News
23 February 2007
Dengue fever activity
This update reports on some of the current dengue outbreaks; it is not a comprehensive listing of all dengue outbreaks.
Asia
According to the Hong Kong Information Services Department, in January 2007 two imported cases were reported in Hong Kong. The source countries were thought to be Malaysia and Indonesia. During 2006, Hong Kong reported 31 cases of dengue fever all of which were imported [1].
In India, 52 cases of dengue fever were reported between 1 and 31 January 2007. The majority of cases were reported in Kerala (43), but cases have also been reported from Karnataka, Gujarat, Delhi and Chandigarh. The outbreak appears to be declining [2].
In Indonesia, 16,803 cases of dengue fever were reported between 1 January and 12 February 2007. West Java reported the most cases, with 4,917 cases and 86 deaths. The elimination of mosquito breeding sites is on-going, as is fumigation and a television-based communication campaign [3].
Media reports from Malaysia [4] and the Philippines [5] described high levels of dengue infection in January and February 2007.
Pacific Islands
During January and February 2007 there have been media reports of an outbreak of dengue fever in the Cook Islands [4]. The Auckland Regional Public Health Service in New Zealand issued a warning to travellers to the Cook Islands following 19 imported cases [6].
South America
As of 7 February 2007, Bolivia reported 459 suspected cases of dengue, 118 confirmed cases of classical dengue fever, 4 cases of dengue haemorrhagic fever and 1 fatality [7]. The most affected area is Santa Cruz de la Sierra with 118 of the cases. A further 70 cases were reported in cities adjacent to Santa Cruz de la Sierra. A mosquito breeding site elimination programme is in place, two mass-media awareness campaigns are on-going and health workers are being updated on the clinical management of cases.
In Brazil, 21,444 cases of dengue, with 11 cases of dengue haemorrhagic fever and 3 deaths have been reported as of 20 January 2007 [8]. Mato Grosso do Sul is the most affected are, reporting 15,335 cases and two fatalities. The current data is incomplete as information has not been received from the states of Amazonas, Roraima and Rio Grande do Sul. The Ministry of Health is monitoring the situation and providing assistance to state and municipality-run dengue prevention and control activities.
In January 2007, 215 cases of dengue fever were reported in Puerta Vallarta, Mexico. Insect control measures are being undertaken by the local public health authorities with the support of the Federal government [9].
As of 8 February 2007, Paraguay reported 3,672 cases of dengue, with 22 cases of dengue haemorrhagic fever and 3 deaths. The majority of cases (90%) have been reported in Asunción and Central department. High-risk areas have been defined and elimination of mosquito breeding sites, insecticide spraying, public communication and case detection is on-going [10].
There have also been media reports of outbreaks in Argentina [11] near the border with Paraguay, on Easter Island, Chile [12] and in La Libertad and Lambayeque in Peru [12].
Advice for travellers
Dengue is an arthropod-borne virus transmitted by the Aedes mosquito; A. aegypti is the principle vector, but A. albopictus is also of importance.
Dengue is recognised in more than 100 countries and between 250,000 to 500,000 cases are reported to the World Health Organization annually. The major disease burden occurs in the Americas, South East Asia and the western Pacific.
The majority of cases of dengue are sub-clinical or mild. However, dengue can progress to the more serious dengue haemorrhagic fever (DHF). This form of dengue is more common in children and is rarely seen in travellers.
There is no vaccine available to protect against dengue. Travellers to endemic areas can reduce their risk of dengue by practising mosquito bite avoidance measures. Aedes mosquitoes are most active during daylight hours. Particular vigilance with bite avoidance should be taken around dawn and dusk.
References
1. Hong Kong Information Service Department. Woman ill with dengue fever. 18 January 2007. [Cited 20 January 2007]. Available at: http://www.news.gov.hk/en/category/healthandcommunity/0701
2. Directorate of National Vector Borne Disease Control Programme, India. Status report on dengue and chikungunya on 08.02.07. [Cited 22 January 2007]. Available at: http://www.nvbdcp.gov.in/Doc/Status%20of%20%20Dengue%
20&%20Chikungunya%20as%20on%2008.02.07.pdf
3. Indonesian Department of Health. Development of dengue fever, early 2007. 15 February 2007. [Cited 21 February 2007]. Available online (in Indonesian) at: http://www.depkes.go.id/index.php?option=news&task=view
4. AsiaPacific disease outbreak surveillance report. Malaysia records 16 dengue deaths so far in 2007. [Cited 20 February 2007]. Available online at: http://pdmin.coe-dmha.org/apdosr/apdosrnews.cfm?newsid=21609
5. ProMED mail. Dengue/DHF update 2007. (06). 7 February 2007. [Cited 20 February 2007]. Available online at: http://www.promedmail.org/pls/promed/f?p=2400:1001:377963
2947633561428::NO::F2400_P1001_BACK_PAGE,F2400_P1
6. Auckland Regional Public Health Service. Concern over increasing numbers of returning travellers with dengue fever. 16 February 2007. [Cited 21 February 2007]. Available at: http://www.arphs.govt.nz/Media_Releases/ 20070216_dengue.asp
7. Pan American Health Organization. Dengue fever outbreak in Santa Cruz de la Sierra, Bolivia. Emerging and Re-emerging infectious disease updates. 8 February 2007. Volume 4 (2). [Cited 21 February 2007]. Available online at: http://www.paho.org/English/AD/DPC/CD/eid-eer-2007-02-08.htm
8. Pan American Health Organization. Dengue fever outbreak in Brazil concentrated in Mato Grosso do Sul. Emerging and Re-emerging infectious disease updates. 12 February 2007. Volume 4 (4). [Cited 21 February 2007]. Available online at: http://www.paho.org/English/AD/DPC/CD/eid-eer-2007-02-12.htm
9. Public Health Agency of Canada. Travel Health Advisory. Dengue fever. 2 February 2007. [Cited 22 January 2007]. Available at: http://www.phac-aspc.gc.ca/tmp-pmv/2007/dengue070202_e.html
10. Pan American Health Organization. Dengue fever outbreak in Paraguay concentrated in Ascuncion. Emerging and Re-emerging infectious disease updates. 9 February 2007. Volume 4 (3). [Cited 21 February 2007]. Available online at: http://www.paho.org/English/AD/DPC/CD/eid-eer-2007-02-09.htm
11. ProMED mail. Dengue/DHF update 2007. (09). 19 February 2007. [Cited 20 February 2007]. Available online at: http://www.promedmail.org/pls/promed/f?p=2400:1202:37796
32947633561428::NO::F2400_P1202_CHECK_DISPLAY,F240
12. ProMED mail. Dengue/DHF update 2007. (08). 13 February 2007. [Cited 20 February 2007]. Available online at: http://www.promedmail.org/pls/promed/f?p=2400:1202:377963
2947633561428::NO::F2400_P1202_CHECK_DISPLAY,F240
Links and Further reading
NaTHNaC dengue information sheet.
http://www.NaTHNaC.org/travel/factsheets/dengue.htm
Guzmán MG, Kouri G. Dengue: an update. Lancet Inf Dis. 2001; 2: 33-42
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