[How to respond to a dengue epidemic: overview and experience in Puerto Rico]

Dengue, a viral disease transmitted by mosquitoes, is endemic and frequently epidemic in many tropical countries. Because low-incidence periods vary in length, it is difficult to know in advance when an epidemic will occur. Response efforts, despite being logical, have been counter-productive at times. Furthermore, experience has demonstrated that dengue epidemics last a long time, making it important that government control efforts be sustainable while they last. This article describes priority activities requiring attention in order to minimize the impact of dengue epidemics. Such activities, which in many cases can be adapted to combat other types of epidemics as well, are as follows: (1) establishment of an inter-sectoral action committee, (2) formalization of an emergency action plan, (3) epidemiologic surveillance, (4) diagnostic laboratory testing, (5) mosquito control, (6) protection of sources of employment and special populations, (7) patient care, (8) education of medical personnel, (9) research, and (10) transparency before the mass media. The best way to reduce the ravaging effects of dengue epidemics is to anticipate their emergence so that infection can be prevented and steps can be taken to protect the ill. Relying on improvisation to solve all the problems that arise in moments of crisis is inefficient and reckless.