Dengue Update: Puerto Rico, Florida & The Americas

 

# 6702

 

While not reaching the levels we saw during their 2010 Dengue epidemic, Puerto Rico is once again seeing epidemic levels of the mosquito-borne virus, as evidenced by this latest chart from the CDC.  

 

As indicated by the red line, the number of cases over the past couple of weeks has been climbing like a homesick angel. 

 

Health Secretary Lorenzo Gonzalez of the Puerto Rico Health Department declared a Dengue epidemic on the island (PDF Link – in Spanish) in early October after six people died or the disease, two of them children.

 

This week, Florida also reported its third locally acquired Dengue case (see Another Central Florida dengue case confirmed) of 2012. This latest case was identified in Osceola County, and a fourth suspected case is being investigated.

 

While once a serious problem in Florida, through aggressive mosquito control efforts during the 1940s Dengue and Malaria were both eliminated from the Sunshine State – and remained so for nearly a half century.

 

In 2009 – for the first time in more than 50 years – we started to see a small number of locally acquired Dengue cases showing up in Key West (see MMWR: Dengue Fever In Key West), and in 2010 they totaled 65 cases in Key West and 1 each in Broward and Miami-Dade County.

 

The number of cases dropped in 2011, and have been low once again in 2012.

 

The concern is - with millions of visitors arriving each year, many from regions where these diseases are endemic – there are plenty of opportunities to re-introduce the virus.

 

The CDC’s MMWR in a report in May of 2010 on Locally Acquired Dengue in Key West, had this to say:

 

Cases of dengue in returning U.S. travelers have increased steadily during the past 20 years (8). Dengue is now the leading cause of acute febrile illness in U.S. travelers returning from the Caribbean, South America, and Asia (9).

 

Many of these travelers are still viremic upon return to the United States and potentially capable of introducing dengue virus into a community with competent mosquito vectors.

 

In truth, it may take many such introductions of Dengue or Malaria to an area before the right combination of weather, insect vectors, and ongoing transmission occur to enable it to get a foothold in a community.

 

But Florida’s latest Arbovirus Surveillance report lists more than 90 cases of Imported Dengue this year:

 

Ninety-four cases of dengue with onset in 2012 have been reported in individuals with travel history to a dengue endemic country in the two weeks prior to onset. Countries of origin were Brazil, Colombia, Cuba (21), Dominican Republic (9), Ecuador (4), El Salvador (2), Ghana, Guyana (2), Haiti (14), Honduras, India, Jamaica (17), Mexico (2), Nicaragua, Panama, Philippines, Puerto Rico (6), South Africa, Sri Lanka, St. Vincent, Suriname, Trinidad (4), and Turks & Caicos.

Counties reporting cases were Brevard (3), Broward (17), Collier, Duval (2), Hillsborough (4), Lee (2), Marion, Miami-Dade (36), Orange (12), Palm Beach (6), Pinellas (2), Polk, Sarasota (2), Seminole (3), and Volusia (2). Nine of the cases were reported in non-Florida residents.

 

The state has also reported more than 50 cases of Imported Malaria, although no locally acquired cases have been reported.

 

Fifty-three imported cases of malaria with onset in 2012 have been reported.  Countries of origin were: Afghanistan (2), Cameroon, Central African Republic, Colombia, Costa Rica, Ethiopia, Ghana (5), Guyana (2), Haiti (9), Honduras (3), India, Ivory Coast (3), Kenya, Liberia (2), Nigeria (8), Pakistan, Peru, Sierra Leone (2), South Africa, Sub Saharan Africa, Sudan, Togo, Uganda, Zambia, and multiple African countries (2).

Counties reporting cases were: Alachua, Brevard, Broward (8), Charlotte, Duval (6), Hillsborough (6), Lake (2), Leon, Manatee, Marion, Martin, Miami-Dade (7), Orange (5), Osceola (2), Palm Beach (4), Pinellas (3), Polk, Seminole, and Volusia. Five of the cases were reported in non-Florida residents.

 

A broader perspective comes from PAHO, who's Oct 31st update shows nearly 1 million cases of Dengue in the Americas this year.

 

An interactive map view of Dengue activity in the Americas, and around the world, can be seen via the CDC-Healthmap collaborative DengueMap.

 

 

Although the overall risk of contracting a mosquito-borne illness in Florida or Puerto Rico remains very small, reports of Dengue (along with West Nile, EEE, SLEV, and other rare arboviral threats) are reason enough that health departments continue to urge people to remember to follow the `5 D’s’:

 

»» Read More

Central Florida Man Diagnosed With Dengue

# 6680

 

 

A Seminole county man, aged 19, has been diagnosed with what is believed to be locally acquired Dengue, according to a press release today from the Orange County Health Department.

 

HEALTH HEALTH ADVISORY – DEPARTMENTS  INVESTIGATING LOCALLY ACQUIRED DENGUE FEVER CASE

Tuesday, October 30, 2012 -

ORLANDO – The Seminole and Orange County Health Departments are investigating a locally acquired case of dengue fever near the Seminole and Orange County line by the University of Central Florida. The 19 year old Seminole County man was diagnosed with dengue fever based on symptoms and confirmed by laboratory tests. The individual is recovering from this illness.

 

Dengue fever is a viral disease transmitted by a type of mosquito common to the southeastern United States and the tropics. It is not spread from person to person. Mosquitoes usually bite at dusk and dawn, but the mosquitoes that carry dengue bite during the day as well – especially indoors, in shady areas, or when the weather is cloudy.

