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CHIKUNGUNYA (21): MADAGASCAR, SOUTHEAST ASIA
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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] Madagascar
[2] Southeast Asia
******
Date: Thu 11 Jun 2009
From: Marc Grandadam <marc.grandadam@pasteur.fr>
Special attention on chikungunya virus (CHIKV) in Indian Ocean
territories was implemented after its spreading from Eastern Africa
to Comoros, Mauritius, Mayotte, and La Reunion islands in late 2004
(1). Since the end of La Reunion outbreak in June 2006, no new cases
were reported by local authorities or the networks for imported viral
diseases. In Madagascar, CHIKV and dengue virus type 1 were
responsible for a large outbreak in 2006 in Toamasina (Tamatave),
coastal town located 350 km [217.5 mi] northeast from Antananarivo
(2). Then outbreaks caused by CHIKV were confirmed in February 2007
in the Sava region (North-East coast), in March 2007 in Antsiranana
(Northern Coast) and in May 2007 in Mahajanga (North-West coast).
Since March 2009, chikungunya confirmed cases have been reported by
the national sentinel surveillance network of the Malagasy Ministry
of Health. These cases occurred in the Toamasina. The 1st case was
confirmed by RT-PCR and virus isolation by the National Reference
Centre for arboviruses at the Institut Pasteur, Antananarivo, on 13
Mar 2009. In May [2009], 2 confirmed cases and one probable case (IgM
positive) were reported. By now 2 confirmed cases have been
registered since [1 Jun 2009]. The riposte to this alert has been
organized by the Ministry of Health including mosquito (_Aedes
albopictus_) control measures and public and medical staff awareness.
An epidemic situation has not been detected and the beginning of the
austral winter will contribute to stop the transmission.
On 29 May [2009], a 67-year-old man returning from Madagascar was
been hospitalized in Limoges, district Haute-Vienne (Central-Western
France) for an acute febrile syndrome associated with arthralgia and
cutaneous rash. Chikungunya diagnosis (IgM and RT-PCR positive) was
confirmed by the National Reference Centre for arboviruses (Institut
Pasteur, Paris). No recognized competent vector for chikungunya
[virus] (that is, _Aedes albopictus_) has been in evidence at present
in the Haute-Vienne department, so this imported case does not
represent any risk of chikungunya endemization in this French region.
[Nor is there a risk of a seasonal outbreak. - Mod.TY]
Altogether, these data support an active circulation of chikungunya
virus in the main Indian Ocean's island. Reinforcement of
surveillance should be organized to prevent the risk of potential
re-emergence of the virus in surrounding archipelagoes. Specific
information of persons visiting these islands, focusing on individual
mosquito bites prevention, should be intensified both locally and in
Northern Hemisphere countries.
References [cited above]
------------------------
1. Schuffenecker I, Iteman I, Michault A, Murri S, Frangeul L, Vaney
MC, Lavenir R, Pardigon N, Reynes JM, Pettinelli F, Biscornet L,
Diancourt L, Michel S, Duquerroy S, Guigon G, Frenkiel MP, Brehin AC,
Cubito N, Despres P, Kunst F, Rey FA, Zeller H, Brisse S: Genome
microevolution of chikungunya viruses causing the Indian Ocean
outbreak. PLoS Med. 2006 Jul; 3(7): e263. Epub 2006 May 23 [available from
<http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1463904>].
2. Ratsitorahina M, Harisoa J, Ratovonjato J, Biacabe S, Reynes JM,
Zeller H, Raoelina Y, Talarmin A, Richard V, Louis Soares J: Outbreak
of dengue and Chikungunya fevers, Toamasina, Madagascar, 2006. Emerg
Infect Dis. 2008, 14(7): 1135-7 [available from
<http://www.cdc.gov/EID/content/14/7/1135.htm>].
