Poor sanitary conditions and a tropical climate made the Dominican Republic vulnerable to the Zika virus, but a strong public health push limited the infection's health and economic impact.
The Dominican Republic is no stranger to outbreaks of disease. The island’s tropical climate and high poverty levels have led to outbreaks of dengue fever, malaria, and chikungunya in the past, some of which have resulted in the deaths of thousands. Health and sanitation improvements have dramatically reduced the incidence rate in recent decades, but infections remain a key public health issue in the Caribbean nation. Most recently, Zika, a mosquito-borne virus, was confirmed in the Dominican Republic in January 2016.
The Zika virus is related to dengue, yellow fever, and West Nile viruses, and was first isolated in Uganda in 1947. It is primarily spread through mosquitos, but can also be sexually transmitted. Outbreaks were contained within the African and Asian continents until 2007, when an outbreak occurred in Micronesia. The virus spread to the Americas in early 2015 and was declared a Public Health Emergency of International Concern by the World Health Organization (WHO) in February 2016 due to mounting evidence of birth defects as a result of the virus. Previously considered a mild infection, the Zika outbreak of 2015 gained significant attention due to images of microcephaly, or severe cranial malformation in newborn babies, and other birth defects due to Zika fever. While not a life-threatening illness for adults, Zika presents serious risks when spread from mother to child in the womb. A smaller proportion of adults who get infected with the Zika virus develop Guillain-Barré syndrome (GBS), a disorder that can cause muscle weakness and paralysis for an extended period of time.
After cases of the Zika virus were reported in 2016, the disease spread quickly; the Dominican Republic’s tropical climate, poor sanitary conditions, and lack of high altitudes all led to favorable conditions for the virus’ transmission, and global health organizations considered the entire population at risk of contracting the disease. Within 15 weeks of confirmed Zika arrival, more than 300 cases were being reported each week, peaking in the summer rainy season before decreasing in the fall. The highest incidence rates were found in females 25-29 and 30-34 years old, a point of particular concern due to the risk of birth complications due to the virus. The WHO’s Pan American Health Organization reported that 271 pregnant women were confirmed to have been infected with the Zika virus in 2016, leading to 22 cases of microcephaly in newborns. The Dominican Republic also reported 285 cases of GBS, which resulted in 17 deaths.
Spurred to action, the Dominican government worked in tandem with regional and global health programs to respond to the outbreak. Their response focused on three main issues: prevention, education, and treatment. Officials warned against storing water in barrels, common in Dominican households due to water access issues, and advised women not to become pregnant. The Ministry of Education and the Ministry of Health joined with the Dominican Red Cross to conduct a nationwide education project, distributing materials on the virus and working with municipalities to conduct home visits and address community organizations where needed. The Ministry of Defense allocated more than 2,000 military staff to remove breeding sites, cleaning gutters and removing garbage where it posed a health risk. Additional fumigation efforts were conducted by the Dominican Republic Air force, which conducted spraying efforts in Santo Domingo. All of the above groups distributed larvicides, chlorine, and informational materials as needed. Special attention was given to the most vulnerable communities, as high levels of overcrowding and lack of standard sanitation systems were listed as one of the most critical and manageable factors to prevent infection.
The Dominican Republic’s primary concerns were the high risk to the population and the potential effects on tourism, one of the nation’s core economic drivers. The strong, well-coordinated response helped cases peak early and prevented any significant drop in tourism; indeed, the nation posted increases over 4.7% during the tourist season. In contrast, other nations recorded far more Zika infections and dealt with lower-than-expected tourist numbers. Moving forward, the Dominican Republic and the region as a whole is well past the epidemic peak of mid-2016, but remain wary of the virus’s potential for breakouts. While it is no longer as severe a threat, scientific research and awareness campaigns are continuing as the nation prepares for the return of the rainy season. The Dominican Republic can remain confident in its ability to act as needed, and its previous public health responses to the virus bodes well in the case of the reemergence of the Zika virus or future outbreaks.