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International Notes Dengue -- the Americas, 1984

In 1984, dengue activity in the Americas remained at a relatively low level, with 43,435 cases reported from 20 countries (Table 1). Three dengue serotypes (DEN-1, DEN-2, and DEN-4) circulated in the region (Figure 1).

Mexico had the greatest activity, with 27,312 cases reported, and experienced its first cases of severe hemorrhagic disease with dengue-associated fatalities in 1984. Three serotypes were involved, DEN-1 and DEN-2 on the west coast and DEN-1 and DEN-4 in Yucatan. Dengue hemorrhagic fever (DHF) occurred in Puerto Vallarta, Jalisco, and in Merida, Yucatan. The outbreak in Yucatan included 5,390 reported cases and was caused by DEN-4. Nine patients had hemorrhagic disease, and four died. DEN-4 was isolated from one patient who died and from two of the other patients with hemorrhagic fever. Five others were confirmed by IgM-capture enzyme-linked immunosorbent assay and/or hemagglutination-inhibition and complement fixation tests, and one could not be confirmed.

In Central America, Belize, El Salvador, and Honduras each reported dengue activity. DEN-1 virus was isolated from cases during a small outbreak in Belize. In Honduras, both DEN-1 and DEN-2 virus transmission were confirmed, but disease occurrence was only sporadic.

In most of the Caribbean islands, the extent of dengue virus transmission was limited in 1984. DEN-1 and DEN-4 transmission was confirmed in the Dominican Republic, while Haiti had confirmed cases of both DEN-1 and DEN-2. Puerto Rico reported 1,872 clinical cases, but only six were confirmed. In Puerto Rico, DEN-1 and DEN-2 viruses were isolated for the first time since 1982 and 1978, respectively. Three cases of DEN-1 were confirmed in the U.S. Virgin Islands. A large outbreak of DEN-1 occurred in Aruba, the Netherlands Antilles, beginning in December 1984. Two fatal cases of hemorrhagic disease were reported, one of which was confirmed as DEN-1 by virus isolation. Low-level DEN-1, DEN-2, and DEN-4 transmission was confirmed in Trinidad. Other Caribbean islands reported sporadic transmission, but the virus serotypes are not known.

In South America, Colombia confirmed cases of DEN-1 and DEN-4, and Venezuela confirmed cases of DEN-1 and DEN-2. Neither country reported major epidemic activity in 1984. Reported by Pan American Health Organization, Washington, DC; Caribbean Epidemiology Center, Port-of-Spain, Trinidad; Pasteur Institute, Cayenne, French Guiana; Instituto de Salubridad y Enfermedades Tropicales, Mexico City, Mexico; Gorgas Memorial Laboratory, Panama City, Panama; Instituto Nacional de Salud, Bogota, Colombia; Instituto Nacional de Higiene "Rafael Rangel," Caracas, Venezuela; Puerto Rico Dept of Health, San Juan; Dengue Br, Div of Vector-Borne Viral Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Dengue has been endemic in the Americas for over 200 years. Recently, the disease appears to be following a pattern similar to that in Southeast Asia 30 years ago, where many countries began to report increased occurrence of sporadic cases of DHF in association with increased incidence of dengue infection. This was followed by major epidemics of the disease in Southeast Asia, and today, DHF is one of the leading causes of hospitalization and death among children in many countries of that region. A similar sequence of events appears to be occurring in the Americas in the 1980s. For example, Cuba, where no dengue had been reported for 30 years, experienced a DEN-1 epidemic in 1977, followed in 1981 by a major DHF epidemic caused by DEN-2, with 158 fatalities. In 1978, Mexico reported its first cases of dengue in many years, and within 6 years, the disease became endemic in most coastal areas of the country. In 1984 the first DHF cases associated with epidemic dengue were reported.

Other countries in the region have also reported increased occurrence of sporadic cases of DHF. This sequence of events, plus the fact that all four serotypes are now endemic in the region, suggest that Caribbean Basin countries are at risk for outbreaks of DHF and underscore the need for more effective surveillance that will facilitate prevention and control of the disease.

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