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Current Trends Imported Dengue -- United States, 1987

In 1987, 94 cases of imported dengue-like illness (i.e., illness following exposures thought to have occurred outside the United States) were reported to CDC from 29 states (Table 1). Eighteen cases (from 10 states and the District of Columbia) were serologically or virologically confirmed as dengue; 53 were serologically negative for dengue, and the etiology of 23 remained undetermined because only a single early serum sample was received.

Travel histories indicated that the confirmed dengue infections had been acquired in four countries in Latin America, three islands in the Caribbean, five countries in Asia, and one country in Africa (Table 1). The infecting virus serotype was determined for five patients: DEN-1 for patients infected in Mexico and Venezuela, DEN-2 for patients infected in Indonesia and India, and DEN-4 for a patient infected in El Salvador (Table 1). Among the 15 patients for whom age was reported, ages ranged from 22 to 79 years. Each patient had a classical dengue syndrome with onset of illness occurring shortly after return to the United States. One patient, a 28-year-old man with a primary DEN-2 infection acquired in India, reported bloody diarrhea. No other hemorrhagic manifestations were reported.

Three of the confirmed cases were reported from Florida and Georgia, where the principal vector of dengue, Aedes aegypti, occurs. Reported by: Participating state health departments. Dengue Br, Div of Vector-Borne Viral Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Dengue is an acute viral disease caused by any of four dengue virus serotypes and manifested by sudden onset of fever, headache, and myalgia, and often by rash, nausea, and vomiting. Thrombocytopenia, as well as hemorrhagic manifestations such as petechiae, epistaxis, and menorrhagia, may also occur. Most infections result in relatively mild illness; however, a small percentage of patients may have a severe form of the disease, dengue hemorrhagic fever, which is characterized by severe hemorrhage and/or shock.

Dengue fever is widespread in the Caribbean, tropical America, Oceania, Asia, and tropical Africa, and from 1977-1987 health-care providers in the continental United States reported an annual average of 31 patients with dengue acquired abroad (Table 2).

Because Ae. aegypti, the principal vector mosquito of dengue, is found in the southeastern United States, indigenous transmission of dengue in these areas is possible. The most recent known transmission within the continental United States occurred in 1986 in an area of Texas infested by Ae. aegypti. An Asian dengue vector, Ae. albopictus, has recently become established in focal areas of the eastern United States as far north as latitude 42 N; however, no case of disease transmission by this mosquito in the continental United States has been documented (1).

Public health officials and clinicians should be aware of the potential for dengue transmission in any area infested with dengue mosquito vectors. Dengue should be considered in the differential diagnosis for any patient with an acute febrile illness and a history of recent travel to tropical areas. If dengue is suspected, the patient's hematocrit and platelet count should be evaluated, and acute- ( less than 5 days from onset) and convalescent-phase (greater than or equal to 14 days from onset) serum samples should be obtained. Suspected dengue should be reported and serum samples sent for confirmation through the state health department to: Dengue Branch, Division of Vector-Borne Viral Diseases, Center for Infectious Diseases, CDC, GPO Box 4532, San Juan, Puerto Rico 00936; telephone (809) 749-4400.

Reference

1.CDC. Update: Aedes albopictus infestation--United States, Mexico. MMWR 1989;38:440, 445-6.

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