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Dengue - Multistate (world) - Monitoring seasonal epidemics (ECDC/CDTR, March 18 2013)

Giuseppe

Emeritus
[Source: European Centre for Disease Prevention and Control (ECDC), full PDF document: (LINK). Edited.]


COMMUNICABLE DISEASE THREATS REPORT

Week 11, 10-16 March 2013

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Dengue - Multistate (world) - Monitoring seasonal epidemics

Opening date: 20 April 2006 Latest update: 14 March 2013



Epidemiological summary

Europe: There have been no reports of confirmed autochthonous dengue infections in Europe in 2013, besides the on-going dengue outbreak in Madeira.

Asia: Regional dengue activity is variable. Cambodia, Lao PDR and Singapore have all reported more cases in 2013 than 2012 for the same time period. Recent trends are declining in Australia, Cambodia and Philippines.

The Caribbean: The US Virgin Islands has reported two confirmed cases of dengue fever this week. In the Cayman Islands, the Public Health Department has declared the dengue season over as there have been no suspected dengue cases reported since 2 March 2013.

Central and South-America: High dengue activity is reported across eastern parts of Mexico. Honduras and Costa Rica are seeing a recent spike in the number of cases. In South America, increased dengue activity is reported in Argentina, Colombia, Paraguay and Venezuela. There are media reports of a new fatality in Cayenne, French Guyana, which, if confirmed, would be the second death since the outbreak started in Kourou last year.

Pacific: New Caledonia continues to see sustained dengue activity and 150 new dengue cases are being reported every day, according to the Ministry of Health. Since 6 February 2013, French Polynesia has reported 15 confirmed cases of dengue fever, according to the Department of Health. The predominant serotypes are DENV-1 (9 cases) and DENV-3 (3 cases). A dengue outbreak with over 300 clinical dengue cases is still on-going in the Solomon Islands.

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ECDC assessment

ECDC monitors individual outbreaks, seasonal transmission patterns and inter-annual epidemic cycles of dengue through epidemic intelligence activities in order to identify significant changes in disease epidemiology.

Of particular concern is the potential for the establishment of dengue transmission in Europe. Before the current outbreak in the Autonomous Region of Madeira, local transmission of dengue was reported for the first time in France and Croatia in 2010. Imported cases are detected in European countries, highlighting the risk of locally acquired cases occurring in countries where the competent vectors are present.



Actions

ECDC has published a technical report on the climatic suitability for dengue transmission in continental Europe and guidance for invasive mosquitoes? surveillance.

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[Madeira Outbreak]

Opening date: 10 October 2012 Latest update: 8 February 2013



Epidemiological summary

In October 2012, the Portuguese public health authorities reported an outbreak of dengue infection on the island of Madeira in the Autonomous Region of Madeira located around 400 km from the Canary Islands, 650 km from the African coast, and 1 000 km from the European continent. The autonomous region has 268 000 inhabitants.

As of 3 March 2013, 2 168 cases of dengue infection have been reported by the Portuguese health authorities. The weekly monitoring of dengue cases indicates that since the middle of November there has been a sharp decrease in the number of dengue cases.

There have been no laboratory confirmed cases since 4 February 2013.

The vast majority of confirmed cases are from the city of Funchal, which is the main port on Madeira island. The island of Madeira has an established mosquito population of Aedes aegypti, the main vector of dengue in tropical and subtropical countries.

Eighty-two patients have been diagnosed in European countries with dengue infection after returning from Madeira:
  • 23 in the UK,
  • 19 in Germany,
  • 11 in Portugal,
  • seven in Finland,
  • six in Sweden,
  • three in France,
  • three in Belgium,
  • two in Denmark,
  • two in Austria,
  • and two in Norway.
  • Croatia, Slovenia, Spain and Switzerland have all reported one case each.
An additional imported case was reported on 8 March 2013 from Sweden with onset of disease 20 November 2012.

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ECDC assessment

This is the first known occurrence of locally transmitted dengue infection in the Autonomous Region of Madeira, and consequently a new geographical area reporting autochthonous cases in the EU. This is a significant public health event but not entirely unexpected because of the known presence of Aedes aegypti, a competent vector for dengue.

The latest figures from the Portuguese Ministry of Health indicate an important decrease in the number of notified cases.

However, disease transmission is still on-going with 28 cases reported in 2013. This is indicative of an uninterrupted transmission since the start of the outbreak and a continuous vector activity.

The cases of dengue among returning travellers from the island highlight the need for travellers to Madeira to take measures in order to reduce mosquito bites. Travellers experiencing febrile symptoms with severe headache, retro-orbital pain, myalgia, arthralgia and maculo-papular rash within 21 days of visiting the island of Madeira are advised to seek medical advice.

Neighbouring geographical areas (e.g. Canary Islands) and other EU Member States need to assess the risk of establishment of Aedes mosquito populations and the introduction of dengue. The epidemiological situation does not imply the need for any trade or travel restriction beyond the disinfestation policies currently implemented.



Actions

ECDC published an updated rapid risk assessment concerning the autochthonous dengue cases in Madeira. Portuguese authorities published recommendations regarding personal protective measures, and measures for the safety of blood, cells, tissues and organ donations within the region.

Blood donor deferral for 28 days from day of departure for travellers returning from the Autonomous region of Madeira is now recommended in other EU countries.

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