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 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.
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
Epidemic pattern
Dengue
Society
which
1902(1,2,3).
1975
archipelago
fever
The
and
has
been
first
DEN-4
in
known
outbreak
1979
of
were
successively
during
disease
These
are
year-round
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 in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation
fever/dengue
shock
occurred.
serotype
Each
replaced
the
epidemic
previous
the
inter-epidemic
period.
the
epidemic
serotype
was
77
Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation
350
Dengue 1
Dengue 3
Number of isolates
300
250
200
15 0
10 0
50
1988
1989
1990
Number of isolate
300
Dengue 3
Dengue 2
250
200
150
100
50
0
1996
78
1997
Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation
accurate
data
regarding
published
literature
and
allowed
unpublished
us
to
obtain
populations
measurements
of
and
absenteeism
in
after
the
epidemic
asymptomatic
infections
was
number
reported
by
of
(i)
clinical
physicians
cases
(reported
the
inter-epidemic
periods
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*
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
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
pandemic
of
DEN-1
80
intensive
movements
of
human
permissive
to
dengue
French
Polynesia.
Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation
increased
1960s,
seaport
activity.
In
the
important
changes
in
the
French
Polynesia(14).
the
geographical
accelerated
epidemics
in
Conversely,
urbanization
that
entomological
surveys
carried
out
population
instance,
while
of
reported
in
Ae.
1953
aegypti
in
was
Tahiti
and
Papeete
from
and
its
neighbouring
its
Tahiti,
in
Islands(17).
first
re-introduction
of
urbanization(18,19).
first
urbanized
became
so
in
Papeete,
the
subjected
during
to
exploitation
of
81
Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation
phosphates.
exchanges
both
of
Regular
Ae.
which
aegypti
were
shows
clearly
that
the
DEN-1
Polynesia(5).
Papeete(6).
reported in 1969 in
The
speed
and
frequency
of
the
infected
and
the
which
occurred
in
the
had
The
secondarily
neighbouring
intensive
disease
from
international
has
these
island
spread
points
countries.
to
For
then
to
archipelagoes(21).
the
These
remote
situations
air
travel
was
more
intense
between
Tahiti
and
the
Leeward
Islands
than
with
the
Clinical features
The disease has been generally mild.
However, dengue illness caused by all
four
serotypes
accompanied
by
is
naturally
haemorrhagic
haemorrhagic
signs:15%
in
occurrences
of
severe
Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation
500
Leeward Is.
400
Marquesas and Austral Is.
300
200
100
0
51
52
10
11
12
13
manifestations
hospitalization
requiring
were
in
1971
(33
haemorrhagic
manifestations
with
haemorrhagic
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)).
83
14
15
16
Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation
epidemic,
network
the
direct
costs
were
of
dengue
control
and
including
laboratory
costs,
per
study,
it
inhabitant).
was
evident
From
this
that
the
epidemic,
cases,
including
was
US $40
the
per
community-based
vector
control
of
preventive
measures,
an
spraying
of
insecticides.
insecticides
of
breeding
sites.
epidemic,
similar
measures
comprised
continued
health
Surveillance, prevention
and control
immediately
available
system
the
programme.
generally
available.
reverse
84
They
were
is
Urgent
surveillance
laboratory-based
diagnosis
transcriptase
of
polymerase
Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation
detected instead.
has
been
based
on
the
cases.
Trends
of
The
detection
different
from
of
the
serotype
one
which
is
important
feature
while
might
occur.
Since
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
after,
reported
and
the
disease
spread
investigated.
Blood
obtained
from
detect
and
specimens
are
dengue
infection
by
virus
Tahiti
antibody
recognized
detection.
In
addition,
island.
The
in
epidemic
August
Furthermore,
the
importance
case
for
recent
Tahiti(21).
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
sequencing
of
corroborate
with
epidemiology.
sequence
the
descriptive
Analyse
of
relatedness
genome
NS3)
allowed
several
authors
to
demonstrated
virus
different
Different
compared(29).
strains
isolated
in
transmission
pathways
of
divergence
of
6%
or
more
genotypes
in
the
same
current
circulation
of
dengue
86
Three
defined
genotype
for
DEN-1
groups
viruses,
were
and
would
epidemiological
observed(32).
be
expected
grounds
Genetic
on
was
relationships
Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation
epidemics
French
1989)
strains
from
and
the
Comoro
Islands
(1993),
as
well
Guiana,
Guadeloupe,
as
French
Rico,
from
Puerto
have
countries
was
Pacific
direction
region
are
due
to
the
ties
with
French
(French
suggested,
of
tropical
Guiana,
French
although
the
spread
was
the
not
determined.
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
approximately
20%
among
DEN-2
genotypes
in
the
have
The
strains).
As
mentioned
by
during
the
actual
recent
isolates
from
New
(personal
communication)
88
the
previous
virus
difference
evidence
introduced
with
the
earlier
of
rather
virus
than
recently
to
the
virus
from
been
Caribbean.
distinct
Four
genotypes
were
defined
1995),
Singapore
(1973)
and
strain
H-87
and
the
Thailand
(1971).
The
fourth
from
Puerto
Rico
(1963).
Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation
(1989
microheterogeneity
to
1995)
Polynesian/New
was
observed
clustered
from
the
20-year
from
genetic
period.
mutation
of
Therefore,
as
for
in
two
Indonesia.
subgroups.
This
variant
was
1996.
mutation
difficult
strain
New
derived
Caledonian
from
strain
(1988)
Whether
to
unpublished
recognition
transportation
of
the
epidemic.
This
its
failure
state
data).
of
virus
to
(M.
be
Laille,
Moreover,
from
one
the
Pacific
favours
the
from
hypothesis
Indonesia
of
via
New
89
Dengue in French Polynesia: Major Features, Surveillance, Molecular Epidemiology and Current Situation
virus
has
been
suggested.
For
Polynesian
strains
(1964
strain
or
between
is
involved
in
the
pathogenicity of DHF/DSS.
and
change
the
Current situation
of
virus
serotype
observations
epidemiology
recent
control
first
genotype.
the
viruses
strains,
efficient
suggest
This
possible
emphasizes
dissemination
of
the
intra-regional
epidemic.
Furthermore,
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
suspected
of
be
that
applied
either
recognition
conclusion,
virus.
of
an
improved
of
circulating
surveillance
viruses,
(specific
and
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.
prevention
and
control
of
References
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9000
Suspected cases
Confirmed cases
% confirmed cases
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50%
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30%
4000
20%
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2000
10 %
10 0 0
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19 9 2
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19 9 5
19 9 6
19 9 7
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