Caribbean Epidemiology Centre (CAREC/PAHO/WHO) 1

Dengue is an acute fever caused by a flavivirus. The dis­ ease can occur in two forms: (1) Dengue Fever (DF) and (2) Dengue Haemorrhagic Fever/Dengue Shock Syn­ drome (DHF/DSS). DF is marked by the onset of sud­ den high fever, severe headache and pain behind the eyes, in the muscles and in the joints. DHF is a more severe form, in which bleeding and sometimes shock oc­ curs – leading to death. It is most serious in children. Dengue spreads rapidly and may affect large numbers of people during an epidemic resulting in reduced work pro­ ductivity, but most importantly causing the loss of lives (WHO, Fact Sheet No. 117, 2002).

Background

DF is endemic in most Caribbean countries as the vec­ tor, the Aedes mosquito (Ae. Aegypti and Ae. Albopictus) is ubiquitous. This disease is a worrisome problem as the potential for DHF and DSS increases with the occur­ rence of more than one virus type in a given country (Heymann D (ed.) 2004). All four dengue serotypes have been isolated in the Caribbean, beginning in 1952 with the introduction of dengue virus type 2 in Trinidad and Tobago; type 3 in Puerto Rico in 1963­64; type 1 in Jamaica in 1977, which spread throughout most of the Caribbean during 1977­78; and type 4 in 1981 in St.

Bathelemy and St. Maarten (CAREC, Annual Report, 1985).

Trends (1980 – 2005)

As DF is endemic in most Caribbean countries, cases are reported every year. A total of 58,461 cases of DF and 1,386 cases of DHF/DSS have been reported during the twenty­five year review period. The general trend has been an increasing one, with outbreaks being reported with increasing frequency in recent years. This is likely to be due to two factors, namely improved reporting from countries and true increases in the occurrence of cases. As expected, the trends in DHF/DSS reflect the trends in DF, and an overall increase has been seen in the num­ bers of DHF/DSS cases reported with the circulation of more virus types.

In 1981/82, type 4 virus reportedly caused an epidemic involving Antigua and Barbuda, Barbados, Belize, Ja­ maica, St. Lucia and Suriname (Review of Communica­ ble Diseases in the Caribbean 1982. Between 1983 and 1993, outbreaks were reported by a few member coun­ tries: 1984/85 – Aruba (Type 1); 1986 – Suriname and Trinidad and Tobago (both Type 2); 1988 – Barbados (Type 2); 1989 – Bahamas (Type not specified); 1990 –

Dengue Fever (DF) and

Dengue Haemorrhagic Fever/Dengue Shock Syndrome (DHF/DSS)

Caribbean Epidemiology Centre (CAREC/PAHO/WHO) 2

Morbidity Review: DF and DHF/DSS

Trinidad and Tobago (Types 1, 2 and 4); 1992 – Trinidad and Tobago (Type not specified); and 1993 – Nether­ lands Antilles (Type not specified).

In 1995, 5,083 cases of DF were reported from fourteen countries. The majority of cases were reported from Bar­ bados (42%), Jamaica (37%), Dominica (6%), and Trini­ dad and Tobago (6%). Virus types 1, 2 and 4 were in cir­ culation during this multi­country outbreak (CAREC, An­ nual Report, 1995) and two countries reported cases with DHF/DSS, namely Jamaica (108 cases) and Gre­ nada (5 cases). In 1996, 87% of the 4,135 DF cases re­ ported to CAREC were from Trinidad and Tobago. In November 1997, Dengue Virus Type 3 was identified in Belize; this was the first identification of this virus type in a CAREC member country since the 1960s, although this specific virus type was identified in Puerto Rico in 1977 (CAREC, Annual Report, 1997).

In 1998, outbreaks involving all four virus types were re­ ported – Aruba (Type 3), Bahamas (Types 1 and 4), Bar­ bados (Type 2), Guyana and Jamaica (Type 3) and St. Vincent and the Grenadines (Type 2). A total of 6,732 cases of DF were reported that year from fourteen coun­ tries. Four countries reported cases with DHF/DSS – Trinidad and Tobago (136 cases), Suriname (60 cases), Jamaica (42 cases) and St. Lucia (1 case).

Between 1999 and 2004, Trinidad and Tobago reported 58% of the 25,917 DF cases recorded at CAREC, while Suriname and Barbados reported 13% and 18% respec­ tively. Trinidad and Tobago reported 75% of the 852 DHF cases reported in those years while Suriname re­ ported 24% of the total.

The year 2002 saw a peak in the number of reported cases with 8,099 DF and 298 DHF/DSS for the year. Trinidad and Tobago, Barbados and Suriname ac­ counted for 77%, 9% and 6% of DF cases respectively; 92% of the DHF/DSS cases for that year were reported from Trinidad and Tobago. It is notable that by 2003, Type 3 virus had been identified in all member countries except Bermuda, Cayman Islands, Montserrat, and the Turks and Caicos Islands (CAREC, Annual Report, 2003).

It should be noted that laboratory confirmation of dengue fever (DF) and dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS) has increased in recent years. During 1995­2003, only 3­11% of DF cases were laboratory confirmed, compared to 29% and 28% being laboratory confirmed in 2004 and 2005 respectively. During 1995­2001, 3­16% of DHF/DSS cases were labo­ ratory confirmed, compared to more than 20% being laboratory confirmed from 2002 onwards.

