Volume 86, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Dengue is an acute febrile illness caused by four mosquito-borne dengue viruses (DENV-1 to -4) that are endemic throughout the tropics. After returning from a 1-week missionary trip to Haiti in October of 2010, 5 of 28 (18%) travelers were hospitalized for dengue-like illness. All travelers were invited to submit serum specimens and complete questionnaires on pre-travel preparations, mosquito avoidance practices, and activities during travel. DENV infection was confirmed in seven (25%) travelers, including all travelers that were hospitalized. Viral sequencing revealed closest homology to a 2007 DENV-1 isolate from the Dominican Republic. Although most (88%) travelers had a pre-travel healthcare visit, only one-quarter knew that dengue is a risk in Haiti, and one-quarter regularly used insect repellent. This report confirms recent DENV transmission in Haiti. Travelers to DENV-endemic areas should receive dengue education during pre-travel health consultations, follow mosquito avoidance recommendations, and seek medical care for febrile illness during or after travel.


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  1. World Health Organization, 2009. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. Geneva, Switzerland: World Health Organization. [Google Scholar]
  2. Gubler DJ, , 2002. Epidemic dengue/dengue hemorrhagic fever as a public health, social and economic problem in the 21st century. Trends Microbiol 10: 100103.[Crossref] [Google Scholar]
  3. Freedman DO, Weld LH, Kozarsky PE, Fisk T, Robins R, von Sonnenburg F, Keystone JS, Pandey P, Centron MS, , GeoSntinel Surveillance Network, 2006. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med 355: 119130.[Crossref] [Google Scholar]
  4. Effler PV, Pang L, Kitsutani P, Vorndam V, Nakata M, Ayers T, Elm J, Tom T, Reiter P, Rigau-Perez JG, Hayes JM, Mills K, Napier M, Clark GG, Gubler DJ, , 2005. Dengue fever, Hawaii, 2001–2002. Emerg Infect Dis 11: 742749.[Crossref] [Google Scholar]
  5. Rodhain R, Rosen L, Gubler DJ, Kuno G, , 1997. Dengue and dengue hemorrhagic fever. , eds. Mosquito Vectors and Dengue Virus-Vector Relationships. New York, NY: CAB International, 4560. [Google Scholar]
  6. Gubler DJ, , 2006. Dengue/dengue haemorrhagic fever: history and current status. Novartis Found Symp 277: 316.[Crossref] [Google Scholar]
  7. Webster DP, Farrar J, Rowland-Jones S, , 2009. Progress towards a dengue vaccine. Lancet Infect Dis 9: 678687.[Crossref] [Google Scholar]
  8. Goodyer LI, Croft AM, Frances SP, Hill N, Moore SJ, Onyango SP, Debboun M, , 2010. Expert review of the evidence base for arthropod bite avoidance. J Travel Med 17: 182192.[Crossref] [Google Scholar]
  9. Lillie TH, Schreck CE, Rahe AJ, , 1988. Effectiveness of personal protection against mosquitoes in Alaska. J Med Entomol 25: 475478.[Crossref] [Google Scholar]
  10. Lenhart A, Orelus N, Maskill R, Alexander N, Streit T, McCall PJ, , 2008. Insecticide-treated bednets to control dengue vectors: preliminary evidence from a controlled trial in Haiti. Trop Med Int Health 13: 5667.[Crossref] [Google Scholar]
  11. Sotir MJ, Hoang Johnson DK, Davis JP, , 2009. Travel-associated dengue illnesses among Wisconsin residents, 2002–2008. WMJ 108: 447452. [Google Scholar]
