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Dengue in Bahamas and Maldives

19 Aug 2011

The Bahamas, a popular tourist destination, is currently experiencing a severe outbreak affecting mainly New Providence, the most populated island in the archipelago with Nassau as national capital. Media quoting the health authorities are reporting that so far in 2011 there have been around 2 000 confirmed cases, with the first case confirmed in late Ma ch and a rapid increase in the last two months; several suspected cases have been reported recently every day. Dengue is not considered to be a common infection in the Bahamas, as limited outbreaks (150-300 cases) were only reported in 1998 and in 2003 over the last 15 years. The national health authorities are implementing control measures and published a public notice on the web. WHO and the Caribbean Epidemiological Center (CAREC) are supporting the national health authorities, mainly in education and information campaigns. As dengue is increasing in general in the area, CAREC this month issued an official public health alert for the region.
The Bahamas is an important destination for tourism, with about five million visitors each year, mostly from the US. The country is also a relevant destination for European tourists. The US embassy in Nassau released this month an emergency message to aware US citizens about the current situation.

In another popular tourist destination, the Maldives, a significant increase in the number of dengue cases has been reported since the beginning of the year. The WHO Country Office for Maldives reports more than 1 600 cases from 44 out of the 200 inhabited islands, while media reports refer to the occurrence of around 2 000 cases and nine deaths. A recent publication from the International Federation of the Red Cross and Red Crescent Societies (IFRC) indicates that the capital Malé and the Hulhumalé island are the most affected; 28% of all cases are in children under five years of age, and 19% of all cases are considered as severe dengue. With the ongoing rainy season a further increase of cases can be expected. For the year 2010, 920 dengue cases including two deaths were reported from Maldives. However, the most recent severe dengue outbreak occurred in 2006, when 2 768 cases were reported, with 10 fatalities.
Maldives is a very important destination for European tourists: in 2009, almost 400 000 tourists arrived from the EU, representing 60% of all tourist arrivals. Moreover, over a third of these EU tourists came from Italy and France, both Member States where the mosquito Aedes albopictus, a potential vector for dengue transmission, is established. In 2010, two autochthonous cases of dengue were reported in France, possibly following the introduction of the virus through a viraemic returning traveller.

Dengue is a mosquito-borne infection in humans, transmitted by Aedes mosquitoes that breed in the peridomestic environment, and are active during daytime. Up to 40–80% of all dengue infections are asymptomatic. Commonly reported clinical symptoms, after an incubation of 1–12 days (average of 3–7 days), include sudden onset of high fever, severe headache and retro-orbital pain (pain behind the eyes), myalgia (muscle pain), arthralgia (joint pain), a maculo-papular rash (small red spots on the skin) and minor haemorrhage. A portion of cases, usually less than 5%, can be severe and a fraction of these may be fatal. Most severe cases and fatalities occur among children and adolescents.

ECDC would like to raise public awareness regarding the ongoing outbreaks in these and other touristic locations and to emphasise the importance of taking appropriate precautionary measures for persons visiting the islands. Prevention of dengue is based on individual protection against mosquito bites, e.g. wearing long-sleeved shirts, tucking trousers into socks, applying insect repellent, etc. Visitors returning from endemic areas who develop symptoms as described below in the two weeks following their return should seek medical attention, indicating their recent travel.

Read more
Dengue fever ECDC health topic site
NaTHNac Insect and Tick Bite Avoidance

PAHO dengue
CAREC dengue Alert August 2011
Bahamas, tourism data
Bahamas, MoH dengue public notice
International Federation of the Red Cross and Red Crescent Societies. Maldives Dengue Outbreak update, 2 August 2011
Ministry of Tourism, Arts and Culture – Republic of Maldives. Tourism year book 2010
WHO Country Office for Maldives. WHO supports country’s fight against Dengue
WHO SEARO Situation update of dengue in the SEA Region, 2010

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