Dengue de novo!

Será?

Dengue Transmission without Involvement of Mosquito Vector

Goro Kuno

Arbovirus Diseases Branch, Division of Vector‐Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Ft. Collins, Colorado

Reprints or correspondence: Goro Kuno, PO Box 2087, Ft. Collins, CO 80521 (gok1@cdc.gov).

Sir—I read with interest the recent article by Chen and Wilson [1], who documented the first case of nosocomial mucocutaneous transmission of dengue in a health care worker involved in an accidental facial splash of blood from a patient with laboratory‐confirmed dengue. Although it is uncertain whether cutaneous infection of dengue is possible, at least intranasal and oral routes of mucosal infection, as 2 major direct transmission mechanisms, have been documented for all major groups of vectorborne arboviruses [2]. In fact, development of dengue virus infection by intranasal instillation of the virus suspension was demonstrated many years ago in human volunteers [3] and experimental animals (monkeys and marmosets) [4]. Similarly, in the absence of skin abnormalities and invasive accidents, aerosol transmission has been strongly suspected to be the cause of dengue or yellow fever infections among laboratory workers and diagnosticians exposed to a high concentration of these viruses [5, 6]. Thus, with the number of cases of imported dengue increasing sharply, the report by Chen and Wilson [1] was a timely reminder—not only to health care workers, but to diagnosticians and laboratory workers dealing with dengue viruses—that such viruses, which are currently classified at a lower biosafety level, can, if concentrated, present a potential for direct transmission.