March 11, 1999
Notable Disease Situations
The occurrence of a number of disease situations that are of relevance to the Caribbean
Sub-Region.
Dengue Fever
In 1998, indigenous dengue virus type 3 infections were confirmed in
Jamaica and in St. Christopher/Nevis, while imported infections with the same virus type
were identified in Barbados. In 1999, dengue virus type 3 has continued to circulate in
some of our member countries as evidenced by recent CAREC laboratory confirmations of
cases in St. Christopher/ Nevis and Barbados. In both these instances, the confirmed
infections have been classified as indigenous. Dengue virus type 3 appears to have been
recently introduced into Aruba, as the Department of Public Health in that country has
notified CAREC of the occurrence of an outbreak of dengue fever due to this same
aetiologic agent. Of 21 clinical specimens referred to the Instituto Nacional de Hygiene
Rafael Rangel in Venezuela, eight were laboratory confirmed, with this specific virus type
being isolated from three samples.
All member countries are once again being reminded of the critical need
for the following: human surveillance; preparedness as regards the clinical management of
dengue haemorrhagic fever and shock syndrome; vector surveillance; source reduction and
public education.
Recent postings on ProMED [an Internet based global electronic network,
which provides information on emerging infectious diseases] suggest that an epidemic of
dengue fever with haemorrhagic cases is occurring in Venezuela. Additional epidemiologic
information on this outbreak is being sought from Venezuelan health authorities.
Cholera
Cholera activity in Venezuela appears to have subsided as no cases were
recorded during epidemiologic week number 8 of 1999 [February 21-27]. As at February 26,
fifty-six cases of cholera and two deaths have been cumulatively notified to the Pan
American Health Organization by the Ministry of Health and Social Assistance in Venezuela.
The greatest proportion of cholera cases occurring both in 1998 and 1999 have been
recorded in the state of Delta Amacuro.
Yellow Fever
Subsequent to the occurrence and documentation of yellow fever virus
activity in Brazil and Venezuela during 1998, postings on ProMED indicate that this
disease was confirmed in Bolivia during January 1999. Deaths have been recorded in this
outbreak.
Measles
During the first eight epidemiologic weeks of 1999, measles virus
activity has been documented in North America as well as in a number of countries in South
America, including Argentina, Chile, Uruguay and Bolivia. Measles virus has also been
circulating in the Latin Caribbean as evidenced by the notification of 109 suspected cases
of measles in the Dominican Republic. Of these suspected cases referred for laboratory
diagnosis, 39 have been confirmed as measles, while 65 cases remain under investigation.
Two suspected cases were also notified from Haiti to PAHO’s Special Programme for
Vaccines and Immunisation. Although, there is currently no indigenous circulation of
measles virus in the English-speaking Caribbean and Suriname, continued vigilance is
essential as the potential for repeated introductions through imported infections is
great.
Note
Although some of these disease outbreaks may appear to be
geographically distant from our region, it must be emphasised that these diseases are no
more than an aeroplane ride away. Numerous airline routes and connections facilitate the
relatively rapid movement of potentially infected individuals and, hence, increase the
probability of introduction of new diseases or aetiologic agents into our sub-region. Once
introduced, the opportunity for transmission is amplified owing to, inter alia, the
presence of competent vectors; large susceptible populations; and the intense
intra-regional movement that occurs in relation to economic, recreational, educational and
other pursuits, some of which may also be illegal.