 

Though some people may experience little to no symptoms; the most commons symptoms of dengue include high fever (over 101 degrees Fahrenheit), severe headache, severe pain behind the eyes, muscle, joint and bone pain, rash, loss of appetite, nausea and vomiting. There is no specific medication or vaccine for dengue fever. If you are experiencing symptoms consistent with dengue fever, please call your healthcare provider to see if you need to be seen.

 

The health departments encourage all residents and visitors to help lower mosquito populations by taking appropriate measures to guard against these diseases by practicing Drain and Cover. 

This includes:

DRAIN standing water:
• Drain water from garbage cans, buckets, pool covers, coolers, toys, flowerpots or any other containers where sprinkler or rainwater has collected.
• Discard old tires, drums, bottles, cans, pots and pans, broken appliances and
other items that aren't being used.
• Empty and clean birdbaths and pets' water bowls at least once or twice a week.
• Protect boats and vehicles from rain with tarps that don't accumulate water.
• Maintain swimming pools in good condition and appropriately chlorinated. Empty plastic swimming pools when not in use.

 

The most recent Florida Arbovirus Surveillance Report (Oct 27th) only lists one other locally acquired case of Dengue in Florida in 2012 (see Miami Reports Locally Acquired Dengue Case).

 

This compared to 28 cases reported in 2009, and then 63 locally-acquired cases in Key West, one in Broward County, and one in Miami-Dade County for 2010.

 

The following year, 2011, saw a significant reduction in cases with just three locally acquired in Miami-Dade County, two in Palm Beach County, and one each in Martin and Hillsborough counties.

 

Although cooler weather has finally arrived in the Sunshine state, we’ve yet to see a freeze, and so mosquitoes are still active.  For this reason, the Florida DOH recommends.

»» Read More

Miami Reports Locally Acquired Dengue Case

 

# 4584

 

# 6591

 

News this afternoon from the Miami-Dade Health Department on the detection of 2012’s first locally acquired case of Dengue fever in the state of Florida.

First some excerpts from the press release, and then I’ll return with more.

 

September 27, 2012

First Locally Acquired Case of Dengue Fever in Miami-Dade County

(Miami, FL – September 27, 2012) – Miami-Dade County Health Department officials received confirmation of the first locally acquired case of Dengue Fever in Miami-Dade County.

 

The individual was diagnosed with Dengue Fever based on symptoms and confirmed by laboratory tests. The individual fully recovered from this illness.

 

Dengue Fever is a viral disease transmitted by a type of mosquito common to the southeastern United States and the tropics. It is not spread from person to person. The symptoms of Dengue Fever include, fever (over 101 degrees Fahrenheit), severe headache, severe pain behind the eyes, muscle, joint and bone pain, rash, loss of appetite, nausea and vomiting. There is no specific medication or vaccine for Dengue Fever. If you are experiencing symptoms consistent with Dengue Fever, please call your healthcare provider to see if you need to be seen.

(Continue . . . )

 

When Dengue fever returned to the state of Florida in 2009 - after an absence of 70 years - (see Dengue Resurfaces In Key West), it wasn’t an entirely unexpected event.

 

The virus was likely reintroduced to the area by an infected traveler or visitor who was bitten by a local mosquito, and that mosquito went on to bite others.

 

Like many viral infections (influenza, West Nile, etc), not everyone who is infected experiences symptoms. And with Dengue, it is often the second or third infection (there are 4 sub-types) that proves the most serious.

 

The 2010 MMWR report  Locally Acquired Dengue --- Key West, Florida, 2009—2010 described South Florida’s vulnerability this way:

 

The environmental and social conditions for dengue transmission have long been present in south Florida: the potential for introduction of virus from returning travelers and visitors, the abundant presence of a competent mosquito vector, a largely nonimmune population, and sufficient opportunity for mosquitoes to bite humans.

 

There were 28 cases reported in 2009, and the state of Florida’s Weekly Data for Arbovirus Surveillance lists 63 locally-acquired cases in Key West, one in Broward County, and one in Miami-Dade County for 2010.

The following year, 2011, saw a significant reduction in cases with just three locally acquired in Miami-Dade County, two in Palm Beach County, and one each in Martin and Hillsborough counties.

 

While the most recent state surveillance report shows 67 cases of imported dengue in individuals with recent travel history to dengue endemic regions, today’s announcement is the first locally acquired case of the year.

 

In order to spread, Dengue requires the right mosquito vector.  And the two species best suited to transmit the virus are the Aedes aegypti and Aedes albopictus mosquitoes, which also can spread such diseases as West Nile, Malaria, Yellow Fever, and Chikungunya.

 

Map showing the distribution of dengue fever (red) and the distribution of the Aedes aegypti mosquito (cyan)  in the world, as of 2006. – Credit Agricultural Research Service of the US Department of Agriculture.

 

Map showing the native habitat (blue) and recent spread (green) of the Aedes albopictus mosquito. --Credit Wikipedia

 

According to a 2009 report, as many as 28 states in the US have at least one of the these mosquito vectors, a factoid that has some epidemiologists worried that Dengue, Chikungunya, and Malaria could one day become threats in the United States.

 

With only one locally-acquired dengue case in Florida this year, it’s pretty obvious the virus has not managed to get a solid foothold in the state. Each year, however - more travelers arrive carrying the virus - and that gives the virus another opportunity to take up residence.

