Reemergence of dengue in Cuba: a 1997 epidemic in Santiago de Cuba.

After 15 years of absence dengue reemerged in 1997 in the municipality of Santiago de Cuba Cuba. After the 1981 epidemic in which there were 10312 cases of dengue hemorrhagic fever/dengue shock syndrome and 158 deaths a campaign to improve mosquito control and eradicate Aedes aegypti was launched and most of Cubas 169 municipalities were free of the vector. The municipality of Santiago de Cuba was reinfested in 1992 by A. aegypti transported in imported tires. Risk factors in the province include limited water supply inadequate eradication efforts high vector infestation and increasing migration of people from endemic countries of Latin America and the Caribbean. Establishment of an active dengue surveillance system in 1997 identified 205 cases of dengue hemorrhagic fever 12 of which were fatal. Secondary infection was implicated in 98% of these cases. No autochthonous transmission to other municipalities has been detected. As a result of the 1997 epidemic an epidemiological alert system has been established and antivector intervention and seroepidemiological surveillance have been strengthened throughout Cuba.