dengue - · pdf filedhf reported cases 60 10312 ... dengue continues to pose a threat to...

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© RKI 01 / 2012

ROBERT KOCH INSTITUT

Dengue outbreak investigation

Source: H. Gelderblom, RKI

Dengue

Matthias Niedrig, Robert Koch Institut, Berlin

© RKI 01 / 2012


Dengue/dengue haemorrhagic feverEbola / RestonLassaYellow feverInfluenza

Crimean Congo haemorrhagic feverJapanese EncephalitisViral MeningitisRift Valley feverHanta

Viral Threats Worldwide

Sources: WHO (outbreak list/EPR), ProMed

2005

Polio

Chikungunya

Polio

Acute HF

Marburg virus

Hepatitis E

Measles

Nipah

/ 2006

Hepatitis A

/ 2007

Machupo virus

Measles

/ 2008

West-Nilevirus

New Arena

Hendra

/ 2009

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© RKI 01 / 2012


ENIVD 03 / 10

Background: causes

travellers / infectious pathogens [Dengue, Malaria, ...]

Goods / vectors [rodents, mosquitoes, ...]

Animal

migrations

climate factors

International transport

livingconditions

© RKI 01 / 2012


Megacities of the world 1992-2010

Increase of population in mega-cities

1992 2010Source: DIE ZEIT

numbers in millions

11.9

13.9

Los AngelesNew York

Lagos

Mexico City

Rio de JaneiroSão Paulo

Buenos Aires

18

15.3

25

19.2

13.7

11.8

17.2

16.2

13.3

11.3

13.4

921.1

8.7

11.9

7

24.4

13.3

17.6

7.4

15.6

8

28.9

25.8

18

11.4

10

17.2

Teheran

Bombay

DelhiDhaka

Beijing

Jakarta

TokyoCairo

© ENIVD 2010

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© RKI 01 / 2012


Epidemiology: population increase in urban areas of Africa

© RKI 01 / 2012


World Population 1850-2050

Increase of world population from 1850 to 2050

1850 1900 1950 1998 2050

392

172

504

809167

729628

547

221

7491766

1402

3585 5268

13 4630

305

numbers in millions

© ENIVD 2010

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© RKI 01 / 2012

ROBERT KOCH INSTITUT Low hygiene conditions in hospital settings

Delhi local hospital, department for treatment of Dengue patients

© RKI 01 / 2012


Dengue Dengue InfectionInfection

AssymtomaticAssymtomatic symtomaticsymtomatic

No schock No schock DengueDengue schockschock (DSS)(DSS)

FeverFever DengueDengue Fever Fever DengueDengue Hemorragic FeverHemorragic Fever

50 – 100.000.000diseased persons

22.000 death

500.000 severcourse of disease

Dengue Dengue InfectionInfection: a : a diaseasediasease withwithdifferent different clinicalclinical picturespictures

5

© RKI 01 / 2012

ROBERT KOCH INSTITUT Dengue in European Dengue in European travellerstravellersclinicalclinical presentationpresentation::

Wichman O., et al. JID 2007, vol 195 (1089-1096)

Statement on dengue CCDR RMTC 2009, vol 35 (1-12)

UNUSUAL MANIFESTATIONS:

Severe hepatitis Encephalitis Visual loss

© RKI 01 / 2012

ROBERT KOCH INSTITUT Dengue Dengue casescases importedimported to Europe: to Europe: Travellers Travellers areare good good indicatorsindicators

DENV1 DENV1

DENV2

DENV1 DENV2 DENV3 DENV4

DENV1 DENV2 DENV3

DENV1 DENV2

DENV2 DENV3 DENV1

DENV3

DENV2 DENV4

DENV3 DENV2

ENIVD-TropNet Dengue Working Group; unpublished results

6

© RKI 01 / 2012


Global distribution of Flaviviruses

Yellow Fever Virus

Japan EncephalitisVirus

Tick Borne Encephalitis Virus

Dengue Virus

West Nile Virus

Dengue Virus

© RKI 01 / 2012


AFRICAN SYLVATIC

CYCLE

URBAN CYCLE

Ae. africanusAe. luteocephalusAe. furcifer-taylori

Ae. dalzieli

Ae. aegyptiAe. albopictus

Primates e.g. forest

redtailmonkey

Livecycle CHIKV

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© RKI 01 / 2012


Aedes aegypti

Aedes albopictus

Dengue transmission cycle

© RKI 01 / 2012


SKIN of UNINFECTED VERTEBRATE

Non-Viremic Transmission

Infected mosquito Uninfected mosquito

McGee et al., (2007) Nonviremictransmission of West Nile virus: evaluation of the effects of space, time and mosquito species. Am. J. Trop. Med. Hyg. 76: 424-30.

