Volume 99, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We instituted active surveillance among febrile patients presenting to the largest Houston-area pediatric emergency department to identify acute infections of dengue virus (DENV), West Nile virus (WNV), and chikungunya virus (CHIKV). In 2014, 1,063 children were enrolled, and 1,015 (95%) had blood and/or cerebrospinal fluid specimens available for DENV, WNV, and CHIKV testing. Almost half (49%) reported recent mosquito bites, and 6% ( = 60) reported either recent international travel or contact with an international traveler. None were positive for acute WNV; three had false-positive CHIKV results; and two had evidence of DENV. One DENV-positive case was an acute infection associated with international travel, whereas the other was identified as a potential secondary acute infection, also likely travel-associated. Neither of the DENV-positive cases were clinically recognized, highlighting the need for education and awareness. Health-care professionals should consider the possibility of arboviral disease among children who have traveled to or from endemic areas.


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  1. Tomashek KM, Gregory CJ, Rivera Sanchez A, Bartek MA, Garcia Rivera EJ, Hunsperger E, Munoz-Jordan JL, Sun W, 2012. Dengue deaths in Puerto Rico: lessons learned from the 2007 epidemic. PLoS Negl Trop Dis 6: e1614.
    [Google Scholar]
  2. Amanna IJ, Slifka MK, 2014. Current trends in West Nile virus vaccine development. Expert Rev Vaccines 13: 589608.
    [Google Scholar]
  3. Chang L-J et al., 2014. Safety and tolerability of chikungunya virus-like particle vaccine in healthy adults: a phase 1 dose-escalation trial. Lancet 384: 20462052.
    [Google Scholar]
  4. World Health Organization, 2016. Immunization, Vaccines and Biologicals. Dengue Vaccine Research. Available at: http://www.who.int/immunization/research/development/dengue_vaccines/en. Accessed August 5, 2016.
  5. Centers for Disease Control and Prevention, 2017. New Vaccine Surveillance Network (NVSN). Available at: http://www.cdc.gov/surveillance/nvsn. Accessed November 15, 2017.
  6. Santiago GA, Vergne E, Quiles Y, Cosme J, Vazquez J, Medina JF, Medina F, Colon C, Margolis H, Munoz-Jordan JL, 2013. Analytical and clinical performance of the CDC real time RT-PCR assay for detection and typing of dengue virus. PLoS Negl Trop Dis 7: e2311.
    [Google Scholar]
  7. Lanciotti RS, Kosoy OL, Laven JJ, Panella AJ, Velez JO, Lambert AJ, Campbell GL, 2007. Chikungunya virus in US travelers returning from India, 2006. Emerg Infect Dis 13: 764767.
    [Google Scholar]
  8. Abcam, 2011. Ab108717. Chikungunya Virus IgM Human ELISA Kit. Available at: http://www.abcam.com/ps/products/108/ab108717/documents/ab108717%20Chikungunya%20Virus%20IgM%20Human%20ELISA%20(Website).pdf. Accessed October 7, 2016.
  9. Texas Department of State Health Services, 2015. Arbovirus Activity in Texas. 2014 Surveillance Report. Available at: https://www.dshs.texas.gov/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=8589999503. Accessed October 5, 2016.
  10. Nakkhara P, Chongsuvivatwong V, Thammapalo S, 2013. Risk factors for symptomatic and asymptomatic chikungunya infection. Trans R Soc Trop Med Hyg 107: 789796.
    [Google Scholar]
  11. Bhatt S et al., 2013. The global distribution and burden of dengue. Nature 496: 504507.
    [Google Scholar]
  12. Mostashari F et al., 2001. Epidemic West Nile encephalitis, New York, 1999: results of a household-based seroepidemiological survey. Lancet 358: 261264.
    [Google Scholar]

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  • Received : 16 Nov 2017
  • Accepted : 11 Apr 2018
  • Published online : 04 Jun 2018
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