Recently there has been numerous headlines pertaining to mosquito-borne diseases in Trinidad and Tobago. I am sure everyone has been graced by these pesky insects’ sweet buzzing, like a catchy song that stays with you long after it’s gone, the sharp sting of them sucking your blood and of course we cannot forget their marks… just reading that, do you not feel like you are being bitten right now or that you can hear one buzzing?
I know I do!
Mosquito-borne diseases are transmitted by a mosquito bite and some of these diseases have even taken the lives of many persons. This tiny insect is so deadly and is labelled a biological hazard where the risk of contracting any of the following mosquito-borne diseases mentioned below can be significantly high. Following all of this, it only seems necessary to sensitize the public about these diseases in order to reduce the number of infected cases and once and for all get rid of these insects!
MALARIA-The first Mosquito Disease to affect Trinidad & Tobago
Trinidad and Tobago was first affected by Malaria, the first mosquito disease to plague the twin island.
Malaria is spread by the bite of the female anophelines mosquito which the blood then contains a plasmodium parasite that is then transmitted from one person to another by that infected mosquito.
In 1944, The Rockerfellar Foundation in New York, came to Trinidad to begin testing in the region for Anopheles Mosquito where they began treatment of applying DDT, which is a larvacide for the spraying of the mosquitoes. Within less than two years time (during the 1950s), the foundation ran tests on the island of Tobago showing that the transmission of Malaria decreased until almost no trace of the Anophelines Mosquito was recorded or found on the island. Trinidad & Tobago then began doing aerial spraying to regions that vehicles could not have reached with the use of airplanes over the Caroni plains, agricultural lands, cocoa and coconut estates throughout the lands.
During the year of 1991, Trinidad had a malaria outbreak in Icacos, a town located to the Southwest Coast of the island where nine persons were affected by the virus that lived on the swamp land of the coast.
Venezuela was also said to be going through a Malaria crisis at that time. A villager of Icacos traveled inland to Veneuzuela where he contracted the virus but did not seek treatment. The parasite then transmitted itself to the swamp lands in Icacos where nine other persons in the village also contracted Malaria. During the periods of 1990-1997 up to 2004 and 2008, more cases were being reported in Trinidad. In 2010 however, there was only one case reported.
Even though Malaria was said to be eradicated in 1965, because of our tropical conditions, vast swamp lands and thick forested areas, our environment is still an easy target for the importation of this parasite by air and sea. Therefore, its eradication should not be taken for granted.
There are three of the many viruses that are currently affecting the world today to which we are going to highlight:
- The Zika Virus
- The Dengue Virus
- The Chikungunya Virus
Specifically, these viruses are spread by not the Anopheles Mosquito but by the female Aedes Aegypti Mosquito.
How Can You Tell A Female From A Male Aedes Aegypti?
Well, obviously, you would not sit and wonder whether you should kill a mosquito because it is not a female mosquito, but females are usually identified by the white stripes on its tips. Though mosquitoes may be small, the white stripes can be easily noticed as shown in the image above. On the other hand, the male mosquitoes do not puncture your skin but the females feed on your flesh getting as much blood as possible and can feed for up to 1-2 hours at a time on several people.
Before we continue to look at the different viruses that have been plaguing our society, let us refresh our memory on the “Life Cycle of the Mosquito”
The first three stages usually take place in a period of four to fourteen days.
The first stage is where the eggs are laid separately or together in which they form “rafts” and there can be up to two hundred eggs in one laying!
The eggs hatch into larvae within forty eight hours. The larvae sheds or molts their skin four times growing larger with each molt.
In the fourth molt, it changes into a pupae. This stage is a resting stage where the pupae are “mobile” and responds to light changes thus moving in ways to protect itself from the light.
Like a butterfly, the adult mosquito emerges from this pupal skin when development is complete. This transition is however not near to being beautiful as that of the butterfly… the adult mosquito surfaces from the water and dries out for a short period allowing for its body to harden. After a couple days from that occurrence only then does the mosquito begin its aim in life of being one of the biggest pest to mankind… imagine all that trouble from a tiny insect like that, so just think about the impact of its 199 siblings which emerged with it!
