• Ralph Huits, Kristina M Angelo, Bhawana Amatya, Sapha Barkati, Elizabeth D Barnett, Emmanuel Bottieau, Hannah Emetulu, Loïc Epelboin, Gilles Eperon, Line Medebb, Federico Gobbi, Martin P Grobusch, Oula Itani, Sabine Jordan, Paul Kelly, Karin Leder, Marta Díaz-Menéndez, Nobumasa Okumura, Aisha Rizwan, Camilla Rothe, Mauro Saio, Jesse Waggoner, Yukihiro Yoshimura, Michael Libman, Davidson H Hamer, and Eli Schwartz.
• Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy (R.H.).
• Ann. Intern. Med. 2023 Jul 1; 176 (7): 940948940-948.

BackgroundDengue virus is a flavivirus transmitted by Aedes mosquitoes and is an important cause of illness worldwide. Data on the severity of travel-associated dengue illness are limited.ObjectiveTo describe the epidemiology, clinical characteristics, and outcomes among international travelers with severe dengue or dengue with warning signs as defined by the 2009 World Health Organization classification (that is, complicated dengue).DesignRetrospective chart review and analysis of travelers with complicated dengue reported to GeoSentinel from January 2007 through July 2022.Setting20 of 71 international GeoSentinel sites.PatientsReturning travelers with complicated dengue.MeasurementsRoutinely collected surveillance data plus chart review with abstraction of clinical information using predefined grading criteria to characterize the manifestations of complicated dengue.ResultsOf 5958 patients with dengue, 95 (2%) had complicated dengue. Eighty-six (91%) patients had a supplemental questionnaire completed. Eighty-five of 86 (99%) patients had warning signs, and 27 (31%) were classified as severe. Median age was 34 years (range, 8 to 91 years); 48 (56%) were female. Patients acquired dengue most frequently in the Caribbean (n = 27 [31%]) and Southeast Asia (n = 21 [24%]). Frequent reasons for travel were tourism (46%) and visiting friends and relatives (32%). Twenty-one of 84 (25%) patients had comorbidities. Seventy-eight (91%) patients were hospitalized. One patient died of nondengue-related illnesses. Common laboratory findings and signs were thrombocytopenia (78%), elevated aminotransferase (62%), bleeding (52%), and plasma leakage (20%). Among severe cases, ophthalmologic pathology (n = 3), severe liver disease (n = 3), myocarditis (n = 2), and neurologic symptoms (n = 2) were reported. Of 44 patients with serologic data, 32 confirmed cases were classified as primary dengue (IgM+/IgG-) and 12 as secondary (IgM-/IgG+) dengue.LimitationsData for some variables could not be retrieved by chart review for some patients. The generalizability of our observations may be limited.ConclusionComplicated dengue is relatively rare in travelers. Clinicians should monitor patients with dengue closely for warning signs that may indicate progression to severe disease. Risk factors for developing complications of dengue in travelers need further prospective study.Primary Funding SourceCenters for Disease Control and Prevention, International Society of Travel Medicine, Public Health Agency of Canada, and GeoSentinel Foundation.

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