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Published Date: 2009-01-05 22:00:41
Subject: PRO/EDR> Dengue/DHF update 2009 (01)
Archive Number: 20090105.0041

DENGUE/DHF UPDATE 2009 (01)
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Australia (Queensland, Cairns)
[2] Australia (Queensland, Townsville)
[3] Indonesia (E. Kalimantan)
[4] Cambodia
[5] Thailand
[6] Brazil (Rio de Janeiro)
[7] Western Hemisphere

******
[1] Australia (Queensland, Cairns)
Date Wed 24 Dec 2008
Source: Queensland Government [edited]
<http://www.health.qld.gov.au/dengue/outbreak_update/current.asp>

[This is an update of the current dengue
situation in Cairns, Queensland, Australia. - Mod.TY]

Outbreak location: the Cairns suburb of Cairns
North has been the centre of dengue transmission
during this outbreak. Please refer to the warning
map [available at the URL above]. Local dengue
transmission has also taken place in Parramatta
Park and Whitfield. Mosquito control work will continue in these areas.

Other Cairns suburbs are also associated with
this outbreak, with warning maps for Portsmith,
Bungalow, Parramatta Park, Manunda, Mooroobool,
Edge Hill, Whitfield, Trinity Park, Kewarra
Beach, and Clifton Beach. Mosquito control has been completed in these areas.

Date outbreak declared: Mon 1 Dec 2008.

Number of cases: as of 24 Dec 2008, there are 52
confirmed cases. The last onset of illness date
was 16 Dec 2008. The outbreak will be declared
officially over after 3 months has elapsed since
the last onset of illness date.

Type of dengue [virus]: dengue type 3 [virus].

Advice: to protect yourself from dengue fever, you should:
- Get rid of mosquito breeding sites in homes and
yards, especially post plant bases, tyres, and
buckets used for striking plant cuttings. See
fact sheet at <http://www.health.qld.gov.au/dengue/documents/22380.pdf>.
- Use insect repellent -- wear personal repellent
during the day and reapply it according to the label.
- Use plug-in mosquito zappers, and use cockroach
surface spray under tables, chairs and beds in the home.

Stop mozzies [_Aedes_ mosquitoes] breeding and
stop the disease. Queensland Health, local
government, local residents and businesses all
play vital roles in the management of dengue
fever. Local residents and businesses are urged
to get rid of dengue mosquito breeding in homes,
buildings and yards. Government authorities work
to control dengue fever according to the Dengue
Fever Management Plan using disease surveillance,
mosquito control and surveillance, and education.

--
Communicated by:
Dr Irene Lai MB BS
Deputy Medical Director
Intl. SOS Online and Corporate Medical R&D
International SOS
Level 5 Challis House 4 Martin Place
Sydney NSW 2000
Australia
<irene.lai@internationalsos.com>

[ProMED-mail will be interested in the progress
made to track the Cairns and vicinity dengue
outbreak and the control effort's results. ProMED
thanks Dr Lai for alerting us to this Queensland government site.

Cairns in northern Queensland can be located on the map at
<http://www.lib.utexas.edu/maps/australia/australia_pol99.jpg>. - Mod.TY]

******
[2] Australia (Queensland, Townsville)
Date: Mon 5 Jan 2009
Source: Magnetic Times [edited]
<http://magnetictimes.com/index.php?ID=2985>

Residents of Townsville and Magnetic Island are
urged to protect themselves against dengue fever,
with 2 confirmed locally-acquired cases having been identified recently.

An unrelated man and a woman, both from North
Ward, have been confirmed as having contracted
dengue fever [virus] type 1. This is a different
strain to that which is currently causing the
outbreak of dengue fever in Cairns [which is
Dengue virus type 3, see summary above. - Mod.TY]

Acting director with Tropical Population Health
Services in Townsville, Mr David Sellars, said
mosquito surveillance and control work was under way in North Ward.

Townsville City Council staff are assisting
Tropical Population Health Services in mosquito control efforts.

Mr Sellars said it was important for all
Townsville residents to protect themselves now
against dengue to avoid an escalation of the outbreak.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[There is no indication where dengue virus type 1 may have come from.

Townsville is 281 km (175 mi) south of Cairns,
where the dengue virus type 3 outbreak is going on currently.

Cairns and Townsville can be located on the
HealthMap/ProMED-mail interactive map of Australia at
<http://healthmap.org/promed/en?g=2172797&g=2146142&v=-16.917,145.767,5>.
- Mod.TY]

******
[3] Indonesia (E. Kalimantan)
Date: Wed 31 Dec 2008
Source: The Jakarta Post [edited]
<http://www.thejakartapost.com/news/2008/12/31/with-9-deaths-monthly-e-kalimantan-dengue-incidents-outpass-national-average.html>

With 9 deaths monthly, East Kalimantan dengue
incidents outpass national average.

