DENGUE outbreaks in the Americas

00000000 Until 1981, only sporadic suspected cases of DHF had been reported in the Americas, although epidemics of classic DF occurred in the Caribbean and northern South America in 1963 - 64, 1968 - 69, 1972 - 75 and 1977 - 78. However, in 1981 as outbreak of DHF/DSS occurred in Cuba that marked the start of DHF in the region of the Americas. During this epidemic, 344 203 cases of dengue were reported, including 10 312 patients classified as severely ill according to the WHO criteria (grades III and IV; see Chapter 2). During the same epidemic, 158 deaths, of which 101 were in children, were reported. In a 3-month period, 116 143 persons were hospitalized. The second largest outbreak of DHF/DSS in the Region occurred in Venezuela from October 1989 to April 1990. Moreover, the epidemic reappeared in the second half of 1990 and in each of the subsequent years up to and including 1993. A total of 11 260 cases of DHF and 136 deaths were reported in Venezuela during the period 1989 - 1993. Dengue virus serotypes 1, 2 and 4 were isolated during these outbreaks.

00000000 Cases of DHF or DHF-like disease have been reported in the Americas nearly every year since 1981. The countries or territories affected include Aruba, Barbados, Brazil, Colombia, the Dominican Republic, El Salvador, French Guiana, Guadeloupe, Guatemala, Honduras, Jamaica, Mexico, Nicaragua, Panama, Puerto Rico, Saint Lucia, Suriname and Venezuela. Dengue has been recorded in virtualy all Latin American countries, with the possible exceptions of Argentina, Chile and Uruguay, and it appears that DHF/DSS is gradually becoming endemic in several countries of the Americas, following the trend observed in Asia. The marked increase in DHF/DSS noted in several Asian countries during the past 30 years clearly illustrates what the Americas may face.

Dengue in the African and Eastern Mediterranean Regions

00000000 All countries with dengue virus transmission should be considered at risk for DHF outbreaks, and while there is comparatively little information on DF and DHF in the African and the Eastern Mediterranean Regions, it is nevertheless clear that they pose a growing threat there. Dengue disease has been prevalent in tropical Africa and has appeared episodically in the temperate regions of North Africa and the Mediterranean region of Europe. Since 1967, dengue virus has been reported in Angola, Burkina Faso, Comoros, Cote d'Ivoire, Demecretic Republic of the Congo, Djibouti, Ethiopia, Ghana, Guinea, Kenya, Madagascar, Mauritius, Mozambique, Nigeria, Pakistan, Reunion, Saudi Arabia, Senegal, Seychelles, Sierra Leone, Somalia, Sudan and the United Republic of Tanzania. Some outbreaks have involved a large portion of the population as for example the 1993 outbreak of serotype 1 in the Comoros, in which more than 60 000 people were estimated to have contracted dengue. The appearance of dengue in Pakistan in 1994 constituted the first epidemic of DHF in these Regions.