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Archive Number 20080806.2407
Published Date 06-AUG-2008
Subject PRO/EDR> Dengue/DHF update 2008 (31)
DENGUE/DHF UPDATE 2008 (31)
****************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1] Brazil (Ceara)
[2] Caribbean Basin
[3] Thailand
[4] Viet Nam
[5] Myanmar
[6] Taiwan ex Myanmar
[7] Philippines (Negros Oriental)
[8] India (New Delhi)

******
[1] Brazil (Ceara)
Date: Sat 2 Aug 2008
Source: O Povo [In Portuguese, trans. & summ. Mod.TY, edited]
<http://www.opovo.com.br/opovo/fortaleza/808673.html>


In Ceara, 167 municipalities have thus far reported dengue cases in 
2008. There have been 36 372 cases of the disease reported, with 18 
deaths. According to the weekly bulletin issued by the state 
Secretariat of Health (SESA), DHF, with 248 confirmed cases, caused 
12 deaths in the week, and dengue with complications another 6 
[deaths] of 482 cases up until now.

According to the SESA, Ceara in 2008 is living through the 2nd 
highest number of dengue cases since 1986. Forteleza has recorded 26 
034 classical dengue cases. Caucaia, in the metropolitan region, has 
the 2nd highest number of cases with 748.

The region hardest hit by dengue this year [2008] is said to be 
Region VI by the Executive Secretariat, with 7110 cases. With 5262 
recorded confirmed [cases], the area of Region V comes next.

The municipalities in Ceara with the most cases in 2008 are:
- Fortaleza - 26 034
- Caucaia - 748
- Taua - 547
- Russas - 520
- Itapipoca - 498
- Lavras da Mangabeira - 468
- Maracanau - 429

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

[A map of Brazil showing states, including Ceara, 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] Caribbean Basin
Date: July 2008
Source: CAREC Surveillance Report - Communicable Diseases Vol. 28 No. 
4 [edited]
<http://www.carec.org/pdf/CSR_CD_JULY_2008.pdf>


During epidemiological weeks 1-24, 2008, dengue virus type 2 was 
identified in the British Virgin Islands, Cayman Islands, Dominica, 
Grenada, St. Lucia and Trinidad & Tobago. Dengue virus type 4 was 
also identified in the British Virgin Islands, and virus type 1 was 
identified in Anguilla and Antigua & Barbuda.

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

[This brief report does not indicate which of the islands had only 
imported dengue cases and which had local dengue virus transmission. 
As of mid-December 2007, the Cayman Islands only had imported dengue 
cases and had mounted an active surveillance and mosquito vector 
control campaign (see ProMED archive no. 20071218.4074). It would be 
interesting to know whether the 2008 cases were also all imported cases.

An interactive ProMED HealthMap showing the location of the Cayman 
Islands can be accessed at: 
<http://healthmap.org/promed?v=19.3,-81.2,6>.  - Mod.TY]

******
[3] Thailand
Date: Fri 1 Aug 2008
Source: The Nation [edited]
<http://www.nationmultimedia.com/2008/08/01/national/national_30079476.php>


Dengue fever has spread across the country, killing 48 people and 
infecting more than 40 000 so far this year [2008], Public Health 
Minister Wicharn Meenchainant said yesterday [31 Jul 2008].

Up to last Saturday [26 Jul 2008], 41 307 patients have been 
diagnosed nationwide with dengue haemorrhagic fever [DHF], and 
Bangkok was the hardest hit with 3763 patients, according to the 
Disease Control Department's Bureau of Epidemiology.

Ratchaburi suffered the 2nd worst outbreak with 1710 victims, 
followed by Nakhon Sawan with 1582, Phetchabun with 1304, and Rayong with 1291.

Vichan said the risk of catching dengue fever from mosquitoes this 
year [2008] was running high compared to last year [2007], which saw 
29 fatalities out of 60 000 cases.