The East Kalimantan health service has reported
that 172 people out of every 100 000 East
Kalimantan residents contract dengue fever each
month, over 8 times the national average of 20
cases for every 100 000 residents.

A total of 101 East Kalimantan residents died of
dengue fever between January and November this
year [2008], East Kalimantan health services
representative Jurnanto said Wednesday [31 Dec
2008], bringing the monthly average in the province to 9.

These newly released 2008 figures put the dengue
fever death rate at 1.9 percent, roughly double
the national average is below 1 percent.

A total of 5270 dengue fever cases were reported
during the 11-month period, with the number spiking in April [2008] at 746.

"The trend each year is that dengue fever occurs
mostly in the beginning of the year," Jurnanto
said, as quoted by tempointeraktif.com Wednesday [31 Dec 2008].

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[No information is provided to explain the higher
dengue attack rate or the higher dengue case
fatality rate, compared to the rest of Indonesia.

A map showing the location of East Kalimantan
province located on the east side of Borneo Island can be accessed at
<http://encarta.msn.com/map_701516230/samarinda.html>.
A HealthMap/ProMED interactive map of Indonesia,
showing East Kalimantan, can be accessed at
<http://healthmap.org/promed/en?g=1641897&v=-2.6,120.9,5>. - Mod.TY]

******
[4] Cambodia
Date: Tue 30 Dec 2008
Source: The Phnom Penh Post [edited]
<http://www.phnompenhpost.com/index.php/2008123023399/National-news/Dengue-fever-casualties-down-nationwide-ministry.html>

Dengue fever casualties down nationwide
---------------------------------------
The head of the Health Ministry's anti-dengue
fever program credits better education and
treatment for the decline. A Health Ministry
official announced Monday [29 Dec 2008] a steep
decline in the number of infections and deaths
from dengue fever countrywide this year [2008].

Ngan Chantha, director of the ministry's
anti-dengue fever program, said 65 people have
died from the disease so far this year [2008],
compared with 407 deaths in 2007. He said 9300
people contracted the disease in 2008, down from 39 851 cases last year [2007].

Dengue fever is a viral disease transmitted by
mosquitoes that causes severe fever, headache,
muscle and joint pain, and skin rash.

Ngan Chantha credited greater funding and
educational programs for the drop in infection
rates and deaths. "We have a preventative program
in place to check the spread of dengue fever," he
told the Post Monday [29 Dec 2008], adding that
the government has also received support from the
World Health Organisation, the World Bank, the
Asian Development Bank, and USAID (US Agency for International Development).

Ngan Chantha said provinces hardest hit by dengue
include Kampong Cham, Kampong Thom, Kandal, and
Siem Reap, but that the disease finds a strong
foothold in areas suffering from poor sanitation.
However, Ngan Chantha identified a troubling
trend in the spread of the disease.

"Now, it is not only the children who get
infected. It is also older men between 20 and
50," he said, adding that the ministry did not
have data on infection rates among adults but
that it would conduct studies in the future.

Srey Acha, director of the Me Sang district
referral hospital in Prey Veng province, said the
hospital treated no cases of dengue fever so far
this year. "People in my district now have a
greater understanding about how to prevent
infection," he told the Post Monday [29 Dec 2008].

[Byline: May Titthara, Sam Rith]

--
Communicated by:
ProMED-MBDS
<promed-mbds@promedmail.org>

[A total of 5552 cases and 43 fatalities
attributable to dengue fever had been identified
in Phnom Penh and Siem Reap at the beginning of December 2008.

For a map of Cambodia with provinces, see
<http://www.lib.utexas.edu/maps/middle_east_and_asia/cambodia_pol_97.jpg>.
For the interactive HealthMap/ProMED map of
Cambodia with links to other ProMED-mail postings
in Cambodia and surrounding countries, see
<http://healthmap.org/promed?v=12.7,104.9,5>. - Mod.YMA

It would be of interest to have more details
about the educational program which, along with
better treatment, is credited for the reduction
in dengue cases and fatalities in 2008. - Mod.TY]

******
[5] Thailand
Date: Tue 30 Dec 2008
Source: Center of Epidemiological Information,
Bureau of Epidemiology, Ministry of Public
Health, Thailand [in Thai with English language tables of cases, edited]
<http://203.157.15.4/surdata/disease.php?ds=66>

[Nationally, there were 36 943 reported dengue
cases with 6 deaths in 2008 (local calendar year
BE2551). There is a breakdown by region in these
English language tables, with morbidity and
mortality rates by age group presented. Click on
2551 at the URL above to see these tables.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