--
Marc Grandadam, Charlotte Renaudat, and Philippe Despres
National Reference Centre for Arboviruses
Institut Pasteur, Paris, France
<marc.grandadam@pasteur.fr>
Roland Robinson Andrianirina
Directeur des Urgences et de la Lutte contre les Maladies
Ministere de la Sante et du Planning Familial, Antananarivo, Madagascar
Soa Fy Andriamandimby and Jean-Marc Reynes
CNR pour les Arbovirus et Virus Responsables de Fievres Hemorragiques
Institut Pasteur, Antananarivo, Madagascar
Laurence Randrianasolo
Unite d'Epidemiologie
Institut Pasteur, Antananarivo, Madagascar
Sebastien Hantz
Laboratoire de Bacteriologie, Virologie, Hygiene Hospitaliere
CHU de Limoges, France
[ProMED-mail thanks Drs Grandadam, Renaudat, Despres, Andriamandimby,
Reynes, Randrianasolo, and Hantz for providing this report. This is
yet another case of long-distance, international movement of
chikungunya virus. Fortunately, there are no competent vectors yet
established in the region of France where the patient became ill.
A HealthMap/ProMED-mail interactive map of Madagascar showing its
location and the other islands cited above in the Indian Ocean can be
accessed at
<http://healthmap.org/r/00ae>. - Mod.TY]
******
[2] Southeast Asia
Date: Wed 10 Jun 2009
Source: European Centre for Disease Prevention and Control (ECDC) [edited]
<http://www.ecdc.europa.eu/en/Health_topics/Chikungunya_Fever/asia/default.aspx>
[The following is an excellent 2009 summary of chikungunya cases in
Southeast Asia. - Mod.TY]
Chikungunya: short epidemiological update, Southeast Asia -- [as of] 9 Jun 2009
----------------------------------------------------------------------
In recent years, countries in Southeast Asia have been severely
affected by outbreaks of chikungunya fever. India was hit in 2006
after a quiescence of 32 years, following the re-emergence in Kenya
in 2004 and the spread in the Indian Ocean islands in 2005.
Indonesia, Maldives, and Sri Lanka have also been affected by
chikungunya. In 2008, India, Sri Lanka, Malaysia, and Indonesia
reported outbreaks.
Thailand
--------
In Thailand, in 2009, a large outbreak has affected mainly the
southern region, some of the areas being touristic destinations. A
total of 24 029 cases have been notified from 1 Jan-2 Jun [2009] in
36 provinces (no deaths are currently reported). The most affected
areas are the southern provinces: Songula (reporting 36.3 percent of
the cases), Narathiwat (28.6 percent), Pattani (14.2 percent), and
Yala (8.6 percent) (1). The 1st cases in Phuket were reported in
March-April [2009]. From 1 May-2 Jun [2009], a total of 5741 cases
were notified; for 9 provinces, it concerned the 1st reported cases
of this year.
Chikungunya infection seems to quickly be spreading from the southern
provinces to the upper parts of the country. Some confirmed cases are
now reported in provinces in Middle, North, and North-East of
Thailand (see map [at URL above]).
Malaysia
--------
A total of 2504 cases have been reported in Malaysia from the
beginning of the year 2009 to 30 May. Kedah is the most affected
province (reporting 27.3 percent of the cases), then Selangor,
Kelantan, Perak, and Sarawak. In week 21 (24-30 May), 475 cases have
been reported, mostly from the Northern provinces: Kedah (reporting
48.2 percent of the cases) and Penang (17.6 percent). The week before
(week 20) 475 cases have been notified, mostly for Kedah province
(87.8 percent) (2).
Singapore
---------
In Singapore, since the beginning of the year [2009] up to week 21
(30 May 2009), 275 cases have been notified including 28 imported
cases and 247 cases following autochthonous transmission (3 of whom
occurred in week 21) (3). In March 2009, one case of chikungunya
infection was identified in a French patient returning from a short
trip to Singapore.