Time: 45 min.

Distance: ≥ 40 mm

Source: S. Higgs, UTMB, USA

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© RKI 01 / 2012

ROBERT KOCH INSTITUT ImportedImported Dengue Dengue casescases intointo Europe: Europe: ReturningReturning travelerstravelers givegive usefuluseful informationinformation

DENV1 DENV1

DENV2

DENV1 DENV2 DENV3 DENV4

DENV1 DENV2 DENV3

DENV1 DENV2

DENV2 DENV3 DENV1

DENV3

DENV2 DENV4

DENV3 DENV2


© RKI 01 / 2012



ImportedImported Dengue Dengue casescases intointo Europe: Europe: ReturningReturning travelerstravelers givegive usefuluseful informationinformation

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© RKI 01 / 2012

ROBERT KOCH INSTITUT Dengue in European Dengue in European travelerstravelers: : EpidemiologicalEpidemiological presentationpresentation

Source:TropNet Europ Sentinel SurveillanceReport, November 2008

1.6%Foreign visitors

3.2%Eurpean expatriates

8.1%Immigrant/refugees

87.1%Europeans living in EU

2008PATIENT CHARACTERISTICS

1.6%Foreign visitors

3.2%Eurpean expatriates

8.1%Immigrant/refugees

87.1%Europeans living in EU

2008PATIENT CHARACTERISTICS

Popularity of these countries as touristic destination

Activity and possible variations in the virulence of dengue viruses

Vector activity in endemic countries

© RKI 01 / 2012

ROBERT KOCH INSTITUT Importe Dengue Importe Dengue casescases intointo Europe: Europe: Travelers as Travelers as „„vectorsvectors““

June-Sept 2006

0

5

10

15

20

25

30

35

40

45

AUG02

OCT02

DEC02

FEB03

APR03

JUN03

AUG03

OCT03

DEC03

FEB04

APR04

JUN04

AUG04

OCT04

DEC04

FEB05

APR05

JUN05

AUG05

OCT05

DEC05

FEB06

APR06

JUN06

AUG06

OCT06

DENGUE IMPORTED INFECTIONS (SPAIN)ACUTE DENGUE CASES NEGATIVE DENGE CASES

June-Sept 2007outbreaks

10

© RKI 01 / 2012


ImortedImorted Dengue Dengue casescases intointo Europe: Europe: Travellers Travellers areare good good indicatorsindicators

NEW LINEAGE DESCRIPTION

Domingo C., et al. J. Clin. Microbiol., 2006; vol. 44: 1519-1529

DENGUE SEROTYPE 1 GENOTYPE AMÉRICA-ÁFRICA

© RKI 01 / 2012

ROBERT KOCH INSTITUT DengueNet registeredDengue cases

854,452

2002-2006

11

© RKI 01 / 2012


African countrieswhereDengue (DEN2, -3) have beenidentified in 2008 / 2009


© RKI 01 / 2012

ROBERT KOCH INSTITUT Reinvasion of Aedes aegyptiinto the Amerika

1970 20011930

12

© RKI 01 / 2012

ROBERT KOCH INSTITUT Dengue Dengue hemorragischichemorragischic FeverFever: : A A newnew form of form of diseasedisease

DHF reported cases

60

10312

3 0 8 12 35 97 96

26823646

2319 1753

4189 4723

8228

5092

11783 12369

5216 5667

1555714374

109949815

14557

9962

02000400060008000

1000012000140001600018000

< 19

8119

8119

8219

83198

419

8519

8619

8719

8819

8919

9019

9119

9219

9319

9419

9519

9619

9719

9819

9920

0020

0120

02200

320

0420

0520

06

Year

NON ENDEMIC

HYPERENDEMIC

Source: PAHO

DHF reported cases in Central, South America and the Caribbean

© RKI 01 / 2012


DENGUE UPDATE 2011

Source: PAHO

13

© RKI 01 / 2012


DENGUE watch 2011

Source: PAHO

© RKI 01 / 2012


DENGUE UPDATE 2011

Source: WHO

14

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DENGUE UPDATE 2011

Source: WHO

© RKI 01 / 2012


DENGUE UPDATE 2011

Source: WHO

15

© RKI 01 / 2012


DENGUE UPDATE 2011

Source: WHO

© RKI 01 / 2012


DENGUE UPDATE 2011

Source: WHO

16

© RKI 01 / 2012


DENGUE UPDATE 2011

Source: WHO

© RKI 01 / 2012


DENGUE UPDATE 2011

Source: WHO

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© RKI 01 / 2012


DENGUE UPDATE 2011

Source: WHO

Action Against Dengue: Dengue Day Campaigns Across AsiaDengue continues to pose a threat to public health in our region. This threat has been recognizedby countries throughout the region, which have taken action to protect their populations. National

leaders also have acknowledged that they must act regionally in order to protect people withintheir own borders.

