An increase in the number of suspected dengue cases in Timor-Leste in 2012, compared with the same period last year, has prompted government health and sanitation warnings.
The mosquito-borne virus causes flu-like symptoms known as dengue. If not properly treated, the more severe form of the disease, known as dengue haemorrhagic fever, has harsher symptoms and can be fatal.
As of 24 February, the Ministry of Health had received 563 reports of dengue (161 confirmed by laboratory tests) in every district except one, including 192 reports of dengue haemorrhagic fever that causes severe abdominal pain, vomiting and in worst cases, death.
This is a 36 percent increase over reports for the first two months of 2011.
As of 1 March, 10 people had died from dengue, according to the government.
"Those who died, their families brought them too late to the hospital for treatment, which includes intravenous medication," Vice-Minister of Health, Madalena Hanjam, told IRIN.
At Guido Valadares National Hospital in the capital, Dili, Jacob Fernandes - whose family lives in a densely packed neighbourhood on the capital's outskirts, Bairo Pite - said he had never heard of dengue before his son's diagnosis. When the two-and-a-half-year-old developed red skin patches and a bloody nose last week, a local clinic gave him aspirin.
"We tried to take him to a clinic for blood tests but the lab tests did not reveal dengue. They [health workers] said my child had a normal fever and gave him aspirin." When his condition did not improve, Fernandes took him to the hospital where he was diagnosed with dengue and was recovering on 1 March.
There is no vaccine or specific treatment for dengue, but early detection and access to proper medical care lower death rates to less than 1 percent, according to the World Health Organization (WHO).
Too-small drains impeding water flow, litter-strewn streets and overcrowded housing that have all expanded breeding grounds for mosquitoes explain the virus's resurgence nationwide, said Hanjam.
Dili, the country's most populated district, has been most affected, followed by Manatuto in the north and Bobanaro in the east.
Infected mosquitoes - drawn to crowded city spaces - breed mostly in man-made containers, such as water jugs, flower pots, water tanks, tyres or discarded food containers, Hanjam said.
"We will also appeal to anyone who consumes food such as rice in public places to please wrap up the container and throw it in the [rubbish] rather than tossing it just anywhere where it can become a place for mosquitoes to lay eggs."
But even proper sanitation is no guarantee against infection, noted WHO's representative in Timor-Leste, Jorge Mario Luna.
"Even countries/cities with good practices, such as Singapore, have difficulties controlling dengue as it is virtually impossible to identify all the places where rainwater stagnates, favouring the breeding of the mosquito," he said.
There were 419 reported infections in Singapore as of 24 February 2012, about the same number of cases as last year. Australia has recorded a 30 percent increase.
Eliminating infected mosquitoes' eggs is "virtually impossible", forcing health workers to focus on reducing infections and providing healthcare to patients, said Luna.
According to the WHO, dengue is the most common mosquito-borne viral disease in humans. An estimated 2.5 billion people - two-fifths of the world's population - are at risk, with an estimated 50 million dengue infections worldwide annually.