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) carried out 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. Complete 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 had been recognized in each affected person A and pool A, suggesting DENV transmission native.

Based mostly 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 experiences 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 doable 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 opinions, 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 had been adverse. This exercise has been reviewed by the CDC and was carried out in compliance with relevant federal regulation and CDC coverage.^†

After discussions with the CDC’s Dengue Department and Florida Public Well being (2,3) Relating to present greatest 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, acquire 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 folks in 59 households (24.5%) had 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 had been adverse 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 end result (1.9%) was optimistic. CDC Arboviral Illnesses Department confirmed DENV-3 by Plaque Discount Neutralization Check. The particular person with the optimistic take a look at end result reported no journey through the 2 weeks previous to the onset of signs. One in every of this particular person’s relations 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 knowledgeable BG-Sentinel mosquito lure^§ adverse end result 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 latest 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 had 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 forestall indigenous transmission of DENV, together with inserting extra mosquito traps round affected person residences and public schooling on mosquito publicity prevention.^¶ A county-wide well being care employee schooling marketing campaign is being carried out to extend employee consciousness of native DENV transmission and encourage testing for sufferers with appropriate 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 marketing 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 Illnesses 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, Workplace of Preparedness and Response Area Staff; Hector Abundis, Dan Armijo, Luis Avalos, Kara Cox, Eric Garcia, Bruce McKinzey, Yunior Osorio Mulet, Jacob Rivera, Maricopa County Environmental Companies Division Vector Management Division Area Staff; Luis Avalos, Trinity Johnson, Adele Malone, Yunior Osorio Mulet, Adela Riehle, Maricopa County Environmental Companies Division 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 Illnesses, Nationwide Heart for Rising Infectious and Zoonotic Illnesses, 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