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DENGUE/DHF UPDATE 2008 (47)
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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] Brazil (Rio de Janeiro)
[2] Peru (Amazon)
[3] St Maarten
[4] Curacao
[5] India (West Bengal)
[6] Indonesia (Central Sulawesi)
******
[1] Brazil (Rio de Janeiro)
Date: 30 Oct 2008
Source: O Globo [in Portuguese, trans. & summ. Mod.JW, edited]
Not available via online edition
Rio de Janeiro state has registered 250 026 cases of dengue in 2008 through
29 Oct 2008, including 181 confirmed deaths, with 143 more deaths awaiting
confirmation; 56 confirmed deaths were from DHF. Half the cases (125 988)
and 105 of the confirmed deaths were in the capital, Rio de Janeiro itself.
The age group with the largest number of cases (44 per cent) was 20-49 years.
According to the WHO classification of risk from infestation by the dengue
vector mosquito _Aedes aegypti_, a house index (measure of houses where
breeding places are found) below one per cent does not constitute an
epidemic risk; 1-4 per cent signals an alert, and over 4 per cent a high
risk. House index figures released yesterday [29 Oct 2008] showed that in 7
districts of the capital, it ranged from 7-10.8 per cent, and in 9 others
above one per cent; only 7 districts surveyed were below one per cent.
--
communicated by
ProMED-mail <promed@promedmail.org>
[As far as I know, Rio de Janeiro does not use a dipstick [rapid test for
dengue]. Some time ago, cases were confirmed by serology or by a clinical
protocol. The difference between DHF and dengue deaths is by the incapacity
to appropriately classify cases as DHF, that is -- low numbers of platelets
and so on. - Mod.LJS
ProMED-mail has reported dengue epidemics in Rio de Janeiro in every year
since it began in 1994, with the exception of 2004 (when the city
registered only 552 cases). So it is notable that the age group of greatest
risk is adults of working age, rather than children under 5 years old as in
other affected countries. An explanation might be that large numbers of
people from rural areas of Brazil, less affected by dengue, are moving each
year to the city in search of work.
A house index of less than one per cent may obscure foci with indexes above
that within the sample area, as Singapore found to its cost a few years
ago. They were surprised to fall victim to a city-wide epidemic when the
overall house index was only one per cent. The same could be true of a
district within a city. - Mod.JW
Prefeitura of 28 Oct 2008 <http://www.saude.rio.rj.gov.br/> (in Portuguese)
reported on a survey from 13-18 Oct 2008 by the Municipal Health
Secretariat (SMS), noting that the city of Rio has an index of infestation
of the mosquito _Aedes aegypti_ of 2.89 per cent. In the same period of
2007 the number was 3.7 per cent. The comparison between the results of the
household survey index of the mosquito that transmits dengue [virus] showed
a gradual decline from 2005 to 2008, with a slight increase in the index
for October in relation to earlier [data], measured in August, which was
1.82 per cent. This is a reflection of the reproductive cycle of _Aedes
aegypti_, which is slower in winter. The area covering the districts of
Lins, Vasconcelos, Meier, Pillars, Engenho de Dentro, and Piedad continues
with the highest rate of infestation, 5.76 per cent, followed by the
regions of Madureira at 4.03 per cent, and the Governor's Island, Penha,
and Tide at 3.88 per cent. The survey also noted the identification of
preferred mosquito breeding sites in several areas of the city. The [water]
deposits were predominantly: gutters and drains (29.76 per cent), trash
(23.65 per cent) and plant vases (18.48 per cent). These data confirm the
suggestion of Mod.JW above that a city-wide index of infestation hides
focal areas where indices may be very high and the risk of dengue virus
transmission correspondingly great.
There were only 2 recorded dengue cases in Rio de Janeiro in
epidemiological week 43 (19-25 Oct 2008). The total number of dengue cases
in 2008 through EW 43 is 123 751, as reported by the Subsecretariat of
Health Services Actions, Superintendent of Health Surveillance, Office of
Epidemiological Surveillance
<http://www.saude.rio.rj.gov.br/saude/pubsms/media/tab_incidengue2008_sem.htm>.