 

Right now, Dengue is a minor threat in Florida, but when you add Dengue to the other mosquito-borne illnesses (EEE, WNV, SLEV) it just makes sense to do whatever you can to limit your exposure.

Which is why the State Health Department urges residents and visitors to follow the `5 D’s’:

 

 

For an extensive list of my blogs on Dengue and Mosquito Borne Diseases you can select the DENGUE Quick Search here,  or on my sidebar.

»» Read More

Florida Reports 5th Locally Acquired Dengue Case

 

 

 

# 5899

 

Compared to last year, when more than 60 cases of locally acquired dengue fever were reported in Florida, 2011 has been pretty quiet.  As of October 8th, only 4 cases had been reported this year; 2 in Miami-Dade county, 1 in Martin County, and 1 in Hillsborough county.

 

Key West, which saw the most cases in 2010, remarkably has yet to report a case this year.

 

While there may be many factors at work in this reduction in cases, an aggressive mosquito awareness campaign has no doubt played a role.

 

 

Yesterday, a 5th case of Dengue was reported in Palm Beach County, which prompted the following advisory from the local health department.

 

DENGUE FEVER IN PALM BEACH COUNTY PROMPTS ADVISORY

OCTOBER 13th, 2011
FOR IMMEDIATE RELEASE

CONTACT: Public Information
561-671-4014 or press50@doh.state.fl.us

PALM BEACH COUNTY, FL—A mosquito borne disease advisory was issued today by the Palm Beach County Health Department following confirmation of a locally acquired case of Dengue Fever.

“We have been closely monitoring the county for the possibility of Dengue being reintroduced in our area since we have seen it in counties north and south of us,” said Health Director Alina Alonso, MD. “With today’s confirmation I am issuing a Mosquito Borne Illness Advisory.”

In 2009 locally acquired cases of Dengue were diagnosed in Key West and since then, others have been found in South Florida. This is the first locally acquired case in Palm Beach County although eight others have been reported this year and acquired out of the country.

(Continue . . . )

 

 

As of the latest Florida Arbovirus Surveillance Report, 20 cases of West Nile Virus have been reported this year as well.  Unlike last year which saw 4 EEE (Eastern Equine Encephalitis) fatalities, no human cases have been reported in 2011.

 

While the risk of contracting Dengue (or West Nile, EEE, or any other mosquito borne illness) in Florida is quite small, it isn’t zero.

 

Although Florida is justifiably famous for its indigenous mosquito population, it isn’t the only state where mosquito borne illnesses may be contracted.

 

As you can see by the CDC map below, West Nile Virus activity has been reported in nearly every state this year (see Borne In The USA).

 

 

 

The Florida Department of Health would like to remind you to practice the 5 D’s of mosquito safety.

 

 

 

Any container of water . . .  even as small as a bottle cap . . . can breed mosquitoes.  Containers with houseplants appear to be particularly good homes for these pests.

 

For more details visit the Florida DOH Mosquito-borne Disease Prevention webpage.

»» Read More

Irene: First Hurricane Of 2011 Season

 

 

 

# 5771

 

Irene reached hurricane status overnight as she moved over the island of Puerto Rico, and now appears poised to miss most of the mountainous terrain of Hispaniola which should allow her to strengthen. 

 

 

The consensus track puts Irene as a strong hurricane moving along the eastern seaboard of Florida by the end of the week. It should be noted that there is still a fair amount of uncertainty on this forecast path and the models have been shifting with every run.

5am EST 8/22 Computer models

 

The National Hurricane Center in their 5am advisory, released this intensity forecast, but cautioned that this might be conservative depending upon the storm’s interaction with the mountains of Hispaniola.

 

 

The bottom line, despite some remaining uncertainties regarding her track and intensity, residents and interests from the Florida Keys, up along the Florida coastline, and even further north along the eastern seaboard need to be getting ready just in case Irene decides to visit.

 

Only two hurricanes have impacted the northeast coast of Florida over the past thirty years, and so millions of residents – from Melbourne to Jacksonville –  have yet to experience a serious hurricane.

 

Hurricane David (1979) and Hurricane Charlie (2005) tracks.

Credit – NOAA Historical Hurricane Tracks

 

For emergency managers all along the coast, the next 120 hours are going to be a tense and hectic time. More than a dozen Florida counties are under the gun in this latest forecast track, and Georgia, the Carolinas, and points north are not out of danger.

 

NOW is the time to review your emergency plan, including where you will go if you are ordered to evacuate, and to make any last minute additions to your emergency kit.

 

To help in this regard, a couple of short videos from the Pinellas County Office of Emergency Management on preparing for a hurricane.

 

Build Your Survival Kit

Time: 3 min. 30 sec.

Building a hurricane survival kit doesn't have to break the bank.  Learn how to put together a well-stocked kit inexpensively.

Tape Strikes Out

Time: 4 min.

When a storm blows in, you put masking tape on your windows and you're fine right? We'll show you just how wrong that assumption can be.

 

 

The National Hurricane Center website should always be your primary source of forecast information, but if you are on Twitter, you should also follow @FEMA, @CraigatFEMA, @NHC_Atlantic, @NHC_Pacific and @ReadydotGov for the latest Emergency information.

 

To become better prepared as an individual, family, business owner, or community to deal with hurricanes, tornadoes, floods, or any other type of disaster: visit the following preparedness sites.

