Clinician Survey to Determine Knowledge of Dengue and Clinical Management Practices, Texas, 2014

摘要

Dengue, a mosquito-borne viral disease, is increasingly being identified as a cause of outbreaks in the United States. During July-December 2013, a total of three south Texas counties reported 53 laboratory-confirmed dengue cases; 26 were locally acquired, constituting the largest outbreak in Texas since 2005. Because dengue outbreaks are expected to continue in south Texas and early case identification and timely treatment can reduce mortality, we sought to determine clinicians' knowledge of dengue and its clinical management. A survey was sent to 2,375 south Texas clinicians; 217 (9%) completed the survey. Approximately half of participants demonstrated knowledge needed to identify dengue cases, including symptoms (56%), early indicators of shock (54%), or timing of thrombocytopenia (48%). Fewer than 20% correctly identified all prevention messages, severe dengue warning signs, or circumstances in which a dengue patient should return for care. Knowledge of clinical management was limited; few participants correctly identified scenarios when plasma leakage occurred (10%) or a crystalloid solution was indicated (7%); however, 45% correctly identified when a blood transfusion was indicated. Because of the ongoing threat of dengue, we recommend clinicians in south Texas receive dengue clinical management training. Dengue is a mosquito-borne acute febrile illness that is caused by one of four dengue viruses (DENV-1, 2, 3, and 4). Dengue is endemic throughout the tropics and subtropics worldwide, including the Americas where the incidence of dengue has increased greater than 4-fold during the last three decades. During the same period, the region has experienced an increase in both frequency of dengue outbreaks and disease severity. In the United States, dengue is endemic in the territories of Puerto Rico and the U.S. Virgin Islands. The majority of dengue cases identified in the 50 states are travel associated, and dengue is the leading cause of febrile illness among U.S. travelers returning from southeast Asia, Latin America, and the Caribbean.