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Dengue Fever, Zika and Chikungunya

 Situation Update:  22 April 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

Case numbers on this page were last updated on: 22 April 2016

DENGUE FEVER

For Dengue updates in the Western Pacific region see: http://www.wpro.who.int/emerging_diseases/DengueSituationUpdates/en/

Australia:

In more recent years dengue outbreaks have been confined to northern Queensland. Over the past 10 years, large outbreaks have occurred in the Torres Strait, Cairns, Mossman, Innisfail, Tully, Townsville and Charters Towers.

Charters Towers, Queensland. 
Outbreak details: Dengue Type 2, 5 confirmed local cases, 4 probable cases, outbreak declared: 3 March 2016. Source: https://www.health.qld.gov.au/news-alerts/health-alerts/dengue/default.asp 

Pallarendra, Queensland. 
Outbreak details: Dengue Type 2 reported. 1 confirmed local case, outbreak declared: 22 February 2016.

Townsville, Northern Queensland. 
22 Feb 2016. (confirmed) 1 case locally acquired, warning issued [indicating other undetected cases are present. - Mod.TY] http://www.townsvillebulletin.com.au/news/townsville-dengue-outbreak-confirmed/news-story/8e6d3ddf426000f244d4e4e0c582532b

Torres and Cape Hospital and Health Service, Queensland.
Outbreak details: Dengue Type 2, 19 confirmed local cases, outbreak declared: 22 March 2016.

Cairns and Hinterland Hospital and Health Service, Queensland.
Outbreak details: Dengue Type 4, 2 confirmed local cases, outbreak declared: 23 March 2016.

Fiji: 

18 Feb 2016. Dengue (confirmed) 94 cases. Divisions affected: Northern 56 cases, Western 36 cases, Central 5 cases. Increasing. http://www.fijitimes.com/story.aspx?id=342028

French Polynesia: 

There were 28 confirmed cases, including 2 hospitalisations for the week ending 10 April 2016. Dengue serotype 1 is in circulation. The weekly number of cases is decreasing. Source: French Polynesia Ministry of Health.

Kiribati: 

As of 24 January 2016 there have been 117 (DLI) cases seen since 3 January 2016.

New Caledonia: 

Two locally-acquired cases of Dengue-1 reported on 29 January 2016 – Source: Report from New Caledonia Department of Health and Social Affairs ”Point arboviroses en Nouvelle Calédonie au 29/01/2016"

Papua New Guinea:

A total of 170 cases were seen at the Daru Hospital Outpatient Department, Daru, Western Province from 4 November 2015 to 8 January 2016. There were a total of 126 clinical cases and 44 confirmed cases (2 confirmed by PCR as DENV-2). Age of cases ranged between 6 to 35 years with children less than 5 years representing 12% (21 of 170) of cases. Seven severe clinical cases were hospitalised, of which all have recovered and been discharged.

Samoa:

Four imported cases of dengue (undetermined serotype) with travel history to Samoa were reported by New Zealand ESR (Institute of Environmental Science and Research Ltd) for the period 27/02/2016 to 04/03/2016. Six imported cases of dengue (1 case of dengue-1, 2 cases of dengue-2 and 3 cases of dengue-3)  with travel history to Samoa were reported by Queensland Health (notifiable conditions data) for the period 1/01/2016 – 6/03/2016 available online.

Solomon Islands

Four imported cases of dengue (2 cases of dengue-3 and 2 cases of dengue undetermined serotype)  with travel history to Solomon Islands were reported by Queensland Health (notifiable conditions data) for the period 1/01/2016 – 6/03/2016 available online.

Dengue serotype 3 circulation reported. Several cases of dengue-like illness reported recently, 1 positive case of dengue (for NS1Ag, IgM and IgG) reported in December and DENV-3 has been identified in some samples sent to Louis Malardé Institute in Tahiti. Source: ad hoc report from country officials of 7 December 2015. One imported case of dengue (undetermined serotype) from Solomon Islands has been reported by Queensland Health (notifiable conditions data) – weekly communicable diseases surveillance report for the period 11/01/2016 – 17/01/2016 available online.

Tokelau:

One imported case of dengue-3 with travel history to Tokelau was reported by Queensland Health (notifiable conditions data) for the period 1/01/2016 – 6/03/2016 available online.

Dengue vaccine:  The WHO Strategic Advisory Group of Experts (SAGE) on immunisation has recommended that a vaccine for dengue, called Dengvaxia (CYD-TDV), be considered for use in geographic settings with high endemicity. Source: WHO


CHIKUNGUNYA

Fiji:

Two imported cases with travel history to Fiji reported by New Zealand ESR (Institute of Environmental Science and Research Ltd) for the period 20/02/2016 to 26/02/2016. Since 20 February to 15 April 2016 there have been 7 imported cases with travel history to Fiji.

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.

Whilst there is limited information on the risk of sexual transmission of Zika virus, due to the potentially serious implications of transmitting this virus to pregnant women, 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 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. Its 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 guidance for health professionals was last updated on 14 April 2016. Their latest resource for the public is a fact sheet called 'Zika: What we do and don’t know’ . The US CDC has now concluded that Zika virus is the cause of microcephaly and other severe fatal brain defects.

All Zika cases reported in New Zealand in 2014 and 2015 came from the Pacific Islands. Nearly 40 cases came from the Cook Islands in 2014, and five cases came in last year from Samoa (four) and Vanuatu (one).  In 2016 (up to 19 April): 86 cases (80 confirmed, 5 probable and 3 under investigation) were reported to EpiSurv. Of the 80 confirmed cases, 53 had travelled to Tonga, 22 to Samoa, 2 to American Samoa (1 case had been to Samoa and American Samoa), 1 to Papua New Guinea (with transit in Australia), 1 to Fiji, 1 to Venezuela and 1 case had not travelled overseas.

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.

Zika virus circulation has also been reported in Thailand and Maldives. 42 countries are experiencing a first outbreak of Zika virus since 2015, with no previous evidence of circulation, and with ongoing transmission by mosquitoes. Six countries (Argentina, Chile, France, Italy, New Zealand and United States of America) have reported locally acquired infection in the absence of any known mosquito vectors, probably through sexual transmission. 13 countries and territories worldwide have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases. Based on a growing body of research, there is scientific consensus that Zika virus is a cause of microcephaly and GBS. See: http://www.who.int/emergencies/zika-virus/situation-report/14-april-2016/en/.

A list of countries and territories that have recently experienced or are currently experiencing local Zika virus transmission can be found here: http://ecdc.europa.eu/en/healthtopics/zika_virus_infection/Zika-countries-with-transmission

ROSS RIVER VIRUS

No reports of current outbreaks.

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. As of 07 April, 1,708 suspected and confirmed cases including 238 deaths have been reported nationally.  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

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