 

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

»» Read More

Updating The Bahamas & Florida Dengue Cases

 

Aedes Albopictus Photo Credit CDC PHIL

# 5754

 

 

In a follow up to a blog from last Thursday (see U.S. Issues Dengue Warning For The Bahamas) we’ve more reports on the increasing number of suspected and confirmed Dengue cases in the Bahamas, and attempts to bring the outbreak under control.

 

The Nassau Guardian reported late last week that the Bahamas had recorded  a record number of Dengue cases – estimated at over 1,500 – and that roughly 100 new suspect cases were showing up every day.

 

Record number of Dengue fever cases

More than 1,500 so far as public health care system is stretched to the limit

Chester Robards

Published: Aug 11, 2011

 

 

Local governments have been attempting to control the outbreak with mosquito fogging, and yesterday the Freeport news ran an editorial Recognizing the seriousness of dengue fever that implored residents to take part in helping to eradicate mosquito breeding grounds.

 

Similarly, Acting Minister of Environment Phenton Neymour asked residents to get rid of mosquito breeding spots, stating that fogging won’t correct the problem until the numerous breeding sites in urban areas are removed.

 

Residents urged to get rid of breeding grounds for mosquitoes

Published On:Saturday, August 13, 2011

 

The Florida Keys, which last year saw more than 60 locally acquired cases of Dengue, mounts a similar campaign in mosquito awareness. This year, in contrast, they’ve not reported any locally acquired cases of dengue.

 

 

 

Last week, Florida reported a couple of imported Dengue cases (Martin & Marion Counties), and one suspected household transmission of the virus (see Borne In The USA). 

 

Testing has now confirmed that in the Martin County case - a traveler recently returned from the Caribbean developed dengue fever – and subsequently a second household member who had not traveled abroad, had contracted the virus.

 

First locally contracted case of dengue fever in Martin County confirmed

08/11/2011

Christin Erazo

 

Every year hundreds of travelers from countries where mosquito borne illnesses are endemic develop symptoms after they return to the United States. While the odds of those diseases being transmitted on are fairly low, they are not zero.

 

In mid-June of 2010 the MMWR came out with a new report on Travel Associated Dengue in the United States between 2006 and 2008.

 

This surveillance pre-dates the Key West outbreak, and as the study reports, `Clinically recognized cases of travel-associated dengue likely underestimate the risk for importation because many dengue infections are asymptomatic or mildly symptomatic’.

 

The link  is Travel-Associated Dengue Surveillance --- United States, 2006—2008.

 

The explosive growth of Dengue around the world is well illustrated by the following graph from the World Health Organization.

 

What this graph doesn’t indicate is another doubling of dengue cases has taken place over the past 5 years.

 

For now, major outbreaks of Dengue, Chikungunya, Malaria, or Yellow Fever remain unlikely in the United States and Europe.

 

Conditions that are conducive to these kinds of epidemics, however, continue to evolve; Dense urban populations, climate change, increased international travel, and the expanding range of mosquito vectors.

 

Florida, after all, went 60 years without seeing locally acquired cases of Dengue, only to have it reemerge in 2009 in Key West.

 

Puerto Rico, which this time last year was in the middle of a major dengue epidemic, is seeing very low activity this year. 

 

Across the rest of South America, Central America, and the Caribbean dengue activity varies considerably, with more than 700,000 cases and 400 deaths reported in 2011.

 

The chart below is gleaned from the latest PAHO Dengue surveillance report.

 

 

While the odds of contracting dengue from mosquito bites in the United States remains very low - if you visit or live in mosquito territory – it is worth remembering Florida Department of Health’s, (FDOH)
recommendation that individuals protect themselves by following the “5 D’s”.

»» Read More

Dengue Roundup: Puerto Rico, Florida, Bahamas

 

 

# 5712

 

Aedes aegypti

 

This time last year Dengue fever was a big story in Puerto Rico, and to a lesser extent, also in South Florida and the Bahamas. 

 

• The worst epidemic in more than a decade had swept across the island of Puerto Rico, and at one point as many as  900 new cases were being reported each week (see Puerto Rico Dengue Week 31: Cases Back On The Ascendant).
• Florida, for the second year in a row, was reporting relatively small numbers of Dengue infections - (2010: a total of 63 locally-acquired cases in Key West, one in Broward County, and one in Miami-Dade County) – after more than six decades without a locally acquired case.
• And last September the Bahamas issued a public health advisory after a rise in Dengue cases and at least one death (see Dengue Reports From The Bahamas).

 

 

Outbreaks of Dengue fever are often cyclical, and thus far in 2011 - for Florida, Puerto Rico, and the Bahamas - reports of Dengue fever have been far lower than we saw last year.

 

The epidemic in Puerto Rico, which claimed 31 lives, finally burned itself out over the winter.  The chart below shows what a difference a year can make.

 

 

 

While fewer than 100 cases are being reported each week right now, it should be noted that the rainy season still lies ahead.  Precautions against mosquitoes are still important.

 

In Florida, only one locally acquired case of Dengue has been reported in 2011, likely due to the extended drought the state has been experiencing. That situation could change, of course, with the arrival of one good tropical storm.

 

For now, mosquito activity remains relatively low for this time of year (see report  Florida Arbovirus Surveillance :Week 28: July 10 – July 16, 2011) with only one county (Seminole) under a mosquito-borne illness advisory.

 

 

 

According to a recent report in The Bahamas Weekly, the Bahamas are once again seeing a rise in Dengue activity, with two laboratory confirmed cases in New Providence, and another eleven cases awaiting test results. 

