Health authorities are staying tight-lipped on reported dengue cases, as numbers increase across the Maldives.

The Health Protection Agency (HPA) refused to reveal statistics for this year so far, while a spokeswoman said there were no confirmed cases of dengue-related deaths reported to them.

However, the Maldives Independent has received unconfirmed reports of two dengue-related deaths this year, including a foreign worker at a resort.

The HPA released a national level dengue alert last week and called on people to take precautions. Annual dengue outbreaks occur across the country with the start of the rainy south-west monsoon.

Prevention and control of the illness solely depends on effective control of mosquito breeding.

The dengue-transmitting mosquitoes thrive in areas with standing water, including puddles, water tanks, containers and old tires. Lack of reliable sanitation and regular garbage collection also contribute to the spread of the mosquitoes.

Symptoms include fever, headache, muscle and joint pains, and a rash.

“Reported cases are increasing across the country and there are cases from resorts as well,” said a HPA source, who wished to remain anonymous.

The source added that the tourism board should warn resorts in the wake of the HPA alert and that a referral system was in place to treat serious dengue cases.

“We are working with hospital staff to identify dengue, as some cases are asymptomatic,” the source told the Maldives Independent. “In severe cases, health centres refer patients to atoll hospitals and they can refer to IGMH (Indira Gandhi Memorial Hospital). ”

The source added that the agency was holding clinical management and review workshops with the help of the state-owned hospital IGMH in the capital and were distributing appropriate materials for dengue care throughout the Maldives.

The agency is also holding ‘dengue and vector’ surveillance workshops in the atolls. Dengue task-forces have been created in atolls, led by atoll councils and supported by police and hospitals.

“We want to start cleaning potential breeding grounds for mosquitoes before a case is reported, so cases can be prevented,” the source said. “Once a case is reported we check the area around the house and neighbourhood to keep it clean from contaminated water.”

— ‘Surviving among trash’ —

Last month Malé city council warned about the risk of disease outbreak due to increased litter in the capital’s streets.

The city council mayor said the housing ministry was not doing enough since seizing control of waste disposal and dengue prevention three years ago.

“We used to cancel permits on construction sites if it was not clean of mosquito breeding grounds, but you don’t see that happening now. Construction sites are not inspected by the ministry,” said Shifa Mohamed.

The HPA source also identified construction sites as a challenge for dengue prevention in Malé.

“The ministry took our staff, budget and facilities,” said Shifa. “So we aren’t able to do enough anymore. For seven years we survived among Malé’s trash. Now in an election year the government announced they have a million dollar budget for waste management. How many kids have died? How many kids faced difficulties because of all the mosquito breeding spots?”

Several people died in 2016 because of dengue, including a seven-month old boy and a 61-year-old woman. There were 1,789 reported cases that year.

Figures for 2017 are unavailable. But annual reported cases of dengue have fluctuated in recent years, from 2,909 cases in 2011 to 775 in 2015 and 1,809 in 2015.

A severe outbreak of dengue in 2011 saw a high of 12 deaths. In 2006, 10 people died of dengue.