The ministry's report identifies 4 strains [the 4 dengue virus 
serotypes. - Mod.TY]. This year's [2008] seasonal epidemic was blamed 
on [dengue virus] type 2, while last year [2007], type 1 [virus] was 
virulent. People could hypothetically get infected by each of the 4 
dengue [virus] strains separately in their lifetime. Permanent 
secretary Prat Bunyawongwiroj said this year [2008] type [virus] 2 
was more dangerous to humans, as it was more resistant to the immune system.

Vichan has ordered provincial public health offices to strictly 
control and monitor the transmission of dengue fever among people in 
the local area. Local authorities should spray insecticide to 
eradicate the adult _Aedes aegypti_ mosquito, which bites humans in 
the daytime. Residents should drain off any stagnant water to prevent 
mosquitoes from breeding and use abate sand, a pesticide, to destroy 
their larvae.

[Byline: Pongphon Sarnsamak]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The following moderator comment accompanied a similar posting on the 
ProMED-mail collaboration with the Mekong Basin Disease Surveillance 
(MBDS) initiative  (see Dengue - Thailand (06)X 20080801.2359). "As 
of 26 Jul 2008, the number of dengue fever cases detected in Thailand 
during 2008 are 41 307 cases and 48 deaths nationwide: 3763 cases in 
Bangkok, 1710 cases in Ratchaburi, 1582 cases in Nakhon Sawan, 1304 
cases in Phetchaburi, and 1291 in Rayong provinces. This represents 
an almost 3-fold (300 percent) increase in the number of reported 
cases since the last PRO/MBDS posting on dengue fever in Thailand in 
early June 2008. At that time, approximately 14 000 cases of dengue 
fever had been reported in Thailand as of 5 Jun 2008, representing a 
72 percent increase from the same period in 2007 (see prior PRO/MBDS 
posting Dengue - Thailand (05) 20080607.1820).

"Viet Nam has also had an increase in reporting of dengue fever 
cases, with 28 980 cases and 28 deaths reported as of 29 Jul 2008 
(see prior PRO/MBDS posting Dengue - Viet Nam (10) 20080731.2349).

"Of note from the newswire above is that type 2 dengue virus, which 
is considered by many to be more "dangerous" than other types, is 
predominant in Thailand in 2008. Through the years, there have been 
"conflicting" theories on the origin of dengue hemorrhagic fever and 
dengue shock syndrome presentations when compared with "simple" 
dengue fever, the former 2 diagnoses being the more serious 
manifestations. Two of the key theories on the cause of the serious 
manifestations have been 1) sequential infection with different 
dengue serotypes (there are 4 dengue virus serotypes, DEN 1, DEN 2, 
DEN 3, and DEN 4); and 2) infection with a more virulent strain of the virus.

"For the interactive HealthMap/ProMED map with links to other 
ProMED-mail postings in Thailand and neighboring countries, see
<http://healthmap.org/promed?v=15.1,101,5>. Other ProMED-mail 
postings can be directly linked through this map. - Mods.YMA/MPP]

******
[4] Viet Nam
Date: Tue 29 Jul 2008
Source: Nhan Dan [edited]
<http://www.nhandan.com.vn/english/life/290708/life_c.htm>


As of late July [2008], 21 000 cases of dengue fever have been 
reported nationwide. Although the outbreak of the disease can happen 
any time, people's awareness of prevention against it has not been much raised.

In the southern provinces, stagnant rainwater has been seen 
everywhere in and around houses. Some houses even have tens or 
hundreds of earthenware jars of rainwater, so if no measures are to 
be taken for treatment of rainwater, this is a good breeding ground 
for mosquitoes to multiply.

As far as the southern provinces are concerned, this year [2008], 
dengue fever occurred earlier than expected. Children under 15 years 
of age have suffered most. However, the number of adults suffering 
from the disease shows signs of gradual increase.

