In the Americas, at the end of the year 2014, a total of 1,176,529 cases of dengue, 16,238 severe dengue cases and 761 deaths, were reported, for a case fatality rate (CFR) of 0.06%. The average incidence for dengue was 194 cases / 100,000 populations. Despite the historical increase in the number of cases reported by this disease, 2014 reported a reduction of approximately 50% in the number of cases, severe dengue cases, and deaths compared to the year 2013. However, the CFR maintained its same value (0.06%).
In 2015, at the closure of the epidemiological week number (EW) 21, a total of 1,206,172 cases have been recorded in the entire continent, for an average incidence of 198 cases/ 100,000 populations. The data recorded to date have already exceeded the total number of cases reported in the end of 2014. However, it is important to emphasize and highlight, that although there is an increase in the number of cases, the total number of severe cases (2,824) and deaths (459) have remained well below the values observed during 2014. The average CFR in the Americas is 0.04%. Brazil, Colombia and Mexico have reported the simultaneous co-circulation of the four serotypes of the dengue virus.
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Dengue is a seasonal disease, and therefore, in the northern hemisphere of the continent the majority of the cases occur during the second half of the year, however, in the southern hemisphere the majority of the cases occur during the first semester of the year. For this reason, and including up to EW 21 of 2015, the sub region of the Southern Cone has reported a total of 1,054,188 cases, contributing 87% of the total cases of the continent, followed by the Andean Sub Region, and the North and Central America sub region, contributing 6% of the total cases. Only Brazil contributes 85% of the total number of cases in the continent (1,021,004 reported cases). The countries and territories with the highest incidence rate above the level of the regional rate are; Brazil (507.9 cases/ 100,000 populations), Paraguay (444.5 cases/ 100,000 populations), French Guiana (399.6 cases/ 100,000 populations), San Martin (269.6 cases/100,000 populations), and Honduras (234.6 cases/ 100,000 populations).
The greatest number of severe cases are observed in the Sub-Region of North and Central America, with a total of 1,415 reported cases, contributing more than half of the total of severe cases in the continent, followed by the Southern Cone sub region (736 severe cases, 26%) and the Andean Sub Region (647 severe cases, 23%). Even though the majority of severe cases are observed in the northern hemisphere, it is in the Southern Cone sub region that contributes to 82% (378 deaths) of fatality cases for this disease, all of which occurred in Brazil, followed by the Andean sub region (11%, 52 deaths), where Colombia and Peru contribute the most amount of deaths in this sub region. The countries in the continent with a CFR superior to the region (0.04%) are; Dominican Republic (1.54%), Peru (0.12%), Guatemala (0.07%) and Colombia (0.07%).
Description by sub-regions
North and Central America: The total number of cases reported was 72,683 cases, with an average incidence of 43.4 cases/100,000 populations, with 1,415 reported cases of severe dengue and 3 deaths reported. Mexico (30,497) and Honduras (20,471) are the countries with the highest amount of cases in this sub-region, with the latter country also reporting the highest incidence. All the deaths reported in this sub-region occurred in Guatemala.Andean: A total of 75,698 cases were reported, with an average incidence of 55 cases/ 100,000 populations, 647 severe cases, and 52 deaths. Colombia and Peru contribute the most amount of cases (43,228 cases and 20,698 cases respectively), the latter country reporting the highest CFR in the sub-region. It is noteworthy to mention that Venezuela has not yet presented its data regarding dengue in their country for this year.
Southern Cone: Historically, this sub-region contributes to about 50-60% of the total dengue cases in the Americas. A total of 1,054,188 cases were reported (incidence of 409.1 cases/ 100,000 populations), 736 severe cases, and 378 deaths. As previously mentioned, Brazil is the main contributor of cases, followed by Paraguay (30,749 cases).
Hispanic Caribbean: Only a total of 2,426 cases of dengue were reported, (incidence 9.5 cases/100,000 populations), however, this is the sub-region with the highest CFR (1.07%) of the continent. The Dominican Republic is the country that reports all of the deaths that occurred in this sub-region, with the total number of severe cases (26 reported cases) all resulted in death. It is noteworthy to mention that Cuba has not yet presented with the data for their country for this year.
English-French-Dutch Caribbean: To date, a total of 1,177 cases have been reported, however, being that this sub-region has the smallest population size the incidence rate is 198.5 cases/100,000 populations. It is the only sub-region that has not reported any deaths.
The problems with the supply of drinking water, as well as an inadequate system of sewage disposal and waste management, coupled with the lack of environmental control in homes and surroundings are the problems and/ or determinants that greatly facilitate the proliferation of mosquito breeding sites that contribute to the spread of this disease.
The PAHO/WHO continues to advice and supports all the countries in order to intensify technical measures for the prevention and control of dengue, based on the Integrated Management Strategy (IMS-Dengue) that the countries have implemented. In the month of June of 2015, an evaluation of Caribbean IMS-Dengue is being performed in Antigua, which included the participation of the following countries; Anguilla, Antigua and Barbuda, Barbados, British Virgin Islands, Dominica, Grenada, Montserrat, Saint Lucia, Saint Vincent and the Grenadines, Saint Kitts and Nevis, and Trinidad and Tobago. Also, recent training sessions regarding the clinical management of patients with dengue have been organized in Chile, Guatemala, and Peru, emphasizing the adequate management beginning from the first level of medical attention, in order to prevent disease progression to severe forms and also to prevent deaths. Similarly, cooperative technical support has been given to Paraguay and Peru for the control of outbreaks, through integrated vector control.
The integrated vector management is a priority for the Pan American Health Organization, and for this reason, in May 2015; a meeting was conducted at the headquarters of PAHO/WHO in Washington DC, with the participation of nearly 30 people, including entomologist experts, members of the GT-Dengue international and PAHO/WHO Staff, to strengthen medical entomology in the Americas. Likewise, the PAHO/WHO Regional Dengue Program is working on a new model of the Regional IMS-Dengue.
Finally, we note that the PAHO/WHO Regional Dengue Program has prepared a progress report on the prevention and control of dengue in the Americas, which will be presented at the 156.a Session of the Executive Committee.