Academic journal article Bulletin of the World Health Organization

Dengue in China: A Clinical Review

Academic journal article Bulletin of the World Health Organization

Dengue in China: A Clinical Review

Article excerpt

History of dengue in China

Epidemics of dengue-like illness in China were not uncommon in the 1940s. For example, in 1947, an epidemic of febrile illness, suspected to be dengue fever (DF), occurred along the south-east coast of China, including Shanghai city and the coastal areas of Jiangsu, Zhejiang and Fujian Provinces. Etiological and epidemiological investigations were not carried out on this or other epidemics. From 1950 to 1978, outbreaks of dengue-like illness were not reported in China.

Since 1978 three etiologically documented outbreaks of DF and an epidemic of dengue haemorrhagic fever (DHF) caused by all four virus serotypes have occurred in south China. An epidemic of DF due to dengue virus type 4 (DEN-4 virus) occurred in Foshan city, Guangdong Province in 1978[1-3]. A more localized outbreak of mild DF due to dengue virus type 1 (DEN-1 virus) occurred in Zhongshan County, Foshan Prefecture, Guangdong Province, in 1979, followed by a large epidemic caused by dengue virus type 3 (DEN-3 virus) on Hainan Island in 1980 (4-6 and Qiu, F.-X., unpublished data, 1980). In 1985-86 an epidemic of DHF caused by dengue virus type 2 (DEN-2 virus) occurred in the same areas of Hainan Island[7].

Circumstantial evidence suggested that the dengue viruses causing these four outbreaks may have been imported. In the late 1970s there was considerable commercial activity between Guangdong Province, Hainan Island, and south-east Asia. Beginning in 1977, many south-east Asian tourists visited southern China, thus providing the ideal means of importing new strains or serotypes of dengue viruses into the country[8]. Moreover, the population densities of Aedes mosquitos were high in these areas of south China, thus putting them at high risk for epidemic transmission of dengue fever when new strains/serotypes of viruses were introduced. Serological data from the 1978 epidemic, however, suggested that most cases had a secondary-type serological response, indicating that, despite the absence of previous epidemics, dengue viruses were endemic in the area.

Epidemic of dengue due to type 4 virus in

1978

An outbreak of a dengue-like illness occurred at Shiwan town, Foshan city, Guangdong Province, in May 1978[1]. Shiwan town (population 24 464) is a centre for the pottery industry, and large amounts of pottery objects and waste pottery are kept outdoors where they get filled with rain water. Clinically, the disease presented as DF. A total of 5195 cases were reported between 2 May and 21 November 1978. There were three deaths.

Investigations in three locations of the town showed a family aggregation of cases. All age groups were affected, with patients ranging in age from 4 months to 80 years. Males and females were affected equally, and there was no apparent occupational risk. Peak transmission occurred from July to September. Aedes albopictus was the dominant mosquito species, comprising 82.9% of adult mosquito collections from human dwellings during the day and 6.4% of collections at night. A. aegypti was absent.

Three strains of DEN-4 virus were isolated from samples of acute-phase serum collected from patients within 3 days of onset of their illness. Attempts to isolate DEN-4 virus from six pools of A. albopictus failed; however, dengue antigen was detected in head squashes of A. albopictus by immunofluorescence and in the bodies by radioimmunoassay[2].

A fourfold or greater increase in the level of complement-fixing (CF) antibody against DEN-4 virus was registered for 140 patients with paired serum samples. The increase was much greater and the antibody titre was higher against DEN-4 virus than against other dengue serotypes. A CF titre [is greater than or equal to] 1:1024 was observed for 48 (62.3%) of 77 patients from whom single convalescent-phase serum samples were taken.

Clinical observations. Two hospitals admitted 583 cases of DF in Foshan city during the epidemic[3]; for 487 of these cases, the diagnosis and admission were based on epidemiological and clinical criteria. …

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