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Letter
Nosocomial Dengue by Mucocutaneous
Transmission
Lin H. Chen*†
and Mary E. Wilson*†
*Mount Auburn Hospital, Cambridge, Massachusetts, USA; and †Harvard Medical
School, Boston, Massachusetts, USA
Suggested
citation for this article
To the Editor: Wagner and colleagues report nosocomial dengue
transmitted by needlestick and note that it is the fourth case of nosocomial
dengue to their knowledge (1). In the same issue of Emerging
Infectious Diseases, Nemes and colleagues report a separate case of nosocomial
dengue also transmitted by needlestick (2). Three other
cases of nosocomial dengue transmission by needlestick have previously
been published (3–5).
We have recently published a case of nosocomial dengue infection that
was transmitted by mucocutaneous exposure to blood from a febrile traveler
who had recently returned from Peru (6). During phlebotomy,
a healthcare worker was splashed in the face with the traveler's blood.
Both the traveler and the healthcare worker were subsequently found to
have dengue fever with dengue virus type 3. This route of infection is
biologically plausible because infection through mucosal surfaces (intranasal
and oral routes) has been shown possible for arboviruses (7).
In our review of the literature, we also found a report of dengue virus
transmission by bone marrow transplantation (8). Other cases of transmission
of dengue virus without a mosquito vector have occurred in 5 reported
instances of infection in newborns as a result of intrapartum or vertical
transmission from mother to child (9–12).
We agree that nosocomial transmission may become more common in temperate
areas as more travelers return home with acute dengue fever. As Wagner
and colleagues pointed out, travelers visiting Southeast Asia have the
greatest risk of acquiring dengue infections because of the high endemicity
of these viruses there. Our report further illustrates the occurrence
of dengue infection in the Americas (13) and the risk
for dengue to travelers visiting this region. Among 33 returned travelers
with dengue infection reported in the United States in 1999 and 2000,
20 had acquired infection in the Caribbean islands (12 cases) or Central
or South America (8 cases) (14). Clinicians and laboratorians
should be alert to the possibility of acquiring infection with a dengue
virus after needlestick or mucocutaneous blood exposure. The magnitude
of nosocomial transmission in dengue-endemic areas is unknown and more
difficult to assess because healthcare workers may be exposed to dengue
virus–infected mosquitoes outside the clinical setting.
References
- Wagner D, de With K, Huzly D, Hufert F, Weidmann M,
Breisinger S, et al. Nosocomial
acquisition of dengue. Emerg Infect Dis. 2004;10:1872–3.
- Nemes Z, Kiss G, Madarassi EP, Peterfi Z, Ferenczi E, Bakonyi T,
et al. Nosocomial
transmission of dengue [letter]. Emerg Infect Dis. 2004;10:1880–1.
- de Wazieres B, Gil H, Vuitton DA, Dupond JL. Nosocomial
transmission of dengue from a needlestick injury. Lancet. 1998;351:498.
- Hirsch JF, Deschamps C, Lhuillier M. Transmission
métropolitaine d'une dengue par inoculation accidentelle hospitalière.
Ann Med Interne (Paris). 1990;141:629.
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virus infection transmitted by needle stick injury. J Infect. 2002;44:269–70.
- Chen LH, Wilson ME. Transmission
of dengue virus without a mosquito vector: nosocomial mucocutaneous
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- Kuno G. Transmission
of arboviruses without involvement of arthropod vectors. Acta Virol.
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- Rigau-Perez JG, Vorndam AV, Clark GG. The
dengue and dengue hemorrhagic fever epidemic in Puerto Rico, 1994–1995.
Am J Trop Med Hyg. 2001;64:67–74.
- Chye JK, Lim CT, Ng KB, Lim JMH, George R, Lam SK. Vertical
transmission of dengue. Clin Infect Dis. 1997;25:1374–7.
- Kerdpanich A, Watanaveeradej V, Samakoses R, Chumnanvanakij S, Chulyamitporn
T, Sumeksri P, et al. Perinatal
dengue infection. Southeast Asian J Trop Med Public Health. 2001;32:488–93.
- Boussemart T, Babe P, Sibille G, Neyret C, Berchel
C. Prenatal
transmission of dengue: two new cases. J Perinatol. 2001;21:255–7.
- Thaithumyanon P, Thisyakorn U, Deerojnawong J, Innis BL. Dengue
infection complicated by severe hemorrhage and vertical transmission
in a parturient woman. Clin Infect Dis. 1994;18:248–9.
- Wilson ME, Chen LH. Dengue in the Americas. Dengue Bulletin. 2002;26:44–61.
- Clark GG, Rigau-Perez JG, Vorndam V, Hayes JM. Imported
dengue—United States, 1999 and 2000. MMWR Morb Mortal Wkly Rep.
2002;51:281–3.
Suggested citation
for this article:
Chen LH, Wilson ME.
Nosocomial dengue by mucocutaneous transmission [letter]. Emerg Infect
Dis [serial on the Internet]. 2005 May [date cited]. Available
from http://www.cdc.gov/ncidod/EID/vol11no05/04-0934.htm
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