The morning at the emergency room of the Mártires de Las Tunas pediatric hospital had the same hectic pace as always. But when the 2-month-old girl arrived with a very high fever, a large team of doctors immediately mobilized around her. The incidence of arboviruses, specifically chikungunya, would mark new ways of acting.

The baby was complaining all the time. Her blistering lesions, which immediately began to spread, were the doctors' greatest concern. The little girl looked like she had been badly burned, because the plaques were converging and she was losing all her epidermis. She was practically exposed.

Drawing on her vast experience, Dr. Yaneisi Salina Medina, deputy director of Medical Care at that institution, confesses to 26 that this case was striking because of its unusual nature. “Based on what was already being reported about chikungunya and the training we had received on this practically new disease, we took on her treatment,” she says.

She assures that the dermatology team, the caumatologists, and the intensive care unit, where she was admitted, immediately reached a consensus. The protocol was effective, the baby responded well to antibiotics, and the skin lesions, thanks to the compresses and gentian violet treatment, evolved favorably.

“I remember that the girl also had joint inflammation in her feet and hands. But despite everything, she never stopped breastfeeding, and that benefited her. She spent several days in intensive care; fortunately, today her life has been saved. Her case alerted us, and from then on, we knew exactly how to act in similar situations that arose later.”

THE SMALLEST FACES OF THE DISEASE

Salina Medina considers 2025 to be a very demanding year in terms of mobilization and updating protocols. Undoubtedly, arboviruses endangered the most cherished link in every household of Las Tunas.

“During that period, the Emergency services treated 5,409 patients with feverish syndromes or suspected arbovirus infections. Generally, when children have a fever and no other accompanying symptoms such as a cold, parents worry and bring them in. That is a reality, although we know that there is underreporting because others stay home with the illness without reporting it,” she points out.

She claims that they counted those children who came in with a fever and were suspected of having a disease transmitted by mosquitoes of the Aedes family. They included suspected dengue, oropouche (which was present at one time of the year), and finally chikungunya.

“Of the total number of patients seen, 1,128 cases were admitted,” says the deputy director. We admitted children under 2 years of age, as per protocol, and those over that age with any comorbidity, whether respiratory, cardiovascular, hepatic, or renal, as well as diabetics, malnourished children, etc."

"We admitted them to a service we have for that purpose, the fever ward. We only studied 839 of them, because the suspicion was ruled out or they were not due for testing. We performed the IGM on the sixth day to confirm dengue and the PCR on the fifth day for chikungunya."

“There were 247 positive cases of dengue. By age group, those aged 1 to 4 and 5 to 9 had the highest incidence.”
The doctor draws attention to infants under 1 year of age, an age at which the utmost care and extreme prevention are required, as in 2025, three were admitted to intensive care with suspected dengue and presented serious health complications.

Regarding the most affected areas, she points out that the Gustavo Aldereguía polyclinic had the highest number of positive cases. Similarly, the Aquiles Espinosa and Manuel (Piti) Fajardo polyclinics had considerable numbers, as did areas belonging to Majibacoa, Manatí, Jobabo, and Colombia.

LAND OF CHIKUNGUNYA

“The chikungunya alarms began in the last quarter,” says the doctor. We have only counted 22 cases to date, as there are many others yet to be reported by the Pedro Kourí Institute of Tropical Medicine (IPK in Spanish).

"We intend to study younger children. We were struck by the clinical characteristics they presented. They began to arrive with fever, severe general malaise, and irritability, which led us to suspect that they might have complications from encephalitis."

"We also saw a lot of skin lesions, which were blistering, bullous, and badly infected, sometimes looking like large burns because they progressed rapidly and spread over the body."

"In children, although joint pain is present, it is not the most prevalent symptom as it is in adults. In children under 1 year of age, the most frequent signs have been fever and irritability, which in many cases lead us to suspect sepsis, because they have alterations in the pediatric assessment triangle, and we treat them as such until proven otherwise."

“There have been cases of secondary encephalitis due to chikungunya. They had high sensor readings, and many arrived convulsing, meaning that this has not been a disease that has run its course without complications in pediatric patients; quite the contrary.”

QUICK ANSWERS

"As soon as the disease began to manifest itself, we organized the protocol for action. Any patient with symptoms, along with suspicious relatives, with fever or irritability, skin lesions, rash, headache, myalgia, arthralgia... we assumed it was a suspected case and, if necessary, due to protocol or comorbidities, they were admitted.

"We decided to provide training because we were dealing with a disease that was new to us. Although it had ravaged the Americas and was well known, Cuba was facing it for the first time on such a large scale. The protocol was established, classifying the disease into acute, subacute, and chronic phases."

"The acute phase ranges from the first day symptoms appear to day 21. The subacute phase lasts up to three months, and the chronic phase covers the time after that. Surveillance up to the seventh day was particularly important, as this was when symptoms most often appeared in children, and we therefore provided them with greater protection and hydration."

"We trained ourselves, and today we can say that to date we have had no deaths from this cause. As the weeks have passed, we have been able to evaluate the situation carefully and establish a treatment strategy that facilitates the follow-up of cases."

"Fortunately, children recover better than adults. They have needed less physical therapy and have had fewer sequelae in terms of the disability caused by the disease. In this regard, we have seen a few cases in our consultations."

"Concerning adolescents, the group with the highest morbidity nationwide, this was not the case in Las Tunas. Here, the most significant complications were in children under 2 years of age. Although I must report that on occasions, the family left them in our care because they were older, and some even arrived with disorders of consciousness. We always warn that everyone in the pediatric age group must be cared for."

...

At the Mártires de Las Tunas Hospital, there is currently a general decline in arbovirus incidence. However, they remain vigilant, and the healthcare staff is now much better equipped to deal with any eventuality.

Dr. Yaneisi speaks today of a journey marked by great challenges. “We have had to learn to deal with all arboviruses; we are researching the disease, and we continue to follow the lead of science. We have also managed to make the population more receptive to guidance, which is essential for reducing complications in children.”