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Imported Dengue -- United States, 1988

In 1988, 124 cases of imported dengue-like illness (i.e., dengue-like illness following apparent exposure outside the United States) were reported to CDC from 36 states and the District of Columbia (Table 1). Twenty-seven cases (from 17 states) were serologically or virologically confirmed as dengue, 72 were serologically negative for dengue, and the etiology of 25 remains undetermined because of lack of a convalescent serum sample.

Travel histories of the 27 persons with confirmed dengue indicated that 12 infections had been acquired in Asia, nine in the Caribbean, two in Africa, one in Central America, and one in Oceania; for two, travel histories were unknown (Table 1). Dengue serotypes were identified in five cases, two by virus isolation and three serologically by plaque reduction neutralization test.

Sixteen (59%) of the confirmed cases were in males. Age was reported for 25 persons and ranged from 3 to 66 years (mean: 33 years). Most patients had symptoms consistent with classic dengue fever (e.g., fever, muscle and joint pain, headache, and rash), although several patients had marked thrombocytopenia and/or severe symptoms. Four of the 27 patients were hospitalized: a 3-year-old male Asian immigrant with thrombocytopenia, epistaxis, oliguria, hypotension, and hyponatremia who required intravenous-fluid therapy and platelet transfusions; a 40-year-old black male with thrombocytopenia, weakness, and hemorrhagic rash; a 13-year-old male Asian immigrant with thrombocytopenia, swollen legs, microhematuria, and lethargy; and a 37-year-old Asian male with thrombocytopenia, palatal petechiae, and severe myalgias. Gastrointestinal bleeding was reported in two additional patients. Reported by: State and territorial health departments. Dengue Br, Div of Vector-Borne Infectious Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Illness associated with imported dengue cases in 1988 appeared to be more severe than illness reported in 1987, when only one of 18 confirmed cases was reported to have had hemorrhagic manifestations (1). Two of the four persons hospitalized in 1988 were immigrant Asian children, who are part of a high-risk group for dengue hemorrhagic fever. U.S. citizens traveling abroad rarely acquire this severe form of dengue fever even when traveling to high-risk areas (2).

Because Aedes aegypti (the principal mosquito vector of dengue) and Ae. albopictus (another potential mosquito vector of dengue) are present in the continental United States (3), the potential exists for indigenous transmission of dengue in most southeastern and central states. In 1988, Texas was the only state with Ae. aegypti to report a confirmed imported case of dengue; however, imported cases were reported from five states (Hawaii, Illinois, Ohio, Texas, and Virginia) where Ae. albopictus is found. Public health officials and clinicians should consider the diagnosis of dengue in any patient with an acute febrile illness and a history of recent travel to tropical areas. Suspected dengue should be reported and serum samples sent for confirmation to CDC through state and territorial health departments.

References

  1. CDC. Imported dengue--United States, 1987. MMWR 1989;38:463-5.

  2. Halstead SB. Dengue haemorrhagic fever: a public health problem and field for research. Bull WHO 1980;58:1-21.

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



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