Dengue fever outbreaks

Dengue fever outbreaks
Worldwide dengue distribution, 2006. Red: Epidemic dengue. Blue: Aedes aegypti.
Disability-adjusted life year for dengue fever per 100,000 inhabitants in 2004.
  no data
  < 10
  10-20
  20-30
  30-40
  40-50
  50-60
  60-70
  70-80
  80-90
  90-100
  100-200
  > 200

As of 2010 dengue fever is believe to infect 50 to 100 million people worldwide a year with 1/2 million life threatening infections.[1] It has dramatically increased in frequency between 1960 and 2010 by 30 fold.[2] This increase is believed to be due to a combination of urbanization, population growth, increased international travel, and global warming.[1] The geographical distribution is around the equator with 70% of the total 2.5 billion people living in endemic areas from Asia and the Pacific.[2]

Contents

Recent outbreaks

Main articles: 2005 dengue outbreak in Singapore, 2006 dengue outbreak in India, 2006 dengue outbreak in Pakistan, and 2009 Bolivian dengue fever epidemic

The first recognized Dengue epidemics occurred almost simultaneously in Asia, Africa, and North America in the 1780s, shortly after the identification and naming of the disease in 1779. A pandemic began in Southeast Asia in the 1950s, and by 1975 DHF had become a leading cause of death among children in the region. Epidemic dengue has become more common since the 1980s. By the late 1990s, dengue was the most important mosquito-borne disease affecting humans after malaria, with around 40 million cases of dengue fever and several hundred thousand cases of dengue hemorrhagic fever each year. Significant outbreaks of dengue fever tend to occur every five or six months. The cyclical rise and fall in numbers of dengue cases is thought to be the result of seasonal cycles interacting with a short-lived cross-immunity[clarification needed] for all four strains in people who have had dengue. When the cross-immunity wears off the population is more susceptible to transmission whenever the next seasonal peak occurs. Thus over time there remain large numbers of susceptible people in affected populations despite previous outbreaks due to the four different serotypes of dengue virus and the presence of unexposed individuals from childbirth or immigration.

There is significant evidence, originally suggested by S.B. Halstead in the 1970s, that dengue hemorrhagic fever is more likely to occur in people who have secondary infections by another one of dengue fever's four serotypes. One model to explain this process is known as antibody-dependent enhancement (ADE), which allows for increased uptake and virion replication during a secondary infection with a different strain. Through an immunological phenomenon, known as original antigenic sin, the immune system is not able to adequately respond to the stronger infection, and the secondary infection becomes far more serious.[3]

Reported cases of dengue are an under-representation of all cases when accounting for subclinical cases and cases where the patient did receive medical treatment.

There was a serious outbreak in Rio de Janeiro in February 2002 affecting around one million people and killing sixteen. On March 20, 2008, the secretary of health of the state of Rio de Janeiro, Sérgio Côrtes, announced that 23,555 cases of dengue, including 30 deaths, had been recorded in the state in less than three months. Côrtes said, "I am treating this as an epidemic because the number of cases is extremely high." Federal Minister of Health, José Gomes Temporão also announced that he was forming a panel to respond to the situation. Cesar Maia, mayor of the city of Rio de Janeiro, denied that there was serious cause for concern, saying that the incidence of cases was in fact declining from a peak at the beginning of February.[4] By April 3, 2008, the number of cases reported rose to 55,000 [5]

In Singapore, there are 4,000–5,000 reported cases of dengue fever or dengue haemorrhagic fever every year. In the year 2004, there were seven deaths from dengue shock syndrome.[6]

It occurs widely in the tropics, including the Southern United States,[7] northern Argentina, northern Australia, Bangladesh, Barbados, Bolivia,[8] Belize, Brazil, Cambodia, Colombia, Costa Rica, Cuba, Dominican Republic, French Polynesia, Guadeloupe, El Salvador, Grenada, Guatemala, Guyana, Haiti, Honduras, India, Indonesia, Jamaica, Laos, Malaysia, Melanesia, Mexico, Micronesia, Nicaragua, Pakistan, Panama, Paraguay,[9] The Philippines, Puerto Rico, Samoa,[10] Western Saudi Arabia, Singapore, Sri Lanka, Suriname, Taiwan, Thailand, Trinidad and Tobago, Venezuela and Vietnam, and increasingly in southern China.[11]

There is an ongoing 2010 outbreak occurring in Puerto Rico with 5382 confirmed infections and 20 deaths. Nearby Guadeloupe and Martinique, in the French Caribbean, were very much affected as well: over 40000 clinical cases in each island required medical assistance (the outbreak peaked in August 2010 and was practically over by October). .[12][13] A considerable number of cases has been recorded in the French/Dutch island of St.Martin/Sint Marteen as well, where Dengue is endemic and a minor epidemic wave is still ongoing.[14] There is also an ongoing outbreak occurring in Pakistan with more than 5000 confirmed infections and death toll rose to 31. The 2010 and 2009 dengue outbreaks in Key West Florida [15][16] are similar to the 2005 Texas (25 cases) and 2001 Hawaii (122 cases) outbreaks, which were locally sustained on American soil and not a result of travelers returning from endemic areas.[17]

American visitors to and visitors from dengue-endemic regions will continue to present a potential pathway for the dengue virus to enter the United States and infect populations that have not been exposed to the virus for several decades.[17][18] The health risks and rapidly escalating costs to the United States of unmonitored, unvaccinated and disease carrying travelers, legal and illegal, has been recently considered.[17][19]

An outbreak of dengue fever was declared in Cairns, located in the tropical north of Queensland, Australia on 1 December 2008. As of 3 March 2009 there were 503 confirmed cases of dengue fever, in a residential population of 152,137. Outbreaks were subsequently declared the neighbouring cities and towns of Townsville (outbreak declared 5 January 2009), Port Douglas (6 February 2009), Yarrabah (19 February 2009), Injinoo (24 February 2009), Innisfail (27 February 2009) and Rockhampton (10 March 2009). There have been occurrences of dengue types one, two, three, and four in the region. On March 4, 2009, Queensland Health had confirmed an elderly woman had died from dengue fever in Cairns, in the first fatality since the epidemic began last year. The statement said that although the woman had other health problems, she tested positive for dengue and the disease probably contributed to her death.

