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- Title
Dengue Surveillance in Veterans Affairs Healthcare Facilities, 2007–2010.
- Authors
Schirmer, Patricia L.; Lucero-Obusan, Cynthia A.; Benoit, Stephen R.; Santiago, Luis M.; Stanek, Danielle; Dey, Achintya; Martinez, Mirsonia; Oda, Gina; Holodniy, Mark
- Abstract
Background: Although dengue is endemic in Puerto Rico (PR), 2007 and 2010 were recognized as epidemic years. In the continental United States (US), outside of the Texas-Mexico border, there had not been a dengue outbreak since 1946 until dengue re-emerged in Key West, Florida (FL), in 2009–2010. The objective of this study was to use electronic and manual surveillance systems to identify dengue cases in Veterans Affairs (VA) healthcare facilities and then to clinically compare dengue cases in Veterans presenting for care in PR and in FL. Methodology: Outpatient encounters from 1/2007–12/2010 and inpatient admissions (only available from 10/2009–12/2010) with dengue diagnostic codes at all VA facilities were identified using VA's Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE). Additional case sources included VA data from Centers for Disease Control and Prevention BioSense and VA infection preventionists. Case reviews were performed. Categorical data was compared using Mantel-Haenszel or Fisher Exact tests and continuous variables using t-tests. Dengue case residence was mapped. Findings: Two hundred eighty-eight and 21 PR and FL dengue cases respectively were identified. Of 21 FL cases, 12 were exposed in Key West and 9 were imported. During epidemic years, FL cases had significantly increased dengue testing and intensive care admissions, but lower hospitalization rates and headache or eye pain symptoms compared to PR cases. There were no significant differences in clinical symptoms, laboratory abnormalities or outcomes between epidemic and non-epidemic year cases in FL and PR. Confirmed/probable cases were significantly more likely to be hospitalized and have thrombocytopenia or leukopenia compared to suspected cases. Conclusions: Dengue re-introduction in the continental US warrants increased dengue surveillance and education in VA. Throughout VA, under-testing of suspected cases highlights the need to emphasize use of diagnostic testing to better understand the magnitude of dengue among Veterans. Author Summary: Dengue is an important tropical disease seen throughout the world in tropical climate zones and is spread by Aedes mosquitoes. Most cases of dengue in the continental US are imported. In July 2009 through 2010, dengue virus was found to be circulating in Key West, Florida (FL). Dengue virus has been transmitted in Puerto Rico (PR) for many years. This study used electronic and manual surveillance systems to identify dengue cases in VA healthcare facilities and clinically compared dengue cases in Veterans presenting for care in PR as well as in FL. We found that FL dengue cases were similar to those in PR and that Centers for Disease Control and Prevention defined confirmed/probable cases were more likely to be hospitalized within our VA system, and have either lower platelet or white blood cell counts than suspected cases. During July 2009–2010, FL cases were more likely to be tested for dengue and have intensive care admissions, but had lower hospitalization rates and headache or eye pain symptoms compared to PR cases. No one method of capturing dengue cases was perfect. It is important to educate healthcare workers about this disease to help with direct patient care as well as surveillance.
- Subjects
PUERTO Rico; KEY West (Fla.); FLORIDA; DENGUE hemorrhagic fever; HEALTH facilities; CENTERS for Disease Control &; Prevention (U.S.); DENGUE; LEUKOCYTE count; MEDICAL personnel; CLIMATIC zones
- Publication
PLoS Neglected Tropical Diseases, 2013, Vol 7, Issue 3, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0002040