My perspective of Zika and dengue and these other diseases that are gaining attention in the media and among the public is different than most.

I have a degree in infectious diseases, and am very familiar with the names of these diseases. When I studied public health and infectious disease, these are diseases we discussed widely.

Zika has been around for a long time, and was a burden to people around the world.

Gov. David Ige says the state is making progress on stopping the dengue fever outbreak on the Big Island.
Gov. David Ige called a press conference Tuesday also attended by Billy Kenoi, left, mayor of Hawaii County, where the dengue outbreak is occurring. When it comes to dengue and Zika, our public health officials are late to the party because these diseases have long threatened us. Cory Lum/Civil Beat

Americans and our health system seem to recognize diseases only when they begin to inch closer to our borders. However, any reasonably trained public health professional should not be surprised when this happens — it is common sense that diseases will do this, given time, and given the factors that contribute to it (genetic change, human activity, migration, climate change, etc.) are not addressed.

Dengue was “my” disease while a graduate student. It was the disease in which I was most interested. I have read hundreds of papers about dengue. I consider myself as knowledgeable about dengue as nearly anybody on Earth.

Diseases like Zika, yellow fever, guinea worm, trachoma, dengue, and many others (I could continue for pages) are known in the public health field as “neglected tropical diseases.” We in the public health field are well aware of them.

They are neglected by the Western nations because, simply put, they mostly affect poor, marginalized people in poor nations. They affect people we don’t care about, and therefore we don’t put resources into them. That is now coming to haunt us.

Together, all neglected tropical diseases constitute about 10 to 20 percent of the disease burden globally. That is significant. We were taught a lot about them in graduate school. Many of them have been around for millennia.

I bite my tongue now when I hear people at work or strangers talking about Zika and dengue. First, because there is such ignorance of the disease. It is something new to them, and therefore they act as though it has suddenly emerged from nowhere.

Dengue is an ancient disease, one of the oldest in the world. I had my own reasons for choosing dengue as my favored disease. A good reason to know about it is because it is perhaps the most common infection in the world.

It is endemic in 120 nations, putting about 3 billion people at risk, and infects an estimated 500 million people globally annually. So when I overhear people talking about this “new” disease, or talking about it as something new, I find it ridiculous. In fact, dengue was common in the Western Hemisphere up until the 1970s, when it was nearly eradicated.

It was Rachel Carson’s “Silent Spring that put an end to these eradication efforts, as the book provoked the new environmental movement and stopped the use of residual spraying and pesticides that had nearly wiped out the disease. When it came back, over the past few decades, it came back stronger.

There is a specific reason for that – there are four serotypes or distinct dengue viruses. They all co-circulate in regions of the world where this never happened. With four serotypes co-circulating, the risk for dengue hemorrhagic fever is amplified.

We don’t know why, but the widely accepted theory is called antibody enhancement theory. It says that a secondary infection with dengue confuses the immune system.

People shouldn’t know about things simply because it affects or threatens them. That is its own form of racism.

Dengue, as one of the most common infections in the world, is something we should all know about. It is something perhaps half the world deals with on a daily basis. (Full disclosure: I have had dengue. As well as malaria, cholera, amoebic dysentery, and a few others).

As is Zika and all of the other diseases. People also shouldn’t be surprised that the geographic range of these diseases is spreading. They are literally known as “neglected diseases,” and when you neglect diseases, this is what happens. That is common sense.

It is a shame that the public is unaware of this, but it is something worse when our own public health and medical systems are too. That is their job. The ignorance of dengue in our country is quite alarming.

I still have not seen any information about which strains are circulating in Hawaii, Louisiana, Florida and Texas. That is the most important piece of data. If one thing about dengue is reported, this should be it.

Dengue cases have been in the U.S. for at least a decade, because as a graduate student I read about domestic cases in Texas and Louisiana. So we’ve had domestic cases for 10 years, and for the past 40 years dengue has been spreading throughout our hemisphere.

That there is an “epidemic” in Hawaii should come as no surprise, and our lack of preparation is a real crime of our public health system’s incompetence.

This is why we should give more attention to things in the world, even those that do not personally affect us. One day they might. That day is now here, and we are of course rendered totally helpless, ignorant and vulnerable.

Perhaps if people had paid more attention a decade ago when Zika, dengue and other diseases were slowly expanding throughout the globe, we would be better prepared.

We should not permit our public health and medical fields to let us down in this way. We should demand better.

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About the Author

  • Matthew Pflaum
    Matthew Pflaum, 30, grew up in Florida. He studied biology and anthropology at Grinnell College, and earned a Master's in Public Health in global health/infectious disease at Emory University. He has lived or worked in Thailand, Puerto Rico, Tanzania, Central African Republic, Vietnam, Japan, and Bangladesh. He is currently studying economics at University of Hawaii Manoa.