The Association of Southeast Asian Nations (ASEAN) and the World Health Organization haveformed an effective alliance to achieve a shared goal: a healthy and secure population.

One clear sign of this cooperation was seen on 15 June 2011. ASEAN Health Ministers declaredthat day—and each subsequent 15 June—to be ASEAN Dengue Day. This important annual eventallows ASEAN members, in coordination with WHO, to consolidate dengue prevention and control

measures.

© RKI 01 / 2012


Increase of world tourism

Source: WTO

1990459

1996592

2000702

20101018

20201600

(after 2009 forecast)

number of personstravellingabroadin millions

18

© RKI 01 / 2012


Imported Dengue cases into Germany

© RKI 01 / 2012


Age distribution of Dengue fever patients 2005 - 2010

19

© RKI 01 / 2012


Destination of returning travelers with Dengue fever 2005 - 2010

Quelle: Institute of Medical Virology, Frankfurt / Main

© RKI 01 / 2012


DENGUE UPDATE 2011

Source: ECDC, Surveillance report 2010

Notification rates of dengue fever cases in EU and EEA/EFTA countries, by age and

gender, 2008 (n = 429 confirmed) from 530

20

© RKI 01 / 2012


DENGUE UPDATE 2011


Rates of reported confirmed dengue fevercases in EU and EEA/EFTA countries, by age

and gender, 2009

© RKI 01 / 2012


DENGUE UPDATE 2011

Source: ECDC, Surveillancereport 2011

Number and rate of dengue fevercasesreported in EU and EEA/EFTA countries, 2008–09

21

© RKI 01 / 2012


DENGUE UPDATE 2011


Seasonal distribution of reported confirmeddengue cases in the EU and EEA/EFTA

countries, 2009

© RKI 01 / 2012


DENGUE UPDATE 2011

Source: ECDC, Surveillancereport 2011

22

© RKI 01 / 2012

ROBERT KOCH INSTITUT East and West distribution of Aedesalbopictus in the mediterranean area

Source: Development of Aedesalbopictus risk maps, ECDC, Stockholm, 03, 2008

© RKI 01 / 2012


Distribution of Aedes albopictusin Europe, January 2010

surveys and studies on mosquitoes wereconducted during thelast five years (2003–2007) and no specimenof Aedes albopictus was reported

Aedes albopictuswas reported

No information

Source: Development of Aedesalbopictus risk maps, ECDC, Stockholm, March, 2008

Straetemans M. Eurosurveillance 2008, vol 13 (1-3)

AedesAedes aegyptiaegyptiPresencePresence in Europein Europe

authochtoneDengue cases

in 2010


23

© RKI 01 / 2012


Distribution of Viruses and disease vectors within Europe

Tick borneencephalitisvirus

Hanta virus

CrimeanCongohemorraghicfever virus

West Nilevirus

Sandfly fevervirussource:

Snow & Ramsdale, Biologist (2002) 49 (2)

Aedesalbopictus

Ochlerotatusatropalpus

Ochlerotatusjaponicus

WN

WN WNWN

WN

ChikungunyaVirus

© RKI 01 / 2012


Distribution of CHIK since 2005

Reunion

KeyniaSeychelles

ComoresMauritius

CanadaUSA

2006

2005

20072008

2007

20092009

24

© RKI 01 / 2012

ROBERT KOCH INSTITUT Chikungunya outbreak in Italy in June 2007

source:

Distribution of Chikungunya Fever.Source: CDC, USA, 2007

15th June – 21st Sep. 292 suspected cases of Chikungunya Fever 125 cases were confirmed by laboratory diagnosis Increase of Aedes albopictus in the region in recent years

© RKI 01 / 2012


Important requirements for a good diagnosis

Good physician

Consider-ing allcircum-stances

Kind of disease, travel history, vaccinations,

etc….?

25

© RKI 01 / 2012


Cross reactivity between different Flaviviruses in different diagnostic

assays (IFA, EIA)

Tick Borne Enzephalitis TBEV

vaccine available

Japanese Enzephalitis JEV

vaccine available

Yellow FeverYFV

vaccine available

Dengue Fever 1-4DEN V

West Nile FeverWNV

Koraka et al., 2002

© RKI 01 / 2012


What comes next?

CHIKVDengue

26

© RKI 01 / 2012


Quelle: Van der Werf, Pasteur Institut

previous Hotel Metropol in Hong Kong

© RKI 01 / 2012


Acknowledgements

Cristina Domingo

Thomas Jelinek

Stephen Higgs

Klaus Stark

Christina Frank

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