Dengue haemorrhagic fever and Japanese B encephalitis in Indonesia

Dengue haemorrhagic fever (DHF) was first recognized in Indonesia in the cities of Jakarta and Surabaya in 1968, 15 years after its recognition in the Philippines. During the 1968 outbreak, a total of 58 clinical cases with 24 deaths were reported. The number of reported cases since then has increased sharply, with the highest number of cases recorded in the years 1973 (10,189 cases), 1983 (13,668 cases), and 1985 (13,588 cases). Outbreaks of the disease have spread to involve most of the major urban areas, as well as some of the rural areas. In 1985, the disease had spread to 26 of 27 Provinces and 160 of 300 regencies of municipalities. At present, the disease is endemic in many large cities and small towns. Interestingly, DHF has not been reported in some cities, even though dengue virus transmission rates in those cities are high. The epidemic pattern of DHF for the country as a whole has become irregular. Since 1982, the intensity and spread of DHF has created an increasing public health problem in Indonesia, particularly in Java where 60% of the total population of the country resides. Java contributed about 71% of all cases occurring in the country in 1982, 84% in 1983, and 91% in 1984. The peak monthly incidence of DHF was frequently reported during October through April, months which coincide with the rainy season. The morbidity rate for Indonesia, estimated from reported cases over five years (1981-1985), ranged between 3.39 to 8.65 per 100,000 population. The overall case fatality rate has steadily declined from 41.3% in 1968 to 3% in 1984.(ABSTRACT TRUNCATED AT 250 WORDS)     

Dengue virus isolation in Indonesia, 1975-1978.

Virus isolations from dengue hemorrhagic fever patients in Indonesia are reported from 1975 to 1978. All 4 dengue serotypes were endemic in Jakarta, but dengue 3 was the predominant virus isolated. This type was also the most frequently isolated virus from patients outside Jakarta and had the widest distribution in Indonesia. The sensitivity of the mosquito inoculation technique for isolation of dengue viruses is discussed.     

Mangroves protected villages and reduced death toll during Indian super cyclone

Protection against coastal disasters has been identified as an important service of mangrove ecosystems. Empirical studies on this service have been criticized, however, for using small samples and inadequately controlling for confounding factors. We used data on several hundred villages to test the impact of mangroves on human deaths during a 1999 super cyclone that struck Orissa, India. We found that villages with wider mangroves between them and the coast experienced significantly fewer deaths than ones with narrower or no mangroves. This finding was robust to the inclusion of a wide range of other variables to our statistical model, including controls for the historical extent of mangroves. Although mangroves evidently saved fewer lives than an early warning issued by the government, the retention of remaining mangroves in Orissa is economically justified even without considering the many benefits they provide to human society besides storm-protection services.     

Indomethacin-induced rises in blood pressure

The role of prostaglandins in the control of blood pressure is not well understood. Prostaglandins of the 2 series are ubiquitous local hormones derived from the unsaturated fatty acid, arachidonic acid. Prostaglandins are produced by most mammalian cells. Locally produced prostaglandins may modulate blood pressure by opposing the vasoconstrictor effect of norepinephrine and angiotensin II, as well as by limiting the extent of sympathetic neurotransmission. In addition, renally generated prostaglandins are involved in the release of renin, inhibition of antidiuretic hormone action, and excretion of sodium chloride. Because prostaglandins have multiple effects in the kidney, vasculature, and sympathetic neurotransmission, the use of nonsteroidal antiinflammatory drugs (which inhibit prostaglandin synthesis) has not resulted in a consistent effect on blood pressure in humans. Clinical studies using indomethacin have reported an increase, no change, or a decrease in blood pressure after drug administration. Because of this unpredictability in response, the addition of a nonsteroidal antiinflammatory drug to an already hypertensive patient should be followed by more frequent blood pressure measurements.     

Dengue in pregnancy

This was a retrospective study of patients with dengue infection in pregnancy from year 2000 till 2004. Data were analyzed by looking at the presentation, complications of patient and fetus, and pregnancy outcomes. There was a total of 16 cases with an increasing trend (0.12% in 2003 vs 0.25% in 2004). The mean age of patients was 30.19+/-6.85 years. Fifty percent of patients were multiparae and in their third trimester. The average gestation was 24.44 weeks with 7.5 days being the average duration of ward admission. Tourniquet test was positive in 62.5% of patients. Dengue serology IgM was positive in 50% whereas dengue serology IgG were positive in 68.8% of patients. There were three cases of maternal death. One patient presented as missed abortion. Preterm deliveries happened in 50.0% of the women. There were 4 premature babies, one in-utero fetal death, and two fetuses which suffered acute fetal distress. Three babies required intensive care. One unrelated fetal anomaly resulted in early neonatal death.     

