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Published Date: 2011-01-17 17:00:04
Subject: PRO/EDR> Dengue/DHF update 2011 (03)
Archive Number: 20110117.0198

DENGUE/DHF UPDATE 2011 (03)
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In this update:
[1] Yemen (dengue suspected; request for information)
[2] Cases in various countries: Venezuela (National), Venezuela
(Nueva Esparta state), Bolivia, Peru (Iquitos), Peru (Loreto
province), Brazil (Riberao Preto, Sao Paulo state)

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[1] Yemen (dengue suspected; request for information)
Date: Fri 14 Jan 2011
Source: Sabanews.net [in Arabic, trans. Corr.SB, edited & summ.]
<http://www.sabanews.net/ar/news233216.htm>

Since October of last year (2010) a number of directorates in
Hodeidah province [have expressed] great concern due to the spread of
the epidemic known popularly as "Almkrvs" [translated from the Arabic
as "the crunching" - Corr.SB] in relation to symptoms associated with
joint pain and inability to walk, high fever and severe cases of
diarrhea and vomiting in some infections and others with slight [light] rashes.

"Al Siyasiat" [a local Arabic language newspaper - Corr.SB] has
explored the views of academics and specialists on this epidemic.
Specialists affirm that there is no disease [officially] called
"Almkrvs," but there are cases with clinical signs of dengue fever
and a professor of physiology and nutrition at the University of
Hodeidah, Dr. Hazza El Jebel, says that the dengue virus is spread by
a female mosquito "_Aedes aegypti_," which transmits the virus from
an infected persons to healthy ones. The incubation period lasts for
a period of 5 days and [mosquitos] multiply in sewage, garbage and
breed in the winter period. [_Ae. aegypti_ breeds in fresh water in
water catchments in and around buildings, but not in sewage or
garbage. - Mod.TY]

He confirms that the virus, when its attacks a person, leads to a
significant decrease in white blood cells and platelets, and if not
addressed at the beginning of the disease progresses to bleeding and
may cause the patient to bleed to death.There is no disease called
"Almkrvs," but it is a name derived from the symptoms of the disease
in a patient, one of vulnerability and malnutrition, hygiene, housing
and others due to poverty and ignorance, and causes [conditions for]
dengue fever.

The symptoms associated with the disease are muscle weakness, joint
pain, high fever, headache, and eye pain, in addition to a rash. In
addition to the lack of awareness by the patient, [there is]
ignorance about disease states that have been transferred to us from
the affected countries such as South and East Africa. He also refers
to the lack of awareness by media and the competent authorities on
the reasons for the transfer of the virus from infected individuals
to non-infected persons.

He points out that a committee of the University of Hodeidah and the
Office of Health will visit the affected districts and will be taking
samples and a study on the causes of infection.

Dr. Bandar, of the al-Faqih military hospital in Hodeidah, said that
the disease is a viral infection and [based on] the epidemiology [of
the disease], the most important symptoms associated with the
disease are very high temperature and runny nose and pain of the
joints. The disease is confirmed as dengue fever after conducting
tests such as general blood [complete blood count?] giving the
percentage of platelets. The results provide [data on] the proportion
of white blood cells and platelets in particular.

It is confirmed that the clinical situation is evolving with the
progress to bleeding from the nose, which indicates that a critical
situation [exists] due to lack of blood platelets that may lead to
the death of the patient from to internal bleeding if the disease is
not treated in its early stages. Antibiotics are given if the disease
progresses in the patient and when there is inflammation due to
secondary bacterial infections as a result of HIV in the patient
infected with dengue fever.

He says that the symptoms of "Almkrvs" are similar to the symptoms of
dengue fever, with the same and pain associated with this disease,
and can be confirmed by the presence of dengue virus when tested.
Many cases have reached the hospital and have been processed and
given the necessary treatment. If a case has reached the bleeding
stage, it may may cause complications for the patient.

In advanced cases, transfusions may be given to the bleeding patient,
which saves the patient from internal bleeding that causes the
patient's death. Dr Abdullah Al-Hariri, head of laboratory at the
military hospital in Hodeidah, said that complete blood counts are
done on samples that come to the laboratory for diagnosis.

Dr. Abdu-Zeid, head of nursing at the military hospital, says that of
the number of patients examined in December, more than 400 cases have
been tested [by what means?] and were serious.

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

[This outbreak is a continuation of the undiagnosed "Almkrvs" disease
reported from western Yemen in November 2010 (see ProMED-mail archive
number 20101125.4246). Although the above report indicates that the
cases are dengue and DHF, it is difficult to conclude that these are
indeed cases of dengue fever or DHF from this report.

Medical authorities indicate that these are dengue virus infections,
with reduction in platelet counts as the diagnostic criterion. No
mention is made of virus detection or serological diagnosis of dengue
virus infections.

