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Dengue, a mosquito-borne viral disease, is endemic in the Caribbean; the Dominican Republic (DR) reported nearly 10,000 cases in 2007. In February 2008, 33 missionaries from Minnesota and Iowa spent about a week in the DR to aid in storm relief. At least 14 of them sought medical attention after returning to the U.S. and were determined to have dengue on the basis of symptoms (fever, headache, retro-orbital pain, myalgia, arthralgia, rash, hemorrhagic manifestations) plus either positive dengue IgM antibody results or a mosquito-exposure pattern similar to that of a person with positive test results.
Investigators interviewed 13 of these patients. (The other 20 missionaries could not be contacted, so the attack rate could not be calculated.)…