HEALTH

Long-eradicated diphtheria reappears in Venezuela; government blames the CIA

MARDAN, PAKISTAN - MAY 25: Pakistani children get treated at  a special pediatric ward for IDP's the Mardan District hospital on May 25, 2009 in Mardan, Pakistan. Hundreds of thousands of Pakistani people are displaced as a result of the on-going military operations against the Taliban.The refugees have fled from Swat, Buner, and Lower Dir facing extremely harsh living conditions in the searing heat in over crowded camps.The Swati refugees come from a pleasant and temperate valley, and are used to average temperatures of 25 degrees Celsius.The refugee camps are on the plains averaging 40-44 degrees Celsius living under canvas tents. (Photo by Paula Bronstein/Getty Images)

MARDAN, PAKISTAN - MAY 25: Pakistani children get treated at a special pediatric ward for IDP's the Mardan District hospital on May 25, 2009 in Mardan, Pakistan. Hundreds of thousands of Pakistani people are displaced as a result of the on-going military operations against the Taliban.The refugees have fled from Swat, Buner, and Lower Dir facing extremely harsh living conditions in the searing heat in over crowded camps.The Swati refugees come from a pleasant and temperate valley, and are used to average temperatures of 25 degrees Celsius.The refugee camps are on the plains averaging 40-44 degrees Celsius living under canvas tents. (Photo by Paula Bronstein/Getty Images)  (2009 Getty Images)

Diphtheria, an extremely contagious disease that has been mostly eradicated worldwide through vaccination, has reappeared in Venezuela. 

So far it has killed four children.

More than 20 cases have been reported in just one month, including those four fatalities in the southern state of Bolivar.

In the crisis-stricken South American nation, many of the children don't have access to the DPT vaccine that prevents the centuries-old disease. Caused by the Corynebacterium diphtheriae bacterium, the disease becomes serious if the bacterial toxin enters the bloodstream and spreads through the respiratory tract. It leads to heart failure and neurological illnesses.

Even with treatment, death occurs in between 5 and 10 percent of those affected.

This week the sense of urgency went up a few notches when a possible case of diphtheria was reported in Caracas’ Military Hospital, considered the country’s best.

Uncertainty has become commonplace in Venezuelan epidemiology.

The reappearance of diphtheria, a disease not seen here in more than 20 years, is the worst symptom yet of the country’s broken health system.

Venezuela used to be Latin America's richest country, but it is now falling apart as a plunge in the price of oil caps off years of economic mismanagement. Local production of almost everything has stalled, and there is little money to import medicine.

Fearing government retaliation, doctors from Bolivar’s Hospital of Guaiparo Raul Leoni opted to do not reveal their identities when on Sept. 21 they reported they had four diphtheria cases, which soon turned into 23.

In the following days, two other states, Sucre and Nueva Esparta, reported a total of four cases to the Venezuelan Society of Infectious Diseases. All four patients have ties with people who had recently visited Bolivar.

When last week the Ministry of Health finally made the announcement acknowledging the resurgence of diphtheria, Diosdado Cabello, a prominent Chavista, said Venezuela is the target of a "germ warfare orchestrated by the CIA labs."

A few days earlier, Marisol Escalona, Coordinator of the government's Expanded Program on Immunization, came out with an odd warning to the medical community: "You cannot report anything (about diphtheria) because it goes against the [Bolivarian] revolution."

According to opposition lawmaker José Manuel Olivares, members of the Intelligence Agency Sebin are “chasing” doctors in Bolivar to try to keep them from speak out about the outbreak.

Olivares said he has information of at least 20 diphtheria-related deaths since April.

The shortage of antitoxins and antibiotics across the country has the potential to turn this outbreak into a national or perhaps regional crisis.

The minimum dosage of antitoxin recommended to treat diphtheria is between 20,000 and 40,000 units when symptoms are only two days old, and between 80,000 and 100,000 if the disease is present for more than three days and the patient's neck is already swollen.

In Bolivar, doctors have to work around a limited supply of 10,000-unit doses — and most of them expired in 2009. 

"Venezuela is not prepared to deal with a diphtheria outbreak because we don’t meet the immunization standard recommended by the World Health Organization, because we cannot provide medication in a timely manner and because of flaws in the information flow to the community," said Huniades Urbina, president of the Venezuelan Society of Pediatrics, in a video conference at the Central University of Venezuela.

In addition, the Epidemiological Bulletin has not been published since of November 2014.

Dr. Julio Castro, from the Institute of Tropical Medicine, agrees with Urbina in that containing the outbreak requires a wide vaccination effort.

"For over 20 years we had not witnessed cases of diphtheria disease in Venezuela for a simple reason: it can be prevented by the DPT vaccine (diphtheria, pertussis and tetanus),” he said. “It is possible that the government did not vaccinate the number of people necessary to create the epidemiological barrier." 

According to information collected by the Health Ministry but not released to the public (Fox News Latino accessed it through the Venezuelan Society of Public Health), between January and July of 2016 Penta3 vaccination (including diphtheria) covered barely 42 percent of babies in the state of Bolivar. 

The first and second booster shot was fulfilled only in 15 percent of the children, the report said.

Jose Felix Oletta, a former health minister and member of the Society, said it was puzzling that the Pan American Health Organization has not yet issued an epidemiological alert on the diphtheria outbreak in Venezuela.

The Society has issued four warnings so far this year.

"It is clear that the strategy adopted by the national health authorities began with attempting to hide the outbreak of diphtheria and now has been replaced with minimizing the magnitude of the epidemic,” the Society of Public Health said.

María Emilia Jorge M. is a freelancer journalist living in Caracas, Venezuela.