Dengue Situation Update 670

27 April 2023
Update on the Dengue situation in the Western Pacific Region
This report describes the epidemiology of dengue in the World Health Organization Western Pacific
Region. Data are compiled from open sources (national indicator-based surveillance systems) with the
exception of Cambodia, Lao People’s Democratic Republic, Viet Nam, and the Philippines, where data are
provided from WHO Country Offices, and for Pacific Island Countries, where syndromic surveillance data
are provided by the Division of Pacific Technical Support. Information is reported based on countries’
standard dengue case definitions and a summary of these definitions and countries’ dengue surveillance
systems is included as an annex to this report. Due to differences in surveillance methods and reporting
practices, a comparison of trends between countries and areas is not possible however national trends
can be observed over time.

Northern Hemisphere
Cambodia
As of epidemiological week 15 of 2023, a total of 1,667 cases, with 4 deaths (Case Fatality Rate (CFR)
0.24%) were reported to the National Dengue Surveillance System in Cambodia since 1 January 2023
(Figure 1); compared to 608 cases and one death in 2022 over the same period.

Figure 1: Dengue cases reported weekly in 2023 vs Mean and Mean+2SD

during 2015-2020 *excluding 2019 in Cambodia;
Source: National Dengue Surveillance System (NDCP/CNM/MOH)

China
In December 2022, 11 dengue cases were reported respectively in China. There has been a total of 548
dengue cases and no deaths in the country from January 2022 to December 2022. The trend for 2022
remained low (Figure 2).

Dengue Situation Update 670 | 1

 Figure 2: Dengue cases reported monthly from 2015-2022 in China
Source: National Health Commission, China

Lao People’s Democratic Republic

As of epidemiological week 15, of 2023, 85 dengue cases and 0 death were reported. This is lower
compared to the 107 cases reported in the previous week. The cumulative number of cases reported for
epidemiological weeks 15, 2023 was 919. This is 7 times higher compared to the 131 cases reported during
the same period in 2022. There have been no deaths reported in 2023.

Figure 3: Dengue cases reported weekly from 2018-2023 in Lao PDR

Source: National Centre for Laboratory and Epidemiology, Ministry of Health, Lao PDR

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 Malaysia
During epidemiological week 16 of 2023, there were 1,877 compared to 2,399 in the previous week, which
is a decrease of 522 cases (21.8%). One death due to dengue fever complications was reported. The
cumulative number of Dengue cases reported to date is 35,202 cases compared to 11,921 cases for the
same period in 2022, which is an increase of 23,281 cases (195.3%). As of epidemiological week 16, a total
of 22 deaths due to dengue had been reported, compared to 6 death cases in 2022.
Number of cases

Figure 4: Dengue cases reported weekly from 2022, 2023, and median 2018-2022 in Malaysia
Source: Department of Health, Malaysia

Philippines
As of 25 March 2023, epidemiological week 12, a total of 29,885 cases have been reported. The number
of cases is 85% higher compared to the same period in 2022 (n=16,154). From 1 January to 25 March 2023,
there have been 95 deaths (CFR 0.3%), which is lower than 107 deaths (CFR 0.7%) for the same period in
2022.

Figure 5: Dengue cases reported weekly from 2022 and 2023 in the Philippines
Source: Department of Health, the Philippines

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 (Note: there is a 3-4 week systematic delay in reporting and numbers should be interpreted with caution)

Singapore
As of epidemiological week 15 of 2023, 134 dengue cases were reported in Singapore, leading to a total
of 2,612 cases (Figure 6). This is a 44% decrease compared to the same period (4,714 cases) in 2022.
Preliminary results of all positive dengue samples serotyped in Mar 2023 showed DEN-1, DEN-2, DEN-3,
and DEN-4 at 25.6%, 17.4%, 54.5%, and 2.5% respectively.

Figure 6: Dengue cases reported weekly from 2018-2023 in Singapore

Source: Communicable Diseases Division, Ministry of Health, Singapore

Viet Nam
As of 9 April epidemiological (week 14) 2023, there were 26,281, including 3 deaths reported cumulatively
in Viet Nam. Compared to the same period in 2022 (14,266 cases including 7 deaths), the number of
cumulative cases nationwide is 1.8 times higher, and the number of deaths decreased by 4 cases. During
week 14th (from 3 April – 9 April), there were 1,363 cases reported including no deaths; of those 1,066
were hospitalized (78.2%). Compared to the previous week (1,496 cases including 1,194 hospitalizations
and no deaths), the number of cases decreased by 8.9%, and the number of hospitalizations decreased by
10.7%.

