during the
during at least the first year or or the first year and a half,
uh, of the COVID-19 pandemic.
Also, the healthcare services were fully, uh, responding to the COVID-19 pandemic
and the healthcare workers.
And so that also decreased a little bit the surveillance of of arbo
viruses, not just dengue and other diseases. It was not just just dengue.
We we saw an impact on the healthcare
services for immunisation for and for many other,
uh, types of infectious diseases and and issues.
However,
with the with the COVID-19 pandemic,
there were also capacities that were built for diagnosis.
So now we have molecular diagnosis capacities that were used to diagnose covid
and can be used also to do diagnosis of dengue and other arbo
viral diseases. So we can leverage in some of the lessons learned
during the COVID-19 pandemic
to respond to these, uh, dengue
outbreaks and other threats that might be might be coming.
But definitely the the COVID-19 pandemic
impacted the the healthcare services and also
the training of the doctors. There was a lot of rotation, so
that's it from my side. Thank you.
Thank you very much. And as I said, uh, I come back to you. Uh, for the other question.
So let's go to Christian
Eri, uh, our correspondent of the German news agency DP A,
uh, thank you very much. Doctor Ramos,
can you, um, elaborate a little bit on the situation in Europe? Uh, the cases.
And just to understand, do these larvae,
um, survive the winter? Do we have populations of those
moqui
mosquitoes resident in Europe now? And what is the WHO projection in the future?
Thank you.
Thank you very much. So, uh, Europe currently is in is in winter.
But during 2023 Italy reported 82 cases out
cases that were transmitted in Italy.
In France, 43 cases were reported, and in Spain, three cases were reported.
So usually,
Europe reports imported cases from the from the Americas
from the Western Pacific from the endemic regions.
But this
this year, we saw limited clusters of our
docs
transmission.
Uh, as we know, the the summers are getting warmer.
And the there are two main vectors of this of this virus.
One is Aedes albopictus,
which is widely distributed in in Europe and is called the Tiger mosquito.
And then the other one is Aedes aegypti,
which is a better mosquito to transmit dengue, Uh,
which is, uh, currently established in Cyprus, Madeira and
and in Portugal since 2022 and in other areas.
So the cold winters, we prevent
year long transmission, as we saw as we see in in other tropical areas, however,
the eggs are the ones that can
can, uh, stay during the winter hibernate.
And then once spring comes and when the temperature goes up up
to 2020 degrees and the egg gets in contact with water,
they will hatch, and then they will they will increase the mosquito density.
So this this mosquito has, well, the eggs.
They lay the eggs in, in,
in, in
places where there is clean water,
and once the eggs hatch, you will have a larvae
and then
2 to 3 days, the the adult mosquito will start flying.
So there is a There is a full cycle of these mosquitoes,
and the eggs are the ones that can stay hibernating during during the winter.
And once temperature gets up, then they they will have.
So this is a This is a gold opportunity
for Europe to start controlling the mosquito before dengue
becomes a real threat and becomes a, um
Well, now there is transmission.
But with the with, the summer's getting longer and the temperature is going higher,
higher.
This might become, uh, a seasonal, uh, disease in Europe.
So this is the time to control this vector,
given that the the the temperature and the seasonality
is been is in favour of the region.
Thank you. I see. Thank you. I see Christian has a follow up.
Uh, yes. Sorry. Can you just repeat or write in the chat?
The second mosquito, the tiger one.
You mentioned the second one you mentioned because I didn't get that. Thank you.
Yes, a DC GT. I will. I will write it in the chat. Maybe.
Maybe Tarik can do it while you are answering the other questions.
So, um,
Lisa Schlein
has been asking for the flu, but her hand doesn't work.
Apparently so I don't know if my colleagues can open her mic.
Lisa
Schlein
was of America.
Hi.
Yeah, it's very strange. I don't have my hand. I miss my hand. It's not on the screen.
So
anyway, here I am with my voice.
Um, yeah, Just a couple of quick questions is,
uh Is the the surge in Africa unusual?
