U.S. Dengue Fever Outbreak in Returning Haiti Relief Workers

The U.S. Department of State issued a travel warning on 3/15/10, “strongly urging” U.S. citizens to avoid travel to Haiti. The CDC also released a Health Advisory on Tuesday, April 27, 2010 regarding reports of Dengue Fever found in Haiti relief workers returning to the United States. Why all the hoopla about this “Dengue Fever”? Here are details of the Health Advisory report -- If you don’t know what “Dengue Fever” is, make sure to read on…

Transmission:
• Transmitted via the Aedes mosquito. The mosquito is initially infected after biting a human that is infected with one of the 4 subtypes of the Dengue virus. After the mosquito is infected, it can transmit the virus to another human via another bite.
• Symptoms begin 3 to 14 days after being bitten by the mosquito.

Epidimiology:
• Dengue is the leading cause of illness and death in the tropics and subtropics, where 40% of the world’s population currently resides and is at risk.
• More than 100 million people per year are affected by Dengue, yet mortality is less than 1%.
• Endemic areas include Puerto Rico, Latin America, Southeast Asia, Samoa, and Guam.
• United States: Florida, Texas, and Hawaii have had outbreaks in the last 10 years as a result of travelers infected with the virus abroad.

Signs & Symptoms:
• Dengue Fever: high Fever, plus 2 or more of the following symptoms:
     1. headache
     2. pain behind the eye
     3. joint pain
     4. muscle pain
     5. rash
     6. mild bleeding symptoms: for example, nose bleeds, bleeding from gums, subconjunctival hemorrhages (bleeding in the eye), petechiae (a rash with red spots), or easy bruising.
     7. low white blood cell count
• Dengue Hemorrhagic Fever: high fever lasting 2-7days, and the following symptoms begin within 24 to 48 hrs after the fever resolves:
     1. any bleeding symptoms (see above)
     2. persistent vomiting
     3. severe abdominal pain
     4. thrombocytopenia: platelets below 100,000
     5. low albumin
     6. abdominal or pleural effusions
It can result in shock, circulatory failure, and death if patient is not hospitalized.

Diagnosis:
• The CDC advises clinicians seeing patients returning from Haiti with symptoms consistent with Dengue should “seriously consider laboratory testing.”
• The CDC will provide free Dengue diagnostic testing for physicians. Physicians should order the following labs tests:
     1. Acute sample: if patient presents within the first 5 days of symptoms, obtain an “RT-PCR for Dengue Virus”
     2. Convalescent sample: if patient presents between day 6 to 30 of symptom onset, obtain an “ELISA for Dengue IgM”
     3. Send 2 mL of centrifuged serum for the above tests, along with a completed CDC “Dengue Case Investigation Form” from this link: http://www.cdc.gov/Dengue/resources/caseformhaiti.pdf, and send it to:
Centers for Disease Control and Prevention
Dengue Branch
1324 Canada Street
San Juan, Puerto Rico 00920
Phone: 787-706-2399

Treatment:
• There is no specific medication to combat this disease.
• It is treated with supportive measures: fluids, acetaminophen to reduce fevers, and rest.
• Consult your physician.
• If you feel worse 24 to 48 hours after your fever subsides, go straight to the hospital.

Prevention:
• There is no vaccine to prevent this disease.
• Cover or discard containers containing any water, as this attracts mosquitos.
• Empty and clean pet water containers and flower vases with water in order to remove eggs at least once weekly.
• Turn on the air conditioner.
• Use window and door screens to prevent mosquitos from entering your home.
• Apply a mosquito repellent with 20-30% DEET as the active ingredient when you are outside at all times.