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In June of 2007, West Nile virus (WNV) was detected in sentinel chickens and blood donors in Puerto Rico, where dengue virus (DENV) is hyperendemic. Enhanced human surveillance for acute febrile illness (AFI) began in eastern Puerto Rico on July 1, 2007. Healthcare providers submitted specimens from AFI cases for WNV and DENV virology and serology testing. Over 6 months, 385 specimens were received from 282 cases; 115 (41%) specimens were DENV laboratory-positive, 86 (31%) specimens were laboratory-indeterminate, and 32 (11%) specimens were laboratory-negative for WNV and DENV. One WNV infection was detected by anti-WNV immunoglobulin M (IgM) antibody and confirmed by a plaque reduction neutralization test. DENV and WNV infections could not be differentiated in 27 cases (10%). During a period of active WNV transmission, enhanced human surveillance identified one case of symptomatic WNV infection. Improved diagnostic methods are needed to allow differentiation of WNV and DENV in dengue-endemic regions.
Authors' addresses: Jomil M. Torres-Aponte, Epidemiology and Research Office, Puerto Rico Department of Health, San Juan, Puerto Rico, E-mails: email@example.com or firstname.lastname@example.org. Richard R. Luce, Center for Global Health, Centers for Disease Control and Prevention, Libreville, Gabon, E-mail: email@example.com. Elizabeth Hunsperger, Jorge L. Muñoz-Jordan, Manuela Beltrán, Edgardo Vergne, D. Fermín Argüello, and Kay M. Tomashek, Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico, E-mails: firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com. Enid J. García, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico, E-mail: firstname.lastname@example.org. Wellington Sun, Center for Biologics Evaluation and Research, Division of Vaccines and Related Product Applications, Food and Drug Administration, Rockville, MD, E-mail: email@example.com.