References
----------
1. Ministry of Health, Thailand: Chikungunya Epidemiological status
02 Jun 2009. Available from
<http://www.thaivbd.org/cms/index.php?option=com_content&task=view&id=142&Itemid=0>
[in Thai].
and
<http://203.157.15.4/chikun/chikun/situation/y52/chikun_200905281029.pdf>
[in Thai].
2. Director General of Health, Malaysia: Epidemiological week 21,
24-30 May 2009. Available from
<http://moh.gov.my/MohPortal/newsFull.jsp?action=load&id=432> [in Malay].
3. Ministry of Health Singapore, Weekly infectious disease bulletin:
Epidemiological week 21, 24-30 May 2009. Available from
<http://www.moh.gov.sg/mohcorp/uploadedFiles/Statistics/Infectious_Diseases_Bulletin/2009/2009_week_21.pdf>.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[There is an excellent map of cases in the cited countries Southeast
Asia at the URL above. - Mod.TY]
[see also:
Chikungunya (20): Thailand (PU) 20090610.2142
Chikungunya (19): Belgium ex Thailand, India (KA) 20090604.2071
Chikungunya (18): Thailand 20090531.2022
Chikungunya (17): Thailand 20090527.1975
Chikungunya (16): Thailand (south) 20090520.1894
Chikungunya (15): Thailand (south) 20090517.1838
Chikungunya (13): Thailand (PU) 20090515.1818
Chikungunya (14): Malaysia 20090515.1820
Chikungunya (12): Malaysia (KH) 20090514.1816
Chikungunya (11): Malaysia (KH) 20090511.1752
Chikungunya (09): Thailand (SG) 20090429.1615
Chikungunya (08): France ex Singapore 20090423.1524
Chikungunya (03): Malaysia 20090218.0676
Chikungunya (02): Malaysia 20090205.0517
Chikungunya: Japan ex Malaysia 20090204.0494
2008
----
Chikungunya (58): Australia ex Malaysia (Johor) 20081231.4134
Chikungunya (57): Thailand 20081228.4089
Chikungunya (56): Singapore 20081226.4074
Chikungunya (47): Thailand, conf. 20081028.3407
Chikungunya (55): Malaysia 20081222.4028
Chikungunya (55): Malaysia 20081220.4006
Chikungunya (53): Malaysia (Kedah) 20081217.3963
Chikungunya (52): Malaysia (KH) 20081216.3948
Chikungunya (51): Malaysia (KH), susp 20081214.3929
Chikungunya (38): Singapore 20080909.2820
Chikungunya (37): Malaysia 20080904.2768
Chikungunya (36): Singapore 20080826.2665
Chikungunya (35): Singapore 20080817.2558
Chikungunya (34): Singapore 20080814.2525
Chikungunya (33): Singapore, Italy ex Sri Lanka 20080812.2493
Chikungunya (31): Singapore 20080807.2433
Chikungunya (30): Singapore 20080803.2381
Chikungunya (29): Malaysia (Perak) 20080729.2319
Chikungunya (26): Malaysia (Johor), susp. 20080628.1992
Chikungunya (18): Singapore ex Indonesia, India (Kerala) 20080508.1576
Chikungunya (13): Malaysia (Johor) 20080428.1462
Chikungunya (07): Singapore 20080216.0622
Chikungunya (06): Singapore 20080212.0555
Chikungunya (04): Singapore 20080128.0349
Chikungunya (03)- Singapore 20080118.0220
2007
----
Chikungunya, imported, risk of transmission 20070125.0338
2006
----
Chikungunya - Indian Ocean update (03): spread to France 20060225.0619
Chikungunya - French Guiana ex Madagascar 20060316.0814
Chikungunya - Indian Ocean update (07): Madagascar conf. RFI 20060307.0734
Chikungunya - Madagascar: susp., RFI 20060202.0340]
...................................dk/ty/mj/dk
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