Zoonotic Diseases

Diseases discussed here have a history of use as an agent for biological warfare, either in the U.S. or abroad. Its use may have been experimental or actual, and any detrimental consequences upon humans, animals or the environment may have been intentional or not, depending on the circumstances, the point in time, and the nature of the disease.

Thursday, July 15, 2010

Dengue Spreading in the USA

A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

In this update:
[1] USA (Florida)
[2] Puerto Rico
[3] Dominican Republic
[4] Guadeloupe
[5] Mexico (Jalisco)
[6] Mexico (San Luis Porosi)
[7] Brazil

[1] USA (Florida)
Date: Tue 13 Jul 2010
Source: Reuters [edited]

Of the population of Key West, Florida, 5 percent -- more than 1000
people -- have been infected at some point with the dengue virus,
government researchers reported on Tuesday [13 Jul 2010]. Most
probably, they did not even know it, but the findings show the
sometimes deadly infection is making its way north into the United
States, the researchers said.

"We're concerned that if dengue gains a foothold in Key West, it will
travel to other southern cities where the mosquito that transmits
dengue is present, like Miami," said Harold Margolis, chief of the
dengue branch at the U.S. Centers for Disease Control and Prevention.
"These cases represent the reemergence of dengue fever in Florida and
elsewhere in the United States after 75 years," Margolis said in a
statement. "These people had not traveled outside of Florida, so we
need to determine if these cases are an isolated occurrence or if
dengue has once again become endemic in the continental United States."

Dengue is the most common virus transmitted by mosquitoes, infecting
50 million to 100 million people every year and killing 25 000 of
them. It can cause classic flu-like symptoms but can also take on a
hemorrhagic form that causes internal and external bleeding and
sudden death. Companies are working on a vaccine, but there is not
any effective drug to treat it.

Dengue was eradicated in the United States in the 1940s, but a few
locally acquired U.S. cases have been confirmed along the
Texas-Mexico border since the 1980s. More cases have been reported
recently in Mexico and the Caribbean.

After 27 cases of dengue were reported in Florida in 2009, scientists
from the CDC and the Florida Department of Health took blood samples
from 240 randomly chosen Key West residents. Of these, 5 percent had
active dengue infections or antibodies to the virus, showing they had
been infected, the researchers told the International Conference on
Emerging Infectious Diseases being held in Atlanta.

Communicated by:
HealthMap Alerts via ProMED-mail

[Although these figures were the same as those presented in the 21
Apr 2010 report (see ProMED archive no. 20100503.1439), the above
report presents the 1st rough estimate of the numbers of individuals
who have been infected with dengue virus in Key West recently,
justifying the concern that the virus might have become endemic there
with risk of spread to other states in the southeastern USA. There is
evidence of dengue virus transmission in Key West within the past 3
months. The 13 Jul 2010 edition of the Sun Sentinel.com
indicated that Key West physicians had seen 14 dengue cases in Old
Town since April 2010.

A map showing the location of the Florida Keys can be accessed at
. A map of the
Florida Keys themselves can be accessed at
. A
HealthMap/ProMED-mail interactive map of the USA showing the location
of Florida in the southeast can be accessed at
. - Mod.TY]

[2] Puerto Rico
Date: Fri 9 Jul 2010
Source: Noticias Terra [in Spanish, trans. Corr.SB, edited]

CDC reports that a 31-year-old woman became the 4th fatality from DHF
in Puerto Rico. This has been confirmed today [9 Jul 2010] by the
Secretary of the Department of Health (DS), Lorenzo Gonzlez.
According to the latest report of the DS, for the week of 11-17 Jun
[2010], a total of 398 cases of dengue were reported, 311 cases above
the epidemic threshold (i.e. cases statistically expected) for that
week. An additional case of dengue hemorrhagic fever has been added
to the total, bringing the number to 23 so far this year [2010].

Gonzalez also reported that he will meet next week with the mayors of
communities with the highest incidence of dengue to discuss new
strategies to reduce the spread of the virus.

"[Even with] more spraying carried out, unless [we have the]
appropriate cooperation of the public, we accomplish nothing," said
Gonzalez in a press release.

Gonzalez added that they have detected the presence of 3 types of
dengue [virus], and, as one might expect, a significant increase in
those infected with the virus.

