An outbreak of dengue fever in the Philippines has been declared a national

epidemic after causing hundreds of deaths this year in the wake of a government
ban on the vaccine.

The country has recorded 146,062 cases of dengue from January through to 20
July this year, 98% more than the same period in 2018, the department of health
said. The outbreak has already claimed the lives of 622 people. The group worst
affected have been children below the age of 10.

Dengue, a mosquito-borne viral infection found in tropical countries worldwide,

can lead to haemorrhaging and organ failure in severe cases and there is no
specific treatment for the illness.

The outbreak follows a nationwide ban on the sale and distribution of the
Dengvaxia vaccine, a dengue vaccine made by French pharmaceutical firm Sanofi
Pasteur, in February. The company had been at the heart of a scandal in the
Philippines in late 2017 and 2018, when dozens of children given the vaccine as
part of a nationwide immunisation programme died. The firm conceded that the
product could put some children at higher risk.

Dengvaxia is currently the only dengue vaccination available on the market, but
the World Health Organisation recommends that it should only be given to those
in high risk areas who have already been exposed to the virus. It is rarely used in
mass immunisation projects.

The government suspended all dengue vaccination programmes last year and set
up an investigation into Dengvaxia. Sanofi Pasteur was found by the Food and
Drug Administration (FDA) to have shown “complete disregard of government
rules and regulations” and in February the government decided to ban the
vaccine.

However, the nationwide panic and widespread mistrust of vaccinations caused

by the Dengvaxia scandal led immunisation rates for both dengue and measles to
plummet in the Philippines, resulting in an ongoing measles epidemic across the
country and now a dengue epidemic. There have already been more than 35,000
recorded cases of measles and almost 500 deaths, a 600 per cent increase on last
year.

To fight the dengue outbreak, the department of health said that it was
conducting a campaign to focus on finding and destroying mosquito breeding
sites, while also issuing guidelines for people to wear insect repellant and wear
clothes that cover the skin.
Health minister Francisco Duque said the government was studying an appeal to
allow Dengvaxia back in the Philippine market, but ruled out using the drug to
combat the ongoing epidemic which has hit small children the hardest.

“This vaccine does not squarely address the most vulnerable group which is the 5-
9 years of age,” Duque said. The vaccine, now licensed in 20 countries according
to the World Health Organization, is approved for use for those aged nine and
older.

Duque said the United Nations agency also advised Manila that the vaccine was
“not recommended” as a response to an outbreak, adding that it was “not cost-
effective” with one dose costing a thousand pesos ($20).

Other south-east Asian countries have also reported an surge in dengue cases this
year, according to the UN’s World Health Organisation.

The organisation said Malaysia had registered 62,421 cases through to 29 June,
including 93 deaths, compared with 32,425 cases with 53 deaths for the same
period last year. Vietnam over the same period had 81,132 cases with four deaths
reported, compared with 26,201 cases including six deaths in 2018.

In south Asia, Bangladesh has been facing its worst-ever dengue fever outbreak,
putting a severe strain on the country’s already overwhelmed medical system.

https://www.theguardian.com/world/2019/aug/07/philippines-declares-epidemic-after-dengue-fever-
kills-more-than-600

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Dengue is a mosquito-borne viral disease that has rapidly spread in all regions of WHO
in recent years. Dengue virus is transmitted by female mosquitoes mainly of the
species Aedes aegypti and, to a lesser extent, Ae. albopictus. This mosquito also
transmits chikungunya, yellow fever and Zika infection. Dengue is widespread
throughout the tropics, with local variations in risk influenced by rainfall, temperature
and unplanned rapid urbanization.

Severe dengue was first recognized in the 1950s during dengue epidemics in the
Philippines and Thailand. Today, severe dengue affects most Asian and Latin American
countries and has become a leading cause of hospitalization and death among children
and adults in these regions.

Dengue is caused by a virus of the Flaviviridae family and there are 4 distinct, but
closely related, serotypes of the virus that cause dengue (DEN-1, DEN-2, DEN-3 and
DEN-4). Recovery from infection by one provides lifelong immunity against that
particular serotype. However, cross-immunity to the other serotypes after recovery is
only partial and temporary. Subsequent infections (secondary infection) by other
serotypes increase the risk of developing severe dengue.

