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Dengue Fever, Zika and Chikungunya

 Situation Update:  23 November 2016

The notification rate for Dengue is increasing year by year. Dengue has now spread around the world, and is endemic in much of Asia, including India, and South East Asia. Popular tourist destinations such as Vietnam, Thailand and Cambodia are affected.

Dengue outbreaks are occurring across the Pacific - largely due to the urbanisation of these countries. In addition, the arboviral diseases Chikungunya and Zika are causing outbreaks in our region. Prevention of mosquito bites is the best protection.

The situation is changing daily. We try to keep this page up-to-date; however, we cannot guarantee full accuracy as we are dependent on reports from other providers.

For information on emerging diseases in the Pacific, refer to the weekly Pacific Syndromic Surveillance Reports: http://www.wpro.who.int/southpacific/programmes/communicable_diseases/disease_surveillance_response/page/en/index2.html

DENGUE FEVER

For Dengue updates in the Western Pacific region see: http://www.wpro.who.int/emerging_diseases/DengueSituationUpdates/en/
This includes updates on Australia, Malaysia, New Caledonia, Philippines, Singapore, Thailand and the pacific Islands.

Current outbreaks reported include dengue fever in French Polynesia (Denv-1), Solomon Islands (Denv-2 and Denv-3) and Federated States of Micronesia (Denv-4).

CHIKUNGUNYA

Please refer to the Ministry of Health's website and the WHO website for more information on chikungunya.

ZIKA

The virus is not carried by mosquitoes in New Zealand, but it can be carried by mosquitoes present in the Pacific Islands and Northern Queensland, and Zika cases have been reported in the Pacific in the last three years. There is no need for quarantine or isolation of people suspected to have Zika in New Zealand.

Zika virus can be sexually transmitted, hence the Ministry of Health has advised all men who travel to a Zika affected area with a pregnant partner to abstain from sexual activity or use barrier methods for the duration of the pregnancy. For advice for other groups please refer to the Ministry of Health page on Zika.
 
The Ministry of Health is also advising pregnant women and women wanting to become pregnant to delay traveling to places where the virus is currently circulating. If they are already in such a place, they should protect themselves against mosquito bites as much as possible and avoid pregnancy for 8 weeks after leaving the affected country. If the male partner has also travelled to a Zika area, the advice is to use condoms or abstain from sexual activity for 6 months post leaving a Zika affected area.  Bite-prevention advice, along with the latest information on currently-affected countries, is published on the New Zealand Ministry of Health’s website, and on the Safe Travel webpage on the zika virus.

The Ministry of Health's interim guidance for health professionals was last updated on 27 July 2016. Their latest resource for the public is a fact sheet called 'Zika: What we do and don’t know’ updated in July 2016. The US CDC has now concluded that Zika virus is the cause of microcephaly and other severe fatal brain defects.

Currently in the Pacific, Zika cases have been reported in 2016 in American Samoa, Fiji, Federated States of Micronesia (Kosrae State), Marshall Islands, Samoa, and Tonga.

For Zika surveillance data in New Zealand refer to the weekly reports done by ESR, located here.

A list of countries and territories that have recently experienced or are currently experiencing local Zika virus transmission can be found on the ECDC website.

Click
here for the latest ARPHS Health Professional Advice on Zika released 23 November 2016.

ROSS RIVER VIRUS

For information about Ross River Virus see the CDC webpage.

The Pacific Public Health Surveillance Network has published a live map of disease alerts in the Pacific region. These can be searched for by date, disease type and whether they are increasing or decreasing. Click on the live map below for more information. It will open as a separate webpage.

YELLOW FEVER

An outbreak of yellow fever has been reported in Angola (Africa). The outbreak started in the capital city of Luanda in December 2015 and has since spread to 16 of the country’s 18 provinces. Cases of yellow fever have been exported during this outbreak by travellers to countries including China, Democratic Republic of Congo (DRC) and Kenya. Namibia and Zambia are on high alert for imported cases. See: http://www.who.int/features/2016/angola-worst-yellow-fever/en/ and http://www.who.int/csr/don/archive/disease/yellow_fever/en/

Aedes aegypti mosquito in flight.

