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Archive Number 20091123.4016
Published Date 23-NOV-2009
Subject PRO/EDR> Dengue/DHF update 2009 (48)
DENGUE/DHF UPDATE 2009 (48)
***************************
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] Cape Verde
[2] Senegal
[3] Sri Lanka (Vavuniya)
[4] India (Delhi)
[5] Thailand (immunocompromised transplant)
[6] Taiwan
[7] Mexico (Campeche)
[8] Mexico (national)

******
[1] Cape Verde
Date: Wed 18 Nov 2009
Source: WHO Global Alert and Response (GAR) Disease Outbreak News [edited]
<http://www.who.int/csr/don/2009_11_18/en/index.html>


As of 16 Nov 2009, the Ministry of Health has reported 16 744 
suspected cases of dengue in 5 islands: Brava, Fogo, Maio, Sal, and 
Santiago.

The World Health Organization (WHO) is working closely with the 
government of Cape Verde to support technical response to the 
outbreak, as well as to support coordination with other United 
Nations agencies, bilateral partners, and non-governmental 
organizations for the operational response.

WHO has deployed more than 20 experts -- many through the Global 
Alert and Response Network (GOARN) mechanism -- to support Cape Verde 
on epidemiological and entomological surveillance and laboratory 
investigation, vector-control, clinical case management, social 
mobilization, logistics, and information and technology. The experts 
come from Senegal, Thailand, Brazil, Italy, Martinique, Guadeloupe, 
French-Guyana, and from within WHO.

WHO has also deployed personal protection equipment (PPE), larvicide, 
fog machines, and laboratory diagnostics supplies to support the 
government operations for source reduction, vector control, and 
sustaining the onsite laboratory diagnosis of dengue. Dengue 
technical guidelines in Portuguese have also been provided by WHO.

The Ministry of Health of Cape Verde, the Operational Nucleus of 
Information Society (NOSi), and WHO have launched a nationwide 
internet and text messaging (SMS) reporting and alert system for 
dengue, providing real time information to public health experts and 
alerting individuals at risk when and how to seek care.

This is the 1st dengue outbreak in the country and people did not 
have immunity against the disease. During epidemics of dengue, 
infection rates among those who have not been previously exposed to 
the virus are often between 40 and 50 percent, but could reach 80-90 
percent in a worse case scenario.

Dengue is present in sub-Saharan Africa but often unrecognized. 
Although many arboviruses -- such as dengue, chikungunya, 
Crimean-Congo haemorrhagic fever, Rift Valley fever, yellow fever, 
and West Nile virus -- affect human health in west Africa, 
surveillance programmes are not consistently available except for 
yellow fever.

In the recent years, dengue has been documented in travellers 
returning from several countries in West Africa, and particularly 
dengue type-3 virus. Dengue type-3 virus has first isolated in 
travellers returning to Japan and France from Abidjan Cote d'Ivoire 
in 2008 and from Senegal to Italy in October 2009.

--
Communicated by:
ProMED-mail Rapporteurs Marianne Hopp and Brent Barrett

[Since this is the 1st outbreak of dengue on the islands and 
presumably vector mosquitoes are abundant, it is likely to continue 
for some time.

A HealthMap/ProMED-mail interactive map of Cape Verde can be accessed at
<http://healthmap.org/r/00Xw>. - Mod.TY]

******
[2] Senegal
Date: Sat 14 Nov 2009
Source: Sud Quotidien [in French, trans. Mod.TY, edited]
<http://www.sudonline.sn/spip.php?article21282>


The epidemic of dengue type 3 is well established in Senegal. In 
fact, 55 cases have been registered in the country. According to 
authorities of the Ministry of Health who met last Friday [13 Nov 
2009] in a symposium to explain its mode of transmission and its 
prevention, they have established a strategy to halt the progression 
of this disease.

The epidemic of dengue disease continues spread in the country. 
Indeed, there appeared a few weeks ago [dengue virus] type 3, and 
Senegal has already registered 55 declared cases. According to 
professor Bernard Diop of the Infectious Disease Service of the Fann 
Hospital, speaking last Friday [13 Nov 2009] in Dakar during a 
symposium about the disease, "dengue is manifested by high fever (39 
to 40 deg C/102.2-104 deg F), headache, muscle pain fatigue, bloody 
diarrhea, etc. The disease [virus], he said, is transmitted by the 
bite of a mosquito called _Aedes aegypti_. The characteristic of this 
insect is that its area of development is in "flower vases, old 
tires, cans with water, troughs, waste containers with water, and 
abandoned containers. The danger that this mosquito presents is its 
ability to bite both day and night; [_Ae. aegypti_ bites during 
daylight hours, including dawn and dusk. - Mod.TY] It occurs mainly 
in urban and periurban areas.

