Abstract
Dengue is a potentially fatal acute febrile illness caused by any of four mosquito-transmitted dengue viruses (DENV-1 to DENV-4) belonging to the family Flaviviridae and endemic throughout the tropics. Competent mosquito vectors of DENV are present in approximately one half of all U.S. counties. To describe epidemiologic trends in travel-associated and locally acquired dengue cases in the United States, CDC analyzed cases reported from the 50 states and District of Columbia to the national arboviral surveillance system (ArboNET). Cases are confirmed by detection of 1) virus RNA by reverse transcription-polymerase chain reaction (RT-PCR) in any body fluid or tissue, 2) DENV antigen in tissue by a validated assay, 3) DENV nonstructural protein 1 (NS1) antigen, or 4) immunoglobulin M (IgM) anti-DENV antibody if the patient did not report travel to an area with other circulating flaviviruses. When travel to an area with other flaviviruses was reported, IgM-positive cases were defined as probable. During 2010-2017, totals of 5,009 (93%) travel-associated and 378 (7%) locally acquired confirmed or probable dengue cases were reported to ArboNET. Cases were equally distributed between males and females, and median age was 41 years. Eighteen (three per 1,000) fatal cases were reported, all among travelers. Travelers should review country-specific recommendations (https://wwwnc.cdc.gov/travel/notices/watch/dengue-asia) for reducing their risk for DENV infection, including using insect repellent and staying in residences with air conditioning or screens on windows and doors.
Highlights
One half (53%) of travel-associated cases were reported from four states: New York (18%), California (16%), Florida (14%), and Texas (5%) (Table 1)
Hawaii reported the largest number of locally acquired dengue cases (250; 66%), followed by Florida (103; 27%), Texas (24; 6%), and New York (Table 1)
Acquired cases occurred in four states, three of which (Florida, Hawaii, and Texas) experienced local outbreaks. These data, especially the comparatively large outbreak in Hawaii, demonstrate the ongoing risk for local DENV transmission in Aedes-infested areas of the United States following introduction by travelers returning from the tropics
Summary
Environmental, and entomologic approaches have been implemented to control Aedes spp. mosquito populations, none has yet proven to be both sustainable and effective. The first Food and Drug Administration–approved vaccine against dengue, Dengvaxia, is licensed for use in approximately 20 countries, and was recently approved for use in the United States in children aged 9–16 years who have laboratory evidence of prior DENV infection and who live in areas with endemic DENV (6). In 2010, dengue became a nationally notifiable disease; state and territorial health departments report dengue cases to CDC through ArboNET (https://www.cdc.gov/dengue/ statistics-maps/index.html; https://wwwn.cdc.gov/nndss/ conditions/dengue/). This report describes locally acquired and travel-associated, laboratory-confirmed and probable dengue cases reported to ArboNET from the 50 states and District of Columbia with illness onset during January 1, 2010–December 31, 2017. Probable dengue cases met the clinical criteria and were defined by detection of IgM anti-DENV antibody in serum if the person lived in or traveled to an area with transmission of another flavivirus.
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