An extension of one month was requested for this operation because there have been delays in putting together the community health groups for community epidemiological surveillance with the Ministry of Health as the health authorities at local level (in provinces) have not been available to participate in the coordination meetings. This responds to the fact that many of the health authorities have been involved in political activities related to the elections that took place on May 15.
Another issue that affected health activities was the national vaccination day, which coincided with the start of the activities of the Zika DREF; the Ministry of Health spent more or less one month preparing the vaccination campaign and was not available to participate in the coordination meetings at the provinces level.
This has also affected the community selection process. The selection of the communities is based on the zika situation according to the cases reported by the Provincial Directorates of Health; the Health Ministry supports the identification of the communities with data provided by the national surveillance system.
One of the most important activity regarding to water, sanitation and hygiene promotion that the operation also supports is the vector control and activities for sanitation and hygiene promotion, as the Ministry of Public Health (MSP) is coordinating the national response to Zika in the Dominican Republic the educational materials for the awareness raising campaign have to be approved by the General Direction of the Health Promotion Department (the Spanish acronym is DIGPRES), the materials wouldn’t be validated because the Ministry of Health has a delay with their own materials and could not made a cross check with the DRC materials, finally they approved the materials only validating the key messages. The materials will be printed in the coming weeks (third and fourth week of May).
The DRC has a delay in the acquisition of the cleaning kits and the materials for the vector control because of the internal procurement process took more time than normal; the National Society’s procurement department is in the headquarter and had to focus all their efforts in preparing the operation for Easter week, a nationwide holiday that requires the DRC to intensive their prehospital care activities and lifeguarding activities in recreational areas. The cleaning kits were only acquired in April and the distribution is taking place during May; the purchase of the vector control equipment will take place in May according to the planning of the DRC health department. The cleaning campaign is planned to be conducted at the beginning of June.
The Dominican Red Cross continues to perform actions in response to the situation created by the increase Zika cases in the country, besides the increase in cases of Guillain Barre syndrome associated with the virus, active surveillance is maintained in provinces with higher risks (Santo Domingo , National District, Azua, Independence and Puerto Plata mainly) and where outbreaks have been identified mosquito breeding Aede Egytis and zika confirmed cases.
At the headquarter level the DRC maintained communication with the surveillance system of the Ministry of Public Health (MSP) through weekly meetings of the board of health focal points with nationwide organizations that are supporting the response for the Zika control, these meetings are being conducted with the aim of generating continuous and timely information through the registration and identification of cases in different provinces according to alerts generated weekly by each Provincial Health Department, so that they can take preventive measures and timely intervention in the provinces where the highest morbidity occurs.
A. Situation Analysis
Description of the Disaster
On 23 January 2016, the Pan American Health Organization/World Health Organization (PAHO/WHO) reported the presence of the Zika virus in the Dominican Republic after 10 cases were confirmed, eight were contracted locally and two were imported from El Salvador. Affected people are from different locations across the country: the National District and the municipalities of Santo Domingo Norte, Jimaní Oeste near the Haitian border and the provinces of Independencia and the locality of Santa Cruz in Barahona province (southwest Dominican Republic). Eight of the 10 cases were identified in people aged 15 to 57, and the remaining two cases were identified in children under five years of age. The onset of symptoms was detected between 3 and 18 January 2016. Fevers and rash were reported in all of the cases, conjunctivitis was reported in eight of the ten cases, discomfort, headaches and arthralgia’s (joint pain) were reported in six of ten cases and myalgia was reported in five of ten cases.
Cases were confirmed by testing samples through reverse transcription polymerase chain reaction (RT-PCR) by the Centres for Disease Control (CDC).
Dominican health authorities intensified surveillance activities and the implementation of vector control measures, as well as educational activities for the Dominican population on the risks associated with the Zika virus, encouraging them to take precautions to avoid mosquito bites.
After confirming the circulation of the virus, the Dominican government issued Decree 7-16 on 23 January 2016, which instructed the Ministry of Health to coordinate actions to detect and confirm cases of dengue, chikungunya and Zika, address and implement a guidance strategy and to reduce the number of mosquitobreeding sites. The Ministry of Defence and specialized security forces were ordered to conduct any measures required by public health, government agencies were ordered to get actively involved and institutions were ordered to disseminate prevention information through virtual platforms, social networks and other mechanisms.
During Epidemiological Week number 4, 32 new suspected cases of Zika were reported with autochthonous transmission proven, by locality the cases were reported in: National District (8) and municipalities of Jimaní (14), Santo Domingo Norte (3) and Santa Cruz de Barahona (7).
Health authorities are conducting intensified surveillance of febrile rash illness (enferemdad febril exantémica - EFE). Through this surveillance, 45 cases have been identified and investigated in other localities of the country, of which 38 met the criteria for laboratory diagnosis. Samples were sent to the laboratory of the Centre for Disease Prevention and Control (CDC) in the United States. In line with this strategy, the Ministry of Health continues to advance in strengthening the Dr. Defilló National Laboratory with assistance from PAHO and the CDC to enable the samples to eventually be processed in country.
In addition to the detection of virus circulation, the Ministry of Health is encouraging all the components of the health sector in the Dominican Republic to implement systematic monitoring and weekly notifications of EFE episodes, with an aim to monitor the course of the epidemic.
Summary of current response