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Dengue and US Military Operations from Spanish–American War through Today - Vol. 18 No. 4 - April 2012 - Emerging Infectious Disease journal - CDC

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Dengue and US Military Operations from Spanish–American War through Today - Vol. 18 No. 4 - April 2012 - Emerging Infectious Disease journal - CDC

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Volume 18, Number 4–April 2012

Volume 18, Number 4—April 2012

Historical Review

Dengue and US Military Operations from Spanish–American War through Today

Robert V. GibbonsComments to Author , Matthew Streitz, Tatyana Babina, and Jessica R. Fried
Author affiliations: Armed Forces Research Institute of Medical Science, Bangkok, Thailand (R.V. Gibbons); Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA (M. Streitz, T. Babina); Mahidol-Oxford Tropical Medicine Research Unit, Bangkok (J.R. Fried)
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Dengue is a major cause of illness among travelers and a threat to military troops operating in areas to which it is endemic. Before and during World War II, dengue frequently occurred in US military personnel in Asia and the South Pacific. From the 1960s into the 1990s, dengue often occurred in US troops in Vietnam, the Philippines, Somalia, and Haiti. We found attack rates as high as 80% and periods of convalescence up to 3-1/2 weeks beyond the acute illness. The increase in dengue throughout the world suggests that it will remain a problem for military personnel until an effective vaccine is licensed.
Dengue has proven itself a challenge to US military personnel. Even though case-fatality rates are low, dengue can rapidly incapacitate personnel. Dengue caused major illness among US service members stationed in the Philippines beginning after the Spanish–American War, and although not reported in the Iraq and Afghanistan conflicts, it has occurred during many others since that time.
To assess the effect of dengue on US military personnel stationed in dengue-endemic areas, we performed a literature search using “dengue” and “military” (109 titles), “army” (126), “navy” (22), “air force” (7), and “war” (29) and selected articles relevant to the US military. We searched personal files and reviewed military histories and books. References in these publications were reviewed for additional pertinent articles.
Before the Vietnam War, a diagnosis of dengue was usually based on clinical findings, sometimes supplemented by a complete blood count. The clinical diagnosis of dengue, especially in epidemiologically permissive settings of immunologically naive personnel assigned to tropical countries, is relatively accurate. Carefully described outbreaks of dengue in immunologically naive adults are almost pathognomonic. In 2 studies in the Philippines during 1924–1925 (1) and 1929–1930 (2), patients who had not traveled in dengue-endemic areas before or after the study were experimentally infected with the dengue virus, and clinical dengue developed . More than 40 years later, serologic testing confirmed that the patients in the first study had been infected with dengue virus serotype 1 and those in the second study with serotype 4 (3,4). In addition, a study from the Vietnam era serologically confirmed 77%–80% of clinically diagnosed dengue (5). Characteristics that identify a febrile outbreak as dengue include predominant leukopenia, maculopapular rash, retro-orbital headache, and a relatively long period of incapacitation after defervescence.
The references documented that since the Vietnam War, dengue has been diagnosed by hemagglutinin inhibition, plaque neutralization, complement fixation, and/or virus isolation. In most cases, assays (not sampling) were done after the illness to determine its etiology.

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