Dengue haemorrhagic fever in children in Delhi.

An epidemic of dengue haemorrhagic fever occurred in Delhi during 1988. A total of 21 paediatric patients with dengue haemorrhagic fever/dengue shock syndrome were evaluated from September to November 1988. All the patients had fever, restlessness, ecchymotic spots and ascites. Pleural effusion occurred in 19 patients (90%), and 18 (86%) exhibited each of the following: vomiting, thrombocytopenia, and haemoconcentration. Hepatomegaly was observed in 15 patients (71%) and splenomegaly in three (14%). Titres of haemagglutination inhibition (HI) antibodies against dengue virus type 2 were raised in all the 15 cases from whom sera were collected during the acute stage. Convalescent sera from five patients had increased titres of HI antibodies to dengue virus type 2. The remaining 10 cases exhibited raised IgM antibody levels against dengue virus type 2. The fatality rate for serologically proven cases was 13% (2 of 15 patients), while for all patients (including those diagnosed clinically (6) and serologically (15)) it was 33.3% (7 of 21). Patients who survived had no sequelae, except one who had transient hypertension that lasted for two weeks.     

Dengue haemorrhagic fever—case report

A 29-year-old Dutch tourist of the Caucasian race had to break her return journey from Indonesia as she developed dengue haemorrhagic fever. She appeared to have been infected on Bali. Serological investigation revealed very high antibody titres against dengue virus types 1 and 3 and a moderately high titre against type 4 virus in the serum sample collected two weeks after onset of disease. In the sample taken 14 weeks after onset only more normalized antibody titres against type 1 and type 3 remained detectable. Although during earlier trips to the tropics she never showed signs of dengue fever, the timing of her first infection remains uncertain. The influence of age, race and double infections is discussed with relation to the cause of dengue haemorrhagic fever.     

Dengue haemorrhagic fever in Cuba. II. Clinical investigations

Clinical and serological studies were carried out on 114 patients admitted to hospital in Havana, Cuba with Dengue Haemorrhagic Fever and Dengue Shock Syndrome (DHF/DSS). Serological confirmation of dengue was obtained in 90% of cases, with 5% of cases primary and 95% secondary. Fever, haemorrhagic manifestations, vomiting and headache were the most frequent signs and symptoms. Among haemorrhagic manifestations, petechiae and vaginal bleeding were reported in a larger number of patients. 21 patients presented shock and, of these, 20 were secondary infections. The disease appeared more frequently in white persons and in women. The aetiopathogenicity of the syndromes is discussed. 95% of the cases could be explained on the basis of the secondary infection hypothesis.     

Dengue haemorrhagic fever/dengue shock syndrome: lessons from the Cuban epidemic, 1981

Dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS) is one of the principal causes of hospitalization and death among children in several south-east Asian countries. Also, in the Region of the Americas, there has been an increase in the frequency of dengue fever epidemics and in the number of cases of DHF/DSS. In 1981 an epidemic of dengue haemorrhagic fever occurred in Cuba and this suggests that there is a high risk that such epidemics could recur in the region. The article summarizes the main clinical, virological, and epidemiological data obtained during the outbreak, some of which are reported for the first time.     

2009-2015年天津市登革热流行风险分析

目的 分析天津市登革热流行风险,为登革热防治提供科学依据。 方法 根据天津市蚊虫密度监测,白纹伊蚊登革热病毒携带检测,登革热发病报告等资料,采用矩阵法对天津市登革热流行风险进行分析。 结果 2009-2014年天津市全境存在登革热传播媒介白纹伊蚊,密度在0.02~0.1只/(小时×灯)之间,构成比在0.12%~0.6%,2011,2013年有2例输入性病例,白纹伊蚊登革热病毒携带检测阴性,2015年8,9月布雷图指数大于5,经分析天津市登革热流行风险为低风险,但有发生流行的可能。 结论 鉴于登革热可能在天津发生流行,为做好登革热防控工作,应进一步做好登革热传播媒介白蚊伊蚊,媒介病毒携带监测,传播媒介控制,医务人员防治技术培训,大众防治知识宣传等方面工作。     

Dengue haemorrhagic fever in Cuba. I. Serological confirmation of clinical diagnosis

Serological studies by the haemagglutinin inhibition test to confirm a clinical diagnosis of dengue were done on 406 patients during the dengue 2 epidemic in Cuba in 1981. 49% of the cases were serologically positive; of these 64% was classified as primary and 36% as secondary. The frequency of symptoms is described: the most frequent were fever, headache, malaise and vomiting. Haemorrhagic manifestations predominated significantly in the secondary cases. The white race and female sex were found to predominate in the positive cases.     

Dengue type 1 epidemic with haemorrhagic manifestations in Fiji, 1989-90.

