Vol. 18, No. 2	July 1997

Dengue in Cuba

The Ministry of Public Health officially reported that recent infection by dengue was confirmed in a total of 826 people, with 3 deaths, in the city of Santiago de Cuba, located in the southernmost region of the island, through an active search for cases and serological confirmation (IgM) using immuno-enzyme methods. The affected area is 36.5 km² with a population of 168,000; the total area of the city is 184 km² with a population of 465,000. Study of the first cases indicated that initial transmission occurred during the last two weeks of December 1996.

Through viral isolation and PCR, serotype 2 was identified as the etiologic agent of the outbreak. Molecular studies of the strain indicated that it belonged to the Jamaica genotype, which is widely spread in the region and closely related to the occurrence of cases of dengue hemorrhagic fever (DHF) in several countries of the region.

The predominant clinical symptoms have been that of classical dengue (fever, retro-orbital headache, general discomfort, arthralgia, myalgias and rash). Evolution has been positive, although some patients showed thrombocytopenia and hemoconcentration with hemorrhagic manifestations. Only three cases were classified as carriers of Grade III DHF and the rest as Grade I and II. No cases of DHF have been presented in children and it has occurred primarily in adults.

Preliminary studies of the deceased patients indicated the presence of IgM antibodies in the serum and anatomical/pathological studies suggested severe symptoms of the disease.

The remaining provinces of the country continue to be free of the disease and vector control measures and epidemiological surveillance were increased in those areas where the vector was detected. Community participation and specific medical care for severe cases of the disease were strengthened.

Dengue was confirmed by the Pedro Kouri Institute of Tropical Medicine, Collaborating Center of PAHO/WHO for the study of viral diseases. This represents the first outbreak of dengue in Cuba since 1981, when there were 350,000 cases and 158 deaths, 101 of them in children under age 15.

The presence of dengue in Cuba was confirmed for the first time in 1943, although it may have been the cause of an epidemic in 1902. In 1977, serotype 1 was introduced in the eastern part of Cuba, spreading rapidly throughout the entire country. During that epidemic, which lasted until 1978, 553,132 cases were reported. Since 1992, slow and gradual reinfestation by Aedes aegypti found in imported tires has been reported.