Imported Dengue Infection in a Spanish Hospital with a High Proportion of Travelers from Africa: A 9-Year Retrospective Study

Carlos Toro Service of Microbiology and Parasitology, Carlos III Hospital, Madrid, Spain.

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Patricia Trevisi Investigación Hospital La Paz (IdiPAZ), La Paz University Hospital, Madrid, Spain.

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Beatriz López-Quintana Investigación Hospital La Paz (IdiPAZ), La Paz University Hospital, Madrid, Spain.

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Aránzazu Amor National Centre of Tropical Medicine, Carlos III Institute of Health, Madrid, Spain.

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Nuria Iglesias Investigación Hospital La Paz (IdiPAZ), La Paz University Hospital, Madrid, Spain.

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Mercedes Subirats Service of Microbiology and Parasitology, Carlos III Hospital, Madrid, Spain.

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Concepción Ladrón de Guevara Tropical Diseases Unit, Department of Internal Medicine, Carlos III Hospital, Madrid, Spain.

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Mar Lago Tropical Diseases Unit, Department of Internal Medicine, Carlos III Hospital, Madrid, Spain.

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Marta Arsuaga Tropical Diseases Unit, Department of Internal Medicine, Carlos III Hospital, Madrid, Spain.

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Fernando de la Calle-Prieto Tropical Diseases Unit, Department of Internal Medicine, Carlos III Hospital, Madrid, Spain.

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Dolores Herrero Service of Internal Medicine, Quironsalud University Hospital, Madrid, Spain.

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Margarita Rubio School of Biomedical Sciences, European University, Madrid, Spain.

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Sabino Puente Tropical Diseases Unit, Department of Internal Medicine, Carlos III Hospital, Madrid, Spain.

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Margarita Baquero Service of Microbiology and Parasitology, Carlos III Hospital, Madrid, Spain.

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Epidemiological data on dengue in Africa are still scarce. We investigated imported dengue infection among travelers with a high proportion of subjects from Africa over a 9-year period. From January 2005 to December 2013, blood samples from travelers with clinical suspicion of dengue were analyzed. Dengue was diagnosed using serological, antigen detection, and molecular methods. Subjects were classified according to birthplace (Europeans versus non-Europeans) and last country visited. Overall, 10,307 serum samples corresponding to 8,295 patients were studied; 62% were European travelers, most of them from Spain, and 35.9% were non-Europeans, the majority of whom were born in Africa (mainly Equatorial Guinea) and Latin America (mainly Bolivia, Ecuador, and Colombia). A total of 492 cases of dengue were identified, the highest number of cases corresponding to subjects who had traveled from Africa (N = 189), followed by Latin America (N = 174) and Asia (N = 113). The rate of cases for Africa (4.5%) was inferior to Asia (9%) and Latin America (6.1%). Three peaks of dengue were found (2007, 2010, and 2013) which correlated with African cases. A total of 2,157 of past dengue infections were diagnosed. Non-Europeans who had traveled from Africa had the highest rate of past infection (67.8%), compared with non-Europeans traveling from Latin America (38.7%) or Asia (35%). Dengue infection in certain regions of Africa is underreported and the burden of the disease may have a magnitude similar to endemic countries in Latin America. It is necessary to consider dengue in the differential diagnosis of other febrile diseases in Africa.

Author Notes

* Address correspondence to Carlos Toro, Service of Microbiology and Parasitology, Hospital La Paz-Carlos III, C/Sinesio Delgado 10, 28029 Madrid, Spain. E-mail: carlostororueda@hotmail.com

Authors' addresses: Carlos Toro, Mercedes Subirats, and Margarita Baquero, Service of Microbiology and Parasitology, Carlos III Hospital, Madrid, Spain, E-mails: carlostororueda@hotmail.com, mercedessubirats@gmail.com, and margaritabaqueromochales@yahoo.es. Patricia Trevisi, Beatriz López-Quintana, and Nuria Iglesias, Department of Microbiology, Investigación Hospital La Paz, Madrid, Spain, E-mails: crickettrevisi@hotmail.com, bealq@hotmail.com, and nurinu@telefonica.net. Aránzazu Amor, National Centre of Tropical Medicine, Carlos III Institute of Health, Madrid, Spain, E-mail: aranchazu@gmail.com. Concepción Ladrón de Guevara, Mar Lago, Marta Arsuaga, Fernando de la Calle-Prieto, and Sabino Puente, Tropical Medicine Unit, Infectious Diseases Department, Carlos III Hospital, Madrid, Spain, E-mails: mconcepcion.ladron@salud.madrid.org, mariamar.lago@salud.madrid.org, martaarsuaga@gmail.com, fercalleprieto@gmail.com, and sabinopuentepuente@gmail.com. Dolores Herrero, Service of Internal Medicine, Quironsalud University Hospital, Madrid, Spain, E-mail: mdolhermen@yahoo.es. Margarita Rubio, School of Biomedical Sciences, Universidad Europea de Madrid, Madrid, Spain, E-mail: margarita.rubio@universidadeuropea.es.

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