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

[The following moderator comment accompanied a posting on this 
outbreak that appeared on the ProMED-mail/Mekong Basin Disease 
Surveillance initiative collaboration PRO/MBDS (see Dengue - Viet Nam 
(09): RFI 20080729.2313 available at the ProMED-mail website.)   "In 
Viet Nam, the number of dengue cases reported since the beginning of 
2008 has been approximately 21 000 cases nationwide. In the most 
recent prior posting on dengue in Viet Nam from 14 Jul 2008, there 
was a report of an outbreak in Quang Nam province, with more than 250 
cases detected in a local hospital (see PRO/MBDS posting Dengue - 
Viet Nam (08): Quang Nam 20080714.2136 accessible at the ProMED-mail 
website). It appears as though the major increase in reported cases 
of dengue seen in 2007 is continuing in 2008. While official figures 
were not available, according to newswire reports posted on PRO/MBDS 
in late October 2007, there were between 75 000 and 80 000 cases with 
at least 76 deaths reported attributable to dengue virus infections 
in Viet Nam (see Dengue - Viet Nam (16): control measures 
20071031.3535 and Dengue - Viet Nam (15) 20071025.3469 -- both 
reports available at the ProMED-mail website). The mention of an 
increase in reported cases in adults in the newswire above also 
reflects an observation seen in 2007, when there were reports of 
increased reports of dengue infections in adults as well (see Dengue 
- Viet Nam (14): adults, RFI 20071012.3354).

"To be a bit provocative here, one wonders whether perhaps the 
reported increase in dengue cases in adults (and perhaps in children 
as well) might well be a reflection of simultaneous circulation of 
chikungunya virus and misdiagnosis of a mild dengue-like illness 
produced by infection with chikungunya virus.

"PRO/MBDS would greatly appreciate receiving more information from 
knowledgeable sources in the region on the official reports of 
numbers of cases and deaths attributable to dengue, dengue 
hemorrhagic fever, and dengue shock syndrome in Viet Nam, including 
information on age distribution of cases and numbers of laboratory 
confirmed cases of dengue fever. In addition, information on possible 
co-circulation of chikungunya virus in Viet Nam from knowledgeable 
sources would be greatly appreciated.

For maps of Viet Nam with provinces, see
<http://www.lib.utexas.edu/maps/middle_east_and_asia/vietnam_admin01.jpg> and
<http://www.angelfire.com/co/hongnam/vnmap.html>.

The HealthMap/ProMED-mail interactive map of Viet Nam can be accessed 
at <http://healthmap.org/promed?v=14.9,108.5,5>. This map shows other 
outbreaks in Viet Nam and surrounding countries that have been 
reported on ProMED-mail. The postings can be directly accessed 
through this map. - Mods.YMA/MPP"]

******
[5] Myanmar
Date: Tue 29 Jul 2008
Source: Myanmar News [edited]
<http://myamarnews.blogspot.com/2008/07/dengue-fever-outbreak-in-monywa.html>


Residents of Monywa township in Sagaing division have reported an 
outbreak of DHF among children, some of whom are said to have died of 
the disease.

One local resident said the local health system had been overwhelmed 
by the number of cases.

"Monywa hospital was running out of beds for patients, and families 
had to bring along their own beds so their children could be admitted 
to the hospital," the resident said. "Children's clinics in town were 
packed with sick children." He said most of the families had not 
noticed their children had been infected with dengue hemorrhagic 
fever until it had reached the final stages. "We don't know the 
precise number of deaths among children in town, but there have been 
a number of them," he said.

Another local said the authorities had been spraying insecticide in 
areas where the outbreak started to suppress the population of 
mosquitoes, the main carriers of the disease [virus].

[Byline: Khin Hnin Htet]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The above newswire and the following newswire on dengue in returning 
Taiwanese volunteers who worked in Myanmar as part of the relief 
efforts was originally posted on PRO/MBDS, a ProMED-mail regional 
collaboration with the Mekong Basin Disease Surveillance (MBDS) 
initiative.  The following moderator comment appeared on the PRO/MBDS 
posting (see Post cyclone situation - Myanmar (05): dengue 
20080730.2321 available at the ProMED-mail website.  "A similar 
newswire appeared on the Democratic Voice of Burma website 
<http://english.dvb.no/news.php?id=1577>. It should be noted here 
that the Sagaing Division is in the northern part of Burma and was 
not considered one of the 5 divisions declared as emergency zones 
following cyclone Nargi (the 5 Divisions were the Irrawaddy Delta, 
Yangon, Pegu [Bago] Mon and Karen States). But, while not in the 
actual emergency zone, the entire area was inundated with flooding 
and most likely has residual standing water in many areas that is 
ideal for mosquito breeding. In addition, one wonders whether 
resources for dengue control have been diverted from relatively 
'unaffected zones' in the post cyclone period so that the above 
mentioned increase in dengue and dengue hemorrhagic fever has been 
further complicated by an acute shortage of resources.

