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19 October, 2012

Dengue fever: Autonomous Region of Madeira (Portugal) - update

This updates case numbers reported in the Clinical Update of 9 October, 2012

The dengue fever outbreak in Madeira is continuing.  On 3 October 2012, the Autonomous Region of Madeira notified the Public Health Authority of Portugal of cases of dengue fever in the Region, presumed to be locally acquired (autochthonous). The initial two cases were reported in residents of Madeira who had no history of travel abroad.  These are the first cases of locally acquired dengue reported in Madeira [1]. DEN-1 has been identified as the circulating serotype [2].

As of 17 October, a total of 37 cases of dengue virus have been laboratory confirmed; In addition, 262 probable cases are under investigation. Since the start of the outbreak, 30 cases have been hospitalized and six cases are currently receiving hospital care [3].  Cases have been reported in the municipalities of Funchal, Câmara de Lobos and Santa Cruz [4].

Public health responses are underway to reduce the risk of sustained local transmission including strengthening mandatory disinfection of aircraft, enhanced surveillance and reporting. The public are encouraged to take mosquito bite precautions and to be aware of the signs and symptoms of dengue [3-6].

The main mosquito vector for dengue, Aedes aegypti, was identified in Madeira in 2005 [7]. It is likely that due to the presence in the region of this competent vector for dengue, additional cases are to be expected [5]. 

Advice for travellers

There are currently no travel restrictions to Madeira, however, the European Centre for Disease Prevention and Control (ECDC) have undertaken a Rapid Risk Assessment and state that the risk of travellers acquiring dengue fever for travellers to Madeira will depend on the course of the outbreak and the effectiveness of the control measures implemented [5].

All travellers to areas where dengue is known or presumed to occur should practise mosquito bite avoidance. Aedes mosquitoes bite in the day, particularly around dawn and dusk. More information about mosquito bite avoidance is available on the NaTHNaC website.

Travellers who develop symptoms such as fever, severe headache, muscle pain and a maculo-papular rash within 14 days of visiting Madeira are advised to seek medical advice [5].

There is no vaccine available to protect against dengue.

Further information about dengue can be found on the NaTHNaC Health Information Sheet on Dengue.

Advice for health professionals

Dengue does not occur in the UK. In 2010 there were 406 travel-associated cases of dengue fever reported in England, Wales and Northern Ireland; most were associated with travel to Africa, the Americas, Asia and the Caribbean [8]. 

As of 18 October 2012, there have been no confirmed or probable cases of dengue reported in England, Wales or Northern Ireland associated with travel to Europe, including Madeira [9]. Health professionals who suspect a case of dengue fever should send appropriate samples for testing (with full travel and clinical history) to the Health Protection Agency, Rare and Imported Pathogens Laboratory.

References

1. Minestério da Saúde. Comunicado do Director Geral Da Saúde, 3.10.2012. Casos de dengue na Região Autónoma da Madeira. In Portuguese. [Accessed 19 October, 2012]. Available at: http://www.dgs.pt/?f=3&id=23065

2. Instituto Nacional de Saúde. Febre de dengue na Madeira. Diagnóstico Laboratorial. 9 October 2012 [Accessed 19 October, 2012]. Available at: http://www.insa.pt/sites/INSA/portugues/ComInf/Noticias

/Paginas/DengueMadeiraDiaglab.aspx 

3. Minestério da Saúde. Comunicado do Director Geral Da Saúde,17 October 2012. Dengue na Região Autónoma da Madeira - atualização. In Portuguese. [Accessed 19 October, 2012]. Available at: http://www.dgs.pt/?f=3&id=23065

4. Instute de Veille Sanitaire. Bulletin Hebdomadaire International No. 368. 3-9 octobre, 2012.In French. [Accessed 19 October, 2012]. Available at: http://www.invs.sante.fr/Publications-et-outils/Bulletin-hebdomadaire-international/Tous-les-numeros/2012/Bulletin-hebdomadaire-international-du-3-au-9-octobre-2012.-N-368

5. European Centres for Disease Prevention and Control. Rapid Risk Assessment: Autochthonous dengue, cases in Madeira, Portugal. 10 October 2012 [Accessed 19 October, 2012]. Available at: http://ecdc.europa.eu/en/publications/Publications/Dengue-Madeira-Portugal-risk-assessment.

6. Secretaria Regional dosm Assuntos Sociais (SRAS). Instituto de Administratcao da Saude e Assuntos Sociais. IP RAM. Microsite mosquito Aedes aegypti. In Portuguese. [Accessed 19 October, 2012]. Available at: http://iasaude.sras.gov-madeira.pt/mosquitos/

7. Almeida AP, Gonçalves YM, Novo MT, Sousa CA, Melim M, Gracio AJ. Vector monitoring of Aedes aegypti in the Autonomous Region of Madeira, Portugal. Euro Surveill. 2007; 12(46):pii=3311. [Accessed 19 October, 2012]. Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=3311

8. Health Protection Agency. Dengue fever in England, Wales and Northern Ireland: 2009-10.5. Health Protection Report. 5;18, 5 May 2011 [Accessed 19 October, 2012]. Available at: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/

1296685588169

9. Health Protection Agency Travel and Migrant Health Section - personal communication, 9 October 2012

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