Dengue in the Americas and Caribbean (Update 3)

An update from the Pan American Health Organisation/World Health Organisation  on 22 September 2017 shows dengue remains widespread in the Americas and Caribbean. The countries with the highest number of suspected cases (including confirmed) are Brazil (21 9040), Peru (72 274), Nicaragua (45 243), Mexico (37 613) and Colombia (20 391).

Incidence (cases per 100 000 population) is highest in Nicaragua (723.08), Aruba (614.29), Saint Barthélemy (388.89), St Martin (382.93) and Turks & Caicos Islands (314.00).

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

North America

United States: 133 suspected, 133 confirmed (incidence 0.04/100 000)

Central America & Mexico

Belize: 15 suspected, 4 confirmed (incidence 4.31/100 000)
Costa Rica: 4 254 suspected, 0 confirmed (incidence 85.05/100 000)
El Salvador: 2 902 suspected, 136 confirmed (incidence 46.46/100 000)
Guatemala: 2 280 suspected, 386 confirmed (incidence 14.03/100 000)
Honduras: 4 304 suspected, 0 confirmed (incidence 49.35/100 000)
Mexico: 37 613 suspected, 5 660 confirmed (incidence 30.03/100 000)
Nicaragua: 45 243 suspected, 1 674 confirmed (incidence 723.08/100 000)
Panama: 5 152 suspected, 2 375 confirmed (incidence 129.19/100 000)

Andean

Bolivia: 7 910 suspected, 845 confirmed (incidence 71.75/100 000)
Colombia: 20 391 suspected, 5 449 confirmed (incidence 41.17/100 000)
Ecuador: 10 557 suspected, 10 557 confirmed (incidence 65.06/100 000)
Peru: 72 274 suspected, 24 311 confirmed (incidence 231.94/100 000)
Venezuela: 4 929 suspected, 860 confirmed (incidence 15.89/100 000)

Southern Cone

Argentina: 305 suspected, 253 confirmed (incidence 0.72/100 000)
Brazil: 219 040 suspected, 0 confirmed (incidence 107.55/100 000)
Chile: 5 suspected, 5 confirmed (incidence 0.03/100 000)
Paraguay: 1 352 suspected, 311 confirmed (incidence 19.22/100 000)

Hispanic Caribbean

Cuba: 270 suspected, 270 confirmed (incidence 2.4/100 000)
Dominican Republic: 865 suspected, 0 confirmed (incidence 8.12/100 000)
Puerto Rico: 9 suspected, 9 confirmed (incidence 0.24/100 000)

English, French, & Dutch Caribbean

American Virgin Islands: 1 suspected, 1 confirmed (incidence 0.96/100 000)
Anguilla: 18 suspected, 2 confirmed (incidence 112.50/100 000)
Antigua & Barbuda: 1 suspected, 0 confirmed (incidence 1.09/100 000)
Aruba: 688 suspected, 9 confirmed (incidence 614.29/100 000)
Bahamas: 4 suspected, 0 confirmed (incidence 1.03/100 000)
Barbados: 192 suspected, 29 confirmed (incidence 65.98 /100 000)
Bermuda: 0 suspected, 0 confirmed (incidence 0 /100 000)
British Virgin Islands: 42 suspected, 42 confirmed (incidence 127.27/100 000)
Cayman Islands: 23 suspected, 0 confirmed (incidence 41.07/100 000)
Dominica: 31 suspected, 0 confirmed (incidence 41.89/100 000)
French Guiana: 455 suspected, 0 confirmed (incidence 190.38/100 000)
Grenada: 80 suspected, 80 confirmed (incidence 72.07/100 000)
Guadaloupe: 455 suspected, 0 confirmed(incidence 110.71/100 000)
Guyana: 5 suspected, 0 confirmed (incidence 0.62 /100 000)
Jamaica: 70 suspected, 14 confirmed (incidence 2.49/100 000)
Martinique: 72 suspected, 3 confirmed (incidence 18.09/100 000)
Saint Barthélemy: 35 suspected, 0 confirmed (incidence 388.89/100 000)
St. Kitts & Nevis: 7 suspected, 0 confirmed (incidence 13.46/100 000)
St. Lucia: 14 suspected, 14 confirmed (incidence 8.54/100 000)
St. Martin: 157 suspected, 1 confirmed (incidence 382.93/100 000)
St. Vincent & the Grenadines: 3 suspected, 0 confirmed (incidence 2.91/100 000)
Trinidad & Tobago: 206 suspected, 0 confirmed (incidence 15.29/100 000)
*Turks & Caicos Islands: 157 suspected, 157 confirmed (incidence 314.00/100 000)

*Turks & Caicos Islands figure was published 15 September 2017.

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.