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Communicable Diseases Feedback ReportsReporting Period: Epidemiologic Weeks 9-24, 1997A Review of Selected Communicable Diseases MeaslesDuring the period under review 391 suspected cases of measles were reported to CAREC through the enhanced measles surveillance system of the Expanded Programme on Immunisation representing a 2.5-fold increase over the 110 cases notified during the corresponding period of 1996 (Table 1; Figure 1). At the end of epidemiologic week number 24 of 1997 (week ending June 21st), however, 578 suspected cases had been recorded in 19 of the CAREC member countries (CMCs) for a subregional incidence rate of 8.8 cases per 100, 000 population. In 1997, no suspected cases have been reported from either Bermuda, the Cayman Islands or Montserrat to date. Guyana, however, accounted for the greatest proportion, 34.4 percent, of the total cases notified. Two cases of measles were laboratory confirmed in week number 16 of 1997. One of these was a 25 year old woman in the Bahamas, whose source of infection remains unknown, while the other was a 27 year old Italian seaman who was already ill prior to his arrival in Trinidad and Tobago and was therefore classified as an imported case. These cases represent the first confirmation of measles in CMCs since 1991. Rubella And Congenital Rubella SyndromeAt the end of epidemiologic week number 24 of 1997, 403 cases of rubella had been recorded for a subregional incidence rate of roughly 6 cases per 100, 000 population. During the corresponding period of 1996, 184 cases had been reported for an incidence rate of 3 per 100, 000 population (Table 1; Figure 2). Trinidad and Tobago accounted for the greatest proportion, 46.0 percent, of the total cases reported to date in 1997, while Belize and Guyana contributed 22.5 and 21.3 percent of total cases, respectively. Not unexpectedly, cases of congenital rubella syndrome (CRS) have been documented in Trinidad and Tobago (4 cases), Belize (3 cases), Barbados (2 cases), Suriname (1 case) and Jamaica (6 cases). A review of the MESS (measles surveillance system) database indicated that 210 of the 578 suspected cases of measles referred for laboratory diagnosis from sixteen CMCs were confirmed as rubella (Table 2). Dengue FeverAlthough the overall subregional incidence of dengue fever at the end of week number 24 of 1997 is significantly lower than that observed during the corresponding period of 1996 (Table 1), relatively high numbers of cases continue to be recorded in Trinidad and Tobago and Suriname. Of the total cases notified as at week 24 of 1997, 60.6 and 31.0 percent were reported from those two countries, respectively. Data from CAREC’s laboratories indicate that 35 cases of dengue fever have been confirmed, to date, including six (6) which were referred through the measles surveillance system. During 1997, dengue virus type1 has been identified both in Belize and Trinidad and Tobago, while the type 2 virus has only been recovered in Trinidad and Tobago. Of the thirteen CAREC member countries from which specimens have been referred for laboratory diagnosis of dengue fever, dengue fever has been confirmed in six, namely, Trinidad and Tobago, Suriname, St. Lucia, Grenada, Belize and Barbados. GastroenteritisAlthough the overall reported incidence of gastroenteritis among children less than five years of age is lower than that of the corresponding 1996 period, significant increases in morbidity were observed in Antigua, Bermuda, St.Kitts/ Nevis, St. Vincent & the Grenadines and the Cayman Islands. Our laboratories confirmed the presence of rotavirus both in Antigua and in St. Kitts/Nevis. The situation among the over five population in these countries was similar to that of the under fives. Other Epidemiologic SituationsIncreased hepatitis A virus activity has been confirmed in the Bahamas, but this appears to be localized to certain geographic areas. MeaslesAll countries need to continue to be very vigilant as regards the following: maintaining high levels of vaccination coverage against measles; ensuring heightened surveillance for measles at all possible sites, both in the public and private health sectors, and including hospitals; undertaking immediate and thorough investigation of suspected cases including searches for additional cases. RubellaWhile suspected cases of rubella should be captured by the rash-fever surveillance initiatives currently in place in all CAREC-member countries, the public needs to be reminded that pregnant women who develop a febrile rash illness during pregnancy, but especially during the first trimester, should be screened by their health care provider to rule out rubella infection. This advice is also relevant for pregnant women who may have been exposed to someone with rubella. Pregnant women who are found to be rubella IgM positive should be followed and their pregnancy outcomes determined. The babies born to such mothers should also be screened for the presence of rubella IgM. Cases of congenital rubella syndrome should be thoroughly investigated and reported to CAREC’s Epidemiology Division. CAREC member countries need to urgently review their rubella vaccination strategies; determine population susceptibility patterns, especially among women of childbearing age or the older age cohorts; and to implement rubella vaccination programmes as are epidemiologically indicated. Dengue FeverAll countries are reminded of the need to intensify their surveillance of febrile and febrile rash illness, especially in light of the onset of the rainy season in the subregion. Public health practitioners are reminded of the importance of obtaining appropriate clinical specimens from suspected cases of dengue fever for laboratory diagnosis during non-epidemic or inter-epidemic periods. A General ReportAny interpretation of the data presented in this report should be undertaken with the following in mind:
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