  12. CDC, 2010. Travel-associated dengue surveillance—United States, 2006–2008. MMWR Morb Mortal Wkly Rep 59: 715719. [Google Scholar]
  13. Trofa AF, DeFraites RF, Smoak BL, Kanesa-thasan N, King AD, Burrous JM, MacArthy PO, Rossi C, Hoke CH, Jr, 1997. Dengue fever in US military personnel in Haiti. JAMA 277: 15461548.[Crossref] [Google Scholar]
  14. Rossi CA, Drabick JJ, Gambel JM, Sun W, Lewis TE, Henchal EA, , 1998. Laboratory diagnosis of acute dengue fever during the United Nations Mission in Haiti, 1995–1996. Am J Trop Med Hyg 59: 275278. [Google Scholar]
  15. Blum JA, Pfeifer S, Hatz CF, , 2010. Psychiatric manifestations as the leading symptom in an expatriate with dengue fever. Infection 38: 341343.[Crossref] [Google Scholar]
  16. Ventura AK, Ehrenkranz NJ, , 1976. Endemic dengue virus infection in Hispaniola. I. Haiti. J Infect Dis 134: 436441.[Crossref] [Google Scholar]
  17. Halstead SB, Streit TG, Lafontant JG, Putvatana R, Russell K, Sun W, Kanesa-Thasan N, Hayes CG, Watts DM, , 2001. Haiti: absence of dengue hemorrhagic fever despite hyperendemic dengue virus transmission. Am J Trop Med Hyg 65: 180183. [Google Scholar]
  18. Beatty ME, Hunsperger E, Long E, Schurch J, Jain S, Colindres R, Lerebours G, Bernard YM, Dobbins JG, Brown M, Clark GG, , 2007. Mosquitoborne infections after Hurricane Jeanne, Haiti, 2004. Emerg Infect Dis 13: 308310.[Crossref] [Google Scholar]
  19. Rioth M, Beauharnais CA, Noel F, Ikizler MR, Mehta S, Zhu Y, Long CA, Pape JW, Wright PF, , 2011. Serologic imprint of dengue virus in urban Haiti: characterization of humoral immunity to dengue in infants and young children. Am J Trop Med Hyg 84: 630636.[Crossref] [Google Scholar]
  20. CDC, 2010. Dengue Fever/Dengue Haemorrhagic Fever: Haiti Pre-decision Brief for Public Health Action. Available at: http://emergency.cdc.gov/disasters/earthquakes/haiti/dengue_pre-decision_brief.asp#footnote2. Accessed May 1, 2011. [Google Scholar]
  21. CDC, 2010. Potential for Dengue Infection among Relief Workers Returning from Haiti. Available at: http://emergency.cdc.gov/HAN/han00312.asp. Accessed May 1, 2011. [Google Scholar]
  22. Endy TP, Chunsuttiwat S, Nisalak A, Libraty DH, Green S, Rothman AL, Vaughn DW, Ennis FA, , 2002. Epidemiology of inapparent and symptomatic acute dengue virus infection: a prospective study of primary school children in Kamphaeng Phet, Thailand. Am J Epidemiol 156: 4051.[Crossref] [Google Scholar]
  23. Johnson BW, Russell BJ, Lanciotti RS, , 2005. Serotype-specific detection of dengue viruses in a fourplex real-time reverse transcriptase PCR assay. J Clin Microbiol 43: 49774983.[Crossref] [Google Scholar]
  24. Burke DS, Nisalak A, Ussery MA, , 1982. Antibody capture immunoassay detection of japanese encephalitis virus immunoglobulin m and g antibodies in cerebrospinal fluid. J Clin Microbiol 16: 10341042. [Google Scholar]
  25. Johnson AJ, Martin DA, Karabatsos N, Roehrig JT, , 2000. Detection of anti-arboviral immunoglobulin G by using a monoclonal antibody-based capture enzyme-linked immunosorbent assay. J Clin Microbiol 38: 18271831. [Google Scholar]
  26. Miagostovich MP, Nogueira RM, dos Santos FB, Schatzmayr HG, Araujo ES, Vorndam V, , 1999. Evaluation of an IgG enzyme-linked immunosorbent assay for dengue diagnosis. J Clin Virol 14: 183189.[Crossref] [Google Scholar]
