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Dengue in French Polynesia: Major Features,

Surveillance, Molecular Epidemiology and


Current Situation
By

Eliane Chungue, Xavier Deparis & Bernadette Murgue


Institut Territorial de Recherches Mdicales Louis Malard
P.O. Box 30, Papeete, Tahiti, French Polynesia,

Fax : 689-43 15 90, e-mail: echungue@malarde.pf

Abstract
The emergence of dengue epidemics worldwide has paralleled the expansion of the mosquito
vector Aedes aegypti, along with jet air travel and increased urbanization. All the four dengue
virus serotypes (DEN-1, 2, 3 and 4) have occurred in epidemic form during the past 50 years in
French Polynesia. The first epidemic with a known serotype was due to DEN-1 which occurred in
1944 during World War II. The disease disappeared from the Eastern Pacific after a Pacific-wide
pandemic, but a series of epidemics occurred at short intervals during two decades: DEN-3 in
1964-1965, DEN-2 in 1971, DEN-1 in 1975-1976, and DEN-4 in 1979. From 1980 to 1988, the
transmission of DEN-4 continued at a very low level until the resurgence of DEN-1 and DEN-3 in
back-to-back epidemics in 1989. In 1996, DEN-2 reappeared in Tahiti and spread further into
New Caledonia, the Cook Islands, Tonga, Samoa and Fiji.
As in most Pacific countries, epidemics with only one serotype have occurred in French
Polynesia. Each time, the genetic analysis of the causative viruses showed that the current epidemic

_________________________
Reproduced from Pacific Health Dialogue 1998, 5(1):154-162 with the permission of the Editor

74

Dengue Bulletin Vol 22, 1998

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation
was due to the introduction of a genotype which was different from the viruses recovered from the
past epidemics. These observations emphasize the need for an active system of clinical and
virological surveillance for the prevention and control of epidemics, together with molecular
characterization of the viruses as part of the investigation of a dengue epidemic. As of now, a new
genotype of DEN-2, different from the one involved in the 1970s, is disseminating throughout the
Pacific region.
Keywords: DF/DHF, DEN-1,2,3,4, epidemic, molecular epidemiology, French Polynesia.

Dengue Bulletin Vol 22, 1998

75

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation

Introduction
French Polynesia, situated in the South
Pacific

Ocean,

archipelagos
Gambier,

consists
(Society,

Austral

and

of

five

Tuamotu,
Marquesas

Epidemiological features

islands) comprising 120 islands, of

Epidemic pattern

which only 66 are inhabited. Most of

Dengue

the population is concentrated in the

clinically in French Polynesia since the

Society

which

nineteenth century, with documented

encompasses the Windward and the

epidemics in 1852, 1870, 1885 and

Leeward islands. Tahiti, the largest

1902(1,2,3).

island of French Polynesia in the

dengue in Tahiti of a known serotype

Windward group, contains the Capital,

occurred in 1944 as part of the

Papeete. During the past 40 years the

Pacific-wide spread of the disease

population of French Polynesia has

caused by DEN-1 during World War

undergone a dramatic increase. Since

II(4). The disease disappeared from the

1946, it has trebled in 30 years, and it

Eastern Pacific after the pandemic and,

has doubled between 1966 and 1988.

as far as is known, did not reappear

The last census (1996) recorded a

until 1964 and 1969, when DEN-3

population total of 219 521 which is

was involved(5,6). From that time on,

unequally distributed: 74% of it is

epidemics have occurred at shorter

concentrated in the Windward Islands,

intervals: DEN-2 in 1971, DEN-1 in

especially on Tahiti, of which 77% live

1975

archipelago

fever

The

and

has

been

first

DEN-4

in

known

outbreak

1979

of

were

in the urbanized Papeete. In all areas

successively

the climate is hot and tropical. A hot

exception of the DEN-2 outbreak,

rainy season from November to April

during

alternates with a cooler, drier season

cases and three deaths were observed

from May to October. The annual

on Tahiti in 1971, mildness of the

average temperature and rainfall in

disease

Tahiti is 25.7C and 2 m, respectively.

epidemics. A recent succession of

These

are

epidemics took place after nine years

year-round

of continued transmission of DEN-4.

climatic

consistent

with

mosquito breeding.

