Dengue in Fiji: epidemiology of the 2014 DENV-3 outbreak.

INTRODUCTION: Dengue virus serotype-3 caused a large community-level outbreak in Fiji in 2013 and 2014. We aimed to characterize the demographic features of affected individuals and to determine dengue mortality during the outbreak. METHODS: All laboratory-confirmed dengue cases and deaths were included in this study. Incidence and mortality were calculated according to demographic variables. RESULTS: A total of 5221 laboratory-confirmed cases of dengue were included in this analysis. The majority of patients were male (54.5%) and indigenous Fijians (iTaukei) (53.5%). The median age was 25 years old. The overall incidence was 603 per 100 000 population. The age-specific incidence was highest among people between 20 and 24 years of age (1057 per 100 000) for both sexes. The major urban and peri-urban areas of Suva and Rewa subdivisions reported the highest incidence of > 1000 cases per 100 000 population.​: A total of 48 deaths were included in this analysis. The majority of dengue-related deaths occurred in males (62.5%) and in the iTaukei (60.4%) population. The median age at death was 35 years old. The overall dengue-related deaths was estimated to be 5.5 deaths per 100 000 population. Dengue mortality was higher for males (6.8 per 100 000) than females. The highest age- and sex-specific mortality of 18 per 100 000 population was among males aged 65 years and older. DISCUSSION: Dengue morbidity and mortality were highest among males, indigenous people and residents of urban and peri-urban locations. Effective and integrated public health strategies are needed to ensure early detection and appropriate outbreak control measures.

Lessons learnt from a three-year pilot field epidemiology training programme.

PROBLEM: The Pacific region has widely dispersed populations, limited financial and human resources and a high burden of disease. There is an urgent need to improve the availability, reliability and timeliness of useable health data. CONTEXT: The purpose of this paper is to share lessons learnt from a three-year pilot field epidemiology training programme that was designed to respond to these Pacific health challenges. The pilot programme built on and further developed an existing field epidemiology training programme for Pacific health staff. ACTION: The programme was delivered in country by epidemiologists working for Pacific Public Health Surveillance Network partners. The programme consisted of five courses: four one-week classroom-based courses and one field epidemiology project. Sessions were structured so that theoretical understanding was achieved through interaction and reinforced through practical hands-on group activities, case studies and other interactive practical learning methods. OUTCOME: As of September 2016, 258 students had commenced the programme. Twenty-six course workshops were delivered and one cohort of students had completed the full five-course programme. The programme proved popular and gained a high level of student engagement. DISCUSSION: Face-to-face delivery, a low student-to-facilitator ratio, substantial group work and practical exercises were identified as key factors that contributed to the students developing skills and confidence. Close engagement of leaders and the need to quickly evaluate and adapt the curriculum were important lessons, and the collaboration between external partners was considered important for promoting a harmonized approach to health needs in the Pacific.