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Growing number of children at risk for dengue fever linked to travel to endemic countries

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PHILADELPHIA — Proper education about dengue fever is needed for parents and children of immigrant families who are from dengue-endemic countries. Thorough pre-travel advice may help prevent infection if the family plans to return to their native country, according to a presentation here during the American Society of Tropical Medicine and Hygiene 60th Annual Meeting.

Nivedita Krishnan, MD,of Bronx-Lebanon Hospital, Bronx, N.Y., said the increasing global migration is contributing to a growing proportion of children traveling to tropical and subtropical regions because they are at risk for exposure to dengue virus infection.

“Therefore, children of immigrant families originally from dengue-endemic countries may benefit from competent pre-travel advice and may represent candidates for a future dengue vaccine,” Krishnan said during her presentation.

She and colleagues attempted to analyze the travel, clinical and laboratory characteristics of children who were diagnosed with dengue fever after return from international travel because only limited data were available for children.

Data were abstracted from charts of pediatric patients who received a diagnosis of dengue fever at the Bronx-Lebanon Hospital from May 2007 to December 2010. A commercial dengue virus immunoglobulin M capture enzyme-linked immunosorbent assay (ELISA) and a dengue virus IgG indirect ELISA were used for diagnostic testing.

The investigators used WHO criteria to diagnose dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Eight children with acute dengue virus infection, including three children with severe dengue infection (DHF, n=2; DSS, n=1), were identified. All patients had traveled to the Dominican Republic (88%) or Puerto Rico (12%) for a median duration of 32 days (range of 10 days to 4.3 years) and presented to the hospital with illness after a median of 6 days (1 to 11 days) since return from travel.

Of these children, 63% were females and 75% were born in the United States; the median age of patients was 13.6 years, with a range of 3 months to 17 years.

According to the findings, all patients presented with an acute febrile illness accompanied by gastrointestinal complaints (63%), myalgia (50%), petechial rash (38%), dehydration (25%) and headache (13%). Relevant laboratory findings included leukopenia (63%), thrombocytopenia (75%), elevated serum alanine aminotransferase (38%), low serum albumin (38%) and elevated hematocrit (25%). Sonography also revealed ascites (50%), pleural effusion (38%), gallbladder thickening (38%) and heterogeneous liver parenchyma (25%).

For more information:

• Krishnan N. #294. Presented at: the American Society of Tropical Medicine and Hygiene 60th Annual Meeting; Dec. 4-8, 2011; Philadelphia

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