The dengue outbreak has obviously slowed considerably in the city of Rio de
Janeiro. It will be interesting to see whether it resumes with the onset of
warmer weather, especially given the high _Aedes aegypti_ house infestation
rates given in some districts in the above survey.
A map of Brazil showing states, including Rio de Janeiro, can be accessed
at <http://www.lib.utexas.edu/maps/americas/brazil.jpg>. The
HealthMap/ProMED-mail interactive map of Brazil be accessed at
<http://healthmap.org/promed?v=-10.8,-53.1,4>. - Mod.TY]
******
[2] Peru (Amazon)
Date: Fri 31 Oct 2008
Source: Peruvian Times [edited]
<http://www.peruviantimes.com/outbreak-of-dengue-fever-and-health-alert-in-iquitos/>
Peruvian health authorities have reported that a fast-growing outbreak of
dengue fever, aggravated by heavy rain and torrid heat, might lead to the
reappearance of the more serious dengue hemorrhagic fever in Iquitos, a
city of about 300 000 residents in Peru's northern Amazon region.
According to Loreto's Regional Health Office, 4348 people have contracted
dengue fever since January 2008. Extreme heat and heavy rain showers are
being held responsible for the sudden outbreak. Dengue is a mosquitoborne
[virus] infection that causes a severe flu-like illness and sometimes a
potentially lethal complication called DHF.
Climate change may influence the transmission of dengue fever [virus], the
world's most widespread vectorborne virus, by extending the mosquitoborne
disease transmission season, reports Loreto's Regional Health Office.
There is a very high probability that hemorrhaging [DHF] will occur in
cases of the disease, said Carlos Coral Gonzales, the head of the region's
epidemiology department.
The Regional Health Office plans to fumigate 85 000 homes in Iquitos during
the month of November 2008. "We have the necessary equipment for the
fumigations," said Coral. "And we have 60 people carrying out sanitary
inspections home by home to verify whether water storage containers meet
health regulation standards in order to prevent the growth of the disease
[virus]-transmitting mosquito's larvae."
From March-July 1990, an epidemic of dengue occurred in Iquitos and the
surrounding area. A smaller outbreak was reported in Tarapoto, in the
neighboring department of San Martin.
Although cases were reported in Peru from 1953-1955 and in 1958, the 1990
epidemic was the 1st laboratory confirmation of indigenous transmission of
dengue [virus] in the Andean country. Hemorrhagic manifestations, such as
bleeding gums, were noted in 6.5 per cent of patients with clinical dengue.
A 2nd outbreak occurred in the same area from May 2000-May 2001.
Many people would be increasingly affected by dengue in Latin America and
Peru if, as expected, global warming aggravates disease [transmission] and
mosquito transmission processes. According to WHO, current evidence
suggests that inter-annual and inter-decadal climate variability have a
direct influence on the epidemiology of vectorborne diseases.
--
communicated by:
ProMED-mail rapporteur Brent Barrett
[Global climate change, including both temperature and precipitation
components, may well affect the occurrence of dengue virus transmission.
Public health agencies in dengue endemic areas, as well as in neighboring
countries free of dengue virus currently, should be on alert for occurrence
of outbreaks of greater intensity or appearance in new areas.
A map of Peru showing the political boundaries can be accessed at
<http://www.lib.utexas.edu/maps/americas/peru_pol91.jpg>. A
HealthMap/ProMED-mail interactive map of Peru can be accessed at
<http://healthmap.org/promed?v=-9.2,-75.9,5>. - Mod.TY]
******
[3] St Maarten
Date: Fri 1 Nov 2008
Source: The Daily Herald [edited]
<http://www.thedailyherald.com/news/daily/l143/deng143.html>
As authorities scramble to stem the dengue outbreak in St Maarten, the
number of confirmed cases continues to climb.
