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Current Trends Imported Dengue -- United States, 1989

In 1989, 30 states and the District of Columbia reported 94 cases of imported dengue (i.e., dengue-like illness following travel and apparent exposure outside the United States) to CDC (Table 1). Twenty-two cases were serologically or virologically confirmed as dengue; 56 were serologically negative; and 16 could not be determined because of the lack of a convalescent serum sample. In four cases, the dengue serotype was identified by virus isolation.

Travel histories were available for 21 persons with confirmed dengue. Eleven infections were acquired in the Caribbean; five in Oceania; two in South America; and one each in Africa, Asia, and Mexico.

Twelve (55%) of the 22 confirmed cases were in males. Age was reported for 19 patients and ranged from 23 to 74 years (mean: 48 years). Most patients had symptoms consistent with classic dengue fever (e.g., fever, headache, and myalgia). One person with serologically confirmed dengue died with bilateral, diffuse pneumonia within 24 hours of return to the continental United States from St. Croix, U.S. Virgin Islands.

In addition to the cases reported above, nine cases of laboratory-confirmed dengue infections occurred in persons (some from the continental United States) who participated in relief duties on St. Croix in the aftermath of Hurricane Hugo, which struck the island on September 17-18, 1989. Reported by: State and territorial health departments. Dengue Br, Div of Vector-Borne Infectious Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Dengue is an acute viral disease caused by any of four virus serotypes (DEN 1-4) and is characterized by sudden onset of fever, headache, myalgia, rash, nausea, and vomiting. Although most infections result in relatively mild illness, some may cause the severe form of the disease, dengue hemorrhagic fever (characterized by variable degrees of bleeding, most commonly petechiae, purpura, mild gum bleeding, nosebleeds, or menorrhagia and/or gastrointestinal bleeding). The most recent outbreak of dengue hemorrhagic fever occurred in Venezuela in 1989-90 and involved greater than 3000 cases of severe dengue and 74 deaths (1).

In the Americas, dengue is transmitted by the Aedes aegypti mosquito. Although nearly eradicated in the 1960s, this species is now found in all tropical countries of the region. Dengue is endemic in Puerto Rico, many other islands in the Caribbean, Mexico, and several countries in Central and South America. Three of the four serotypes (DEN-1, DEN-2, and DEN-4) have been circulating in the Americas for several years. Although endemic transmission of DEN-3 has not occurred in the region in over a decade, this serotype can be reintroduced into the Americas and was isolated from a Florida resident who returned from Africa in October 1989.

Physicians should consider dengue in the differential diagnosis for all patients presenting with compatible symptoms and a travel history to tropical areas. When dengue is suspected, the patient's hematocrit and platelet count should be monitored for evidence of hemoconcentration and thrombocytopenia. For management of fever, acetaminophen products should be used instead of acetylsalicylic acid (aspirin). Acute ( less than 5 days from onset) and convalescent-phase ( greater than 14 days from onset) serum samples should be obtained for serodiagnosis. Suspected dengue cases should be reported to state health departments along with a clinical summary, dates of onset of illness and blood collection, a detailed travel history with dates and location of travel, and other epidemiologic information (e.g., patient age and sex). Serum samples should be sent for confirmation through the state health department laboratory to: Dengue Branch, Division of Vector-Borne Infectious Diseases, Center for Infectious Diseases, CDC, GPO Box 364532, San Juan, PR 00936; telephone (809) 749-4400; FAX (809) 749-4450.

Reference

  1. PAHO. Dengue hemorrhagic fever in Venezuela. Washington, DC: Pan American Health Organization. Epidemiol Bull 1990;11:7-9.



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