Chikungunya and Dengue Virus Infections Among United States Community Service Volunteers Returning from the Dominican Republic, 2014

Alexander J. Millman Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Douglas H. Esposito Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Holly M. Biggs Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Michelle Decenteceo Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Andrew Klevos Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Elizabeth Hunsperger Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Jorge Munoz-Jordan Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Olga I. Kosoy Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Heidi McPherson Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Carmen Sullivan Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Dayton Voorhees Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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David Baron Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Jim Watkins Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Linda Gaul Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Mark J. Sotir Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Gary Brunette Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Marc Fischer Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Tyler M. Sharp Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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Emily S. Jentes Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas

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DOI:
https://doi.org/10.4269/ajtmh.15-0815
Volume/Issue:
Volume 94: Issue 6
Page(s):
1336–1341
Restricted access
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Chikungunya spread throughout the Dominican Republic (DR) after the first identified laboratory-confirmed cases were reported in April 2014. In June 2014, a U.S.-based service organization operating in the DR reported chikungunya-like illnesses among several staff. We assessed the incidence of chikungunya virus (CHIKV) and dengue virus (DENV) infection and illnesses and evaluated adherence to mosquito avoidance measures among volunteers/staff deployed in the DR who returned to the United States during July–August 2014. Investigation participants completed a questionnaire that collected information on demographics, medical history, self-reported illnesses, and mosquito exposures and avoidance behaviors and provided serum for CHIKV and DENV diagnostic testing by reverse transcription polymerase chain reaction and IgM enzyme-linked immunosorbent assay. Of 102 participants, 42 (41%) had evidence of recent CHIKV infection and two (2%) had evidence of recent DENV infection. Of the 41 participants with evidence of recent CHIKV infection only, 39 (95%) reported fever, 37 (90%) reported rash, and 37 (90%) reported joint pain during their assignment. All attended the organization's health trainings, and 89 (87%) sought a pretravel health consultation. Most (∼95%) used insect repellent; however, only 30% applied it multiple times daily and < 5% stayed in housing with window/door screens. In sum, CHIKV infections were common among these volunteers during the 2014 chikungunya epidemic in the DR. Despite high levels of preparation, reported adherence to mosquito avoidance measures were inconsistent. Clinicians should discuss chikungunya with travelers visiting areas with ongoing CHIKV outbreaks and should consider chikungunya when diagnosing febrile illnesses in travelers returning from affected areas.

Author Notes

* Address correspondence to Emily S. Jentes, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-03, Atlanta, GA 30329. E-mail: efj8@cdc.gov

Financial support: This investigation was supported by the Centers for Disease Control and Prevention.

Authors' addresses: Alexander J. Millman, Douglas H. Esposito, Holly M. Biggs, Mark J. Sotir, Gary Brunette, and Emily S. Jentes, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: irm6@cdc.gov, hgj4@cdc.gov, xdc6@cdc.gov, mps6@cdc.gov, fvd3@cdc.gov, and efj8@cdc.gov. Michelle Decenteceo, Andrew Klevos, and Jim Watkins, Centers for Disease Control and Prevention, Miami, FL, E-mails: vqi8@cdc.gov, hvc4@cdc.gov, and gpf4@cdc.gov. Elizabeth Hunsperger, Jorge Munoz-Jordan, and Tyler M. Sharp, Centers for Disease Control and Prevention, San Juan, Puerto Rico, E-mails: enh4@cdc.gov, ckq2@cdc.gov, and iyp4@cdc.gov. Olga I. Kosoy and Marc Fischer, Centers for Disease Control and Prevention, Fort Collins, CO, E-mails: oak3@cdc.gov and mxf2@cdc.gov. Heidi McPherson, Carmen Sullivan, Dayton Voorhees, and David Baron, Amigos de las Américas, Houston, TX, E-mails: hmcpherson@amigoslink.org, csullivan@amigoslink.org, dvoorhee@phs.org, and dbaron@challiance.org. Linda Gaul, Texas Department of State Health Services, Austin, TX, E-mail: linda.gaul@dshs.state.tx.us.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2016
Received:
13 Nov 2015
|
Accepted:
06 Jan 2016
|
Published Online:
01 Jun 2016
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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