76

conditions
the

epidemic(7,8,9).

which

severe

characterized

Back-to-back

With the

haemorrhagic

these

epidemics

past

involving

Dengue Bulletin Vol 22, 1998

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation

DEN-1 and DEN-3 occurred in 19881989. It is noteworthy that dengue


haemorrhagic

fever/dengue

shock

syndrome (DHF/DSS) occurred in the


latter epidemic (11 fatalities) while
mildness characterized the former.
These viruses were spread throughout
the Pacific region with varying degrees
of disease severity(10).
Epidemics with only one serotype
have

occurred.

serotype

Each

replaced

the

epidemic
previous

serotype that had been transmitted


during

the

inter-epidemic

period.

Simultaneous transmission of both


serotypes was only observed for a
short period of time (2-4 months)
when

the

epidemic

serotype

was

taking place. During these periods,


co-circulations were demonstrated for
DEN-2/DEN-1 in 1975, DEN-1/DEN-4
in 1979, DEN-1/DEN-3 in 1989, and
DEN-3/DEN-2 in 1996. The endemic
virus was generally swept out 7 weeks
to 4 months after the recognition of
the new epidemic. This is illustrated
by Fig.1a and Fig.1b.

Dengue Bulletin Vol 22, 1998

77

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation

Figure 1a. DEN-1 and DEN-3 epidemics (1988-1990):


Monthly distribution of dengue virus serotypes

350

Dengue 1
Dengue 3

Number of isolates

300

250

200

15 0

10 0

50

1988

1989

1990

Figure 1b. DEN-2 epidemic (1996-1997):

Monthly distribution of dengue virus serotypes


350

Number of isolate

300

Dengue 3
Dengue 2

250
200
150
100
50
0

1996

78

1997

Dengue Bulletin Vol 22, 1998

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation

serological surveys, the proportion of

Morbidity and mortality


Although

accurate

data

regarding

morbidity are not available, a review


of

published

literature

and

allowed

unpublished

us

to

obtain

estimates of dengue infection in the


Windward Islands during the major
epidemics which occurred between
1944 and 1997 (Table 1). Estimated
morbidity rates were calculated by
using the data obtained by serological
and/or epidemiological surveys. The
estimation of the attack rates involved
antibody prevalence in cohorts of
susceptible

populations

measurements

of

and

absenteeism

in

schools and government and business


offices. The serological attack rate was
generally around 50% as determined
immediately

after

the

epidemic

asymptomatic

infections

was

estimated to be 30%(8,11,12). During an


outbreak the mortality rate is usually
low (see Table 1). The morbidity trend
of the epidemics is also illustrated by
the

number

reported

by

of

(i)

clinical

physicians

cases

(reported

cases), (ii) cases for which a request


for laboratory confirmation is made
(suspected cases), and (iii) virologically
and/or serologically confirmed cases
(Table 2). The annual incidence rate
during

the

inter-epidemic

periods

(endemic transmission) is unknown.


One study that concerned the long
inter-epidemic period between 1980
and 1987 showed an acquisition rate
of dengue antibodies of 3% per year in
a cohort of susceptible children(13).

transmission. According to clinical and


Table 1. Morbidity and mortality of dengue during major epidemics between
1944 and 1997 in the Windward Islands (French Polynesia)
Year of
epidemic

Serotype

Population

Estimated

Windward Is.

morbidity

(1000s)

rate(%)

No.of
No. of fatal
cases

infected
persons
(1000s)

1944

DEN-1

29.8

62

26

1964-65

DEN-3

55.2

20

ND*

1969

DEN-3

79.1

ND*

ND*

Dengue Bulletin Vol 22, 1998

79

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation

1971

DEN-2

84.5

50

42.2

1975-76

DEN-1

94.6

25

34.1

1979

DEN-4

104.2

25

37.5

1988-89

DEN-1

140.3

17

35.1

1989-90

DEN-3

143.9

25

11

49.5

1996-97

DEN-2

162.6

19

43.5

*ND: not determined.