 

DEHS ‘steps up’ source reduction in response to 2 cases of dengue

Jul 21, 2011 - 5:27:13 PM

 

 

Across the rest of South America, Central America, and the Caribbean dengue activity varies considerably, with more than 700,000 cases and 400 deaths reported in 2011.

 

The chart below is gleaned from the latest PAHO Dengue surveillance report.

 

 

 

 

The explosive growth of Dengue around the world is well illustrated by the following graph from the World Health Organization. . 

 

Since the 1950s a rare, but far more serious form of the disease – DHF or (Dengue Hemorrhagic Fever) –  has emerged.  

 

The WHO now estimates there may be as many as 50 million dengue infections each year (Dengue and dengue haemorrhagic fever fact sheet).

 

 

For an extensive list of my blogs on Dengue and Mosquito Borne Diseases you can select the DENGUE Quick Search here,  on my sidebar.

 

Despite the lower numbers of dengue cases this year, the threat of mosquito borne illnesses (which may include Dengue, EEE, St. Louis Encephalitis, West Nile Virus, and others) remains.

 

So if you live in mosquito territory, it pays to be mindful of the 5 D’s.

 

»» Read More

Miami-Dade Announces 2nd Locally Acquired Dengue Case

 

 

 

# 5350

 

 

When it comes to mosquito activity in Florida, February is normally about as quiet as it gets.  The weather is cool – or sometimes cold – and we’ve usually been in droughty conditions for a couple of months.

 

Aedes aegypti

 

In fact, the latest Florida mosquito vector surveillance report, issued less than a week ago stated:

 

Florida Arbovirus Surveillance

Week 8: February, 20 – February 26, 2011

 

During the period February 20, – February 26, 2011, the following arboviral activity was recorded in Florida:

• DENV activity: No new cases of dengue associated with Key West were reported this week.
• EEEV activity: No EEEV activity was reported this week.
• WNV activity: No WNV activity was reported this week.
• SLEV activity: No SLEV activity was reported this week.
• HJV activity: No HJV activity was reported this week.

 

Not much activity, although Miami-Dade County was listed as being under a mosquito-borne illness advisory.

So it comes as a bit of a surprise that yesterday the Miami-Dade County Health department issued a statement confirming their second locally acquired case of Dengue in the past 50 years.

 

 

News
Press Releases

March 2, 2011

Second Locally Acquired Case of Dengue Fever in Miami-Dade County

 

(Miami, FL – March 2, 2011) – Miami-Dade County Health Department officials received confirmation of the second locally acquired case of Dengue Fever in Miami-Dade County.

 

The individual was diagnosed with Dengue Fever based on symptoms and confirmed by laboratory tests. The individual fully recovered from this illness.

 

Dengue Fever is a viral disease transmitted by a type of mosquito common to the southeastern United States and the tropics.  It is not spread from person to person.  The symptoms of Dengue Fever include, fever (over 101 degrees Fahrenheit), severe headache, severe pain behind the eyes, muscle, joint and bone pain, rash, loss of appetite, nausea and vomiting. There is no specific medication or vaccine for Dengue Fever.  If you are experiencing symptoms consistent with Dengue Fever, please call your healthcare provider to see if you need to be seen.

(Continue . . . )

 

Exactly when this individual was infected wasn’t disclosed, nor do we know which of the four serotypes of Dengue was involved. 

 

All we are told is that the patient recovered.

 

Each year usually see a couple of hundred imported cases of Dengue and/or Malaria among travelers who had recently visited areas where those viruses are endemic.

 

Two years ago – for the first time in more than 50 years – we started to a small number of locally acquired Dengue cases showing up in Key West (see MMWR: Dengue Fever In Key West), and in 2010 they totaled 65 cases in Key West and 1 each in Broward and Miami-Dade County.

 

Through aggressive mosquito control efforts during the 1940s, Dengue and Malaria were both eliminated from Florida – and remained so for nearly a half century. 

 

Since 1990 there have been a few scattered suspected (and confirmed) cases of locally acquired malaria in Florida, including one l reported on last December (see Florida: Locally Acquired Malaria Case Suspected).

 

But with millions of visitors arriving each year, many from regions where these diseases are endemic, it is basically only a matter of time before someone who is infected arrives – is bitten by a mosquito – and that mosquito manages to carry the virus on to someone else.

 

The CDC’s MMWR in a report last May on Locally Acquired Dengue in Key West, had this to say:

 

Cases of dengue in returning U.S. travelers have increased steadily during the past 20 years (8). Dengue is now the leading cause of acute febrile illness in U.S. travelers returning from the Caribbean, South America, and Asia (9).

 

Many of these travelers are still viremic upon return to the United States and potentially capable of introducing dengue virus into a community with competent mosquito vectors.

 

 

In truth, it may take many such introductions of Dengue or Malaria to an area before the right combination of weather, insect vectors, and ongoing transmission occur to enable it to get a foothold in a community.

 

But when it does, it can be very difficult to completely eradicate.

 

The explosive growth of Dengue around the world is well illustrated by the following graph from the World Health Organization.

 

What this graph doesn’t indicate is a doubling of dengue cases over the past 5 years.  

 

PAHO, in this pdf file, dated December 10th, showed more than 1.5 million cases reported during 2010 in the Americas alone (many more are likely undiagnosed).

 

 

 

For a fascinating podcast on the efforts of Florida’s mosquito control efforts, I would direct you to an episode of Vincent Racaniello’s TWiV taped last December with regulars Alan Dove & Rich Condit.

