Notes from the sector: first proof of native acquisitions ..

On November 7, 2022, dengue 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) assay on the Arizona State Public Well being Laboratory (ASPHL). The affected person (Affected person A) was hospitalized on October 19 for dengue-like sickness, 7 days after touring to and staying in Mexicali, Mexico for lower than 4 hours. Affected person A was hospitalized for 3 days and subsequently recovered. The Maricopa County Environmental Companies Division (MCESD) performed retrospective testing for DENV on samples collected from 21 mosquito swimming pools positioned inside 5 miles (8 km) of Affected person A’s residence through the interval October 1-November 3. A pattern collected from a pool of mosquitoes (pool A) on 5 October was optimistic for DENV. Entire genome sequencing by the Dengue Department of the CDC later revealed that carefully associated DENV-3 strains not identified to be circulating within the affected person’s journey area have been recognized in each affected person A and pool A, suggesting DENV transmission native.

Primarily based on a pre-existing mosquito-borne illness response plan regionally acquired from the Maricopa County Division of Public Well being (MCDPH), MCESD, and the Arizona Division of Well being Companies, MCDPH and MCESD activated a command workplace of incidents on November tenth. MCDPH took the next actions: 1) Prioritized potential investigations of laboratory and healthcare supplier studies of DENV and suspected arboviral visitations questioned by the Nationwide Syndromic Surveillance Program (BioSense)* BioSense platform; 2) retrospectively examined confirmed, possible, and suspected dengue circumstances through the interval July 1-November 10 for proof of native transmission of DENV; 3) alerted healthcare staff to attainable native transmission; and 4) suggested distributors to check and report suspected DENV to MCDPH. No proof of native acquisition was recognized in 13 suspicious arbovirus visits recognized within the Biosense database, 10 closed case critiques, and 10 new case investigations. MCESD retrospectively examined samples collected between Sept. 18 and Nov. 19 from an extra 4,299 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 prolonged testing interval, for DENV by RT-PCR; all have been unfavorable. This exercise has been reviewed by the CDC and was performed in compliance with relevant federal legislation and CDC coverage.^†

After discussions with the CDC’s Dengue Department and Florida Public Well being (2,3) Concerning present finest practices for managing regionally acquired DENV infections, Nov. 17-19, MCDPH and MCESD surveyed residences inside a 0.09 mile (150 m) radius (4) of affected person residence A and pool A to interview residents, gather human samples for DENV testing, and consider mosquito breeding properties. The groups approached 241 households; residents of 72 households (29.9%) agreed to environmental assessments and 73 individuals in 59 households (24.5%) have been interviewed. Of those 73 respondents, 12 (16.4%) reported the onset of dengue-like signs inside 14 days of the interview and acquired testing; all outcomes have been unfavorable for DENV by RT-PCR at ASPHL. A serum enzyme immunoassay for DENV immunoglobulin M take a look at was carried out by ASPHL on blood samples from 53 (72.6%) respondents; amongst these, one consequence (1.9%) was optimistic. CDC Arboviral Ailments Department confirmed DENV-3 by Plaque Discount Neutralization Take a look at. The individual with the optimistic take a look at consequence reported no journey through the 2 weeks previous to the onset of signs. Certainly one of this individual’s members of the family reported dengue-like signs however refused to be examined; each have since recovered. Environmental evaluation of this recognized residence Aedes aegypti mosquitoes and breeding websites; mosquitoes collected in an expert BG-Sentinel mosquito lure^§ unfavorable consequence for DENV by RT-PCR. The outbreak (consisting of two autochthonous DENV infections) ended on January 4, 2023, after >45 days with no extra regionally acquired circumstances, as indicated by the newest steerage (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 fast and coordinated response to non-endemic arboviral transmission. MCDPH and MCESD will improve future surveillance actions to establish and stop indigenous transmission of DENV, together with inserting extra mosquito traps round affected person residences and public training on mosquito publicity prevention.^¶ A county-wide well being care employee training marketing campaign is being carried out to extend employee consciousness of native DENV transmission and encourage testing for sufferers with suitable sicknesses, no matter journey historical past.

Thanks

Blanca Caballero, Maricopa County Division of Environmental Companies; Angela Moreth, Nicholas Moyte, Sonia Singh, Maricopa County Division of Public Well being Workplace of Advertising and Communications; 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 department, CDC; Arboviral Ailments Department, CDC; Andrea Morrison, Danielle Stanek, Florida Division of Well being; Maricopa County Survey Individuals.

County crew members

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 Infectious and Zoonotic Ailments, CDC; ⁶Occupational Epidemiology Area Officer Program, CDC.

References

1. CENTER FOR DISEASE CONTROL AND PREVENTION. Dengue: Dengue 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 epidemic 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. Florida Well being: Martin County Dengue Outbreak and Serologic Survey. 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. CENTER FOR DISEASE CONTROL AND PREVENTION. 2017 Interim Response Plan Zika CDC: 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