Nov 7, 2022 Dengue virus (DENV) not endemic in continental United States1), identified in a resident of Maricopa County, Arizona, by reverse transcription-polymerase chain reaction (RT-PCR) testing at the Arizona Public Health Laboratory (ASPHL). The patient (Patient A) traveled to Mexicali, Mexico and stayed less than 4 hours before he was admitted to the hospital on October 19 with dengue-like illness 7 days later. Patient A. She was hospitalized for 3 days and then recovered. The Maricopa County Environmental Services Department (MCESD) collected from Patient A’s 21 mosquito pools within 5 miles (8 km) of her residence between October 1 and her November 3 A retrospective test of her DENV was performed on the sample obtained. He tested positive for DENV on 5 October in a sample collected from one mosquito pool (Pool A). Whole-genome sequencing by CDC’s Dengue Branch identified a closely related her DENV-3 strain, not known to circulate in the patient’s traveled area, in both patient A and pool A, indicating that local DENV It was later revealed that an infection was suggested.

Based on the existing Mosquito-borne Disease Response Plan obtained locally by the Maricopa County Department of Public Health (MCDPH), MCESD, and the Arizona Department of Health Services, MCDPH and MCESD activated their Incident Command Office on November 10. bottom. MCDPH has taken the following actions: ) prioritized prospective surveys of healthcare providers and laboratory reports from DENV and suspected arbovirus visits referred from the National Syndrome Surveillance Program’s BioSense platform (BioSense)*; 2) 1 July We retrospectively reviewed confirmed, probable, and suspected cases of dengue investigated from to 10 November for evidence of DENV transmission in the community. 3) warned healthcare providers of possible community transmission; 4) Advise healthcare providers to test for suspected DENV and report to MCDPH. A visit of 13 suspected arboviruses identified in the Biosense database, a review of 10 closed cases, and an investigation of 10 new cases confirmed no evidence of local acquisition. The MCESD retrospectively tested samples collected from her additional 4,299 mosquito pools stationed throughout the county between September 18 and November 19. This included mosquito pools within 5 miles of patient A’s place of residence collected during the extended testing period and for her DENV by RT-PCR. All were negative. This activity was reviewed by the CDC and was conducted in accordance with applicable federal law and CDC policy.^†

After discussions with the CDC Dengue Chapter and the Florida Department of Public Health (2,3) regarding current best practices for managing locally acquired DENV infections, on November 17-19 MCDPH and MCESD examined dwellings within a 0.09 mile (150 m) radius (Four) Interview residents of Patient A’s residence and Pool A, collect human specimens for DENV testing, and assess their properties for mosquito breeding. The team approached her 241 households. Residents of 72 households (29.9%) consented to the environmental assessment, and her 73 of 59 households (24.5%) were interviewed. Of these 73 interviewees, 12 (16.4%) reported that he developed dengue-like symptoms within 14 days of the interview and underwent testing. All her DENV results by RT-PCR in ASPHL were negative. A serum enzyme immunoassay for DENV immunoglobulin M test was performed by ASPHL on blood samples from 53 (72.6%) interviewees. Of these, one (1.9%) result was positive. The CDC Arboviral Diseases Branch confirmed DENV-3 through a plaque reduction neutralization study. The person who tested positive had not traveled in her two weeks before the onset of symptoms. One of her family members reported dengue-like symptoms, but she declined testing. Both have since recovered.An environmental rating for this residence has been identified Aedes aegypti Mosquitoes and breeding grounds; mosquitoes collected with professional BG-Sentinel mosquito traps^§ Negative for DENV by RT-PCR test. Latest guidance (Four).

Coordinated surveillance and response activities identified the first locally acquired human DENV infection in Maricopa County, Arizona. Established partnerships and existing plans were essential to initiate a rapid and coordinated response to non-endemic arbovirus infections. MCDPH and MCESD will step up future surveillance efforts to identify and prevent spontaneous DENV infections, including installation of additional mosquito traps around patient residences and public mosquito exposure prevention education.^¶ A countywide health care provider education campaign is underway to raise health care provider awareness of local DENV transmission and encourage testing of patients with compatible diseases, regardless of travel history.

Acknowledgments

Blanca Caballero, Maricopa County Department of Environmental Services. Angela Moreth, Nicholas Moyte, Sonia Singh, Maricopa County Department of Public Health Office of Communications and Marketing; Maricopa Medical Reserve Corps, Maricopa County Department of Public Health Office of Preparedness and Response; Guillermo Adame, Richard Turner, Arizona Department of Health Services; Arizona State Institute of Public Health; Dengue Branch, CDC; Arbovirus Diseases Division, CDC; Andrea Morrison, Danielle Stanek, Florida Department of Health. Maricopa County study participants.

county team member

Cindy Bitcon, Adam Costello, Cathy Dumet, Gruminder Singh Gill, Michael Hagan, Sierra Lamb, Jamie Lee, Georgina Marin, Jason Nelson, Patti O’Neill, Kayla Grace Sullivan-Land, Carly Taylor, June Vutrano, Darby Watters-Royval, Kyle Willman, Maricopa County Public Health Preparedness and Response Field Team. Hector Abundis, Dan Armijo, Luis Avalos, Kara Cox, Eric Garcia, Bruce McKinzey, Yunior Osorio Mulet, Jacob Rivera, Maricopa County Environmental Services Department Vector Control Division field team. Luis Avalos, Trinity Johnson, Adele Malone, Yunior Osorio Mulet, Adela Riehle, Maricopa County Environmental Services Division Vector Control Division Laboratory.

¹Maricopa County Public Health Department, Phoenix, Arizona. ²Maricopa County Environmental Services Vector Control, Phoenix, Arizona. ³Arizona Department of Health; ^FourOffice of Epidemic Information, CDC; ^FiveNational Center for Emerging and Zoonotic Diseases, CDC, Division of Vector-borne Diseases. ⁶Carrier Epidemiology Field Officer Program, CDC.

References

1. CDC. Dengue: Dengue fever in US states and territories. Atlanta, GA: US Department of Health and Human Services, CDC. 2022. Accessed 13 January 2023. https://www.cdc.gov/dengue/areaswithrisk/in-the-us.html
2. Radke EG, Gregory CJ, Kinziger KW, et al. In 2009, an epidemic of dengue fever occurred in Key West, Florida, USA. Emerg Infect Dis 2012;18:135–7. https://doi.org/10.3201/eid1801.110130 PMID: 22257471
3. Florida Department of Health. Florida Health: Martin County Dengue Epidemic and Serum Survey. Tallahassee, FL: Florida Department of Health. 2014. Accessed 24 January 2023. https://www.floridahealth.gov/diseases-and-conditions/dengue/_documents/mc-dengue-survey-summary-june2014.pdf
4. CDC. 2017 Zika CDC Interim Response Plan: May 2017. Atlanta, GA: US Department of Health and Human Services, CDC. 2017. Accessed 24 January 2023. https://stacks.cdc.gov/view/cdc/45532