The sex ratio was 9/1 (6/1 in the armed forces as a whole); median age was 33 years (range: 19–56). (per 1000 person-years) Symptoms and clinical signs were

myalgia (95%), fever (94%), headache (90%), retro-orbital pain (56%), rash (25%), and digestive symptoms (21%). Twenty-five patients LY294002 were hospitalized for observation, but their condition was not serious. Surveillance results highlighted dengue circulation in the West Indies, French Polynesia, Africa (Djibouti, Ivory Coast, Mayotte, Tanzania), French Guiana, and Indonesia. More exactly, laboratory results enabled the serotype to be identified: DENV-1 in Guadeloupe, Martinique, French Guiana, New Caledonia, and Djibouti; DENV-3 in Mayotte and Djibouti; and DENV-4 in French Guiana. Incidence rates of dengue according to location are presented in Table 1. The incidence rate was highest in the French West Indies, immediately followed by French Guiana (p < 10−9). The risk was high in the French West Indian islands where an outbreak occurred among the local population during the summer of 2010. No dengue cases occurred in the French military in the Central African Republic, Chad, Gabon, Uganda, Reunion Island, and Senegal. The limits of epidemiological surveillance have to be taken

into account when considering these results. The actual number of cases is usually underestimated, this website resulting from failure to declare cases:[8] In French overseas departments and territories, patients have access to civilian health care and can thus be missed by military surveillance, whereas when stationed in foreign countries, they do not have that choice, but diagnostic capabilities are not always available. To detect

early warning signals for an outbreak, we chose to use a sensitive case definition.[9] That is why possible dengue cases (without biological confirmation but in an epidemic context) and serologically confirmed dengue cases were included. However, serology could create confusion with other flaviviruses due to cross-reactive antibodies. In fact, only confirmed cases using culture, RT-PCR, or Ag NS1 methods were actual dengue cases. Locations where the French armed forces’ epidemiological surveillance system identified dengue circulation in 2010 to 2011 (French West Indies, French Polynesia, French Guiana, Africa, and Indonesia) were well known for dengue virus circulation.[10] Dynein In the French West Indies, the serotype was not the same as during the previous outbreak in 2007.[11] DENV-1 and DENV-4 circulated in 2010, whereas DENV-2 circulated in 2007. This type of situation is usually responsible for intense virus circulation and therefore for outbreaks. Serotype identification is very important to highlight epidemic risk. Our circulation results were complementary to WHO global surveillance results, and could serve to improve knowledge about serotype circulation, that is, detection of DENV-1 circulation in New Caledonia,[12] and DENV-3 in Djibouti.