April 20, 2006
Dengue Emerging Infectious Disease Update
continues to hold its position as an infectious disease with wide reaching
effects in tropical and subtropical areas across the globe. The month of March,
2006 saw cases of dengue in Mexico, Paraguay, Ecuador, the Philippines, Malaysia, Saudi Arabia, Madagascar, Maldives, Bolivia, the French Islands, Indonesia, Argentina, Brazil and Venezuela.
MEXICO: A case of fatal dengue hemorrhagic
fever was confirmed on March 23 in Nuevo Leon . The victim, a 15 year old girl
from the Linares community is the first victim of this disease since 1999.
The Nuevo Leon sub-secretary for disease prevention and control, Ricardo
Huerta-Gallaga, blames this yearís increased rate of dengue fever on low winter
2005 populations of mosquitoes. Vector extermination was not used as it had
been previously. During this year, it is estimated that 3,000 people will be
infected with the disease.
PARAGUAY: On March 26, two cases of dengue
were confirmed in a 26-year-old woman in Asuncion and an 11-year-old boy in Itaugu
.† Factors such as warm weather,
rainfall, virus circulation in neighboring Brazil and ubiquitous water collecting
sites in metropolitan areas create the risk for a dengue outbreak. While
community preventative measures involving the elimination of water collecting
sites are needed to prevent an outbreak, they are usually not used.
have been confirmed in Loma Pyta and 7 cases in La Encarnacion. .
ECUADOR: The Guayaquil, Guayas province saw 5 confirmed
cases of dengue hemorrhagic fever . There have been 57 cases of dengue
hemorrhagic fever with four deaths this year alone. Many Ecuadorians are at
risk of developing dengue hemorrhagic fever because of previous exposure to
classic dengue fever .
PHILIPPINES: In the city of Zamboanga there were 9 cases of dengue. A 3-year
old from Sitio Luyahan, Barangay Pasonanca died from the disease . A
citywide clean up by residents, involving the destruction of mosquito breeding
grounds, is expected to take place in Zamboanga in April.
MALAYSIA: From the beginning of the year
until March 12, 304 cases of dengue have been reported
. The victims, ages 7-52 years old, are from 13 housing estates and villages
from 5 districts in Kedah. The State Health Committee chairman, Datuk
Saravanan, needs neighborhood organizations to cooperate in eliminating
mosquito breeding grounds.
there were 10 cases of dengue in the last month . The Malacca city council
and Health Department have started a mobile dengue awareness campaign, however
it has not been well received.
February 26 to March 5, there were 58 cases of dengue in Penang . That is a 93% increase in cases
from the week before when there were only 30 reported cases in the state. The
Health Ministry Parliamentary Secretary, Datuk Lee Kah Choon, says the
situation is no need for alarm, as these numbers are apparently normal for the
area. According to health Committee chairman, Datuk V. Saravanan, mosquito
fogging has been conducted in 2 dengue hotspots in Alor Star, where dengue
hemorrhagic fever cases have been on the rise since February.
SAUDI ARABIA: Jeddah is battling an outbreak of
dengue, where 400 cases have been reported . The Council of Ministers has
approved 378 million (USD) on projects to tackle mosquito-borne disease.
Culture and Information Minister Iyad Madani said programs to combat dengue
include filling in areas with stagnant water, health awareness campaigns,
aerial spraying, and refurbish rainwater canals. A three-year insect
surveillance program will begin soon.
MADAGASCAR (SAINTE-MARIE): The eastern island of Sainte-Marie is battling an outbreak of dengue
fever . A medic on the island said medical services could not cope with the
number of victims, with 30-50 people being sent the islandís only hospital
every day. The island does not have the resources to fight the outbreak.
MALDIVES: From January to March
there were 602 cases of dengue fever, with 64 cases of dengue hemorrhagic fever
and 9 cases of dengue shock syndrome . Aedes aegypti is the presumed vector
in the Maldives, biting during the day and resting
and feeding mainly indoors. The Communication for Behavioral Impact (COMBI)
Approach is seen as a strategy to promote mosquito control through the
mobilization of communities. The COMBI approach works by encouraging
populations to practice dengue control and prevention actions through
communication, behavioral-change theories and health education .
BOLIVIA: During the week of March 2, 12
cases of classic dengue fever were reported in Santa Cruz and 2 cases were reported in La Paz . From January to March, there
have been 86 cases of dengue .
MARTIN): The French side of St. Martin is facing an outbreak of classic dengue fever . Stanley
Hanson, the head of the Health Department, says the outbreak is manageable,
with 2-3 cases reported a week. Currently, DSDS is managing the situation by
spraying aircraft coming into St. Martin, as well as recommending the elimination of mosquito
FRANCE (REUNION ISLAND): Dengue was detected, along with
Chikungunya virus, in 15 patients on Reunion Island . Both viruses are transmitted by
the mosquito species Aedes albopictus. The last epidemic on the island,
involving several hundred people, occurred in 2004.