Um, be because it it it doesn't seem to be a region that is,
uh, really principally or greatly, uh, affected by
by the by dengue.
And And I'm wondering,
uh, if there is a global surge due to climate change, whether you could
talk about the relationship if there is such
between, uh, the surge
in dengue
and, uh, climate change. Thank you.
Absolutely. Thank you very much for your question.
So in the
it's not just climate change,
So the main drivers of dengue transmission
are mostly social and environmental factors.
So,
uh, unplanned organisation, population growth
and other factors that are related with the globalisation
process are part of the transmission dynamics of of the
climate change has an impact in
dengue transmission because it increases rainfall,
humidity and temperature. So these mosquitoes are very sensitive to temperature
and temperature regulates how fast they grow.
How fast they, uh,
incubate the virus inside them and they are going to have
an impact in in the in the transmission per SE.
So climate change has a A definitely an an impact because the warmer temperatures
create the conditions for the mosquitoes carrying the infection through spread.
So what we are seeing with climate change
is in in many in many ways or, let's say, with the increasing temperatures.
So one
is what we what we are seeing in in Europe and in
temporary regions where the mosquito was not present few few years ago,
and now it is widely distributed, so it puts the population at risk.
And now there is also transmission of the virus.
Because it was introduced from, uh,
it could be someone to travel because the ones
who carry the virus around are the humans.
The mosquitoes,
they don't fly more than 200 metres
around the house
or around where they where they where they, uh, hatch their eggs?
Um, uh, So this is what we are seeing in in in Europe,
even in in the south part of North America and even in the Southern Hemisphere.
This year, we had cases in in Uruguay, which is in the in the south, in Buenos Aires,
in Argentina.
So So this is the This is one of the of the impacts of the mosquito, uh,
going up in latitude and also down in latitude.
But Also,
we are seeing in endemic countries changes in spatial and seasonal patterns.
So, for example, in Nepal,
they are seeing dengue in areas with more than 2000 metres above the sea level
that before these mosquitoes they used to survive just up to 16,000 metres above the
sea.
Yeah, 16,000 metres above the sea level,
or, for example, with the unusual rainfalls.
Uh, if there are,
if there are a potential breeding sites that with the
rain they are going to be filled with water,
that might also increase the mosquito densities.
And that's what we saw in Bangladesh after the monsoon season in Oman,
in Saudi Arabia that these unusual rainfalls lead to
an increased number of mosquitoes and increased number of transmission
also in areas in Latin America.
In in, uh, countries like Colombia, which also have, uh, mountains,
the mosquito is found even higher and higher,
and that brings population that was previously
completely naive and un exposed to dengue
to be at risk for for this kind of viruses.
So your question about the African region,
I think it's a combination of multiple factors.
One is that, uh, now that there is a more, uh, capacity to do diagnosis.
So probably the there are more. Um, there is more detection of these arbo
viruses,
but but also like what we saw in Burkina Faso, around 100 and 50,000 cases, that
that's significant. And
there is still a large amount of population that might be susceptible.
As I mentioned before,
we are currently working with partners to do set
of prevalence surveys to understand a little bit better,
Which is the the real burden of disease, uh, of dengue
in the in the African region.
So we can we can target a little bit, uh, better our interventions
over. Thank you.
Thank you very much. Uh, Gabriela Sotomayor
Rosso
O like Gabriella.
Oh, Alessandra, thank you very much. And thank you. Dr
Rojas.
Uh, my question is, in Mexico, uh, in Acapulco,
dengue cases have skyrocketed since Hurricane
O
hit Acapulco.
So the port was devastated and it still flooded with garbage.
So are you observing this situation? Are you worried about, uh, this, uh,
situation in Mexico E? Especially in in Acapulco.
And, uh, apparently, the government is underestimating this situation.
So if you can elaborate also on the situation in Mexico. A
part of Acapulco. Thank you so much.
You, The
rocket.
You are muted. Just one second. Sorry.
Ok, now you're on
now
and I see that the name of the mosquito has been put in the chat. The C GP T.
