The focus of the dengue fever epidemic in the northern Pacific has shifted from Marshall Islands to Yap.

More than 200 hundred cases have been reported in the small community in Yap.

The World Health Organisation has been asked by the FSM Ministry of Health to assist with the Yap outbreak.

In Marshall Islands, there maybe some good news as the dengue outbreak may have reached its peak.

Presenter:Geraldine Coutts Speaker:Dr Eric Nilles, World Health Organisation

Listen: Windows Media

NILLES: Well so far there are a total of 286 total cases that have been identified, most of them on Yap Island, several cases on one of the adjacent atolls, Ulithi atoll and it's been about just under 70 admissions to the hospital, secondary to this outbreak.

COUTTS: Is this the first outbreak of dengue in Yap?

NILLES: Yap actually, has had several outbreaks over the last ten years, there's been four different outbreaks actually, so that it's fairly frequent outbreaks here in Yap actually.

COUTTS: Would you consider this outbreak of dengue fever in Yap is the same as or worse than previous occasions?

NILLES: Well, there have been multiple outbreaks in the past actually and so it sort of depends which outbreak you're looking at. It certainly is the worst outbreak that they have had in several years in quite sometime, that is clear. It's also fairly early and it's difficult to say whether or not this will continue on and they'll be a lot more cases at this point, but yeah, I mean the scale of severity considering the size of the population, this is a significant outbreak.

COUTTS: Well, last time we checked in Majuro, in Marshall Islands, the cases were 600 and still rising. Have you or the World Health Organisation been there recently?

NILLES: Yes, I was in Majuro before I came to Yap actually, so I was there for a little bit under two weeks. So I was working with the Centre of Disease Control and Prevention in Atlanta the CDC there and they also have a team there and the latest update that that's outbreak has actually peaked and is starting to decrease actually, so it looks like they're passed the worst of it and early predictions are that may be in another couple of weeks that the outbreak may be over there.

COUTTS: And do we have official statistics on how many people have been affected by dengue fever in the Marshalls?

NILLES: There are official statistics, but I am not up to date with the latest numbers actually right now since leaving been focused really much more on...

COUTTS: What were they while you were there?

NILLES: Well, when I first arrived, it was in the 300s and or the high 200s and then it went up to the 400s by the time I left. So but that was over a week ago now, so that has evolved a lot the situation.

COUTTS: And any reported deaths there?

NILLES: No reported deaths, no.

COUTTS: So when will you conclude your work in Yap?

NILLES: I will probably conclude at the end of next week actually, so most of the surveillance and the clinical update objectives really have hopefully will have been reached by that time. In addition, there's also a CDC team coming here to help out and they will be here about two weeks in addition. So I think by the end of next week, hopefully the infrastructure will have been reinforced and we'll leave the Ministry of Health to continue the good work that they were doing actually before we arrived here. I want to emphasis that we're really here to support the Ministry and that this really the Ministry doing the work and we sort of give some technical guidance but they're actually doing a lot of very good work before we arrived.

COUTTS: As I understand it, there's been two unconfirmed deaths as a consequence of dengue fever. Were they in Yap or in Majuro?

NILLES: These two were on Yap actually, but I would just like to emphasis at this time, these are unconfirmed deaths associated with the dengue outbreak.

COUTTS: What are the conditions for, and I mean is it poor general health of the citizens or is it cyclical weather patterns that produce dengue fever?

NILLES: Well, you need certain mosquitoes and the mosquitos are present here in the island. There is not a large enough population to have the virus circulate year round, so it's not endemic here, because the population is too small, but you do have cases brought in from the outside and then you have an outbreak or an epidemic and then that sort of burns itself out and then usually, several years later or a couple of years later, then you have another outbreak, sometimes is one of the different serotypes and this is fairly common, this pattern in these small island nations in the Pacific.

COUTTS: Dr Nilles, you've already mentioned that it's a small population and so the cases you've got in excess of 280 would be a sizeable percentage of a small population. What can you do for them?

NILLES: Well, really there's two things that can be done. The first is prevention, prevention activities, avoiding being bitten by mosquitoes, that's really the cornerstone, making sure the people who are infected are under mosquito nets if possible. So that's the sort of preventative aspect and then when people get sick, supportive measures, meaning if you follow the very sick patients very closely, and you make sure that they're IV fluids are closely monitored and the hydration status is monitored, then these patients actually have a much better outcome than if they're not really followed very closely in hospital.

COUTTS: Are you going elsewhere within Micronesia after you've finished your duties in Yap?

NILLES: This will be it actually. As far as we know at this time, in the Federated States of Micronesia, Yap is the only state that is having cases at this time.

COUTTS: And why would that be, why is there only one of the several states being Yap to have it, why isn't it in Chuuk for instance?

NILLES: That's a good question and there's two answers to that. So one is it's always possible that there are cases there that have not been identified, there is always a possibility. The second is you always need somebody to go to one of these other states who is infectious, meaning they have the virus in the blood and so that mosquito in one of those other states can bite them and then pass it on to somebody else. The transportation between these states and islands in the Pacific in general, it's quite difficult, it's quite challenging and so Chuuk's for example is a long way away from here and there's only two flights a week, so it's a sort of a chance issue. You have to have somebody who gets on the plane and then develops the viremy or the virus replicates in the blood and then is present in the blood when they're in Chuuk and then they would have to be bitten at that point in time. So a lot of it is quite random and chance actually.