TECHNICAL CONSULTATION Meeting: "Analysis of the dengue situation in the South American region and the role of the National Institutes of Health" Suriname

Epidemiological situation of dengue Proportion of the territory affected by the dengue: mostly the capital as around 45% of the population resides here/ but rural and interior areas show outbreaks too Proportion of the territory with the presence of vector: probably 100% (also in the interior) Incidence of severe cases: depends on circulating types- AND epidemics seem to be cyclical ( showed epidemic numbers) Death rate: varies per year -median 2-3 deaths per year Epidemic year 2000: 16 deaths = 0.03/ 1000/ year Epidemic year 2005: 12 deaths = 0.024/ 1000/ year Epidemic year 2009: 4 deaths = 0.008/ 1000/ year Serotypes circulating in the country: all types, have occurred so far type 4 was the main circulating type

Epidemiological situation of dengue Main determinants Vector: areas with a high mosquito index Environment: areas with water flooding and many overgrown terrains and areas with lots of garbage in the neighboorhood show more cases Season: rainy seasons show more cases Tourists and migrants from areas with no dengue (europe/ china?) are also vulnerable East indian people also seem to be somewhat more vulnerable compared to creole population Occupation: schools / workplaces in problem areas, though no recent outbreaks reported- chinese possible also affected more, due to working hours, long opening hours shops?

Dengue epidemics often show 2 or more dengue types occurring concurrently- figure shows suspect & confirmed hospitalized cases

Epidemiological situation of dengue Main control strategies implemented Surveillance Outbreak investigation: clusters of cases Reporting to environmental officers Spraying 100 m diameter around outbreaks areas (no spraying in schools or areas with high number of cases) During epidemics Incidental: collection of bulky waste (old cars/ broken machines) Area wide spraying

Higher numbers seen in rainy seasons; epidemic numbers in 2009

2009 showed high numbers of hospitalizations in the small rainy season while dengue type 1 & 3 were circulating; In 2010, dengue type 4 was the main circulating type

Role of National Institute of Health or equivalent Laboratory methods available in the country: PCR/ serology :dengue ELisa Availability of commercial kits and / or in- house: Rapid tests Technical assistance from carec-lab for confirmation

Role of National Institute of Health or equivalent Dengue surveillance system 2 levels available: Primary care: sentinel surveillance (no testing done only with outbreaks) Trend analysis Secondary care: all hospitalized cases Usually tests done depending on onset date (PCR or serology- Igm) DHF and DSS also included

Role of National Institute of Health or equivalent Surveillance of insecticide resistance Not done?

Role of National Institute of Health or equivalent Main results of research on dengue No research done

Opportunities and needs for technical cooperation between institutes / countries Intrasectoral cooperation strategies: evironmental health/ epidemiology? How is this done in other countries Training & studies for improved vector surveillance Spraying strategies Intersectoral cooperation: Public works & MOH (garbage disposal/ environmental health strategies0 Information sharing: Guyanas and other neighbooring countries Health education strategies Vaccination strategies : trials in other countries succesful?/ vaccine availability?