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ISSN 1020 - 6256
Volume 6, Issue 2

Dengue Fever

During the reporting period under review, epidemiologic weeks 13-25, 312 cases of Dengue Fever were reported to CAREC’s Epidemiology Division, compared to 638 cases reported in the corresponding period last year [Appendix 1, Figure 1]. This 51% decrease is mainly a reflection of the fact that an outbreak of Dengue Fever occurred in Suriname last year. Fifteen cases of Dengue Haemorrhagic Fever/Shock Syndrome were reported during the period under review, eleven cases from Trinidad and Tobago and four from Suriname. This compares to zero cases reported during the corresponding period last year.

During epidemiologic weeks 13-25, dengue virus type 3 was identified from samples from Suriname and St. Lucia for the first time. Dengue virus types 1 and 2 also continue to circulate in some member countries [Table 1]. Since dengue virus types 1, 2 and 4 have been circulating in the sub-region in previous years and dengue virus type 3 has been introduced in recent years, many people would be at an increased risk of Dengue Haemorrhagic Fever and Dengue Shock Syndrome. Thus countries should establish a Dengue Fever/Dengue Haemorrhagic Fever outbreak contingency plan and physicians should be updated on Dengue Fever/DHF management and reporting.

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FOOD-BORNE ILLNESS AND GASTROENTERITIS

In the sub-region as a whole, during the period under review, there was a 50% decrease in Food-borne illness, a 35% decrease in Gastroenteritis among children aged less than 5 years and a 19% decrease in Gastroenteritis among those aged 5 years and over, compared to the corresponding period last year [Appendix 1]. However, some member countries reported increased numbers of cases of Food-borne illness and Gastroenteritis.

Trinidad and Tobago reported 6,170 cases of Gastroenteritis (age unspecified), 35% more cases than in the corresponding period last year. Barbados, Belize, Cayman Islands, Grenada, Jamaica, St. Lucia and Suriname also reported increased numbers of cases of Gastroenteritis in both children aged less than 5 years and those aged 5 years and over.

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LEPTOSPIROSIS

During epidemiologic weeks 13-25, 2001, 52 cases of Leptospirosis were reported to CAREC's Epidemiology Division, compared to 121 cases during the corresponding period last year. This decrease was mainly due to a decrease in the number of reported cases of Leptospirosis from

Trinidad and Tobago and Suriname, who reported 62% and 58% less cases respectively in the second quarter of this year compared to that last year. Barbados, Grenada and Jamaica also reported decreased numbers of cases in the second quarter of this year compared to that last year.

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THE PUBLIC HEALTH LABORATORY INFORMATION SYSTEM NETWORK [PHLIS]

During the period under review, thirty-two (32) samples positive for Salmonella were reported to CAREC through the PHLIS network [Table 2]. Four of these Salmonella samples, which were identified as group D of unknown serotype, were reported as being part of an outbreak in Paramaribo, Suriname in May. All four patients were aged under 13 years and had been hospitalized. In May, a fifth Salmonella sample from Wanica, Suriname was also reported to be part of an outbreak. This sample was identified as Salmonella Typhi, phage type 25. The patient was 21 years old and had also been hospitalized.

On May 23rd, Trinidad and Tobago reported one sample positive for Salmonella, as being part of an outbreak. This sample was identified as Salmonella group D, serotype unknown. The patient was 11 months old and was from county Victoria. Also at the end of May, Trinidad and Tobago also reported four cases of Salmonella Enteritidis from San Fernando in county Victoria. All four patients had been hospitalized and three were children under 9 years old, one was aged 56 years.

Three member countries reported twenty-eight (28) samples that were positive for dengue through the PHLIS network [Table 2]. Serotypes were not identified as all the samples had been confirmed by IgM. During the period under review, no samples were reported as positive for HIV through the PHLIS network.