Global burden of dengue

The incidence of dengue has grown dramatically around the world in recent decades. A
vast majority of cases are asymptomatic and hence the actual numbers of dengue
cases are underreported and many cases are misclassified. One estimate indicates 390
million dengue infections per year (95% credible interval 284–528 million), of which 96
million (67–136 million) manifest clinically (with any severity of disease).1 Another study,
of the prevalence of dengue, estimates that 3.9 billion people, in 128 countries, are at
risk of infection with dengue viruses.2

Member States in three WHO regions regularly report the annual number of cases. The
number of cases reported increased from 2.2 million in 2010 to over 3.34 million in
2016. Although the full global burden of the disease is uncertain, the initiation of
activities to record all dengue cases partly explains the sharp increase in the number of
cases reported in recent years.

Other features of the disease include its epidemiological patterns, including hyper-
endemicity of multiple dengue virus serotypes in many countries and the alarming
impact on both human health and the global and national economies. Dengue virus is
transported from one place to another by infected travelers.

Distribution trends

Before 1970, only 9 countries had experienced severe dengue epidemics. The disease
is now endemic in more than 100 countries in the WHO regions of Africa, the Americas,
the Eastern Mediterranean, South-East Asia and the Western Pacific. The America,
South-East Asia and Western Pacific regions are the most seriously affected.
Cases across the Americas, South-East Asia and Western Pacific exceeded 1.2 million
in 2008 and over 3.34 million in 2016 (based on official data submitted by Member
States). Recently the number of reported cases has continued to increase. In 2015,
2.35 million cases of dengue were reported in the Americas alone, of which 10 200
cases were diagnosed as severe dengue causing 1181 deaths.

Not only is the number of cases increasing as the disease spreads to new areas, but
explosive outbreaks are occurring. The threat of a possible outbreak of dengue fever
now exists in Europe as local transmission was reported for the first time in France and
Croatia in 2010 and imported cases were detected in 3 other European countries. In
2012, an outbreak of dengue on the Madeira islands of Portugal resulted in over 2 000
cases and imported cases were detected in mainland Portugal and 10 other countries in
Europe. Among travellers returning from low- and middle-income countries, dengue is
the second most diagnosed cause of fever after malaria.

In 2015, Delhi, India, recorded its worst outbreak since 2006 with over 15 000 cases.
The Island of Hawaii, United States of America, was affected by an outbreak with 181
cases reported in 2015 and ongoing transmission in 2016. The Pacific island countries
of Fiji, Tonga and French Polynesia have continued to record cases.

The year 2016 was characterized by large dengue outbreaks worldwide. The Region of
the Americas region reported more than 2.38 million cases in 2016, where Brazil alone
contributed slightly less than 1.5 million cases, approximately 3 times higher than in
2014. 1032 dengue deaths were also reported in the region. The Western Pacific
Region reported more than 375 000 suspected cases of dengue in 2016, of which the
Philippines reported 176 411 and Malaysia 100 028 cases, representing a similar
burden to the previous year for both countries. The Solomon Islands declared an
outbreak with more than 7000 suspected. In the African Region, Burkina Faso reported
a localized outbreak of dengue with 1061 probable cases.

In 2017, a significant reduction was reported in the number of dengue cases in the
Americas - from 2 177 171 cases in 2016 to 584 263 cases in 2017. This represents a
reduction of 73%. Panama, Peru and Aruba were the only countries that registered an
increase in cases during 2017. Similarly, a 53% reduction in severe dengue cases was
also recorded during 2017. The post Zika outbreak period (after 2016) has seen a
decline of cases of dengue and the exact factors leading to this fall decrease is still
unknown. WHO’s Western Pacific Region has reported dengue outbreaks in several
countries in the Pacific, as well as the circulation of DENV-1 and DENV-2 serotypes.

