Professional Documents
Culture Documents
Dr Wilson Lam
Division of Infectious Diseases
Department of Medicine QEH
3 June 2003
Dengue fever
Dengue history
The viruses and the vector
Transmission of viruses
Epidemiology
Global
Southeast Asia
Hong Kong
Epidemiological features
DF
DHF/DSS
Incubation
Period:
3-14 days
Susceptible hosts,
(population)
Viraemia & Fever: 5-7 days
Source patients
Transmission of viruses
Extrinsic incubation period
10 to 14 days
Depends on
Ambient temperature
Humidity
Virus strains
WHO 2001
Stratification of DF/DHF in
South-East Asia Region
Category A (Indonesia, Category B (Bangladesh,
Myanmar, Thailand) India, Maldives, Sri Lanka)
Major public health problem DHF is an emergent disease
Leading cause of hospitalization Cyclical epidemics are
and death among children becoming more frequent
Cyclical epidemics in urban
Multiple virus serotypes
centres with 3-5 year periodicity
circulating
Spreading to rural areas
epidemic vector
Aedes aegypti is the
Role of Aedes albopictus is
principal epidemic vector
uncertain Role of Aedes albopictus is
uncertain
DF – Macau
1,502 cases in 2001 mostly indigenous
First 14 cases reported in late August 2001
Last case in December
0
2
4
6
8
Jan 02
Feb 02
Mar 02
Apr 02
Lo
Im
p
cal
orte
d
May 02
Jun 02
Jul 02
Aug 02
Sep 02
DF – Hong Kong 2002
Oct 02
Nov 02
Dec 02
DF – Hong Kong 2002
6
5
No
nMaWan
MaWa
nre
late
d
4
0
15to28 29Jul to 12to25 26Augto 9to22 23Septo
July 11Aug Aug 8Sep Sep 6Oct
Dengue in Hong Kong
From 1994 to 2001, inclusive
Cases: DF (68), DHF (4)
All were imported cases
Peak incidence at September (?return from travel)
2002 (up to 19 October)
20 indigenous cases
all DF, aged 20 to 72 yrs., Male: 13
strains.
DF – Hong Kong 2003
18
16 Lo
cal
14 Im
porte
d
12
10
8
6
4
2
May 03
Feb 03
Jan 03
Apr 03
Mar 03
0
Epidemiological features
Dengue fever (DF)
Dengue haemorrhagic fever (DHF) and
dengue shock syndrome (DSS)
DHF is not DF with haemorrhagic features
DF – epidemiology
Spread
Endemic or epidemic
Travel along transportation routes
Immune status
Highly immune population less reported disease
DF – epidemiology
Severity
Ethnicity
Strain variation
Disease severity and haemorrhagic phenomenon vary
from outbreak to outbreak
Unique serotype or viral strain-specific factors
antigens
DHF/DSS epidemiology
Age
Greatest susceptibility to shock is 8 to 10 years
? Capillaries of of children more prone to cytokine-
mediated increased permeability
Sex
Shock cases and deaths more frequently in female
than in male children
? Immune responses of females more competent
80
39.0 225
60
38.5
150
38.0 40 viraemia
37.5 20 75
37.0 0 0
-4 -3 -2 -1 0 1 2 3 4 5 6
Fever Day
Mean Max. Temperature Virus Dengue IgM
Vaughn et al., J Infect Dis, 1997; 176:322-30.
Virological Diagnosis
Dengue-specific tests
Virusisolation
Serology
HAI
IgM
Immunochromatographic
IgM EIA
Ovitrap
black container, with rough surface, water
placed 1m above the ground, 100m apart
50 traps in an area of 0.5 km2
incubate for 1 week at 25°C
Index
the % of trap showing Aedes albopictus
larva
reflects the extent (but not the density) of
infestation.
Ovitrap in hospital area
Ovitrap index in %
Ovitrap index in Hong Kong
35
30 2
001
25 2
002
20
15
10
5
September
November
December
October
August
0
J uly
Case investigation
confirm diagnosis
travel history
local movement
potential mosquito breeding sites
S/S among travel & local collaterals
medical surveillance of collaterals
Blood Transfusion transmitted DF
Donor: M/17 lives in Ma Wan.
• Date of donation: 17/07/2002 well and
asymptomatic
• attended YCH AED on 24 July, DX: Viral rash
• ? DF during case finding exercise in Ma Wan in
October
• blood tested positive for Dengue
• his serum sample in BTS archive was PCR +ve