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May 21, 1997, Vol 277, No. 19 >
ARTICLE | May 21, 1997

Dengue Fever in US Military Personnel in Haiti FREE

Andrew F. Trofa, MD; Robert F. DeFraites, MD; Bonnie L. Smoak, MD; Niranjan Kanesa-thasan, MD; Alan D. King, VMD; Jeanne M. Burrous, MS; Phillip O. MacArthy, PhD; Cindy Rossi, MS; Charles H. Hoke, Jr, MD
[+] Author Affiliations

The views expressed in this article are those of the authors and do not reflect the official policy or position of the US Department of the Army, the US Department of Defense, or the federal government.

Reprints: Andrew F. Trofa, MD, South Jersey Infectious Disease, 732 Shore Rd, Somers Point, NJ 08244.


JAMA. 1997;277(19):1546-1548. doi:10.1001/jama.1997.03540430058033
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References

Objective.  —To describe clinical manifestations and public health implications of an outbreak of dengue fever (DF) during Operation Uphold Democracy, Haiti, 1994.

Design.  —Consecutive sample.

Setting.  —Military combat support hospital, Port-au-Prince, Haiti.

Patients.  —A total of 101 US military personnel with acute febrile illnesses.

Interventions.  —A disease surveillance team collected clinical and epidemiologic data from US military clinics throughout Haiti. Febrile patients admitted to the combat support hospital were evaluated with standardized clinical and laboratory procedures. The surveillance team followed patients daily.

Main Outcome Measures.  —Arbovirus isolation and specific antibody determination and symptoms and physical findings.

Results.  —Febrile illnesses accounted for 103 (25%) of the 406 combat support hospital admissions during the first 6 weeks of deployment. All patients with febrile illness recovered. A total of 30 patients had DF; no patient had evidence of infection with malaria. Dengue virus serotypes 1,2, and 4 were isolated from 22 patients, and 8 patients developed IgM antibody to dengue virus. Patients with DF could not be distinguished from other febrile patients on clinical grounds alone. No arboviruses other than dengue were identified.

Conclusions.  —Active surveillance, with clinical and laboratory evaluation directed by an epidemiologic team, led to the timely recognition of an outbreak of febrile illness among US troops in Haiti. Viral isolation and serological studies were essential in confirming DF. During the surveillance period, DF accounted for at least 30% of the febrile illnesses among hospitalized US troops. Dengue fever is a significant threat to military personnel and civilian travelers in Haiti and has the potential for introduction to and transmission in the United States.

REFERENCES

1 +
Monath T.  Viral febrile illnesses . In: Strickland GT, ed. Hunter's Tropical Medicine . 6th ed. Philadelphia, Pa: WB Saunders Co; 1984;:143-147.
2 +
Ehrenkranz NJ, Ventura AK, Cuadrado RR, Pond WL, Porter JE.  Pandemic dengue in Caribbean countries and the southern United States: past, present, and potential problems . N Engl J Med . 1971;;285:1460-1469.
3 +
Ventura AK, Ehrenkranz NJ.  Endemic dengue virus infection in Hispaniola, I: Haiti . J Infect Dis . 1976;;134:436-441.
4 +
Gubler DJ, Trent DW.  Emergence of epidemic dengue/dengue hemorrhagic fever as a public health problem in the Americas . Infect Agents Dis . 1993;;2: 383-393
5 +
World Health Organization.  Dengue in the Americas: an update . Wkly Epidemiol Rec . 1994;;69:177-180.
6 +
Centers for Disease Control and Prevention.  Imported dengue: United States, 1993-1994 . MMWR Morb Mortal Wkly Rep . 1995;;44:353-356.
7 +
Rigau-Perez JG, Gubler DJ, Vorndam AV, Clark GG.  Dengue surveillance: United States, 1986-1992 . MMWR CDC Surveill Summ . 1994;;43:7-19.
8 +
Wallace MR, Sharp TW, Smoak B, et al.  Malaria among United States troops in Somalia . Am J Med . 1996;;100:49-55.
9 +
Sharp TW, Wallace MR, Hayes CG, et al.  Dengue fever in US troops during Operation Restore Hope, Somalia, 1992-1993 . Am J Trop Med Hyg . 1995;;53: 89-94.
10 +
Newton JA Jr, Schnepf GA, Wallace MR, Lobel HO, Kennedy CA, Oldfield EC III.  Malaria in US Marines returning from Somalia . JAMA . 1994;;272: 397-399.
11 +
Gambel JM.  Debugging the battlefield: winning the war against insect bites and related diseases . Mil Rev . 1996;;76:51-57.
12 +
Innis BL, Nisalak A, Nimmannity S, et al.  An enzyme-linked immunosorbent assay to characterize dengue infections where dengue and Japanese encephalitis co-circulate . Am J Trop Med Hyg . 1989;; 40:418-427.
13 +
Tesh RB.  A method for the isolation and identification of dengue viruses using mosquito cell cultures . Am J Trop Med Hyg . 1979;;28:1053-1059.
14 +
Henchal EA, Gentry MK, McCown JM, Brandt WE.  Dengue virus-specific and flavivirus group determinants identified with monoclonal antibodies by indirect immunofluorescence . Am J Trop Med Hyg . 1982;;31:830-836.
15 +
Epi Info, Version 5: A Word Processing, Database, and Statistics Program for Epidemiology on Microcomputers. Stone Mountain, Ga: USD Inc; 1990.
16 +
Hyams KC, Bourgeois AL, Escamilla J, Burans J, Woody JN.  The Navy Forward Laboratory during Operations Desert Shield/Storm . Mil Med . 1993;;158: 729-732
17 +
Hyams KC, Oldfield EC, Scott RM, et al.  Evaluation of febrile patients in Port Sudan, Sudan: isolation of dengue virus . Am J Trop Med Hyg . 1986;;35: 860-865
18 +
Schwartz E, Mendelson E, Sidi Y.  Dengue fever among travelers . Am J Med . 1996;;101:516-520.
19 +
Bakker RC, Veenstra J, Dingemans-Dumas AM, Wetsteyn CFM, Kager PA.  Imported dengue in the Netherlands . J Travel Med . 1996;;3:204-208
20 +
Morens DM.  Antibody-dependent enhancement of infection and the pathogenesis of viral disease . Clin Infect Dis . 1994;;19:500-512.
21 +
Gubler DJ.  Aedes aegypti and Aedes aegyptiborne disease control in the 1990s: top down or bottom up . Am J Trop Med Hyg . 1989;;40:571-578.
22 +
Centers for Disease Control and Prevention.  Dengue fever among US military personnel: Haiti, September-November 1994 . MMWR Morb Mortal Wkly Rep . 1994;;43:845-848.