After a drop in the number of cases in 2017-18, sharp increase in cases is being
observed in 2019. In the Western Pacific region, increase in cases have been observed
in Australia, Cambodia, China, Lao PDR, Malaysia, Philippines, Singapore, Vietnam
while Den- 2 was reported in New Caledonia and Den-1 in French Polynesia. Dengue
outbreaks have also been reported in Congo, Côte d’Ivoire, Tanzania in the African
region; Several countries of the American region has also observed an increase in the
number of cases.An estimated 500 000 people with severe dengue require
hospitalization each year, and with an estimated 2.5% case fatality, annually. However,
many countries have reduced the case fatality rate to less than 1% and globally, 28%
decline in case fatality have been recorded between 2010 and 2016 with significant
improvement in case management through capacity building at country level.

https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue

who 2019

LOILO CITY – The Department of Health-Center for Health Development in Region 6 (DOH-CHD 6)
with the concurrence of Health Secretary Francisco T. Duque III, on Monday declared a dengue
outbreak in Western Visayas, except for Negros Occidental, which will be placed on alert status.

In a video conference at the DOH-CHD 6 office here, the agency's head, Regional Director Marlyn
Convocar, received a go signal from Duque after he was apprised of the region’s dengue situation.

DOH data showed that Iloilo, Capiz, Aklan, and Guimaras already declared an outbreak while
Antique has expanded the scope of the declaration of its state of calamity to ill-effects of dengue
from just the El Niño phenomenon.

In giving his approval, Duque also commended DOH-6 and local officials for their three timely
interventions that include the declaration of the epidemic, management of cases in hospitals and for
rural health units to serve as hydration centers or stations.

DOH regional data showed that from January to July 6, 2019, Western Visayas had 15,746 cases
and 87 deaths. The average increase was computed at 236 percent when compared with 4,684 and
40 deaths for the same period last year.

Among four provinces in Western Visayas, Guimaras recorded the highest increase at 1,030 percent
while the highest case fatality rate (CFR) is in Aklan, Negros Occidental and Bacolod City at 0.7
percent. CFR is computed as total number of death over the total number of cases.

National data covering the January 1 to June 29, 2019 period showed Western Visayas as having
the most number of cases among 17 regions with 13, 164 cases and 60 deaths; followed by Region
4–A with 11,474 and 46 deaths; Region 7 with 9,199 cases and 60 deaths and Region 12 with 9,107
cases and 41 deaths.

During the video conference, Duque committed 18,375 NS1 dengue test kits to be delivered to
Western Visayas as soon as possible. Convocar said the region has been doing emergency
purchases but the supply is still not enough.

Following the declaration of the outbreak, the secretary also gave his go signal to delay the
implementation of the school-based immunization (SBI) by two months to allow health workers to
focus their attention on the dengue issue. The SBI is scheduled from July to September.

“Instead of September, we will have to wait until end of November to be able to achieve our target of
95 percent herd immunity in Region 6,” Duque said.

Moreover, a moratorium on the conduct of trainings will be implemented to allow DOH to focus on
“reversing the epidemic and alert thresholds or trends in your region,” he said.

Personnel of rural health units (RHUs) will also be deployed at hospitals to augment the latter’s
workforce. They will include 24 medical technologists, 16 doctors, and 189 nurses.

Duque reminded the regional office, however, to make sure that there are enough personnel left in
RHUs to monitor efficient and effective operation of hydration stations.

Convocar assured that some 500 personnel are left to man various RHUs.

Meanwhile, Convocar appealed to the public to do their share of curbing dengue cases by
intensifying the practice of the "4S" strategy.

She said that focus of the cleanup should be done at the household level by making sure that there
are no breeding grounds for dengue-carrying mosquitoes. “This is where we have to start now; in our
homes," she said.

Meanwhile, to protect children, it is recommended that they wear high-knee socks, wear jogging
pants or use mosquito repellant lotion.

Dengue vectors are day-biting mosquitoes, from 6 to 8 in the morning and 4 to 6 in the afternoon.
They prefer to stay in dark and cold places and are more likely to bite those who are wearing dark
colors.

“The status of our affected children is one to 10 years old. Sixty-two percent of children in this age
bracket who were affected by dengue died,” she said.

Convocar recommended that suspected cases be referred to RHUs if they have fever for one to two
days, for testing.

