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.
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