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Three cases of indigenous dengue fever in Europe is just the beginning?

Over the past two issues of Eurosurveillance, the online magazine of ECDC, appeared in two separate notices, one from France el 'the other from Germany, regarding cases of dengue fever contracted in Europe rather than, as usually happens in the tropics.

The first article describes two cases in which the transmission of the virus occurred in Nice in fact neither of the two patients had a history of recent international travel (1). The first case (A man in his sixties) developed fever, myalgia and asthenia August 23 last year and was hospitalized August 27. Laboratory tests, as well as highlighting thrombocytopenia, confirmed the diagnosis of infection with dengue virus - serotype 1 - and through the detection of specific antibodies or via PCR. The patient recovered within a few days.

The second case, an eighteen year old boy who lives about 70 meters the first patient, on 11 September showed fever, myalgia, headache and fatigue. The diagnosis of dengue was confirmed by PCR analysis. It was revealed the serotype 1, with characteristics quite similar to strains circulating in Martinique. The clinical picture, which also included moderate thrombocytopenia resolved without complications.

Eurosurveillance The second article was published on October 7 and describes the case of a seventy-two that appeared last August 16 with fever, chills, arthralgia, retro-orbital pain and headache (2) . The patient had just returned to Germany from a vacation in Croatia, where he stayed from 1 to 15 August. The clinical picture was resolved in about two weeks. The diagnosis was confirmed serologically. Again there was a moderate thrombocytopenia.

The two articles in Eurosurveillance document a new fact for Europe: local transmission of dengue virus by the Aedes albopictus , normally one of the two carriers involved (the other is Aedes aegypti that, as we know, is present in tropical areas but not in Europe). Since the '70s, Aedes albopictus has been established in some countries of Southern Europe, where it has come primarily through imports of truck tires. Its presence is indicated both in southern France and Croatia, as well as in Italy, Greece, Slovenia, Spain, Albania and other Balkan countries and even in Switzerland.

In particular in our country, we need a lot of attention for at least three reasons:

a) climatic conditions favorable to the proliferation of Aedes albopictus

b) frequent trips for tourism, business or other reasons to areas where the diseases transmitted by mosquitoes of the genus Aedes such as dengue and chikungunya, are endemic

c) the well-known previous outbreak of chikungunya in Cervia (3), with more than 300 cases (the index case was then a traveler from India).

surveillance of dengue and other vector diseases must be especially careful, since the cases with mild or moderate symptoms may escape the etiologic diagnosis. To this end, the general practitioners, pediatricians and family doctors in the DEA should also receive training on diseases hitherto considered unusual, such as dengue, chikungunya and West Nile Virus infections.

surveillance activities to be complemented by local monitoring and control of the carrier. Finally, a role it is for the Centers Travel Medicine: the well-informed traveler is less likely to become infected and then introduce the virus in our country.

Bibliography

(1) La Ruche G, Souarès Y, Armengaud A et al. First two autochthonous dengue virus infections in metropolitan France, September 2010. Euro Surveill. 2010, 15 (39): pii = 19676. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19676   

(2) Schmidt-Chanasit J, Haditsch M, Schöneberg I, Günther S, Stark K, Frank C. Dengue virus infection in a traveller returning from Croatia to Germany. Euro Surveill. 2010;15(40):pii=19677. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19677

(3) Angelini R, Finarelli AC, Angelini P, Po C, Petropulacos K, Silvi G, et al. Chikungunya in north-eastern Italy: a summing up of the outbreak. € Surveill. 2007, 12 (47). pii: 3313. Available online:
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=3313