Posted April 12, 2024. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.
Washington healthcare providers are advised to remain alert for patients with symptoms of dengue, and to test for dengue when symptomatic patients report recent travel to high-risk areas due to a global increase in cases of dengue.
Currently, many countries are experiencing dengue outbreaks. 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.
Current Situation in Washington
Washington DOH has also seen an increase in reported cases of dengue in persons arriving from affected areas. 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).
Actions Requested
- Healthcare providers should 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 NSAIDs until dengue is ruled out.
- If the patient 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. Report positive results to the local health jurisdiction of the patient.
- If the patient is presenting 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. Report positive results to the local health jurisdiction of the patient.
- If the patient with suspected dengue is hospitalized with encephalopathy or aseptic meningitis, also order PCR on cerebral spinal fluid. Report positive results to the local health jurisdiction of the patient.
- Dengue testing is not recommended for asymptomatic patients.
- 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: Plan for Travel
Resources for Providers
- CDC Travel Notices (Dengue):
To report suspected cases, or for any other questions, please contact Spokane Regional Health District at CDEpi@srhd.org, 509.324.1442 with questions, or 509-324-1449 for reporting. Reports could also be faxed to 509.324.3623.