Communicated by:
HealthMap Alerts via ProMED-mail

[A HealthMap/ProMED-mail interactive map showing the location of
Puerto Rico in the Caribbean can be accessed at
. - Mod.TY]

[3] Dominican Republic
Date: Mon 12 Jul 2010
Source: La Nacion [in Spanish, trans. Corr.SB, edited]

Given the dramatic increase in those affected by dengue in the
Dominican Republic, the Ministry of Public Health and Welfare during
the weekend has increased action at a national level to prevent and
combat dengue and other diseases in order to prevent the advance and
spread of the disease in the population.

During the weekend, there was an increase in cases that went to
health centers at a rate of 20 per day. Just in the Robert Reid
Cabral Children's Hospital yesterday [11 Jul 2010], there were 27
admissions due to the disease, and the emergency room remained
crowded with children with febrile symptoms. The center's director,
Emilio Mena, said that in dealing with the high demand in the
hospital, since Saturday [10 Jul 2010], they proceeded to renovate
and expand the consultation areas to attend to patients in a timely manner.

The situation was similar in Los Minas Maternity Hospital, where a
group of more than 30 children were waiting for care in the emergency
area, most with fever. There were also a large number of patients in
emergency units of the Luis Eduardo Aybar and el Santo Socorro Hospitals.

In particular, measures to prevent dengue intensified on Sunday [11
Jul 2010] in more than 15 neighborhoods and sectors of Peravia
province, where dozens of technicians and health workers carried out
fumigation, elimination of mosquito breeding sites, trash cleanup,
and conducted educational activities for the public. Similar work was
carried out simultaneously during the weekend in Santo Domingo,
Santiago, San Francisco de Macoris, Salcedo Haina, San Cristobal and
San Jose de Ocoa, among other places. He also said that the
provincial governments and health sectors will carry out tasks of
home visits coordinated together with local organizations and
institutions, community leaders and health teams, informing
[citizens] about the importance of "bleach treatment and covered
[water] tanks" to control the disease [virus vector mosquitoes].

Public Health reported that in support of these actions, thousands of
informational brochures aimed at households have been distributed,
and 25 000 posters are to be placed in strategic locations to promote
the prevention and control actions.

Clearing the rubbish in homes was stressed; that consists of the need
of maintaining clean patios, gardens, alleys and the whole
environment of the homes individually or collectively, through
conferences with the support of neighborhood associations, local
governments and other grass-roots community and faith organizations
to prevent mosquito breeding sites.

Communicated by:
HealthMap Alerts via ProMED-mail

[A HealthMap/ProMED-mail interactive map showing the location of the
Dominican Republic in the Caribbean can be accessed at
. - Mod.TY]

[4] Guadeloupe
Date: Sat 10 Jul 2010
Source: Atout Guadeloupe [in French, trans. Corr.SB, edited]

The epidemic is progressing and reached almost the 2007 level (in
time for) the summer holidays, Guadeloupe has a very severe epidemic
of dengue. Fortunately, most people are affected by the best known
serotype, which is the least dangerous [dengue virus serotype
unspecified here - Mod.TY]. However, our island travelers still need
to arm themselves with mosquito repellents and to place nets over
their beds. The 2300 laboratory confirmed cases represent 5 percent
of the population, but you do need to be especially vigilant,
especially for those weaker members of the community.

Since the beginning of the epidemic that occurred in an unusual way,
out of the epidemic risk period, the number of cases clinically
suggestive of dengue fever has progressed slowly and steadily until
mid May [2010]. Since mid-May 2010, there has been a dynamic change,
and there is a rapid weekly increase of clinically suggestive cases.
During the last week (week 26 of 2010), the number of cases seen in
consultation [clinically suggestive of dengue] is estimated at about
2200 cases, about 20 percent more than the week before. This number
is close to the level of the peak of the epidemic of 2007 (2500 cases).

In recent weeks, all indicators of epidemiological evidence show the
continued intensification and generalization of the epidemic:
- the level currently achieved is close to the level of the 2007 epidemic;
- the number of trips to the emergency dengue (clinics) is increasing;
- the monthly number of laboratory confirmed cases, hospitalized,
stable so far, has doubled during the month of June 2010;

The proportion of severe forms remained stable since the beginning of
the epidemic.

Until now, the system of hospital care has not encountered
difficulties in addressing the epidemic. The epidemiological
situation of Guadeloupe corresponds always to Phase 4 of PSAG
[epidemic rating system] confirmed outbreak.

[This report includes a graph of the 2007 and current epidemic curves
and a map of case distribution.]

