The diffusion of the chikungunya virus across Mexico

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Nov 162015
 

It is now just over a year since the first locally locally transmitted cases of chikungunya were reported in Mexico. (Local transmission means that mosquitoes in Mexico have been infected with chikungunya and are spreading it to people).

Distribution of Chicungunya, as of October 2015

Distribution of Chikungunya, as of October 2015 (WHO)

The virus, first isolated in Tanzania in 1952, began to spread rapidly after an outbreak that originated in Kenya in 2004. By 2006, the virus had reached India, and by 2007 northern Italy. Imported cases were identified in Taiwan, France and the USA in 2010. In these stages, chikungunya was spread to new areas primarily by travelers infected with the virus.

The first locally-transmitted cases in the Americas were on the Caribbean island of St. Martin in 2013.

The chikungunya virus was first recorded in Mexico in October 2014 and has since spread rapidly from Chiapas through much of the country (map).

Incidence of Chikungunya, 2015, up to 24 October

Incidence of Chikungunya, 2015, up to 24 October. Data: SINAVE/DGE. Cartography: Geo-Mexico

As of 24 October 2015, 9423 cases have been reported in Mexico in total. The states most affected (in terms of number of cases) are Guerrero (1620 cases since October 2014), Michoacán (1548), Veracruz (1203), Oaxaca (1151) and Yucatán (1131).

Two mosquito vectors (Aedes aegypti and Aedes albopictus) are involved in the spread of chikungunya. Aedes aegypti is exclusively tropical in distribution, but Aedes albopictus also thrives in temperate climes, giving chikungunya the potential to spread virtually throughout the Americas.

The number of cases spikes with the rainy season since mosquitoes breed in stagnant water. Curiously, about two-thirds of the cases in Mexico have been in females, and only one-third in males. Presumably, this is due to differences in work and/or living habits, with females having greater exposure than males to the mosquitoes involved.

There is no vaccine to prevent chikungunya or medicine to treat the viral infection.

The most common symptoms of chikungunya virus infection are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. Joint pains can last months or even years. The disease is debilitating, but rarely fatal. Someone who has contracted chikungunya develops lifelong immunity (unlike dengue fever, where no such immunity exists).

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Medical tourism and the medical equipment industry in Mexico

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Jun 212014
 

Mexico is both a growing market for medical tourism and a world leader for the manufacture of medical equipment.

Growing market for medical tourism

The global market for medical tourism in 2013 was estimated to be worth about $2.847 billion, with some 7 million patients seeking medical treatment outside their home country each year. According to Patients without Borders, a U.S. business that specializes in the field, Mexico is currently the second most popular destination for medical tourists, after Thailand. Nationwide, Mexico has more than 71,000 doctors working in hospitals and private clinics. Almost two-thirds of all doctors in Mexico are specialists, compared to an average of 57.7% for all OECD member nations.

Mexico’s Economy Secretariat estimates that, combined, the one million medical tourists in 2013 and the numerous affiliated services such as spas, massages and non-conventional therapies, contributed $4.2 billion to the national economy. This figure is growing at about 7% a year.

Patients without Borders claims that patients from the USA and Canada pay between 36 and 80% less for operations and medical treatments in Mexico than the cost in their home country. The most important states for medical tourism are Nuevo León, Baja California, Baja California Sur, Sonora, Tamaulipas, Chihuahua, Jalisco, Quintana Roo and Yucatán.

A plan to build a new “medical city” has been announced by health officials in Quintana Roo. It would be called “Jardines de la Sabiduría” (Gardens of Wisdom) and located on a 550-hectare lot between Cancún and Puerto Morelos. The new city would have four zones: residential, hospitals, recreation and cultural/educational, and would include at least four hospitals: for children, cancer care, dental work and orthopedic surgeries respectively. It remains to be seen if sufficient foreign investment can be found to bring this project to fruition.

World leader for medical equipment

Mexico is a major manufacturer of medical devices. Sales of Mexican-made medical equipment exceed $10.6 billion a year and are predicted to reach $14.9 billion by 2020. Manufacturing costs for medical devices in Mexico average 25% below those in the USA, the world’s largest market for such products.

