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Health officials tell US doctors to be alert for dengue as cases ramp up worldwide

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Health officials tell US doctors to be alert for dengue as cases ramp up worldwide
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Health officials tell US doctors to be alert for dengue as cases ramp up worldwide

2024-06-26 21:43 Last Updated At:21:50

NEW YORK (AP) — U.S. health officials on Tuesday warned doctors to be alert for dengue cases as the tropical disease breaks international records.

The virus, which is spread by mosquitoes, has been surging worldwide, helped by climate change. In barely six months, countries in the Americas have already broken calendar-year records for dengue cases.

The World Health Organization declared an emergency in December, and Puerto Rico declared a public health emergency in March.

Dengue remains less common in the continental United States, but in the 50 states so far this year there have been three times more cases than at the same point last year. Most were infections that travelers got abroad, and officials note there is no evidence of a current outbreak. But they also warn that local mosquitos pose a threat.

In its health alert Tuesday, the Centers for Disease Control and Prevention advised doctors to know the symptoms, ask questions about where patients recently traveled and consider ordering dengue tests when appropriate.

Dengue (pronounced DEHN'-gay) is caused by a virus spread by a type of warm weather mosquito that is expanding its geographic reach because of climate change, experts say.

Many infected people don’t get sick, but some experience headache, fever and flu-like symptoms. Severe cases can involve cause serious bleeding, shock and death.

Repeated infections can be especially dangerous.

There are four types of dengue virus, simply known as 1, 2, 3 and 4. When someone is first infected, their body builds antibodies against that type for life. If they get infected with another type of dengue, the antibodies from the first infection may fail to neutralize the second type — and actually can help the virus enter immune cells and replicate.

That's a concern in Puerto Rico, which for the last two decades has been widely exposed to type 1. Last month, the island reported its first dengue death of the year.

“We’re currently seeing is increases in the cases due to dengue 2 and dengue 3, for which the population has very little immunity,” said Dr. Gabriela Paz-Bailey, the Puerto-Rico-based chief of the CDC's dengue branch.

There is no widely available medicine for treating dengue infections.

Vaccines have been tricky. U.S. officials in 2021 recommended one vaccine, made by Sanofi. The three-dose vaccine is built to protect against all four dengue types and is recommended only for children ages 9 to 16 who have laboratory evidence of an earlier dengue infection and who live in an area — like Puerto Rico — where dengue is common.

Given those restrictions and other issues, it hasn't been widely used. As of late last month, only about 140 children had been vaccinated in Puerto Rico since shots became available there in 2022, and Sanofi Pasteur has told the CDC it is going to stop making the vaccine.

A different vaccine made by the Tokyo-based pharmaceutical company Takeda is not currently licensed in the U.S. Others are in development.

Across the world, more than 6.6 million infections were reported by about 80 countries last year. In the first four months of this year, 7.9 million cases and 4,000 deaths have been reported, according to the World Health Organization. It's been particularly intense in the Americas, including in Brazil and Peru.

In the United States, the numbers have been far more modest — about 3,000 cases last year in U.S. states and territories. But it was the worst in a decade, and included more infections that occurred locally, courtesy of native mosquitoes. Most were in Puerto Rico, but about 180 were in three U.S. states — Florida, Texas and California.

So far this year, there have been nearly 1,500 locally-acquired U.S. cases, nearly all of them in Puerto Rico.

Most cases in the continental U.S. continue to be people who were infected while traveling internationally.

It's "a traveler's nightmare” and a growing international concern, said Dr. Lulu Bravo, who studies pediatric tropical diseases at the University of the Philippines Manila and who has worked with Takeda on its vaccine.

“When you have an outbreak in a country, tourists might not want to come,” Bravo said.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

FILE - This 2003 photo provided by the Centers for Disease Control and Prevention shows a female Aedes albopictus mosquito acquiring a blood meal from a human host. Dengue, a tropical illness caused by a virus, is spread by Aedes mosquitos, a type of warm weather insect that is expanding its geographic reach because of climate change, experts say. (James Gathany/Centers for Disease Control and Prevention via AP, File)

FILE - This 2003 photo provided by the Centers for Disease Control and Prevention shows a female Aedes albopictus mosquito acquiring a blood meal from a human host. Dengue, a tropical illness caused by a virus, is spread by Aedes mosquitos, a type of warm weather insect that is expanding its geographic reach because of climate change, experts say. (James Gathany/Centers for Disease Control and Prevention via AP, File)

ATLANTA (AP) — A federal judge on Friday sentenced former Georgia Insurance Commissioner John Oxendine to serve three-and-a-half years in prison after Oxendine pleaded guilty to conspiracy to commit health care fraud.

U.S. District Judge Steve Jones had one question for the 62-year-old Republican, who was elected four times to the office before mounting a failed run for governor:

"Why?"