Table 2. Dengue cases reported during the epidemics in French Polynesia, 1964-1997
Year of epidemic

Serotype

1964-65

Number of
Reported cases*

Suspected cases

Confirmed cases

DEN-3

1358

1969

DEN-3

72

1971

DEN-2

12943

1975-76

DEN-1

2032

2018

694

1979

DEN-4

7489

1783

630

1988-89

DEN-1

6034

4836

1976

1989-90

DEN-3

6330

5583

1357

1996-97

DEN-2

7230

4424

2027

data not available; *Institut Malarde & Direction de la Sante

Transportation and spread


of virus
In addition to the lack of effective
mosquito control, the origin of the
Pacific-wide

pandemic

of

DEN-1

(1941-1945) was very likely related to

80

intensive

movements

of

human

populations among and into areas that


were

permissive

to

dengue

transmission during World War II.


Hence, in 1944, an extensive epidemic
of dengue occurred in the Society
archipelago,

French

Polynesia.

Dengue Bulletin Vol 22, 1998

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation

Together with entomological surveys

increased

in other Pacific islands(14,15,16), the

1960s,

evidence of experimental transmission

ecology of dengue in French Polynesia

of dengue virus between monkeys

occurred after the construction of the

seaport

activity.

In

the

important

changes

in

the

suggested that Aedes polynesiensis

international airport in 1960-1961.

served as a natural vector in the past

This event suddenly brought French

French

Polynesia(14).

Polynesia into the modern era, with

the

geographical

accelerated

epidemics

in

Conversely,

urbanization

that

distribution of the disease and the

paralleled an increasing number of

entomological

dengue outbreaks. The increase of

surveys

carried

out

during the post-war epidemics (1964-

population

1996) were more consistent with the

surrounding localities comprised of

role of Ae. aegypti as a vector. For

workers recruited from the rural part

instance,

while

of

reported

in

Ae.

1953

aegypti

in

was

Tahiti

and

Papeete

from

and

its

neighbouring

its

islands. Between 1956 and 1988 the

presence had expanded progressively

population of Tahiti rose from 50% to

throughout French Polynesia, which

76% of the total population of French

was coincidental with the advent of

Polynesia; of these, 79% resided in

inter-island air connections: in the

urban areas. The expansion of Papeete

1970s in the Tuamotu, in 1982-1986

led to the growth of adjacent suburbs.

in the Marquesas Islands, and in

At this time, the metropolitan Papeete

1979-1986 in the Austral

Tahiti,

in

Islands(17).

The size and frequency of dengue


epidemics are related directly to social

lied along a 40 km coastal border only


a half kilometre wide.
The

first

re-introduction

of

and economic development, especially

dengue viruses was related to multiple

urbanization(18,19).

factors: increased jet air travel, high

first

urbanized

became

so

in

For instance, the


locale,
1850

Papeete,
the

urban areas, and lack of mosquito

European colonization. Coincidentally,

control. Papeete was hit by a DEN-3

the first occurrence of dengue on

epidemic in 1964, as was Makatea

Tahiti was reported in 1852. The

island, a nearby island of the Tuamotu

disease was limited to Papeete which

archipelago whose urban areas were

had been recently urbanized with an

subjected

Dengue Bulletin Vol 22, 1998

during

density of susceptible population in

to

exploitation

of
81

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation

phosphates.

exchanges

of the epidemics may be seen in the

existed between these two sites, in

dynamics of the recent epidemics. Fig.

both

of

Regular

Ae.

which

aegypti

were

shows

clearly

that

the

DEN-1

abundant. The limited transmission

epidemic in 1988-1989 moved from

within these areas was apparently

the Windward Islands to the Leeward

related to the sparse distribution of

Islands and on to the Marquesas and

Ae. aegypti in most islands of French

Austral Islands(21). Furthermore, DEN-

Polynesia(5).

