1. Dengue in Japan ? ! ver 2 2014/08/27 updated

2. Euro Surveill. 2014;19(3):pii=20681.

3. 50 NS1IgMIgG IgG

4.

5. 0 82 7 1 2 6 27

6. 10 8 20 8 25 8 26

7.

8.

9. Aedes 100 57

10. http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/dengue

11. http://www0.nih.go.jp/vir1/NVL/denguecases

12.

13. 5

14.

15. Culex Aedes Anopheles ! ! ! ! / Jong Travel and Tropical Medicine Manual, 4th ed.

16. 1 Aedes aegyptiAedes albopictus ( 2009) 2010 (2007) (2011) 2000 (IASR Vol. 32 p. 167-168: 20116) 4 z 5 10 2013 2 11C 2 (2007 100 Km 1950

17. 2001-2002100 2002 2007 DENGUE RESEARCH Dengue Fever, Hawaii, 20012002 Paul V. Effler,* Lorrin Pang,* Paul Kitsutani, Vance Vorndam, Michele Nakata,* Tracy Ayers,* Joe Elm,* Tammy Tom,* Paul Reiter, Jos G. Rigau-Perez, John M. Hayes, Kristin Mills,* Mike Napier, Gary G. Clark, and Duane J. Gubler* for the Hawaii Dengue Outbreak Investigation Team1 Autochthonous dengue infections were last reported in Hawaii in 1944. In September 2001, the Hawaii Department of Health was notified of an unusual febrile illness in a res-ident with no travel history; dengue fever was confirmed. During the investigation, 1,644 persons with locally acquired denguelike illness were evaluated, and 122 (7%) laboratory-positive dengue infections were identified; dengue virus serotype 1 was isolated from 15 patients. No cases of dengue hemorrhagic fever or shock syndrome were reported. In 3 instances autochthonous infections were linked to a person who reported denguelike illness after travel to French Polynesia. Phylogenetic analyses showed the Hawaiian isolates were closely associated with contemporaneous isolates from Tahiti. Aedes albopictus was present in all communities surveyed on Oahu, Maui, Molokai, and Kauai; no Ae. aegypti were found. This out-break underscores the importance of maintaining surveil-lance and control of potential disease vectors even in the absence of an imminent disease threat. Dengue viruses cause a wide range of illness, including dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Four dengue serotypes, known as DENV-1, -2, -3, and -4, can cause severe and fatal disease. Dengue typically occurs in tropi-cal and subtropical areas in the world and is transmitted by Aedes mosquitoes; Aedes aegypti is the principal vector worldwide (1). DF and DHF are the most important arboviral diseases of humans; 50100 million dengue infections and several hundred thousand cases of DHF occur annually (2). The first large-scale dengue fever epidemic in Hawaii Hawaii (4). Epidemic dengue occurred again on Oahu in 1943 to 1944, when 1,498 infections were reported, most-ly in urban areas of Honolulu (5). Ae. albopictus had been introduced into Hawaii at the beginning of the century, and by 1940 it was the dominant day-biting Stegomyia mosqui-to species in the islands (4,5). After the Second World War, no confirmed autochtho-nous dengue infections were reported in Hawaii. Nevertheless, dengue illnesses were occasionally identi-fied among travelers to Hawaii who had been infected overseas. The annual number of imported cases was low, with 20 infections recorded during the 10-year period from 1991 through 2000 (P. Effler, unpub. data). On September 12, 2001, the Hawaii State Department of Health (HDOH) received a call from a physician in Hana, Maui, who had seen a patient with febrile illness and rash 1 week earlier. The physician indicated that several of the patients family members had become symptomatic; none had a history of recent foreign travel. On investiga-tion by HDOH staff, dengue fever was suspected, and clin-ical specimens were collected and forwarded to the Centers for Disease Control and Prevention (CDC) for diagnosis. On September 21, CDC confirmed recent dengue infection in the index patient. We report the results of an investigation into the first outbreak of dengue fever in Hawaii in 56 years. Methods Case Finding From September 23 to 28, 2001, HDOH contacted all peaked in July and August 2001; exposures in the Society Islands accounted for the largest proportion of cases dur-ing this time (n = 9, 47%). Hawaiian High associated subsequent from Ae. on were of landing small Hana, adult rates surveys Hawaii, in Figure 2. Confirmed dengue infections by week of illness onset and island, Hawaii, May 20, 2001, to February 17, 2002. Emerg Infect Dis. 2005 May;11(5):742-9.

18.

19.

20. 85 n=85 % 25 (29.4) 20 (23.5) 16 (18.8) 65 (77.3) 51 (60.7) 17 (20.0)

21. 57

22. 85 WBC(/mm) 2780 (20203610) Hct(%) 41.8 (39.645.2) Plt(/mm) 11.9 (8.3516.1) GOT(IU/L) 37.0 (28.061.8) GPT(IU/L) 27.0 (19.047.5) LDH(IU/L) 256 (194326) CRP(mg/dL) 0.5 (0.30.9) CRP

23. Current PCRConcepts NS1IgMIgG IgM IgG confounded if the patient has very recently been infected or vaccinated with an antigenically related flavivirus (e.g., a virus associated with yellow fever or Japanese encephalitis). In addition, patients with secondary infections mount rapid anamnestic antibody responses in which dengue virusreactive IgG may predominate over IgM. In clinical settings where methods of molecular detection (e.g., RT-PCR) are not available, investigation for elevated levels of dengue virusreactive IgM or soluble NS1 in serum is a pragmatic diagnostic approach in a patient in whom dengue is suspected.43,45 Management Currently, no effective antiviral agents to treat den-gue infection are available, and treatment remains supportive, with particular emphasis on careful fluid management.1 Patients who have no com-plications IgG (secondary infection) E^>/^ 1 2 3 4 5 6 7 8 9 10 Day of Illness sZdWZ /D IgG (primary infection) Figure Simmons 4. Laboratory CP, et Diagnostic al. Dengue. Options N Engl in a J Med Patient 2012;with 366:Suspected 1423-32. Dengue Infection. Detection of viral nucleic acid, nonstructural protein 1 (NS1), or IgM sero-conversion

24.

25. 1. 2. 3. 2 ! 2cm HCT ! ! ! ASTALT1000 Dengue WHO 2010 Guidelines for Diagnosis, Treatment, Prevention and Control

26. Dengue WHO 2010 Guidelines for Diagnosis, Treatment, Prevention and Control

27. DEET20 12% DEET12%2

28. DEET PS12DEET12%2 DEETDEET DEET DEET 20DEET4%DEET Regul Toxicol Pharmacol 2010;56:939. J Am Acad Dermatol 2000;43:21922. 19. Aust N Z J Public Health 2009;33(5):48590.! Am J Trop Med Hyg 2001;65:2859.

29.