What are dengue, Zika, and chikungunya?

Dengue, Zika, and chikungunya are all diseases caused from being bitten by infected Aedes mosquitoes, which are present in many tropical countries, Asia, and the Pacific.

Dengue fever emerged as a worldwide problem in the 1950s, and is becoming more and more widespread. With more than one-third of the world's population now living in areas at risk of infection, dengue virus is a leading cause of illness in the tropics and subtropics. Up to 400 million people are infected worldwide every year.

Zika and chikungunya spread to Asia and the Pacific in 2013.

How do you catch dengue, Zika, and chikungunya?

You catch these illnesses by being bitten by mosquitoes that live in many popular tourist destinations, such as Southeast Asia and the Pacific Islands. You cannot catch dengue, zika, or chikungunya in New Zealand, and if you have returned to New Zealand with one of these illnesses, you cannot infect other household members.

What are the symptoms of dengue, Zika, and chikungunya?

Dengue fever usually begins with a sudden onset of a high fever and a severe headache. Those affected may also get a skin rash and muscle and joint pain. Nausea, vomiting, and loss of appetite are common. The illness usually lasts up to 10 days, but recovery may take some time, and people can feel tired and depressed for weeks.

Zika and chikungunya cause similar illnesses to dengue, but tend to be milder. However, they can still cause an unpleasant illness with painful joints and skin rashes and zika has recently been linked with severe abnormalities in unborn babies.


Image taken from UpToDate (2016)

How are dengue, Zika, and chikungunya diagnosed?

All are diagnosed by a combination of typical symptoms, and blood tests.

How are dengue, zika, and chikungunya treated?

There is no specific treatment for dengue, zika, and chikungunya, but it is important to take paracetamol rather than aspirin for the fever, headache and muscle pains with dengue, as aspirin can increase the risk of bleeding. People should also rest and drink plenty of fluids. Those who become more unwell may need hospital treatment with fluids into their veins and close monitoring, to make sure they don’t start to bleed or lose too much fluid from their bloodstream.

How can dengue, zika, and chikungunya be prevented?

Aedes aegypti mosquito biting a human hand.

There is no vaccine to protect against dengue, Zika, and chikungunya, and no drugs you can take to prevent them (like you can with malaria). The most effective way to protect against it is to avoid mosquito bites. Please note that these mosquitoes bite during all hours of the day, not just in the evenings:

  • Apply insect repellent to skin. The most effective repellents are those containing DEET (diethyl toluamide) – at a concentration of between 30% to 50%, or picaridin - at a concentration of 20%. You can apply repellent over sunscreen.
  • Wear clothing that covers the arms and legs
  • Wear hats and shoes (rather than sandals)
  • Apply permethrin insecticide to clothes
  • Use mosquito nets impregnated with permethrin
  • Use electric insect-repellent devices, or mosquito coils
  • When possible, stay in accommodation that has screens on doors and windows, or is air-conditioned.

Can dengue, Zika, and chikungunya be fatal?

There is a severe form of dengue fever - known as dengue haemorrhagic fever - which can cause bleeding and collapse, and can be fatal. This is more common in people who get dengue fever more than once. Dengue haemorrhagic fever is fatal in about five percent of cases, mostly among children and young adults. This risk is important for Pacific peoples who may make a number of visits back to their home country over the years, and so risk repeat infections. 

Zika and chikungunya are not thought to cause fatal illnesses in adults, though there is increasing concern that Zika causes severe illness and death in unborn babies.

What does the public health service do?

Auckland Regional Public Health Service (ARPHS) receives notifications of all cases of dengue, Zika and chikungunya in the Auckland region, and is responsible for investigating the country of origin of infection, and giving health advice to prevent further infection. ARPHS also works to make sure exotic mosquitoes do not become established in Auckland.

Useful Links

Download the fact sheet

This includes updates on Australia, Malaysia, New Caledonia, Philippines, Singapore, Thailand and the pacific Islands.

Current outbreaks reported include dengue fever in French Polynesia (Denv-1), Solomon Islands (Denv-2 and Denv-3) and Federated States of Micronesia (Denv-4).

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