A Cluster of Dengue Cases in American Missionaries Returning from Haiti, 2010

Tyler M. Sharp Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Nebraska Department of Health and Human Services, Lincoln, Nebraska; Central District Health Department, Grand Island, Nebraska; Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia

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Parvathy Pillai Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Nebraska Department of Health and Human Services, Lincoln, Nebraska; Central District Health Department, Grand Island, Nebraska; Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia

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Elizabeth Hunsperger Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Nebraska Department of Health and Human Services, Lincoln, Nebraska; Central District Health Department, Grand Island, Nebraska; Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia

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Gilberto A. Santiago Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Nebraska Department of Health and Human Services, Lincoln, Nebraska; Central District Health Department, Grand Island, Nebraska; Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia

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Teresa Anderson Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Nebraska Department of Health and Human Services, Lincoln, Nebraska; Central District Health Department, Grand Island, Nebraska; Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia

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Trina Vap Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Nebraska Department of Health and Human Services, Lincoln, Nebraska; Central District Health Department, Grand Island, Nebraska; Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia

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Jeremy Collinson Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Nebraska Department of Health and Human Services, Lincoln, Nebraska; Central District Health Department, Grand Island, Nebraska; Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia

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Bryan F. Buss Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Nebraska Department of Health and Human Services, Lincoln, Nebraska; Central District Health Department, Grand Island, Nebraska; Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia

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Thomas J. Safranek Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Nebraska Department of Health and Human Services, Lincoln, Nebraska; Central District Health Department, Grand Island, Nebraska; Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia

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Mark J. Sotir Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Nebraska Department of Health and Human Services, Lincoln, Nebraska; Central District Health Department, Grand Island, Nebraska; Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia

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Emily S. Jentes Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Nebraska Department of Health and Human Services, Lincoln, Nebraska; Central District Health Department, Grand Island, Nebraska; Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia

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Jorge L. Munoz-Jordan Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Nebraska Department of Health and Human Services, Lincoln, Nebraska; Central District Health Department, Grand Island, Nebraska; Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia

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D. Fermin Arguello Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Nebraska Department of Health and Human Services, Lincoln, Nebraska; Central District Health Department, Grand Island, Nebraska; Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia

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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.

Author Notes

*Address correspondence to D. Fermin Arguello, Centers for Disease Control and Prevention—Dengue Branch, 1324 Calle Cañada, San Juan, Puerto Rico 00920. E-mail: darguello@cdc.gov
†These authors contributed equally to this manuscript.

Authors' addresses: Tyler M. Sharp, Elizabeth Hunsperger, Gilberto A. Santiago, Jorge L. Munoz-Jordan, and D. Fermin Arguello, Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico, E-mails: tsharp@cdc.gov, enh4@cdc.gov, fbz3@cdc.gov, ckq2@cdc.gov, and darguello@cdc.gov. Parvathy Pillai, Bryan F. Buss, and Thomas J. Safranek, Nebraska Department of Health and Human Services, Lincoln, NE, E-mails: ihc9@cdc.gov, feu7@cdc.gov, and tom.safranek@nebraska.gov. Teresa Anderson, Trina Vap, and Jeremy Collinson, Central District Health Department, Grand Island, NE, E-mails: tanderson@cdhd.ne.gov, tvap@cdhd.ne.gov, and jcollinson@cdhd.ne.gov. Mark J. Sotir and Emily S. Jentes, Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: mps6@cdc.gov and efj8@cdc.gov.

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