Table 1.

Summary of published cases of DENV transmission via non-vector routes

Route of transmission	Comment	References
Mucocutaneous	A health care worker who was splashed in the face by blood from a confirmed dengue patient was documented to have dengue infection, both identified to be DENV-3.	1
Percutaneous (needle stick, laboratory injury)	Health care workers including laboratory personnel acquired DENV infection after needlestick injuries.	4–8
Blood transfusion	Transfusion-transmitted dengue has been documented in Brazil and American Red Cross/CDC Dengue Branch; a DENV-4 outbreak in Brazil resulted in transfusion transmission in about a third of recipients of RNA-positive donations.	9–11
Bone marrow transplant	Transmission of DENV-4 in a 6-year old child from Puerto Rico via bone marrow transplant led to a fatality.	12
Solid organ transplant	DENV transmission occurred from donor to recipient after living donor liver transplantation.	13
Intrapartum/perinatal	Newborns whose mothers had acute DENV infections in the peripartum period developed dengue infection, ranging from mild febrile illness with thrombocytopenia to severe manifestations.	14–26
	Case reports have documented intracerebral hemorrhage and fatality in infants.
	Systematic reviews and meta-analysis found increase risk for miscarriage for women with dengue during pregnancy, preterm birth, and low birthweight.	18–19
Breast milk	A woman confirmed to have DENV infection postpartum breastfed on days 2–4 of her illness. The infant developed symptoms of dengue starting on day 4 of mother’s illness, was confirmed by PCR with high viral load in blood, and breast milk was positive by PCR and culture.	3
Oronasal	No confirmed transmission reported, but the case of mucocutaneous exposure raises possibility of oronasal infection.	1
Sexual	None reported	-