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Dengue Fever – French Territory of America – French Guiana, Guadeloupe, Martinique, Saint-Martin and Saint-Barthélemy

 


On 12 February 2020, the European Center for Disease Prevention and Control (ECDC) reported an increase in cases of dengue infection in French Guiana, Guadeloupe, Martinique and Saint-Martin. In January 2020, health authorities in the region declared a dengue epidemic in Guadeloupe and Saint-Martin and indicated that Martinique was also threatening the epidemic.

Dengue epidemics in these territories most commonly occur when there is a shift in the predominant circulating serotype of DENV, and non-immune populations (e.g., tourists, newcomers, or people not previously exposed to circulating serotypes) are exposed to the new serotype through people moving within the territory or through neighboring countries. Local transfer happens via Aedes mosquito vector present on islands and in French Guiana.

French Guiana

Between January 2019 and February 17, 2020, a total of 487 confirmed dengue cases were reported, with no serious cases or death (Figure 1). The communes were the most affected by the Kourou coast with 225 confirmed cases and Maripasoula, in southeastern France, with 55 confirmed cases. Except during 2017 and 2018, dengue cases were recorded each year, with the last largest outage recorded in 2013, resulting in 13,240 suspects, including 6 deaths.

Laboratory tests identified DENV-1 and DENV -2 as the predominant serotypes circulating in 2019 and 2020 (February 17, 2020). So far, in 2020, DENV-2 represented 63% of reported cases.

Figure 1. Distribution of suspected dengue cases per epidemiological week, French Guiana, January 2019 to February 15, 2020.


Source: Le point épidémio, Santé publique France – Cellule Guyane, February 20, 2020 and reproduced by PAHO / WHO

Guadeloupe

From October 14, 2019 to February 16, 2020, a total of 5,840 dengue cases were reported, with no serious cases and deaths. Of these, more than 1,200 were confirmed by antistructural protein 1 (NS1) assay and / or polymer reverse transcription (RT-PCR) chain reaction. Forty-three percent (n = 2,540) of the total number of cases were reported since the beginning of January 2020 (Figure 2).

From January 19 to February 16, 2020, clinically diagnosed cases were reported in 14 out of 24 municipalities by sentinel GPs (out of 32 communes that make up the archipelago). Most cases were reported in the following communities: Basse-Terre, Le Gosier, Le Moule, Petit-Canal, Petit-Bourg, Pointe-Noire, Saint-François and Marie-Galante Island (eastern and central main island). The latest major epidemic recorded in Guadeloupe was in 2013, in which 12,706 cases were suspected, including 8 deaths.

Between 2005 and 2010, the main circulating serotypes were DENV-4 (2005), DENV-2 (2006 and 2007) and DENV-1 (2008 and 2010). In 2019, laboratory tests identified DENV-2 as the predominant dengue serotype, which is currently circulating and has been reported in all affected areas.

Figure 2. Distribution of suspected dengue cases per epidemiological week, Guadeloupe, August 2017 to February 8, 2020.


Source: Le point épidémio, Santé publique France – Cellule Antilles, February 20, 2020 and reproduced by PAHO / WHO

Martinique

From July 2019 to February 16, 2020, 2,470 cases of dengue suspected and 575 cases confirmed by the NS1 antigen test and / or RT-PCR were reported, including two severe cases and one death (Figure 3). Forty-seven percent of suspected cases (n = 1,155) were reported from the beginning of January 2020. From 19 January to 15 February 2020, cases were confirmed in 18 of the 34 municipalities in the island. The hardest hit parts of the island are to the south and central Martinique. The results of laboratory tests indicate that DENV-2 and DENV-3 are the predominant circulating serotypes.

In 2018, no confirmed case was reported by Martinique. The last outbreak reported in Martinique was from 2013 to 2015 with 7,040 suspected cases and no fatalities were reported. The outbreak was due to DENV-1, which was the predominant circulating serotype.

Figure 3. Distribution of suspected dengue cases per epidemiological week, Martinique, August 2017 to February 8, 2020.


Source: Le point épidémio, Santé publique France – Cellule Antilles, February 20, 2020 and reproduced by PAHO / WHO

Saint-Martin

From January 12 to February 16, 2020, a total of 530 cases of suspected dengue were reported, including one serious and fatal case. The results of laboratory testing indicate that DENV-1 and DENV-3 serotypes are currently circulating, and DENV-1 is predominant.