Major medical device manufacturing areas in Mexico

Major medical device manufacturing areas in Mexico. Credit: Economy Secretariat.

Mexico’s exports of medical equipment and supplies were worth $6.2 billion in 2011, making Mexico by far the largest exporter of medical devices in Latin America, and the 11th largest in the world. 92 % of medical devices manufactured in Mexico are exported to the USA, accounting for two-thirds of all U.S. imports of those products.

According to Pro-Mexico, Mexico is the world’s largest exporter of bore needles; the 4th largest exporter of medical, surgical, dental and veterinary furniture; the 5th largest exporter worldwide of medical,surgical, dental and veterinary instruments and apparatus; and the 7th largest exporter worldwide of ozone therapy, oxygen therapy, aerosol therapy apparatus, breathing apparatus and other respiratory therapy apparatus.

More than 2,000 separate businesses, and about 135,000 workers help invent, design and manufacture medical devices in Mexico. Medical device manufacturing is concentrated mainly in northern border states, especially Baja California, where the cluster of more than 60 specialist firms includes Smiths, Tyco Healthcare, Cardinal Health, Medtronic, Gambro, ICU Medical, CLP, Sunrise Medical and North Safety Products.

Data:

  • The Medical Device Industry, 2012 (Pro-Mexico; pdf file)

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Sep 172012
 

The 1991-96 cholera epidemic in Mexico originated in Peru in January 1991. It quickly spread northwards, reaching Central America by March and Mexico by July (see map). The cholera epidemic then spread slowly across Mexico before abating.

The spread of cholera in Mexico, 1991-1996

The spread of cholera in Mexico, 1991-1996 (Geo-Mexico Fig 18-6)

The incidence of cholera was much higher in the Gulf coast states than either inland or along the Pacific coast. By the time the epidemic was over in 1996, more than 43,500 cases had been reported in Mexico and 524 people had died.

Main Source:

PAHO 1997 (Pan American Health Organization) Cholera Situation in the Americas 1996, Epidemiological Bulletin, vol 18 (1)

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Medical tourism in Mexico, and where the Maya live

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Apr 222010
 

A few months ago, English journalist Rachel Rickard Straus wrote an article entitled “How I swapped a medical trial for a free holiday in Mexico” and published on the telegraph.co.uk website.

This is an interesting variation on the increasingly important field of medical tourism, much studied by geographers over the past decade or so. Several forms of medical tourism have been important in Mexico for a long time, mainly because of the significant price differential either side of the USA-Mexico border for almost all medical and dental procedures. Guadalajara was one of several cities where Americans could afford cosmetic surgery at the hands of (often) American-trained experts at a fraction of the cost back home, and were able to recuperate in relative luxury away from the preying eyes of family and colleagues.

Ms Straus appears to have thoroughly enjoyed her free holiday and apparently suffered no ill effects from the medical trial. Or did she?

Her article describes how she “lapped up the Mexican sunshine, admired the incredible Mayan pyramids and even took a road trip to San Miguel de Allende, a world heritage site.” This is fairly remarkable, since she managed all this without even leaving central Mexico! Presumably she actually meant either Aztec pyramids (if she visited El Templo Mayor in downtown Mexico City) or, much more likely the Teotihuacan pyramids, where Ms Straus had her picture taken. Archaeologists do not know all that much about the people who built the Teotihuacan pyramids, who are usually called simply Teotihuacanos. As any Mexican 5th grader knows, the Maya built their pyramids far to the east, in and around the Yucatán Peninsula, where sites such as Uxmal, Chichen Itza, Palenque, Calakmul and Tulum, among dozens of others, are proof of the Maya’s very considerable architectural skills.

The geography of cholera in Mexico

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Feb 282010
 

When Mexico braced herself for the imminent arrival of cholera from South America in 1991, many people believed that the disease had never previously been known here. However, during the 19th century, there were several outbreaks, including the epidemic of 1833 in which more than 3,000 people died in the city of Guadalajara alone.

