Dengue FeverMultiple cases of locally-acquired dengue fever (DEN-1)
have been identified with exposure in Martin County, Florida. Dengue fever is an important mosquito-borne disease worldwide. It is caused by four related dengue viruses (DEN-1, DEN-2, DEN-3, DEN-4) that are related to the viruses that cause West Nile infection and yellow fever. Globally, there are an estimated 50 to 100 million cases per year, and some 2.5 billion people could be at risk for dengue infection. The virus is found primarily in sub-tropical climates and is thought to be present in approximately 100 countries worldwide. Dengue infection is acquired through the bite of certain species of mosquitoes, primarily Aedes aegypti, but also Aedes albopictus, both of which are present in Florida.
Dengue fever is a painful, debilitating disease but is rarely fatal. Symptoms appear 3-14 days after the bite of an infected mosquito and include sudden onset of fever, severe headache, eye pain, muscle and joint pain (giving the disease the nickname "breakbone fever"), and bleeding. Gastrointestinal symptoms like vomiting and diarrhea may also be present in some cases. Dengue fever symptoms usually lasts 4-7 days. The disease is often diagnosed incorrectly because the symptoms are similar to influenza and other viruses. Dengue hemorrhagic fever is a rare but more severe form of dengue infection that can be fatal if not recognized and treated with supportive care. The primary risk factor for hemorrhagic fever is previous infection with a different dengue serotype (i.e. getting DENV-2 if you have already DENV-1 puts you at increased risk of hemorrhagic fever).
Countries/Areas at risk of dengue transmission While previously present in Florida, the virus was eliminated from the United States several decades ago. Until 2009, there were no reports of dengue acquired in Florida since 1934. In 2009, an outbreak of dengue was identified in Key West (see the Florida Keys page for more information). No dengue cases were reported in Key West After November 2010. Several cases are reported in Florida each year in travelers to areas where the disease is present. These imported cases are usually from dengue endemic regions such as the Caribbean, Central and South America, and Asia. The close proximity of areas with dengue such as Puerto Rico and frequent international travel in Florida residents and immigrants makes it possible to have dengue re-introduced. Several transient dengue introductions have been identified in Florida since the Key West outbreak. Fortunately, so far none of the more recent dengue introductions persisted and resulted in large outbreaks as was seen in Key West. There is some evidence that the United States lifestyle, such as routine use of air conditioning and screened windows, as well as spending more time indoors, may protect us from having large outbreaks.
There is no treatment for dengue fever or dengue hemorrhagic fever, but quick recognition and management of symptoms and complications is effective at preventing deaths. There is currently no vaccine for dengue and the research has been challenging due to variation in the four viral types, but multiple vaccine candidates are currently in development. Dengue can largely be prevented by taking personal protective measures against mosquitoes such as using insect repellent and staying inside when mosquitoes are biting. Resources For mosquito-borne disease prevention tips: http://www.doh.state.fl.us/Environment/medicine/arboviral/Prevention.html For information on the 2009/2010 dengue fever outbreak in Key West, please visit the Florida Keys page Centers for Disease Control (CDC): http://www.cdc.gov/dengue Dengue brochure from CDC: English Spanish (160 KB PDF) How to prevent the spread of the mosquito that causes dengue (English and Spanish) (282 KB PDF) World Health Organization: http://www.who.int/topics/dengue/en/ CDC Current International Dengue Outbreaks: http://www.cdc.gov/dengue/travelOutbreaks/index.html Outbreak Notice: Dengue, Tropical and Subtropical Regions - Travelers' Health - CDC: http://wwwnc.cdc.gov/travel/notices/outbreak-notice/dengue-tropical-sub-tropical.htm Information for Physicians and Healthcare Providers Information for dengue patients (English and Spanish) (269 KB PDF) Dengue information for healthcare practitioners (1143 KB PDF) Dengue Guide for Clinicians in Florida (18 KB PDF) Information for County Health Departments Dengue Clinical Specimen Submission Guidelines (20 KB PDF) References Kyle J, Harris E. Global Spread and Persistence of Dengue. Annual Review of Microbiology. 2008; 62: 71-92. Wilder-Smith A, Schwartz E. Dengue in Travelers. New England Journal of Medicine. 2005; 353(9): 924-932. Reiter P, Lathrop S, Bunning M, Biggerstaff B, Singer D, et al. Texas Lifestyle Limits Transmission of Dengue Virus. Emerging Infectious Diseases. 2003; 9(1): 86-89. http://www.cdc.gov/ncidod/eid/vol9no1/02-0220.htm |
