The Silent Spread of Diphtheria

A contagious disease has reappeared in Venezuela. After 24 years of being considered eradicated, the inhabitants of the south of the country are experiencing a diphtheria outbreak of hitherto incalculable scales. Minister of Health Luisana Melo has recognized as official medical report only two deaths out of the four cases confirmed by her office until October 11. But several death certificates, collected in situ by Armando.info, indicate that the number of deaths is higher.
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Diphtheria,
the contagious disease eradicated 24 years ago in Venezuela, has reborn in
Bolívar state (south of the country). Epidemiologists presume that the outbreak
has arisen in an indigenous community, San Antonio Roscío, and has spread since
April through other towns. At Hospital Raúl Leoni -known as Guaiparo- arrive
suspicious cases from the states of Anzoátegui, Bolívar and Delta Amacuro.
"Runny nose, swollen tonsils, signs like a cold. It could be confused with
tonsillitis, but nobody dies of that. So when death comes, we suspect that it is
diphtheria," says a doctor.
Eight-year-old
Abismael Espinoza Rodríguez arrived at the Guaiparo hospital with this clinical
condition, one night in late September. The parents of the child had gone first
to a medical module of Barrio Adentro —the health program sponsored by former
President Hugo Chávez with Cuba’s cooperation— in the town of San Félix. "The
doctor said it was tonsillitis, so we went back home and just follow the
treatment. But as days passed, he got worse. We decided to take him to a
hospital and that's when the worst happened," says Gregoria Rodríguez, the boy's
mother.
On
October 11, the Minister of Health, Luisana Melo, spoke for the first time about
the outbreak of the disease: "It is a regional issue, in Bolívar state only. Of
all the suspected cases, four cases of diphtheria were found and two confirmed
deaths. "But 12 days before these statements, there was another government
diagnosis. Francisco Rangel Gómez, the governor of Bolívar, launched a much
higher number in late September: "We have had 13 cases of
diphtheria."
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According
to the death certificate of Abismael Espinoza, the child died as a result of
diphtheric cardiomyopathy. Like his, the death certificates of three other
children from Bolívar - Sara Bastardo, Jhoangely Alexandra Ochoa, and Dariervys
Brazón -, issued between September 24 and October 10, and obtained by
Armando.info, indicated diphtheria as the cause the deaths. For physicians in
the health centers of Bolívar, witnesses of the resurgence of diphtheria, an
epidemic is hidden. "The confirmation of cases is usually delayed, because
almost all of the evidence is sent to Caracas. However, we already have several
patients, dozens, and they do not know each other. There are more than 20 deaths
from this disease. Even the pediatric ward of the hospital (Raúl Leoni) has been
enabled to attend only potential patients of diphtheria," says a doctor at this
hospital.
Diphtheria
is a preventable disease. The expedited way to avoid an outbreak in the
population is vaccination. In Venezuela, immunization depends on health programs
run by the State. According to recommendations of the World Health Organization
(WHO), countries should immunize 90 percent of the population, in this case with
the vaccine known as DPT3, to prevent the re-emergence of this disease. However,
this guideline has not been complied with in Bolívar state in the last
decade.
The
parents of Abismael Espinoza do not remember if the child got the three doses of
the vaccine against diphtheria. In 2008, the year in which Espinoza was born,
coverage of the DPT3 vaccine in Bolívar state reached 16.5 percent, according to
records of the Yearbook of the Expanded Program on Immunizations (1962-2009) of
the Ministry of Health. The figures from entities have not been disclosed
periodically in the last six years, although the Venezuelan Society of Public
Health has got the feel of the epidemiological situation based on official and
other leaked statistics. "Bolívar is one of the six most vulnerable states in
Venezuela, because until mid-2016 the immunization coverage against this disease
was at an annual rate of 42 percent. Other states in similar conditions are
Barinas, Carabobo, Delta Amacuro, Monagas and Zulia. This reveals that it is not
a regional problem, as the minister points out. It is already an epidemic, a
single case is enough to be considered an epidemic, and it can expand to other
places," says José Félix Oletta, a member of this organization and former
Minister of Health. Until
a few days ago, there were no evident signs of health prevention. At the airport
of Puerto Ordaz, in Bolívar, and at the main land terminals, the health
conditions of the passengers were not examined. In contrast, the outbreak is
considered a danger abroad, although the Pan American Health Organization (PAHO)
has not yet issued an alert. In Guyana, which borders Venezuela precisely on the
border of Bolívar state, they have implemented an intense vaccination campaign
to prevent the spread of the disease, while the Ministry of Public Health of the
Dominican Republic has recommended the medical staff of the International
Airport of Las Americas to be vigilant with travelers from Venezuela in the face
of the resurgence of diphtheria.