By knowing the life cycle of mosquitoes it can be easier to target them and engage in preventative methods at an early stage before they become adults.
“Kathryn R. Bown | BelleNews.com | Page 2.” BelleNews.com | Breaking News, Current News, Current Events, World, Business, Sports, Entertainment News. Accessed October 28, 2016.
The Zika virus is transmitted by the Aedes Aegypti mosquito which was first identified in Uganda in 1947 in monkeys through a network that monitored yellow fever and was later identified in humans in 1952. Outbreaks of the virus have been recorded in Africa, the Americas, Asia and the Pacific.
In July 2015, Brazil reported an association between Zika virus infection and Guillain-Barré syndrome (a disorder in which the body’s immune system attacks part of the peripheral nervous system). Three months later, October 2015 Brazil also reported a link between Zika virus infection and microcephaly. According to the Trinidad Express Newspaper, the first Zika case was reported on February 16, 2016 by a 61 year old woman from Gulf View, La Romaine who had recently traveled to New Zealand.
How is the virus spread?
Zika virus is transmitted primarily through the bite of an infected Aedes species mosquito. When an infected mosquito bites a person, the virus is then transferred into the person’s bloodstream. Zika virus can also be transmitted through: sexual contact, blood transfusion and from a pregnant woman to her fetus.
Zika virus infections during pregnancy have been linked to miscarriages and microcephaly as mentioned before, a fatal congenital brain condition. However, if contracted it is recommended that the individual take adequate rest, drink plenty fluids to prevent dehydration and take medicine such as acetaminophen to reduce fever and pain.
For 2016 thus far, Trinidad and Tobago reported over 294 Zika cases of pregnant women out of the total 489 Zika cases in the country. Officials also reported that on average yearly, 12 babies are born with micorocephaly and though four babies have been tested as being diagnosed with microcephaly, Zika was however not the cause of the disorder.
However, pregnant women should not take this for granted and should try in their best manner to stay protected from being bitten by mosquitoes.
Symptoms of the virus:
- Joint pain
- Red eye
- Muscle/joint pain
Most persons with the Zika virus do not know that they have contracted the virus as the symptoms can range from mild to severe with no major indicator unless the individual is examined by a medical practitioner. The symptoms usually last for several days to a week.
Genetically Modified Mosquitoes to Fight Zika:
Recent developments to combat the spread of the Zika virus has lead to the development of genetically engineered mosquitoes frequently referred to as genetically modified mosquitoes or simply GM Mosquitoes which resulted in mosquito eggs being injected with DNA that contains lethal genes. The aim is to produce and release the genetically modified male mosquitoes into the wild to mate with the female Aedes Aegypti mosquitoes that is responsible for the spread of the Zika virus. The offspring of the lab-tweaked males is unable to survive into adulthood, thus, it is the hope that the population of the Aedes Aegypti mosquitoes would be much reduced. However, GM mosquitoes have been the cause of much alarm to many individuals across the Caribbean leaving persons to believe that pest control has gone terribly wrong, not to mention, the fear of the unknown.
It is important to remember that cases of the Zika virus typically occur in tropical climates. Living or traveling in tropical and subtropical areas where there have been outbreaks increases an individual risk of exposure to the virus. Avoiding mosquito bites is a key aspect of Zika virus prevention and other ways to avoid this is discussed late down.
What is the dengue virus?
Dengue Virus (DENV) is considered to be a vast spreading mosquito-borne infectious disease and at present is one of the most evolving diseases worldwide. Dengue is transmitted through a mosquito bite, specifically a bite from the Aedes Aegypti mosquito.
The viruses may range from: mild febrile syndrome, to a classic dengue fever and even life-threatening (Dengue hemorrhagic and Dengue shock syndrome).
In Trinidad & Tobago, Dengue has been considered to be an endemic to the twin island since the period of the 1980’s. All four serotypes (DEN-1, DEN-2, DEN-3, DEN-4) of the virus has affected the nation. Recently, medical practitioners discovered another trace of the virus (DEN-5) in 2013 when tests were taken from an agricultural farmer in Malaysia.
