Notes from the Locations: First Proof of Native Acquisition ..

Melissa Kretchmer, M.Sc1; Jennifer Collins, MPH1; Ariella P. Dale, Ph.D1; Brenna Garrett1; Leah Kosky, MPH1; Karen Zabel, MSN1; R. Nicholas Staab, MD1; Kathy Turnbow1; Judah Nativio, MS1; Kelsey Andrews1; William E. Smith, MS1; John Townsend2; Nicole Basser2; James Will2; Kathryn Burr, DVM1,3,4; Forrest Okay. Jones, Ph.D4,5; Gilberto A. Santiago, Ph.D5; Kelly A. Fitzpatrick, MSPH5; Irene Ruberto, Ph.D3; Katherine Fitzpatrick, MPH3; Jessica R. White, DrPH1; Laura Adams, DVM5; Rebecca H. Sanenschein, MD1,6 (See creator affiliations)

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On November 7, 2022, dengue virus (DENV), which isn’t endemic to the continental United States (1), was recognized in a resident of Maricopa County, Arizona, utilizing reverse transcription-polymerase chain response (RT-PCR) testing on the Arizona State Public Well being Laboratory (ASPHL). A affected person (Affected person A) was admitted to the hospital on October 19 with a dengue-like sickness, 7 days after touring to Mexicali, Mexico, and staying there for lower than 4 hours. Affected person A was hospitalized for 3 days and subsequently recovered. The Maricopa County Environmental Providers Division (MCESD) carried out retrospective DENV testing in samples collected from 21 mosquito swimming pools situated inside 5 miles (8 km) of Affected person A’s residence between October 1 and November 3. A pattern taken from one mosquito pool (pool A) on October 5 was constructive for DENV. Complete-genome sequencing by the CDC Dengue Unit later revealed that intently associated DENV-3 strains not identified to be circulating within the affected person’s journey area had been recognized in each Affected person A and Pool A, suggesting native transmission of DENV.

Constructing on an present joint Maricopa County Division of Public Well being (MCDPH), MCESD, and Arizona Division of Public Well being, domestically procured mosquito-borne illness response plan, MCDPH and MCESD activated the incident command workplace on November 10. MCDPH initiated the next actions: 1 ) prioritized potential research of well being care supplier and laboratory experiences of DENV and suspected arbovirus visits requested from the BioSense platform of the Nationwide Syndrome Surveillance Program (BioSense)*; 2) retrospectively reviewed confirmed, possible, and suspected dengue circumstances investigated between July 1 and November 10 for proof of native DENV transmission; 3) warning medical professionals about potential native transmission; and 4) advisable that suppliers check and report suspected DENV to MCDPH. No proof of native an infection was present in 13 suspected arbovirus visits recognized within the Biosense database, 10 closed case evaluations, and 10 new case investigations. MCESD retrospectively examined samples collected between September 18 and November 19 from an extra 4,299 mosquito swimming pools situated all through the county, together with mosquito swimming pools inside 5 miles of Affected person A’s residence collected throughout the prolonged testing interval, for DENV utilizing RT- PCR; all had been destructive. This exercise has been reviewed by CDC and is carried out in accordance with relevant federal regulation and CDC coverage.

After discussions with the CDC Dengue Unit and Florida Public Well being (2,3) relating to present greatest practices for domestically acquired DENV infections, throughout November 17-19 MCDPH and MCESD carried out a survey of residential buildings inside a 0.09 mile (150 m) radius (4) residence of affected person A and pool A to survey residents, acquire human samples for DENV testing, and assess mosquito breeding properties. The groups approached 241 homes; Residents of 72 households (29.9%) agreed to conduct an environmental evaluation, 73 folks had been interviewed in 59 (24.5%) households. Amongst these 73 interviewees, 12 (16.4%) reported the onset of dengue-like signs inside 14 days of the interview and had been screened; all outcomes had been destructive for DENV by RT-PCR on ASPHL. Serum enzyme-linked immunosorbent assay for DENV immunoglobulin M was carried out by ASPHL on blood samples of 53 (72.6%) respondents; amongst them, one (1.9%) consequence was constructive. CDC’s Division of Arboviral Illnesses confirmed DENV-3 by plaque discount neutralization check. The one that examined constructive reported that he had not traveled for two weeks previous to the onset of signs. One of many man’s members of the family reported dengue-like signs however refused to be examined; each have since recovered. An environmental evaluation of this residence has been decided Aedes aegypti mosquitoes and breeding websites; of mosquitoes collected in a BG-Sentinel skilled mosquito lure§ examined destructive for DENV by RT-PCR. The outbreak (consisting of two autochthonous DENV infections) ended on January 4, 2023, after greater than 45 days with no further native infections, as indicated within the newest tips (4).