Espromed Bio C.A. façade. Photo: Ministry of People’s Power for Health Press
The Distant Antidote
The
parents of the four children whose death certificates indicate that they died of
diphtheria admitted that they did not completed the required doses of the
vaccines. "I always wanted to vaccinate my baby, but when I went to the
outpatient clinic or the hospital, they told me that the vaccine had run out. At
some point, I threw in the towel and did not keep going," says
Melville.
Diphtheria
vaccines depend on an agreement signed between Cuba and Venezuela, through the
Socialist Company for the Production of Biological Medicines, Espromed Bio C.A.,
created on June 12, 2014 by a decree of President Nicolás
Maduro.
However,
Espromed Bio was not an invention of the Government. The vaccine plant, in
Universidad central de Venezuela, already existed since 2000 and depended on the
Rafael Rangel National Hygiene Institute. The Government only decided to
transfer the administration directly to the Ministry of Health to reinforce its
operation. The company was expected to meet the country's demand, since it is
made up of three independent laboratories for the industrial fermentation
process with the capacity to produce 160 million doses of diphtheria toxoid,
anti-Pertussis vaccine and tetanus toxoid per year, and with a plant of
formulation, filling and final processing, with an installed capacity of 120
million doses per year.
The
emerging promise has not escaped from the Venezuelan decline though. Last year,
Espromed Bio only produced the packaging and labeling of 21,718,906 doses of
biological products and essential medicines to prevent diseases caused by
viruses, bacteria, toxins, among other agents. Only 5,104,842 out of this amount
—almost all the doses acquired from the agreement between Cuba and
Venezuela—were distributed in the country. According to the 2015 Annual Report
of the Ministry of Health, the company was victim of delays in the allocation of
foreign currency to import spare parts and supplies for production, among other
administrative obstacles.
The
reappearance of diphtheria has coincided with the worst health crisis faced in
Venezuela. The country, dependent on oil and subject to strict foreign exchange
control, has fallen into a financial meltdown that causes a drop in imports.
This situation has affected hospitals, pharmacies and laboratories that, in most
cases, are supplied with inputs acquired abroad. It is estimated that there is
almost a deficit of 85 percent of drugs -according to the Venezuelan
Pharmaceutical Federation- and a growing deterioration of medical centers. But
the Government of Maduro has coined the term of "economic war" to hold it
responsible for all ills.
The Gospel of Omission
In
the Christian church of the Buen Retiro neighborhood of San Felix, in the heart
of Bolívar state, they have said a prayer for the soul of Saraí Bastardo. The
inhabitants of this walled village still cannot find explanations for the sudden
death of the girl. Solmaira Melville, the mother of Saraí, resents not having
noticed in time the signs of faintness of the daughter: "Dyspnea, sore throat,
stifling sensation in the chest. Since she was asthmatic, we thought that was
what she had, and that she would improve with medication. But it was not that,
it was diphtheria."
The
outbreak of diphtheria has unleashed fear in Bolívar. Melville denounces that
one of his three children has been isolated at school. "A teacher began to say
that the child could not be with the other children; that he had to be subject
to medical exams before rejoining. After the death of my baby, we have all been
vaccinated. Already, after several complaints, the principal is aware of this
and allowed the child to attend school," she says.
In
the neighborhood of the Espinoza Rodriguez family, the mourners of Abismael, is
already aware of the diphtheria due to the death of the child. "Ask about the
mother of the child who died of diphtheria! Anyone can tell you where my home
is," says Gregoria Rodríguez, when scheduling a journalistic
interview.
According
to Oletta, the worst recipe applied by the Ministry of Health is "concealment"
of information. "Minister Melo has made a serious mistake. The worst that can be
done in an epidemic is to say nothing or that everything is under control when
it is not. In the end, that delegitimizes her. It also causes discrimination
within the population due to uncertainty. Damage is being caused in the country
due the bad policies and for not having the courage to rectify and admit that
they have been wrong," he explains.
Since
the health authority gave a statement on October 11, no more official figures on
the outbreak have been released. Armando.info contacted the Ministry of Health
to obtain updated statistics on diphtheria, but they responded that it was not
possible to know them because Melo was in the presentation of Venezuela’s Human
Rights report before the United Nations Organization in Geneva (Switzerland),
and other spokespersons had to be authorized to give a
statement.
The
silence of the Ministry of Health is questioned. This week, Melo received strong
criticism on Twitter, to the point of becoming a trend in the social network, by
omitting the health crisis in Venezuela during her speech to the United Nations
in Geneva, in the second Universal Periodic Review. She said that the government
has distributed over 6.5 million vaccines to protect Venezuelans from 16
different types of diseases, but she failed to talk about diphtheria. There is
also no information on the outbreak in the south of the country in the portal of
health or in its social networks. The State apparatus continues admitting only
two deaths caused by this disease, although at least twice as many deaths could
be confirmed for this report. The silence is still
official.
*This
work had the support of the reporting work of Marcos David Valverde in Bolívar
state.