The Dengue Action Response Team (DART) announced on Thursday [23 Oct 2008]
that 90 laboratory-confirmed cases of dengue had been recorded 1-25 Oct
[2008]. The results of 48 lab tests are pending, and DART said the figure
was expected to surpass 100 this month [November 2008].
Meanwhile, St Maarten Laboratory Services (SLS) has introduced a new
laboratory system for dengue testing. The new system will enable Dutch-side
health officials to obtain immediate results of laboratory tests carried
out by SLS rather than having to send them to Curasao or the lab on the
French side, as was being done in the past.
Sector Health Care Affairs (SHCA) Preventive Health Department head Dr
Rachel Eersel met with family physicians on Tuesday evening [21 Oct 2008]
to inform them about the latest strategies being implemented to fight
dengue fever and to inform them about the new laboratory form. "The DART
team is requesting every household to take immediate measures as the
outbreak continues to (worsen). The only way to stop the dengue outbreak
from growing is by every household taking mosquito-breeding preventive
action. By taking measures, you are protecting your family from getting
dengue fever," the Government Information Service said.
In the meantime, the Hygiene and Veterinary Department is continuing with
its fogging campaign in the various districts, weather conditions permitting.
The house-to-house/yard inspections are part of the public health response
to dengue on the island and are part of an intensified community campaign
to eradicate the mosquito that transmits dengue fever.
--
communicated by:
ProMED-mail <promed@promedmail.org>
[This report is from the Dutch side of St. Maarten/St. Martin Island. The
Daily Herald <http://www.thedailyherald.com/news/daily/l142/dengue142.html>
reported that authorities are continuing their efforts to stem the spread
of dengue fever in St Maarten with intensified house-to-house inspection
around the Island Territory. Inspections will focus on potential breeding
grounds for mosquitoes, and inspectors are hoping to inspect some 15 000
households by the end of the campaign.
A number of civil servants who have been reassigned to carry out the
inspections will start the inspections, and the final logistics are
currently being put into place, the Government Information Service (GIS)
said in a press release on Wednesday [22 Oct 2008].
Maps showing the location of St Maarten/St Martin in the Caribbean can be
accessed at
<http://www.worldatlas.com/webimage/countrys/namerica/caribb/stmartin.htm>,
and the HealthMap/ProMED-mail interactive map can be found at
<http://healthmap.org/promed?g=3578421&v=18.067,-63.067,10>. - Mod.TY]
******
[4] Curacao
Date: Wed 28 Oct 2008
Source: Amigoe.com [edited]
<http://www.amigoe.com/artman/publish/artikel_48577.php>
At the moment, there is a dengue outbreak on the island. Authorities are
officially confirming this event.
Last month [September 2008], there were 23 registered cases; this month
[October 2008], there were 32. That is more than usual for this time of
year, when there is always an increase in dengue cases due to rainfall. The
rising trend has been established since July of this year [2008]. The
chance is great that more registered cases will be added because results
from more laboratory tests are expected.
The GGD has intensified its actions, which take place throughout the year,
regarding [mosquito] control in neighborhoods. There will not be spraying
yet, says Lanionel Tromp of the Hygiene Service. "That will only happen
when we are speaking of clusters of a lot of dengue cases in one area."
The service has 6 sprayers at its disposal, of which one has been loaned to
Bonaire, but it is already on its way back according to Tromp. The spraying
in the neighborhoods needs to take place strategically. Besides, it is an
expensive endeavor. It requires the employment of at least 10 persons that
have to spray early in the morning or later in the evening. The weather
also needs to cooperate, because if it rains, it doesn't make sense to
spray. The pesticide itself is also not cheap, says Tromp. Moreover the
spraying needs to go hand in hand with preventive measures, for which the
government is calling now. That means that pots, tires, washing machines,
cans, and other artifacts that can hold water need to be cleaned up or
turned upside down. The mosquitoes like to lay their eggs in places with
fresh water.