INDONESIA: Dengue is on the rise in the Bekasi
region of Indonesia . From January to March, there
were 924 cases of dengue in Bekasi, with 8 deaths. Due to the alarming level of
infections, the Bekasi Municipal Administration has allocated funds to dengue
prevention (30,000 USD).
In Jakarta, the cases of dengue are also
increasing . In the greater Jakarta area there were 2470 cases of dengue
in January, 2433 cases in February and 2718 cases in March.
ARGENTINA: In Puerto Iguazu, there were 3
reported confirmed cases . The Public Health Ministry is performing
environmental control actions.
BRAZIL: 2 cases of dengue were confirmed in
Penapolis, with a total number of 3 since January .
During the epidemiological week of Mar 5-Mar 11, there were 665 cases of
dengue fever . 38 of those cases were dengue hemorrhagic fever. There have
been 8277 total cases since the beginning of the year.
In the southern localities of the Mekong delta region, including Ho Chi Minh City, there was a 20% increase in a
year-on-year comparison.† This
substantial increase before the peak rainy season is due to environmental
sanitary conditions.† The total number of
confirmed cases during the 1st quarter of the year stands at over
8,000 with 4 confirmed fatalities.
The Taiwanese Centers for Disease Control has reported that the
incidence of imported dengue fever has risen 60% in a year-on-year
comparison.† So far there have been 16
imported cases of dengue fever from South and Southeast Asian countries.
In a journal
published 24 March 2006, by Zhou H. and Deem M.W., a novel
vaccine procedure known as a polytopic injection can be used to elicit a host
immune response to dengue fever and reduce immunodominance.† Using the polytopic injection, different
vaccine serotypes are injected into different regions of the body.† These injections contain epitopes of different
dengue serotypes (1-4) that are subdominant; therefore eliciting T cell
responses in separate regional lymph nodes.†
This will then prime the immune system to seek out the subdominant
determinants instead of the cross-reactive dominant epitopes for each of the 4
dengue serotypes.† This will allow for
the avoidance of an immunodominance reaction and provide the host immunity
against each serotype of dengue virus.
1. Dengue/DHF update 2006 (12).† ProMed-mail.† 2006.†
Available at: http://www.promedmail.org/pls/promed/f?p=2400:1202:117264820838218646::NO::F2400_P1202_CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,32488.
Accessed April 1, 2006.
2. Dengue/DHF update 2006 (11). ProMed-mail.
Available at: http://www.promedmail.org/pls/promed/f?p=2400:1202:1730551883410139200::NO::F2400_P1202_CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,32375.
Accessed April 13, 2006.
3. PAHO regional program on dengue. Pan
American Health Organization. Available at: http://www.paho.org/English/AD/DPC/CD/dengue-program-page.htm.
Accessed April 13, 2006.
4. Dengue/DHF update 2006 (10). ProMed-mail.
Available at: http://www.promedmail.org/pls/promed/f?p=2400:1202:1730551883410139200::NO::F2400_P1202_CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,32316.
Accessed April 13, 2006.
5. Dengue/DHF update 2006 (9). ProMed-mail.
Available at: http://www.promedmail.org/pls/promed/f?p=2400:1202:5629139836179426979::NO::F2400_P1202_CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,32236.
Accessed April 18, 2006.
6. Dengue/DHF update 2006 (13). ProMed-mail.
Available at: http://www.promedmail.org/pls/promed/f?p=2400:1202:5629139836179426979::NO::F2400_P1202_CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,32553.
Accessed April 18, 2006.
7. Dengue/DHF update 2006 (16).† ProMed-mail.† 2006.†
Available at:† http://www.promedmail.org/pls/promed/f?p=2400:1202:12018940092736001950::NO::F2400_P1202_CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,32680
. Accessed April 19, 2006.
8. Taiwanese Government Advisory. MyEGov. 2006. Available at: http://english.www.gov.tw/TaiwanHeadlines/index.jsp?categid=10&recordid=93740.
Accessed April 19, 2006.
9. Zhou H, Deem MW. Sculpting the immunological response to dengue fever by polytopic
vaccination. Vaccine. 2006 Mar 24;24(14):2451-9. Epub 2005 Dec 28.
Deepu Alex, Carlene Gong, Chelsea
Johnson, Cheryl King, Anthony Ho,
Katarro Rountree, and Lisa Sani
students in the Georgetown Medical School MICB-524 course on Emerging
Infectious Diseases: the Past as Prologue (Instructor, Daniel R. Lucey, MD,
MPH), Master of Science Program in Biohazardous Threat Agents and Emerging
Institutes, Washington Hospital Center