Dengue/DHF Situation of Dengue/ Dengue Haemorrhagic Fever in South-East Asia Region

Countries in SEA Region reporting Dengue Countries in SEA Region reporting Dengue in 2003 in 2007

In 2003 only 8 countries in South East Asia Region reported dengue cases. As of 2006, ten out of the eleven countries in the Region (Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste) reported dengue cases. Bhutan reported the first dengue outbreak in 2004. An outbreak, with a high case fatality rate (3.55%) was first reported in Timor -Leste in 2005. Nepal reported dengue cases for the first time in November 2006. The Democratic Peoples Republic of Korea is the only country in this Region of WHO that has no report of indigenous transmission of DF/DHF.

Of the total world population of 6.2 billion, countries of the South-East Asia Region (SEAR) account for 1.5 billion (24%). On that scale, of the 2.5 billion people (living in the tropics and sub-tropics) at risk of DF/DHF, 52%, i.e. 1.3 billion population, live in SEAR. (Figure 1). Figure 1: Population at risk of DF/DHF in the South-East Asia Region

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Dengue/DHF Reported Cases of DF/DHF in Selected Countries in SEA Region (1985 2005)

Reported Cases The total number of reported cases and deaths of DF/DHF from nine countries of the SEA Region for the period 1985-2006 is included in the following Table 1 Total cases ranged from 46,458 (1986) to 218,821 (1998) and 188,684 (2006). Since 2003 the trend of reported dengue cases is rising although the case fatality rate is maintained below 1%..Figure 2. Till 2003 Thailand reported the highest number of dengue cases in the region. Since 2004 Indonesia reports the highest number of cases from the region. In 2006 57 % of the cases were reported from Indonesia alone.

Figure 3: Thailand reported the highest number of dengue cases in the Region till 2003; from 2004 onwards Indonesia reported highest number of dengue cases in the region. In 2006 Indonesia reported 57% of the dengue cases in the region.

South East Asia Region : Reported dengue cases (1885 2006)

In 2006 most countries have reported increase in dengue cases (Bangladesh, Bhutan, Indonesia, Thailand, Maldives and Sri Lanka) whereas India, Myanmar and Timor Leste have reported slightly lesser cases than in 2005. Nepal reported dengue cases for the first time in November 2006. In 2006 countries that reported less than 1% of the total cases are Bhutan, Nepal and Timor Leste. Maldives, and Bangladesh reported about 1% of the cases, India, Myanmar and Sri Lanka reported 6% each , Thailand 23% and Indonesia reported 57 % of the dengue cases in the South East Asia region of WHO. Figure 4

Figure 4:

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Dengue/DHF Situation of Dengue/Dengue Haemorrhagic Fever in the South-East Asia Region Variable endemicity for DF/DHF in countries of SEA Region

Variable endemicity for DF/DHF in countries of SEA Region

Although Dengue/Dengue Haemorrhagic Fever is endemic in most countries of the region, all four serotypes have been detected in all the countries . The transmission potential, however , is different both at the macro- and micro levels.

The current situation of DF/DHF in countries of the South East Asia Region can be stratified as follows:

Category A (Indonesia, Thailand, Sri Lanka and Timor- Leste) Major public health problem Leading cause of hospitalization and death among children Cyclical epidemics in urban centers Spreading to rural areas Multiple virus serotypes circulating

Category B (Bangladesh, India, Maldives) Cyclical epidemics are becoming more frequent Multiple virus serotypes circulating

Expanding geographically within countries

Category C ( Bhutan and Nepal ) Endemicity uncertain Bhutan: First outbreak reported in 2004 Nepal: Reported dengue cases for the first time in November 2006.

Category D ( DPR Korea ) No evidence of endemicity.

While the ecological and climatic factors influence the seasonal prevalence of the species, factors related to human ecology determine the extent and intensity of breeding. On the basis of climatic factors, the countries oft the Region can be divided into four distinct climatic zones with different DF/DHF transmission potential. These are as follows: Tropical Monsoon and Equatorial Climatic Zone Deciduous Dry and wet Climatic Zone Sub-Himalayan foothill Region Temterate Climate Region

Tropical Monsoon and Equatorial Climatic Zone

This zone includes four countries, viz. Indonesia, Myanmar, Thailand and Timor-Leste. The annualrainfall in this zone is >150 cm. Aedes aegypti is widespread in both urban and rural areas. Transmission is extended and DHF epidemics occur in 3-5 years cycles, associated with high morbidity in children.
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