ISSN 1020-3256

October 13, 1998

COMMUNICABLE DISEASES FEEDBACK REPORT

Reporting Period: Epidemiologic Weeks 13-34, 1998

A Review of Some Selected Communicable Diseases

DENGUE FEVER

An update on the status of dengue fever in the Caribbean as at September 26th was provided in a recent CAREC Epinote, dated October 2, 1998. The following key points were highlighted in that release:

to dengue virus infections; and

At this time, we wish to report the confirmation of dengue virus type 3 infections in a second CAREC-member country. Of 52 clinical samples referred to CAREC’s laboratories from persons in Jamaica during the month of September, dengue virus type-3 was identified in 10 specimens. Dengue virus type-1 was isolated from one person. Jamaica is the second Caribbean island in which type-3 viral circulation has been documented, the other being Puerto Rico.

Once again, the need for preparedness at the national and subregional levels (refer to the CAREC Epinote cited above and to other previous reports), as regards the possible occurrence of outbreaks of dengue haemorrhagic fever is being raised. It is with concern that we note the occurrence of numerous reported outbreaks of dengue fever and haemorrhagic fever globally.

Cholera

Although cholera had been documented in three CAREC member countries soon after its introduction into the Americas in 1991, Belize is the only member country in which this disease continues to occur. As at August 29, a cumulative total of 12 laboratory confirmed cases of cholera have been notified from Belize (Table 1). These cases have ranged in age from 8– 56 years, with a median age of 30 years. Eight cases had onsets of illness in June,1998. The greatest proportion of confirmed cases have been residents of the Cayo District. Two cases were recorded in Belize City, while another two were from the Orange Walk district. One of the cases from Belize City reportedly acquired his infection during a visit to a border town that was experiencing an outbreak. Of cases for whom gender was specified, 6 were female and 5 male.

Measles

During the reporting period under review, 305 suspected cases of measles were notified through the Measles Elimination Surveillance System (MESS). One case was, however, laboratory confirmed during epidemiologic week number 23 in an 11 year old girl who was visiting Jamaica from Germany. This girl who arrived in Jamaica on June 1, had an onset of symptoms on June 6, 1998. This girl’s brother, however, had presented with a similar symptom profile three weeks prior to her arrival in Jamaica. This case has been classified as an imported infection. Between January 1 and August 29, 1998, a cumulative total of 373 suspected cases of measles have been referred through the MESS.

In light of the occurrence of numerous recent outbreaks of measles in countries within the Region of the Americas as well as in other areas of the world, the potential for infected persons to reach our shores is real. Our member countries are therefore being reminded of the important need to aggressively investigate all suspected cases of measles, even among visitors, and to ensure that the appropriate follow-up of contacts is undertaken as expeditiously as possible, even if a clinical specimen may not be available from the suspected index case.

Errata

Please note that in the Communicable Diseases Feedback Report for epidemiologic weeks 1-12, dated May 29, 1998, (limited to the early printed version only), it was reported in error that 65.0 percent of the suspected cases of measles had been notified from St. Vincent and the Grenadines, rather than from Suriname. We do sincerely apologise for this error on our part.

Rubella

Between January 1 and August 29, 1998, 41 cases of rubella were notified to CAREC’s Epidemiology Division via the weekly communicable disease reports from five member countries. However, during the same period, 81 of 346 (23.4%) suspected cases of measles referred through the specialised surveillance system were laboratory confirmed as rubella. Suriname accounted for the greatest proportion (88.9%) of these confirmations. Of 170 referrals from that country to the MESS, 72 or 42.3 percent were confirmed as rubella.

As regards febrile rash illnesses, both rubella and dengue viral activity have been documented in Suriname (Figure 1). Only 7 cases of congenital rubella syndrome have been formally notified to the Epidemiology Division from two member countries during the first 8 months of 1998.

A General Comment

Any interpretation of the data presented in Table 1 of this report should be undertaken with the following in mind:

1. There is no unusual epidemiologic situation as regards malaria in the subregion. Guyana has only recently recommenced its weekly reporting of communicable diseases. The 1997 database would therefore not have contained any malaria reports from Guyana.
   
2. ARIs among under fives are not under surveillance in four CMCs.
   
3. Only five CMCs are currently reporting data on genital syndromes.
   
4. Data on gastroenteritis from Trinidad and Tobago is not provided in an age-categorized format, and have therefore been excluded from the age-specific sub-regional totals. However, 8,293 cases of gastroenteritis have been cumulatively reported from that country during the first 8 months of 1998.
   
5. To date, no AIDS Surveillance Reports for 1998 have been received from Trinidad & Tobago, St. Christopher/Nevis, the Turks & Caicos Islands and Belize.

The completion and operationalisation of a Laboratory Information System (LABIS) at CAREC’s laboratories has allowed the Epidemiology Division to access additional information that can be used for completing communicable disease epidemiologic profiles. The creation of this new electronic database also facilitates more timely assessment of changing disease situations in our member countries.

During this reporting period, no weekly communicable disease reports have been received from either Anguilla, Aruba, Suriname or the Netherlands Antilles.

Dr. M.J. Lewis & Team
CAREC’s Epidemiology Division

October 13, 1998