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