A guide to vaccinology: from basic principles to new developments

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What Is Dengue Fever?

Where did dengue originate? The origin of dengue is unclear, but scientists have recently proposed that dengue originated in Asian forests in an infectious cycle involving mosquitoes and primates. As early as 992, a dengue-like outbreak in humans was recorded in a Chinese medical encyclopedia. Epidemics of dengue-like illnesses were reported in the French West Indies in 1635 and in Panama in 1699.

In 1771, Dr. Jose Sabater, a physician at the military hospital in San Juan, Puerto Rico, recommended treating dengue with small quantities of rum. At the time, the disease was called "break-bone fever." Where did this name come from? As you might guess, patients with the disease experienced a high fever accompanied by such severe bone and joint pains that they felt their bones were breaking.

In 1780, Dr. Benjamin Rush recorded an epidemic of the disease later known as dengue in Philadelphia, Pennsylvania. Rush described the symptoms of patients with the disease, which he called "bilious remitting fever." These symptoms included fever, joint and muscle pain, headache, rash, weakness, nausea, vomiting, and bleeding.

As early as 1801, people called the disease "dengue." In a letter written by Queen Luisa of Spain during her recovery from a dengue infection in 1801, she said, "I'm feeling better, because it has been the cold in fashion, that they call dengue, and since yesterday I've had some blood, which is what is making me uncomfortable, and after talking some time the throat hurts." What does dengue mean? The word dengue is Spanish for "affectation," "careful," or "fastidious." The term probably described the cautious, stiff movements of patients suffering from the muscle, bone, and joint pain caused by dengue fever. Some researchers believe that the name came from a Swahili phrase Ka dinga pepo, or a disease caused by an evil spirit.

In 1818, there was a serious dengue epidemic in Peru — 50,000 people were stricken with the illness. The first recorded dengue pandemic occurred between 1827 and 1828, and it affected the Virgin Islands, Jamaica, Cuba, Venezuela, the United States, and Mexico. Pandemics are epidemics that affect a very large region, multiple countries, or even the entire globe. Later in the 1800s, epidemics plagued Brazil, the southern United States, and the Caribbean. Dengue epidemics continued to occur more often through the first half of the 1900s. During World War II, dengue spread to new regions as large numbers of soldiers were stationed throughout the world. The first epidemic of severe dengue was reported in Manila, Philippines, in 1953, and the disease continued to spread in Southeast Asia during the next 20 years. Due to organized efforts to eliminate dengue in Central America and South America, fewer dengue epidemics occurred in these areas during the 1960s and 1970s, but when these efforts ended, dengue infections returned to these regions.

Health Department Still Monitoring Dengue, Legionnaires' Outbreaks

The V.I. Health Department is still monitoring the dengue outbreak that caused a confirmed 194 infections across the Virgin Islands in 2024, and it's likely that only represents a fraction of the actual number of cases.

The rate of dengue infections in the territory "is incredibly high, if you look at the trends over time, 2023 it was one case. So, it's definitely important to get tested. We know that number 194 is extremely underestimating our true burden of dengue," Territorial Epidemiologist Esther Ellis said in a phone call with The Daily News on Tuesday.

Dengue is spread by mosquitoes, and can cause four distinct but closely-related viruses. That means an individual can become infected with dengue up to four times, but can only catch each type once, Ellis said, and the second infection is usually the most serious.

The number of dengue infections in 2024 accurately reflected a spike in the disease, which Puerto Rico also reported, and was not due to an increase in testing efforts by the V.I. Health Department, Ellis said.

Mosquito-borne virus outbreaks also tend to occur around once a decade, Ellis said, as herd immunity wanes after each round of infections.

"I've been saying for about two years, we're due for a dengue outbreak," as the last to occur was in 2012, Ellis said.

The last chikungunya outbreak was in 2014, and the most recent Zika outbreak occurred in 2016, which is why residents are encouraged to become vaccinated.

While some symptoms may be similar for each disease, their impact and treatment can differ. For example, ibuprofen is not recommended for dengue because it can increase the risk of internal bleeding, and testing provides not only public health data but "it also lets us do targeted interventions," Ellis said.