  27. Rodriguez-Figueroa L, Rigau-Perez JG, Suarez EL, Reiter P, , 1995. Risk factors for dengue infection during an outbreak in Yanes, Puerto Rico in 1991. Am J Trop Med Hyg 52: 496502. [Google Scholar]
  28. Burke DS, Nisalak A, Johnson DE, Scott RM, , 1988. A prospective study of dengue infections in Bangkok. Am J Trop Med Hyg 38: 172180. [Google Scholar]
  29. Russell PK, Nisalak A, Sukhavachana P, Vivona S, , 1967. A plaque reduction test for dengue virus neutralizing antibodies. J Immunol 99: 285290. [Google Scholar]
  30. Calisher CH, Karabatsos N, Dalrymple JM, Shope RE, Porterfield JS, Westaway EG, Brandt WE, , 1989. Antigenic relationships between flaviviruses as determined by cross-neutralization tests with polyclonal antisera. J Gen Virol 70: 3743.[Crossref] [Google Scholar]
  31. CDC, 2010. Dengue fever among U.S. travelers returning from the Dominican Republic to Minnesota and Iowa, 2008. MMWR Morb Mortal Wkly Rep 59: 654656. [Google Scholar]
  32. Lyerla R, Rigau-Perez JG, Vorndam AV, Reiter P, George AM, Potter IM, Gubler DJ, , 2000. A dengue outbreak among camp participants in a Caribbean island, 1995. J Travel Med 7: 5963.[Crossref] [Google Scholar]
  33. CDC, 2011. Outbreak Notice. Update: Dengue, Tropical and Subtropical Regions. Available at: http://wwwnc.cdc.gov/travel/notices/outbreak-notice/dengue-tropical-sub-tropical.htm. Accessed May 1, 2011. [Google Scholar]
  34. Schwartz E, Weld LH, Wilder-Smith A, von Sonnenburg F, Keystone JS, Kain KC, Torresi J, Freedman DO, , 2008. Seasonality, annual trends, and characteristics of dengue among ill returned travelers, 1997–2006. Emerg Infect Dis 14: 10811088.[Crossref] [Google Scholar]
  35. Kuno G, , 1995. Review of the factors modulating dengue transmission. Epidemiol Rev 17: 321335.[Crossref] [Google Scholar]
  36. Guzman MG, Kouri G, , 2003. Dengue and dengue hemorrhagic fever in the Americas: lessons and challenges. J Clin Virol 27: 113.[Crossref] [Google Scholar]
  37. Yamashiro T, Disla M, Petit A, Taveras D, Castro-Bello M, Lora-Orste M, Vardez S, Cesin AJ, Garcia B, Nishizono A, , 2004. Seroprevalence of IgG specific for dengue virus among adults and children in Santo Domingo, Dominican Republic. Am J Trop Med Hyg 71: 138143. [Google Scholar]
  38. Schneider J, Droll D, , 2001. A Timeline for Dengue in the Americas to December 31, 2000 and Noted First Occurrences. Washington, DC: Pan American Health Organization, 120. [Google Scholar]
  39. Carrington CV, Foster JE, Pybus OG, Bennett SN, Holmes EC, , 2005. Invasion and maintenance of dengue virus type 2 and type 4 in the Americas. J Virol 79: 1468014687.[Crossref] [Google Scholar]
  40. Huang HL, Chiu TY, Huang KC, Cheng SY, Yao CA, Lee LT, , 2011. Travel-related mosquito-transmitted disease questionnaire survey among health professionals in Taiwan. J Travel Med 18: 3438.[Crossref] [Google Scholar]
  41. Ivatts SL, Plant AJ, Condon RJ, , 1999. Travel health: perceptions and practices of travel consultants. J Travel Med 6: 7680.[Crossref] [Google Scholar]
  42. CDC, 2010. Locally acquired dengue—Key West, Florida, 2009–2010. MMWR Morb Mortal Wkly Rep 59: 577581. [Google Scholar]

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  • Received : 04 Jul 2011
  • Accepted : 12 Sep 2011
  • Published online : 01 Jan 2012

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