Funchal City Council will initiate the 2014 combat against the Aedes aegypti mosquito - the Dengue Fever vector - Tuesday 29 July with the application of salt water in the city´s gutters and drainage system, especially in the most critical areas of the city, marked in red.

Salt water has been confirmed as an effective measure against the evolution of mosquito larva with little or no relevant environmental impact since most of the city´s road / rainwater drainage systems empty into the sea.

Funchal City Council maintains its own monitoring network of both ovitraps and mosquito traps and sends these results to the regional health board - IASAUDE who in turn, together with a larger monitoring network, produce a regional entomological report. 

This combat will continue through to October / mid-November in intervals of no more than 3 weeks and adjusted according the meteorological alterations and monitoring results

Source: DN Noticas Madeira "Operação de combate ao mosquito vector de transmissão da dengue no Funchal", 2014-07-28

Ana Clara Silva, vice-president of IASUADE confirms that Madeira and Porto Santo participate in a national vector monitoring programme REVIVE, which have indicated 50% less mosquito activity in 2014 compared to 2012.

Eradication of the mosquito is unlikely. Locals and visitors must learn to live with the mosquito, as in other destinations such as Greece or Madrid in Spain where 38 cases of imported Chinkunguya virus infections were declared and are transmitted by the Aedes mosquito, which is settling not only in tropical destinations.

Prevention is still the key action, both in the reduction of breeding grounds, especial water ways, as well as wearing light coloured, long sleeve clothes and mosquito repellent to prevent being bitten.


Lastly, travellers visiting known Dengue or Chinkunguya outbreak regions, such as Brazil, should  adhere to recommendations to prevent being bitten and/or infected by the Aedes mosquito. Those returning from Dengue outbreak regions and have any symptoms of Dengue within 2-3 weeks after returning, should contact their doctor ... as they could cause an outbreak in regions with Aedes mosquito.

Source "Mosquitos de regresso, Aedes aegypti já estão em maior actividade. Iasaude recomenda cuidados" in DN Noticias Madeira 2014-07-23

Monitoring Aedes mosquito population, as well as their viral load, could be a key step to reduce the risk of a Dengue or Chikungunya fever outbreak in European locations where the Aedes mosquito is know to be resident.

Source: IASAUDE / July 2014

The World Cup in 2014 was held in Brasil, the country with the highest number of Dengue cases in the world. 

The World Cup is expected to attract 600,000 international visitors and , with the substantial decrease of mosquito and dengues cases in 2013 and early 2014, an estimated 3-59 and expected 33 visitors will become infected  ... estimating the number of dengue infections in international visitors to Brazil may also help anticipate the risk of importation of dengue into currently non-dengue endemic countries when the travellers return home. Travellers contribute to the spread of dengue globally which for example has led to the dengue outbreak in Europe in 2012, in the Island of Madeira (Portugal) (Wilder-Smith et al. 2014). 

Data on air passengers and air travel patterns may help identify risks for importation (Napoli et al. 2012, Sessions et al. 2013). The establishment of dengue in currently uninfected area will depend on the presence and density of Aedes mosquitoes. Assessing the likelihood of local transmission of these viruses into currently uninfected countries such as most of Europe depends on the number of viraemic person-days among air-travellers arriving in the European Union (Seyler et al. 2009).

Finally, the dengue number of cases observed in the first 14 weeks of 2014 is more than 80% lower than the same period in 2013. Many factors could explain this observation, in particular the huge epidemic that occurred in 2013 (the highest ever in Brazilian dengue history with more than 1.3 million cases) and the severe drought observed in the summer period of 2103/2014. The latter factor has been previously reported in Brazil (Olívêr et al. 2014), when a significant negative correlation was observed between dengue cases and bushfires, a phenomenon strongly influenced by drought. In addition, important vector control measures were reinforced as a result of the huge outbreak in 2013. In any case, it is expected that the number of dengue cases among travellers visiting Brazil in the World Cup will be very low.

Source:
"Risk of symptomatic dengue for foreign visitors to the 2014 FIFA World Cup in Brazil", Massad E. et al, 
Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 109(3): 394-397, May 2014

Wilder-Smith A, Quam M, Sessions O, Rocklov J, Liu-Helmersson J, Franco L, Khan K. The 2012 dengue outbreak in Madeira: exploring the origins . Euro Surveill. 
2014;19(8):pii=20718. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20718

Since the start of the Dengue outbreak in Madeira on 3rd October 2012, a total of 2164 Dengue fever cases have been reported in the Autonomous Region of Madeira health network, with new number of reported cases per week in local population continuing to drop.