Maps of Thailand can be accessed at
<http://www.lib.utexas.edu/maps/middle_east_and_asia/thailand_admin_2005.jpg>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/promed/en?v=15.1,101,5> - Mod.TY]

******
[6] Brazil (Rio de Janeiro)
Date: Wed 10 Dec 2008
Source: Subsecretaria de Atencao a Saude,
Superintendencia de Vigilancia em Saude,
Coordenacao de Vigilancia Epidemiologica, Divisao
de Transmissiveis e Imunoprevinveis [in
Portuguese, trans. & summ. Mod.TY, edited]
<http://www.saude.rj.gov.br/Docs/Acoes/dengue/Relatório%20de%20Casos%20de%20Dengue%20_10-12-2008%20-%2018h25m_.pdf>

Summary report of dengue cases - 2008
-------------------------------------
To date [for 2008], the State of Rio de Janeiro
reported 248 609 cases of dengue, with 17 467 in
January, 25 258 in February, 83 592 in March, 91
136 in April, 23 902 in May, 4290 in June, 1343
in July, 692 in August, 343 in September, 290 in
October, 285 in November, and 11 in December.

The 10 municipalities that recorded the highest
number of cases were: Rio de Janeiro (124 203
[cases]), Nova Iguacu (18 912), Campos dos
Goytacazes (17 788), Duque de Caxias (15 381),
Angra dos Reis (11 008), Belford Roxo (7355),
Niteroi (6847), Sao Joao de Meriti (6678),
Niagara Falls (3427) and Itaborai (3257). These
municipalities account for 86 percent of total
cases reported, and 50 percent in municipality of Rio de Janeiro.

The age group that presents the greatest number
of reports (54 percent) is 15-49 years.

Of the total [dengue] cases reported in the
state, 69 838 were classified as "classical
dengue [fever]", 13 516 "dengue [virus infection]
with complications, " 1761 as "DHF" [dengue
hemorrhagic fever], and 46 as dengue shock syndrome [DSS].

To date [in 2008], 15 022 [dengue] cases were
admitted in [hospitals of] the State Rio de
Janeiro, where 48 percent of the admissions
occurred in the age group of children under 15 years.

Dengue in pregnant women
-------------------------
In pregnant women in the state, 1101 suspected
cases of dengue fever have been reported [in
2008]: January (115 [cases]), February (122),
March (435), April (338), May (70), June (14),
July (5), September (2). Of these, 4 progressed
to maternal and fetal death (the patients lived
in the cities of Rio de Janeiro, Duque de Caxias,
and Italva Angra dos Reis, respectively), 4
[were] maternal deaths. All the deaths are
confirmed [as due to dengue virus infection].

[A breakdown of deaths by municipality are presented at this site. - Mod.TY]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[This 2008 outbreak began in January, accelerated
through March, and then began a slow decline
through the rest of the year. It will be
interesting to see if this same epidemiological
curve is repeated in 2009, starting now, in
January 2009, and intensifying as warmer weather
occurs. One hopes not. - Mod.TY

According to official records, 2008 was, by far,
the worst year for numbers of dengue cases since
1986
(<http://www.saude.rj.gov.br/Docs/Acoes/Dengue/Casos%20Notificados%20de%20Dengue%201986-2008%20RJ.pdf>).
The numbers of dengue cases by month in Rio de
Janeiro state 1986-2008 can be seen at
<http://www.saude.rj.gov.br/Docs/Acoes/Dengue/Dengue%20CLÁSSICA%20E%20HEMORRÁGICA.pdf>.
- Mod JW

The state of Rio de Janeiro can be located on the
HealthMap/ProMED-mail interactive map of Brazil at
<http://healthmap.org/promed/en?g=3451189&v=-22,-42.5,5>. - CopyEd.MJ]

******
[7] Western Hemisphere
Date: 26 Oct 2008
Source: Pan American Health Organization (PAHO) [edited]
<http://www.paho.org/english/ad/dpc/cd/dengue-cases-2008.htm>

[Data received by PAHO from individual countries
for 2008 up to 26 Oct 2008. - Mod.TY]

Through week / no. clinical cases / no. lab
confirmed / *dengue virus serotype / no. DHF cases / no. deaths

Central America and Mexico Region
Belize wk 36 / 16 / ?** / ? / 0 / 0
Costa Rica wk 38 / 6153 / ? / DENV* 1,2 / 49 / 0
El Salvador wk 41 / 5008 / 1173 / ? / 0 / ?
Guatemala wk 23 / 963 / 83 / DENV 1,2 / 4 / 0
Honduras wk 36 / 11 167 / ? / DENV 2,4 / 1185 / 2
Mexico wk 33 / 40 940 / 11 911 / DENV 1,2,3 / 2009 / 0
Nicaragua wk 33 / 504 / 342 / ? / 24 / 2
Panama wk 35 / 538 / 388 / DENV 3 / 2 / 0