What do we mean by endemic? – Well, it means that the amount of Dengue cases recorded has become so high and consistent that, the virus can be referred to as something so common that one can easily contract it.
In the year 2010, the local Newspaper “Newsday” captured this bold front page headline that magnified on the amount of Dengue cases recorded in Trinidad and the cases of confirmed deaths that resulted from the Dengue outbreak. It seemed as though crime was placed on the back burner making room for Dengue which was more of a crisis…
There are many reasons for the outbreak of the virus but these mosquitoes are said to be attracted to the hot and humid climate within Trinidad. Studies has proven that areas with higher temperatures tend to have higher amounts of the Dengue causing mosquito species as well as higher amounts of outbreaks.
How is the Dengue Virus contracted?
Dengue is not an airborne disease like the common cold. The Dengue virus is spread when an Aedes Aegypti mosquito becomes infected with the person’s blood they have bitten, then spreading the fever by biting another healthy person. This is shown in the cycle below.
Geographical history of Dengue
Did you know that the first indication of a disease with symptoms consistent with dengue is of “water poison,” documented in China over 1500 years ago? Yes! 1500 years ago! Research by various explorers has indicated that the dengue virus was born in the forest of the Old World (West Africa and South East Asia).
Dengue in Trinidad and Tobago
When did Dengue become a threat to Trinidad and Tobago?
Research done by the Pan American Health Organization (PAHO), links Dengue to the early 1980s.This resulted in a widespread outbreak in 1991 which approximately 3,000 cases were reported.
The dengue hemorrhagic fever first appeared in 1996 creating severe health problems overtime. Subsequently, in 1997 the dengue fever outbreaks became a yearly event, with some years more severe than others.
However, dengue was not as prevalent for the period 2004 to 2007 since compared to the other years, it only reported 2,340 cases for that four-year period with the lowest number in 2005 (400 cases). In 2008 there were 4,921 cases recorded, 2,508 recorded in 2009, and 4,894 recorded in 2010. There were six deaths in 2008. In April 2014, the then Minister of Health, Dr Fuad Khan pointed out that there was a 36 percent increase in Dengue infections for 2014. He provided evidence that seven people died in 2013 as a result of Dengue fever.
Just recently, our present Minister of Health contracted the Dengue Fever where he revealed in a newspaper article quoted on July 22nd, 2016 that the statistical count for the number of persons in Trinidad with Dengue for the year thus far had been 23 persons.
Symptoms of the Dengue Virus
The Ministry of Health of Trinidad and Tobago has been working diligently with the public throughout the years to enlighten everyone on the spread of Dengue.
They have provided web information, local advertisements as well as flyers to educate the public on the signs and symptoms and what precautions can be taken.
The Ministry of Health also outlined the various symptoms of the dengue virus. These symptoms include: headaches (sometimes with severe high fever), vomiting and nausea, skin rashes, backaches, muscle and joint pains, diarrhea and tension or pain behind the eyes. They noted that the symptoms can appear 5-6 days after being bitten by a mosquito and can last from 1-2 weeks.
Where the symptoms worsen and there is failure to see a doctor, the virus can be life threatening
In extreme cases an individual can develop severe dengue where symptoms include bleeding (nose, gum bleeds or easy bruising), abdominal pain, persistent vomiting, irritability, breathing difficulty, dizziness, hypertension
At this point in time, it is necessary to visit your doctor or medical center.
A blood sample is usually tested to examine whether an individual contracted the virus and the level of severity.
What is being done today around the world to alleviate the spread of the Dengue Virus?
Scientists after 20 long years have finally come up with a vaccine that they believe can curb and treat the Dengue
Virus. As of 2016, is being given to children in the Philippines where it is said that over one million children prone to living in Dengue affected areas will be vaccinated.
Dengvaxia- is the name of the first vaccine to be ever created to fight against Dengue. However, officials have said that though there seems to be a medical alternative, preventative methods of keep breeding sites for these mosquitoes should continue to be treated.
