DengueFever(DF)

and
DengueHaemorrhagicFever/DengueShockSyndrome(DHF/DSS)
Dengueisanacutefevercausedbyaflavivirus.Thedis
easecanoccurintwoforms:(1)DengueFever(DF)and
(2) Dengue Haemorrhagic Fever/Dengue Shock Syn
drome (DHF/DSS). DF is marked by the onset of sud
den high fever, severe headache and pain behind the
eyes, in the muscles and in the joints. DHF is a more
severeform,inwhichbleedingandsometimesshockoc
curs leading to death. It is most serious in children.
Denguespreadsrapidlyandmayaffectlargenumbersof
peopleduringanepidemicresultinginreducedworkpro
ductivity, but most importantly causing the loss of lives
(WHO,FactSheetNo.117,2002).

Background
DF is endemic in most Caribbean countries as the vec
tor,theAedesmosquito(Ae.AegyptiandAe.Albopictus)
is ubiquitous. This disease is a worrisome problem as
thepotentialforDHFandDSSincreaseswiththeoccur
rence of more than one virus type in a given country
(Heymann D (ed.) 2004). All four dengue serotypes
have beenisolatedin the Caribbean, beginning in1952
with the introduction of dengue virus type 2 in Trinidad
andTobagotype3inPuertoRicoin196364type1in
Jamaica in 1977, which spread throughout most of the
Caribbean during 197778 and type 4 in 1981 in St.

CaribbeanEpidemiologyCentre(CAREC/PAHO/WHO)

Bathelemy and St. Maarten (CAREC, Annual Report,

1985).

Trends(19802005)
As DF is endemic in most Caribbean countries, cases
are reported every year. A total of 58,461 cases of DF
and1,386casesofDHF/DSShavebeenreportedduring
thetwentyfiveyearreviewperiod.Thegeneraltrendhas
been an increasing one, with outbreaks being reported
with increasing frequencyinrecent years. Thisislikely
tobeduetotwofactors,namelyimprovedreportingfrom
countriesandtrueincreasesintheoccurrenceofcases.
Asexpected,thetrendsinDHF/DSSreflectthetrendsin
DF, and an overallincrease has been seenin the num
bers of DHF/DSS cases reported with the circulation of
morevirustypes.
In 1981/82, type 4 virus reportedly caused an epidemic
involving Antigua and Barbuda, Barbados, Belize, Ja
maica, St. Lucia and Suriname (Review of Communica
bleDiseasesintheCaribbean1982.Between1983and
1993, outbreaks were reported by a few member coun
tries: 1984/85 Aruba (Type 1) 1986 Suriname and
Trinidad and Tobago (both Type 2) 1988 Barbados
(Type2)1989Bahamas(Typenotspecified)1990

MorbidityReview:DFandDHF/DSS

TrinidadandTobago(Types1,2and4)1992Trinidad
and Tobago (Type not specified) and 1993 Nether
landsAntilles(Typenotspecified).
In1995,5,083casesofDFwerereportedfromfourteen
countries.ThemajorityofcaseswerereportedfromBar
bados(42%),Jamaica(37%),Dominica(6%),andTrini
dadandTobago(6%).Virustypes1,2and4wereincir
culation during this multicountry outbreak (CAREC, An
nual Report, 1995) and two countries reported cases
with DHF/DSS, namely Jamaica (108 cases) and Gre
nada(5cases).In1996,87%ofthe4,135DFcasesre
ported to CAREC were from Trinidad and Tobago. In
November 1997, Dengue Virus Type 3 was identifiedin
Belizethiswasthefirstidentificationofthisvirustypein
a CAREC member country since the 1960s, although
this specific virus type was identified in Puerto Rico in
1977(CAREC,AnnualReport,1997).
In1998,outbreaksinvolvingallfourvirustypeswerere
portedAruba(Type3),Bahamas(Types1and4),Bar
bados (Type 2), Guyana and Jamaica (Type 3) and St.
Vincent and the Grenadines (Type 2). A total of 6,732
casesofDFwerereportedthatyearfromfourteencoun
tries. Four countries reported cases with DHF/DSS
TrinidadandTobago(136cases),Suriname(60cases),
Jamaica(42cases)andSt.Lucia(1case).