A flare-up of DEN-3 was

3 was first detected in the tourist

Papeete(6).

island of Bora Bora in the Leeward

reported in 1969 in
The

speed

and

frequency

of

human exchanges by jet air travel


make possible the introduction of
dengue viruses by a dengue-infected
traveller from hyperendemic areas. A
parallel has been observed between
the spread of dengue viruses and the
route and frequency of air travel
between

the

infected

and

the

permissive areas within the Pacific


region(20). This was exemplified by the
epidemics

which

occurred

in

the

Pacific islands in the 1970s, which


always emerged from countries/areas
which
traffic.

had
The

secondarily
neighbouring

intensive
disease
from

international
has

these

island

spread

points

countries.

to
For

instance, in 1979 the first occurrence


of DEN-4 outside Asia was observed
on Tahiti. Three years later, DEN-4
had spread to many islands of the
Pacific. At the country level, in French
Polynesia, the geographical diffusion
82

Islands, and spread subsequently to


Tahiti,

then

to

archipelagoes(21).

the

These

remote
situations

were consistent with the fact that


inter-island

air

travel

was

more

intense

between

Tahiti

and

the

Leeward

Islands

than

with

the

Marquesas and Austral Islands.

Clinical features
The disease has been generally mild.
However, dengue illness caused by all
four

serotypes

accompanied

by

is

naturally

haemorrhagic

manifestations(22). In most epidemics,


a proportion of cases presented with
minor

haemorrhagic

signs:15%

in

1964 (DEN-3), 4% in 1969 (DEN-3), 3%


in 1971 (DEN-2), 15% in 1975-1976
(DEN-1), 5% in 1989 for epidemic
DEN-1, 14% for epidemic DEN-3, and
18% in 1996-1997 for DEN-2. The
two

occurrences

of

severe

Dengue Bulletin Vol 22, 1998

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation

Figure 2. DEN-1 epidemic (1988-1989): Geographical distribution


of reported cases, by week
Windward Is.

Number of reported case

500

Leeward Is.
400
Marquesas and Austral Is.
300
200
100

0
51

52

10

11

12

13

Calendar week 1988-1989

manifestations
hospitalization

requiring
were

in

1971

(33

cases, 3 fatalities) and 1989-1990


(401 cases, 11 fatalities). The 1971
epidemic involved mostly adults (63%)
while children represented 69% of the
cases in 1989-1990, an outbreak in
which

haemorrhagic

manifestations

were observed among 59% of the


hospitalized children. In 1996, among
the 232 hospitalized children, the
number of severe forms was low (19
cases), and the proportion of children
presenting

with

haemorrhagic

manifestations was 36%. Only one


death (adult) was reported(5,6,7,8,10,23).

Socioeconomic impacts
In islands with limited populations,
dengue fever is generally an epidemic
disease. In Asia, where the occurrence
of DHF/DSS is frequent, the social and
economic cost is high (US $31.48
million

per

year

in

Thailand(24)).

However, epidemics of the classical


disease are not to be overlooked. For
instance, during the last epidemic of
DEN-1 in French Polynesia, of the 161
subjects from whom a reply to the
question about the number of days
absented from work was obtained,
125 indicated a 3-5 days of absence.

