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21 Jan 2013

Dengue - Portugal - Madeira outbreak (ECDC/CDTR, January 21 2013, edited)

[Source: European Centre for Disease Prevention and Control (ECDC), full PDF document: (LINK). Edited.]


Dengue - Portugal - Madeira outbreak

Opening date: 10 October 2012 Latest update: 13 December 2012

Epidemiological summary

On 3 October 2012, the Portuguese public health authorities reported two cases of dengue infection confirmed in patients residing on the island of Madeira in the Autonomous Region of Madeira located around 400 km from the Canary Islands, 650 km from the African coast, and 1 000 km from the European continent.

The autonomous region has 268 000 inhabitants.

Since the beginning of the outbreak, 2 144 cases of dengue infection have been reported from the public health sector in Madeira.

The sequence analysis of viral genomes (600 nucleotides) from several positive human samples indicates high sequence similarity with DENV-1 circulating in Venezuela and Colombia, strongly suggesting a Latin American origin.

The vast majority of confirmed cases are from the city of Funchal, which is the main port on Madeira island. The island of Madeira has an established mosquito population of Aedes aegypti, the main vector of dengue in tropical and subtropical countries.

As of 17 January 2013, 74 patients have been diagnosed with dengue after returning from Madeira:

  • 10 in Portugal,
  • 23 in the UK,
  • 19 in Germany,
  • three in France,
  • five in Sweden,
  • four in Finland,
  • two in Denmark,
  • two in Austria, and
  • two in Norway.
  • Croatia, Slovenia, Spain and Switzerland have all reported one case each.

The last reported case was on 3 January 2013.

Web sources: ECDC fact sheet for health professionals | PT Directorate-General of Health | National Institute of Health Dr. Ricardo Jorge | ECDC Rapid Risk Assessment | WHO | Madeira Institute of Health Administration and Social Affairs


ECDC assessment

This is the first known occurrence of locally transmitted dengue infection in the Autonomous Region of Madeira, and consequently a new geographical area reporting autochthonous cases in the EU.

This is a significant public health event but not entirely unexpected because of the known presence of Aedes aegypti, a competent vector for dengue.

The updated figures indicate that the outbreak has peaked, with a decrease in the number of cases being reported since mid-November. Entomological surveillance has shown a decrease in mosquito activity as well.

The cases of dengue among returning travellers from the island highlight the need for travellers to Madeira to take measures in order to reduce mosquito bites. Travellers experiencing febrile symptoms with severe headache, retro-orbital pain, myalgia, arthralgia and maculo-papular rash within 21 days of visiting the island of Madeira are advised to seek medical advice.

Neighbouring geographical areas (e.g. Canary Islands) and other EU Member States need to assess the risk of establishment of Aedes mosquito populations and the introduction of dengue. The epidemiological situation does not imply the need for any trade or travel restriction beyond the disinfestation policies currently implemented.



ECDC published an updated rapid risk assessment concerning the autochthonous dengue cases in Madeira. An epidemiological update was published on the ECDC website on 13 December 2012.

Portuguese authorities published recommendations regarding personal protective measures, and measures for the safety of blood, cells, tissues and organ donations within the region.

Blood donor deferral for 28 days from day of departure for travellers returning from the Autonomous region of Madeira is now recommended in other EU countries.