Professor Diop indicated that "the treatment is mainly symptomatic, 
not curative." It consists mainly of treatment of the patients to 
reduce their pain. However, said professor Diop, this disease has a 
significant economic impact because "convalescence requires 6-7 
weeks". For the authorities in charge of individual and collective 
[dengue] prevention in Senegal, the only means of coping with the 
illness is to eliminate places where the mosquito can breed.

 From this same viewpoint, Seyni Thiam of the National Health Service 
indicated that in addition to this, the Ministry of Health will 
proceed under "emergency measures to fight against the vector-borne 
diseases including dengue, [to carry out] a spraying campaign with 
insecticides within and outside homes within the territory of the 
Dakar region." He indicated that this campaign started yesterday, 
Friday [13 Nov 2009] afternoon. Senegal has already experienced 
several times in the past dengue [virus] type 2. For the 1st time in 
history, it is [dengue virus] type 3 disease, which broke out in the 
country.

[Byline: Mamadou Amadou Diop]

--
Communicated by:
ProMED-FRA
<promed-fra@promedmail.com>

[After Cote d'Ivoire and Cape Verde, Senegal, in turn, is facing the 
epidemic of dengue type 3. This confirms the emergence and the spread 
of the disease in West Africa. - Mod.SC]

[ProMED-mail appreciates receiving this dengue report, as we get so 
few from Africa. It would be of interest to know in which areas 
dengue virus transmission is occurring. Is it focal in Dakar or 
widespread?

A HealthMap/ProMED-mail interactive map of Senegal can be accessed at
<http://healthmap.org/r/00-d>. - Mod.TY]

******
[3] Sri Lanka (Vavuniya)
Date: Sat 21 Nov 2009
Source: TamilNet [edited]
<http://www.tamilnet.com/art.html?catid=13&artid=30651>


Dengue is spreading fast in Vavuniya and its suburbs. Up until 
Thursday [19 Nov 2009], 2 persons have died and 13 others warded in 
Vavuniya general hospital due to dengue fever. Over 1000 people seek 
treatment for dengue in Vavuniya general hospital daily and the 
majority of them are internally displaced people now detained in 
camps in Vavuniya, hospital sources said.

One of the 2 dengue victims has been identified as a 3-year old 
child. The child died in Vavuniya hospital and a police inspector 
died while being taken to Anuradhapura Teaching Hospital in an 
ambulance.

However, civil society sources blamed that health authorities have so 
far failed to launch any special treatment procedure or create public 
awareness about the increasing cases of dengue fever in Vavuniya.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Apparently, this area is one of numerous refugees following the end 
of the recent civil war in Sri Lanka. Refugee camps often have 
substandard sanitation that can lead to creation of breeding sites 
for _Aedes aegypti_, the dengue virus vector.

A map of Sri Lanka showing the location of Vavuniya can be accessed at
<http://www.maplandia.com/sri-lanka/northern/vavuniya/>.
A HealthMap/ProMED-mail interactive map of Sri Lanka can be accessed at
<http://healthmap.org/r/00-Y>. - Mod.TY]

******
[4] India (Delhi)
Date: Sun 22 Nov 2009
Source: Prokerala.com, Indo Asian News Service (IANS) report [edited]
<http://www.prokerala.com/news/articles/a94878.html>


With 7 new cases of dengue reported in the national capital Saturday 
and Sunday [21, 22 Nov 2009], the total number of people infected 
with the vector-borne disease has touched 999, a health official 
said. "7 new cases were recorded within last 24 hours and with that 
dengue cases in Delhi have reached 999," state nodal officer for 
dengue cases, Debashish Bhattacharya, told IANS.

According to the Delhi Health Department, the dengue cases are likely 
to come down within next 7-10 days with the fall in temperature.

So far, 2 dengue deaths have been reported in the capital -- one of a 
9-year-old and another of a 15-year-old boy.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[A HealthMap/ProMED-mail interactive map of India showing the 
location of Delhi can be accessed at
<http://healthmap.org/r/00-Z>. - Mod.TY]

******
[5] Thailand (immunocompromised transplant)
Date: Sun 22 Nov 2009 [accessed]
Source: Infectious Disease Reports [edited]
<http://www.pagepress.org/journals/index.php/idr/article/view/idr.2009.e3/1585>


Abstract
--------
Dengue infection, a mosquito-borne infectious disease in tropical and 
subtropical areas, has recently become an emerging global disease. 
Clinical course of dengue infection may be unfavorable in 
immunocompromised patients. In this report, we present a 16-year-old 
female patient with acute myeloid leukemia and receiving allogeneic 
peripheral blood stem cell transplant who was hospitalized at King 
Chulalongkorn Memorial Hospital, Bangkok, Thailand, due to fever, 
headache, and myalgia for one day. During hospitalization, she 
developed capillary leakage syndrome and progressive 
thrombocytopenia. A diagnosis of DHF was made and confirmed by 
positive dengue serology and polymerase chain reaction testing. She 
made a full recovery 14 days after hospitalization. In conclusion, 
this is the 1st reported case of DHF in a peripheral blood stem cell 
transplant recipient. In addition, we review all previous reports of 
dengue infection in organ transplant recipients.