“We should not be complacent if the fever subsides on the third day because it doesn’t mean that
he/she is okay. Possibly there is complication and that’s what we should watch out for,” she said.

Fogging is selective, and only when there is clustering of cases and deaths, she added.
Convocar emphasized that each one has an obligation to help address dengue. She said that if
everyone does her/his share, then dengue can be stopped.

She warned that if there will be no cooperation among the residents, there would be more cases in
the next three months.

Western Visayas experienced a spike in dengue cases in 2010, 2013 and 2016. In 2010, dengue
cases for the whole year reached 27,264 with 137 deaths; 22,392 with 69 deaths in 2013; and
26,440 cases and 88 deaths in 2016.

However, this is the first time that an outbreak was declared in Western Visayas. (PNA)

https://www.pna.gov.ph/articles/1074974

DOH declares dengue outbreak in Western Visayas

By Perla Lena July 15, 2019, 7:54 pm

MANILA, Philippines – The Department of Health (DOH) on Tuesday, August 6,

declared a national dengue epidemic as cases of the mosquito-borne disease continued
to rise in the country.

According to the DOH, 622 people have died due to dengue as of July 20 this year.
These deaths came from the 146,062 dengue cases from January to July – a number
98% higher than the recorded incidence during the same period last year.

Health secretary Francisco Duque III said that declaring a national epidemic is important
“to identify where a localized response is needed and to enable local government units
to use their Quick Response Fund to address the epidemic situation.”

Based on DOH data, Western Visayas had the highest number of cases, with 23,330 for
the first 7 months of the year. This is followed by Calabarzon with 16,515, Zamboanga
Peninsula with 12,317, Northern Mindanao with 11,455, and Soccsksargen with 11,083.

Two other regions have breached the epidemic threshold: Bicol region, which has had
3,470 cases in the last 3 weeks, and Eastern Visayas with 7,199 cases.

The DOH in July had declared a national dengue alert, but the status was raised to
epidemic to "level up the response" against the viral disease.

‘Deng-get out’
The health department on the same day launched the “Sabayang 4-o’clock Habit para
Deng-Get Out,” which will focus on the destruction of mosquito breeding sites. The DOH
said that it would release checklists and guidelines to local government units, schools,
and hospitals to ensure that they make the activity a habit.

https://www.rappler.com/nation/237196-doh-declares-national-dengue-epidemic-august-2019