Communicated by:
HealthMap Alerts via ProMED-mail

[A HealthMap/ProMED-mail interactive map showing the location of
Guadeloupe in the Caribbean can be accessed at
. - Mod.TY]

[5] Mexico (Jalisco)
Date: Tue 13 Jul 2010
Source: Milenio.com [in Spanish, trans. Corr.SB, edited]

The intensification of the storm is now reflected in the increase in
the number of dengue cases in Jalisco. In [epidemiological] week 26
of this year [2010], which runs from 27 Jun-3 Jul [2010], there were
27 new patients, 10 more than the average of the previous weeks, said
Lucia Salazar Montes, head of the Department of Epidemiology at the
Jalisco Health Secretariat (SSJ). Most recent infections occurred in
the metropolitan area of Guadalajara.

In Tlaquepaque are 8 confirmed cases (all of classical dengue) and a
"small outbreak" in the Lomas de Tlaquepaque neighborhood, where
there were 2 confirmed cases with 3 more probable [cases]. Other
neighborhoods with dengue patients are El Campesino, Los Olivos,
Hidalgo, Colonial Tlaquepaque and Adolfo Lopez Mateos.

Of the 27 cases, 23 were of the classical type and 4 of DHF.
Distribution per municipality was: 8 in Tlaquepaque, 4 in
Guadalajara, 4 in Casimiro Castillo, 3 in Zapopan and Tomatlan, 2 in
Puerto Vallarta and one in Tonala, Cihuatlan and Casimiro Castill.

That is, 16 of the new infections (59.2 percent) were concentrated in
municipalities in the ZMG [municipal area of Guadalajara]. But
Salazar Montes said that except for the case of Lomas de Tlaquepaque,
none of the detected infections are related in time and space, and,
therefore, one cannot speak of "outbreaks" of dengue in any of the

In Guadalajara, the cases of the disease [virus] transmitted by the
_Aedes aegypti_ mosquito occurred in the Artesanos and Lagos del
Country, and in Zapopan, in St. Lucia and Nuevo Vergel.

With the 27 new cases in [epidemiological] week 26 -- which was the
highest recorded for a period of 7 days since [epidemiological] week
9 of this year (28 Feb- 6 Mar [2010]), when there were 30 after the
extraordinary rainy period in February 2010 -- the cumulative number
of patients with dengue in Jalisco reached 623 cases (166 percent
more than the 234 recorded in the same period in 2009), which puts
Jalisco in 4th place nationally.

Currently, 48 percent of the [dengue] cases are concentrated in 3
coastal municipalities. These are Puerto Vallarta, Cihuatlan and
Tomatlan, where there are 347 of the 623 patients. Meanwhile, with
115 infected individuals, the SMG reported 18.4 percent of the total.

Leandro Barrios Hernandez, head of Vectors and Zoonoses SSJ [Health
Secretariat of Jalisco], announced that the "small outbreak" of
dengue in Lomas de Tlaquepaque now was treated this past weekend and
that fogging and spraying has been undertaken in homes where infected
patients are living, with the placement of abate [larvicide] for 9
blocks around them.

It is expected that the health problem in this area will be
controlled, and next week, we will work on preventive action in the
neighborhoods of Coronillia, Crucero de Guadeloupe and Tulipanes
(Zapopan), in Azucena (El Salto), in the township of Tlajomulco, El
Vergel and Las Juntitas (Tlaquepaque), and in Hermosa Provincia,
Lagos de Oriente and Providencia (Guadalajara).

Both officials agreed that "yes, there is concern" that with the
mobility of people following the summer vacation period, the cases
will increase because people travel to places of risk such as the
beaches of Guerrero, Colima and Jalisco.

[Byline: Ignacio Perez Vega]

Communicated by:
HealthMap Alerts via ProMED-mail

[A map of Mexican states showing the location of Jalisco can be
accessed at
. A
HealthMap/ProMED-mail interactive map of Mexico can be accessed at
. - Mod.TY]

[6] Mexico (San Luis Porosi)
Date: Wed 13 Jul 2010
Source: El Sol de San Luis [in Spanish, trans. Corr.SB, edited]

More than 500 outbreaks of dengue have been reported in the Huasteca
region, of which some are of DHF, and 60 are of the classic (type),
while the remainder are [classified as] probable, as the results of
the samples have not been received back from the laboratory. For now,
preventive measures and actions will be taken to combat and control
the mosquito vector.