--
communicated by:
ProMED-mail <promed@promedmail.org>
[A map showing the location of Curacao, just north of Venezuela, can be
accessed at
<http://www.worldatlas.com/webimage/countrys/namerica/caribb/curacao.htm>.
- Mod.TY]
******
[5] India (West Bengal)
Date: Fri 31 Oct 2008
Source: Expressindia.com [edited]
<http://www.expressindia.com/latest-news/fresh-dengue-cases-in-murshidabad-midnapore/379699/>
Two fresh cases of dengue were reported from Murshidabad and Midnapore
districts on Thursday [30 Oct 2008].
Director of the state health services, Sanchita Bakshi, said: "Medical
teams are visiting the districts and collecting blood samples on a
day-to-day basis. We are trying our best to check the outbreak. But due to
climatic change, sporadic rainfall and global warming, it will spread, and
more people will be affected."
--
communicated by:
ProMED-mail rapporteur Brent Barrett
[The dengue outbreak continues to spread in West Bengal. A map of India
showing the location of West Bengal state can be accessed at
<http://www.lib.utexas.edu/maps/middle_east_and_asia/india_pol01.jpg>, and
a map of West Bengal state showing where these cases occurred can be found
at
<http://maps.google.com/maps?hl=en&q=map+Murshidabad+india&um=1&ie=UTF-8&sa=X&oi=geocode_result&resnum=1&ct=title>.
The HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/promed?g=1252881&v=22.9,79.6,5>. - Mod.TY]
******
[6] Indonesia (Central Sulawesi)
Date: Sun 26 Oct 2008
Source: Kompas.com [in Indonesian, machine trans., edited]
<http://www.kompas.com/read/xml/2008/10/26/08030455/pemkab.poso.tetapkan.kasus.klb.dbd>
The Regional Government of Poso in Central Sulawesi determined that the
conditions for spread of dengue fever are classified as extraordinary,
because the number of patients that were infected with dengue [virus]
increased sharply over the last month [September 2008] compared to the
usual situation.
From last month [September 2008] up to the present, 20 additional dengue
sufferers and those suspected of having dengue infection entered the
hospital, said Dr Poso Drg Urip of the Heriyanto Regency. "However, several
other districts in Poso city have reported one or 2 cases," he said. Doctor
Urip said that to control dengue in order for it not to spread, the local
Kesehatan Service has carried out fumigation (fogging) around the
sufferers' houses. But this step, according to him, is not the best
solution, because it only can kill adult _Aedes aegypti_ mosquitoes, the
dengue virus transmitter [implying that elimination of larvae in breeding
sites is the better solution, which it is. - Mod.TY]
--
communicated by:
ProMED-mail <promed@promedmail.org>
[A map showing the location of Sulawesi island in Indonesia can be accessed
at <http://encarta.msn.com/map_701516829/sulawesi.html>. A map of Central
Sulawesi showing the location of Poso can be accessed at
<http://www.indonesiamatters.com/images/central-sulawesi.jpg>. - Mod.TY]
[see also:
Dengue/DHF update 2008 (46) 20081028.3398
Dengue/DHF update 2008 (45) 20081020.3316
Dengue/DHF update 2008 (44) 20081013.3243
Dengue/DHF update 2008 (43) 20081007.3165
Dengue/DHF update 2008 (42) 20080929.3078
Dengue/DHF update 2008 (41) 20080922.2979
Dengue/DHF update 2008 (40) 20080915.2891
Dengue/DHF update 2008 (39) 20080909.2821
Dengue/DHF update 2008 (37) 20080826.2662
Dengue/DHF update 2008 (34): Peru, Brazil 20080818.2562
Dengue/DHF update 2008 (31) 20080806.2407
Dengue/DHF update 2008 (30): Brazil 20080728.2305
Dengue/DHF update 2008 (20) 20080519.1668
Dengue/DHF update 2008 (01): Brazil 20080104.0052]
..................lm/jw/ty/msp/sh
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