OK, so thank you very much So So But Mexico is endemic for for dengue
a couple of decades. They ha, they are hyper endemic, so they have co circulating
the four different stereotypes.
So as I mentioned
this before, But then it has four different stereotypes.
So people can get infected up to four times in their life.
And the second infection is the one that might lead to severe to severe dengue.
So in Mexico, they have the
circulation of all these stereotypes since, uh, several years ago this year,
they reported about
almost 230,000 cases.
And that is about 100 and 80 cases per 100,000 population.
So, uh, the South is is mostly affected.
So the Yucatan and as you were mentioning in in Acapulco, but, um,
I know that the Pan American Health
Organisation is being coordinating with the country office
and with the Ministry of health in the in Mexico to address the situation.
Because now, with all the, um
these unusual, uh, uh,
climate events such as the hurricanes, also the floods and all,
And and they will lead to more, um, mosquito densities and and high transmission.
So I'm sure they are. They are working on it. There is. There is risk, and we have it on
on on the list.
So they I know the Pan American Health Organisation and the and
the Moh in In Mexico are are are aware of the situation,
and they are acting accordingly in a with a multisectoral plan and
and trying to to control the transmission of of dengue
and potentially other threats.
Thank you. Thank you. Nina Larson. A FP?
Yes. Hi. Thank you, Uh, for taking my question. I was, uh,
wondering if you could say a little bit about the situation in North America.
Uh, I think you said it was similar to Europe, but,
um, are you seeing, uh, a similar development there?
And also,
if you could say something about, um,
you know, you're you're talking about a disease where most people will recover, uh,
after a week or two.
you know what? What is the What is the impact for countries?
If if this, uh, of this illness, if it becomes more endemic, uh,
or if it spreads more widely,
if you say I guess you know the the what the death toll might be Or, uh,
also impact on economies.
Thank you.
Thank you very much for your question. So in in North America,
uh, there were some cases reported in in in Florida and, of course, in in
Puerto Rico. Puerto Rico is endemic for for dengue
in the in the US.
Um, and the eighties
AIC,
which is one of the vectors is getting,
is getting more and more,
uh, space in the south of the the US. So now you can fight it in the south of Texas,
Um, and in in in Florida and and some of the Southern states. So the risk is there.
The risk for introduction is there, as we saw, as we have seen,
uh, previously in other years with, uh, clusters that are, uh,
controlled easily.
But the the risk is there,
and the issue with this virus is that most of the infections are asymptomatic,
so you can have trans
silent transmission for a few weeks before you start seeing the the first case.
So it it's good to,
uh, be aware of which are the the vector that is in in the area
and then take action to reduce the the mosquito densities
to also reduce the the risk of transmission in the population
and your question about severe illness.
So this disease is, as as I mentioned before, is mostly, uh, mild.
However,
around 10% of this of the of the patients can evolve to what we call severe dengue,
which might involve severe bleeding and severe organ impairment, which will, um,
make them go to the to the IC U.
And can they can they can die. Dengue is a very is a typical disease
because usually
the severity of the disease starts after the fever has gone away,
which is very misleading
because people are used that What if the fever is there? Then we need to be, um,
we need to be checking the patient and then once the fever goes away,
the per the person is getting better in dengue
is completely the opposite. When the fever goes away,
that is where the warning signs and the severe disease might present.
So the what is important here is that the population detects the warning signs,
which are intense abdominal pain, persisting, vomiting, bleeding in the gums.
In the gastrointestinal system,
uh, fluid accumulation.
They get sleepy and and also when the liver gets a little bit large.
But some of these things are are detected in at the hospital,
so it is important for the population to be aware of these symptoms.
So they go to the healthcare facility and seek for
for care if they if they if it's needed.
So with the proper uh care, which is mainly fluids,
the person might we might prevent the that patient to evolve to severe dengue
or if it has severe dengue.
We might prevent that person from from dying
because the treatment is just with with fluids,
as there is no specific treatment,
and the real burden of dengue
is estimated that there are about 390 million infections per year.
So what we get reported
is just a fraction of what it was the of the of the real of the real infections.