Reference
---------
Jirayu Visuthranukul, Udomsak Bunworasate, Panisinee Lawasut, Chusana 
Suankratay. 2009: Dengue hemorrhagic fever in a peripheral blood stem 
cell transplant recipient: the first case report. Infect Dis Rep, 
1(1): 5-6.

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

[Normally ProMED-mail does not post dengue case reports. However, 
since this case is unique, and provides a cautionary account 
concerning tissue transplants, we are posting it. - Mod.TY]

[The HealthMap/ProMED-mail interactive map of Thailand is available at
<http://healthmap.org/r/00aF>. - Sr.Tech.Ed.MJ}

******
[6] Taiwan
Date: Tue 17 Nov 2009
Source: Taiwan News, Central News Agency (CNA) report [edited]
<http://www.etaiwannews.com/etn/news_content.php?id=1111074&cate_img=logo_taiwan&cate_rss=TAIWAN_eng>


Taiwan recorded over 70 new cases of dengue fever [virus] infection 
in the past week, bringing to 387 the number of people infected with 
the mosquito-borne disease since the summer, the [Taiwan] Centers for 
Disease Control (CDC) reported Tuesday [17 Nov 2009]. All are 
indigenous cases, including 5 DHF infections, CDC deputy director 
Chou Jih-haw said.

DHF is a severe, potentially fatal infection that is [clinically] 
different from normal dengue fever.

Chou noted that all the outbreaks this year [2009] have been reported 
from 7 cities and counties, mostly in southern Taiwan. In Kaohsiung 
City, Kaohsiung County, and Pingtung County, there are signs showing 
an expanding outbreak, he added.

Notably, the outbreak in Kaohsiung County has spread through 9 of the 
county's 11 administrative districts, Chou went on, warning that 
although the weather has been becoming colder, temperatures in 
southern areas are still higher than 15 deg C [59 deg F], which means 
that mosquitoes are still active. Chou urged the public to take 
precautions against mosquito bites and to make sure their 
environments do not harbor stagnant water where mosquitoes breed.

Dengue fever is an influenza-like viral disease spread by the bite of 
infected mosquitoes. Patients develop symptoms including fever, 
headache, nausea, fatigue, and pain in the muscles and joints.

Chou urged those who feel they might have been infected with the 
disease to report to their local health authorities, adding that 
those who report and test positive are entitled to a cash reward of 
TWD 2500 (USD 77.85) for reporting the case.

[Byline: Chen Ching-fang, Elizabeth Hsu]

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

[The HealthMap/ProMED-mail interactive map of Taiwan is available at
<http://healthmap.org/r/00-_>. - Sr.Tech.Ed.MJ]

******
[7] Mexico (Campeche)
Date: Fri 20 Nov 2009
Source: Malaysian National News Agency (Bernama) [edited]
<http://www.bernama.com/bernama/v5/newsworld.php?id=456764>


Mexico's eastern coastal state Campeche on Thursday [20 Nov 2009] 
reported its 1st death due to DHF, China's Xinhua news agency 
reported. The identity of the victim has not been released yet.

Meanwhile, the Health Ministry of Campeche State said that there were 
132 new dengue cases in one week, among whom 15 percent suffered the 
deadliest DHF variant.

Dengue, an incurable endemic disease in tropical areas, is spread by 
the _Aedes aegypti_ mosquito, which breeds in stagnant water. The 
Mexican states that were hit worst by heavy rains in late October and 
early November [2009] are now all facing an outbreak of dengue.

Epidemiologists suspect that DHF is caused by 2 different dengue 
viruses infecting one person at the same time. [This is not correct. 
A 2nd infection caused by a different dengue virus type may follow an 
initial dengue virus infection after some time has lapsed, eliciting 
immune enhancement and more severe disease. But these are sequential 
infections, not concurrent ones. - Mod.TY]

According to World Health Organization's records, DHF that causes 
massive blood loss usually affects less than 2 percent of dengue 
cases.

