Notes from the Area: Early Proof of Regionally Acquired Dengue Virus An infection Maricopa County, Arizona, November 2022

On November 7, 2022, dengue fever virus (DENV), which isn’t endemic to the continental United States (1), was recognized in a resident of Maricopa County, Arizona, by reverse transcription-polymerase chain response (RT-PCR) testing on the Arizona State Public Well being Laboratory (ASPHL). The affected person (Affected person A) was admitted to hospital on October 19 with a dengue-like sickness, 7 days after touring and staying in Mexicali, Mexico for lower than 4 hours. Affected person A was hospitalized for 3 days after which recovered. The Maricopa County Environmental Companies Division (MCESD) carried out retrospective testing for DENV in samples collected from 21 mosquito swimming pools positioned inside 5 miles of Affected person A’s residence from October 1 via November 3. A pattern taken from a mosquito pool (Pool A) on October 5 was optimistic for DENV. Entire genome sequencing by the Dengue Department of the CDC later revealed that carefully associated DENV-3 strains not recognized to be circulating within the affected person’s area of journey had been recognized in each affected person A and in group A, suggesting native transmission of DENV.

Based mostly on a pre-existing joint response plan from the Maricopa County Public Well being Division (MCDPH), MCESD, and the regionally acquired Arizona Division of Well being Companies towards mosquito-borne ailments, the MCDPH and MCESD activated an Incident Command Workplace on November 10. ) prioritized potential investigations of well being care supplier and laboratory reviews of DENV and suspected arbovirus visits queried with the Nationwide Syndromic Surveillance Program (BioSense)* BioSense platform; 2) retrospectively reviewed confirmed, possible and suspected dengue instances investigated between July 1 and November 10 for proof of native DENV transmission; 3) alerted well being care suppliers of potential native transmission; and 4) suggested suppliers to check and report suspected DENV to MCDPH. No proof of native acquisition was recognized in 13 suspected arbovirus visits recognized within the Biosense database, 10 closed case opinions, and 10 new case investigations. MCESD retrospectively examined samples collected from September 18 via November 19 from 4,299 extra mosquito swimming pools positioned all through the county, together with mosquito swimming pools inside 5 miles of Affected person A’s residence collected through the interval. prolonged take a look at, for DENV by RT-PCR; all have been damaging. This exercise has been reviewed by the CDC and was carried out in accordance with relevant federal regulation and CDC coverage.^†

After discussions with the Dengue department of the CDC and Florida Public Well being (2,3) relating to present finest practices for managing regionally acquired DENV infections, from November 17-19, MCDPH and MCESD surveyed residences inside a 0.09 mile (150 m) radius (4) from the residence of affected person A and pool A to interview residents, accumulate human samples for DENV testing, and assess mosquito breeding properties. The groups approached 241 households; residents of 72 households (29.9%) consented to EAs, and 73 folks in 59 (24.5%) households have been interviewed. Of those 73 respondents, 12 (16.4%) reported onset of dengue-like signs inside 14 days of their interview and have been examined; all outcomes have been damaging for DENV by RT-PCR at ASPHL. A serum enzyme immunoassay for the DENV immunoglobulin M take a look at was carried out by ASPHL on blood samples from 53 (72.6%) respondents; of those, one (1.9%) consequence was optimistic. The Arboviral Ailments Department of the CDC confirmed DENV-3 by a plaque discount neutralization assay. The individual with the optimistic take a look at consequence has not reported any journey within the 2 weeks previous to the onset of signs. Considered one of this individual’s family members reported dengue-like signs however declined testing; each have since recovered. Environmental evaluation of this residence recognized Aedes aegypti mosquitoes and breeding locations; mosquitoes collected in a BG-Sentinel skilled mosquito entice^§ examined damaging for DENV by RT-PCR. The outbreak (composed of two autochthonous DENV infections) ended on January 4, 2023, after greater than 45 days with out extra regionally acquired instances, as indicated by the latest pointers (4).

Coordinated surveillance and response actions recognized the primary regionally acquired human DENV infections in Maricopa County, Arizona. Established partnerships and pre-existing plans have been important to mount a speedy and coordinated response to non-endemic arbovirus transmission. MCDPH and MCESD will strengthen future surveillance actions to establish and forestall autochthonous transmission of DENV, together with putting in extra mosquito traps round affected person residences and elevating public consciousness about stopping mosquito publicity.^¶ A county-wide healthcare supplier schooling marketing campaign is being applied to teach suppliers about native DENV transmission and encourage testing for sufferers with suitable illness, no matter historical past of journey.

Thanks

Blanca Caballero, Maricopa County Division of Environmental Companies; Angela Moreth, Nicholas Moyte, Sonia Singh, Maricopa County Public Well being Division Workplace of Communications and Advertising and marketing; Maricopa Medical Reserve Corps, Maricopa County Division of Public Well being Workplace of Preparedness and Response; Guillermo Adame, Richard Turner, Arizona Division of Well being Companies; Arizona State Public Well being Laboratory; Dengue Directorate, CDC; Arboviral Ailments Department, CDC; Andrea Morrison, Danielle Stanek, Florida Division of Well being; Maricopa County survey individuals.

County staff members

Cindy Bitcon, Adam Costello, Kathie Dumais, Gurminder Singh Gill, Michael Hagan, Sierra Lamb, Jayme Lee, Georgina Marin, Jason Nelson, Patti O’Neil, Cayla Grace Sullivan-Land, Karli Taylor, June Vutrano, Darby Watters-Roybal, Kyle Willman, Maricopa County Division of Public Well being, Preparedness and Response Area Workforce; Hector Abundis, Dan Armijo, Luis Avalos, Kara Cox, Eric Garcia, Bruce McKinzey, Yunior Osorio Mulet, Jacob Rivera, Maricopa County Division of Environmental Companies Vector Management Division Area Workforce; Luis Avalos, Trinity Johnson, Adele Malone, Yunior Osorio Mulet, Adela Riehle, Maricopa County Division of Environmental Companies Vector Management Division Laboratory.

¹Maricopa County Division of Public Well being, Phoenix, Arizona; ²Maricopa County Environmental Companies Vector Management, Phoenix, Arizona; ³Arizona Division of Well being Companies; ⁴Epidemic Intelligence Service, CDC; ⁵Division of Vector-Borne Ailments, Nationwide Heart for Rising and Zoonotic Infectious Ailments, CDC; ⁶Profession Epidemiology Area Officer Program, CDC.

The references

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