Outbreak Dengue CDC Marzo 2010

Outbreak Notice

Update: Dengue, Tropical and Subtropical Regions

This information is current as of today, May 26, 2010 at 13:39 EDT
Updated: March 16, 2010

Situation Information

Dengue fever is the most common cause of fever in travelers returning from the Caribbean, Central America, and South Central Asia.1

This disease is caused by four similar viruses (DENV-1, -2, -3, and -4) and is spread through the bites of infected mosquitoes.

Dengue infections are frequently reported from most tropical countries of the South Pacific, Asia, the Caribbean, the Americas, and Africa. Although dengue transmission often occurs in both rural and urban areas, dengue infections are most frequently reported from urban settings.

Since early 2009, an increased number of dengue cases have been reported from countries throughout several regions of the world.

Africa
Cape Verde: In 2009, more than 21,000 suspected cases and 6 deaths (as of December 6, 2009) were reported.

Approximately 60 cases were reported in nearby Senegal, according to the UN Office for the Coordination of Humanitarian Affairs.

South Pacific
Dengue activity continues to circulate throughout this region. Examples of outbreaks include the following:
• Malaysia: In the first 6 weeks of 2010, more than 6200 cases and 23 deaths were reported throughout the country, especially in Selangor and Sarawak.
• Indonesia: Dengue activity is ongoing. From January–October 2009, more than 100 deaths were attributed to dengue hemorrhagic fever. In December 2009, the Ministry of Health issued an alert about heightened dengue hemorrhagic fever transmission during this rainy season.
• Sri Lanka: As of February 23, 2010, 7500 cases have been reported throughout the country, including in the Colombo capital district.

Central and South America and the Caribbean

Certain countries in Central and South America as well as in the Caribbean, are reporting dengue activity. These areas include Brazil, Colombia, Dominican Republic, Guatemala, Honduras, Nicaragua, Puerto Rico, St. Barthelemy, and Saint Martin.

Middle East
Dengue activity has been reported in recent months in this region, including areas popular among travelers such as Jeddah and Mecca in Saudi Arabia.
To view areas where cases have been reported in previous years, see the Distribution of Dengue maps. For more information on dengue and updates on worldwide activity, see CDC’s Dengue website and WHO’s Dengue webpage.

Advice for Travelers

Travelers can reduce their risk of getting dengue fever by protecting themselves from mosquito bites. The mosquitoes that spread dengue usually bite at dusk and dawn but may bite at any time during the day, especially indoors, in shady areas, or when the weather is cloudy.

Travelers should follow the steps below to protect themselves from mosquito bites:

• Where possible, stay in hotels or resorts that are well screened or air conditioned and that take measures to reduce the mosquito population. If the hotel is not well screened, sleep under bed nets to prevent mosquito bites.
• When outdoors or in a building that is not well screened, use insect repellent on uncovered skin. If sunscreen is needed, apply before insect repellent.
o Look for a repellent that contains one of the following active ingredients: DEET, picaridin (KBR 3023), Oil of Lemon Eucalyptus/PMD, or IR3535. Always follow the instructions on the label when you use the repellent.

o In general, repellents protect longer against mosquito bites when they have a higher concentration (percentage) of any of these active ingredients. However, concentrations above 50% do not offer a marked increase in protection time. Products with less than 10% of an active ingredient may offer only limited protection, often no longer than 1-2 hours.

o The American Academy of Pediatrics approves the use of repellents with up to 30% DEET on children over 2 months old.

o Protect babies less than 2 months old by using a carrier draped with mosquito netting with an elastic edge for a tight fit. For more information about the use of repellent on infants and children, please see the “Insect and Other Arthropod Protection” section in Traveling Safely with Infants and Children and the “Children” section of CDC’s Frequently Asked Questions about Repellent Use.
o For more information on the use of insect repellents, see the information on the Mosquito and Tick Protection webpage.
• Wear loose, long-sleeved shirts and long pants when outdoors.
o For greater protection, clothing may also be sprayed with repellent containing permethrin or another EPA-registered repellent. (Remember: don't use permethrin on skin.)

Symptoms and Treatment

Symptoms of dengue include:
• fever
• severe headache
• pain behind the eyes
• joint and muscle pain
• rash
• nausea/vomiting
• hemorrhagic (bleeding) manifestations

Usually dengue fever causes a mild illness, but it can be severe and lead to dengue hemorrhagic fever (DHF), which can be fatal if not treated. People who have had dengue fever before are more at risk of getting DHF.

No vaccine is available to prevent dengue, and there is no specific medicine to cure illness caused by dengue. Those who become ill with dengue fever can be given medicine to reduce fever, such as acetaminophen, and may need oral rehydration or intravenous fluids and, in severe cases, treatment to support their blood pressure. Aspirin (acetylsalicylic acid), aspirin-containing drugs, and other nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) should be avoided because of the possibility of bleeding. Early recognition and treatment of severe dengue (e.g., signs and symptoms consistent with impending blood pressure failure) can reduce the risk of death.

If you return from a trip abroad and get sick with a fever, you should seek medical care. Be sure to tell the doctor or other health-care provider about your recent travel.
Information for Health-Care Providers
Proper diagnosis of dengue is important, as many other diseases may mimic dengue. Health-care providers should consider dengue, malaria, and (in south Asia and countries bordering the Indian Ocean) chikungunya 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 regarding reporting dengue cases and instructions for specimen shipping. Serum samples obtained for viral identification and serologic diagnosis can be sent through state or territorial health departments to:

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

More Information
For more information about dengue and protection measures, see the following links:
• Dengue Fever in CDC Health Information for International Travel 2010
• Mosquito and Tick Protection
• Questions and Answers: Insect Repellent Use and Safety
• CDC Dengue website

For more information about dengue in travelers, see
• Travel-Associated Dengue—United States, 2005 [MMWR 2006, 55 (25)].
• Travel-Associated Dengue Infections—United States, 2001-2004 [MMWR 2005, 54 (22)]
1Freedman DO, Weld LH, Kozarsky PE, Fisk T, Robins R, von Sonnenburg F, et al., for the GeoSentinel Surveillance Network. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med 2006;354:119-130.