More information on the current status of dengue fever in Myanmar 
from knowledgeable sources would be greatly appreciated." - Mod.MPP]

[One wonders whether the period immediately following extensive 
flooding has prompted households to store fresh water in and around 
their houses, providing ideal breeding sites for _Aedes_ mosquitoes 
that transmit dengue virus. - Mod.TY]

[For maps of Myanmar, see
<http://www.worldatlas.com/webimage/countrys/asia/lgcolor/mmcolor.htm> and
<http://www.lib.utexas.edu/maps/middle_east_and_asia/burma_pol_96.jpg>.

For the interactive HealthMap/ProMED-mail map of Myanmar with links 
to other ProMED-mail reports in Myanmar and surrounding countries, 
see <http://healthmap.org/promed?v=21.2,96.5,5>.  - Mod.MPP]

******
[6] Taiwan ex Myanmar
Date: Tue 29 Jul 2008
Source: Reorbit.com [edited]
<http://www.redorbit.com/news/health/1500055/taiwan_records_dengue_infection_charity_workers_caught_in_burma/>


Ten members of a Taiwan religious group have been infected with 
dengue fever [virus] while taking part in volunteer relief efforts in 
Myanmar in the aftermath of Cyclone Nargis, marking the 1st case of 
mass overseas dengue fever infections to be recorded in Taiwan in 
recent years, a Centres for Disease Control (CDC) official said 
Tuesday [29 Jul 2008].

The cases were discovered after one of the patients, a 48-year-old 
Taipei County woman, sought treatment earlier this month [July 2008] 
at the Far Eastern Memorial Hospital and was diagnosed on 18 Jul 2008 
with dengue fever, according to CDC Deputy Director-General Shih Wen-yi.

A subsequent investigation conducted by health authorities found that 
she and 10 other members of her group had visited Myanmar to help 
with the aftermath of the disaster and that 10 of the 11-member 
mission had been infected with the disease [virus] in Myanmar and had 
already fallen ill while in the Southeast Asian country, Shih said.

The patients were aged between 48 and 87 and come from Taipei County, 
Taipei City, Taoyuan County and Changhua County, Shih said. The CDC 
official said the centre is still awaiting the results of a 3rd test 
on the remaining member of the mission, who tested negative for 
dengue fever in 2 previous tests.

Shih said the CDC had also notified local health authorities to check 
other people who might have had contact with the 10 patients after 
their return to Taiwan to make sure they are not infected with the 
disease [virus], which is contracted through the bite of the mosquito 
that carries the disease [virus].

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[This is a good illustration of how dengue viruses and other 
pathogens can be moved quickly from one location to a distant one. 
Should there be a significant population of competent vectors at the 
destination, there is a real risk of starting a new outbreak. - Mod.TY]

******
[7] Philippines (Negros Oriental)
Date: Sat 2 Aug 2008
Source: GMA News TV [edited]
<http://www.gmanews.tv/story/111067/Dengue-kills-3-people-in-Negros-Oriental>


The Department of Health (DoH) reported that 3 people died from the 
dreaded dengue virus this year [2008] in Negros Oriental province.

DoH investigation shows that the deaths were a result of late 
referral to doctors.

With this, Dr Socrates Villamor, Provincial Epidemiology Surveillance 
Unit, advised relatives of possible dengue victims to seek early 
consultation at the nearest hospital.