As Jones noted at a hearing in Atlanta, Oxendine only personally gained $40,000 from the scheme, although Jones ordered him to pay a $25,000 fine and to share in $760,000 in restitution with Dr. Jeffrey Gallups, who pleaded guilty to health care fraud before he could even be indicted.

Oxendine answered that he is “too much of a pleaser” and said he was trying to make his client Gallups happy.

That meant that Oxendine stood up before doctors who worked for Gallups at a September 2015 meeting at a Ritz-Carlton hotel in Atlanta and urged them to order unnecessary medical tests on patients and bill insurers, Oxendine said. It also meant Oxendine devised a plan to collect $260,000 in kickbacks from medical testing company Next Health through his consulting firm and funnel most of the money to Gallups, prosecutors said. Oxendine paid a $150,000 charitable contribution and $70,000 in attorney’s fees on Gallups′ behalf, prosecutors said.

Oxendine noted that his father, who was legally blind, served as a Gwinnett County judge. But Oxendine said he had betrayed his own duties as a lawyer.

“I chose to be blind, but it was my own doing,” Oxendine told the judge. “I just sat there; I shut my eyes. I was blind to my actions and the consequences, how other people would suffer."

Defense attorney Drew Findling asked Jones to sentence Oxendine to no more than two-and-a-half years, compared to the 3 years and 8 months prosecutors sought. Findling argued Oxendine should serve no more time that Gallups, who was sentenced to three years in 2021. Gallups is now asking for his imprisonment to be reduced because he made secret recordings as evidence against Oxendine.

About 60 people submitted letters seeking mercy for Oxendine, including family members, lawyers, former U.S. Rep. Bob Barr and insurance commissioners from other states.

“I know John regrets the choices he made," Ivy Oxendine, his wife, told Jones through tears. "They were his choices that brought him here today. He has expressed remorse to me and his children.”

But prosecutors said Oxendine misused his position as an attorney and his political “sway” from his four terms as insurance commissioner to commit fraud.

“He should have stopped the scheme instead of designing it," said Assistant U.S. Attorney Christopher Huber. “He should have reported the kickbacks instead of collecting them.”

Huber noted that the scheme hurt not only insurers, but patients, including one who got an $18,000 bill.

Prosecutors have said Oxendine told Gallups to falsely tell a compliance officer at Gallups' company that the payments from Oxendine were loans. Oxendine told Gallups to repeat the lie when questioned by federal agents, prosecutors said. And they said Oxendine falsely said he didn’t get money from Next Health when interviewed by The Atlanta Journal-Constitution.

Jones said Oxendine discarded his political pledge to advocate for the ”little guy.”

“In this situation, you weren’t helping the little guy,” the judge said. “You were hurting the little guy.”

Jones did show some mercy, dropping prosecutors' requested $700,000 fine to $25,000. And after Huber told Jones that Gallups has paid $197 toward the $760,000 in shared restitution, Jones pledged Gallups would face scrutiny on his payments. Oxendine made an initial $100,000 payment toward the sum on Friday.

Gallups separately owes $5.4 million after a whistleblower filed a lawsuit saying Gallups defrauded the federal government through the Next Health scheme and a kickback scheme with a separate medical device company.

Oxendine ran for governor in 2010 but lost the Republican primary. The Georgia Ethics Commission began investigating campaign finance violations in 2009, alleging Oxendine illegally used campaign funds to buy a house, lease luxury cars and join a private club.

Oxendine settled that case with the commission in 2022, agreeing to hand over the remaining $128,000 in his campaign fund while admitting no wrongdoing.

He was also accused of accepting a $120,000 bundled contribution, 10 times the legal limit, from two Georgia insurance companies when he was running for governor. A judge ruled state officials waited too long to pursue Oxendine on those charges.

Assistant U.S. Attorney David O'Neal leaves the federal courthouse in Atlanta, Friday, July 12, 2024, after former Georgia Insurance Commissioner John Oxendine was sentenced to three-and-a-half years in prison. O'Neal was among prosecutors who pursued the case against Oxendine. (AP Photo/Jeff Amy)

Assistant U.S. Attorney David O'Neal leaves the federal courthouse in Atlanta, Friday, July 12, 2024, after former Georgia Insurance Commissioner John Oxendine was sentenced to three-and-a-half years in prison. O'Neal was among prosecutors who pursued the case against Oxendine. (AP Photo/Jeff Amy)

Defense attorney Drew Findling speaks to reporters outside the federal courthouse in Atlanta, Friday, July 12, 2024, after former Georgia Insurance Commissioner John Oxendine was sentenced to three-and-a-half years in prison. Findling, representing Oxendine, had sought less prison time for his client. (AP Photo/Jeff Amy)

Defense attorney Drew Findling speaks to reporters outside the federal courthouse in Atlanta, Friday, July 12, 2024, after former Georgia Insurance Commissioner John Oxendine was sentenced to three-and-a-half years in prison. Findling, representing Oxendine, had sought less prison time for his client. (AP Photo/Jeff Amy)

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