Spatial Distribution of Epidemiological Cases of Dengue Fever in Suriname, 2001–2012

Abstract

Objective: To characterize the frequency, incidence and severity of dengue fever in Suriname and to detect INTRODUCTIONOver the last 50 years, the incidence of dengue fever (DF) worldwide has increased by 50-fold and 2.5 billion people currently live in dengue-endemic regions. An estimated 50 million cases of DF occur worldwide every year (1). Currently, dengue is hyperendemic in most of the countries of the World Health Organization's (WHO) Region of the Americas, including Suriname (2). Over the past 30 years, an increased level of urbanization and successful re-infestation of Aedes aegypti, the primary vector of dengue transmission, have contributed to the rapid spread of dengue in Suriname (3). The first endemic cases of DF occurred in 1981, with a total of 22 laboratory confirmed cases and an estimated 10% of the population of Paramaribo suffering from DF-like symptoms (4). An annual resurgence of DF and dengue haemorrhagic (DHF) fever began in 1997 (5) and the last registered dengue outbreak occurred toward the end of the rainy season in 2012. This annual resurgence of DF and DHF cases is influenced by demographic and environmental factors that have not been previously studied in Suriname. Thus, it is imperative to identify which factors exhibit patterns associated with the spatial and temporal distribution of DF and DHF. This study aims to 1) characterize the frequency, incidence and severity of dengue cases in Suriname from 2001 to 2012 and 2) integrate clinical and demographic information of all dengue cases to identify historic clusters of DF in Suriname.The dengue virus (DENV) is a pathogenic human virus that belongs to the genus Flavivirus (family Flaviviridae). Four different types of DENV (DENV type 1 through 4, DENV1-4), which result in distinguishable serological strains, are capable of causing DF in humans (6). DENV-1 became the first documented serotype circulating in Suriname and subsequently DENV-4 was reported in 1981 (7). DENV4 was reported in Suriname in 1994, followed by DENV1 in 1998, DENV2 in 1999 and DENV3 in 2001. Moreover, different serotypes have co-circulated within the population: DENV1, DENV2 and DENV3 were isolated from the patients during the largest dengue outbreak in Suriname in 2005.The Surinamese Bureau of Public Health (Bureau Openbare Gezondheidzorg -BOG), under the Ministry of Health, is the national institute in charge of dengue surveillance and control. In 2001, epidemiological surveillance of dengue began by

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