Dengue in the Americas and Caribbean (Update 1)

An update from the Pan American Health Organisation/World Health Organisation on 31 July 2017 shows dengue remains widespread in the Americas and Caribbean. The countries with the highest number of probable cases (including confirmed) are Brazil (192 123), Peru (66 687), Nicaragua (33434), Colombia (16774 and Ecuador (9713).

Incidence (cases per 100 000 population) is highest in Aruba (590.18), Nicaragua (534.35), Saint Barthélemy (331.13), Turks & Caicos Islands (314.00) and Peru (278.05).

PAHO/WHO probable case numbers for dengue include confirmed cases. Area headings are those used by PAHO/WHO.

North America

United States: 62 probable cases, 62 confirmed (incidence 0.02/100 000)

Central America & Mexico

Costa Rica: 2 802 probable cases, 0 confirmed (incidence 56.02/100 000)

El Salvador: 2 126 probable cases, 49 confirmed (incidence 33.08/100 000)

Guatemala: 1 296 probable cases, 230 confirmed (incidence 7.97/100 000)

Honduras: 3 437 probable cases, 0 confirmed (incidence 39.41/100 000)

Mexico: 5 372 probable cases, 2 622 confirmed (incidence 4.29/100 000)

Nicaragua: 33 434 probable cases, 1 325 confirmed (incidence 534.35/100 000)

Panama: 2 906 probable cases, 1 305 confirmed (incidence 72.87/100 000)

Andean

Bolivia: 7 647 probable cases, 0 confirmed (incidence 69.36/100 000)

Colombia: 16 774 probable case, 8 357 confirmed ( incidence 33.87/100 000)

Ecuador: 9 713 probable cases, 9 713 confirmed (incidence 59.86/100 000)

Peru: 68 687 probable cases, 22 079 confirmed (incidence 220.43/100 000)

Venezuela: 2 722 probable cases, 309 confirmed (incidence 8.77/100 000)

Southern Cone

Argentina: 7 290 probable cases, 295 confirmed (incidence 121.00/100 000)

Brazil: 192 123 probable cases, 0 confirmed (incidence 94.34/100 000)

Chile: 5 probable cases, 5 confirmed (incidence 0.03/100 000)

Paraguay: 1 285 probable cases, 285 confirmed (incidence 18.27/100 000)

Hispanic Caribbean

Cuba: 270 probable cases, 0 confirmed (incidence 2.4/100 000)

Dominican Republic: 624 probable cases, 0 confirmed (incidence 5.86/100 000)

Puerto Rico: 9 probable cases, 9 confirmed (incidence 0.24/100 000)

English, French & Dutch Caribbean

American Virgin Islands: 1 probable case, 1 confirmed ( incidence 0.96/100 000)

Anguilla: 15 probable cases, 2 confirmed (incidence 93.75/100 000)

Antigua & Barbuda: 1 probable case, 0 confirmed (incidence 1.09/100 000)

Aruba: 661 probable cases, 8 confirmed (incidence 590.18/100 000)

Bahamas: 4 probable cases, 0 confirmed (incidence 1.03/100 000)

Barbados: 151 probable cases, 29 confirmed (incidence 51.89/100 000)

British Virgin Islands: 28 probable cases, 28 confirmed (incidence 84.85/100 000)

Cayman Islands: 12 probable cases, 0 confirmed (incidence 21.43/100 000)

Dominica: 22 probable cases, 0 confirmed (incidence 29.73/100 000)

French Guiana: 165 probable cases, 0 probable (incidence 69.04/100 000)

Grenada: 59 probable cases, 59 confirmed (incidence 53.15/100 000)

Guadaloupe: 83 probable cases, 0 confirmed (incidence 20.19/100 000)

Jamaica: 64 probable cases, 11 confirmed (incidence 2.28/100 000)

Martinique: 73 probable cases, 1 confirmed (incidence 18.34/100 000)

Saint Barthélemy: 30 probable cases, 0 confirmed (incidence 331.13/100 000)

St. Kitts & Nevis: 4 probable cases, 0 confirnmed (incidence 7.69/100 000)

St. Lucia: 14 probable cases, 14 confirmed (incidence 8.54/100 000)

St. Martin: 114 probable cases, 0 confirmed (incidence 278.05/100 000)

St. Vincent & the Grenadines: 2 probable cases, 1 confirmed (incidence 1.94/100 000)

Trinidad & Tobago: 61 probable cases, 0 confirmed (incidence 4.53/100 000)

Turks & Caicos Islands: 157 probable cases, 157 confirmed (incidence 314.00/100 000)

Advice for Travellers

Dengue is the second most common identified cause of febrile illness in returning travellers and the number of cases in travellers continues to increase. All travellers to endemic regions are potentially at risk of dengue fever and should be aware of this infection. Prevention relies on avoiding mosquito bites.

Aedes mosquitoes are particularly persistent and aggressive and bite between dawn and dusk.
Methods of bite avoidance include:

• Wearing long, loose, lightly coloured clothing to cover up the skin during the day.
• The use of insect repellent containing DEET applied to any exposed skin between dawn and dusk.
• When sunscreen and DEET are used together, DEET should be applied after sunscreen. The effectiveness of repellent reduces more rapidly than sunscreen, therefore, repellent may have to be reapplied on top of sunscreen.
• The use of permethrin, impregnated mosquito nets protects against early morning bites and should also be used when sleeping during the day.
• The use of air conditioning if available and/or mesh screening of windows and doors.
• Eradication of mosquito breeding sites around accommodation/home (e.g. open containers, old tyres or flower pots that may collect water).

Vaccine

There is no vaccine against dengue fever licensed in the UK.

At present the World Health Organisation (WHO) is trialling several candidate vaccines against dengue fever.

• Dengvaxia®, developed by Sanofi Pasteur MSD, is the first vaccine to be licensed for the prevention of dengue.
• It is a live, attenuated, recombinant, tetravalent vaccine approved for use in people 9–45 years of age living in highly endemic regions on a 3 dose schedule.
• Prior dengue infection increases the efficacy of the vaccine; efficacy is reduced in populations with low previous exposure to dengue and may lead to increased rates of hospitalisation due to severe dengue.
• Mexico, Costa Rica, the Phillippines and Brazil are the first countries to have granted marketing authorization for Dengvaxia®

For further information see Dengue Fever.