NOTE: reporting is monthly, so possible that exported cases could have occurred since previous report issue rather than a significant outbreak.

Total number of exported cases has increased from 74 to 78 since the last monthly report in January 2013, with one new case reported in Portugal and three in Finland. The last report was on 1st February 2013 (ECDC - CDTR report week 6).

Although the number of new local Dengue Fever cases reported per week continue to drop (due to reduced mosquito population activity because of lower temperatures), dengue still exists in the vector Aedes aegypti mosquito in Madeira, as the new cases confirm. Health authorities maintain the recommendation of prevention measures to avoid getting bitten by mosquito.

We maintain developing the Aedes aegypti Mosquito Monitoring Programme which will allow participants to monitor mosquito eggs and larvae as well as adult mosquito population and, according to weekly results, take preventative measures to avoid adult mosquito outbreaks and consequent Dengue Fever transmission/outbreak.
The Aedes aegypti Mosquito Monitoring Programme can also include a site visit and audit to identify potential mosquito breeding sites and recommend actions to reduce or eliminate breeding sites as well as regular audits to verify implementation of recommendations.

We are working with the Chamber of Commerce and local  authorities to develop a network of participants who want to monitor their own private areas, which can complement the monitoring network being done by local authorities.

Sources:

• DGS report 3 February 2013
  
• ECDC Communicable Disease Threats Report (CDTR) - week 6/2013 - 12 February 2013
  

In the weekly update on 12 December 2012 regarding Dengue Fever outbreak in Madeira since 3 October  2012, the National Health Authorities reported 2050 cases of dengue fever, as follows:

• total number of confirmed cases 2050

         57 new cases in week 49 (03 - 09 December 2012) on previous week,  a 44% retraction in new cases

• total cumulated hospitalized cases 121
  
• number of patients currently hospitalized 2
• Number of cases reported by non-resident citizens with recent stay in Madeira: 52

NOTE:
ECDC report of 13 December 2012 (see below for link) identifies 58 exported cases until 12 December 2012

The prevention recommendations remain in place as well as actions to reduce local transmission and export of the Aedes aegypti mosquito vector.

The ECDC in is weekly "Communicable Disease Threats report", Week 49, 2-8 December 2012 reconfirmed there are no trade or travel restrictions to and from Madeira.

Source: 
Comunicado do Diretor-Geral da Saúde sobre casos de dengue na Região Autónoma da Madeira "DGS"
ECDC  weekly "Communicable Disease Threats report", Week 49, 2-8 December 2012
ECDC "Epidemiological update: Outbreak of dengue in Madeira, Portugal" 13 December 2012
Analysis: ZINO - Consultadoria

Local news paper and TV station have confirmed that Madeira Regional Health Authorities have started fogging public spaces in an integrated action to reduce the Aedes aegypti mosquito population, vector of Dengue virus.

Prevention including the elimination of breeding areas and prevention from getting bitten are still the key actions which all the population must participate to reduce the mosquito population, especially as with the slight decrease in temperature, the mosquito will search for warmer environments including homes.

In the weekly update, the regional health authorities reported the following on 17 October 2012:

• total probable number of cases 262
  
• total cumulated cases confirmed 37
• number of patients currently hospitalized 6
• total cumulated cases hospitalised 30

Maintain strong emphasis on prevention form being bitten by Mosquito. Use long sleeves, light coloured clothes, trousers, socks and closed shoes at the mosquito´s most active period (sunrise  and sunset) and repellents containing DEET, as well as reducing and eliminating breeding grounds for the Aedes aegypti mosquito,  vector of the Dengue fever.

Source: Comunicado IASAÚDE, IP-RAM - 17-10-2012 "Instituto de Administração da Saúde e Assuntos Sociais, IP-RAM"

ECDC Rapid Risk Assesment report issued 10 October 2012 confirms that there are no restrictions regarding travel to and from Madeira. and that standard prevention from mosquito bites should be adhered to.

A 3 Outubro 2012, foram notificados dois casos  autóctones de febre do dengue na Ilha da Madeira.

A data de 10 Outubro 2012:

• foram confirmados 18 casos de dengue DEN-1
  
• aguardam confirmação laboratorial 191 casos (totais prováveis)
• foram hospitalizados, cumulativamente, 26 doentes desde o inicio do surto
• neste momento estão hospitalizados 11 doentes

Fonte: Comunicado C46.03.01 de 10/10/2012 da "Direcção Geral de Saúde", elaborado em conjunto com o "Instituto de Administração da Saúde e Assuntos Sociais, IP-RAM"