Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 11, Number 5—May 2005
Dengue and Dengue Hemorrhagic Fever
Dengue and Dengue Hemorrhagic Fever

Nosocomial Dengue by Mucocutaneous Transmission

On This Page
Article Metrics
citations of this article
EID Journal Metrics on Scopus

Cite 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 (35).

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 (912).

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.


Lin H. Chen*†Comments to Author  and Mary E. Wilson*†
Author affiliations: *Mount Auburn Hospital, Cambridge, Massachusetts, USA; †Harvard Medical School, Boston, Massachusetts, USA



  1. Wagner  D, de With  K, Huzly  D, Hufert  F, Weidmann  M, Breisinger  S, Nosocomial acquisition of dengue. Emerg Infect Dis. 2004;10:18723.PubMedGoogle Scholar
  2. Nemes  Z, Kiss  G, Madarassi  EP, Peterfi  Z, Ferenczi  E, Bakonyi  T, Nosocomial transmission of dengue [letter]. Emerg Infect Dis. 2004;10:18801.PubMedGoogle Scholar
  3. de Wazieres  B, Gil  H, Vuitton  DA, Dupond  JL. Nosocomial transmission of dengue from a needlestick injury. Lancet. 1998;351:498. DOIPubMedGoogle Scholar
  4. Hirsch  JF, Deschamps  C, Lhuillier  M. Transmission métropolitaine d'une dengue par inoculation accidentelle hospitalière. Ann Med Interne (Paris). 1990;141:629.PubMedGoogle Scholar
  5. Langgartner  J, Audebert  F, Schölmerich  J, Glück  T. Dengue virus infection transmitted by needle stick injury. J Infect. 2002;44:26970. DOIPubMedGoogle Scholar
  6. Chen  LH, Wilson  ME. Transmission of dengue virus without a mosquito vector: nosocomial mucocutaneous transmission and other routes of transmission. Clin Infect Dis. 2004;39:e5660. DOIPubMedGoogle Scholar
  7. Kuno  G. Transmission of arboviruses without involvement of arthropod vectors. Acta Virol. 2001;45:13950.PubMedGoogle Scholar
  8. 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;64:6774.PubMedGoogle Scholar
  9. Chye  JK, Lim  CT, Ng  KB, Lim  JMH, George  R, Lam  SK. Vertical transmission of dengue. Clin Infect Dis. 1997;25:13747. DOIPubMedGoogle Scholar
  10. Kerdpanich  A, Watanaveeradej  V, Samakoses  R, Chumnanvanakij  S, Chulyamitporn  T, Sumeksri  P, Perinatal dengue infection. Southeast Asian J Trop Med Public Health. 2001;32:48893.PubMedGoogle Scholar
  11. Boussemart  T, Babe  P, Sibille  G, Neyret  C, Berchel  C. Prenatal transmission of dengue: two new cases. J Perinatol. 2001;21:2557. DOIPubMedGoogle Scholar
  12. 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;18:2489. DOIPubMedGoogle Scholar
  13. Wilson  ME, Chen  LH. Dengue in the Americas. Dengue Bull. 2002;26:4461.
  14. Clark  GG, Rigau-Perez  JG, Vorndam  V, Hayes  JM. Imported dengue—United States, 1999 and 2000. MMWR Morb Mortal Wkly Rep. 2002;51:2813.PubMedGoogle Scholar


Cite This Article

DOI: 10.3201/eid1105.040934

Related Links


Table of Contents – Volume 11, Number 5—May 2005

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.



Please use the form below to submit correspondence to the authors or contact them at the following address:

Lin H. Chen, Travel Medicine Center, Division of Infectious Diseases, Mount Auburn Hospital, 330 Mount Auburn St, Cambridge, MA 02138, USA; fax: 617-499-5453

Send To

10000 character(s) remaining.


Page created: April 24, 2012
Page updated: April 24, 2012
Page reviewed: April 24, 2012
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.