MMWR Surveill Summ. 2023 May 19;72(4):1-12. doi: 10.15585/mmwr.ss7204a1.
PROBLEM/CONDITION: Dengue is one of the most common vectorborne flaviviral infections globally, with frequent outbreaks in tropical regions. In 2019 and 2020, the Pan American Health Organization reported approximately 5.5 million dengue cases from the Americas, the highest number on record. In the United States, local dengue virus (DENV) transmission has been reported from all U.S. territories, which are characterized by tropical climates that are highly suitable for Aedes species of mosquitoes, the vector that transmits dengue. Dengue is endemic in the U.S. territories of American Samoa, Puerto Rico, and the U.S. Virgin Islands (USVI). Dengue risk in Guam and the Commonwealth of the Northern Mariana Islands is considered sporadic or uncertain. Despite all U.S. territories reporting local dengue transmission, epidemiologic trends over time have not been well described.
2010-2020.
State and territorial health departments report dengue cases to CDC through ArboNET, the national arboviral surveillance system, which was developed in 2000 to monitor West Nile virus infections. Dengue became nationally notifiable in ArboNET in 2010. Dengue cases reported to ArboNET are categorized using the 2015 Council of State and Territorial Epidemiologists case definition. In addition, DENV serotyping is performed at CDC's Dengue Branch Laboratory in a subset of specimens to support identification of circulating DENV serotypes.
During 2010-2020, a total of 30,903 dengue cases were reported from four U.S. territories to ArboNET. Puerto Rico reported the highest number of dengue cases (29,862 [96.6%]), followed by American Samoa (660 [2.1%]), USVI (353 [1.1%]), and Guam (28 [0.1%]). However, annual incidence rates were highest in American Samoa with 10.2 cases per 1,000 population in 2017, followed by Puerto Rico with 2.9 in 2010 and USVI with 1.6 in 2013. Approximately one half (50.6%) of cases occurred among persons aged <20 years. The proportion of persons with dengue who were hospitalized was high in three of the four territories: 45.5% in American Samoa, 32.6% in Puerto Rico, and 32.1% in Guam. In Puerto Rico and USVI, approximately 2% of reported cases were categorized as severe dengue. Of all dengue-associated deaths, 68 (0.2%) were reported from Puerto Rico; no deaths were reported from the other territories. During 2010-2020, DENV-1 and DENV-4 were the predominant serotypes in Puerto Rico and USVI.
U.S. territories experienced a high prevalence of dengue during 2010-2020, with approximately 30,000 cases reported, and a high incidence during outbreak years. Children and adolescents aged <20 years were disproportionately affected, highlighting the need for interventions tailored for this population. Ongoing education about dengue clinical management for health care providers in U.S. territories is important because of the high hospitalization rates reported. Dengue case surveillance and serotyping can be used to guide future control and prevention measures in these areas.
The Advisory Committee on Immunization Practices recommends vaccination with Dengvaxia for children aged 9-16 years with evidence of previous dengue infection and living in areas where dengue is endemic. The recommendation for the dengue vaccine offers public health professionals and health care providers a new intervention for preventing illness and hospitalization in the age group with the highest burden of disease in the four territories (Paz Bailey G, Adams L, Wong JM, et al. Dengue Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021. MMWR Recomm Rep 2021;70[No. RR-6]). American Samoa, Puerto Rico, and USVI are all considered endemic areas and persons residing in these areas are eligible for the new dengue vaccine. Persons aged 9-16 years in those jurisdictions with laboratory evidence of previous dengue infection can receive the dengue vaccine and benefit from a reduced risk for symptomatic disease, hospitalization, or severe dengue. Health care providers in these areas should be familiar with the eligibility criteria and recommendations for vaccination to reduce the burden of dengue among the group at highest risk for symptomatic illness. Educating health care providers about identification and management of dengue cases can improve patient outcomes and improve surveillance and reporting of dengue cases.
问题/情况：登革热是全球最常见的虫媒病毒感染之一，在热带地区经常爆发。2019 年和 2020 年，泛美卫生组织报告美洲有大约 550 万例登革热病例，这是有记录以来的最高数字。在美国，所有美国领土都有本地登革热病毒（DENV）传播的报告，这些领土的特点是热带气候非常适合传播登革热的埃及伊蚊。登革热在美国领土美属萨摩亚、波多黎各和美属维尔京群岛（USVI）流行。关岛和北马里亚纳群岛联邦的登革热风险被认为是零星或不确定的。尽管所有美国领土都报告了本地登革热传播，但随着时间的推移，流行病学趋势并未得到很好的描述。
2010-2020 年。
州和地区卫生部门通过 ArboNET 向疾病预防控制中心报告登革热病例，ArboNET 是 2000 年为监测西尼罗河病毒感染而开发的国家虫媒病毒监测系统。2010 年，登革热在 ArboNET 中成为全国报告疾病。ArboNET 报告的登革热病例使用 2015 年州和地区流行病学家理事会病例定义进行分类。此外，疾病预防控制中心登革热分部实验室对一部分标本进行 DENV 血清分型，以支持对循环 DENV 血清型的鉴定。
2010-2020 年，四个美国领土向 ArboNET 报告了总共 30903 例登革热病例。波多黎各报告的登革热病例最多（29862 [96.6%]），其次是美属萨摩亚（660 [2.1%]）、美属维尔京群岛（353 [1.1%]）和关岛（28 [0.1%]）。然而，2017 年美属萨摩亚的年发病率最高，每 1000 人中有 10.2 例，其次是 2010 年的波多黎各，每 1000 人中有 2.9 例，2013 年的美属维尔京群岛，每 1000 人中有 1.6 例。约一半（50.6%）的病例发生在年龄<20 岁的人群中。四个领土中有三个领土的登革热住院患者比例较高：美属萨摩亚为 45.5%，波多黎各为 32.6%，关岛为 32.1%。在波多黎各和美属维尔京群岛，约有 2%的报告病例被归类为严重登革热。所有与登革热相关的死亡病例中，68 例（0.2%）来自波多黎各；其他领土没有报告死亡病例。2010-2020 年期间，DENV-1 和 DENV-4 是波多黎各和美属维尔京群岛的主要血清型。
2010-2020 年期间，美国领土登革热流行率较高，报告病例约 3 万例，疫情年份发病率较高。年龄<20 岁的儿童和青少年受到不成比例的影响，突出表明需要针对这一人群制定干预措施。由于报告的住院率较高，美国领土的卫生保健提供者对登革热临床管理的持续教育非常重要。登革热病例监测和血清分型可用于指导这些地区未来的控制和预防措施。
免疫实践咨询委员会建议对有既往登革热感染证据且居住在登革热流行地区的 9-16 岁儿童接种登革热疫苗。该疫苗建议为公共卫生专业人员和卫生保健提供者提供了一种新的干预措施，以预防四个领土（Paz Bailey G、Adams L、Wong JM 等人。登革热疫苗：美国免疫实践咨询委员会的建议，2021 年。MMWR Recomm Rep 2021;70[No. RR-6]）中年龄组（16 岁以下）疾病和住院的最高负担。美属萨摩亚、波多黎各和美属维尔京群岛都被认为是流行地区，居住在这些地区的人有资格接种新的登革热疫苗。有实验室证据证明以前感染过登革热的 9-16 岁的人可以接种登革热疫苗，从而降低患症状性疾病、住院或重症登革热的风险。这些地区的卫生保健提供者应熟悉资格标准和疫苗接种建议，以减轻高危人群患登革热的负担。教育卫生保健提供者识别和管理登革热病例可以改善患者结局，并改善登革热病例的监测和报告。
