Lessons Learned during Dengue Outbreaks in the United States, 2001–2011

Amesh A. Adalja

, Tara Kirk Sell, Nidhi Bouri, and Crystal Franco

Author affiliations: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

Abstract

Since 2001, three autochthonous dengue fever outbreaks have occurred in the United States: in Hawaii (2001); Brownsville, Texas (2005); and southern Florida (2009–2011). We sought to characterize and describe the response to these outbreaks from the perspectives of public health and vector control officials. By conducting a medical literature review through PubMed and news media searches through Google, we identified persons involved in managing each outbreak; 26 persons then participated in qualitative, semistructured interviews. After analyzing the 3 outbreaks, we found the following prominent themes in the response efforts: timely detection of illness; communication of up-to-date, correct information; and development of a rapid response that engages the community. We therefore recommend that public health authorities involve the clinical and laboratory community promptly, provide accurate information, and engage the local community in vector control and case identification and reporting.

Dengue is a mosquito-borne viral disease, endemic to tropical regions. In the United States, most dengue infections have been limited to travelers returning from dengue-endemic regions; the last outbreak in the continental United States occurred in 1945 (1). However, epidemic dengue remains a threat to US areas that have competent mosquito vector populations and host large numbers of travelers from dengue-endemic regions, as evidenced by the return of dengue to Florida (1).
Practical experience with dengue in the United States is decades old, and mitigation measures used decades ago may not be fully applicable today. As the threat of dengue grows, the risks for an outbreak and the responses needed must be understood.
In this article, we describe the responses to 3 recent US dengue outbreaks (in Hawaii, 2001; Brownsville, Texas, 2005; and southern Florida, 2009–2011) from the perspectives of public health and vector control officials at local, state, and federal levels. We conducted a retrospective analysis to assess mitigation strategies used during each outbreak and identify policy implications for public health departments, vector control agencies, and clinicians in areas vulnerable to dengue and other mosquito-borne diseases. The goal of this study was to help improve community responses to future dengue outbreaks. The analysis concludes with recommendations for practitioners and policy makers.