Dengue is one of the fastest spreading mosquito-borne viral diseases in the world. The virus is active in many parts of the world, mainly in (sub) tropical areas. Dengue virus belongs to the flaviviridae family as do West-Nile virus and Yellow fever for example. The virus consists of four different serotypes, which can circulate simultaneously during an epidemic. Infection with one serotype will activate the immune system and will give lifelong protection against this serotype, though secondary infection with a different serotype will establish a more severe course of disease. One of the hypotheses on this topic is the antibody enhancement theory, which suggests that besides the damage caused by the viral infection, an auto-immune response might lead to a potentially fatal course of Dengue called Dengue Hemorrhagic Fever / Dengue Shock Syndrome (DHF/ DSS).
In Curacao Dengue has been active during the rainy season, though the clinical course was relatively mild. This changed in 2008, when there was an alarming rise of Dengue fever in Curacao. The infections seen were relatively mild and Dengue Hemorrhagic Fever / Dengue Shock Syndrome did not occur. The question was raised: why was the course of disease relatively mild compared to surrounding countries like Venezuela and Cuba? Countries where dengue outbreaks are more common and DHF/DSS do occur.
In 2010 there was a new epidemic due to changes in weather (early start of the rainy season and hurricane Thomas), which made the climate perfect for the Aedes Aegypti (mosquito carrying dengue virus) to multiply and transmit the virus to human beings. During this epidemic cases of DHF/DSS did occur, especially in children. Dengue has no specific treatment, only symptoms can be treated. The development of specific treatments and a vaccine is still a work in progress.
The last few years the virus has been an increased health, economic and social burden on Curacao and this is why the Erasmus MC and the Public Health Organization of Curacao decided to investigate dengue virus and other circulating viruses on this island.
With the help of a group of highly motivated general practitioners we recently started the Invest-study: ‘The one-year epidemiology of viral infectious diseases in Curacao’. We will include patients presenting to the general practitioner suffering from fever and respiratory complaints, patient with diarrhea with or without fever, patients with suspected dengue and undifferentiated fever. A case record form will be filled out and research material will be taken after informed consent. If there is suspected dengue extra blood will be drawn for further investigations.
The aim of this study is to identify the circulating viruses, which has never been done before. Furthermore we want to investigate whether there are specific biomarkers, coagulation factors and hostfactors that might be specific for the course of dengue in this population.
With this study we want to reach out to the patients and provide them with more information on this topic. By doing so we want to increase the awareness of dengue fever and hopefully help prevent infections, and make patients seek medical help earlier which will be beneficial in preventing a more fatal outcome.
PhD candidate Fleur Moesker (Erasmus MC).