Coordinated surveillance and response recognized the primary domestically acquired DENV infections in Maricopa County, Arizona. Established partnerships and pre-existing plans had been important for a fast, coordinated response to non-endemic arbovirus transmissions. MCDPH and MCESD will broaden future surveillance actions to detect and forestall autochthonous transmission of DENV, together with further placement of mosquito traps round affected person residences and public training to forestall mosquito publicity. A countywide well being care supplier training marketing campaign is underway to extend supplier consciousness of native DENV transmission and to encourage testing of sufferers with suitable situations, no matter journey historical past.


Blanca Caballero, Maricopa County Division of Environmental Providers; Angela Moret, Nicholas Moite, Sonya Singh, Maricopa County Well being Division Communications and Advertising; Maricopa Medical Reserve Corps, Maricopa County Division of Public Well being Workplace of Preparedness and Response; Guillermo Adame, Richard Turner, Arizona Division of Well being; Arizona State Well being Laboratory; Dengue Division, CDC; Division of Arboviral Illnesses, CDC; Andrea Morrison, Danielle Stanek, Florida Division of Well being; Maricopa County Ballot Contributors.

Members of the district staff

Cindy Bitcon, Adam Costello, Kathy Dumay, Gurminder Singh Gill, Michael Hagan, Sierra Lamb, Jamie Lee, Georgina Marin, Jason Nelson, Patti O’Neill, Kayla Grace Sullivan-Land, Carly Taylor, June Wutrano, Darby Watters-Roybal, Kyle Willman, Maricopa County Division of Public Well being Preparedness and Response Discipline Workforce; Hector Abundis, Dan Armijo, Luis Avalos, Cara Cox, Eric Garcia, Bruce McKinsey, Junior Osorio Mullet, Jacob Rivera, Maricopa County Division of Environmental Safety Discipline Workforce; Luis Avalos, Trinity Johnson, Adele Malone, Junior Osorio Mullet, Adela Rille, Maricopa County Division of Environmental Providers Laboratory, Vector Management Division.

1Maricopa County Well being Division, Phoenix, AZ; 2Maricopa County Environmental Providers Service Management, Phoenix, Arizona; 3Arizona Division of Well being; 4CDC Epidemic Intelligence Service; 5Division of Communicable Illnesses, Nationwide Heart for Rising and Zoonotic Infectious Illnesses, CDC; 6Profession Epidemiology Officer Program, CDC.


  1. CENTER FOR DISEASE CONTROL. Dengue: Dengue in US States and Territories. Atlanta, GA: US Division of Well being and Human Providers, CDC; 2022. Accessed January 13, 2023.
  2. Radke EG, Gregory CJ, Kintziger KW, et al. An outbreak of dengue in Key West, Florida, USA, 2009. Emerg Infect Dis 2012; 18:135–7.
  3. Florida Division of Well being. Florida Public Well being: Dengue Outbreak in Martin County and Serologic Survey. Tallahassee, FL: Florida Division of Well being; 2014. Accessed January 24, 2023.
  4. CENTER FOR DISEASE CONTROL. CDC 2017 Interim Zika Response Plan: Could 2017. Atlanta, GA: US Division of Well being and Human Providers, CDC; 2017. Accessed January 24, 2023.

Instructed quotation for this text: Kretschmer, M., Collins, J., Dale, AP., et al. Notes from the sector: First proof of native dengue virus an infection—Maricopa County, Arizona, November 2022. MMWR Morb Mortal Wkly Rep 2023;72:290–291. DOI:

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