Dengue Virus Infections among Peace Corps Volunteers in Timor-Leste, 2018–2019

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  • 1 Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico;
  • 2 Epidemiology and Surveillance Unit, Office of Health Services, United States Peace Corps, Washington, District of Columbia;
  • 3 Timor-Leste Country Office, Office of Health Services, U.S. Peace Corps, Washington, District of Columbia;
  • 4 U.S. Public Health Service, Rockville, Maryland

Dengue is an ongoing health risk for Peace Corps Volunteers (PCVs) working in the tropics. On May 2019, the Peace Corps Office of Health Services notified the Centers for Disease Control and Prevention (CDC) of a dengue outbreak among PCVs in Timor-Leste. The purpose of this investigation was to identify the clinical, demographic, and epidemiological characteristics of PCVs with dengue and recommend dengue preventive measures. To identify PCVs with dengue and describe disease severity, the medical records of PCVs reporting fever during September 2018–June 2019 were reviewed. To identify factors associated with dengue virus (DENV) infection, we administered a questionnaire on demographics, travel history, and mosquito avoidance behaviors and collected blood specimens to detect the anti-DENV IgM antibody to diagnose recent infection. Of 35 PCVs in-country, 11 (31%) tested positive for dengue (NS1, IgM, PCR), eight requiring hospitalization and medical evacuation. Among 27 (77%) PCVs who participated in the investigation, all reported having been recently bitten by mosquitoes and 56% reported being bitten most often at home; only 16 (59%) reported having screens on bedroom windows. Nearly all (93%) PCVs reported using a bed net every night; fewer (70%) reported using mosquito repellent at least once a day. No behaviors were significantly associated with DENV infection. Raising awareness of dengue risk among PCVs and continuing to encourage mosquito avoidance behavior to prevent dengue is critical. Access to and use of measures to avoid mosquito bites should be improved or implemented. Peace Corps medical officers should continue to receive an annual refresher training on dengue clinical management.

Author Notes

Address correspondence to Liliana Sánchez-González, 1324 Calle Cañada, San Juan, Puerto Rico 00920. E-mail: naq5@cdc.gov

Financial support: The investigation was supported, but not specifically funded, by CDC and the U.S. Peace Corps.

Disclaimer: The views expressed in this article are ours and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention or the U.S. Public Health Service.

Authors’ addresses: Liliana Sánchez-González, Chelsea G. Major, Jorge L. Munoz-Jordan, Freddy A. Medina, Gabriela Paz-Bailey, and Tyler M. Sharp, Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico, E-mails: naq5@cdc.gov, lhi5@cdc.gov, ckq2@cdc.gov, fkt3@cdc.gov, gmb5@cdc.gov, and iyp4@cdc.gov. Margaret Venuto, Scott Poe, and Karen Becker, Office of Health Services, Epidemiology and Surveillance Unit, Paul Coverdell Peace Corps HQ/Office of Health Services, Washington, DC, E-mails: mvenuto@peacecorps.gov, spoe@peacecorps.gov, and kbecker2@peacecorps.gov. Leonardus Baskara and Sevinj Abdiyeva, Office of Health Services, Timor-Leste Country Office, Paul Coverdell Peace Corps HQ/Office of Health Services, Washington, DC, E-mails: lbaskara@peacecorps.gov and sabdiyeva@peacecorps.gov. Daniel Murphy, Office of AIDS Research, Office of the Director, National Institutes of Health, Rockville, MD, E-mail: danny.murphy@nih.gov. Kyle Petersen, Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, E-mail: kyle.petersen@usuhs.edu.

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