Outbreak of Dengue Virus Type 2 - American Samoa, November 2016-October 2018.

The U.S. territory of American Samoa has experienced recent outbreaks of illnesses caused by viruses transmitted by Aedes species mosquitoes, including dengue, chikungunya, and Zika virus. In November 2016, a traveler from the Solomon Islands tested positive for infection with dengue virus type 2 (DENV-2). Additional dengue cases were identified in the subsequent weeks through passive and active surveillance. Suspected dengue cases were tested locally with a dengue rapid diagnostic test (RDT) for DENV nonstructural protein 1 (NS1). Specimens from RDT-positive cases and patients meeting the dengue case definition were tested by real-time reverse transcription-polymerase chain reaction (real-time RT-PCR) at Hawaii State Laboratories. During November 2016-October 2018, a total of 3,240 patients were tested for evidence of DENV infection (118 by RDT-NS1 alone, 1,089 by real-time RT-PCR alone, and 2,033 by both methods), 1,081 (33.4%) of whom tested positive for dengue (19.5 per 1,000 population). All 941 real-time RT-PCR-positive specimens were positive for DENV-2. The monthly number of laboratory-confirmed cases peaked at 120 during December 2017. Among laboratory-confirmed dengue cases, 380 (35.2%) patients were hospitalized; one patient, who was transferred to American Samoa for care late in his illness, died. The public health response to this outbreak included disposal of solid waste to remove mosquito breeding sites, indoor residual spraying of pesticides in schools, reinforcement of dengue patient management education, and public education on mosquito avoidance and seeking medical care for symptoms of dengue.

Argon laser iridoplasty.

We performed laser iridoplasty on 15 eyes, 7 of which had medically unbreakable attacks of angle closure glaucoma and 8 eyes had plateau iris configuration. We were successful in controlling intraocular pressure in 13 of the 15 eyes. The procedure was performed in O.P.D. under topical anaesthesia with minimal complications. As is evident from our results, iridoplasty is a safe and effective procedure, rapidly gaining favour with the ophthalmologists to treat certain difficult conditions. However long term and larger studies are required to further evaluate this procedure.

Argon laser iridectomy.

By using a continuous wave argon laser, successful iridectomy was achieved in 41 out of 51 phakic eyes selected for the procedure. Three of the successful procedures required multiple sittings. The procedure was performed on an out-patient basis under topical anaesthesia, usually required less than one-half hour for completion with a negligible complication rate. Therefore, where available ArLI appears to present a viable alternative to surgical iridectomy for the definitive treatment of angle closure glaucoma.