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OUTBREAK CORNER

DENGUE FEVER IN VENEZUELA

A Dengue Fever epidemic has been declared in Venezuela. To date, in 2001, there have been more than 30,000 reported cases of Dengue Fever in Venezuela, approximately 10% of which were Dengue Haemorrhagic Fever/Shock Syndrome. Three deaths due to dengue were also reported. Dengue virus type 3 began circulating in Venezuela in October 2000, but dengue virus types 1, 2 and 4 have previously been identified. The recent introduction of a new dengue virus type, the increased rainfall in recent months, combined with difficulties with the domestic water supply in some urban areas leading homeowners to store water, has resulted in conditions that encourage and sustain a widespread epidemic of Dengue Fever and Dengue Haemorrhagic Fever/Shock Syndrome.

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AN UPDATE ON THE CIRCULATION OF WEST NILE VIRUS

Further to the Fax Alert of September 7, 2000, this is an update of the current situation with respect to West Nile Virus in the USA and Canada.

West Nile Virus was first identified in the USA in the summer of 1999 and reappeared in summer of 2000. In both 1999 and 2000, infections in humans peaked in August and infections in horses peaked in September.

In the USA, in 2001, the first human infection of West Nile Virus occurred in a 73-year old man in Florida in July. In August, a 71-year old woman from Georgia became the first casualty from West Nile Virus in the USA and the first case of West Nile Virus infection in that state. As at September 10, 2001, fifteen human cases of West Nile Virus have been reported, four confirmed cases in Florida, three confirmed cases and one presumptive case in New York, two confirmed cases in Maryland, one confirmed death in Georgia, one suspected case in New Jersey and three presumptive cases in Connecticut.

In 2001 in the USA, as at September 5, more than 1,000 wild birds in 15 states and the District of Columbia have been reported as positive for West Nile Virus. This is the first year that the six states of Florida, Georgia, Indiana, Louisiana, Michigan and Ohio have reported West Nile Positive birds. Six sentinel birds have also been reported as West Nile Positive, the most recent two in Florida.

In 2001 in the USA, as at September 5, there have been 66 clinically confirmed cases of West Nile Virus infection detected in horses from Florida, Georgia, Pennsylvania, Kentucky, New York, Connecticut and Louisiana. More than 200 mosquito pools in the five states of Connecticut, Maryland, New Jersey, New York and Rhode Island, have been reported as positive for West Nile Virus, with New Jersey reporting the highest number of positive pools.

In Canada as at September 5, there have been no reports of human cases of West Nile Virus. However, a total of 29 birds, crows and blue jays, have been confirmed as infected with West Nile Virus from Toronto, Peel, Halton and Windsor-Essex Regions.

Most persons who are infected with West Nile Virus may be asymptomatic or experience very mild illness such as fever, headache and body pains and will subsequently have a full recovery. However, the virus can also cause severe illness, and sometimes, fatal encephalitis. The elderly and people with compromised immune systems are at greatest risk of severe illness.

With the increase in reported cases of West Nile Virus in the Eastern areas of the USA and Canada, there is a very real possibility of importation of the virus into the Caribbean via infected humans. It is therefore important to include data on recent travel in any investigation of early cases.

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Tables and Figures attached to this Report

Figure 1
Table 1
Table 2
Appendix 1

CARIBBEAN EPIDEMIOLOGY CENTRE [CAREC]
P.O. Box 164 16-18 Jamaica Boulevard 
Federation Park, Port of Spain Trinidad and Tobago, W.I.

Telephone: 868-622-4261 
Fax: 1-868-622-2792

Epidemiology Direct: 
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Fax: 1-868-622-1008

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Caribbean Epidemiology Centre
16-18 Jamaica Boulevard, Federation Park
P.O. Box 164, Port of Spain
Republic of Trinidad and Tobago
Tel: (868) 622-4261, Fax: (868) 622-2792
E-mail: postmaster@carec.paho.org

Page last modified 14 September, 2001