Um, the issue is that um Well,
it it if you the case is 10% will go to severe to a severe form of the disease.
And we are expecting less than 1% of case fatality rate. Right.
So,
uh, during outbreaks, for example, if you have an outbreak with 5 million cases,
then
the the the healthcare facilities get completely packed, as we saw with,
as you probably saw with the COVID-19 pandemic.
And it's very difficult to care and to follow up these patients,
so that might increase also the risk of death
as we as we see with other infectious diseases.
So the the the
the burden of disease is estimated in almost 400 million infections per year.
So what we?
But as most of the infections are asymptomatic,
we get just a proportion that were captured by the surveillance system.
And actually it made it to report. That's why
we are working with the countries in how to strengthen
the surveillance of of of dengue
and other Arab viruses to get more more cases reported and have
a better view of the of the real burden of of dengue.
Thank you. Over.
Thank you very much, Doctor
Rojas I think that was our last question to you.
Uh, although I haven't forgotten Paula, but, uh,
thank you very much for this extensive, uh,
briefing on this very important illness.
Uh, Paula, you had two questions for WHO, I guess. Maybe for Tariq or,
uh, yeah, I don't know if, um, if Doctor
Rojas can also, um, add to to my question, but,
uh, just, uh, wanted to know the concern, uh, that the WHO.
May have regarding bird flu.
Uh, last year we saw a, uh uh, a very sharp spike in, um, affecting animals,
uh, birds as well as I think, uh, sea lions and seals, uh, along Peru's,
uh, Pacific coast. Uh, it seems that, uh,
there have been, um, outbreaks of bird flu, uh, in Europe as well. Canada,
Um, just just wondering, you know what level of concern the WHO may have, uh,
regarding?
thank you. I don't know if, uh, Paula, um, Doctor, uh, Rojas
or
Tariq want to take the floor?
I don't know if, uh, Dr Rojas
wants to say something, but, uh, Paula, I would really need to come back to you and,
uh, look for for the information I know that we have been, uh
we haven't been looking into into bird's flu globally,
but I would need to get all the details and and send it to you by email.
Uh, maybe Dr
Rojas,
is there anything you would like to add on this?
No, we are I.
I just wanted to add that we are monitoring not just bird flu,
but other stenosis all around the world.
So please try to get back to her with with the detailed information,
because it is available as we daily monitor these threats.
Thank you very much as well.
But I keep Tariq because Emma has a question for you, Emma. For writers.
Uh, yeah, thanks. It's it's on a different topic. Um,
I'm hoping that the WHO can, um,
respond to, uh the fact that dual use items, including
medical items, are being blocked from getting into Gaza at the moment.
Um, I'm wondering what sort of items you're seeing blocked and
and how that's affecting your your aid operations on the ground
and and how badly they're sort of needed within Gaza.
Thanks a lot.
Uh,
em.
I'm I'm really not aware of it,
So please send us an email and we will check with our colleagues on the ground.
Um, any other questions for WHO? I don't see other Hands up.
Uh,
and I would also ask if there's any
other questions for other colleagues who are connected.
And we have
UN HCR.
And we have, uh, also
pa
and
CM as a question for me.
Emma, go ahead.
It it It's like a housekeeping one.
Alison Yeah, just one second. Just one second. Let me see if uh
um, Christian is that because I I like to to let, uh, doctor
Rojas
go if if she's not, uh, um
on the grill anymore.
So let me just ask Christian if this is for WHO on
any other question on any other matter and then come to you.
Emma,
Uh, thank you, Alexandra. This is for, uh, human rights. So not WHO.
OK, and they are not there. So let me, uh let me thank very much.
Uh, Tariq and, uh, Doctor
Rojas, Uh, Alvarez for this, uh, for this extensive briefing and also for answering
other questions. Let me see. I have something in the chat. No, it's not for them.
So thank you. very much. Doctor
Rojas, come back and and and update us on this, uh,
situation, which is really is, uh, in needing of monitoring and and attention.
And thanks, Tariq, for for being with us today. So let me go now. I don't know.