A dengue type 1 epidemic occurred in Fiji between July 1989 and July 1990. Virus isolation in C6/36 cell cultures and Toxorhynchites mosquitos yielded 36 strains. Of the 3686 cases recorded by the Ministry of Health, 60% involved indigenous Fijians and 37%, Indians. A house-to-house survey revealed that a large majority of patients had classical dengue symptoms and 8% reported haemorrhagic manifestations. Among the children and adults hospitalized for dengue, 43% had haemorrhagic manifestations, including epistaxis, gingival bleeding, haematemesis, melaena and haematuria. A total of 15 patients with haemorrhagic manifestations and/or shock died, 10 of whom were aged 0-15 years; the diagnoses were confirmed in four cases by virus isolation or serology.     

咸宁县流行性出血热流行病学调查

The incidence, distribution pattern and trend of disease spreading of EHF in Xianning Country, Hubei province during 1971-1985 are described. Serologic study showed that the serum antigen positivity rate was 12.90% for Apodemus Agragrius and 6.67% for Rattus Norvegicus and that the serum antibody positivity rate was 61.54% in FHF patients and 30.85% in the exposed contacts of the patients' families in the epidemic area. In 1985, the HFRS virus A24 was isolated from Apodemus Agragrius and identified.     

2004-2008年云南省登革热流行现状

目的分析云南省2004-2008年登革热流行态势,为制定预防控制措施提供参考依据。方法收集2004-2008年网络直报系统登革热疫情统计数据、卡片个案及现场调查等信息,用Arc View GIS3.3及Excel2007软件对2004-2008年登革热流行形式进行分析和描述。结果 2004-2008年云南省共报告登革热病例116例,除2月外各月均有病例报告,病例主要集中在8-11月,以9-10月最多。104例为来自缅甸、老挝为主的东南亚各国的输入病例,12例为本地感染病例。就诊属地县（市、区）涉及10个一线边境县（市、区）及4个非边境县（市、区）。本省、外省、外籍各类人群均有一定数量的病例报告。男性病例多于女性;70岁以下各年龄组均有发病,但发病数以0～9、15～29、35～39及50～54岁年龄组居多,占72.41%（84/116）;职业分布以商业服务者、农民、学生、工人、散居儿童、干部职员和民工为主。结论云南省登革热主要为输入或输入引起本地传播的病例,我国与缅甸、老挝接壤的边境地区是登革热预防控制的重点地带,男性、商业服务者、农民、学生、工人和散居儿童是感染该病高风险人群和重点防控对象。     

Dengue haemorrhagic fever integral hypothesis: confirming observations, 1987-2007

In 1987, Kouri et al. published in Transactions their integral hypothesis to explain the development of dengue haemorrhagic fever (DHF) epidemics (Kouri, G.P., Guzmán, M.G., Bravo, J.R., 1987. Why dengue haemorrhagic fever in Cuba? 2. An integral analysis. Trans. R. Soc. Trop. Med. Hyg. 81, 821-823). Based on observations carried out during the 1981 Cuban DHF epidemic, the authors integrated in one model the most advanced knowledge at that time. Observations in the last 20 years confirm the importance of this multifactorial and unifying view of the problem, where the interaction between the host, the virus and the vector in an epidemiological and ecosystem setting might determine DHF as a final outcome. Investigations on the interaction among host, virus and mosquito with an ecosystemic view are needed.     

小盾纤羔螨自然感染流行性出血热病毒的调查研究

Leptotrombidium (L.) scutellare was considered to be the suspected vector of epidemic haemorrhagic fever (EHF). In order to clarify the relationship between this mite and EHF, from Oct to Nov 1988 and Oct of 1989, the larvae of this mite were collected from rats in areas with constantly high incidence of EHF in Shanxi Province and larvae with only small quantity of meal were selected and for more than 15 days before isolation of EHFV. Six strains of virus were isolated. The viruses isolated were identified to be EHFV by serum test, immunofluorescent blocking test as well as neutralization test. The above results further demonstrate this mite can naturally be infected by EHFV and therefore serve as vector of EHF.     

Dengue haemorrhagic fever �� a public health problem and a field for research

Dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS) is an enigmatic and growing public health problem which is confined at present to countries of South-East Asia. Since 1956, over 350 000 patients have been hospitalized and nearly 12 000 deaths have been reported. Dengue viruses, a group of four flaviviruses, are transmitted to man by Aedes aegypti. Currently, dengue viruses are actively transmitted in 61 countries which circle the globe in the tropical zone and have a combined population of 1500 million. Because the precise antecedents to DHF/DSS are unknown, the public health hazard posed by this syndrome is potentially worldwide. Epidemiological studies in South-East Asia clearly link DHF/DSS to individuals who have had a previous dengue infection or who have acquired maternal dengue antibody. Such antibody may serve as an opsonin, enhancing dengue virus infection of mononuclear phagocytes—the type of cell in man to which dengue infection may be confined. Antibody-mediated infection of these cells is the central concept in the hypothesis of immune infection enhancement. This hypothesis provides a conceptual framework for design of future research. There is an urgent need for a comprehensive identification of ”risk factors” in DHF/DSS. This research could be approached by undertaking comparative prospective epidemiological studies in dengue-endemic areas with and without DHF/DSS. Although important progress is being made in the development of attenuated dengue vaccines for each dengue type, a clearer understanding of the pathogenesis of DHF/DSS may be required to provide guidelines for safe and lasting immunoprophylaxis in man.     