The term "crunching" makes one wonder if chikungunya virus infections
might be involved as well. The dengue and chikungunya virus vector
mosquito, _Aedes aegypti_, is present in this area in Yemen (see
ProMED-mail archive no. 20050308.0685). Dengue has been reported in
other parts of Yemen in August 2010, with 309 out of 2200 suspected
dengue cases confirmed positive and many Yemeni governorates
reporting the spread of this epidemic, according to a June 2010
report issued by the Ministry of Health (see ProMED-mail archive
number 20100826.3010). Additional information about this current
outbreak and laboratory testing that has been done would be appreciated.

A map of the provinces and cities of Yemen can be accessed at
<http://www.citypopulation.de/Yemen.html#Land>.
A HealthMap/ProMED-mail interactive map of Yemen can be accessed at
<http://healthmap.org/promed/index.php?v=15.9,47.6,5>. - Mod.TY]

******
[2] Cases in various countries: Venezuela (National), Venezuela
(Nueva Esparta state), Bolivia, Peru (Iquitos), Peru (Loreto
province), Brazil (Riberao Preto, Sao Paulo state)

- Venezuela (National). 14 Jan 2011. In 2010 up to 1 Jan 2011
(epidemologic week No.52), there were 124 931 cases of dengue. But
the highest incidence occurred in mid-year, and now there is a
downward trend in 22 States which is expected to continue.
<http://www.avn.info.ve/node/38355> in Spanish trans. Corr.SB.
[A HealthMap/ProMED-mail interactive map of Brazil can be accessed at
<http://healthmap.org/promed/index.php?v=7.1,-66.2,5>. Mod.TY]

- Venezuela (Nueva Esparta state). In the dengue epidemic of 2010,
there were 1935 positive dengue cases of a total of 2217 suspected
cases, and one DHF case in Nueva Esparta.
<http://www.elsoldemargarita.com.ve/Noticias.aspx?NoticiaId=72074&SeccionId=1>
in Spanish, trans. Corr.SB.

- Bolivia. 10 Jan 2011. So far in 2011, there are 321 dengue cases in
Beni department (state or province equivalent), 12 of which are
serious. A 2010 report from the Ministry of Health indicated that [in
2009] up to 31 Jan 2010, Beni and Santa Cruz departments had the most
dengue cases, with Santa Cruz reporting 3044 probable and 269
confirmed cases and Beni reporting 1616 suspected and 328 confirmed
cases. In Santa Cruz, the Director of Epidemiological Surveillance
indicated that dengue was under control.
<http://www.eldeber.com.bo/vernotaahora.php?id=110109230739> in
Spanish, trans. Corr.SB.
15 Jan 2011. A "red alert" has been declared by the Ministry of
Health because the dengue outbreak has spread to 7 of Bolivia's 9
departments. [In 2009 there was an epidemic with more than 40 000
cases and nearly 50 deaths nationally (see ProMED-mail archive number
20100322.0910) - Mod.TY].
<http://news.xinhuanet.com/english2010/health/2011-01/15/c_13692009.htm>
A map showing the administrative divisions of Bolivia can be accessed at
<http://www.lib.utexas.edu/maps/americas/bolivia_admin_2006.jpg>
A HealthMap/ProMED-mail interactive map of Bolivia can be accessed at
<http://healthmap.org/promed/index.php?v=-16.7,-64.7,5>. - Mod.TY]

- Peru (Iquitos). 11 Jan 2010. The Hospital Apoyo in Iquitos is
receiving 60 febrile cases per day. Yesterday (10 Jan 2011), the
emergency area was filled with dengue cases and there are more than
30 patients hospitalized with dengue fever.
<http://proycontra.com.pe/2011/01/11/acondicionarian-hospital-por-brote-de-dengue/>
in Spanish trans. Corr.SB.
[A HealthMap/ProMED-mail interactive map of Peru can be accessed at
<http://healthmap.org/promed/index.php?v=-9.2,-75.9,5>. Mod.TY]

- Peru (Loreto province). 14 Jan 2011. At least 5 people died of
dengue since the beginning of the year (2011) in the province of
Loreto in the northeast Amazon, almost as many as throughout Peru in
2010, and more than 1110 cases were reported in this province,
according to the regional health authority. 1130 dengue cases were
diagnosed, including 26 serious cases. The most affected areas, are
in indigenous communities that are difficult to access.
<http://www.romandie.com/infos/news2/110114222209.xtx6bn9z.asp> in
French, trans. Corr.SB.

- Brazil (Riberao Preto, Sao Paulo state). 14 Jan 2011. In 2010,
Riberao Preto had the worst dengue epidemic in its history, with
approximately 30 000 cases. This year (2011), in the 1st 12 days of
the year, 47 cases has been recorded.
<http://eptv.globo.com/noticias/NOT,2,2,331432,Ribeirao+Preto+tem+54+casos+confirmados+de+dengue+em+13+dias.aspx>
in Portuguese, trans. Mod.TY
[A map showing the states of Brazil can be accessed at
<http://www.lib.utexas.edu/maps/americas/brazil.jpg>
A HealthMap/ProMED-mail interactive map of Brazil can be accessed at
<http://healthmap.org/promed/en?v=-10.8,-53.1,4>. - Mod.TY]

See Also