CaribbeanEpidemiologyCentre(CAREC/PAHO/WHO)

Between 1999 and 2004,Trinidad andTobago reported

58%ofthe25,917DFcasesrecordedatCAREC,while
SurinameandBarbadosreported13%and18%respec
tively. Trinidad and Tobago reported 75% of the 852
DHF cases reported in those years while Suriname re
ported24%ofthetotal.
The year 2002 saw a peak in the number of reported
cases with 8,099 DF and 298 DHF/DSS for the year.
Trinidad and Tobago, Barbados and Suriname ac
counted for 77%,9%and 6%of DF cases respectively
92% of the DHF/DSS cases forthat year were reported
from Trinidad and Tobago. It is notable that by 2003,
Type3virushadbeenidentifiedinallmembercountries
except Bermuda, Cayman Islands, Montserrat, and the
Turks and Caicos Islands (CAREC, Annual Report,
2003).
Itshouldbenotedthatlaboratoryconfirmationofdengue
fever (DF) and dengue haemorrhagic fever/dengue
shock syndrome (DHF/DSS) has increased in recent
years.During19952003,only311%ofDFcaseswere
laboratory confirmed, compared to 29% and 28% being
laboratory confirmed in 2004 and 2005 respectively.
During19952001,316%ofDHF/DSScaseswerelabo
ratory confirmed, compared to more than 20% being
laboratoryconfirmedfrom2002onwards.

MorbidityReview:DFandDHF/DSS

Figure9:Reported(andConfirmed)CasesofDengueFever
inallCARECMemberCountries
19802005
9,000
8,000

6,000
5,000
4,000
3,000
2,000

2005

2004

2003

2002

2001

2000

1999

1998

1997

1996

1995

1994

1993

1992

1991

1990

1989

1988

1987

1986

1985

1984

1983

1982

1981

1,000

1980

No.ofReportedCases

7,000

Year
TotalReportedCases

CaribbeanEpidemiologyCentre(CAREC/PAHO/WHO)

ConfirmedCases

MorbidityReview:DFandDHF/DSS
Table9:ReportedandConfirmedDengueFeverCases
Year

Country

Total

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

Anguilla

12

12

12

64

112

AntiguaandBarbuda

77

24

10

25

166

Aruba

76

28

173

277

Bahamas

87

336

180

605

Barbados

99

63

78

18

89

2,149

132

1,855

1,155

696

1,226

674

740

997

349

320

10,660
1,523

Belize

482

26

127

48

274

41

380

Bermuda

BritishVirginIslands

13

11

25

68

CaymanIslands

NetherlandsAntilles

24

21

580

265

890

Dominica

18

293

38

11

387

Grenada

11

21

37

27

12

84

20

272

Guyana

12

202

62

99

178

560

Jamaica

51

21

72

12

40

11

296

10

17

1,884

46

16

1,509

23

25

29

90

57

46

4,293

Montserrat

75

88

St.Lucia

23

31

164

65

14

24

57

301

43

11

11

781

St.VincentandtheGrenadines

21

89

56

205

152

589

St.KittsandNevis

10

27

89

20

178

Suriname

22

25

64

30

40

77

171

1,031

126

183

179

495

691

1,093

516

446

218

309

1,584

7,305

TrinidadandTobago

15

16

117

31

145

106

31

11

526

31

642

3,060

504

282

3,588

2,081

2,984

1,199

2,238

2,417

6,246

2,464

546

411

29,696

TurksandCaicosIslands

20

239

687

287

173

10

388

195

59

149

616

89

1,026

3,361

1,635

5,083

4,135

4,452

6,732

2,758

4,796

4,138

8,099

4,027

2,099

3,208

58,461

434

490

286

229

390

432

490

761

224

455

1,193

5,384

Total
Confirmedcases

107

DataSource:CARECSurveillanceDatabaseasatOctober2008

Notes:
Datanotavailable

CaribbeanEpidemiologyCentre(CAREC/PAHO/WHO)

MorbidityReview:DFandDHF/DSS

Figure10:ReportedCasesofDengueHaemorrhagicFever/Shock
SyndromeinallCARECMemberCountries
19942005
350

No.ofReportedCases

300

250

200

150

100

50

0
1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

Year
TotalReportedCases

CaribbeanEpidemiologyCentre(CAREC/PAHO/WHO)

ConfirmedCases

MorbidityReview:DFandDHF/DSS

Table10:DengueHaemorrhagicFever/ShockSyndromeCases
Country

Year

Total

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

Anguilla

AntiguaandBarbuda

Bahamas

Barbados
Belize

0
0

Bermuda

BritishVirginIslands

CaymanIslands

Dominica
Grenada

0
0

0
0

4
0

4
9

Guyana

0
108

0
0

42

Jamaica

0
0

150

Montserrat

St.Lucia
St.VincentandtheGrenadines
St.KittsandNevis

0
0

0
0

0
0

1
0

1
0

0
0

0
0

3
0

0
2

0
0

0
0

0
0

5
2
0

Suriname

0
81

60
136

69
65

85
54

21
93

18
273

4
106

5
40

96
0

366

TrinidadandTobago

TurksandCaicosIslands

113
4

6
0

82
13

239
24

134
12

139
17

117
12

298
67

110
28

45
15

100
50

1,386
242

Total
Confirmedcases

848

DataSource:CARECSurveillanceDatabaseasatOctober2008
Notes:
Datanotavailable

CaribbeanEpidemiologyCentre(CAREC/PAHO/WHO)