Caribbean Epidemiology Centre (CAREC/PAHO/WHO) 3

Morbidity Review: DF and DHF/DSS

Figure 9: Reported (and Confirmed) Cases of Dengue Fever in all CAREC Member Countries

1980 ­ 2005

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eported Cases

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Caribbean Epidemiology Centre (CAREC/PAHO/WHO) 4

Morbidity Review: DF and DHF/DSS Table 9: Reported and Confirmed Dengue Fever Cases

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Anguilla 0 1 0 0 0 0 0 0 0 0 12 2 ­ ­ 0 0 1 0 0 12 12 64 5 3 0 0 112

Antigua and Barbuda 1 77 5 1 0 0 0 0 0 0 0 0 0 0 3 24 6 10 4 2 8 25 0 0 0 0 166

Aruba ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ 76 ­ 28 ­ 173 ­ 277

Bahamas 0 0 0 0 0 0 0 0 0 87 0 0 0 0 0 1 0 0 336 0 0 0 0 180 1 0 605

Barbados 0 6 99 63 0 0 0 78 7 2 18 0 0 89 5 2,149 132 1,855 1,155 696 1,226 674 740 997 349 320 10,660

Belize 4 7 482 26 127 0 5 0 0 0 3 0 0 0 48 107 0 274 6 3 6 2 41 0 2 380 1,523

Bermuda 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2

British Virgin Islands 0 0 0 0 0 0 1 0 13 0 3 5 1 0 11 25 0 1 0 3 5 0 0 0 0 68

Cayman Islands 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 1 1 0 1 5

Netherlands Antilles ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ 24 21 ­ ­ ­ 580 265 890

Dominica 0 18 0 2 0 0 6 2 0 0 0 2 0 1 0 293 3 0 1 5 38 1 0 0 4 11 387

Grenada 0 2 7 6 3 0 0 4 0 1 3 0 0 8 11 9 21 4 6 37 27 12 84 20 7 0 272

Guyana 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 12 4 ­ ­ ­ 202 62 99 178 560

Jamaica 9 51 21 72 12 3 3 3 6 40 11 5 296 10 17 1,884 46 16 1,509 23 25 29 90 57 9 46 4,293

Montserrat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 75 2 0 0 0 9 0 1 1 0 0 88

St. Lucia 6 23 31 0 0 0 164 1 2 4 2 4 3 0 3 6 65 14 24 57 5 301 43 11 11 1 781

St. Vincent and the Grenadines 0 7 1 0 0 0 0 0 0 0 8 0 7 21 6 89 56 6 205 7 3 3 152 6 4 8 589

St. Kitts and Nevis 0 10 0 0 0 2 0 0 0 0 0 0 0 1 7 27 4 1 0 2 6 89 20 5 4 0 178

Suriname 0 22 25 0 0 0 64 1 0 4 30 40 77 171 1,031 126 183 179 495 691 1,093 516 446 218 309 1,584 7,305

Trinidad and Tobago 0 15 16 117 31 5 145 106 31 11 526 31 642 3,060 504 282 3,588 2,081 2,984 1,199 2,238 2,417 6,246 2,464 546 411 29,696

Turks and Caicos Islands 0 0 0 0 0 0 0 0 0 0 0 0 0 ­ ­ 0 ­ ­ 0 0 0 0 0 2 1 1 4

Total 20 239 687 287 173 10 388 195 59 149 616 89 1,026 3,361 1,635 5,083 4,135 4,452 6,732 2,758 4,796 4,138 8,099 4,027 2,099 3,208 58,461 Confirmed cases ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ 434 490 286 229 390 432 490 761 224 455 1,193 5,384

Country Year

Total

Notes: ­ Data not available

Data Source: CAREC Surveillance Database as at October 2008

Caribbean Epidemiology Centre (CAREC/PAHO/WHO) 5

Morbidity Review: DF and DHF/DSS

Figure 10: Reported Cases of Dengue Haemorrhagic Fever/Shock Syndrome in all CAREC Member Countries

1994 ­ 2005

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1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Year

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eported Cases

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Caribbean Epidemiology Centre (CAREC/PAHO/WHO) 6

Morbidity Review: DF and DHF/DSS

Table 10: Dengue Haemorrhagic Fever/Shock Syndrome Cases

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Anguilla ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ 0 ­ 0 Antigua and Barbuda ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ 0 Bahamas ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ 0 Barbados ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ 0 Belize ­ ­ 0 0 0 0 0 0 0 0 ­ 0 0 Bermuda ­ ­ ­ ­ 0 0 0 0 0 0 0 0 0 British Virgin Islands ­ ­ ­ 0 0 0 0 0 0 0 0 0 0 Cayman Islands ­ ­ ­ ­ 0 0 0 0 0 0 0 0 0 Dominica ­ ­ ­ ­ 0 0 ­ ­ ­ ­ ­ 4 4 Grenada 1 5 0 0 0 0 0 0 3 0 0 0 9 Guyana 0 0 0 ­ ­ ­ ­ ­ 2 0 0 0 2 Jamaica 0 108 0 0 42 0 ­ ­ ­ ­ ­ ­ 150 Montserrat ­ ­ ­ ­ 0 0 0 0 0 0 0 0 0 St. Lucia 0 0 0 1 1 0 0 3 0 0 0 0 5 St. Vincent and the Grenadines 0 0 0 0 0 0 0 0 2 0 0 0 2 St. Kitts and Nevis ­ 0 0 0 ­ ­ ­ ­ ­ ­ ­ ­ 0 Suriname 2 0 6 0 60 69 85 21 18 4 5 96 366 Trinidad and Tobago ­ ­ ­ 81 136 65 54 93 273 106 40 0 848 Turks and Caicos Islands ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ 0

Total 3 113 6 82 239 134 139 117 298 110 45 100 1,386 Confirmed cases ­ 4 0 13 24 12 17 12 67 28 15 50 242

Total Country Year

Notes: ­ Data not available

Data Source: CAREC Surveillance Database as at October 2008