Central America and the Caribbean: Dengue and P.Vivax malaria

Abstract

In recent decades, the incidence, distribution and clinical severity of dengue have increased dramatically in most tropical and subtropical areas worldwide. As a consequence, and due to the expanding international tourism, health care providers in travel clinics of developed countries are increasingly confronted with dengue, reflecting its global impact. No specific prophylactic or therapeutic agents exist for dengue infections. All four serotypes of dengue viruses are widespread in Central America and the Caribbean basin. Dengue is most common in cities but can be found in rural areas. It is rarely found in mountainous areas above 4,000 feet. Dengue fever is the most common cause of fever in travelers returning to the USA from the Caribbean and Central America. In some case studies, dengue has been the second most common cause of hospitalization (malaria is the most common) among travelers returning from the tropics. Infection rates (based on anti-dengue serology) among febrile travelers returning from those areas may range from 2.9% to 8.0%. Similar results have been reported in travelers returning to Europe. Persons travelling to areas where dengue is endemic should avoid exposure to mosquitoes, and health care providers should consider dengue as a differential diagnosis in febrile travelers returning from the tropics after discounting malaria. Surveillance of imported dengue is crucial to monitor the risk of infection for travelers and to strengthen clinical awareness of the disease. The risk for a traveler acquiring malaria differs substantially from different areas within the region and from traveler to traveler, even within a single country. In a large series of 10,745 cases of malaria among U.S. residents reported to CDC from 1997 through 2006, 1,427 (13.3%) were acquired in the Caribbean and Centra/South America. Malaria has been reported in about 1 per 100,000 European travelers to Central America and the Caribbean. The risk of vivax malaria may be relatively high in some Central American countries, including several large or middle size cities. Travelers to malaria-risk areas, including infants, children, and former residents of Mexico and Central America, should take an antimalarial drug. There is no chloroquine resistance in Central America, so this drug can still be recommended for travelers to these countries. Malaria is not a risk in most of the Caribbean islands, but P. falciparum is endemic to most of Haiti and some areas of the Dominican Republic, where there is variable to low risk. Malaria in these areas is still sensitive to chloroquine, which is therefore recommended for prevention. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive