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Is Dengue Fever on the Rise in the U.S.?


WebMD Health News

Dec. 23, 1999 (Atlanta) -- Dengue fever, a viral illness most often seen in the tropics of Asia and Africa, is becoming a bigger threat here on U.S. soil. Florida researchers report in the Dec. 24 issue of the CDC's Morbidity and Mortality Weekly Report that incidence of dengue is higher than previously reported in their state. Experts call for improved prevention, surveillance, and reporting to prevent the spread of the virus to other parts of Florida and to other states.

But some states seem to be having their own problems with dengue already. In an unrelated report, the Texas state department of health has announced that a girl who died earlier this month is the first casualty of a dengue outbreak there that has infected 51 people this year -- the biggest outbreak there this decade. It's thought the girl picked up the disease during a trip to Mexico.

Dengue fever -- mainly transmitted via the Aedes aegypti mosquito -- is commonly referred to as "break-bone fever" due to pain so intense that bones are often felt to be breaking. In addition to such pain, infection with any of dengue's four types can lead to acute illness with joint pain, headache, fever, rash, and hemorrhage. After infection with one type, the antibodies that are produced usually protect the patient from future infections related to that particular serotype. However, infection with a different type puts the patient at risk for a more severe form of the illness, marked by internal bleeding, called dengue hemorrhagic fever. Patients usually recover from dengue within a few days, though related fatigue can last as long as a month or two.

"In the last 10 years, a mean of 1.3 cases per year were reported in the state [of Florida]," says lead author Julia Gill, PhD, MPH. "The number of cases reported to the state was so low that I couldn't believe that that was the true number of cases. ... I thought [by conducting this surveillance study] we'd find a lot more cases." Gill is with the Florida Department of Health in St. Petersburg.

This laboratory-based active surveillance study was implemented in Florida for a year starting in April of 1997. Sixty-seven county health department epidemiologists were mailed information explaining the program and requesting participation; the dengue case definition, specimen requirements, and transport instructions were provided. Departments were instructed to distribute enclosed materials to clinics, hospital ERs, health departments, and infectious disease physicians. Samples were tested, and those found to be in the acute phase of the disease were sent to the CDC for further analysis.

In Florida, 83 suspected dengue cases were analyzed. Of these cases, recent dengue infection was detected in 22%. Of the cases studied, all four dengue types were identified. In 29% of the suspected cases, dengue was ruled out, and in 49% of the cases, a diagnosis was indeterminable due to inadequate blood samples.

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