Health and Wellness Minister Dr Christopher Tufton has countered a story in last Sunday’s Jamaica Observer which reported doctors claiming that he and his Chief Medical Officer Dr Jacquiline Bisasor McKenzie, were not open enough in providing statistics in respect of the correct number of dengue deaths.

According to the doctors, the number of people who have died from dengue was way more than the 66 officially reported as having died from the disease. The numbers, they claimed, were in the hundreds.

“This is patently untrue,” Dr Tufton shot back in a response sent to the Sunday Observer. “In fact, the ministry has, as a matter of record, been accountable and transparent in respect of the correct and verified number of such deaths.

No less than three press conferences have been held on the subject of dengue; in addition to the presentation of several parliamentary statements and numerous one-on-one interviews with various media houses.

“In most of those instances, the data have been presented and the collection process explained. We also make available our weekly surveillance bulletins online. Still, the article has cast aspersions on key functionaries of the ministry, and with potentially negative implications for the long-term success of the public health response to the ongoing dengue outbreak,” the health and wellness minister said. Here is his full response.

“As a Ministry of Health and Wellness, we are tasked with the promotion and protection of the health of the Jamaican population. To withhold data from the public on a critical issue such as dengue and at the time of an outbreak is to set ourselves up to fail to fulfil that mandate. This is not, nor will it ever be an acceptable outcome for the ministry and its leadership.

I was therefore taken aback by the article published in the Jamaica Observer of Sunday, December 15, 2019 and headlined ‘Worst Medical Crisis Ever: Doctors describe dengue outbreak as Caribbean’s greatest nightmare’.

Not only was it lacking the journalistic rigour one would expect on such a critical public health issue facing Jamaica and the Caribbean at this time, but it also called into question the credibility of named officials of the ministry, who were accused of not being “open enough” in providing statistics on dengue- related fatalities.

This is patently untrue. In fact, the ministry has, as a matter of record, been accountable and transparent in respect of the correct and verified number of such deaths. No less than three press conferences have been held on the subject of dengue; in addition to the presentation of several parliamentary statements and numerous one-on-one interviews with various media houses.

In most of those instances, the data have been presented and the collection process explained. We also make available our weekly surveillance bulletins online. Still, the article has cast aspersions on key functionaries of the ministry and with potentially negative implications for the long-term success of the public health response to the ongoing dengue outbreak.

The fact is that the ministry relies on the public trust to successfully do its work, and unsubstantiated articles such as these are decidedly unhelpful and downright reckless. In the particular instance, the officers of the ministry were not even provided the opportunity to respond or, at the very least, to have another officer do so in their stead.

It is necessary, therefore, to, once again, clarify the collection and verification process for dengue-related data, which have been captured by the National Epidemiological Surveillance System for decades, in line with international disease surveillance standards.

To begin with, dengue is a notifiable condition requiring medical practitioners to notify, on suspicion, the parish health department or the National Surveillance Unit (NSU) of the ministry, as stipulated in the Public Health Act. To be clear, the number of notifications are dependent on doctors reporting cases on suspicion, and the NSU can only report on what is notified. Many practitioners do not report and, therefore, the numbers can only reflect trends in the population.

Meanwhile, all notifications of dengue — which form part of the Integrated Arbovirus Surveillance System that also accounts for chikungunya and Zika — are reviewed by a medical doctor in the NSU. They are classified as dengue when the World Health Organization/Pan- American Health Organization (PAHO/WHO) case definition, which can be accessed at www.moh.gov.jm/dengue-facts/media/paho-guideline-2016-Dengue-469.pdf, is met.

At this point in the surveillance system the classification is of suspected dengue. If a Polymerase Chain Reaction (PCR) blood test is positive for dengue, then the classification is elevated to confirmed dengue. However, if non-PCR blood tests suggest a recent infection, then the classification is considered presumed dengue.

All dengue-related deaths in health facilities are reported. In addition, for those deaths that may occur outside of hospitals, doctors are required by law to report them. However, in case a report is not done, the NSU receives reports from the Registrar General’s Department where dengue is listed as a cause of death.

Dengue-related deaths on notification are reviewed by at least two medical doctors in the NSU for a preliminary classification. These are then referred to the expert panel of consultant doctors who deliberate over each case and classify, based on the WHO/ PAHO case definitions.

That panel is comprised of eight physicians with specialisations in paediatrics, internal medicine, infectious diseases, emergency medicine and medical epidemiology, and include the chief medical officer and the chief nursing officer. Together they also assess for any delays or problems in the management of the dengue cases and make recommendations for improvement.

Meanwhile, if a PCR blood test is positive for dengue, the classification becomes confirmed dengue-related death. If no confirmatory test result is available, the death is classified as a dengue-related death if it meets the case definition.

Data are entered daily into the ministry’s Surveillance Module of Electronic Patient Administrative System and reports are generated twice weekly. The reported trends and the numbers for suspected, presumed and confirmed cases are presented to the public unchanged. These data give an accurate characterisation of the current dengue situation in Jamaica, which reflect the trends observed in the Americas and globally.

The ministry wishes to assure the public that at no time would any member of its leadership deliberately provide them with misleading data, and certainly not during an outbreak when all are at risk. Now is the time to give the public the full information as we have it and to make ourselves available to answer any questions that they may have; and we have been doing so.”