Figure 7: Number of dengue hospital admissions and deaths by weeks in 2022

compared to 2023 as of week 14 2023, Viet Nam
Dengue Situation Update 670 │ 4
 Source: General Department of Preventive Medicine, Ministry of Health, Viet Nam
Note hospitalizations include inpatients and outpatients
Alert threshold is a 5-year mean plus 2 standard deviations

Southern Hemisphere
Australia
There were 21 dengue cases reported in Australia during the reported fortnight (06 March to 19 March
2023). The number of cases was higher 152 for the current year to 19 March 2023, compared with the
trend for the years 2020 -2021(Figure 8). This may be attributed to COVID-19-related travel restrictions
in 2020-2021. Prior to COVID-19, Australia had seen notifications of overseas-acquired cases from
travellers returning from dengue-endemic areas.

Figure 8: Laboratory-confirmed dengue cases reported monthly from 2015-2023 in Australia

Source: Department of Health, Australia

Pacific Islands Countries

New Caledonia
There are no further updates since the previous report. From 1 January to 28 February 2023, 4 confirmed
dengue cases were reported in New Caledonia (Figure 9). This is higher compared to the same period in
2022 when a total of 1 dengue cases were reported. Of the 4 confirmed dengue cases in 2023, two were
imported cases. 2 imported cases were DENV-1 and DENV-2.

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 Figure 9: Dengue cases reported by week from 2021 to 2023 in New Caledonia
Source: Network of sentinel physicians, New Caledonia
Pacific Island Countries and Areas (PICs) – Dengue-like illness (DLI) Surveillance

During epidemiological week 15 of 2023, Pacific Island Countries and Areas with available surveillance
data (14/18 PICs) are reporting no or low numbers of DLI cases. Fiji, Samoa and Solomon Islands reported
a higher weekly number of cases compared with the corresponding epidemiological week of 2022. No
other countries reported case numbers above the alert threshold.

Cook Islands DLI Trend - 2021 -2023 (W15) Fiji DLI Trend - 2021 -2023 (W15)
20 800

15 600
Cases

10
Cases

400

5
200
0
1 3 5 7 9 111315171921232527293133353739414345474951 0
Epi week 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
Epi week
DLI 2023 DLI 2021
DLI 2022 DLI 2023 DLI 2021

French Polynesia DLI Trend - 2021 -2023

(W12)
120
100
80
Cases

60
40
20
0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49
Epi week

DLI 2023 DLI 2021 DLI 2022

Dengue Situation Update 670 │ 6

 Kiribati DLI Trend - 2021 -2023 (W15) Marshall Islands DLI Trend - 2021 -2023 (W15)
10
16
8
14
12
6
10

cases
Cases

8
4
6
4
2 2
0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 0
1 3 5 7 9 111315171921232527293133353739414345474951
Epi week
Epi week
DLI 2021 DLI 2022
DLI 2023 DLI 2023 DLI 2021

N Mariana Is DLI Trend - 2021 -2023 (W15)

10

6
Cases

0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
DLI 2021 EpiDLI
week
2022 DLI 2023

Niue DLI Trend - 2021 -2023 (W15) Palau DLI Trend - 2021 -2023 (WK15)
10

8 8

6 6
cases

cases

4 4
2 2
0
0
1 3 5 7 9 111315171921232527293133353739414345474951
1 3 5 7 9 111315171921232527293133353739414345474951
Epiweek
Epiweek
DLI 2021 DLI 2022 DLI 2023
DLI 2021 DLI 2022

Pitcairn Islands DLI Trend - 2021 -2023 (W15)

10
8
6
cases

4
2
0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
Epi week
DLI 2021 DLI 2022

Dengue Situation Update 670 │ 7

 Solomon Islands DLI Trend - 2021 -2023 Tokelau DLI Trend - 2021 -2023 (W 13)
70
(WK15)
60 10
50 8
40
Cases

Cases
30
4
20
2
10
0
0 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49
1 3 5 7 9 111315171921232527293133353739414345474951 Epiweek
Epi week DLI 2021 DLI 2022
DLI 2023 DLI 2021

Tuvalu DLI Trend - 2021 -2023 (W13) Tonga DLI Trend - 2021 -2023 (WK15)
10
10
8 8
6 Cases 6
Cases

4
4
2
2
0
0 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 Epi week
EPI week DLI 2023 DLI 2021 DLI 2022
DLI 2021 DLI 2022