The DoH top official here warned of an abrupt increase of dengue 
cases in August 2008 due to the rainy season. Villamor also noted 
that cases of dengue in the months of June and July 2008 increased 
compared to the previous months. DoH also reported an increase of 
dengue cases by 18 percent.

Villamor said that there are 486 cases recorded as of 26 Jul [2008] 
this year compared to 897 cases of the same period last year. He 
clarified, however, that although the cases are alarming, there is no 
epidemic status in the province.

He said proper sanitation is the most important and effective tool to 
prevent dengue-carrying mosquitoes.

--
Communicated by:
ProMED-Rapporteur Brent Barrett

[Interestingly, reports from 16 Jun 2008 on dengue cases in several 
cities in Negros Oriental province indicated that the number of 
dengue cases was significantly higher than last year (2007) (see 
ProMED archive no. 20080618.1901). While there may not be a 
province-wide dengue epidemic as Dr. Villamor indicated, there may be 
a number of outbreaks in several locations there.

An interactive map showing the location of Negros Occidental province 
can be accessed at
<http://www.maplandia.com/philippines/region-6/negros-occidental/>. - Mod.TY]

******
[8] India (New Delhi)
Date: Wed 30 Jul 2008
Source: Express India.com [edited]
<http://www.expressindia.com/latest-news/Three-cases-in-a-week-dengue-alert-sounded/342129/>


With 3 cases being reported within a week in the capital, civic 
authorities have started fumigating areas where there are high 
chances of mosquitoes breeding.

"We're following the standard protocol of fumigating neighborhoods 
from where cases are reported," said Dr V K Monga, Health Committee 
Chairman, Municipal Corporation of Delhi.

Dengue fever, caused by the _Aedes aegypti_ mosquito, is a 
post-monsoon disease, but record-high pre-monsoon showers in May 2008 
and the early onset of monsoons have resulted in early onset of the 
dengue season, say experts. [This statement is incorrect. Dengue 
viruses cause the disease, and _Aedes aegypti_ transmit the viruses. - Mod.TY]

"We were expecting an early onset of the dengue season this year 
[2008] and are prepared for the worst-case scenario," said Dr V K 
Monga, chairman of MCD's health committee.

According to health experts, humidity is conducive to mosquito 
breeding. [High humidity promotes adult mosquito survival. Water 
catchments provide mosquito breeding sites. - Mod.TY]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Although fogging may provide some short-term reduction in adult 
mosquito populations and help calm the public by indicating that 
health authorities are doing something about the problem, longer term 
effective mosquito vector control requires elimination of the water 
catchments that provide breeding sites.

A map of India showing the location of New Delhi can be accessed at: 
<http://www.lib.utexas.edu/maps/middle_east_and_asia/india_pol01.jpg>. 
- Mod.TY]

[see also:
Dengue/DHF update 2008 (30): Brazil 20080728.2305
Dengue/DHF update 2008 (29) 20080721.2211
Dengue/DHF update 2008 (28) 20080715.2144
Dengue/DHF update 2008 (27) 20080707.2059
Dengue/DHF update 2008 (26) 20080701.2005
Dengue/DHF update 2008 (25) 20080622.1933
Dengue/DHF update 2008 (24) 20080618.1901
Dengue/DHF update 2008 (23) 20080609.1831
Dengue/DHF update 2008 (22) 20080603.1776
Dengue/DHF update 2008 (21) 20080525.1716
Dengue/DHF update 2008 (20) 20080519.1668
Dengue/DHF update 2008 (10) 20080309.0962
Dengue/DHF update 2008 (05) 20080206.0483
Dengue/DHF update 2008 (01): Brazil 20080104.0052
2007
----
Dengue/DHF update 2007 (49) 20071218.4074
Dengue/DHF update 2007 (40) 20071022.3444
Dengue/DHF update 2007 (30) 20070730.2440
Dengue/DHF update 2007 (20) 20070514.1541
Dengue/DHF update 2007 (10) 20070225.0683
Dengue/DHF update 2007 (01) 20070103.0030]
...............................lm/mpp/jw/ty/mpp/msp/mpp

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