Dengue Fever: An Emerging Disease in Oman Requiring Urgent

Public
Health Interventions
Salah T. Al Awaidy1,* and Faryal Khamis2

Author information Article notes Copyright and License information Disclaimer

Dengue, the most widespread mosquito-borne viral infection in humans, is an emerging public
health problem in countries of the Eastern Mediterranean region threatening national, regional,
and global health security.1,2 The disease is endemic in more than 128 countries in the African,
Americas, Eastern Mediterranean, Southeast Asian, and the Western Pacific regions3,4 with
estimates of 390 million cases representing 17% of the global burden of infectious diseases in
2013.5
Outbreaks and sporadic cases of dengue, dengue-like disease, and dengue hemorrhagic fever
(DHF) have been reported across the Eastern Mediterranean region, from Pakistan, Saudi Arabia,
Yemen, Somalia, Sudan, Djibouti, and Oman (travel-related).6-9
Dengue fever (DF) is a self-limiting illness with clinical manifestations evoking a common viral
illness. However, a few patients will develop DHF, which is a serious and potentially life-
threatening disease.2 Aedes aegypti is the primary vector transmitting the dengue virus and three
other viruses causing yellow fever, chikungunya, and Zika fever.2,10
In Oman, DF and DHF are notifiable diseases.8 Between 2001 and 2017, 173 cases were
reported, and all were travel-related.8,9 Between 2013 and 2017, the annual notification rate of
dengue exhibited an upward trend from 0.3 to 1 per 100 000 population, and the case fatality rate
was 0.01%.8 Cases were mainly reported from the Muscat (9.6/100 000), Dhofar (2.4/100 000),
and North Batinah (2/100 000) governorates. Ninety-five percent of cases were foreign-born
adults from India, Sri Lanka, Pakistan, and other Asian nationalities. Only two indigenous cases
of DF were reported both from the Dhofar governorate; a suspected case in 2004 (personal
communication) and a confirmed case in 2009.8,11
In 2006, a one-year entomological survey was conducted in the Muscat governorate.
Three Aedes species were discovered (A. arabiensis, A. granti, and A. vittatus), but the vector of
dengue, A. aegypti, was not found. However, in December of 2018, entomological surveys
yielded the vector A. aegypti in A´Seeb, Busher, and Muttrah in the Muscat governorate.
A similar survey was conducted in the Dhofar governorate in 2008, 2010, and 2012 and A.
aegypti was captured in Sarfet, Deem, and Dhalqut with 10% of households positive for
breeding. Other species found were A. vittatus and A. arabiensis.8,12 The vector breeding was
continuously observed from July to August.
In 2018, a total of 67 DF cases were notified, of which 30 cases (44.8%) were travel-related.
None developed DHF, and no mortality was recorded. Between 12 November 2018 and 6
January 2019, 40 indigenous DF cases were reported13 and confirmed by using the
immunoglobulin M antibody-capture enzyme-linked immunosorbent assay (MAC-ELISA) or the
polymerase chain reaction. During the same period, 14 cases were admitted to our hospital, 64%
were male. The patients mean age was 43.4 years. Nine out of 14 cases were Omani, and five
(35.7%) were foreign-born persons residing in Oman. All except one had no recent travel history
to countries in which dengue was endemic (within 30 days of disease onset). All cases were
residing in A´Seeb namely Al Hail and Al Mawaleh. All patients presented with fever, myalgia,
and thrombocytopenia (mean platelet count was 46). Patients had dengue virus serotype 2.
Since 2008, A. aegypti and A. albopictus have been documented in some areas of Oman;
however, autochthonous transmission of dengue has not been widely reported. Between
November 2018 and January 2019, DF was reported in individuals without a recent history of
travel to dengue-endemic countries, suggesting the occurrence of autochthonous transmission
and the first ever outbreak of indigenous dengue transmission. The first case was reported on 25
November 2018 in an Omani patient with no travel history from A´Seeb and the rest of the cases
started to cluster on 9 December 2018. The first case could be an index case exposed to
mosquitoes infected from an asymptomatic viremic traveler residing in the same area.
In a tropical area such as Muscat, from November to February, the temperature ranges between
24–28 °C, which is the ideal temperature for A. aegypti breeding.14 The mosquito often circulates
when vector control measures are poor facilitating imported dengue viruses to infect vector
populations during permissive climatic conditions.
The main factors contributing to the current outbreak were poor vector control interventions
(including routine monitoring of key entomological indicators and qualitative monitoring of
vector control operations), weak entomological surveillance systems, inadequately trained
personnel, funding gaps for the prevention and control of vectors, and a lack of multidisciplinary
and intersectoral collaboration.
Other contributing factors include certain local practices (e.g., man-made habitats that promote
the growth of mosquitoes), an unprecedented increase in travel of foreign-born and Omani
population by air, and import of goods (e.g., tyres, containers, plants) from dengue-endemic
countries.14
Vector control remains the key strategy in prevention and control. Therefore, preventing dengue
virus transmission depends entirely on controlling the vectors or interruption of human-vector
contact. Given the imminent current outbreak in Oman, there is an urgent need to step-up an
efficient entomological surveillance system guiding the program on vector control interventions.
Control of dengue also requires a sustained national commitment, concerted actions by
multidisciplinary and intersectoral collaborations from civil society and communities, the
capability for rapid and effective outbreak investigation at all levels, and sound technical support
at the local level to channel resources effectively.
Strategies for vector control should focus on source reduction of the urban habitats of competent
vectors and careful environment management to deprive the A. aegypti of stagnant water for
breeding.
Vector-borne diseases contribute to lost productivity, school absenteeism, social stigma, high
healthcare costs, and overburdened public health services.15 Oman's Ministry of Health should
aim to reduce mortality and morbidity from dengue to zero through an active vector control
program that focuses on functional surveillance, preparedness, and adopting the World Health
Organization Integrated Vector Management approach.15 Additionally, a strong seaport
monitoring system for goods that could potentiate entrance of the vector should be established.
Festivals occur annually in Muscat in January, and Dhofar during July and August; the period
where the temperature is ideal for A. aegypti breeding and dengue virus transmission.
Henceforth, comprehensive strategies should be in place to prevent the disease in these areas.
Without all these critical elements in place, most prevention and control efforts will have limited
success.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6425053/

