Dengue Virus: Reporting and Surveillance
Dengue is a category II reportable condition in Wisconsin. Health care providers and laboratories should report to the patient's local public health department:
- Electronically, through the Wisconsin Electronic Disease Surveillance System (WEDSS).
- By calling the Bureau of Communicable Diseases at 608-267-9003.
Reporting should be completed within 72 hours upon recognition of a case. For more information, please visit the DHS Disease Reporting page.
DHS Surveillance Resources
- Arboviral Infection EpiNet, P-01930 (PDF): An arboviral infection case reporting and investigation protocol for health professionals.
- Arbovirus Management Protocol, P-00894 (PDF): Information for arboviral disease management, including surveillance, testing, reporting, and follow-up, in humans and animals.
Dengue Virus Information for Health Care Providers: Information on clinical presentation, laboratory testing and reporting, diagnosis and laboratory guidance from the Centers for Disease Control and Prevention (CDC).
Laboratory diagnosis of dengue virus most often involves the detection of viral RNA or antibodies against dengue virus. Molecular methods, commonly reverse-transcription polymerase chain reaction (RT-PCR), can be performed on acute specimens collected in the first five days of symptoms. Serologic testing can be performed on specimens collected between five days and 12 weeks from the onset of symptoms. Often, collection of both acute and convalescent specimens may be necessary to make a diagnosis of dengue infection. For further information on laboratory diagnosis of dengue infection, please visit CDC Dengue Laboratory Guidance.
Dengue virus testing can be requested through the Wisconsin State Laboratory of Hygiene (WSLH) using an arbovirus PCR panel (includes tests for dengue, Zika, and chikungunya viruses) or dengue IgM antibody capture enzyme-linked immunosorbent assay (MAC-ELISA). The WSLH will forward specimens with positive dengue IgM results to CDC for confirmatory testing by plaque reduction neutralization test (PRNT).
The arbovirus PCR panel is only available at the WSLH fee-exempt and requires patients to meet the Division of Public Health (DPH) clinical and travel exposure criteria. Please contact a vectorborne disease epidemiologist at 608-267-9003 to obtain authorization prior to specimen submission.
Dengue IgM testing is available at the WSLH fee-for-service. It is not required for patients' symptoms to meet DPH clinical and travel exposure criteria to submit serum specimens to WSLH for dengue MAC-ELISA.
For patients who meet certain criteria, fee-exempt serologic and molecular testing is currently performed by the WSLH for dengue, with confirmatory testing performed by CDC. Please contact a vectorborne disease epidemiologist at 608-267-9003 for fee-exempt approval.
Fee-exempt arboviral testing will be offered to clinicians whose patients meet the following criteria:
- Request for confirmatory testing of dengue positive commercial test results (performed at laboratories other than the WSLH).
- The patient has at least two of the following symptoms: rash, fever, arthralgia, conjunctivitis, or hemorrhagic manifestations.
- The patient has history of travel to dengue-affected area(s) within two weeks of illness onset.
- The local health department may request fee-exempt testing be performed if the case-patient lacks insurance coverage or the ability to pay.
Instructions for collection and shipping of clinical specimens to the WSLH:
- Submit 3-7 mL of serum in sterile screw-capped vials on cold packs using a WSLH kit #22 or equivalent with five days of collection. Specimens should be triple packaged as a Category B Biological Substance (include UN3373 label).
- Fee-exempt testing submissions must include a WSLH Enhanced Wisconsin Arbovirus Surveillance form provided by a DPH vectorborne disease epidemiologist.
- Fee-for-service testing submissions must include a WSLH CDD Requisition Form B. Please contact the WSLH Clinical Orders at 800-862-1088 or 608-224-4275 to obtain blank copies of WSLH CDD Requisition Form B and to order specimen shipping kits.
- It is essential that the lab requisition form be as complete as possible, including patient name, city, date of birth, specimen type, submitting agency, onset date, signs and symptoms, collection date, and recent travel history. Note: Testing for dengue virus may be delayed on specimens missing the above data until information is available.
- Ship specimens with appropriate completed form to:
Wisconsin State Laboratory of Hygiene
2601 Agriculture Drive
PO Box 7904
Madison, WI 53718
Customer Service: 800-862-1013
Diagnosis of dengue can be complicated by the fact that Zika and chikungunya viruses are transmitted by the same mosquitoes, have overlapping geographical ranges, and have similar clinical presentations. Diagnosis of dengue can be challenging since many of the signs and symptoms can be similar to other viral infections. Additionally, dengue IgM antibodies can cross-react with related viruses, such as Zika virus and West Nile virus, requiring confirmatory laboratory testing and/or convalescent specimen collection. A patient’s clinical signs and symptoms and risk activities can help to inform a preliminary diagnosis prior to laboratory confirmation.
Clinical presentation of a dengue infection can range from a mild, non-specific febrile illness to severe dengue hemorrhagic fever or dengue shock syndrome. Severe forms of dengue typically develop after a two to seven day febrile phase, and can involve sudden onset of plasma leakage or other hemorrhagic manifestations, or shock. Warning signs after fever subsides indicate the need for immediate medical attention. These warning signs can include mucosal bleeding, persistent vomiting, liver enlargement, increase in hematocrit with decrease in platelet count, pleural effusion or ascites. For additional information on clinical diagnosis of dengue virus infection, visit CDC Dengue Clinical Guidance.
There is currently no treatment or vaccine for dengue. Over-the-counter pain relievers, such as Tylenol, may be given to relieve the symptoms. Patients should not take aspirin or ibuprofen, as they can increase the risk of bleeding. In severe cases, patients may need to be hospitalized to receive supportive treatment.
Questions about illnesses spread by mosquitoes? Contact us!
Phone: 608-267-9003 | Fax: 608-261-4976