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Dengue Fever

During the reporting period under review, epidemiologic weeks 25-39, 1,083 cases of Dengue Fever were reported to CAREC’s Epidemiology Division, compared to 1,230 cases reported in the corresponding period last year [Appendix 1, Figure 1].

Most countries, as well as the English speaking Caribbean as a whole, reported less cases in the third quarter of 2001 compared to 2000. However in 2001, dengue virus type 3 spread to five new countries, namely St Lucia, Antigua and Barbuda, the British Virgin Islands, Anguilla and Suriname. In St Lucia, the first confirmed case of DEN-3 was reported in August 2001 and during weeks 26-39, 89 cases (clinically or laboratory confirmed) were reported, compared to 1 case during the same period of 2000. In Antigua and Barbuda the first confirmed case of DEN-3 occurred in January 2001, in the British Virgin Islands the first confirmed case was in October and in Anguilla the first confirmed case was in October 2001. In Suriname, DEN-3 was first identified in May 2001 and during weeks 26-39, 515 cases were reported, which is a five-fold increase compared to the same period of 2000. Furthermore epidemic situations linked to DEN-3 were observed in the French Caribbean (Martinique, Guadeloupe) [Outbreak corner].

Acute Respiratory Infection Among <5 Years Olds And Influenza

During the period under review, there was a 53% percent reduction in the total number of reported cases of acute respiratory infection among children under five years of age compared to the corresponding period last year [Appendix 1]. This was mostly due to non-reporting from Guyana, who reported 54% of the acute respiratory infections among those under five years old in the third quarter of 2000. However, during the period under review, four member countries reported increased numbers of cases of acute respiratory infections among the under five years olds compared to the third quarter of last year, Belize increased from 6 cases to 91 cases, St. Lucia increased from 97 cases to 128 cases, St. Vincent and the Grenadines increased from 595 cases to 890 cases and Turks and Caicos increased from 75 cases to 284 cases.

During the period under review, 11,089 cases of influenza were reported to CAREC’s Epidemiology Division, compared to 17,388 cases reported in the corresponding period last year. However, four countries reported more cases of influenza during the third quarter of this year compared to the corresponding period last year, British Virgin Islands had a three-fold increase, Montserrat and Turks and Caicos had a two-fold increase and St. Vincent and the Grenadines had a 43% increase. Of these countries, British Virgin Islands, Montserrat and St. Vincent and the Grenadines reported more cases of influenza for weeks 1-39 of 2001, compared to the corresponding period last year.

To date, there was no available information about the type of influenza virus circulating in the Caribbean.

The Public Health Laboratory Information System Network [Phlis]

This year PHLIS evaluations were conducted in all the countries in the network and one of the positive outcomes of these evaluations was that many reporting sites have since updated their PHLIS databases.

During the period under review, 47 cases of Salmonella samples were reported to CAREC through the PHLIS network [Table 2]. A large proportion (49%) of the Salmonella samples remained with an unknown serotype, which is partly a reflection of the capacity of laboratories in the sub-region. While the largest proportion (24%) of the Salmonella samples identified for the year so far have been Salmonella Enteritidis, a wide variety of other Salmonella serotypes have been identified in the sub-region [Table 2].

During the period under review, 22 Salmonella samples were reported as being part of an outbreak, 19 from Trinidad and Tobago and 3 from Suriname. The 19 cases from Trinidad and Tobago were part of a large hotel-based outbreak (more than 100 persons ill) in the county St. George West at the end of June, 2001. Salmonella Enteritidis was identified as the aetiologic agent responsible for this outbreak.

The three cases reported as being part of an outbreak in Suriname were all from the area Plaats Ligging Onbek and had all been hospitalized with abdominal cramps, diarrhea and fever. Samples had been taken from the three patients from three different families at the end of July, 2001. One patient was the only person ill in the family, one patient was one of three persons ill in the family and the last patient was one of seven persons ill in the family. Salmonella group D was identified as the aetiologic agent responsible for this outbreak, the serotype was unknown.

The largest proportion of Shigella samples (62%) reported during the period under review were Shigella Sonnei. The remaining 38% were Shigella flexneri [Table 2].

Of the 13 Shigella Flexneri, unspecified samples reported, 12 were from Suriname and 11 of these had been hospitalized. Five member countries reported 54 samples that were positive for dengue through the PHLIS network [Table 2]. Serotypes were not identified for most of the samples as they had been confirmed by IgM.

During the period under review, 36 HIV samples were reported through the PHLIS network. Twenty-four (24) of these samples were from the parish of St. Michael in Barbados. The largest proportion of the HIV samples had no information reported on the age or sex of the patients.