An epidemic broke out in Bolivia in early 2009, in which 18 people have died and 31,000 infected.

In 2009, in Argentina, a dengue outbreak was declared the northern provinces of Chaco, Catamarca, Salta, Jujuy, and Corrientes, with over 9673 cases reported as of April 11, 2009 by the Health Ministry [7]. Some travelers from the affected zones have spread the fever as far south as Buenos Aires [8]. Major efforts to control the epidemic in Argentina are focused on preventing its vector (the Aedes mosquitoes) from reproducing. This is addressed by asking people to dry out all possible water reservoirs from where mosquitoes could proliferate (which is, in other countries, known as "descacharrado"). There have also been information campaigns concerning prevention of the dengue fever; and the government is fumigating with insecticide in order to control the mosquito population.[20]

The first cases of dengue fever have recently been reported on the island nation of Mauritius in the Indian Ocean. One of the South Asian countries still suffering highly from this problem is Sri Lanka.[21]

2010

In many undeveloped regions, including parts of India, "authorities do not have adequate facilities to detect dengue cases."[22] Notably, in the Philippines where patients seek herbal medication in lieu of hospitals for treating dengue, death rates as evidenced below are statistically far greater than other affected areas. As many cases go unreported, higher statistics here do not necessarily indicate a larger outbreak. In 2010, Latin America alone reported a sum of 1.5 million cases.[23]

Country Region Confirmed Cases Dengue
(Year: 2010)		 Suspected Cases
(Year: 2010)		 Reported Deaths
(Year: 2010)		 Compared with previous year Figures as of**
 World (sum of all regions) 1,785,059 N.A. 2,398
 Brazil - 936,000 - 592 489,819 mid Oct[24]
 Colombia - 121,600 - 161 - Sep 24[25]
 Indonesia - - N/A N/A 155,000 and 1386 deaths[26] no date
 Philippines - 119,789 - 724 49,319 (up 140%) Nov 17[27]
 Venezuela - 124,931 - - 65,869 all of 2010[28]
 Thailand - 108,863 - 131 up 134.7% on sep 27[29] Nov 20[30]
 Vietnam - ~80,000 - 59 105,370 (whole year) Sep [31]
 Honduras - 69,745 - 81 13,351 (whole year) December 2010[32]
 Malaysia - 45,037 - 133 39,537 dec 17[33]
 Sri Lanka - 26,824 - 192 mid Jul[34]
 Costa Rica - 21,000 - N/A 3,326 end Aug[35]
 Laos - 14,659 - 39 7,214(whole year) aug 28[36]
 Puerto Rico - 13,990 - 22 - Sep 18[37]
 Paraguay - 13,678 6138 n/a n/a sep 30[38]
 Mexico - 12,240 - 20 15,032 week 32 (sep)[39]
 Indonesia Bali 10,230 - 29 N/A Jan-Oct[40]
 Dominican Republic - 8,839 - 41 3,000 Sep 3[41]
El Salvador El Salvador - 6,458 15,068 1 n/a week 28[42]
 India Delhi 5,837 - 8 1,153 Nov 9 [43]
 Pakistan - 7,000+ - 35 - Nov 22[44]
 Indonesia North Sumatra 5,805 - N/A 4,643 (whole year) Sep [45]
 Indonesia Semarang 5,284 - 43 3,883 Oct 12 [46]
 Singapore - 5,103 - 41 4,497 dec 11[47]
 Cambodia - 3,771 - 10 2,355 to July[48]
 Saudi Arabia Jeddah 2219 - N/A dec 16[49]
 France Martinique 644 41970 17 Nov 22 [13]
 France Guadeloupe 418 44000 5 Nov 22 [50]
 Guatemala - 1,925 11,800 25 1 sep[51]
 Indonesia Yogyakarta 1123 - - 688 (whole year) Sep 26[52]
 Taiwan - 1211 - 2 1052 Nov 1[53]
 Trinidad and Tobago - 1,200 - 4 N/A end aug[54]
 India Uttar Pradesh 496 - 8 Oct 20[55]
 Nepal Chitwan 280 - - - Oct 17, 2010[56]
 United States - 198 (24-2010FL, 27-2009FL, 25-2005TX, 122-2001HI) [16][17][57] 2 (2010, suspected)[58][59] Cases down 11% from 2009[57] Aug 3, 2010 [60]
 France Mayotte 75 - N/A Sep 1[41]
 Australia Queensland 13 0 1 Nov 3, 2010[61]

2011

Philippines dengue case load for Q1 2011 was some 5% higher than the preceding year, at 18,885 cases and 115 deaths.[62] For 2011 until April 16, Brazil has recorded some 56,882 cases with 39 deaths, Paraguay with 27,000 cases and 31 deaths.[63]

A notable case was that of Trinidad and Tobago's first female Prime Minister, Kamla Persad-Bissessar, who was diagnosed with dengue fever in August 2011[64], prompting investigation into the possibility of an epidemic on the twin-island republic.

References

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