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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 Providers Division (MCESD) performed 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. Entire 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.

Primarily based 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 Providers, 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 instances 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 evaluations, and 10 new case investigations. MCESD retrospectively examined samples collected between September 18 and November 19 from a further 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 unfavorable. This exercise has been reviewed by the CDC and was performed in compliance with relevant federal regulation and CDC coverage.^†

After discussions with the CDC’s Dengue Department and Florida Public Well being (2,3) Concerning present finest 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, accumulate 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 individuals 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 unfavorable for DENV by RT-PCR at ASPHL. A serum enzyme immunoassay for DENV immunoglobulin M check was carried out by ASPHL on blood samples from 53 (72.6%) respondents; amongst these, one consequence (1.9%) was optimistic. CDC Arboviral Illnesses Department confirmed DENV-3 by Plaque Discount Neutralization Check. The particular person with the optimistic check consequence reported no journey through the 2 weeks previous to the onset of signs. Considered one of this particular person’s members of the family 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 entice^§ unfavorable consequence for DENV by RT-PCR. The outbreak (consisting of two autochthonous DENV infections) ended on January 4, 2023, after >45 days with no further regionally acquired instances, 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 stop indigenous transmission of DENV, together with putting further mosquito traps round affected person residences and public training on mosquito publicity prevention.^¶ A county-wide well being care employee training marketing campaign is being carried out to extend employee consciousness of native DENV transmission and encourage testing for sufferers with suitable diseases, no matter journey historical past.

Thanks

Blanca Caballero, Maricopa County Division of Environmental Providers; Angela Moreth, Nicholas Moyte, Sonia Singh, Maricopa County Division of Public Well being Workplace of Advertising 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 Providers; 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 Contributors.

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 Workforce; Hector Abundis, Dan Armijo, Luis Avalos, Kara Cox, Eric Garcia, Bruce McKinzey, Yunior Osorio Mulet, Jacob Rivera, Maricopa County Environmental Providers Division Vector Management Division Area Workforce; Luis Avalos, Trinity Johnson, Adele Malone, Yunior Osorio Mulet, Adela Riehle, Maricopa County Environmental Providers Division Vector Management Division Laboratory.

¹Maricopa County Division of Public Well being, Phoenix, Arizona; ²Maricopa County Environmental Providers Vector Management, Phoenix, Arizona; ³Arizona Division of Well being Providers; 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 Providers, 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 Providers, CDC; 2017. Accessed January 24, 2023. https://stacks.cdc.gov/view/cdc/45532