Dengue

The four dengue viruses are transmitted in tropical countries that circle the globe. All can cause syndromes that are self-limited or severe. The common severe syndrome--dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS)--is characterised by sudden vascular permeability generated by cytokines released when T cells attack dengue-infected cells. Dengue 1 virus became prevalent in Hawaii where it was transmitted by Aedes albopictus, producing a classic virgin soil epidemic, with clinical disease seen largely in adults. In Cuba and Singapore, sequential dengue infections at long intervals produced unusually severe disease in adults. Evidence suggests that enhancing and cross-reactive neutralising antibodies regulate dengue epidemics and disease severity. Classic DHF/DSS arises during initial dengue infections in infants with low circulating amounts of maternal dengue antibodies, an observation that precludes an exclusive causal role for secondary T-cell responses. Here, I review and discuss data on clinical diagnosis and pathophysiology of vascular permeability and coagulopathy, parenteral treatment of DHF/DSS, and new laboratory tests.     

Dengue

PURPOSE OF REVIEW: Because efforts to control dengue are flagging, this review focuses on the mechanisms underlying severe disease and on treatment options, good and bad. RECENT FINDINGS: The year 2001 witnessed unprecedented global dengue epidemic activity in the American hemisphere, the Pacific islands and continental Asia. Early diagnosis of dengue is important but what is the value and appropriate use of the tourniquet test? A negative test does not rule out dengue infection, a positive test should be followed by close surveillance for early signs of dengue hemorrhagic fever. Low platelet counts do not predict clinically significant bleeding in dengue. It follows that platelet or blood transfusions should not be administered based upon platelet count alone. Dengue hemorrhagic fever or dengue shock syndrome cases frequently have compensated consumptive coagulopathy that seldom requires treatment. Bleeding is most likely caused by activated platelets resulting from damaged capillary endothelium. Dengue hemorrhagic fever and dengue shock syndrome can be safely treated with just normal saline. Colloids should be immediately given to children presenting with a pulse pressure at or below 10 mmHg. Human leukocyte antigen alleles correlate with both protection and susceptibility to dengue hemorrhagic fever and dengue shock syndrome; studies in Haiti suggest that blacks have a gene providing nearly complete protection against severe dengue illness. SUMMARY: The role that antibodies play in protecting and enhancing dengue infections has been largely ignored. Such studies require definitive knowledge of what cells are infected in human dengue and an understanding of all the early antibody-accessible steps of infection of these target cells.     

Risk of Dengue in Travelers: Implications for Dengue Vaccination

Purpose of Review

Dengue is found in tropics and subtropics that are considered to be popular travel destinations. We set out to review the burden of dengue on international travelers.

Recent Findings

GeoSentinel, a global network of travel medicine providers, has seen an increasing trend of dengue in returning travelers over the past decades. In Southeast Asia, annual proportionate morbidity increased from 50 dengue cases per 1000 ill-returned travelers in non-epidemic years to an average of 159 cases per 1000 travelers during epidemic years. Dengue is the leading cause of fever in returning travelers, having overtaken malaria for travelers to Southeast Asia. Most dengue seroconversion studies in travelers report an attack rate of around 5% depending on duration of travel and destination.

Summary

Dengue vaccination would be justified for travelers. The first licensed dengue vaccine CYD-TDV is only recommended in seropositive individuals. This review considers preventive measures including how best to use the first licensed dengue vaccine CYD-TDV.

     

Correlation between rises of gonadotrophins and rises of sex steroids during clomiphene test in men.

Serum FSH, LH and testosterone and urinary excretion of androsterone, aetiocholanolone, dehydroepiandrosterone and total oestrogens were measured in normal and oligospermic men before and after clomiphene stimulation. Responses in all parameters were highly variably from one individual to another and this great variation formed the basis for investigating the correlations between responses. There was no correlation between increase of FSH and LH or increase of LH and steroids. Also there was no correlation between rises of FSH and rises of androgens. But a significant correlation existed between rises of FSH and rises of oestrogens. This confirms that one action of FSH is to stimulate production of testicular oestrogens which presumably takes place in the Sertoli cells.