 

Joining them are Ed Fussell, Andrea Leal, and Amy Sargent of the Florida Keys Mosquito Control District at Florida Gulf Coast University (Ft. Myers) in a 105 minute show on Dengue in Florida and Mosquito control in the Florida Keys.

 

TWiV 111: Live at Florida Gulf Coast University

 

 

Although the overall risk of contracting a mosquito-borne illness in Florida remains very small, scattered cases of Dengue (along with West Nile, EEE, SLEV, and other rare arboviral threats) are why Florida health departments continue to urge people to remember to follow the `5 D’s’:

 

 

 

A few mosquito-disease centric posts from last year include:

 

Florida: Locally Acquired Malaria Case Suspected

 

ASTMH: Dengue and Insect-Borne EIDs In The US

 

Eastern Equine Encephalitis (EEE)

 

Making Themselves At Home

Update On The Florida Dengue Cases

»» Read More

Puerto Rico/Florida Dengue Update

 

 

# 5080

 

 

With the cholera epidemic raging in Haiti, a rare but high profile bird flu case in Hong Kong, and a plethora of stories on antibiotic resistance over the past couple of weeks, the dengue epidemic in Puerto Rico has taken a bit of a backseat in the news.

 

Yesterday, however, the CDC updated their dengue surveillance numbers for the past two weeks. It shows that after several weeks of steep decline, a leveling off of new dengue cases, albeit at levels still far above the epidemic threshold.

 

 

 

 

Although endemic to the island, the last really big dengue outbreak was in 1998, when just over 10,000 cases were recorded (and 19th deaths). 

 

Much of Central and South America, along with many islands islands of the Caribbean, are dealing with unusually high numbers of Dengue cases this year.

 

PAHO, the Pan American Health Organization, recently (Nov. 5th) released updated year-to-date numbers indicating more than 1.5 million total infections for the Americas.

 

 

 

A little over a year ago, locally acquired Dengue was reported in Florida after an absence of roughly 60 years.  The Florida Department of Health’s arbovirus surveillance system  - in their latest report (issued Nov 20th) – indicates 2 new Dengue cases last week, both in Key West.

 

 

            Year to Date Human Case Summary

                               (Excerpts)

Eastern Equine Encephalitis Acquired in Florida: Four human cases of EEE have been reported in 2010  . . . One incidental infection was reported in Hillsborough County.

West Nile Virus Infection Acquired in Florida: Eleven human cases of WNV have been reported in 2010  . . .  One positive asymptomatic blood donor was reported in Brevard County.

Dengue Acquired in Florida: In 2010, 62 cases of locally acquired dengue have been reported in Broward (1),  Miami-Dade (1) and Monroe (60-Key West) counties. 

Imported Dengue: One hundred and twenty-three cases of dengue with onset in 2010 have been reported in individuals with travel history to a dengue endemic country in the two weeks prior to onset.

Imported Malaria:  One hundred and seven imported cases of malaria with onset in 2010 have been reported. 

Imported cases of Dengue (and Malaria), as you can see, far exceed locally acquired cases.  The CDC  addressed this issue earlier this summer (see MMWR: Travel Associated Dengue Surveillance 2006-2008), warning:

 

`Clinically recognized cases of travel-associated dengue likely underestimate the risk for importation because many dengue infections are asymptomatic or mildly symptomatic’.

 

 

 

Dengue’s spread has increased dramatically over the past 50 years, and since the 1950s a rare, but far more serious form of the disease – DHF or (Dengue Hemorrhagic Fever) –  has emerged.

 

 

None of this should dissuade you from making that long anticipated trip to Florida or the Caribbean, of course. The odds of acquiring a mosquito-borne disease while visiting these locales remain quite small.

 

Particularly if you follow the advice of health departments who continue to urge people to follow the `5 D’s’:

 

 

 

For an extensive list of my blogs on Dengue and Mosquito Borne Diseases you can select the DENGUE Quick Search here,  on my sidebar.

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Locally Acquired Dengue In Miami

 

 

 

# 5048

 

 

The Miami-Dade Health Department has announced a confirmed locally acquired case of Dengue fever in an unusual Veterans Day press conference.  

 

This is the statement from their website.

November 11, 2010

First Locally Acquired Case of Dengue Fever in Miami-Dade County

Contact: Olga Connor
Miami-Dade County Health Department Rosa Oses-Prealoni  (786) 336-1276

First Locally Acquired Case of Dengue Fever in Miami-Dade County (Miami, FL – November 11, 2010) – Miami-Dade County Health Department officials received confirmation of the first locally acquired case of Dengue Fever in Miami-Dade County.

 

The individual was diagnosed with Dengue Fever based on symptoms and confirmed by laboratory tests. The individual fully recovered from this illness
Miami-Dade County Health Department will hold a media availability (information as follows).

Last July there was another suspected case of Dengue in Miami, but that turned out to be a false alarm.  Today’s announcement is Florida’s 2nd case of locally acquired dengue outside of the Florida Keys this year.

Posted on Thursday, 11.11.10

Dengue fever case turns up in Miami

The case is the first in more than 50 years where the disease was contracted locally. Health officials warned people to take precautions against the mosquito carriers.

 

 

According to this  Miami Herald report, this case involved a different strain that the one being reported in the Keys (there are 4 serotypes of Dengue).   This suggests a fresh importation, probably from someone visiting or returning from an area where Dengue is endemic.

 

Prior to this announcement, the Florida Department of Health’s latest arbovirus surveillance report (Nov 6th) listed the following locally acquired dengue cases for 2010.