Besides Campeche, dengue has also begun spreading in Veracruz and 
Tabasco, the 2 states that suffered the heaviest rains in the 
country. Beginning this week [week of 16 Nov 2009], medical workers 
started to carry out anti-mosquito spraying activities in the 2 
states. Enrique Ivan Gonzalez Lopez, head of Campeche's health 
department, said Campeche will also begin a spraying campaign soon.

Mexico has so far recorded some 105 000 suspected cases of dengue, 
and some 50 000 of them have been confirmed, said the Mexican Health 
Ministry's health promotion department.

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

[A map of Mexico showing the states can be accessed at
<http://lib.utexas.edu/maps/americas/mexico_pol97.jpg>.
A HealthMap/ProMED-mail interactive map of Mexico can be accessed at
<http://healthmap.org/r/00-->. - Mod.TY]

******
[8] Mexico (national)
Date: Thu 19 Nov 2009
Source: Focus Information Agency [edited]
<http://www.focus-fen.net/index.php?id=n200839>


The Mexican states that were hit worst by heavy rains in late October 
and early November [2009] are now facing an outbreak of dengue, a 
senior health official said Wednesday [18 Nov 2009] in a nationally 
televised statement, Xinhua News Agency informed. Mauricio Hernandez, 
head of the Mexican Health Ministry's Health Promotion Department, 
said the ministry has so far recorded some 105 000 suspect cases of 
dengue, an incurable endemic disease in tropical areas, and some 50 
000 of them have been confirmed.

Beginning this week [week of 16 Nov 2009], the official said, medical 
workers started to carry out anti-mosquito spraying activities in 
Veracruz and Tabasco, the 2 states that suffered the heaviest rains 
in the country. According to the official, Mexico's Interior Ministry 
has declared a state of emergency in some municipalities in the 2 
states.

Preliminary statistics show that residents in Tabasco, a state on 
Mexico's east coast, have been affected by heavy rains and 250 000 of 
them have suffered big losses in financial and material resources, 
particularly when Hurricane Ida passed through the Gulf of Mexico 
last weekend [7-8 Nov 2009]. "Mosquitoes can be seen almost 
everywhere in the flooded areas," he said, adding that 120 medical 
workers have been dispatched to fumigate the areas and distribute 
medicine [repellant]-treated patches to people to help them frighten 
insects away from them when putting them on their skin.

The official said more dengue cases have been recorded this year 
[2009] than last year when there were only 29 000 cases registered.

Dengue [viruses] are spread by the _Aedes aegypti_ mosquito, which 
breeds in stagnant water.

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

[see also:
Dengue/DHF update 2009 (47) 20091115.3944
Dengue/DHF update 2009 (46) 20091111.3898
Dengue/DHF update 2009 (45) 20091102.3779
Dengue/DHF update 2009 (44) 20091026.3705
Dengue/DHF update 2009 (43) 20091021.3625
Dengue/DHF update 2009 (42) 20091020.3609
Hemorrhagic fever - Italy ex Senegal (02): dengue 20091016.3559
Dengue/DHF update 2009 (41) 20091012.3524
Dengue/DHF update 2009 (40) 20091005.3454
Dengue/DHF update 2009 (39) 20090928.3393
Dengue/DHF update 2009 (37) 20090915.3240
Dengue/DHF update 2009 (36) 20090907.3144
Dengue/DHF update 2009 (35) 20090831.3065
Dengue/DHF update 2009 (34) 20090823.2977
Dengue/DHF update 2009 (33) 20090817.2908
Dengue/DHF update 2009 (32) 20090811.2864
Dengue/DHF update 2009 (31) 20090803.2723
Dengue/DHF update 2009 (29) 20090720.2574
Dengue/DHF update 2009 (28) 20090713.2501
Dengue/DHF update 2009 (27) 20090706.2425
Dengue/DHF update 2009 (26) 20090629.2353
Dengue/DHF update 2009 (24) 20090614.2211
Dengue/DHF update 2009 (23) 20090608.2121
Dengue/DHF update 2009 (22) 20090601.2040
Dengue/DHF update 2009 (21) 20090525.1952
Dengue/DHF update 2009 (20) 20090518.1868
Dengue/DHF update 2009 (19) 20090512.1774
Dengue/DHF update 2009 (18) 20090505.1677
Dengue/DHF update 2009 (17) 20090428.1595
Dengue/DHF update 2009 (16) 20090419.1485
Dengue/DHF update 2009 (12) 20090314.1049
Dengue/DHF update 2009 (10) 20090302.0854
Dengue/DHF update 2009 (08) 20090216.0650
Dengue/DHF update 2009 (06) 20090210.0603
Dengue/DHF update 2009 (05) 20090204.0487
Dengue/DHF update 2009 (03) 20090119.0242
Dengue/DHF update 2009 (01) 20090105.0041]
...................................jw/dk/sc/ty/mj/lm

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