Dengue Bulletin Vol 22, 1998

83

14

15

16

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation

Moreover, in the 1996-97 DEN-2

Commission) and local authorities, a

epidemic,

network

the

direct

costs

were

of

dengue

control

and

estimated to be US $2.5 million,

surveillance was set up. Subsequent

including

funding supported the development of

laboratory

costs,

hospitalization, and medical care. The


indirect costs, including morbidityrelated absenteeism from work, the
cost of lost production and prevention
and control activities was around US
$1.98 million. The estimated total cost
worked around US $4.48 million (i.e.
US $20

per

study,

it

inhabitant).
was

evident

From

this

that

the

estimated total cost of the 1989-90


DEN-3
DHF/DSS

epidemic,
cases,

including
was

US $40

the
per

inhabitant, whereas the estimated cost


of the 1988-89 DEN-1 epidemic was
US $15 per inhabitant. Estimation of
the costs for loss of tourism was not
made.

community-based

vector

control

programme. Despite the implementation

of

preventive

measures,

an

epidemic occurred a short time later.


Epidemic control involved adulticiding
of mosquitoes using ultra low volume
(ULV)

spraying

of

insecticides.

Larvicidal source reduction measures


involved the destruction or treatment
by

insecticides

of

breeding

sites.

Educational programmes accompanied


these measures(8). During the 1979
DEN-4

epidemic,

similar

measures

were implemented. After these series


of epidemics, the control programme
was maintained at a minimum level
which

comprised

continued

health

education and limited entomological

Surveillance, prevention
and control

surveillance at the international airport


and at a few sentinel stations.
Finally, the only constant and

Before 1975, the DHF epidemics did

immediately

available

not benefit from any special control

system

the

programme.

generally

system. Laboratory capabilities were

explosive and ended after exhaustion

reinforced, and modern and rapid viral

of the susceptible population. In 1975,

and serological analyses were made

Tahiti was expected to have DEN-1

available.

virus reintroduced from Fiji. With the

suspected DHF/DSS was carried out by

efforts of both regional (South Pacific

reverse

84

They

were

is

Urgent

surveillance

laboratory-based

diagnosis

transcriptase

of

polymerase

Dengue Bulletin Vol 22, 1998

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation

chain reaction (RT-PCR), allowing a

Caledonia(28). Subsequently, DEN-2 was

result within as little as one day(25).

detected instead.

Since 1988, the surveillance of dengue


fever

has

been

based

on

the

monitoring of (i) cases reported by


physicians; (ii) suspected cases; and
(iii) confirmed

cases.

Trends

of

dengue activity and the virus serotype


are continuously monitored.

The

detection

different

from

of

the

serotype

one

which

is

endemically transmitted constitutes a


very

important

feature

while

considering whether further epidemic


transmission

might

occur.

retrospective analysis of the situation

Actually, the weekly incidence of

in French Polynesia in recent years

suspected cases constitutes a valuable

shows that a new epidemic followed

Since

each detection of a new serotype in a

all the diagnoses are made only in our

sizeable susceptible population in a

laboratory, the data are immediately

country where mosquitoes were always

available. A sudden rise in laboratory

present. In 1988, the first isolation of

requests

immediate

DEN-1

in

Tahiti

sentinel

during

nine-year

indicator of dengue

activity(26,27).

precipitates

telephone

survey

an

among

island

intervened

inter-epidemic

physicians. In addition, through a small

period of a low-level incidence of DEN-

group of selected sentinel physicians,

4(11). The epidemic peaked a few weeks

any increase in dengue-like illness is

after,

reported

and

the

disease

spread

investigated.

Blood

throughout most of the islands of

obtained

from

French Polynesia. The first isolation of

representative cases and processed to

DEN-3 was observed in April 1989 in

detect

Bora-Bora island, then in June 1989 in

and

specimens

are

dengue

infection

by

virus

isolation or RT-PCR and/or dengue IgM

Tahiti

antibody

recognized

detection.

In

addition,

island.

