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86 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES
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during 2013–2014, the DEN-3 virus serotype was recorded in Fiji and in several other islands,
inflating the number of reported cases. Malaysia and Singapore indicated sustained epidemic
activity during the same period. Since late 2013, a few countries in the Pacific have reported
concurrent outbreaks of dengue, chikungunya and Zika viruses (Box 4.3.1). Diagnosis and
management remain a challenge, with all efforts now focused on vector control with active
community involvement.
Fig. 4.3.2 shows the global number of dengue cases reported to WHO and Fig. 4.3.3 the trend
in the number of deaths.
Box 4.3.1 Chikungunya
Chikungunya virus has caused large epidemics of chikungunya fever since 2004, with considerable morbidity and
suffering. The virus is transmitted by the same vectors as those responsible for dengue. After initially affecting the
African and Asian regions, the virus has spread to the Region of the Americas.
As of October 2014, more than 776 000 suspected cases of chikungunya (including 152 deaths) had been recorded
in the Caribbean islands, Latin American countries and some South American countries. Mexico and the United States
of America have also recorded imported cases. On 21 October 2014, France confi rmed four cases of locally-acquired
chikungunya infection (in Montpellier).
Fig. 4.3.2
Number of dengue cases reported to WHO, by region,
1995–2013
Millions
3.5
3
Number of cases reported
2.5
2
1.5
1
0.5
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Year
Eastern Mediterranean Region Region of the Americas South-East Asia Region
Western Pacific Region