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.
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