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TRANSMISSION OF EPIDEMIC DENGUE HEMORRHAGIC FEVER IN EASTERNMOST INDONESIA

In April 2001, a second suspected outbreak of dengue hemorrhagic fever in the easternmost region of Indonesia was investigated in Merauke, a town located in the southeastern corner of Papua, by the Indonesian Ministry of Health and the U.S. Naval Medical Research Unit No. 2. Principal case criteria of hemorrhagic disease provided for a study enrollment of 15 clinically acute and 37 convalescing subjects. Additionally, 32 comparable age/sex controls were selected from neighboring households. Laboratory diagnosis involved three testing methodologies: virus isolation by cell culture, a reverse transcriptase–polymerase chain reaction (RT-PCR) assay, and serologic assays. Antibody (IgM) to dengue virus was detected in 27% of the acute clinical cases, 30% of the convalescing cases, and only 3% of the matched controls. Dengue 3 was the only viral serotype detected from acute serum samples by the RT-PCR. The mean ± SD age of the acute and convalescing cases was 7.8 ± 5.4 years. Overall hospital records accounted for 172 suspected outbreak cases, all urban residents of Merauke with no recent travel history outside the area. The estimated outbreak-associated case fatality rate among all suspected dengue cases was 1.2%. A seven-year retrospective review of hospital records in Merauke showed negligible disease reporting involving hemorrhagic disease prior to the outbreak.

Received October 2, 2002. Accepted for publication January 3, 2003.

Financial support: This study was supported by the Department of Defense (DoD)–Global Emerging Infections System (GEIS).

Disclaimer: The views of the authors expressed herein do not purport to reflect those of the U.S. Navy, the U.S. Department of Defense, or the Indonesian Ministry of Health.

Authors’ addresses: Nono C. Sukri, Kanti Laras, Ria P. Larasati, Sri Hartati, Erlin Listyaningsih, Kevin R. Porter, Charmagne G. Beckett, Narain Punjabi, H. James Beecham, Michael J. Bangs, and Andrew L. Corwin, U.S. Naval Medical Research Unit No. 2, American Embassy Jakarta, Unit 8132 NAMRU-2, FPO AP 96520-8132, Jakarta, Indonesia, Telephone: 011-62-21-421-4460, Fax: 011-62-21-424-4507, E-mail: corwinal{at}namru2.med.navy.mil. Toni Wandra and Sukman Didi, Directorate General of Communicable Diseases Control and Environmental Health, Ministry of Health, Jakarta, Indonesia. Josef R. Rachdyatmaka, Regency Health Service, Merauke, Papua, Indonesia. Stevie Osok and Petrus Tjia, Merauke Public Hospital, Papua, Indonesia. John M. Saragih, Ingerani S. Prawira, and Sri A. Suparmanto, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia.

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