Vanuatu DLI Trend - 2021 -2023 (W15) Wallis & Futuna DLI trend -2021 -2023
(WK15)
12
30
10
25
8
20
Cases
cases

6
15
10 4

5 2
0 0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
Epi week EPI Week
DLI 2023 DLI 2022 DLI 2023 DLI 2021 DLI 2022
DLI 2021

Figure 10. Reported cases of dengue-like illness in Pacific Islands Countries and Areas
Source: WHO Division of Pacific Technical Support
Note: Caution should be taken in interpreting these data as there may be changes in the number of sentinel sites reporting to the Pacific Syndromic
Surveillance System (PSSS). Furthermore, the syndromic case definition of DLI may capture cases with non-dengue acute febrile illnesses (AFI) with
similar clinical manifestations to dengue. This includes AFI such as chikungunya, influenza, hantavirus, leptospirosis, malaria,
measles, paratyphoid and typhoid fevers, scrub typhus, yellow fever, zika, other diseases. The PSSS may also capture dengue cases under
‘prolonged fever’ surveillance. Alert threshold for DLI is twice the average number of cases seen in the previous 3 weeks.
FSM: Federated States of Micronesia

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Annex 1. Summary of dengue case definitions, laboratory sampling and testing methods used for surveillance in Member States as of 2023
Case definition
Country Clinically confirmed case
Australia Fever, headache, arthralgia, myalgia,
rash, nausea and vomiting
Cambodia Suspected dengue: very high fever at
39-40 degrees celcius for 2-7 days
(usually 3-4 days), with 2 or more of
the following signs: flushed face,
headache, retro-orbital pain,
myalgia/arthralgia, cutaneous rash,
haemorrhagic signs (petechiae,
positive tourniquet test), and
leucopenia.
Probable dengue: signs of suspected
dengue plus laboratory test results
(see right column)) or that the case
occurred in an area where the dengue
case has been confirmed.
China (i) more than two symptoms of acute
onset fever, severe headache, orbital
pain, myalgia, arthralgia, fatigue with
a history of travel in a dengue
endemic area within 15 days before
symptom onset or cohabitation with
an individual with confirmed dengue;
or no travel history, but with a rash or
positive tourniquet test AND
leucopenia or thrombocytopenia or
serum IgM positivity.
Lao People's WHO dengue case classification
Democratic Republic (2009) †
Surveillance system
Laboratory Description
confirmation
required
Yes National Notifiable Diseases Surveillance System
(NNDSS) indicator-based surveillance system
National Dengue Control Program (NDCP) enhanced
sentinel surveillance system
Communicable Disease Control (CDC) syndromic
surveillance system (CamEWARN).
Yes Health Management Information System (HMIS)
collects data on confirmed cases and deaths.
No Reported to the Chinese Centre for Disease Control
and Prevention (China CDC) through the Chinese
National Notifiable Infectious Disease Reporting
Information System (CNNDS).
No National Surveillance System for Notifiable Selected
Diseases, indicator-based surveillance system that
consists of passive weekly reports of clinically
suspected cases, on admission, from all health-care
facilities across the country.
Laboratory sampling and testing method Reference
Testing is recommended in persons who have a 1
clinically compatible illness and have travelled
to an area with known dengue activity during
the exposure period (3-14 days prior to onset of
symptoms). Both confirmed and probable cases
are nationally notifiable.
2
Data collected for Cambodia Laboratory
Information System (CamLIS), comprised of 32
participating hospital laboratories where NS1
detection is conducted.
Laboratory testing: Antibody HI>= 1/1280 or
IgM/IgG positive by ELISA test in convalescence
serum
Laboratory confirmation is done by real-time WHO internal
RT-PCR, NS1 in acute-phase serum, or virus communication
isolation from an acutely infected patient’s
serum.
3
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 Malaysia WHO dengue case classification Yes National Dengue Surveillance System, indicator-based All suspected cases are to be tested by the 4
(2009) † surveillance system following laboratory tests: Rapid Combo Test
(RCT) (NS1, IgM, IgG), Dengue Antigen and
Serology tests by ELISA, Dengue Viral RNA
Detection (Real time RT-PCR), Viral Isolation
Philippines WHO dengue case classification Yes Philippine Integrated Disease Confirmed dengue is a suspect case with 5, 6
(2009) † Surveillance and Response (PIDSR), indicator-based positive (+) viral culture isolation and/or PCR.
surveillance system. Reporting delays of 2-3 weeks, NS1 (+), IgM is used to identify probable
making comparison of current weekly and cumulative dengue.
figures with previous years difficult.
Singapore Fever, headache, backache, myalgia, No Samples are tested by the laboratory as 7
(endemic) rash, abdominal discomfort and ordered by the physician. Laboratory
thrombocytopenia and laboratory confirmation is done by dengue NS1 (+), IgM (+)
testing (see right column) or PCR (+)

