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Imported Dengue Fever -- United States, 1982

In 1982, 144 cases of dengue-like illness were reported to CDC by 28 states. Only single blood samples were received for many of these, and the etiology could not be determined. However, 45 cases, imported into 14 states, were confirmed as dengue fever (Figure 1). Eight cases of confirmed dengue were imported into southern states where Aedes aegypti is found at least part of the year, and most of the others were imported into eastern or midwestern states (Figure 1). No indigenous transmission of dengue was reported in the continental United States in 1982.

Six cases were confirmed virologically, and dengue types 1, 2, and 4 were isolated. Dengue type 1 was isolated from patients returning from Michoacan state, Mexico, and New Delhi, India. Dengue type 2 was isolated from a student who had been living in Jamaica and from a traveler returning from Sri Lanka. Dengue type 4 was isolated from two individuals, one who had visited Puerto Rico, the other who was returning from Martinique. The majority of serologic confirmations came from persons returning from tropical areas of the Western Hemisphere, including Puerto Rico, Jamaica, Surinam, Martinique, Dominican Republic, Guyana, Venezuela, El Salvador, and Mexico. Southeast Asia, the Pacific Islands, India, and Africa accounted for smaller numbers of imported cases.

At least two patients with imported, confirmed dengue had associated hemorrhagic manifestations. One, a 54-year-old Hispanic male with a history of travel to Puerto Rico, was hospitalized with hematemesis, epistaxis, gingival bleeding, purpura, and a platelet count of 15,000. The second patient, a 41-year-old male returning from India, had petechiae and a platelet count of 20,000. Reported by AL Moede, MD, American Embassy, New Delhi, India; H Artsob, PhD, University of Toronto, Ontario, Canada; JW Thomford, MD, Cleveland Metropolitan General Hospital, Cleveland, Ohio; E Sawicki, MD, Wyndam Hospital, Willimantic, RE Shope, MD, RB Tesh, MD, YARU, Yale University, School of Medicine, New Haven, Connecticut; MW Brandriss, MD, H Kothari, MD, University of Rochester School of Medicine, New York; WE Brandt, PhD, Walter Reed Army Institute of Research, Washington, DC; San Juan Laboratories, Dengue Br, Div of Vector-Borne Viral Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: The increase in epidemic dengue activity in most of the tropics during the past decade has been aided by increased frequency of air travel, which provides an ideal mechanism for dengue virus movement between world population centers, and by lack of control of Ae. aegypti, the principal vector mosquito. An increase in imported dengue into the United States has paralleled this increased epidemic activity in the tropics; since 1977, 855 suspected cases of dengue have been reported.

A large part of the southeastern United States, from Texas to Florida and the Carolinas, is infested with Ae. aegypti. Moreover, a recent study has shown that Ae. triseriatus, the principal vector of La Crosse virus encephalitis in man, is an efficient transmitter of dengue virus under laboratory conditions (1). This report suggests that dengue virus might be transmitted in areas without Ae. aegypti, although there is no present epidemiologic evidence to suggest such transmission.

It is important that physicians consider dengue in the differential diagnosis of acutely ill, febrile patients returning from any tropical part of the world. If possible, they should submit acute- and convalescent-phase serum samples, as well as clinical and epidemiologic information on such patients, to appropriate state or federal public health laboratories for serologic and virologic confirmation.

Reference

  1. Frier, JE, Grimstad PR. Unpublished data.



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