 

In 2010, one case of dengue has been reported as acquired in Broward County and 57 cases of dengue have been reported as acquired in Key West (Monroe County). 

 

Of the Key West cases, 49 are Key West residents, eight are residents of other Florida counties, and one resides out of state.  Onset dates ranged from March 17 to October 28, 2010.

 

 

While the risk of contracting Dengue (or West Nile, EEE, or SLEV) in Florida is quite  small, the Florida Department of Health would like to remind you to practice the 5 D’s of mosquito safety.

 

 

For more details visit the Florida DOH Mosquito-borne Disease Prevention webpage.

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Puerto Rico & Florida Dengue Surveillance

 

 

 

# 5025

 

 

Although still running nearly 3 times above the epidemic threshold for this time of year, the number of new Dengue cases reported by the CDC in their latest weekly surveillance has dropped by nearly 40% over the past couple of months.

 

 

Roughly 600 new suspected Dengue cases were reported during the first week of October, along with 1 death.

 

The totals for 2010 far exceed that seen in the last big Dengue epidemic on that island back in 1998, when 19 deaths and a little over 10,000 cases were recorded.

 

 

The latest weekly surveillance report for Puerto Rico may be found at this link.

 

 

While this is a hopeful trend, we’ll have to wait a few weeks to see what impact – if any – the rains brought to Puerto Rico by its brief encounter with Tropical storm Otto in early October ultimately have on the mosquito population and the incidence of disease.

 

Track of T.S. Otto

 

Over the past year, there have been a relative small handful of Dengue cases reported in Florida as well.

 

The latest arbovirus surveillance numbers from the Florida Department of Health report a total of 56 locally acquired cases of Dengue in Florida this year.

 

• 55 cases in Key West
• 1 Case in Broward County
• Additionally, there have been 115 cases of Imported Dengue in Florida (recent travelers returning from Dengue endemic areas)

 

Although the overall risk of contracting a mosquito-borne illness in Florida is very small, this (along with West Nile, EEE, SLEV, and other rare arboviral threats) is why health departments continue to urge people to remember to follow the `5 D’s’:

 

 

For more on these, and other vector borne diseases, you may wish to revisit:

 

ASTMH: Dengue and Insect-Borne EIDs In The US

MMWR: Dengue Epidemic In Puerto Rico

MMWR: Dengue Fever In Key West

Eastern Equine Encephalitis (EEE)

»» Read More

Locally Acquired Dengue In Florida

 

 

# 4804

 

 

Early last month I wrote a blog called A Message of Import, which talked about concerns expressed by  the Western Australia Health Department regarding visitors returning from Bali, Indonesia.

 

They warned that "Dengue fever notifications in WA have increased from 16 in 2006 to 151 in the first half of 2010, with most of these cases associated with travel to Bali. "

 

I then spent some time detailing the outbreak of Dengue in Key West, Florida and the prospects of Dengue being introduced into new areas by infected travelers. 

 

I also discussed the introduction of Chikungunya to northern Italy in 2007 by a traveler returning from India.

 

The reality is, while once we were protected from rare, exotic diseases by vast oceans and lengthy travel times, an outbreak of an infectious disease in Asia or the Caribbean today may well be on a plane to  Atlanta, London, or Sydney tomorrow. 

 

Which brings us to the story out of Broward County, Florida late yesterday confirming a locally acquired case of Dengue Fever . . . the first in Florida outside of Key West.

 

You can read the details in the Sun Sentinel story First case of Broward dengue fever confirmed or the local CBS TV station report Dengue Fever Is Confirmed In Broward County but the details are basically:

 

An adult, who had not traveled outside of the county in weeks was diagnosed with Dengue Fever (DENV-3), and has since recovered (most Dengue cases do recover).  

 

The county will step up mosquito control efforts and urges people to lessen their exposure to mosquito bites.

 

Given the incubation period of Dengue, it is pretty certain this person contracted the virus from a local mosquito . . . and that mosquito could only have gotten the virus by biting someone who was already infected.

 

Interestingly, the serotype detected in this case is reportedly DENV-3, which is not the same as has been detected in Key West (DENV-1).  

 

DENV-3 hasn’t been among the serotypes detected in Puerto Rico this year, either - which would argue against the importation of the virus from that island as well.

 

Which leads local officials to believe that this virus was introduced to Broward county by an infected traveler recently arrived from the Caribbean, Central, or South America (or some other country where that serotype is found).

 

The recent importation of Dengue to South Florida isn’t a complete surprise, given the amount of international travel to and from that region, and the favorable environment (weather, urban population, ample mosquito vectors) for its spread.  

 

The CDC’s MMWR in a report last May on Locally Acquired Dengue in Key West, had this to say:

 

Cases of dengue in returning U.S. travelers have increased steadily during the past 20 years (8). Dengue is now the leading cause of acute febrile illness in U.S. travelers returning from the Caribbean, South America, and Asia (9).

 

Many of these travelers are still viremic upon return to the United States and potentially capable of introducing dengue virus into a community with competent mosquito vectors.

 

 

None of this means to suggest that Dengue has taken up permanent residence in Broward County.  It would take the detection of a lot more locally acquired cases before that becomes a concern.

 

In fact, it may take many introductions of Dengue to an area before the right combination of weather, insect vectors, and ongoing transmission occur to enable it to get a foothold in a community.

 

What this does highlight is the need to pursue aggressive mosquito control measures and to instill good mosquito protection habits in the population.