Outbreak Corner

Dengue Fever In Martinique

During the third quarter of 2001, an outbreak of dengue virus type 3 was reported in the French Department of Martinique and this outbreak is continuing into the fourth quarter of the year. Dengue virus type 3 was first detected in Martinique in December 1999 and has since been circulating at low levels in some districts with no increase of cases of either classical dengue or DHF/DSS. However, during weeks 24-29, 2001, clusters of suspected dengue cases were detected by the Physician Based Sentinel (PBS) Network in the North-Eastern district of Tartane. The increase in trans-mission begun in weeks 34-35, and during weeks 36-38 the PBS Network (50 of 300 general practitioners) detected 503 suspected cases island-wide. During weeks 36-37, 116 cases were confirmed by IgM. No cases of DHF/DSS were reported during the period under review.

Dengue Fever In Venezuela

During the third quarter of 2001, an outbreak of Dengue Fever/DHF/DSS was reported in Venezuela. At week 43, the outbreak was continuing in 20 of 24 states, including the Metropolitan District of Caracas. As of week 43, 70,228 cases were notified to the Ministry of Health, 5,488 (8%) of these being DHF cases and 14 of these cases died. 19% of the total cases were from the Metropolitan District of Caracas. The national ratio of classical dengue to DHF is 12:1.

West-Nile Virus: An Update Of The Situation In The Western Hemisphere

The West Nile Virus has survived two winters in the USA and so far has been reported in 28 states (including the District of Columbia) and in Ontario, Canada. The virus spread rapidly, with infected birds being found from Southern Ontario to the Florida Keys, and as far west as Iowa and Louisiana. The distribution of the virus in the USA can be seen on a map on the USGS National Wild-life Health Center website: www.nwhc.usgs.gov/research/west_nile/wnv_map.html

Epidemiological patterns of West Nile Virus transmission in the USA shows that migrating birds are the key to zoonotic transmission and were responsible of the spread of the virus from New York across the USA. The USGS National Wildlife Health Center website lists the species of birds found to be positive for West Nile Virus: www.nwhc.usgs.gov/whats_new/wha/wha0102.html

Between July 13 and October 7, 2001, 37 human cases of West Nile Virus infection, including 1 death, were reported in the USA (Florida 10; Maryland 6; New York 6; New Jersey 6; Connecticut 5; Pennsylvania 3; Georgia 1). The median age of the cases was 69 years.

To date, laboratories participating in the West Nile Virus Surveillance in the Caribbean (i.e. Instituto Pedro Kouri in Cuba, Institut Pasteur de Guyane in French Guiana and CAREC in Trinidad) have not reported any cases of West Nile Virus infection. A suspected case of West Nile Virus infection was recently reported in the Cayman Islands. High antibody titers against West Nile Virus, or a very closely related flavivirus, were found in a 32 year-old patient with viral encephalitis [CAREC Fax Alert, October 17, 2001]. To date, no evidence or indication of enzootic West Nile Virus circulation has been reported in Cayman Islands.

West Nile Virus is a flavivirus, part of the group of the Japanese Encephalitis, which includes Saint Louis Encephalitis, Kunjin, Murray Valley, Ilheus, Rocio, Bussuquara and Cacipacore viruses. West Nile Virus is also related to Dengue and Yellow Fever sub-groups. Since some of these flavivirus are endemic to the Caribbean and/or Latin America, the interpretation of serology results is very difficult. CAREC emphasizes the importance of viral isolation from human, animal or entomological materials to monitor the spread of West Nile Virus into the sub-region. CAREC also recommends that positive serology results must be followed by a comprehensive case investigation including a survey of the ecosystem (birds, mosquitoes, horses). Further Public Health strategies for the control and prevention of West Nile Virus must be designed based on a complete understanding of patterns of West Nile Virus transmission in the Caribbean. Please refer to CAREC’s website for West Nile Virus Surveillance Guidelines: http://www.carec.org/data/alerts/west_nile_virus011001.htm

Anthrax In The USA

As of November 7, 2001 CDC reported 22 cases of anthrax, 17 confirmed (10 inhalation and 7 cutaneous) and 5 suspected cutaneous cases. Four of the 10 confirmed inhalation anthrax cases died. The reports were from Washington DC, New Jersey, New York and Florida.

APPENDIX 1

REPORTED CASES OF COMMUNICABLE DISEASES ¹
Epidemiologic Weeks: 26 - 39 of 2000 and 2001
With Incidence Rates per 100,000 Population
CAREC Member Countries

General Comments

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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 23 November, 2001