A meeting of public health officials in January 1833 stressed the need for public areas to be regularly cleaned. This meeting called for the construction of six carts, to be used each night for removing the excrement left on street corners, since not all the houses had “accesorios” (toilets). This proposal reveals the unsanitary conditions which prevailed in Guadalajara at that time.

The epidemic struck in July, and peaked in August, when more than 200 people died of the disease each day. Sporadic cases dragged on into early 1834.

The shout of “Aguas!” (“Waters!”) as a warning of imminent danger, still used in many contexts today, actually dates back to when there was no sewage collection or provision. It was used to warn passers-by in the street below that the contents of “night buckets” were about to be emptied onto their heads…

In 1849 the city of Guadalajara feared a second epidemic. The authorities published a list of precautions that they considered essential, and a list of the “curative methods for Asiatic cholera.” At that time, the only major hospital in the city was the Hospital Belén. Its rival, the San Juan de Díos hospital, was “small and poorly constructed, insufficiently clean, and careless in waste disposal.”

The situation was made worse because  the  San Juan De Díos River was little more than an open sewer running through the center of the city. This river is now entirely enclosed and runs directly beneath the major avenue of “Calzada Independencia.”

Only two methods of sewage disposal were in use in 1850. Some houses took their sewage to the nearest street corner, where it was collected by the nightly cart for subsequent removal from the city. Other (higher class) houses deposited their sewage in open holes in the ground which allowed the wastes to separate, with the liquids permeating into the subsoil and the solids accumulating. Not exactly ideal in terms of public health!

The town council called for the construction of more of these latrines and for the activities of the night carts to be reduced.

The council also advocated increasing the air circulation in the city and simultaneously fumigating it. Authorities in Cuba had tried something similar in 1840, when they had spread resin, and fired batteries of cannons simultaneously, all over Havana! It was believed that the air housed cholera and other diseases and that it could directly affect the organism, through its “miasmas.”

The “Cuban solution” is tried in Guadalajara

In 1850, the epidemic began and the Guadalajara council voted to try the Cuban solution. On August 7th , at the height of the epidemic, fireworks, artillery and everything else were ignited – even the church bells were rung – in order to stimulate air movement and purification , “to increase the electricity in the air and reduce the epidemic.”

During the 1833 epidemic, various industrial plants, including ones making soap, starch and leather, had been closed, though no regulations were ever passed for their subsequent improvement. This time, in 1850, more drastic measures were taken. Tanneries had to construct their own watercourses, and their water was not allowed to collect and stagnate by bridges. Soap works were transferred out of the city completely. Despite these efforts, many stagnant pools of water would have lain on the city’s poorly constructed cobblestone streets: pools of water just waiting for an outbreak of cholera.

The police force was given the power to supervise everyone’s adherence to the regulations. Inspectors were appointed for each district or barrio to see that all “night activities” (carts included) terminated before 8:00 a.m., that sewage water was not used for the irrigation of plants, that gatherings were not too large, and that billiard, lottery and society halls all closed at the start of evening prayers.

A group of doctors was obliged to give its services free to anyone who needed medical help. The doctors apportioned the city among themselves and were told by the town council that they would be paid for their services as soon as council funds permitted. The main idea, of course, was to help the poor, perhaps not so much from any altruistic motives but to avoid any inconvenience to the rich!

Fortunately, any new outbreak of the disease in modern Guadalajara will be handled very differently to these 19th century epidemics. The excellent modern medical facilities in the city, and the large number of qualified doctors, mean that anyone unlucky enough to contract the disease should be able to get adequate treatment ensuring a full and speedy recovery.

This is an edited version of an article originally published on MexConnect

Click here for the complete article

Note: The diffusion of cholera in Mexico during the 1991-1996 epidemic is discussed, alongside a map showing the incidence of the disease, in chapter18 of Geo-Mexico: the geography and dynamics of modern Mexico.

Geo-Mexico also includes an analysis of the pattern of HIV-AIDS in Mexico, and of the significance of diabetes in Mexico.