Well, Christian, you are. You are already on, so just go ahead.
And then, uh, I I'll give the floor to Emma
and
Christian.
Yeah, my question was on, um, this, uh, incident reported incident at the, uh,
uh of of summary
executions in the Gaza Strip
in the A
building.
I don't know whether there's anyone who can answer because in the relief web there,
there is a reference to some European
monitoring organisation that I've never dealt with.
And I wonder whether there are any
actual,
uh uh,
uh facts that were gathered by the office. Yes. Sorry about that.
No, no, it's OK. It's OK. Yeah, unfortunately, H HR is is not with us today,
and I wouldn't be able to answer on this. Uh, let me,
uh let me just send Or maybe you wanna You wanna send a message?
We have sent you the list that I
have.
Yeah, who are on, uh, on duty,
uh, these days,
so maybe you want to to contact them and eventually to come back to me If, uh,
we need to dig more.
Uh,
and, uh,
I'm sorry if I missed it. Alexandra is there? Um, an up to date, um,
list of spokespersons on duty during the holiday season. Um,
and when was it sent out? Sorry.
Uh, Solange
sent it out. I I Some of you missed it. Indeed. Maybe we we can just, uh, solo
is listening to me. Maybe we can send it, uh, again. It was sent
at least a couple of weeks ago.
Um, and, uh and, um, it ba basically covers the whole, uh, uh, UN family in Geneva. So
I think you have there all the all the people on duty.
I know that, uh, we have had some updates from WHO, including from WHO. So maybe,
uh So
I know you're listening. Maybe we can send it out again,
making sure that the information by WHO is updated.
Um, so that all the colleagues have it.
Uh, and And this gives me also the opportunity and, uh,
and colleagues to remind you that, uh of course.
This is, uh,
going to be our last briefing of 2023.
Unless something happens, then in this case, of course, we will
come back to you. Otherwise, we are going to post updates messages sent You,
um all the information that we receive
on, uh, news of the system.
Uh, otherwise, uh uh, we will reconvene,
uh, for the next briefing on the fifth of, uh,
january and it will be virtually again again because the Palais
stay close until the seventh of January.
Um, so yeah, Let let's let's maybe recirculate that list.
And, um,
it would probably be useful also for the others.
any other question
for me or for the other colleagues who are online?
I don't see any.
So let me just, uh uh,
uh inform you that the Secretary general will give a stick out today.
So short briefing today at 1230 New York Times.
And of course, you can follow this on uh, the, uh, UN Web TV.
And I expect there would be quite a few uh uh uh, points on the on the Middle East.
So you may want to to have that update
otherwise We will distribute the transcript of afterwards,
Of course.
And, um, I've told you about the arrangements. I wanted to apologise for the,
um, information that we gave about the accesses.
Uh uh uh, to the Palais during this period,
Uh, there were some changes. We have sent you an updated note.
I hope everybody has received it
about the arrangements. Uh uh, for the entrance from prey
Gate, Whether you come by car, bike or foot, uh, from eight.
In the morning to I think it's, uh,
five in the afternoon
after which,
um, you can access, uh, through the national
gates with, uh, when you go by foot or again prey
by car and bike.
And, of course, the same thing on holidays on the on the holiday days.
And, uh, and on the weekends.
Um, so sorry again for for the inconvenience that it does, uh, you may have, uh,
uh uh created And, um Yeah, that's what I I had for you.
and I I look at the platform. I don't see any end up,
uh, and therefore Yeah, I'm left with the wishing you,
um a very, very, uh, restful and, um
hopefully more peaceful, uh, period of, uh,
holidays with your families And dear ones,
uh, we'll see you in the new year.
And, of course, again, don't hesitate to ask us if you have any questions.
It's not time for celebrating. The news are are so terrible.
Um, that we think of all the people who will be suffering during this period,
including journalists.
But I still want to wish you all the very, very best for these holidays.
And of course, uh, for the new year, let's hope it will bring more peace on Earth.
Thank you. And, um, I'll see you in 2024. Thank you.