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Update: Dengue in Tropical and Subtropical Regions

Filed under: disease/health — admin @ 4:30 pm

Dengue virus is present in all tropical and many subtropical areas worldwide. The mosquitoes that carry dengue bite most often in the morning and evening and during hot, wet times of the year. However, they can bite and spread infection all year long and at any time of day.

As of August 2012, cases of probable dengue continue to occur in Mogadishu, Somalia. As of May 2012, probable dengue cases have been reported in eastern Kenya, and cases have been confirmed in Mandera, Kenya. The Kenyan Ministry of Health and local health officials are working with local hospitals and clinics to monitor the situation.
Atlantic Islands

According to the European Centre for Disease Prevention and Control (ECDC), 1,148 cases of dengue (517 cases laboratory confirmed) have been reported as of November 4, 2012, on the Portuguese island of Madeira. Fifty-seven people have been hospitalized. No deaths have been reported.
South Pacific and Southeast Asia

From September 2011 to April 2012, an outbreak of dengue in the Federated States of Micronesia resulted in more than 1,200 cases and two deaths. Starting in July 2012, cases have increased on Yap Main Island. Cases of probable dengue are also being reported in the Yap Outer Islands.

Confirmed dengue cases have been reported in US travelers returning from destinations in Asia, specifically the Philippines and Thailand. Singapore, Malaysia, Cambodia, Taiwan, the Philippines, Vietnam, India, Sri Lanka, and Thailand are among the countries reporting dengue activity in 2012.

Australia also continues to report sporadic dengue activity in areas of northern Queensland. For more information about dengue reports, visit the World Health Organization (WHO) Western Pacific Regional Office and the WHO South-East Asia Regional Office websites.
The Americas and the Caribbean

In 2012, dengue cases have been reported in most countries in Latin America. Confirmed dengue cases have been reported in US travelers returning from Brazil, Cuba, the Dominican Republic, Ecuador, Haiti, Jamaica, and Puerto Rico.
Middle East

Dengue activity is reported occasionally throughout the Middle East, including areas popular with travelers, such as Jeddah in Saudi Arabia. Currently, dengue cases are being reported in Pakistan and Yemen.
What is Dengue?

Dengue fever is the most common cause of fever in travelers returning from the Caribbean, Central America, and South Central Asia. This disease is spread through the bites of infected mosquitoes and cannot be spread person to person.

Severe dengue can be fatal, but with good treatment, less than 1% of patients die from dengue.

Symptoms of dengue include:

* fever
* headache
* pain behind the eyes
* joint and muscle pain
* rash
* nausea/vomiting
* mild bleeding, such as nose or gum bleeding or easy bruising

People who have had dengue before may get severe dengue if they are infected again. Anyone with dengue who experiences the following warning signs should go to a doctor or emergency room immediately:

* Severe abdominal pain or persistent vomiting
* Red spots or patches on the skin
* Bleeding from nose or gums
* Vomiting blood
* Black, tarry stools (feces, excrement)
* Drowsiness or irritability
* Pale, cold, or clammy skin
* Difficulty breathing

How Can Travelers Protect Themselves?

Travelers can reduce their risk of dengue infection by protecting themselves from mosquito bites:

* Stay in hotels that are well screened or air conditioned.
* Use insect repellent on uncovered skin.
o Look for a repellent that contains one of the following active ingredients: DEET, picaridin (KBR 3023), Oil of Lemon Eucalyptus/PMD, or IR3535.
o Always follow the instructions on the label when you use the repellent.
o If sunscreen is needed, apply before applying insect repellent.
* Wear loose, long-sleeved shirts and long pants when outdoors.
o For more protection, clothing may be sprayed with a repellent containing permethrin. (Don’t use permethrin on skin.)

If you return from a trip abroad and get sick with a fever, seek medical care right away. Tell the doctor about your recent travel.
Clinician Information:

Early and proper diagnosis of dengue is important, as many other diseases may mimic dengue. Health care providers should consider dengue, malaria, chikungunya, and leptospirosis, depending on the itinerary and exposure, in the differential diagnosis of patients who have fever and a history of travel to tropical areas during the 2 weeks before symptom onset.

See the Clinical & Laboratory Guidance on the CDC dengue website for information about reporting dengue cases and guidance regarding dengue diagnostic testing. A serum sample should be obtained as early after the onset of fever as possible for dengue diagnostic testing. Molecular testing for DENV and immunodiagnostic testing for IgM anti-DENV should be ordered and can be obtained from commercial reference laboratories and a number of state or territorial health department laboratories. Consultation regarding management of suspect dengue cases or diagnostic testing can be obtained from:

CDC Dengue Branch
Division of Vector-Borne Diseases
National Center for Emerging and Zoonotic Infectious Diseases
1324 Calle Cañada
San Juan, Puerto Rico 00920-3860
Telephone: 787-706-2399; fax, 787-706-2496

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