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Dengue Fever
For information on the dengue fever activity in Key West, please visit the
Florida Keys page.
Dengue activity is currently at a 20 year high in the Caribbean and
Central and South America. CDC recently issued a
Health Advisory on Dengue in Travelers. The number of cases in Florida travelers
returning from these areas is also higher than normal. If you are
traveling to a tropical or sub-tropical area, you can protect yourself from
dengue and other mosquito-borne diseases by following the suggestions on our
Prevention page, including using insect repellent. You can get more
information about Traveler's Health at
http://www.cdc.gov/dengue/travelOutbreaks/index.html. To see how many
cases have been reported in Florida, see our weekly surveillance report at
http://www.doh.state.fl.us/Environment/medicine/arboviral/surveillance.htm.
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.
Aedes aegypti
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).
While previously present in Florida, it 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 or more information). In addition, a number of 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.
An outbreak in Cairns, Australia in 2008-09 provides a good example of how
dengue can be introduced to a new area. Australia has a similar standard of
living and healthcare system to that of the United States, indicating that we
may be at risk for future outbreaks. Both Aedes aegypti and Aedes albopictus are
present in Florida, making local transmission possible, particularly in southern
Florida where Aedes aegypti is present. 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. However, there
is some evidence that the United States lifestyle, such as 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.
Graph from World Health Organization
Public Information
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/
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 (20 KB PDF)
Letter to Travel Clinic Providers on Dengue (35 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
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