At the start of the Roundtable discussion on the impact of arboviruses on the health of the Cuban population. Dr. Ileana Morales Suárez, National Director of Science and Technological Innovation at the Ministry of Public Health (MINSAP), reported that chikungunya presents a dynamic scenario in 2025. With very high transmission rates in 40 countries worldwide.
The director pointed out that this disease, like COVID-19, shares a common factor: a vector that produces “a significant number of severe cases and, in some cases, deaths.” She explained that its emergence and spread in Cuba are due to global triggering factors.
Among these factors, she identified, first and foremost, climate change. “High temperatures directly influence the vector. The more heat, of course… the heat, the humidity,” she specified. Secondly, she mentioned the high level of urbanization existing both globally and in Cuba. As a third element, she highlighted the high population mobility, citing the example of COVID-19. “It started in one place in China and within days, and then months, it was all over the world.” The fourth factor is the presence of “a vector capable of transmitting the disease. With a high prevalence in many countries.”
Factors that led to the epidemiological collision in Cuba
Dr. Morales Suárez explained that, in addition to global factors, there were specific conditions in Cuba. The country had “a high level of susceptibility. We were all susceptible because we had not yet encountered the vector.” She explained that the epidemic occurred due to a “coalition” where the vector and a particularly vulnerable population converged.
This vulnerability, she added, is due to “a high rate of population aging. Where practically one in four Cubans is 60 years of age or older. Generally, older adults have one, two, or even three underlying health conditions.” She added that environmental problems also contribute to the vector’s reproduction. Also the “lack of hygiene… accumulated garbage, stagnant water… and other practices.”
“When these four factors come together, they create a collision,” she summarized. “So, this is where we found such a susceptible population. Evidently… that’s why we have such high numbers of disease cases.” However, she pointed out that they are facing a known disease for which there is an established protocol. Similar to the strategy followed with COVID-19.
Activation of the Scientific System and Initial Health Interventions
Following the working model implemented during the COVID-19 pandemic. The Innovation Committee was reactivated. “From here on out, the committee is activated… with tremendous frequency and speed, just like with COVID,” the director stated. This mechanism guarantees “scientific rationale” for proposed interventions and studies. Always respecting ethical and regulatory components.
Showing a record, she reported that “five new research projects were approved this week, and we have new research projects in preparation.” These include “new product development, clinical studies, already proposed clinical trials. Complex health interventions” and research to better characterize the virus’s behavior in Cuba.
The first health interventions will focus on older adults and will begin in Havana. Stratified by the epidemiological situation of each municipality. One immediate intervention will be “the administration of Biomodulin T to older adults between 70 and 74 years of age.”
Simultaneously, influenza vaccination will begin for those over 75 years of age in the capital. As well as for residents of social and health institutions. “We decided to cover that 70-74 age group with Biomodulin,” he explained. Another planned intervention involves the product Curmeric, which “will be distributed to a population group in Havana… between 60 and 69 years of age.”
All these interventions will be accompanied by studies to gather data on their effectiveness. A Call for Civic Responsibility and Updated Protocols
Dr. Morales Suárez called on the public to avoid self-medication and seek medical attention. “Medical evaluation is irreplaceable,” she emphasized. “You can read a chart, some medical information. But the doctor’s eyes, the doctor’s examination… not all patients are the same. Therefore, not everyone is at the same risk.”
Also she warned about the dangers of self-medication based on information from social media. “That carries risks, even life-threatening ones… there are very high-risk individuals staying home, and their lives are in danger.”
Regarding the protocols, she reported that an improved version (protocol 1.2) is now available. Incorporating the knowledge accumulated in recent months, including strengthened sections for patient care.
How does the disease behave?
During another segment of the Roundtable discussion, Dr. Osvaldo Castro Peraza, an expert from the Pedro Kourí Institute of Tropical Medicine (IPK), explained that chikungunya presents more visible and widespread symptoms than other arboviral diseases. “For every 10 or 15 people infected with dengue, only one shows symptoms. With chikungunya, for every 10 infected individuals, nine develop the disease,” he noted. This difference, he emphasized, leads to “a significant number of cases” and increases the magnitude of outbreaks. Which can manifest in multiple forms, including severe ones.
The specialist stressed that this is not a disease that ends in seven or fifteen days, but rather one that continues its inflammatory course. Affecting the joints and potentially impacting multiple organs.
Among the characteristic symptoms, he mentioned that chikungunya fever “is among the most severe of arboviral diseases,” and can be preceded by joint pain and accompanied by debilitating arthritis “that affects virtually all joints symmetrically.” Skin rashes, conjunctivitis, and lymphadenopathy may also occur in some cases.
As part of the more serious manifestations, the doctor warned that neurological problems such as meningoencephalitis, myelitis, and Guillain-Barré síndrome. As well as cardiovascular complications, can also appear.
“A chikungunya patient must rest because their organs are damaged. If they engage in physical activity. They risk suffering an arrhythmia or another cardiovascular event,” he stated. Other possible complications include liver and kidney damage, hemorrhagic episodes, and severe dermatological lesions.
