The health official in charge of tackling Paraguay's dengue fever outbreak, which has claimed at least 10 lives, has been sacked.
Doctors say the number of cases is higher than officially reported
Humberto Recalde was removed after it emerged his department had used expired chemicals in its fumigation campaigns.
So far this year 16,297 dengue cases have been officially reported - eight times the total for the whole of 2006. A state of emergency is in place.
Doctors' groups in Paraguay say the true figure could be closer to 150,000.
A severe outbreak has also been reported in the neighbouring south-western Brazilian state of Mato Grosso do Sul, where the number of cases is estimated over 45,000.
Argentina and Bolivia have also reported a rise in cases of dengue, which is endemic in much of the Americas.
The rise in cases has been blamed by experts on a higher rainfall and uncommonly warm weather, which have boosted the population of the aedes aegypti mosquito.
Dengue fever causes severe headaches, as well as muscle and joint pain.
Experts fear the use of expired chemicals - used for the past two years - could have built up more resistance in the mosquitoes which transmit the disease.
Transmitted by mosquitoes
Symptoms of the severe, flu-like illness include severe headaches, fever, rash, joint pains
Seldom deadly, but has potentially lethal variants
Dengue fever is found in Africa, South-east Asia and China, the Indian sub-continent, the Middle East, South and Central America, the Caribbean and Australia
Health Minister Oscar Martinez told the BBC that the outbreak was "under control" and that the government had boosted efforts to eliminate mosquito breeding spots.
The minister said he would not resign, despite growing pressure from both private and public health workers.
Last week, President Nicanor Duarte declared a 60-day state of emergency to tackle the outbreak.
Doctors in Paraguay say that at least five of those who died were suffering from a particularly virulent variant of the disease called "gastric dengue", never seen before in the country.
Gastric dengue attacks vital organs - such as the liver, heart, lungs or brain - and can cause death within hours.
Other patients died of dengue haemorrhagic fever, a variant which can lead to enlargement of the liver, and in some cases, circulatory failure.
International experts have been arriving in Paraguay to study the outbreak and advise the government.