In 1982, 144 cases of dengue-like illness were reported to CDC
by
28 states. Only single blood samples were received for many of
these,
and the etiology could not be determined. However, 45 cases,
imported
into 14 states, were confirmed as dengue fever (Figure 1). Eight
cases of confirmed dengue were imported into southern states where
Aedes aegypti is found at least part of the year, and most of the
others were imported into eastern or midwestern states (Figure 1).
No
indigenous transmission of dengue was reported in the continental
United States in 1982.
Six cases were confirmed virologically, and dengue types 1, 2,
and
4 were isolated. Dengue type 1 was isolated from patients
returning
from Michoacan state, Mexico, and New Delhi, India. Dengue type 2
was
isolated from a student who had been living in Jamaica and from a
traveler returning from Sri Lanka. Dengue type 4 was isolated from
two
individuals, one who had visited Puerto Rico, the other who was
returning from Martinique. The majority of serologic confirmations
came from persons returning from tropical areas of the Western
Hemisphere, including Puerto Rico, Jamaica, Surinam, Martinique,
Dominican Republic, Guyana, Venezuela, El Salvador, and Mexico.
Southeast Asia, the Pacific Islands, India, and Africa accounted
for
smaller numbers of imported cases.
At least two patients with imported, confirmed dengue had
associated hemorrhagic manifestations. One, a 54-year-old Hispanic
male with a history of travel to Puerto Rico, was hospitalized with
hematemesis, epistaxis, gingival bleeding, purpura, and a platelet
count of 15,000. The second patient, a 41-year-old male returning
from India, had petechiae and a platelet count of 20,000.
Reported by AL Moede, MD, American Embassy, New Delhi, India; H
Artsob, PhD, University of Toronto, Ontario, Canada; JW Thomford,
MD,
Cleveland Metropolitan General Hospital, Cleveland, Ohio; E
Sawicki,
MD, Wyndam Hospital, Willimantic, RE Shope, MD, RB Tesh, MD, YARU,
Yale University, School of Medicine, New Haven, Connecticut; MW
Brandriss, MD, H Kothari, MD, University of Rochester School of
Medicine, New York; WE Brandt, PhD, Walter Reed Army Institute of
Research, Washington, DC; San Juan Laboratories, Dengue Br, Div of
Vector-Borne Viral Diseases, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: The increase in epidemic dengue activity in most
of
the tropics during the past decade has been aided by increased
frequency of air travel, which provides an ideal mechanism for
dengue
virus movement between world population centers, and by lack of
control of Ae. aegypti, the principal vector mosquito. An increase
in
imported dengue into the United States has paralleled this
increased
epidemic activity in the tropics; since 1977, 855 suspected cases
of
dengue have been reported.
A large part of the southeastern United States, from Texas to
Florida and the Carolinas, is infested with Ae. aegypti. Moreover,
a
recent study has shown that Ae. triseriatus, the principal vector
of
La Crosse virus encephalitis in man, is an efficient transmitter of
dengue virus under laboratory conditions (1). This report suggests
that dengue virus might be transmitted in areas without Ae.
aegypti,
although there is no present epidemiologic evidence to suggest such
transmission.
It is important that physicians consider dengue in the
differential diagnosis of acutely ill, febrile patients returning
from
any tropical part of the world. If possible, they should submit
acute- and convalescent-phase serum samples, as well as clinical
and
epidemiologic information on such patients, to appropriate state or
federal public health laboratories for serologic and virologic
confirmation.
Reference
Frier, JE, Grimstad PR. Unpublished data.
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