In November in Southern Taiwan, the winds are cool and there's no sign of winter. But with the arrival of dengue fever, the warmth of the sun is more cause for concern. If the temperature is too high, mosquitoes won't die this year. . . .

The first case showed up last September and spread fast. Although no new cases appeared in the next six months as winter came and went, several areas in the south were struck again this July, and the situation has become very serious in specific districts. The illness is spreading toward the north. That this illness, associated with lack of attention to hygiene and the environment, should reappear on Taiwan after all these years is extremely disquieting.

While young people are unaware of dengue fever, elders are not. Taiwan was hit by the illness from 1942 to 1944, when five million of the island's six million inhabitants suffered. Its only other appearance was on Hsiaoliuchiu, in 1981, when 81 percent of residents were hit.

While the death rate is slight, the illness causes high fever and severe pain over the entire body. Later stages may include the measles, itching so annoying that it prevents sleep, and hematoma or bruising. There is no inoculation and ordinary pain relievers are useless. And after the one week which the illness takes to run its course, one must still rest for a considerable time to overcome the exhaustion.

A bigger danger is the possibility of hemorrhagic disease with fatality rates from ten to fifty percent. In theory, this develops with the overlapping recurrence of the four types of dengue fever virus over a five-year period. In fact, though only the first type has hit Taiwan, many cases are very serious and some include hemorrhaging.

Dr. Tsai Ching-yang of Juan Hospital goes further to explain that the illness can reduce the number of blood platelets and affect the functioning of the liver. Several victims have had their paltelet level drop so low that a danger existed of hemorrhaging over the entire body, requiring emergency transfusions and use of coagulants. Three have been admitted to intensive care.

While as yet no deaths are directly attributable to the illness, three deaths may have been caused indirectly. Fortunately, the level of medical care on Taiwan is high, so that the high death rates characteristic of Southeast Asia are not likely to appear here.

Importantly, the most common carrier in the south is the Aedes aegysti mosquito. Its sensitivity to viruses is low, so that it only picks up the more serious forms. It thus makes for more serious cases than the Aedes albopictus mosquito, the other major carrier.

Right now deaths are far fewer than anticipated. Unfortunately, whether one merely feels like one has the flu, develops severe pain, or begins massive hemorrhaging, depends on one's constitution, the number of times infected, or mutations in the virus, factors for which medical science can offer no help.

The disease is now one that must be reported; out of Kaohsiung's population of 1.35 million, 5,000 cases have been reported. Kaohsiung has many open areas and construction sites which provide ideal breeding grounds after it rains. In response, the city has mobilized, with the Bureau of Construction sending out inspectors to building sites, the army dispatching soldiers to clean up open areas, and numerous civic groups participating in education campaigns.

But prevention work is by no means easy. The first problem is just ascertaining the number of cases; many small clinics may not report cases rigorously, so that it is possible there are really more than 30,000 cases. The second problem is lack of funding and staffing. And even where staff exists, investigators are often unwelcome. Some housewives feel insulted at being investigated, and just say, "My home is very clean; there are no mosquitoes here!" For others getting the illness is a matter of fate, and there's no point trying to do anything. Still others are reluctant to believe that the ever-present, tiny mosquito is responsible for this sudden epidemic.

"In fact, people are really afraid of and care about getting such a painful illness as dengue fever; but trying to get them to understand the overall situation, to lift a hand to protect themselves or protect others, now that's difficult," says Dr. Han Ming-jung.

While most people know that you get the illness from mosquitoes, they don't know that after getting the illness it is even more important to use mosquito netting and repellent and to avoid large open spaces to avoid giving the disease to a mosquito who may bite one person, pick up the illness, and pass it on to a second person.

Chemical prevention (insecticide) cannot eradicate the mosquitoes. Since it is sprayed in the air, it only affects full adults; even then most reside in hard-to-reach places where spraying is unlikely to be effective. Larvae remain unaffected. Further, not only can spray have side effects, the mosquitoes may develop a resistance to it, so that its disadvantages outweigh the advantages.

From Singapore's fourteen-year battle to eradicate dengue fever it can be seen that a comprehensive effort is required, including public hygiene and cleanliness, education, and legislation.

The only way to eradicate the carriers is to eliminate their breeding places, since each female can produce 60 to 80 offspring a week. The mosquitoes breed wherever water collects: under refrigerators or sinks, in vases, in old tires or discarded bottles. Only the general public can insure that these places are eliminated or remain mosquito-free; the government can only look after places no one else is responsible for. People must clean containers thoroughly and change the water often, and use covers or fill in with sand places where water collects. Easy to say, hard to do.

In Singapore the government fined households which had too many mosquitoes. That is not likely to work on Taiwan, where the habit of respecting the law is less common. Besides, government standards on Taiwan are much less strict than in Singapore.

Scholars believe dengue fever has already become "domesticated" and can only be wiped out with a long-term, cooperative effort on the part of the government and the public. In the process, perhaps both will learn from their errors and disappointments and know each other better; only then could this experience have a valuable meaning.

[Picture Caption]

Even in a Prosperous city, there are dirty areas all over where water can collect. This photo is of the fire escape between two large building s.

Workers at the Kaohsiung County Department of Environmental Sanitation are busy putting together test samples to send to the Institute of Preventive Medicine of the Department of Health of the Executive Yuan.

The main victims of dengue fever this time have been healthy young people between twenty and forty.

Basins and pots must be turned over or covered, and even the water basin beneath the fridge must be periodically brushed clean.

The Aedes aegysti and the Aedes albopictus are both active during the day, so it is necessary to use mosquito repellent, hang mosquito netting for afternoon naps, and use repellent incense.

After it rains, look carefully: bamboo sections, holes in trees, coconut shells, calyxes that fall to the ground--there is no place the larvae can't be!

Workers from the Department of Environmental Protection, in full combat gear, root out the enemy in house-to-house fighting. (photo courtesy of the Kaohsiung City Department of Environmental Protection)

These devices designed to attract mosquitoes to lay their eggs there include a chemical to kill the larvae. These are placed in homes in affected areas and observed for a year--a new method of dealing with the dengue carriers. (photo courtesy of the Kaohsiung City Department of Environmental Sanitation)

Workers at the Kaohsiung County Department of Environmental Sanitation are busy putting together test samples to send to the Institute of Preventive Medicine of the Department of Health of the Executive Yuan.

The main victims of dengue fever this time have been healthy young people between twenty and forty.

Basins and pots must be turned over or covered, and even the water basin beneath the fridge must be periodically brushed clean.

The Aedes aegysti and the Aedes albopictus are both active during the day, so it is necessary to use mosquito repellent, hang mosquito netting for afternoon naps, and use repellent incense.

After it rains, look carefully: bamboo sections, holes in trees, coconut shells, calyxes that fall to the ground--there is no place the larvae can't be!

Workers from the Department of Environmental Protection, in full combat gear, root out the enemy in house-to-house fighting. （photo courtesy of the Kaohsiung City Department of Environmental Protection）

These devices designed to attract mosquitoes to lay their eggs there include a chemical to kill the larvae. These are placed in homes in affected areas and observed for a year--a new method of dealing with the dengue carriers. （photo courtesy of the Kaohsiung City Department of Environmental Sanitation）