Castro Peraza emphasized that self-care begins with individual responsibility: seeking medical attention and avoiding physical activity during the acute phase. “When joint symptoms are less debilitating, we tend to be more adventurous with activities. And that shouldn’t be the case,” he warned.
Regarding the clinical course, he explained that the acute phase extends from the first day to the third week. This is a period in which inflammation is active. So the patient requires close monitoring and, in many cases, home care.
Hospitalization is necessary for elderly adults living alone or with comorbidities, infants under one year old, pregnant women, and those who present with persistent high fever for more than three days. Moderate or severe dehydration, decompensation of comorbidities, behavioral disturbances, disorientation, or inability to care for themselves.
The subacute stage, from three weeks to three months, maintains joint inflammation without severe symptoms. “Most people will improve within three months,” the doctor assured. Although he acknowledged that a small group may develop chronic conditions, with persistent pain or synovial fluid effusions.
Regarding treatment, he specified that the acute phase requires complete rest, hydration, and relief of fever and pain. Paracetamol and dipyrone are the first-line analgesics, while tramadol is reserved for second-line treatment. He noted that aspirin is contraindicated and that ibuprofen or similar medications are not recommended during this stage.
In the subacute phase, nonsteroidal anti-inflammatory drugs (NSAIDs)—such as ibuprofen—can be used for a period of seven to ten days. Prednisone can be prescribed for five days at low doses, although “not all patients need it.”
For the chronic stage, he pointed out that care should be provided by multidisciplinary teams and rheumatology specialists, focused on managing persistent pain. He added that the virus affects the peripheral nerves, so “B vitamins help alleviate these effects.”
High Surveillance in the Pediatric Population
Dr. Lissette López González, head of the National Pediatric Group, warned of the need to remain vigilant for any symptoms in children under five years old. Describing the disease as “highly symptomatic.” She explained that the current protocol mandates hospital admission for all patients under two years of age.
For children older than two, the decision to admit is based on the “pediatric evaluation,” a clinical tool that allows for the detection of warning signs. “These are routine medical practices that require no supplies or medical technology. Only a physical examination,” the specialist stated.
Dr. López González pointed out that newborns, and among them, infants under three months old, bear a “significant burden” in terms of the morbidity and severity of the disease. Due to their immunological immaturity, physiology, and anatomy. “This is a virus that affects all organs and systems, is highly symptomatic, and has a very long duration of expression,” she emphasized.
Among the most frequent atypical cases in neonatal and pediatric wards, she identified difficult-to-manage seizures and central nervous system infections. In light of this, Dr. Lissette López González made an urgent appeal against self-medicating children and emphasized prioritizing hydration. As it “influences temperature control” and “has a significant impact on reducing inflammation and lubricating joints.”
She also clarified that “there is no documented evidence that breastfeeding is a route of transmission for the virus,” and therefore advised against discontinuing it.
Moreover she stressed that the pediatric age range extends from birth to 18 years, and “this gives us a wide range of clinical variables. Adolescents share many similarities with adults, but we have observed that young children have presented with very unique characteristics.” “The golden rule in pediatrics lies in being able to clearly define the difference between the common symptoms described in most patients and those patients who have risks, warning signs, or severe symptoms,” the specialist emphasized.
Why are newborns such a cause for concern? “Well, logically, because of their immaturity, their limited resources when facing a viral disease that has a significant systemic impact,” she said.
Jusvinza: A Cuban drug being studied for chikungunya
For her part, Dr. María del Carmen Domínguez Horta, a researcher at the Center for Genetic Engineering and Biotechnology (CIGB), explained the potential of Jusvinza, a drug originally created for rheumatoid arthritis and later used in more than 15,000 patients with Covid-19, with a recovery rate exceeding 85 percent.
Domínguez Horta indicated that, given that chikungunya is characterized by severe joint pain, Jusvinza—whose active ingredient is an immunomodulatory peptide—could be useful. However, she emphasized the ethical responsibility of not using a medication without prior studies for that specific indication.
“Clinical trials and studies with this medication are currently underway […] at the Justino Pérez Hospital in Matanzas,” he confirmed. “As scientists, we believe that Jusvinza may help reduce pain, but this is a hypothesis that must be corroborated by studies. If so, Jusvinza will be incorporated into the protocols.”
Comprehensive Protocol and Vector Control
At the program’s conclusion, Dr. Ileana Morales Suárez, National Director of Science and Technological Innovation at the Ministry of Public Health (MINSAP), explained that the national protocol for addressing this arbovirus is structured around three scenarios, similar to those used for COVID-19: prevention, treatment, and rehabilitation.
It was also emphasized that vector control, through extra-domestic sanitation and family responsibility, is a fundamental pillar of primary prevention. Especially for protecting infants, identified as a highly vulnerable group.
With information from Arleen Rodríguez Derivet, Claudia Fonseca Sosa, Yilena Héctor Rodríguez, and Frank Martínez Rivero
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