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Published Date: 2014-01-09 17:02:15
Subject: PRO/EDR> Dengue/DHF update (03): Germany (Berlin) ex Japan, RFI
Archive Number: 20140109.2162194
DENGUE/DHF UPDATE (03): GERMANY (BERLIN) ex JAPAN, REQUEST FOR INFORMATION
************************************************** ************************
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Thu 9 Jan 2014
From: Jonas Schmidt-Chanasit <jonassi@gmx.de> [edited]
Autochthonous dengue virus infection in Japan
---------------------------------------------
A previously healthy 51-year-old woman sought treatment in a hospital in Berlin on 9 Sep 2013 after returning from travel to Japan (Honshu). Since 3 Sep 2013 she suffered from fever up to 40 deg C [104 deg F] and nausea, followed by a maculopapular rash. 9 days before admission she had returned from a 2 week round trip (19-31 Aug [2013]) from Japan [with sites visited on the following dates in August 2013]:
19-21 Ueda
21-24 Fuefuki
24-25 Hiroshima
25-28 Kyoto
28-31 Tokyo
She reported several mosquito bites while grape picking in Fuefuki. She flew nonstop from Frankfurt (International Airport) to Tokyo (Narita International Airport) and [back the same way]. Among several other diseases, dengue fever was suspected, because of the clinical picture. Initially, the 1st serum sample collected 7 days after disease onset gave a positive result in the dengue virus (DENV) IgM and IgG antibody tests (IFA [indirect fluorescent antibody] and rapid test), as well as for DENV NS1 antigen (ELISA and rapid test) demonstrating an acute DENV infection of the patient. Real-Time RT-PCR for DENV RNA and generic flavivirus RT-PCR were negative. After one week in hospital the patient was discharged with a characterization of restitutio ad integrum [total recovery]. A follow-up serum sample was collected in December 2013, because this acute case of dengue fever imported from Japan was considered very unusual. This 2nd serum sample collected 110 days after disease onset revealed a significant DENV IgG titer decrease (IFA) and negative results for DENV NS1 antigen (ELISA and rapid test) and DENV IgM (IFA and rapid test), respectively.
This is the 1st laboratory confirmed case of DENV infection imported from Japan to Germany. Most likely, according to the patient's activities and DENV incubation period, the infection was acquired in Japan. Thus, differential diagnosis in febrile returning travelers from Japan (Honshu) in late summer [2013] should include dengue fever. In addition, the autochthonous transmission of DENV in Japan should be further investigated to take adequate prevention measures early.
--
Jonas Schmidt-Chanasit, Petra Emmerich, Dennis Tappe, Stephan Gunther
Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, National Reference Centre for Tropical Infectious Diseases, Hamburg, Germany
<jonassi@gmx.de>
Daniel Sagebiel, Kathrin Hentsche
State Office of Health and Social Affairs, Berlin, Germany
Christina Frank, Irene Schuneberg, Klaus Stark
Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
[This case is, indeed, highly unusual because it implicates a dengue virus infection acquired locally in Japan, and indicates that there must have been other infected individuals in the area where she became infected. This is the 1st case of locally acquired dengue virus infection in Japan that ProMED-mail has ever posted.
There have been several examples of individuals who have become infected with dengue viruses in Southeast Asia and Africa and subsequently become ill in Japan, indicating that viremic individuals have been bringing dengue virus into the Japanese islands.
It would be of interest to know if there have been other cases of dengue virus infection acquired locally in Japan during the summer of 2013, and to know about the status of populations of dengue virus vector mosquitoes (_Aedes aegypti_ and _Ae. albopictus_) in the areas that the patient visited.
ProMED-mail thanks Dr Jonas Schmidt-Chanasit and colleagues for sending in this 1st-hand report.
A HealthMap/ProMED-mail map of Japan can be accessed at http://healthmap.org/r/62Cn. - Mod.TY]
Subject: PRO/EDR> Dengue/DHF update (03): Germany (Berlin) ex Japan, RFI
Archive Number: 20140109.2162194
DENGUE/DHF UPDATE (03): GERMANY (BERLIN) ex JAPAN, REQUEST FOR INFORMATION
************************************************** ************************
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Thu 9 Jan 2014
From: Jonas Schmidt-Chanasit <jonassi@gmx.de> [edited]
Autochthonous dengue virus infection in Japan
---------------------------------------------
A previously healthy 51-year-old woman sought treatment in a hospital in Berlin on 9 Sep 2013 after returning from travel to Japan (Honshu). Since 3 Sep 2013 she suffered from fever up to 40 deg C [104 deg F] and nausea, followed by a maculopapular rash. 9 days before admission she had returned from a 2 week round trip (19-31 Aug [2013]) from Japan [with sites visited on the following dates in August 2013]:
19-21 Ueda
21-24 Fuefuki
24-25 Hiroshima
25-28 Kyoto
28-31 Tokyo
She reported several mosquito bites while grape picking in Fuefuki. She flew nonstop from Frankfurt (International Airport) to Tokyo (Narita International Airport) and [back the same way]. Among several other diseases, dengue fever was suspected, because of the clinical picture. Initially, the 1st serum sample collected 7 days after disease onset gave a positive result in the dengue virus (DENV) IgM and IgG antibody tests (IFA [indirect fluorescent antibody] and rapid test), as well as for DENV NS1 antigen (ELISA and rapid test) demonstrating an acute DENV infection of the patient. Real-Time RT-PCR for DENV RNA and generic flavivirus RT-PCR were negative. After one week in hospital the patient was discharged with a characterization of restitutio ad integrum [total recovery]. A follow-up serum sample was collected in December 2013, because this acute case of dengue fever imported from Japan was considered very unusual. This 2nd serum sample collected 110 days after disease onset revealed a significant DENV IgG titer decrease (IFA) and negative results for DENV NS1 antigen (ELISA and rapid test) and DENV IgM (IFA and rapid test), respectively.
This is the 1st laboratory confirmed case of DENV infection imported from Japan to Germany. Most likely, according to the patient's activities and DENV incubation period, the infection was acquired in Japan. Thus, differential diagnosis in febrile returning travelers from Japan (Honshu) in late summer [2013] should include dengue fever. In addition, the autochthonous transmission of DENV in Japan should be further investigated to take adequate prevention measures early.
--
Jonas Schmidt-Chanasit, Petra Emmerich, Dennis Tappe, Stephan Gunther
Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, National Reference Centre for Tropical Infectious Diseases, Hamburg, Germany
<jonassi@gmx.de>
Daniel Sagebiel, Kathrin Hentsche
State Office of Health and Social Affairs, Berlin, Germany
Christina Frank, Irene Schuneberg, Klaus Stark
Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
[This case is, indeed, highly unusual because it implicates a dengue virus infection acquired locally in Japan, and indicates that there must have been other infected individuals in the area where she became infected. This is the 1st case of locally acquired dengue virus infection in Japan that ProMED-mail has ever posted.
There have been several examples of individuals who have become infected with dengue viruses in Southeast Asia and Africa and subsequently become ill in Japan, indicating that viremic individuals have been bringing dengue virus into the Japanese islands.
It would be of interest to know if there have been other cases of dengue virus infection acquired locally in Japan during the summer of 2013, and to know about the status of populations of dengue virus vector mosquitoes (_Aedes aegypti_ and _Ae. albopictus_) in the areas that the patient visited.
ProMED-mail thanks Dr Jonas Schmidt-Chanasit and colleagues for sending in this 1st-hand report.
A HealthMap/ProMED-mail map of Japan can be accessed at http://healthmap.org/r/62Cn. - Mod.TY]