The first locally transmitted case of dengue fever reported in New York has been confirmed in Suffolk County, providing evidence that mosquitoes can spread the tropical affliction just about anywhere.
"We were all surprised," said Dr. Scott Campbell, chief of the arthropod disease laboratory in the Suffolk County Health Department. Arthropods include a vast kingdom of life-forms and mosquitoes are key constituents.
"This goes to show you why public health officials need to be vigilant when it comes to arthropod-acquired diseases and to be prepared for the unexpected," Campbell said.
The patient is described by Suffolk health Commissioner Dr. James Tomarken as a male older than 50, and a resident of Babylon, who was hospitalized in September with symptoms consistent with dengue. He has since fully recovered.
Dengue is caused by a virus carried by mosquitoes with a taste for blood. An infection can trigger mild, flulike symptoms or, more rarely, severe, life-threatening complications.
"The whole cycle of dengue is from person to mosquito and from mosquito to person," Campbell said Wednesday, adding that there is no reservoir host, such as birds, as with West Nile virus.
Health officials theorize that the infected man likely acquired the virus from a mosquito that had bitten a person who had probably recently returned from a dengue endemic region. State and local health officials say despite this theory, they do not expect dengue to become widespread on Long Island.
Campbell defined the likely mosquito carrier as either the Aedes aegypti mosquito or Aedes albopictus, known colloquially as the Asian tiger.
Dengue infections have swept forcefully around the globe since 2012. A record-breaking number of infections have been reported by the World Health Organization, which estimates a staggering 100 million people could be affected this year. In recent years, dengue has been found with increasing frequency in Texas, Florida and Hawaii.
Dengue is generally found between 35 and 40 degrees above the equator and about 35 to 40 degrees below the equator, said Dr. Aaron Glatt, chief administrative officer and executive vice president of Mercy Medical Center in Rockville Centre.
Glatt, an expert in infectious diseases, said while dengue may produce no symptoms, it is capable of morphing into dangerous, life-threatening manifestations in a small percentage of people.
Serious forms of infection are known as breakbone fever because of the extreme pain; dengue hemorrhagic fever, which results in excessive bleeding; and dengue shock syndrome, which is typified by dangerously low blood pressure, Glatt said.
Public health experts say a vaccine is needed because there's no way to prevent infection.
"For me, the New York case illustrates how astute the clinicians there are," said Kay Tomashek, with the federal Centers for Disease Control and Prevention's Dengue Branch in San Juan, Puerto Rico.
"Physicians were really thinking about the possibility of dengue and putting it on a differential diagnosis because it can look like any other infection showing symptoms of fever.
"We have had an incredible outbreak here, which started in 2012 and is now at its tail end. We have had 23,000 cases," she said.
Dr. Erich Mackow, a professor of molecular genetics at Stony Brook University, is working on ways to better understand dengue, particularly how it affects endothelial cells, which line the capillaries. Plumbing the infection for more intimate details, he said, will help point the way to better forms of intervention.
Dengue fever case
Dengue is a serious tropical viral infection transmitted by mosquitoes. The global incidence, according to the World Health Organization, has grown dramatically in recent years.
Despite the confirmation of a locally transmitted case, experts do not expect dengue to become widespread on Long Island.
However, travelers to endemic regions sometimes return to Nassau and Suffolk with the infection.
Travelers' cases year-to-date
Additional dengue facts
Dengue can be mild or occasionally severe.
Severe dengue is a leading cause of serious illness and death among children in some Asian and Latin American countries.
There is no specific treatment for dengue/severe dengue, but early detection and access to proper medical care lowers fatality rates below one percent.
Dengue prevention and control depends on effective mosquito control measures.
Sources: Nassau and Suffolk health departments, World Health Organization