The

in

epidemic

August

Furthermore,

Pacific region is taken into account in

epidemic peaked in January 1997 after

order to stimulate awareness in the

the

medical community or to set up timely

laboratory survey in August 1996.

sentinel surveillance, as happened in

Thus, virological surveillance is of

1996 when DEN-4 was detected in New

importance

case

for

recent

Tahiti(21).

information on dengue activity in the

first

the

in

was

was

an

DEN-2

detected

early

by

warning

surveillance system.
Dengue Bulletin Vol 22, 1998

85

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation

epidemiology

Molecular epidemiology
By using molecular techniques, the
transmission pathways of the viruses

of

DEN-2

viruses

is

particularly worthy of emphasis.


Nucleotide

sequencing

of

have been suggested and seem to

different parts of the genome as short

corroborate

fragments or entire genes (prM, E or

with

epidemiology.
sequence

the

descriptive

Analyse

of

relatedness

genome

NS3)

allowed

several

authors

to

demonstrated

perform comparative analysis of a

genotype groupings among all four

large variety of dengue virus strains.

DEN virus serotypes(29). Thus, one to

Sequence data obtained recently in

five genotypes were defined among

our laboratory or those retrieved from

virus

different

published databases were compared

geographic areas and over periods

within each serotype virus. Hence,

ranging from 33 to 53 years. Each

fragments of the E protein gene of (i)

genotype seems to have a defined

180 nucleotides (nt 82 to 261) from

focus of endemicity. However, certain

DEN-1 and DEN-4 viruses, (ii) 198

genotypes appeared to have been

nucleotides (nt 85 to 282) from DEN-2

transported to another part of the

viruses, and (iii) 195 nucleotides (nt

world where they became established.

73 to 267) from DEN-3 viruses were

Different

compared(29).

strains

isolated

in

transmission

pathways

of

divergence

of

6%

these viruses around the world are

within the studied region was taken as

pointed out, and co-circulation of two

a cut-off point for virus groupings.

or

more

genotypes

in

the

same

geographic region has been observed,


especially for DEN-2 viruses. The first
genetic evidence of the existence of a
sylvatic cycle of dengue virus, clearly
different from outbreak viruses, was
demonstrated, and further confirmed
by molecular analysis(30,31). Owing to
the

current

circulation

of

dengue

viruses in our region, the molecular

86

Three
defined

genotype

for

DEN-1

groups
viruses,

were
and

clustering of virus isolates for which


linkages

would

epidemiological
observed(32).

be

expected

grounds

Genetic

on
was

relationships

were detectable over a 50-year span


(Hawaii, 1944, to the Indian Ocean,
1993). For instance, earlier epidemic
strains from the Pacific (1974-1978)

Dengue Bulletin Vol 22, 1998

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation

clustered in genotype 1 while recent

strain derived from mutation through

epidemics

French

silent transmission. Furthermore, a

Polynesia and New Caledonia (1988-

high level of dissemination of DEN-1

1989)

strains

from

and

the

Comoro

Islands

genotype 2 during recent years, as

(1993),

as

well

Guiana,

Guadeloupe,

as

French

shown by the clustering of the viruses

Rico,

recently isolated in countries that

from
Puerto

Brazil, Peru, Nicaragua and Cuba, fell

have

in genotype 2 (as do the American

countries

strains). Therefore, it is likely that the

Pacific territories, Comoro Islands)

recent epidemics of DEN-1 in the

was

Pacific

direction

region

are

due

to

the

introduction of a new variant of virus

ties

with

French

(French

suggested,
of

tropical

Guiana,

French

although

the

spread

was

the
not

determined.

rather than the


re-emergence
a
Figure
3. Molecularof
epidemiology
of DEN-2 viruses
TORRES STRAIT 96
BURKINA FASO