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1 +
Monath T.  Viral febrile illnesses . In: Strickland GT, ed. Hunter's Tropical Medicine . 6th ed. Philadelphia, Pa: WB Saunders Co; 1984;:143-147.
2 +
Ehrenkranz NJ, Ventura AK, Cuadrado RR, Pond WL, Porter JE.  Pandemic dengue in Caribbean countries and the southern United States: past, present, and potential problems . N Engl J Med . 1971;;285:1460-1469.
3 +
Ventura AK, Ehrenkranz NJ.  Endemic dengue virus infection in Hispaniola, I: Haiti . J Infect Dis . 1976;;134:436-441.
4 +
Gubler DJ, Trent DW.  Emergence of epidemic dengue/dengue hemorrhagic fever as a public health problem in the Americas . Infect Agents Dis . 1993;;2: 383-393
5 +
World Health Organization.  Dengue in the Americas: an update . Wkly Epidemiol Rec . 1994;;69:177-180.
6 +
Centers for Disease Control and Prevention.  Imported dengue: United States, 1993-1994 . MMWR Morb Mortal Wkly Rep . 1995;;44:353-356.
7 +
Rigau-Perez JG, Gubler DJ, Vorndam AV, Clark GG.  Dengue surveillance: United States, 1986-1992 . MMWR CDC Surveill Summ . 1994;;43:7-19.
8 +
Wallace MR, Sharp TW, Smoak B, et al.  Malaria among United States troops in Somalia . Am J Med . 1996;;100:49-55.
9 +
Sharp TW, Wallace MR, Hayes CG, et al.  Dengue fever in US troops during Operation Restore Hope, Somalia, 1992-1993 . Am J Trop Med Hyg . 1995;;53: 89-94.
10 +
Newton JA Jr, Schnepf GA, Wallace MR, Lobel HO, Kennedy CA, Oldfield EC III.  Malaria in US Marines returning from Somalia . JAMA . 1994;;272: 397-399.
11 +
Gambel JM.  Debugging the battlefield: winning the war against insect bites and related diseases . Mil Rev . 1996;;76:51-57.
12 +
Innis BL, Nisalak A, Nimmannity S, et al.  An enzyme-linked immunosorbent assay to characterize dengue infections where dengue and Japanese encephalitis co-circulate . Am J Trop Med Hyg . 1989;; 40:418-427.
13 +
Tesh RB.  A method for the isolation and identification of dengue viruses using mosquito cell cultures . Am J Trop Med Hyg . 1979;;28:1053-1059.
14 +
Henchal EA, Gentry MK, McCown JM, Brandt WE.  Dengue virus-specific and flavivirus group determinants identified with monoclonal antibodies by indirect immunofluorescence . Am J Trop Med Hyg . 1982;;31:830-836.
15 +
Epi Info, Version 5: A Word Processing, Database, and Statistics Program for Epidemiology on Microcomputers. Stone Mountain, Ga: USD Inc; 1990.
16 +
Hyams KC, Bourgeois AL, Escamilla J, Burans J, Woody JN.  The Navy Forward Laboratory during Operations Desert Shield/Storm . Mil Med . 1993;;158: 729-732
17 +
Hyams KC, Oldfield EC, Scott RM, et al.  Evaluation of febrile patients in Port Sudan, Sudan: isolation of dengue virus . Am J Trop Med Hyg . 1986;;35: 860-865
18 +
Schwartz E, Mendelson E, Sidi Y.  Dengue fever among travelers . Am J Med . 1996;;101:516-520.
19 +
Bakker RC, Veenstra J, Dingemans-Dumas AM, Wetsteyn CFM, Kager PA.  Imported dengue in the Netherlands . J Travel Med . 1996;;3:204-208
20 +
Morens DM.  Antibody-dependent enhancement of infection and the pathogenesis of viral disease . Clin Infect Dis . 1994;;19:500-512.
21 +
Gubler DJ.  Aedes aegypti and Aedes aegyptiborne disease control in the 1990s: top down or bottom up . Am J Trop Med Hyg . 1989;;40:571-578.
22 +
Centers for Disease Control and Prevention.  Dengue fever among US military personnel: Haiti, September-November 1994 . MMWR Morb Mortal Wkly Rep . 1994;;43:845-848.

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