Dengue in the United States: Challenges in Case Identification, Outbreak Investigation, and Response Efforts

Brief Summary:
Dengue is a potentially fatal acute febrile illness that is increasingly being detected in travelers returning from the tropics to the United States.  The incidence of dengue in the Americas has increased roughly 30-fold in the past three decades, and dengue is the most common cause of fever in travelers returning from South-central and Southeast Asia, South America, Mexico and the Caribbean. Consequently, hospitalizations due to travel-associated dengue are becoming more frequent in the United States.  In areas with competent mosquito vectors of dengue, there is risk of imported dengue cases leading to local outbreaks.  This occurred in 2013 in Florida, Texas and New York, resulting in at least 22, 10, and one locally-acquired dengue cases, respectively.  Challenges in responding to such outbreaks include case identification, availability of diagnostic testing, appropriate clinical case management, case reporting, rapid and accurate messaging to the public, and organized local response efforts to limit spread.  All of these aspects will be discussed to assess states’ needs. Recommendations will be made based on recent experiences that CDC Dengue Branch has had in responding to outbreaks, which have yielded outbreak response protocols to improve case detection, burden estimation, and response efforts.