Andean Region
Bolivia wk 37 / 3,181 / 321 / ? / 3 / 0
Colombia wk 38 / 21 128 / 3394 / DENV 1,2,3 / 2374 / 7
Ecuador wk 19 / 1894 / ? / ? / 15 / 0
Peru wk 30 / 9528 / 2266 / ? / 28 / 1
Venezuela wk 16 / 20 601 / ? / DENV 1,2,3,4/ 1410 / 0

Southern Cone
Argentina wk 18 / 28 / 3 / DENV 1 / 0 / 0
Brazil wk 35 / 734 384 / ? / DENV 1,2,3 / 9957 / 212
Chile wk 36 / 16 / ? / DENV 1 / 0 / 0
Paraguay wk 18 / 1953 / 8 / ? / ? / ?
Uruguay wk 39 / 0

Hispanic Caribbean
Cuba no cases reported
Dominican Republic wk 33 / 1585 / 571 / ? / 43 / 9
Puerto Rico wk 41 / 2310 / ? / DENV 1,2,3 / 7 / 2

English-, French-, and Dutch-speaking Caribbean
American Virgin Islands no cases reported
Anguilla wk 36 / 4 / ? / DENV 1 / 2 / 0
Antigua & Barbuda wk 20 / 16 / ? / DENV 1 / ? / ?
Aruba wk ? no cases reported
Bahamas wk 26, no cases reported
Barbados wk 16 / 1 / ? / ? / ? / ?
Bermuda wk 36 / 0 / ? / ? / ? / ?
British Virgin Islands wk 32 / 2 / ? / DENV 2,4 / ? / ?
Cayman Islands wk 32 / 1 / ? / DENV 2 / 0 / 0
Curacao wk ? no cases reported
Dominica wk 36 / 33 / ? / DENV 2 / 0 / 0
French Guiana wk 17 / 191 / ? / DENV 1,2,4 / 0 / 0
Grenada wk 4 no dengue cases reported
Guadeloupe wk 21 / 160 / ? / DENV 1,2 / ? / ?
Guyana wk 32 / 253 / ? / ? / 0 / ?
Haiti no data provided
Jamaica wk 36 / 249 / ? / ? / 2 / 0
Martinique wk 19 / 485 / ? / ? / ? / ?
Montserrat wk 36 no dengue cases reported
St. Kitts & Nevis wk 32 / 2 / ? / ? / ? / ?
St. Lucia wk 36 / 23 / ? / DENV 2 / 0 / 0
St. Vincent & the Grenadines wk 20 / 1 / ? / ? / ? / ?
Suriname wk 36 / 9 / ? / ? / 9 / 0
Trinidad & Tobago wk 37 / 2366 / 206 / DENV 2,3 / 8 / 3
Turks & Caicos Islands wk 32 / 0 /

[**? indicates no numbers provided, including 0. - Mod.TY]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Note that
1. Data only go up to epidemiological week (EW) 44 (end October 2008)
2. The only countries reporting nearest to EW 44
are El Salvador and Puerto Rico (EW41/6-12 Oct
2008); most are EW37/8-14 Sep 2008 or earlier;
some nothing since EW4/21-27 Jan 2008 (Grenada);
Cuba and Haiti not reporting; (El Salvador,
Mexico, and others also marked "f -- without reports" -- obviously wrongly)
3. therefore subregional totals are meaningless
4. only 2.4 percent were laboratory confirmed overall
5. DHF was 2 percent overall
6. CFR (case fatality rate) 238/865 697 = 2.7/100
000 cases (extraordinarily low compared to Asia?)
- Mod.JW]. [In Asia, dengue occurs mainly in
children, which may explain the difference in the CFR. - Mod.TY]

[Although the differences in reporting the weeks
covered in 2008 make country-to-country
comparisons invalid, the tables presented do give
an indication of the relative intensity of
outbreaks for 8-10 months in most instances. The
information indicates clearly that all 4 dengue
viruses are circulating in the tropical and
subtropical Western Hemisphere. The substantial
gaps in information make accurate hemisphere-wide
assessment and timely surveillance of this
important disease complex impossible.

A map of the Western Hemisphere can be accessed at
<http://www.teachervision.fen.com/tv/printables/scottforesman/SSMAP080.pdf>.
- Mod.TY]

[The outbreaks reported in this update can be
found on the HealthMap/ProMED-mail interactive map at
<http://www.healthmap.org/promed>. - Mod.TY]

See Also