Dengue hemorrhagic fever outbreak in children in Port Sudan

Dengue fever (DF)/dengue hemorrhagic fever (DHF) has emerged as a global public health problem with countries in Asia and the Pacific sharing more than 70% of the disease burden. In 2004-2005 a total of 312 cases admitted to Pediatric and Sea Port Hospitals in Port Sudan were clinically diagnosed as DHF. The mortality rate recorded was 3.8% (n=12). Of the cases 73.4% were patients 5-15 years of age. A total of 91.2% of cases were admitted during May and June 2005 with 49.4% residing in the eastern region of Port Sudan. Dengue shock syndrome was observed in 37 of 312 (11.9%). All patients had thrombocytopenia with platelets count ranged from <100,000 to <150,000 cell/mm3. Of the 40 sera tested using RAPID-cassette test in the Khartoum Central Public Health Lab, 36 (90%) were dengue IgM positive. A subset of these sera (n=23) were sent to NAMRU-3 and confirmed by IgM-capture ELISA; 9 of 23 were PCR positive for dengue serotype 3.     

Dengue fever epidemic potential as projected by general circulation models of global climate change.

Climate factors influence the transmission of dengue fever, the world's most widespread vector-borne virus. We examined the potential added risk posed by global climate change on dengue transmission using computer-based simulation analysis to link temperature output from three climate general circulation models (GCMs) to a dengue vectorial capacity equation. Our outcome measure, epidemic potential, is the reciprocal of the critical mosquito density threshold of the vectorial capacity equation. An increase in epidemic potential indicates that a smaller number of mosquitoes can maintain a state of endemicity of disease where dengue virus is introduced. Baseline climate data for comparison are from 1931 to 1980. Among the three GCMs, the average projected temperature elevation was 1.16 degrees C, expected by the year 2050. All three GCMs projected a temperature-related increase in potential seasonal transmission in five selected cities, as well as an increase in global epidemic potential, with the largest area change occurring in temperate regions. For regions already at risk, the aggregate epidemic potential across the three scenarios rose on average between 31 and 47% (range, 24-74%). If climate change occurs, as many climatologists believe, this will increase the epidemic potential of dengue-carrying mosquitoes, given viral introduction and susceptible human populations. Our risk assessment suggests that increased incidence may first occur in regions bordering endemic zones in latitude or altitude. Endemic locations may be at higher risk from hemorrhagic dengue if transmission intensity increases.     

Serodiagnosis of Crimean-Congo haemorrhagic fever.

Several methods for demonstrating antibody to Crimean-Congo haemorrhagic fever virus were compared on serum samples taken from 101 patients during the acute stage of illness and at intervals for up to 59 months thereafter, with emphasis on early detection of the immune response. The deaths of 23 patients on days 5-14 of illness were ascribed to the effects of the disease; two patients died later from other causes. Very few of the patients who died from the acute illness mounted an antibody response detectable by the methods tested. Four patients who died and 18 who recovered were treated with immune plasma collected from recovered patients. Treated patients acquired IgG antibody from the plasma, but it was possible to discern the onset of an endogenous IgM response in those individuals who survived the disease by all of the methods tested. Indirect immunofluorescence (IF) tests detected IgM and/or IgG antibodies at the earliest on day 4 of illness in about 10% of patients who survived the disease, and by day 9 all survivors had antibodies demonstrable by IF. A biotin-streptavidin IF technique offered no advantage over the standard IF test for the early detection of IgG antibody, but demonstrated higher antibody titres and detected IgM antibody earlier in about a quarter of the patients tested. An IgM-capture enzyme-linked immunoassay (ELISA) and an IgG sandwich ELISA demonstrated higher antibody titres than did IF tests, and detected antibody responses at an earlier stage of infection than did IF tests in about one-fifth of patients, but the reverse was true in a similar proportion of instances. A competition ELISA, which detected total antibody activity, produced lower titres than did the IgM and IgG ELISAs, but yielded results which were in close agreement with the findings in IF tests. It was concluded that the IF tests were most convenient for use in making a rapid serodiagnosis of the disease.