Dengue Fever is a disease intimately associated with the majority of the regions studied by the students in this course. According to D. J. Gubler1, the incidence of dengue infection has increased dramatically in the past 30 years, first in Asia, then in the Pacific and Americas, and finally in Africa. If warming occurs, it is likely that cases of dengue fever will rise even further. The possibility of warming may enhance the environmental changes focused on by the students of this course which have the potential to enhance dengue transmission. Therefore the policy measures recommended in my paper to mitigate future impacts, namely control and surveillance, should also be implemented in the other regions studied.

In her paper, Thommasack Manokham detailed the loss of forested area in Southeast Asia to create land suitable for agriculture. Increased agriculture may provide food to support a greater population. Increased population in a region already very dense may facilitate transmission. It

is estimated that that in Southeast Asia alone, there have been over 700,000 hospitalized cases of Dengue Hemorrhagic Fever in the past 30 years with over 200,000 deaths. These numbers may jump dramatically if the population continues to expand.

In 1987, seriological surveys estimated that one million infections occurred in Rio de Janeiro in 1986 and 1987.2 The implications of this number for the region studied by Ken Lo are tremendous. Lo's study focused on the effects of urbanization on the public health of this region. He found that urbanization has not only decreased the general public health of this area as measured by life expectancy and incidence of various diseases, but that the difference between the heath of the rich and poor was dramatic. Increased urbanization will increase the incidence of dengue fever in this region as has been found in past studies. Also, because of the living conditions of the poor in which a lack of running water necessitates containers of water often infested by Aedes aegypti, those living in poverty will be disproportionately impacted. The effects of global warming may cause the expected rise in dengue fever to be even greater.

The two situations illustrated in Southeast Asia and Brazil underscore the importance of dengue fever surveillance and control measures in the Americas, Asia, and Africa as well. Public policy should mandate that dengue be a reported disease in hospitals and clinics to allow scientists and doctors to monitor the problem and focus on the most sensitive regions. Control policies should also be mandated in order to decrease the population of infectious Aedes aegypti. Because the possible effects of global warming are not restricted to Trinidad alone, comprehensive measures to mitigate the likely increase in dengue fever in all tropical and subtropical regions is necessary.