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

Dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) is one of the major causes of hospitalization and death in people living in southeast Asia. Until recently, the incidence of DHF/DSS and dengue fever in the Americas has been limited. In 1981, there was an epidemic of dengue hemorrhagic fever in Cuba, with 344,203 reported cases, with 10,312 severe illnesses and 158 deaths. The clinical, virological and epidemiological findings from 124 cases of DHF/DSS in children and 104 cases in adults, including 57 deaths of children and 26 of adults are reported. The dengue virus, serotype 2, was isolated from affected individuals and from Aedes aegypti mosquitoes, which are the insect vector of the virus. Clinical symptoms of children included fever, rash (hemorrhagic manifestations), gastrointestinal illness, petechiae (minute areas of hemorrhage in the skin), stomach pain, enlarged liver, and shock occurring after sudden onset of fever and vomiting. The mean age of the children who were hospitalized was four years old. In areas where the disease is endemic, adults do not generally develop dengue fever, as they are usually infected as children and thus develop immunity to the virus. Therefore, this is the first time clinical data has been reported in adults. In adults, the disease was characterized by fever, gastrointestinal symptoms, purpura, upper gastrointestinal bleeding, swelling of the liver, abdominal pain, and shock. Risk factors included the existence of antibodies to dengue virus, and preexisting chronic diseases including asthma, sickle cell anemia and diabetes mellitus. Children, adult women, and whites were at greatest risk. The epidemic was brought under control, thanks to the rapid diagnosis and early treatment of the disease and to the eradication of the mosquito vector. The economic cost of the epidemic was estimated to be about $103 million. It is felt that other epidemics of DHF/DSS in this region may occur, because there are at least three subtypes of the dengue virus circulating to which individuals are not immune, and because the mosquito vector is abundant in other areas outside of Cuba. (Consumer Summary produced by Reliance Medical Information, Inc.)
Introduction Although circulation of dengue virus has been widely documented in the Region of the Americas, reports of dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS) have been sporadic--in contrast to the [...]