Background

The worldwide distribution of dengue is expanding, in part due to globalized traffic and trade. Aedes albopictus is a
competent vector for dengue viruses (DENV) and is now established in numerous regions of Europe. Viremic
travellers arriving in Europe from dengue-affected areas of the world can become catalysts of local outbreaks in
Europe. Local dengue transmission in Europe is extremely rare, and the last outbreak occurred in 1927–28 in
Greece. However, autochthonous transmission was reported from France in September 2010, and from Croatia
between August and October 2010.

Methodology

We compiled data on areas affected by dengue in 2010 from web resources and surveillance reports, and collected
national dengue importation data. We developed a hierarchical regression model to quantify the relationship
between the number of reported dengue cases imported into Europe and the volume of airline travellers arriving
from dengue-affected areas internationally.

Principal Findings

In 2010, over 5.8 million airline travellers entered Europe from dengue-affected areas worldwide, of which 703,396
arrived at 36 airports situated in areas where Ae. albopictus has been recorded. The adjusted incidence rate ratio for
imported dengue into European countries was 1.09 (95% CI: 1.01–1.17) for every increase of 10,000 travellers; in
August, September, and October the rate ratios were 1.70 (95%CI: 1.23–2.35), 1.46 (95%CI: 1.02–2.10), and 1.35
(95%CI: 1.01–1.81), respectively. Two Italian cities where the vector is present received over 50% of all travellers
from dengue-affected areas, yet with the continuing vector expansion more cities will be implicated in the future. In
fact, 38% more travellers arrived in 2013 into those parts of Europe where Ae. albopictus has recently been
introduced, compared to 2010.
 Conclusions

The highest risk of dengue importation in 2010 was restricted to three months and can be ranked according to
arriving traveller volume from dengue-affected areas into cities where the vector is present. The presence of the
vector is a necessary, but not sufficient, prerequisite for DENV onward transmission, which depends on a number of
additional factors. However, our empirical model can provide spatio-temporal elements to public health
interventions.

Author Summary
The global disease burden of dengue is staggering. Continuous expansion and vaccine failures illustrate the
limitations of current dengue control efforts. Novel approaches and additional tools are required to combat and
contain the disease. In Europe, dengue infections are rare and the last outbreak of dengue occurred in the late 1920s,
in Greece. In 2010, however, local transmission occurred in France and Croatia. Based on 2010 data, we present a
novel quantitative model of the risk of dengue importation for Europe. The 2010 model predicts the risk of dengue
importation to be greatest for Milan, Rome and Barcelona in August, September and October, precisely when vector
activity is the highest. With the current expansion of the vector in Europe, more cities are projected to be at risk in
the future. Thus, the model based on 2010 data quantifies the likelihood and timing of importation. This approach
employs global travel data to assess dengue importation risk in the EU and illustrates how quantitative models could
tailor infectious disease control to certain regions and time periods.

https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003278

 Jan C. Semenza ,
 Bertrand Sudre,
 Jennifer Miniota,
 Massimiliano Rossi,
 Wei Hu,
 David Kossowsky,
 Jonathan E. Suk,
 Wim Van Bortel,
 Kamran Kh

 Published: December 4, 2014

 https://doi.org/10.1371/journal.pntd.0003278

On 3 January 2019, the International Health Regulations (IHR) National Focal Point of Jamaica notified
WHO of an increase in dengue cases in Jamaica.

From 1 January though 21 January 2019, 339 suspected and confirmed cases including six deaths were
reported (Figure 1). In 2018, a total of 986 suspected and confirmed cases of dengue including 13 deaths
have been reported. The number of reported dengue cases in 2018 was 4.5 times higher than that reported
in 2017 (215 cases including six deaths). Cases reported to date for 2019 exceed the epidemic threshold
(Figure 2).

