The Washington Post
Thursday, March 21, 2002; Page A20

Dengue Outbreak Has Rio in Fear

1,000 Infected Daily; Authorities Blamed For Inept Response

By Anthony Faiola
Washington Post Foreign Service

RIO DE JANEIRO -- In the poor suburbs of this sweltering city, fearful residents have begun saturating their bodies and their homes with insect repellent. They have
good reason: Leandro Caroni, 19, died last year after four days of splitting headaches, gut-wrenching coughs and a temperature topping 106 degrees -- telltale signs
of dengue fever.

The mosquito-borne ailment, caused by one of several viruses, is wreaking havoc in Brazil. It has hit especially hard in Rio de Janeiro, a dense metropolis packed
between jade-colored mountains. Since Jan. 1, the illness, which attacks the blood and human immune system, has infected more than 160,000 people in Brazil,
Latin America's largest nation. It has caused at least 37 deaths and 90,000 infections since then in the state of Rio de Janeiro alone.

But Leandro's mother, Eloisa Caroni, a 42-year-old nurse who still keeps her late son's electric guitar on the couch in her modest concrete-block home, does not
blame Aedes aegypti, the centimeter-long black and white bloodsucker that transmits the disease. She blames the government.

"My son died because of politics," said Caroni, who filed a class action lawsuit with other victims' families against the local, state and federal governments. "They all
knew this epidemic was coming since my son died last April. Yet they did nothing, nothing! All they did was pass the buck. They were too afraid to assume
responsibility, too afraid that they would be blamed for the problem. And now, look how many more mothers are crying."

Caroni's anger underscores the political current running through Brazil's dengue outbreak. Leading scientists and citizen activist groups here blame government
ineptitude and squabbles between federal and local authorities for a lapse in mosquito control that allowed the crisis to grow. They say local authorities, after
mismanaging mosquito control for months, waited too long to ask for federal help, while federal authorities did not intervene soon enough on their own initiative.

Critics argue that politics played a role. Until last month, Brazil's Health Ministry was headed by Jose Serra, a leading contender in this year's presidential race who
had vowed to make dengue one of his top priorities when appointed in 1998. Rio's governor, Anthony Garotinho, is also weighing a presidential bid, while its mayor,
Cesar Maia, is reportedly interested in higher office as well.

Despite warnings from scientists that an epidemic was brewing, federal health authorities did not launch fumigation and larva eradication until Feb. 6 -- after roughly
40,000 cases had been reported in Rio state.

"Look, this is campaign season," said a high-ranking government authority now dealing with the epidemic. "No one wanted to be the father of this child."

Hermann Schatzmayr, Brazil's leading dengue expert and a specialist on tropical diseases, alerted national and local authorities to a looming crisis 16 months ago.
Although two lesser forms of the dengue virus had been present in Rio for years, Schatzmayr detected the arrival of a more aggressive, third strain in December

At the same time, fumigation had dropped by more than 50 percent in the Rio area, with the number of agents spraying mosquitoes and eradicating larva falling from
3,000 to fewer than 1,300. Schatzmayr said he repeatedly warned health officials last year that the combination of factors would spark an epidemic, and
recommended a rapid and broad eradication program. But he said he met resistance on all levels.

"They called me a troublemaker. Nobody wanted to admit there was a serious problem," said Schatzmayr, director of the virology department at Rio's Oswaldo
Cruz Foundation, Latin America's largest health research institute. "We have the kind of epidemic we have today because there was no efficient control strategy. . . .
My sense is that no one wanted to be associated with this problem."

As a result, this sultry city of 13 million people is struggling to cope with an epidemic that is infecting an estimated 1,000 people a day.

Although dengue is a menace in Rio's honeycomb-like hillside slums, this epidemic has equally hit middle- and upper-class neighborhoods. Ads for mosquito repellent
are everywhere. Television stars have been laid up by dengue, forcing Brazil's famously melodramatic soap operas to write around sick actors. Soccer players and
singers have also been infected. In a city infamous for "dental floss" bikinis, some residents are even doing the once unthinkable -- covering up.

Dengue fever -- its more deadly form is dengue hemorrhagic fever -- is a debilitating illness found in Africa, Asia and, more recently, Latin America. It is not new to
Brazil, which has suffered lesser outbreaks in the past. The last major outbreak was in Rio in 1991. But since then, the disease has been largely controlled through
vigorous fumigation and public health programs.

In previous years, death from dengue was relatively rare. Most patients recovered with acetaminophen and saline injections after a week of flu-like symptoms. This
year's outbreak of a more aggressive form of the virus has already caused a 50 percent rise in deaths over the toll from the 1991 outbreak.

Both federal and local officials insist they correctly handled the epidemic and say political concerns played no role in countering it. They blame unusually heavy rains
for an explosion in Rio's mosquito population.

Serra, running second in public opinion polls about the October presidential election, did not respond to a request for an interview. Brazil's current health minister,
Barjas Negri, declined a request to be interviewed. Other federal authorities, however, rejected criticism that they should have intervened more quickly.

"The action should have been taken by the municipality," said Jarbas Barbosa, director of Brazil's National Center of Epidemiology. "We only take action when there
is a situation that surpasses the capacity of the local officials. We stepped in when we felt we had to."

Rio's municipal authorities, meanwhile, are mostly blaming Mother Nature -- and human nature.

"This is being raised by people who want to put the mosquito in the electoral campaign, but the fact is, the political aspect of this is an illusion," said Ronaldo Cezar
Coelho, Rio's health secretary. "We did the best we could. This is about climate, weather patterns and teaching people to change their habits to control the mosquito
in their homes. I don't think additional fumigation from us or anyone would have prevented this."

Nevertheless, scientists say the lack of early intervention has now made dengue eradication virtually impossible. Unhatched larvae can live as long as a year in potted
plants, damp walls and other water deposits in the corners of dense Rio.

"The mosquito has now become entrenched in the urban and suburban areas of Rio," Schatzmayr said. "I think it is too late now. The mosquito has won."

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