From 2002 to 2005, DENV-3 was the only serotype in traffic. Between 2006 and 2010, the predominant circulating serotypes were DENV-2 (2006, 2009) and DENV-1 (2007, 2008, and 2010) with DENV-3 and DENV-4 co-circulation. In 2013 and 2014, DENV-4 was the predominant serotype.

Saint-Barthélemy

From December 2019 to February 15, 2020, a total of 100 cases of dengue were reported, including 20 cases confirmed by the NS1 antigen test and / or RT-PCR (Figure 4). Laboratory tests identified DENV-1 and DENV-2 as circulating serotypes.

The last outbreak reported in Saint-Barthélemy was from 2013 to 2014 with 970 suspects and one death. The outbreak was due to DENV-4, which was the predominant circulating serotype; with DENV-2 co-circulation. DENV-1 was identified during the 2009/2010 epidemic.

Figure 4. Distribution of suspected dengue cases per epidemiological week, Saint-Barthélemy, August 2017 to February 8, 2020.


Source: Le point épidémio, Santé publique France – Cellule Antilles, February 20, 2020 and reproduced by PAHO / WHO

Public health response

The health authorities of French Guiana, Guadeloupe, Martinique, Saint-Martin and Saint-Barthélemy are implementing the following measures:

  • Strengthening Integrated Vector Management (IVM);
  • Enhanced case monitoring;
  • Updating clinical management guidelines;
  • Social mobilization; and
  • Emergency communications

WHO risk assessment

The Caribbean islands have a tropical climate. There are two main seasons: the wet season from June to November and the dry season from December to May.

French Guiana, Guadeloupe, Martinique, Saint-Martin and Saint-Barthélemy report dengue cases during 2020; however, an increase was observed towards the end of 2019.

In Guadeloupe and Martinique, cases exceeded the seasonal threshold of October and November 2019, respectively.

Changing the dominant DENV serotype in these territories may result in more serious secondary dengue infections and may require comprehensive risk communication. Due to the presence of a competent vector and, given that these areas are popular tourist destinations, the risk of spreading to neighboring islands and other countries cannot be ruled out.

Tip of WHO

In light of the rise in dengue and severe dengue cases in several countries and territories of the US region, especially in 2019, the Pan-African Health Organization / World Health Organization (PAHO / WHO) encourages Member States to follow the key recommendations regarding preparedness and response to the outbreak, case management, laboratory and integrated vector management (IVM). These recommendations were published in a journal November 21, 2018 PAHO / WHO Dengue Epidemiological Notice and the November 11, 2019 PAHO / WHO Epidemiological Update of Dengue .

There is no specific dengue treatment; however, timely case detection, recognition of any warning signs of severe dengue, and proper early case management are key elements of care to prevent dengue deaths. Dengue deaths are often associated with delays in seeking medical care in severe dengue cases.

IVM activities should be further improved to eliminate potential breeding sites, reduce vector populations and minimize individual exposure. This should include strategies for controlling vector larvae and adults (i.e., environmental management and source reduction and chemical control measures). Vector control measures should be implemented in households, workplaces, schools, healthcare facilities and other environments where individuals, families and communities come together to prevent vector and person contact.

Aedes mosquitoes, the vectors in charge, have more activity throughout the day. In view of this, personal protection measures such as the use of clothing that minimize skin exposure and repellents that can be applied to exposed skin or clothing are recommended; the use of repellents must be in strict accordance with the instructions on the label. Window and door screens and mosquito nets (impregnated or non-insecticidal) can be helpful in reducing the contact between vectors and indoors during the day or night. Community-supported source reduction measures should be initiated and vector surveillance and control implemented.

WHO does not recommend the application of any general travel or trade restrictions based on the information available for this event.

For more information:

References

  • L’Azou M, Taurel A-F, Flamand C, Que´nel P (2014) Recent epidemiological trends in dengue in the French territories of America (2000–2012): a systematic review of the literature. PLoS Negl Trop Dis 8 (11): e3235. doi: 10.1371 / journal.pntd.0003235
  • L’Azou M, Jean-Marie J, Bessaud M, et al. Dengue seroprevalence in the French West Indies: a prospective study of adult blood donors. Am J Trop Med Hyg. 2015 92 (6): 1137–1140.
  • Laurence Farraudière, Fabrice Sonor, Said Crico et al. The first detection of dengue and chikungunya in the natural population of Aedes aegypti in Martinique during the simultaneous epidemic of 2013-2015. Revista Panamericana de Salud Pública. 2017. Available here .

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