Dengue fever in US military personnel in Haiti
A. F. Trofa, R. F. DeFraites, B. L. Smoak, N. Kanesa-thasan, A. D. King, J. M. Burrous, P. O. MacArthy, C. Rossi and C. H. Hoke Jr
Division of Preventive Medicine, Walter Reed Army Institute of Research, Washington, DC, USA.
OBJECTIVE: To describe clinical manifestations and public health
implications of an outbreak of dengue fever (DF) during Operation Uphold
Democracy, Haiti, 1994. DESIGN: Consecutive sample. SETTING: Military
combat support hospital, Port-au-Prince, Haiti. PATIENTS: A total of 101 US
military personnel with acute febrile illnesses. INTERVENTIONS: A disease
surveillance team collected clinical and epidemiologic data from US
military clinics throughout Haiti. Febrile patients admitted to the combat
support hospital were evaluated with standardized clinical and laboratory
procedures. The surveillance team followed patients daily. MAIN OUTCOME
MEASURES: Arbovirus isolation and specific antibody determination and
symptoms and physical findings. RESULTS: Febrile illnesses accounted for
103 (25%) of the 406 combat support hospital admissions during the first 6
weeks of deployment. All patients with febrile illness recovered. A total
of 30 patients had DF; no patient had evidence of infection with malaria.
Dengue virus serotypes 1, 2, and 4 were isolated from 22 patients, and 8
patients developed IgM antibody to dengue virus. Patients with DF could not
be distinguished from other febrile patients on clinical grounds alone. No
arboviruses other than dengue were identified. CONCLUSIONS: Active
surveillance, with clinical and laboratory evaluation directed by an
epidemiologic team, led to the timely recognition of an outbreak of febrile
illness among US troops in Haiti. Viral isolation and serological studies
were essential in confirming DF. During the surveillance period, DF
accounted for at least 30% of the febrile illnesses among hospitalized US
troops. Dengue fever is a significant threat to military personnel and
civilian travelers in Haiti and has the potential for introduction to and
transmission in the United States.
