Current Trends Imported Dengue -- United States, 1990

In 1990, 102 cases of suspected imported dengue (1) were reported to CDC from 24 states and the District of Columbia (Table 1). Of these, 24 (22%) cases (from 14 states and the District of Columbia) were serologically or virologically confirmed as dengue. The dengue serotype was identified by virus isolation in two of these cases. Fifty-five of the suspected cases were serologically negative for dengue, and the laboratory diagnosis of 23 remained undetermined because convalescent serum samples were not submitted.

Travel histories were available for 22 of the 24 persons with confirmed dengue. Eight cases were acquired in Oceania, six in the Caribbean, six in Asia, and one each in Mexico and Peru.

Of the 23 persons with laboratory-confirmed dengue for whom gender was reported, 13 were female. Age was reported for 18 persons with confirmed dengue and ranged from 20 to 70 years (mean: 37 years). The most commonly reported symptoms for confirmed cases were consistent with classic dengue fever (e.g., fever, rash, headache, and myalgia). Reported by: State and territorial health depts. Dengue Br, Div of Vector-Borne Infectious Diseases, National 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 forms of the disease, dengue hemorrhagic fever ((DHF) characterized by petechiae, purpura, mild gum bleeding, nosebleeds, menorrhagia, or gastrointestinal bleeding) and dengue shock syndrome.

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 except Bermuda. Dengue is endemic in Puerto Rico and many other islands in the Caribbean, Mexico, and several countries in Central and South America. The most recent major epidemic in the Americas, which involved more than 76,000 cases, occurred in Peru in 1990, with DEN-1 and DEN-4 as the infecting serotypes (2). The most recent large outbreak of DHF occurred in Venezuela in 1989-1990 and involved more than 3108 cases of severe dengue and 73 deaths (3).

Three of the four serotypes (DEN-1, DEN-2, and DEN-4) have been circulating in the Americas since 1981. Although endemic transmission of DEN-3 has not occurred in the region since 1977, it could be reintroduced into the Americas; in 1989, DEN-3 was isolated from a Florida resident who had returned from Africa and, in January 1990, from a California resident who had returned from Oceania.

Physicians should consider dengue in the differential diagnosis for all patients who present with the above symptoms and a history of travel to tropical areas. When dengue is suspected, the patient's hematocrit and platelet count should be monitored for evidence of hemoconcentration and thrombocytopenia. Acetaminophen products are recommended for management of fever to avoid the anticoagulant properties of acetylsalicylic acid (aspirin). Acute and convalescent-phase serum samples should be obtained for viral isolation and serodiagnosis.

Suspected dengue cases should be reported to state health departments along with a clinical summary, dates of onset of illness and blood collection and epidemiologic information, including a detailed travel history with dates and location of travel. Serum samples should be sent for confirmation through the state health department laboratory to CDC's Dengue Branch, Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, P.O. Box 364532, San Juan, Puerto Rico 00936-4532; telephone (809) 749-4400; FAX (809) 749-4450.

References

1. CDC. Case definitions for public health surveillance. MMWR 1990;39(no. RR-13):10-1.

2. CDC. Dengue epidemic--Peru, 1990. MMWR 1991;40:145-7.

3. Pan American Health Organization. Dengue hemorrhagic fever in Venezuela. Epidemiol Bull 1990;11:7-9.

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