RIO DE JANEIRO, Brazil — A deadly dengue fever epidemic has sickened tens of thousands of people and clamed at least 80 lives since the start of the year, and it shows no signs of slowing.
Fear of infection has forced thousands of tourists to cancel vacations to the city of Rio de Janeiro and pushed many residents indoors rather than risk being bitten by the striped Aedes aegypti mosquito that transmits the disease.
The epidemic also has collapsed public health services, which are overwhelmed by the crush of patients seeking aid, sparking widespread criticism that government officials were caught unprepared by the outbreak. Last week, the government of Rio de Janeiro state, with a population of 15 million, asked Brazil's military to open three field hospitals to serve thousands of infected people.
"There's been a total lack of attention," said Gabriel Fonseca, 41, an electrician who suffers from the most serious form of the disease, dengue hemorrhagic fever, which can be fatal. Fonseca said he had to wait all night at a city clinic over the weekend to receive hydration treatment that would boost his resistance to the virus.
"I've always been afraid of hospitals, for exactly this reason," he said.
It's been an embarrassing episode for this world-famous city, which is known for its bustling beaches and sporty lifestyle. Now, street vendors sell electrified mosquito racquets — which pop and flash when swatted against a mosquito — instead of soccer jerseys. Gossip columns, instead of listing marriages and break-ups, announce the latest celebrity to be struck by the disease.
Among those recently stricken are two-time gymnastics world champion and Olympic hopeful Diego Hypolito and model and actress Grazielli Massafera. Both are recovering.
The U.S. and other embassies have alerted citizens to take precaution when coming to Rio, and planes proceeding abroad are being sprayed with insecticide.
Children under the age of 16 have been hit hardest by the outbreak, making up nearly half of the state's fatalities. Health officials are investigating 79 more deaths possibly linked to the dengue outbreak.
Dengue fever, which infects about 50 million people around the world a year, has proliferated in dense, growing cities, where sanitation is poor and public health services often have deteriorated, said Josh Ruxin, an assistant clinical professor of public health at Columbia University.
The number of people infected by dengue in Brazil quadrupled from 2004 to 2007, when 560,000 people came down with the disease, according to the Pan American Health Organization. While the national infection rate is down this year, it has exploded in Rio de Janeiro state and, at more than 75,000 cases, has surpassed the total number of infected all of last year.
This year's outbreak, however, pales in comparison to that of 2002, when more than 288,000 people became infected in Rio de Janeiro state, official figures show. Nonetheless, this year's death total is poised to surpass the 91 people killed in 2002, fueling criticism that state health officials have failed to reach the sick in time.
Worldwide, dengue runs a distant second to the most prevalent mosquito-borne disease, malaria, which infects about half a billion a people a year and kills as many as 3 million. Dengue is still relatively rare in the United States, with 488 cases reported last year. While Brazil claims among the highest infection rates in the world, deadly dengue hemorrhagic fever is far more common in Asia and claims more lives.
"Dengue is a disease that's eminently preventable, but in this case (in Brazil), the public officials were blindsided," Ruxin said. "We know the public health interventions that can prevent this, but when the guard comes down, the disease and vectors make a comeback."
Rio state public health officials admitted they needed to radically reform public services, especially by shifting dengue patients from overloaded hospitals to special clinics during the peak infection period between January and March.
"If the health system is directing everyone to hospitals, which are already overloaded, you're not going to be able to provide the basic attention people need," said state health official Victor Berbara. "Then dengue will break out like it has."
Even worse, heavier-than-normal rains followed by days of heat have dashed hopes that the epidemic would tail off this month, Berbara said.
Berbara blamed the epidemic on a poor sanitation infrastructure that had failed to drain standing water, uncoordinated mosquito control programs and insufficient health services. The Aedes aegypti mosquito breeds easily in clean, standing water and is known to bite principally during the day and close to the ground.
Berbara's worries for this month were confirmed by Adriana Andrade, Rio director for the U.S. humanitarian group World Vision, who said she's seen no retreat in the outbreak in the poor suburbs of Rio where she works.
"This epidemic is not slowing," she said. "We're seeing more cases all the time."