83

SOMALIA

84

INDONESIA

76

SRI LANKA
SRI LANKA
SRI LANKA

85a
85b
90a

SRI LANKA
SRI LANKA

89
90b

PHILIPPINES

83

TAIWAN

87

BURMA

76

THAILAND

64

NEW GUINEA

44

CUBA

81

THAILAND

80d

JAMAICA

83

VIETNAM

87

VIETNAM

96

Dengue 2

FRENCH GUIANA 90

TAHITI
96
COOK
97
NEW CALEDONIA96
QUEENSLAND
92
PUERTO RICO

69

TONGA

74

INDIA

57

TAHITI

75

TRINIDAD

57

SENEGAL

74

SENEGAL

81

BURKINA FASO

80
0

10

12

14

16

18

20

% Divergence
Dengue Bulletin Vol 22, 1998

87

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation

The maximum divergence over

Samoa isolates in the same genotype.

the E protein gene fragment was

This new genotype is significantly

approximately

20%

among

DEN-2

viruses. The dendrogram shown in


Fig. 3 depicted five genotypic groups
and agreed generally with previously
published phylogenetic trees(30,31,33).
Two
involved

genotypes
in

the

have

The

Jamaican genotype (genotype 2) was


confirmed as to be related to virus
strains from South-East Asia (97.5%
similarity with Vietnamese 1974 and
1996

strains).

As

mentioned

by

Guzman et al.(33), the Cuban strain


the old New Guinea C strain (1944)
and clustered in the same genotype 2.
The Puerto Rican strain is shown to be
transmitted in the Caribbean, Central
America, India, and the South Pacific
(Tonga 1974, Tahiti 1975) within the
genotype 4. Interestingly, the recent
isolated

during

the

actual

epidemic on Tahiti in 1996 falls into a


new genotype (genotype 3) together
with

recent

isolates

from

New

Caledonia. Data sequence from D.


Phillipps

(personal

communication)

allowed also the classifycation of 1992


Queensland, 1997 Cook Islands and

88

the

previous

virus

groups (9% divergence with genotype


4). The Tahiti 1996 strain presented a
12.5%
the

difference

evidence

introduced

with

the

earlier

of

rather

virus
than

recently
to

the

hypothesis of a new variant derived


from earlier virus. Its closer genotype
is genotype 1, in which isolates from
Torres Strait (D. Phillipps, personal
communication), Burkina Faso or Sri
Lanka fell.

(1981) was closer (98% similarity) to

virus

from

Tahitian virus (1975), and agreed with

been

Caribbean.

distinct

Four

genotypes

were

defined

among 30 isolates of DEN-3 viruses


with the entire gene or restriction
analysis(34). The first group contained
isolates from the South Pacific (1988
to

1995),

Singapore

(1973)

and

Indonesia (1973 to 1991). The second


group comprised the viruses from
Asia (1956 to 1995) including the
reference

strain

H-87

and

the

Vietnamese strains (1974 and 1995).


The third was composed of one isolate
from

Thailand

(1971).

The

fourth

genotype included the early strains


from French Polynesia (1964 to 1969)
and

from

Puerto

Rico

(1963).

Dengue Bulletin Vol 22, 1998

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation

Maximum divergence over the studied

the three other serotypes since the

region was approximately 12% and

maximum divergence was 20% for

corresponded to the distance between

DEN-2 viruses, 12% for DEN-3 viruses,

the early (1964 and 1969) and recent

and 6.9% for DEN-1 viruses. However,

(1989

microheterogeneity

to

1995)

Polynesian/New

was

observed

Caledonian DEN-3 strains. Hence, it is

within DEN-4 geographic strains that

unlikely that the recent isolates result

clustered

from

the

Interestingly, the recent isolate from

remaining endemic virus, since no

New Caledonia (1996) appears to be

DEN-3 virus has been isolated within a

more closely related to the viruses

20-year

from

genetic

period.

mutation

of

Therefore,

as

for

in

two

Indonesia.

subgroups.