According to historic data, Jamaica reported a major outbreak in 2016, when 2297 cases of dengue
infection including two deaths were reported. Dengue virus 3 (DENV3) and DENV4 circulations were
confirmed at the time.

By the end of 2018, the largest number of reported cases were notified by Kingston and Saint Andrew
parishes. In 2019 so far, the largest proportion of cases have been reported by Saint Catherine parish.

Laboratory tests have identified DENV3 as the dengue serotype currently circulating.

In January 2019, some countries and territories in the Caribbean region, such as Guadeloupe, Martinique,
and Saint Martin, reported an increase in dengue cases. Of note, in Saint Martin and Guadeloupe,
serotype DENV1 is currently circulating.

Public health response

 The Ministry of Health (MoH) declared the dengue outbreak on 3 January 2019.

 Health authorities in Jamaica are implementing measures for the following activities; strengthened
integrated vector control, enhanced surveillance of cases, social mobilization, clinical management,
enhanced laboratory diagnostic capacity, and emergency risk communications.

 The MoH has been collaborating with the Pan American Health Organization (PAHO/WHO) and
other international agencies to strengthen and co-ordinate the response activities.

 Since July 2018, the MoH has intensified its vector control activities.

 The MoH launched the Emergency Operations Centre on 27 December 2018; and fully activated it on
3 January 2019 to facilitate the coordination and reporting of activities. The response activities are
geared towards strengthening the response capacity with adequate human resources, as well as
supporting efforts to reduce the entomological indices for the Aedes aegypti mosquito across the
island and enhancing clinical management capacity.

WHO risk assessment

Jamaica has been reporting dengue cases since 1990 and throughout 2018; however, an increase has been
observed since December 2018 exceeding the epidemic threshold. Similar large increases were reported in
2010 (2887 cases), 2012 (4670 cases), and 2016 (2297 cases). The increase of dengue in the Caribbean
islands may result in more severe secondary dengue virus infections and require comprehensive risk
communication.

WHO advice

On 21 November 2018, PAHO/WHO alerted Member States about an increase in dengue cases in
countries and territories in the Americas and recommended coordinated actions both inside and outside
of the health sector, including prioritizing activities to prevent transmission of dengue as well as deaths
due to this disease.

PAHO/WHO further advises to follow the key recommendations regarding outbreak preparedness and
response, case management, laboratory, and integrated vector management as published in the 21
November 2018 PAHO/WHO Epidemiological Update on Dengue, available at the link below.

There is no specific treatment for disease due to dengue; therefore, prevention is the most important step
to reduce the risk of dengue infection. WHO recommends proper and timely case management of dengue
cases. Surveillance should continue to be strengthened within all affected areas and at the national level.
Key public health communication messages should continue to be provided to reduce the risk of
transmission of dengue in the population.

In addition, integrated vector management (IVM) activities should be enhanced to remove potential
breeding sites, reduce vector populations, and minimize individual exposures. This should include both
larval and adult vector control strategies (i.e. environmental management and source reduction, and
chemical control measures), as well as strategies to protect individuals and households. Where indoor
biting occurs, household insecticide aerosol products, mosquito coils, or other insecticide vaporizers may
also reduce biting activity. Household fixtures such as window and door screens and air conditioning can
also reduce biting. Since Aedes mosquitoes (the primary vector for transmission) are day-biting
mosquitoes, personal protective measures such as use of clothing that minimizes skin exposure during
daylight hours is recommended. Repellents may be applied to exposed skin or to clothing. The use of
repellents must be in strict accordance with label instructions. Insecticide-treated mosquito nets afford
good protection for those who sleep during the day (e.g. infants, the bedridden, and night-shift workers)
as well as during the night to prevent mosquito bites.
WHO does not recommend any general travel or trade restrictions be applied based on the information
available for this event.

https://reliefweb.int/report/jamaica/dengue-fever-jamaica-disease-outbreak-news-4-february-2019

https://www.researchgate.net/publication/277923100_A_descriptive_study_on_dengue_fever_reporte
d_in_a_Medical_College_Hospital/link/5abfecaaaca27222c759b7aa/download

https://doi.org/10.1155/2019/3092073