 

And it isn’t just for Dengue.

 

The latest Florida Arbovirus Surveillance report (Aug 7th) lists the following Year-to-Date summary:

Eastern Equine Encephalitis Acquired in Florida: Four human cases of EEE have been reported in 2010 in Hillsborough (2), Wakulla, and Leon counties with onset dates in June (1) and July (3).

Dengue Acquired in Florida: Twenty-five cases of dengue have been reported as acquired in Key West in 2010.  Of these, 18 are Key West residents, six are residents of other Florida counties, and one resides out of state.  Onset dates ranged from March 17 to July 22, 2010.

Imported Dengue: Fifty-seven cases of dengue with onset in 2010 have been reported in individuals with travel history to a dengue endemic country in the two weeks prior to onset. 

Imported Malaria:  Sixty-five imported cases of malaria with onset in 2010 have been reported. 

 

 

I’ve stated often that as a native Floridian, I don’t live in fear of being bitten by a mosquito. I understand that the odds of acquiring a disease that way are actually very small.

 

But I do take reasonable precautions, and try to remember to follow the `5 D’s’:

 

Don't go outdoors at DUSK and DAWN when mosquitoes are most active.

 

DRESS so your skin is covered with clothing

 

Apply mosquito repellent containing DEET to bare skin and clothing.

 

Other effective repellents include picaridin, oil of lemon eucalyptus, and IR3535

 

Empty containers and DRAIN standing water around your home where mosquitoes can lay eggs.

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Florida Records 4th EEE Death In July

 

 

# 4774

 

 

Over the past decade there have been an average of about 7 cases (not deaths) of `Triple E’ (Eastern Equine Encephalitis) in the United States each year (range range: 3—21), which makes EEE an exceedingly rare disease in humans.

 

What makes EEE such a concern is that it has a high fatality rate (35%), and among the survivors, a high percentage suffer ongoing neurological problems.

 

Among the mosquito-borne encephalitis viruses, however, it runs a distant third when compared to the number of California serogroup (predominantly La Crosse virus (LACV)) and St. Louis Encephalitis (SLEV) cases.

 

MMWR Domestic Arboviral Diseases 1999-2008

 

Given its rarity, it is therefore a bit surprising that Florida has just recorded its fourth EEE death for the month of July (My thanks to the reader who alerted me to this latest victim).

 

 

LCHD ISSUES MOSQUITO-BORNE ILLNESS ADVISORY

LEON COUNTY HEALTH DEPARTMENT ISSUES MOSQUITO-BORNE ILLNESS ADVISORY

--Medical director urges precautions against mosquitoes--

Tallahassee-- The Leon County Health Department announces that there has been increased mosquito-borne disease activity in Leon County. “We have had a confirmed human death due to Eastern equine encephalitis (EEE),” said Dr. Marjorie Kirsch, medical director, and,“the risk of transmission of mosquito-borne viruses to humans is increased.” A Leon County horse has also been recently diagnosed with EEE.

 

EEE virus is spread by the bite of an infected mosquito. It isn’t spread person to person. An average of six human cases of EEE are reported each year in the United States.

 

The Leon County Health Department reminds residents and visitors to avoid being bitten by mosquitoes that may cause disease. Leon County Mosquito Control and the Leon County Health Department continue surveillance and prevention efforts and encourage everyone to take basic precautions to help limit exposure. More Info Available

 

This update was submitted at 7/31/2010 6:04:43 PM

 

While obviously a concern, and certainly worthy of public discussion, it is only fair to point out that the odds of contracting EEE from a mosquito in Florida are extremely low. 

 

And while the spotlight right now is focused on Florida, this isn’t just a problem for the sunshine state. 

 

The graphic below shows that while Florida leads the pack that over the years Massachusetts, New Jersey, Georgia, and Louisiana have seen their share of cases as well.

 

Given its severity (and the prevalence of other mosquito borne diseases like West Nile, Dengue, SLEV), it makes sense to take steps to protect yourself and your family.

 

Yesterday I wrote about the Aedes Albopictus or `Asian tiger’ mosquito’s willingness to move in, and breed inside your home (see Making Themselves At Home). 

So today would be a good day to go around and look for likely breeding places in, and around your home. This should become a weekly habit – at least during mosquito season.

 

I’ve repeated the Florida Department of Health’s mantra that to help protect themselves against mosquito borne diseases people  should practice the "5 D's"

Don't go outdoors at DUSK and DAWN when mosquitoes are most active.

DRESS so your skin is covered with clothing

Apply mosquito repellent containing DEET to bare skin and clothing. 

Other effective repellents include picaridin, oil of lemon eucalyptus, and IR3535

Empty containers and DRAIN standing water around your home where mosquitoes can lay eggs.

Today I’ve got a new resource for you.  

 

An interactive insect repellant search engine developed by the EPA that will that will allow you to input your needs and it will spit out the best repellants to use.

 

(click image to go to search engine)

 

Since knowledge is power, and prevention is a far better strategy than trying to cure a disease, here are some some of my earlier blogs on EEE:

 

Third Florida EEE Death in July

Eastern Equine Encephalitis (EEE)

 

And here is a list of recent Dengue/Arbovirus posts as well:

 

ASTMH: Dengue and Insect-Borne EIDs In The US

Update On The Florida Dengue Cases

Dengue Reports From The Caribbean

MMWR: Dengue Epidemic In Puerto Rico

MMWR: Dengue Fever In Key West 

»» Read More