Chikungunya is one of the many viral diseases also transmitted by the bite of an infected Aedes Aegypt mosquito. In the year 1952 the first case was reported in Tanzania and from then to now the disease is a major threat to individuals’ well being. Chikungunya has been identified in 60 countries and it is no stranger to the Caribbean. The disease first entered the Caribbean in the year 2013 on the island of St. Martin.
On Thursday, 11th of September, 2014, officials recorded that there was a total of 43 Chikungunya cases in Trinidad and Tobago and between then to this present date, this number has increased drastically affecting the lives of all citizens even the unborn. By the month of April 2015, there was a total of 1.4 million reported cases of Chikungunya in the Caribbean, Latin American countries and the United States.
It must be stated that currently there is no vaccine or medication to cure the infection so once an individual is diagnosed with the disease, medication is given to that individual to reduce the symptoms they experience.
Symptoms of Chikungunya
When the mosquito bites an individual, symptoms is experienced within a period of 3-7 days after. The disease does not directly result to death, but the symptoms can be severe and disabling. The symptoms one can expect are as follows:
- Joint Pain
- Muscle pain and joint swelling
For some individuals the joint pain last for weeks even months having a negative impact on individual’s daily operations.From a personal standpoint, one of the group members have actually had to bear witness to a family member having to retire from a job due to experiencing severe joint pain which inhibited effective job performance…
Cause of Chikungunya Virus
As highlighted earlier, Chikungunya virus is transmitted to humans by the Aedes Aegypti mosquito. This mosquito breeds in stagnant water which gives it the opportunity to exist basically anywhere possible. This mosquito bites during daytime with peaks of early morning and late afternoon. The mosquito acquires the virus from human beings and after a period of 8-10 days it is transferred to another human being through their blood streams while the mosquito is feeding. The virus circulates in the blood of the infected person for several days at approximately the time when the person gets the fever and then the cycle continues when a mosquito feeds from an infected person
So jumping right into preventative methods, while there is no vaccine to prevent Zika, it is one of the diseases that can be spread through sexual contact thus an obvious preventative method and practice would be to use protection. Educating the public about the disease caused by the mosquitoes and increasing campaigns for public awareness can decrease the spread of the mosquito borne viruses as persons would take better precaution.
With the proper preventative methods these diseases can be eradicated. Mosquitoes tend to breed in stagnant, shallow and high in organic matter water. Unfortunately, humans lack caution and attention when disposing of their garbage or any materials around the house such as tires and containers.
Improper disposal of materials kept outdoors may collect water which would result in a perfect breeding ground for mosquitoes. Eliminating mosquito breeding grounds is a primary control when it comes to preventative methods.
In order to prevent breeding, the collection of water around the house and outdoors such as installed pools, rainwater barrels, hot tubs, bird baths, fountains and pet bowls need to be emptied, chlorinated, cleaned regularly and adequately covered. Other items such as tires, empty and used containers should be removed. Items like wheelbarrows and wading pools can be turned over to prevent water collection.
Since some water collection items may be a bit difficult to constantly empty, such as ponds and even birdbaths, a fountain can be used to ensure the water is always moving. Another remedy that can be used in ponds or even birdbaths is frogs or fishes as they feed on them such as minnows. Methoprene, an insect growth regulator, can be used as it prevents or eliminates mosquito larvae from molting as well as kills other insects or pests.
Bird baths, flower pots, pet bowls and pool covers must also be drained once per week as well to prevent breeding. Gutters and poor drainage areas must also be cleaned regularly to prevent a backup of water. There are gutter guards such as “Blue Mountain Mesh” and also leaf prevention instruments such as “Leaf Eaters, Leaf Beaters and Mozzie Stoppas” which can aid in the prevention of clogged areas thus reducing the amount of available breeding ground.
Larvae can be removed by the use of larvicides such as Bacillus thuringiensis israelensis (BTI) which includes Microbe-Lift , Mosquito Dunks and Mosquito Bits which are poisons that the mosquitoes ingest. Mineral based larvicides can be used by spraying the top layer of water with it as it suffocates the mosquitoes.
Water tanks can be installed with something called a “First Flush Water Diverter” which is basically a down-pipe attachment that “collects the first ‘flush’ of rainwater most likely to carry contaminants and mosquito larvae from the roof.