According to the information provided, it is known that a total of
537 probable cases of dengue are registered in the region up to now
in Health District 5, which covers the municipalities of the northern
Huasteca, with Dr. Margarita Ibarra Villanueva in charge.

The trouble is that with the rains that have occurred and changes in
weather, conditions are favorable for breeding of the mosquito _Aedes
aegypti_, but it is being fought, and moreover, a call to the people
is being made to keep their lots free of weeds and dispose of
containers where water is stored, where the mosquito reproduces.

Of the probable cases, 60 are the classic dengue type, and 4 are DHF,
which are being treated; rapid recuperation is expected for those
patients who respond satisfactorily to treatment. The remaining cases
were discarded, but taking into account the weather conditions, the
following months will be under risk that new cases will appear.

To avoid a health problem in this part of the state, the "clean yard"
program will be strengthened due to the increase in rainfall, for
which is planned strict compliance with abate [larvicide] treatment
and fogging, and maintenance of epidemiological activity.

From this perspective, the promotion of active participation of the
population to collaborate with preventive measures and thereby avoid
the problem of dengue becoming higher than in previous years [is
essential]. It is important for people to acquire a culture of prevention.

Meanwhile, abate treatment and fogging have been strengthened in
areas where outbreaks have occurred, in addition to providing
information to the public on new habits of the mosquitoes, which now
breed even in plant leaves, so it is important for grounds to remain
free of weeds of all kinds.

Communicated by:
HealthMap Alerts via ProMED-mail

[7] Brazil
Date: Fri 9 Jul 2010
Source: Yahoo! Brasil Noticias [in Portuguese, trans. Mod.TY, edited]

In a preliminary epidemiological survey carried out by the Ministry
of Health between 1 Jan-1 May 2010, 737 756 dengue cases were
recorded in Brazil in 2010. This number is 120 percent higher than
for the same period last year [2009], during which 335 265 [dengue]
illnesses were registered. Nearly 80 percent of the cases are
concentrated in 7 states: Acre, Mato Grosso do Sul, Rondonia, Goias,
Mato Grosso, Minas Gerais, and Sao Paulo.

According to the Ministry, preventive actions have been intensified
since 2009 in the regions of the country with increases in incidence,
such as the dispatch of equipment for the application of insecticides
and an increase in medical supplies.

Communicated by:

[A map showing the states of Brazil can be accessed at
. A
HealthMap/ProMED-mail interactive map of Brazil can be accessed at
. - Mod.TY]

[see also:
Dengue/DHF update 2010 (34) 20100715.2368
Dengue/DHF update 2010 (33) 20100713.2342
Dengue/DHF update 2010 (32) 20100705.2240
Dengue/DHF update 2010 (31) 20100701.2196
Dengue/DHF update 2010 (30) 20100627.2152
Dengue/DHF update 2010 (29) 20100622.2085
Dengue/DHF update 2010 (28) 20100618.2043
Dengue/DHF update 2010 (27) 20100616.2009
Chikungunya and dengue - France ex overseas 20100616.2008
Dengue/DHF update 2010 (26) 20100607.1903
Dengue/DHF update 2010 (24) 20100524.1722
Dengue/DHF update 2010 (23) 20100517.1620
Dengue/DHF update 2010 (22) 20100510.1528
Dengue update 2010 (21) 20100503.1439
Dengue/DHF update 2010 (20) 20100426.1347
Dengue/DHF update 2010 (19) 20100420.1279
Dengue/DHF update 2010 (18) 20100412.1190
Dengue/DHF update 2010 (17) 20100405.1094
Dengue/DHF update 2010 (16) 20100329.0982
Dengue/DHF update 2010 (15) 20100323.0922
Dengue/DHF update 2010 (14) 20100322.0910
Dengue/DHF update 2010 (13) 20100316.0840
Dengue/DHF update 2010 (12) 20100315.0835
Dengue/DHF update 2010 (11) 20100308.0753
Dengue/DHF update 2010 (10) 20100304.0707
Dengue/DHF update 2010 (09) 20100302.0685
Dengue/DHF update 2010 (08) 20100222.0597
Dengue/DHF update 2010 (07) 20100216.0537
Dengue/DHF update 2010 (06) 20100208.0426
Dengue/DHF update 2010 (05) 20100201.0346
Dengue/DHF update 2010 (04) 20100125.0277
Dengue/DHF update 2010 (03) 20100119.0211
Dengue/DHF update 2010 (02) 20100111.0131
Dengue/DHF update 2010 (01) 20100104.0038]

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