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Am J Trop Med Hyg. 2016 Nov 2;95(5):1130-1136. Epub 2016 Aug 29.

Dengue Virus Seroconversion in Travelers to Dengue-Endemic Areas.

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Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts.
Center for Global Health and Development, Boston University School of Public Health (BUSPH), Boston, Massachusetts.
Department of Global Health, Boston University School of Public Health (BUSPH), Boston, Massachusetts.
Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
Division of Pediatric Infectious Diseases, Miami Children's Hospital, Miami, Florida.
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia.
Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Department of Infectious Disease, Lahey Clinic Medical Center, Burlington, Massachusetts.
Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts.
Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts.


We conducted a prospective study to measure dengue virus (DENV) antibody seroconversion in travelers to dengue-endemic areas. Travelers seen in the Boston Area Travel Medicine Network planning to visit dengue-endemic countries for ≥ 2 weeks were enrolled from 2009 to 2010. Pre- and post-travel blood samples and questionnaires were collected. Post-travel sera were tested for anti-DENV IgG by indirect IgG enzyme-linked immunosorbent assay (ELISA) and anti-DENV IgM by capture IgM ELISA. Participants with positive post-travel anti-DENV IgG or IgM were tested for pre-travel anti-DENV IgG and IgM; they were excluded from the seroconversion calculation if either pre-travel anti-DENV IgG or IgM were positive. Paired sera and questionnaires were collected for 62% (589/955) of enrolled travelers. Most participants were 19-64 years of age, female, and white. The most common purposes of travel were tourism and visiting friends and relatives; most trips were to Asia or Africa. Median length of travel was 21 days. DENV antibody seroconversion by either anti-DENV IgM or IgG ELISA was 2.9-6.8%; lower range percent excluded potential false-positive anti-DENV IgG due to receipt of yellow fever or Japanese encephalitis vaccines at enrollment; upper range percent excluded proven false-positive anti-DENV IgM. Eighteen percent of those with seroconversion reported dengue-like symptoms. Seroconversion was documented for travel to Africa as well as countries and regions known to be highly dengue endemic (India, Brazil, southeast Asia). Given widespread risk of dengue, travel medicine counseling should include information on risk of dengue in endemic areas and advice on preventing insect bites and seeking prompt medical attention for febrile illness.

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