Preventative methods which can be used for adult mosquitoes areinsecticides, herbal plants such as basil, lavender, rosemary and peppermint, flowers such as marigold and pennyroyal and other plants such as catnip, garlic, citronella and lemon balm. In order to prevent mosquitoes from entering the house the use of screen doors is recommended since they usually come out from dawn to dusk. Closing doors can eliminate the amount of mosquitoes entering the room.
Other methods which can be used are mosquito nets, repellents such as creams or body sprays and the infamous and well loved mosquito racquets. Mosquitoes also feed on plant nectar, therefore, by keeping tall grass trimmed and mowed can decrease their presence as they also use the tall grass to beat the heat during the day. In addition to these methods there are now many homemade prevention techniques such as ground coffee, dry ice and camphor.
One of the more innovative ones is the use of mosquito repellent lights like yellow bug lights or sodium lights. These tend to attract mosquitoes and kills them upon contact with the light. The mosquito racquets is another effective method allowing persons to get some satisfaction from hearing the zapping that brings the death of those pesty insects.
Some other areas which can be breeding grounds for mosquitoes are natural wetlands such as lakes, swamps, marshes and streams where special attention must be paid. These areas usually have the highest mosquito population. Natural wetlands would contain fish, insects and frogs which can reduce the breeding and survival of larvae and pupa. However, as these natural water bodies are essential to the water cycle, quality must be prioritized. Therefore, water authorities should regularly seek to ensure that the quality is maintained by doing regular check to ensure the elimination of mosquito breeding grounds and the presence of larvae and pupa.
In the case of a mosquito bite, one can use various creams such as hydrocortisone cream, calamine lotion or an antibiotic cream for relief from itching or home remedies such as ice cubes, a cold pack or a clean bath without soap. In terms of more serious cases such as allergic reactions, treatments of oral antihistamines such as Benadryl or Claritin, topical anti-itch lotion or benzocaine should be used.
There is no specific medicine or treatment for the Zika, Dengue or Chikungunya viruses. Pain relievers and medication such as paracetamol should be used and medicines with asprin should be avoided as this can increase or worsen bleeding. Patients who are ill should take adequate rest, large intake of fluids, and have regular check ups by their doctor to monitor the illness.
If symptoms worsen then the patient should visit a hospital immediately. Vaccines are being developed and tested but only a yellow fever and dengue vaccine have been established and licensed for use, unfortunately, the dengue vaccine is commonly available in the Caribbean, as yet.
Apart from treatment it is recommended that the Government of Trinidad and Tobago implement and impose fines for persons who facilitate breeding grounds, increase mobile health facilities to test the virus, and increase research and development on vaccinations and mosquito eradication.
As we conclude our discussion on these mosquito-borne diseases, it is important to remember that the mosquito diseases contracted from the Aedes Aegypti mosquito such as Zika, Dengue and Chikungunya are transmitted by a bite from the mosquito. We would like to remind you to follow these simple measures to prevent yourselves from contracting any of the mosquito-borne diseases mentioned above. The major at risk groups for mosquito-borne diseases are pregnant women where the fetus is at risk of developing microcephaly and older persons who may not have the strength to sustain attacks from diseases and the newly discovered Guillain-Barré syndrome.
Research has shown that the aedes mosquitoes thrive in tropical climates. Therefore individuals living and traveling in tropical and subtropical areas are more exposed to these mosquito-borne diseases. To combat mosquito diseases, the government of Trinidad and Tobago specifically, the Ministry of Health should increase public sensitization of the Aedes Aegypti mosquitoes along with the related diseases and preventative methods as discussed above.
Individuals should also ensure personal safety by implementing some simple measures such as keeping their surroundings free from stagnant water and trees that can trap water, use insect repellents, mosquito screens and nets.
“18 Proven Home Remedies to Get Rid of Mosquitoes.” n.d. http://www.homeremedyhacks.com/18-proven-home-remedies-to-get-rid-of-mosquitoes/.
“Aedes africanus – Wikipedia.” Accessed October 24, 2016. https://en.wikipedia.org/wiki/Aedes_africanus.
