TABLE 2. Characteristics of reported travel-associated and locally acquired dengue cases — ArboNET, United States, 2010–2017.
| Characteristic | No. (%) |
||
|---|---|---|---|
| Travel-associated cases (n = 5,009) | Locally acquired cases (n = 378) | Total (N = 5,387) |
|
|
Case definition
| |||
| Probable |
3,539 (71) |
58 (15) |
3,597 (67) |
| Confirmed |
1,470 (29) |
320 (85) |
1,790 (33) |
|
Infecting DENV*
| |||
| DENV-1 |
119 (45) |
189 (96) |
308 (67) |
| DENV-2 |
71 (27) |
4 (2) |
75 (16) |
| DENV-3 |
45 (17) |
3 (2) |
48 (10) |
| DENV-4 |
28 (11) |
0 (0) |
28 (6) |
|
Sex†
| |||
| Female |
2,500 (50) |
188 (50) |
2,688 (50) |
| Male |
2,508 (50) |
190 (50) |
2,698 (50) |
|
Race
| |||
| White |
2,240 (45) |
245 (65) |
2,485 (46) |
| Asian |
729 (15) |
24 (6) |
753 (14) |
| Black or African American |
277 (6) |
5 (1) |
282 (5) |
| Native Hawaiian or other Pacific Islander |
37 (1) |
72 (19) |
109 (2) |
| American Indian or Alaska Native |
16 (0) |
5 (1) |
21 (0) |
| Asian, White |
2 (0) |
0 (0) |
2 (0) |
| Asian, Native Hawaiian or other Pacific Islander |
0 (0) |
1 (0) |
1 (0) |
| Unknown |
1,708 (34) |
26 (7) |
1,734 (32) |
|
Age group (yrs)§
| |||
| 0–9 |
129 (3) |
14 (4) |
143 (3) |
| 10–19 |
515 (10) |
46 (12) |
561 (10) |
| 20–29 |
887 (18) |
67 (18) |
954 (18) |
| 30–39 |
847 (17) |
43 (11) |
890 (17) |
| 40–49 |
897 (18) |
70 (19) |
967 (18) |
| 50–59 |
904 (18) |
57 (15) |
961 (18) |
| 60–69 |
574 (11) |
56 (15) |
630 (12) |
| ≥70 |
246 (5) |
24 (6) |
270 (5) |
|
Region of travel
| |||
| Caribbean |
1,649 (33) |
— |
1,649 (33) |
| Asia |
1,469 (29) |
— |
1,469 (29) |
| Central America |
676 (14) |
— |
676 (14) |
| North America¶ |
477 (10) |
— |
477 (10) |
| South America |
327 (7) |
— |
327 (7) |
| Unknown |
222 (4) |
— |
222 (4) |
| Africa |
89 (2) |
— |
89 (2) |
| Oceania |
85 (2) |
— |
85 (2) |
| Europe |
7 (<1) |
— |
7 (<1) |
| Multiple regions |
8 (<1) |
— |
8 (<1) |
|
Clinical syndrome**
| |||
| Dengue†† |
4,597 (94) |
353 (94) |
4,950 (94) |
| Dengue-like illness§§ |
254 (5) |
24 (6) |
278 (5) |
| Severe dengue¶¶ |
46 (<1) |
1 (<1) |
47 (<1) |
|
Outcome
| |||
| Hospitalized |
2,119 (42) |
57 (15) |
2,176 (40) |
| Died | 18 (<1) | 0 | 18 (<1) |
* Not available before 2014 (n = 459).
† One unknown sex among travelers.
§ Ten unknown age group among travelers and one among locally acquired cases.
¶ 99% of patients (472) traveled to Mexico.
** National Notifiable Diseases Surveillance System (NNDSS) dengue definitions from 2010 and 2015. Dengue hemorrhagic fever and dengue shock syndrome cases were classified as severe dengue in this analysis; dengue fever and dengue fever with hemorrhage cases were classified as dengue. https://wwwn.cdc.gov/nndss/conditions/dengue-virus-infections/case-definition/2015/.
†† Dengue is defined by fever as reported by the patient or health care provider and the presence of one or more of the following signs and symptoms: nausea/vomiting, rash, aches and pains (e.g., headache, retro-orbital pain, joint pain, myalgia, or arthralgia), tourniquet test positive, leukopenia (a total white blood cell count of <5,000/mm3), or any warning sign for severe dengue: abdominal pain or tenderness, persistent vomiting, extravascular fluid accumulation (e.g., pleural or pericardial effusion or ascites), mucosal bleeding at any site, liver enlargement >2 cm, or increasing hematocrit concurrent with rapid decrease in platelet count.
§§ Dengue-like illness (59 cases) was combined with febrile illness (two), and uncomplicated fever (217); 91 cases with unknown clinical syndrome and 21 classified as other clinical syndrome were excluded, all of them were travel-associated.
¶¶ Severe dengue is defined as dengue with any one or more of the following: 1) severe plasma leakage evidenced by hypovolemic shock or extravascular fluid accumulation (e.g., pleural or pericardial effusion or ascites) with respiratory distress; 2) severe bleeding from the gastrointestinal tract (e.g., hematemesis or melena) or vagina (menorrhagia) as defined by requirement for medical intervention including intravenous fluid resuscitation or blood transfusion, or 3) severe organ involvement, including any of the following: elevated liver transaminases: aspartate aminotransferase or alanine aminotransferase ≥1,000 per liter (U/L), impaired level of consciousness or diagnosis of encephalitis, encephalopathy, or meningitis, or heart or other organ involvement including myocarditis, cholecystitis, and pancreatitis.