Health Advisory: Global Increase in Dengue Cases

Be alert for potential cases in Snohomish County

April 3, 2024

Action Requested 

• Be aware that many countries are experiencing dengue outbreaks and Washington State Department of Health (WA DOH) has also seen an increase in reported cases of dengue in persons arriving from affected areas. 
  • CDC has recently issued Level 1 travel notices for Central and South America, Mexico, the Caribbean, parts of Africa and the Middle East, and many parts of Asia and the Pacific Islands. Anyone arriving from an affected area could be at risk.
• No cases of dengue have been reported in Snohomish County so far in 2024. There have been previous travel-related cases. The most recent was in November 2023.
• Take a detailed travel history for a patient who reports fever or rash and who recently arrived from an affected region.
  • Dengue can cause fever, rash, headache, body aches, and joint aches. Severe symptoms include central nervous system infection and hemorrhage.
• If dengue is a possible diagnosis based on symptoms and recent travel, recommend the patient avoid nonsteroidal anti-inflammatory drugs (NSAIDs) until dengue is ruled out.
• If the person is within the first week of illness (acute phase), order PCR or dengue virus antigen tests AND serology (IgM and IgG) for dengue and for any other likely conditions.
• If the person is after the first week of illness, order serology (IgM and IgG) for dengue and any other likely conditions. IgM antibodies can remain detectable for 3 months or longer after infection.
• If the person with suspected dengue is hospitalized with encephalopathy or aseptic meningitis, also order PCR on cerebral spinal fluid.
• Report any suspected or confirmed cases of dengue in Snohomish County to the Snohomish County Health Department.
  • Call 425-339-3503 to reach the Communicable Disease program by phone.
  • Please complete and fax the Communicable Disease Report Form (PDF) and any accompanying lab reports to 425-339-8706.
• Dengue testing is not recommended for asymptomatic persons.
• When providing pre-travel consultation, recommend prevention measures to avoid mosquito bites if the person is traveling to an area at risk for dengue, including use of an EPA-registered insect repellant: https://www.cdc.gov/dengue/prevention/plan-for-travel.html

Background

While WA DOH receives an average of 13 dengue cases per year, 31 cases were reported in 2023, and cases remain high in 2024. In many cases, appropriate diagnostic testing is not ordered by providers (namely, serologic testing is ordered too early after symptom onset, when it may be negative, and PCR testing that allows serotyping is not performed). 

WA DOH issued a Provider Alert on March 27. The full alert is available online here.

Resources

• CDC Travel Notices (Dengue):
  • Central and South America, Mexico, the Caribbean: https://wwwnc.cdc.gov/travel/notices/level1/dengue-americas
  • Africa and the Middle East: https://wwwnc.cdc.gov/travel/notices/level1/dengue-africa
  • Asia and Pacific Islands: https://wwwnc.cdc.gov/travel/notices/level1/dengue-asia 
• CDC - Areas at risk for dengue: https://www.cdc.gov/dengue/areaswithrisk/around-the-world.html
• CDC Dengue testing guidance: https://www.cdc.gov/dengue/healthcare-providers/testing/testing-guidance.html

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Message categories

• Health Alert: High-importance information about a public health incident. Warrants immediate action.
• Health Advisory: Important information about a potential or ongoing public health incident. May not require immediate action.
• Health Update: Updates about an ongoing public health incident. Immediate action not required.