“Breaking News, Politics, Sports, Entertainment, Carnival, Video, Weather and More – Trinidad Express and TrinidadExpress.com.” n.d. http://www.trinidadexpress.com/news/JUMP-IN–l.
“CDC – NIOSH – Mosquito-Borne Diseases.” n.d. http://www.cdc.gov/niosh/topics/outdoor/mosquito-borne/.
“CDC – Page Not Found.” n.d. http://www.cdc.gov/dengue/entomologyecology/climate.htm.
“Dengue Danger | Positive Parenting.” n.d. http://mypositiveparenting.org/2016/03/23/dengue-danger/.
“Dengue Treatment & Management: Approach Considerations, Suspected Dengue, Severe Dengue.” n.d. http://emedicine.medscape.com/article/215840-treatment.
“How to Prevent Mosquitoes from Breeding: 15 Steps – wikiHow.” Accessed October 24, 2016. http://www.wikihow.com/Prevent-Mosquitoes-from-Breeding.
“Malaria – Prevention – NHS Choices.” n.d. http://www.nhs.uk/Conditions/Malaria/Pages/Prevention.aspx.
“Malaria | GSK.” n.d. http://www.gsk.com/en-gb/media/resource-centre/malaria/.
“Malaria: Causes, Symptoms and Treatments – Medical News Today.” n.d. http://www.medicalnewstoday.com/articles/150670.php.
“The Ministry of Health – Trinidad and Tobago.” n.d. http://www.health.gov.tt/news/newsitem.aspx?id=282.
“The Ministry of Health – Trinidad and Tobago.” n.d. http://www.health.gov.tt/news/newsitem.aspx?id=694.
“Mosquito Bites Allergies Symptoms and Treatment.” n.d. http://www.healthline.com/health/allergies/mosquito-bite#Treatment5.
“Mosquito Prevention | Rain Harvesting.” n.d. http://rainharvesting.com.au/knowledge-center/mosquito-prevention/.
“PAHO WHO | Health ministers adopt new plan for malaria elimination in the Americas.” n.d. http://www.paho.org/hq/index.php?option=com_content&view=article&id=12543&Itemid=1926&lang=en.
“prevent mosquito breeding – Google Search.” n.d. https://www.google.tt/search?q=prevent+mosquito+breeding&espv=2&biw=1366&bih=613&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi-3fe7v9TPAhVJpx4KHfbBAvAQ_AUIBigB#imgrc=1Yh47Kh1EkMWUM%3A.
“prevent mosquito breeding – Google Search.” n.d. https://www.google.tt/search?q=prevent+mosquito+breeding&espv=2&biw=1366&bih=613&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi-3fe7v9TPAhVJpx4KHfbBAvAQ_AUIBigB#imgrc=JHzgP-aVIPwDKM%3A4.
“prevent mosquito breeding – Google Search.” n.d. https://www.google.tt/search?q=prevent+mosquito+breeding&espv=2&biw=1366&bih=613&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi-3fe7v9TPAhVJpx4KHfbBAvAQ_AUIBigB#q=prevent%20mosquito%20breeding&tbm=isch&tbs=rimg%3ACciX9NldfU8UIjgLoA-3fC61jf133lAe6KNKVM3sbaMnZCXYmF21Wo-JQrGEru2iWlOiBLJvfdUwTjUwOgjMQsXvzioSCQugD7d8LrWNEU902jx3PzKZKhIJ_1XfeUB7oo0oRq3BB12-Nak4qEglUzextoydkJRFd9agvTRKavSoSCdiYXbVaj4lCEUe_1U9L5snoQKhIJsYSu7aJaU6IRVDjzhnFnthkqEgkEsm991TBONRHha7KtbubMwSoSCTA6CMxCxe_1OERoBO2oK8cDw&imgrc=_.
“preventative maintenance for mosquitoes – Google Search.” n.d. https://www.google.tt/search?q=preventative+maintenance+for+mosquitoes&espv=2&biw=1366&bih=662&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjmpa7e79bPAhXMHh4KHU8eDeUQ_AUIBigB#imgrc=8yhERbYiCukKpM%3A.
