Dengue Fever Among U.S. Travelers Returning from the Dominican Republic — Minnesota and Iowa, 2008

In February 2008, a group of U.S. residents became ill with symptoms and clinical findings suggestive of dengue fever after returning from the Dominican Republic, where they had traveled to work as missionaries. Dengue is endemic in the Dominican Republic and most tropical and subtropical areas of the world, including the Caribbean, and represents a known health risk for U.S. residents traveling to or working in those areas. Subsequent investigation by the Minnesota Department of Health (MDH), the Iowa Department of Public Health (IDPH), and CDC determined that at least 14 (42%) of 33 missionaries traveling to the Dominican Republic met the case definition for dengue fever, and 12 had cases that were confirmed serologically. Of the 13 patients interviewed, all had weakness and fever, with 12 reporting chills and body or joint pain. Ten patients had noticed mosquitoes inside or outside their house in the Dominican Republic, but only three had used repellent. Before departing on their trip, none of the 13 ill travelers interviewed had been aware of dengue in the Dominican Republic, and only two had sought pre-travel medical advice. The Dominican Republic is a frequent destination for U.S. travelers providing missionary and humanitarian services and also for vacationers. These cases indicate a need to increase awareness of dengue prevention measures among U.S. travelers to areas where they might be at risk for dengue.