Only one dengue case has been reported so far in 2025, and Ellis encouraged those who are able, to consult with a doctor and get tested if they have symptoms.

Dengue symptoms can range from mild to severe, sometimes becoming life-threatening, particularly for infants, pregnant women, and individuals with prior infections. Symptoms may include fever, pain behind the eyes, muscle or joint pain, nausea, vomiting, and rash, typically lasting two to seven days. Rest and acetaminophen are recommended for fever relief, while aspirin and ibuprofen should be avoided.

Severe dengue may develop 24 to 48 hours after fever subsides, characterized by severe abdominal pain, vomiting, bleeding, or extreme fatigue. Emergency medical attention is required for these symptoms.

To prevent mosquito bites, use EPA-approved insect repellent, wear long sleeves and pants, and remove standing water around your home.

Ellis emphasized that those who test positive for dengue should be especially cautious to avoid mosquitoes even while recovering indoors, as the infected mosquitoes can transfer the disease to others in your home.

Getting a test can be easier said than done, and it is cost prohibitive, especially for the uninsured.

For instance, Community Medical Laboratory on St. Thomas provides testing, but will only utilize a patient's insurance with a doctor's referral. The out-of-pocket cost for an influenza test is $225, and a dengue test is $125, so the cost for those two alone would be $350.

That is not affordable for many Virgin Islanders struggling to make ends meet, and Ellis acknowledged that fact in an email Tuesday.

"We are aware of many barriers and unfortunately due to lack of funding at this time cannot provide free testing. We do strive to get as much data as possible to capture the trend, and that is being completed by demonstration of an outbreak in 2024," Ellis wrote.

For data about infection rates, visit https://doh.Vi.Gov/ and click on the yellow banner at the top of the page that says, "View the USVI Epidemiology Data Dashboard Here!" At the top of that page, you can select COVID-19, Dengue, or Influenza to see current and historic information about suspected and confirmed cases for each disease.

The Daily News asked Government House Communications Director Richard Motta Jr. On Tuesday if Gov. Albert Bryan Jr. Will be declaring a health care state of emergency, as recommended by Sen. Ray Fonseca.

Motta was apparently unaware of a press release Fonseca had sent out, decrying the lack of support to the territory's hospitals, and responded, "A healthcare state of emergency for the listeria situation at hotel on the cay?"

Legionella bacteria recently sickened several guests at Hotel on the Cay resort on St. Croix, and the Health Department has issued several statements in an attempt to clarify the situation.

In a press release Friday, the department said the hotel had been issued a cease-and-desist order "due to Legionella contamination in multiple water sources," and later issued another statement clarifying that the closure does not apply to the beach bar or Rolling Smokes BBQ restaurant.

On Tuesday, the department issued a statement from Health Commissioner Justa Encarnacion that "the hotel was utilizing cistern water. We want to state unequivocally that the contamination source was neither the potable water system nor the wastewater treatment system."

Tuesday night, the department issued another statement to correct the previous press release: "VI Health Commissioner Justa Encarnacion contacted Chris Pardo, owner of the Hotel on the Cay, following the release. 'On the contrary, Mr. Pardo validated that the hotel has been and currently utilizes 100% potable water,' Commissioner Encarnacion said. 'The VI Department of Health apologizes for the error.'"

The tests "validated that the potable water in the cistern showed no evidence of Legionella contamination, and the cases of Legionnaires' disease "are directly linked to the freshwater systems within the affected hotel rooms. The testing identified Legionella in the showerhead, kitchen sink, and/or bathroom sinks in those rooms."

Legionella is most commonly contracted while showering, as the bacteria can be in the mist from the showerhead and enter an individual's lungs, eyes, or mouth.

Encarnacion acknowledged the hotel's cooperation in addressing the issue, noting their collaboration in preventing further cases. Extensive plumbing replacements and decontamination efforts were completed over the last few days, according to the statement.

Motta in a follow-up response relative to questions about Fonseca's call for a health care state of emergency said: "The administration is focused on continuing the diligent work with its federal partners toward the rebuilding of our critical health care facilities and toward assisting the territory's hospitals in addressing their immediate needs. There is no indication that the governor has been made privy to that suggests calling a state of emergency would expedite those efforts."

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