THE FIRST REPORTED OUTBREAK OF DENGUE HEMORRHAGIC-FEVER IN IRIAN-JAYA, INDONESIA

During the months of September 1993 through February 1994, an outbreak of hemorrhagic fever occurred in the city of Jayapura, the provincial capital of Irian Jaya, Indonesia. Seventy-two patients (age range = 1 -41 years) with suspected dengue hemorrhagic fever (DHF) were enrolled into the outbreak investigation conducted during October-November 199 3. The pediatric patient population consisted of 36 individuals ages 1 -12 years of age with a similar male to female ratio. From clinical hi stories obtained from the children diagnosed with DHF (n = 23), the pr edominant complaints were fever (100%), headache (96.7%), vomiting (47 .8%), abdominal pain (39.1%), back/ bone pain (39.1%), cough (39.1%), sore throat (21.7%), convulsions (17.4%), and eye pain (13.0%). Clinic al findings of the same pediatric patients included a positive tourniq uet test result (100%), thrombocytopenia (100%), hemoconcentration (10 0%), skin petechiae (43.5%), epistaxis (39.1%), and maculopapular rash (26%). All four of the children diagnosed with DHF grade IV had hepat omegaly, pleural effusion, ascites, cold perspiration, and confusion. Serologic data demonstrated that a majority (46 of 70, 68.7%) of the i ndividuals assessed did not have significant levels of IgM specific fo r dengue viruses at the time of their admission. However, the nine suc cessful dengue virus isolations were only from these serononreactive c ases (19.6%). From the other patients assessed, 11.4% had a primary (o r first exposure) serologic response to dengue virus antigen (predomin antly IgM); 17.1% had a secondary (or subsequent exposure) serologic r esponse to the same dengue antigens (predominantly IgG response) and 5 .7% (four adults) had indeterminate serologic data that could not diff erentiate between reactivity to dengue or Japanese encephalitis virus antigen preparations. Virus culture of blood samples produced nine den gue virus isolates: DEN-1 (2), DEN-2 (1), and DEN-3 (6). Japanese ence phalitis and influenza viruses were not isolated from blood and pharyn geal specimens, respectively, from any of the patients. Thus, this fir st reported outbreak of DHF in Irian Jaya, Indonesia was found to be a ttributed to dengue viruses types 1, 2, and 3.