“Protecting Your Kids from Dengue Fever | Samitivej Hospital Bangkok Thailand – JCI Accredited World Class Hospital.” n.d. https://www.samitivejhospitals.com/en/protecting-your-kids-from-dengue-fever/.
“Retention basin – Wikipedia.” Accessed October 24, 2016. https://en.wikipedia.org/wiki/Retention_basin.
“Statistics show 1,800 reported cases up to July | The Trinidad Guardian Newspaper.” n.d. http://www.guardian.co.tt/news/2011/08/11/statistics-show-1800-reported-cases-july.
“Symptoms and causes – Zika virus disease – Mayo Clinic.” n.d. http://www.mayoclinic.org/diseases-conditions/zika-virus/symptoms-causes/dxc-20189274.
“transmission.” n.d. http://denguechikungunya.com/tag/transmission/.
“Trinidad and Tobago’s Newsday : newsday.co.tt :.” n.d. http://www.newsday.co.tt/news/0,227612.html.
“Trinidad Express Newspapers: News | Zika cases hit 68 in Trinidad.” n.d. http://www.trinidadexpress.com/20160617/news/zika-cases-hit-68-in-trinidad.
“Trinidad Express Newspapers: | JUMP IN DENGUE CASES.” n.d. http://www.trinidadexpress.com/news/JUMP-IN–DENGUE-CASES-254285751.html.
“UWI Today.” n.d. https://sta.uwi.edu/uwitoday/archive/april_2013/article6.asp.
“WHO | Fact Sheet: World Malaria Report 2015.” n.d. http://www.who.int/malaria/media/world-malaria-report-2015/en/.
“WHO | Malaria.” n.d. http://www.who.int/malaria/en/.
“Works Cited – Metamorphosis.” Metamorphosis – Home. Accessed October 28, 2016. http://metamorphosis4kids.weebly.com/works-cited.html.
“Zika Virus: Symptoms, Facts, Diagnosis – Medical News Today.” n.d. http://www.medicalnewstoday.com/articles/305163.php.
“Malaria Overview – International Medical Corps.” International Medical Corps – International Medical Corps. Accessed October 27, 2016. http://internationalmedicalcorps.org/page.aspx?pid=501.
“Icacos, Trinidad and Tobago Weather Forecast.” 10 Day Weather Forecast Worldwide. Accessed October 27, 2016. http://www.weather-forecast.com/locations/Icacos-1/forecasts/latest.
“Genetically Modified Mosquitoes Combat Disease | Sci-Tech | 05.08.2012.” DW.COM. Accessed October 27, 2016. http://www.dw.com/en/genetically-modified-mosquitoes-combat-disease/a-16146195.
“Trinidad Express Newspapers: News | Baby Born with Microcephaly.” Breaking News, Politics, Sports, Entertainment, Carnival, Video, Weather and More – Trinidad Express and TrinidadExpress.com. Accessed October 27, 2016. http://www.trinidadexpress.com/20160927/news/baby-born-with-microcephaly.
“History of Trinidad from 1781-1839 and 1891-1896 – Lionel Mordant Fraser.” Google Books. Accessed October 27, 2016. https://books.google.tt/books?id=jT8sBgAAQBAJ&pg=PA343&lpg=PA343&dq=malaria+trinidad+history&source=bl&ots=5FPio3PwfE&sig=gRKkTempdQR95WHSUbKukK9WiWY&hl=en&sa=X&ved=0ahUKEwi68fOd6PvPAhWGCD4KHVPJD5k4UBDoAQhHMAc#v=onepage&q=malaria%20trinidad%20history&f=false.
“The Beautiful Icacos Swamps 2009.08.23 – A Report on the Icacos Swamps.” The Trinidad and Tobago NatureLink. Accessed October 27, 2016. http://www.ttnaturelink.com/ttnaturetrips/beautiful-icacos.
“Kathryn R. Bown | BelleNews.com | Page 2.” BelleNews.com | Breaking News, Current News, Current Events, World, Business, Sports, Entertainment News. Accessed October 28, 2016. http://www.bellenews.com/author/kathryn-r-bown/page/2/.