This

variant

was

DEN-1, these data suggest that the

present for only a few weeks in early

recent epidemics in the Pacific are due

1996.

to the introduction of a new variant

transmitted intensively is related to a

virus rather than the re-emergence of

weak adaptation of the virus to its

mutation

vector and /or host or to unfavourable

through silent transmission. Moreover,

climatic conditions, combined with an

there is a sequence similarity between

active vector control programme, is

difficult

strain

New

derived

Caledonian

from

strain

(1988)

Whether

to

recovered four months before the

unpublished

recognition

transportation

of

the

epidemic.

This

its

failure

state
data).
of

virus

to

(M.

be

Laille,

Moreover,
from

one

the

continent to another is illustrated by

emergence of DEN-3 epidemics in the

the isolation of the Haiti 1981 strain in

Pacific

Senegal from a patient who had just

favours

the
from

hypothesis
Indonesia

of
via

New

Caledonia after several months of


latency.
DEN-4 viruses seem to occur as a
single genotype around the world. The
sequence variation in the same region
of the E protein gene among DEN-4
viruses was lower (4.9%) than among
Dengue Bulletin Vol 22, 1998

arrived from Haiti(31).


These studies demonstrated that
dengue viruses could be identified and
classified in genotypic groups that
may circulate concurrently in the same
region. Moreover, in some instances,
the origin of the newly introduced

89

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation

virus

has

been

suggested.

For

instance, close relationships between


the

Polynesian

strains

(1964

strain

or

between

is

involved

in

the

pathogenicity of DHF/DSS.

and

1969) and the Puerto Rican (1963)


DEN-3

change

the

Current situation

Polynesian (1975) and Puerto Rican

Fig. 4 illustrates the yearly distribution

(1969) strains or Trinidad (1957) DEN-

of

virus

dengue cases from 1988 to 1997.

exchanges between the Caribbean and

Since its recent introduction, DEN-2

the South Pacific owing to the frequent

has been continuously transmitted. In

trades from Europe via the Panama

view of the risk of epidemic dengue,

channel. The South Pacific-American

when considering the time elapsed

connection was also suggested by the

since the last epidemic of a given

close genetic relationships between

serotype

DEN-4 viruses (99 to 100% homology).

population born subsequently, French

In more recent years, the introduction

Polynesia is at high risk for the

of a new virus in the South Pacific

reintroduction of DEN-4, and to a

seems to be more related to frequent

lesser extent, of DEN-1. Retrospective

air travel exchanges with Indonesia

observations

(DEN-3 in 1989, and DEN-4 in 1996).

epidemiology

Each time, a new epidemic was due to

recent

the introduction of a new genotype.

emergency adulticiding and larvicidal

The current DEN-2 virus spreading

control

from Tahiti to New Caledonia and the

immediately after the detection of the

Cook Islands belongs to the same

first

genotype.

the

Advantage may be taken of the usual

viruses

one-to- several months of the time

strains,

efficient

suggest

This

possible

emphasizes

dissemination

of

the

intra-regional

epidemic.

Furthermore,

been associated with severe disease


potential. However, it is still unclear
whether

90

any

particular

molecular

the

have

before

In

confirmed

size

of

the

concerning
and

control

the

the
of

the

showed

to

emergence

lag

travel.

and

and

epidemics

among these island countries through


certain genotypes of the viruses have

suspected

of

be

that
applied

either

recognition

conclusion,

virus.

of

an

improved

laboratory-based surveillance, genetic


investigation
disease

of

circulating

surveillance

viruses,

(specific

and

Dengue Bulletin Vol 22, 1998

Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation

febrile

diseases),

programmes,

health

and

education

vector

D.

control

Pons

for

their

secretarial

assistance.

programmes must be promoted for the


better

prevention

and

control

of

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Figure 4. Yearly distribution of dengue in French Polynesia,


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60%

9000

Suspected cases
Confirmed cases
% confirmed cases

Number of cases

8000
7000

50%

40%

6000
5000

30%
4000
20%

3000
2000

10 %
10 0 0
0

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