title: Chikungunya and Dengue Virus Infections Among United States Community Service Volunteers Returning from the Dominican Republic, 2014.
abstract: Chikungunya spread throughout the Dominican Republic (DR) after the first identified laboratory-confirmed cases were reported in April 2014. In June 2014, a U.S.-based service organization operating in the DR reported chikungunya-like illnesses among several staff. We assessed the incidence of chikungunya virus (CHIKV) and dengue virus (DENV) infection and illnesses and evaluated adherence to mosquito avoidance measures among volunteers/staff deployed in the DR who returned to the United States during July-August 2014. Investigation participants completed a questionnaire that collected information on demographics, medical history, self-reported illnesses, and mosquito exposures and avoidance behaviors and provided serum for CHIKV and DENV diagnostic testing by reverse transcription polymerase chain reaction and IgM enzyme-linked immunosorbent assay. Of 102 participants, 42 (41%) had evidence of recent CHIKV infection and two (2%) had evidence of recent DENV infection. Of the 41 participants with evidence of recent CHIKV infection only, 39 (95%) reported fever, 37 (90%) reported rash, and 37 (90%) reported joint pain during their assignment. All attended the organization's health trainings, and 89 (87%) sought a pretravel health consultation. Most (∼95%) used insect repellent; however, only 30% applied it multiple times daily and < 5% stayed in housing with window/door screens. In sum, CHIKV infections were common among these volunteers during the 2014 chikungunya epidemic in the DR. Despite high levels of preparation, reported adherence to mosquito avoidance measures were inconsistent. Clinicians should discuss chikungunya with travelers visiting areas with ongoing CHIKV outbreaks and should consider chikungunya when diagnosing febrile illnesses in travelers returning from affected areas.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Millman
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Douglas H
authors.initials: DH
authors.lastname: Esposito
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Holly M
authors.initials: HM
authors.lastname: Biggs
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Michelle
authors.initials: M
authors.lastname: Decenteceo
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Andrew
authors.initials: A
authors.lastname: Klevos
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hunsperger
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Jorge
authors.initials: J
authors.lastname: Munoz-Jordan
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Olga I
authors.initials: OI
authors.lastname: Kosoy
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Heidi
authors.initials: H
authors.lastname: McPherson
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Carmen
authors.initials: C
authors.lastname: Sullivan
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Dayton
authors.initials: D
authors.lastname: Voorhees
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Baron
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Jim
authors.initials: J
authors.lastname: Watkins
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Linda
authors.initials: L
authors.lastname: Gaul
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sotir
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Gary
authors.initials: G
authors.lastname: Brunette
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Marc
authors.initials: M
authors.lastname: Fischer
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas.
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Sharp
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas efj8@cdc.gov.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Jentes
mesh_terms: D065632:Chikungunya Fever / Q000453:epidemiology*; D003715:Dengue / Q000453:epidemiology*; D004293:Dominican Republic / Q000453:epidemiology; D006801:Humans; D014195:Travel; D014481:United States / Q000453:epidemiology; D014838:Volunteers