Jimenez's hypertension had combined with a new, debilitating illness, and the complications had killed her, her mother said. The sudden death shook her neighborhood, but the rapid onset and severity of her illness surprised no one. Hundreds of residents of Bajos de Haina, a gritty, industrial town just south of Santo Domingo, were suffering from the same symptoms. They had fevers as high as 104, migraine-like headaches, and sometimes bright-red rashes covering their limbs. But worst was the joint pain -- typically so severe it made ordinary tasks like twisting doorknobs and tying shoelaces unbearable and forced even healthy young men to walk as if they had aged 50 years overnight.
"This is like a plague that the Bible talks about," one elderly woman said after Jimenez's death.
The cause was a mosquito-borne virus that, just months earlier, almost no one in the town knew: chikungunya. There is no cure or antidote, and while typically not fatal, the disease can leave victims in agonizing pain for months or years. In parts of Africa and Asia, it has been around for decades, but in the Dominican Republic -- and the rest of the Americas -- it was brand new. Though travelers had been diagnosed before, never had someone in the Western Hemisphere contracted the disease from local mosquitoes until last December 6, when the Pan American Health Organization (PAHO) confirmed two cases in the tiny Caribbean nation of Saint Martin.
The region soon faced a pandemic. By midsummer, when the world's attention was suddenly consumed by another African viral epidemic -- Ebola -- chikungunya had infected hundreds of thousands in the Caribbean and was gradually creeping into the United States. People from Maine to California contracted it after traveling to affected countries, and this past July 17, public health officials announced that two Florida residents had been infected by local mosquitoes -- marking the first time chikungunya had been acquired in the United States. The door was open to thousands of new American cases.
"It's a new disease," says Dr. Scott Weaver, a virologist at the University of Texas Medical Branch. "I think it's one of the most serious threats from a mosquito-borne disease in the U.S. in many years."
Just after 8 a.m. on a bright Tuesday in early August, Yasser Compagines walked through a middle-class neighborhood in Hialeah, his eyes darting from one neatly fenced-in driveway to the next. Compagines, a well-built man with a shaved head and a quick stride, wore a light-blue polo tucked into dark khakis, a black wristwatch, and sunglasses hanging around his neck. On the back of his shirt, in huge capital letters, were the words "Miami-Dade Mosquito Inspector." A neighborhood resident had called to complain, and Compagines had come to locate and kill.
The inspector walked past two houses, then spotted a broad, gray cement flowerpot, maybe two feet tall and engraved with an intricate, curved-line pattern. He approached the pot and stopped, then doubled at the waist so his bald head was just inches from the container's top. "This is fresh water from the rain," he announced. It was not a mosquito breeding ground.
But the pot was resting on a cement base that was a few inches tall and saucer-shaped, like a large, upside-down Frisbee. Compagines crouched to the ground, his face creasing from the glare. This time the water, about two inches deep, was green-tinted, with dark spots of algae and dirt. Swimming in it were dozens of black, wriggly, pinhead-sized creatures -- larvae of the Aedes aegypti mosquito. "These are ready to pop," Compagines said.
Aedes aegypti were first identified three centuries ago by a Swedish entomologist in Asia Minor. The speckled black, white, and brown mosquito is found in tropical locations around the globe and has long been identified with diseases like yellow and dengue fevers. But about 60 years ago, scientists discovered it was also transmitting another, potentially even more devastating virus: chikungunya . Although it has likely been present in parts of Asia and Africa for millennia, this virus was identified by scientists only in 1953, after thousands of villagers living on the Makonde Plateau, in present-day Tanzania, suddenly became crippled and bedridden.