Viet Nam Acute onset of fever continuously
(endemic) lasting from 2-7 days AND at least 2 of
the following: haemorrhagic
manifestation /presentation;
headache, loss of appetite, nausea,
vomiting; rash; muscle pain, joint
pain, orbital pain; lethargy; abdominal
pain.
Pacific Island WHO dengue case classification
Countries (2009) †
No As per the MOH dengue surveillance guideline, 8
in routine surveillance MAC-ELISA is conducted
for at least 7% and virus isolation is conducted
for at least 3% of clinical cases. In an outbreak,
at least 5 to 10 suspected cases are tested.
No Pacific Syndromic Surveillance System Confirmed case: Isolation of dengue virus or 9
detection of dengue-specific antigen or
antibodies in tissue, blood, CSF or other body
fluid by an advanced laboratory test

Only the minimum criteria required for fulfilling a clinical dengue case definition are included here; additional signs and symptoms required for more severe forms are not listed.
† A probable dengue case is defined as any case living in or travel to dengue endemic area with fever and two or more of the following: nausea, vomiting, rash, aches and pains, positive tourniquet test,
leucopenia and any warning sign. A case with warning signs is defined as a clinically diagnosed case with any of the following: abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation,
mucosal bleed, lethargy, restlessness, liver enlargement > 2 cm and increase in haematocrit concurrent with rapid decrease in platelet count. Severe dengue is defined as severe plasma leakage leading to any of
the following: shock, fluid accumulation with respiratory distress OR severe bleeding as evaluated by clinician OR severe organ involvement of liver (aspartate amino transferase or alanine amino transferase ≥
1000), central nervous system (impaired consciousness) or heart and other organs. 10

References:
1. Australian Government Department of Health AGDo. Dengue virus infection case definition 2017 [updated 17 January 2017. Available from:
https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-nndss-casedefs-cd_dengue.htm. https://www.health.gov.au/sites/default/files/documents/2020/02/dengue-cdna-
national-guidelines-for-public-health-units.pdf
2. Cambodia Ministry of Health NCfP, Entomology and Malaria Control. National Guideline for Clinical Management of Dengue, 2018. 2018. Available from:
https://niph.org.kh/niph/uploads/library/pdf/GL055_National_guideline_for_ClM_Dengue.pdf.

Dengue Situation Update 670 │ 10

3. Khampapongpane B, Lewis HC, Ketmayoon P, Phonekeo D, Somoulay V, Khamsing A, et al. National dengue surveillance in the Lao People's Democratic Republic, 2006-2012: epidemiological and
laboratory findings. Western Pac Surveill Response J. 2014;5(1):7-13. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24734212.
4. Ministry of Health Malaysia DCD. Case definitions for infectious diseases in Malaysia. 2017. Available from:
https://www.moh.gov.my/moh/resources/Penerbitan/Garis%20Panduan/Pengurusan%20KEsihatan%20&%20kawalan%20pykit/Case_Definition_Of_Infectious_Disease_3rd_Edition_2017.pdf
5. Secretary PDoHOot. Guidelines for the Nationwide Implementation of Dengue Rapid Diagnostic Test (RDT), Administrative order No.2016-0043. 2016(2016-0043).
6. Secretary PDoHOot. Revised Dengue Clinical Case Management Guidelines 2011, Administrative order No.2012-0006. 2012 22 March 2012. Report No.
7. Diseases SNCfI. Diseases and Conditions, Dengue 2020 [updated 14 September 2020. Available from: https://www.doh.gov.ph/Health-Advisory/Dengue.
8. Viet Nam Ministry of Health VNMo. Circular 54/2015 / TT-BYT 2015 [updated 26 April 2016. Available from: https://syt.thuathienhue.gov.vn/?gd=27&cn=108&tc=3993.
9. Pacific Islands Outbreak Manual. Available from: https://www.pphsn.net/resources/outbreak-manual/
10. WHO dengue outbreak toolbox. Available from: https://www.who.int/docs/default-source/outbreak-toolkit/updates-documents_july-5/dengue-outbreak-data-collection-toolbox---inis-3-july-
1.pdf?sfvrsn=ec3ffcf3_2

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