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Archive Number 20080808.2446
Published Date 08-AUG-2008
Subject PRO/EDR> Dengue/DHF update 2008 (32): France ex Cote d'Ivoire
DENGUE/DHF UPDATE 2008 (32): FRANCE ex COTE D'IVOIRE
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[ProMED-mail apologizes for the delay in posting. 
We usually post dengue/DHF updates as a weekly 
update given the high volume of reports of 
dengue/DHF activity worldwide. Given the 
importance of the information provided to us by 
GeoSentinel, we have decided to depart from the 
usual weekly update and post this report now.- Mod.MPP]

Date: 5 Aug 2008
From: GeoSentinel [edited]
<geosentinel@geomed.dom.uab.edu>


GeoSentinel, the global surveillance program of 
the International Society of Travel Medicine 
(ISTM) wishes to report what we believe to be the 
1st case of Dengue virus type 3 (DENV-3) from 
West Africa. A sentinel case in a returned 
traveler from Cote d'Ivoire may herald the 
beginning of a local outbreak and indicate the 
need for enhanced surveillance locally.

Dr. Philippe Parola at the Marseilles France 
Geosentinel site (MRS) has reported the molecular 
detection of a dengue 3 virus strain from the 
blood of a 53-year-old French expatriate living 
in Abidjan, the capital. He arrived in France on 
[17 Jul 2008] and was hospitalized 4 ([21 Jul 
2008]) days later because of high fever (40 
degrees C), headache, and a rash. At the time 
platelets were (103 000 /L), leukocytes (2.41 X 
10´9 /L); no malaria was found. At admission, IgM 
and IgG assays were negative for dengue and 
Chikungunya. However, PCR confirmed DENV-3 
viremia. The patient recovered by hospital day 6 
without complication or haemorrhage. The virus is 
currently being characterized by Professor X. de Lamballerie in Marseille.

In Africa, recent reports of epidemic or endemic 
dengue activity are usually from East Africa and 
dengue 2 (DENV-2) is usually isolated. Dengue is 
infrequently reported in West Africa. In 2000, a 
Dengue virus Type 1 had been isolated from a 
French soldier in Ivory coast (Emerg Infect Dis. 
2000;6(1):83-4.). Of importance is that DENV-3 
such as is reported here has recently caused 
unexpected outbreaks of dengue hemorrhagic fever 
(DHF) in Sri Lanka, East Africa and Latin America 
(Emerg Infect Dis. 2003 Jul;9(7):800-9.).

We have recently reported on the use of returned 
travelers as sentinels in the early detection of 
local outbreaks of dengue (Emerg Infect Dis. 
2008;14(7):1081-8.) in other parts of the 
world.  GeoSentinel sites and network members 
have intensified surveillance for further suspect 
cases, and we would appreciate hearing from 
others if they encounter such cases.

--
Communicated by:
Philippe Parola, MD, PhD <philippe.parola@univmed.fr> &
Philippe Gautret, MD, PhD, <philippe.gautret@ap-hm.fr>
Infectious Diseases and Tropical Medicine Unit,
Hopital Nord,
Marseille, France
and
David O Freedman, MD
For GeoSentinel
<geosentinel@geosentinel.org>

[ProMED-mail would like to thank our colleagues 
at GeoSentinel, Drs. Parola, Gautret and Freedman 
for this very complete report on the confirmation 
of this laboratory documented dengue type 3 
infection from an expatriate returning to France 
after living in Cote d'Ivoire. We look forward to 
further information as it becomes available. 
Thirty plus years ago, many dengue outbreaks were 
confirmed by infections in travellers returning 
to their home countries and not through country 
reports of dengue activity. In many instances, 
the travellers were returning tourists from 
Island beach holidays in countries that feared 
announcing an outbreak would result in "scaring" 
away tourism with a resultant negative economic 
impact. In other regions, the lack of 
infrastructure resulting in inability to perform 
laboratory confirmation of infections most likely 
contributed to the lack of reports.

This moderator has attempted a review of 
ProMED-mail archived postings on dengue/DHF 
(almost 1000 postings since 1994) looking for 
reports on dengue outbreaks in African countries. 
There was one posting on a suspected outbreak of 
dengue in Somalia in 2005 (see Dengue/DHF update 
2005 (08)]  20050423.1139), and another posting, 
earlier this year (2008) on an outbreak in 
Reunion, an Island in the Indian Ocean just east 
of  Madagascar (see Dengue/DHF update 2008 
(17)  20080429.1477). There was also a case 
report of a returning Taiwanese national who had 
been travelling in Madagascar prior to the onset 
of illness in 2006 (see Dengue/DHF update 2006 
(31)  20060911.2577).  There were no reports on 
dengue fever cases with known infection in West 
African countries, albeit dengue is known to be 
present. So this current report is the 1st report 
ProMED-mail has carried related to dengue virus 
transmission in West Africa.  Interestingly our 
archives reflect the observations mentioned by 
Drs. Parola, Gautret and Freedman -- no reports 
of outbreaks of dengue in West Africa, 2 reports 
of outbreaks in the East Africa region (Somalia 
and Reunion), and now 2 reports of dengue in 
returning travellers from Africa (one from 
Madagascar, and this present one from Cote d'Ivoire).

For a map of Cote d'Ivoire, see
<http://www.lib.utexas.edu/maps/africa/ivory_coast_pol88.jpg>
And for a map of the African continent, see
<http://www.lib.utexas.edu/maps/africa/africa_pol_2007.jpg>

For the interactive HealthMap/ProMED map of Cote 
d'Ivoire with links to other recent ProMED-mail 
postings on events in Cote d'Ivoire and 
surrounding countries, see <http://healthmap.org/promed?v=7.6,-5,5>. - Mod.MPP]

[see also:
Dengue/DHF update 2008 (31)  20080806.2407
Dengue/DHF update 2008 (30): Brazil  20080728.2305
Dengue/DHF update 2008 (29)  20080721.2211
Dengue/DHF update 2008 (28)  20080715.2144
Dengue/DHF update 2008 (27)  20080707.2059
Dengue/DHF update 2008 (26)  20080701.2005
Dengue/DHF update 2008 (25)  20080622.1933
Dengue/DHF update 2008 (24)  20080618.1901
Dengue/DHF update 2008 (23)  20080609.1831
Dengue/DHF update 2008 (22)  20080603.1776
Dengue/DHF update 2008 (21)  20080525.1716
Dengue/DHF update 2008 (20)  20080519.1668
Dengue/DHF update 2008 (10)  20080309.0962
Dengue/DHF update 2008 (05)  20080206.0483
Dengue/DHF update 2008 (01): Brazil  20080104.0052
2007
----
Dengue/DHF update 2007 (49)  20071218.4074
Dengue/DHF update 2007 (40)  20071022.3444
Dengue/DHF update 2007 (30)  20070730.2440
Dengue/DHF update 2007 (20)  20070514.1541
Dengue/DHF update 2007 (10)  20070225.0683
Dengue/DHF update 2007 (01)  20070103.0030
2006
----
Dengue/DHF update 2006 (31)  20060911.2577
2005
----
Dengue/DHF update 2005 (08)]  20050423.1139
....................mpp/ejp/mpp

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