Imported viremic dengue case in a southeastern European country: Established Aedes mosquitoes warrant urgent surveillance

Abstract

In 2023, international tourism nearly reached the levels seen before the COVID-19 pandemic. Tropical and sub-tropical countries are a popular travel destination, where mosquito-bome diseases pose a significant public health challenge[1]. Dengue, the most prominent human arboviral disease is transmitted by several species of Aedes mosquitoes, particularly Aedes aegypti and Aedes albopictus[2]. These vectors are also present in Europe, especially Aedes albopictus, which has been recorded in most countries in Mediterranean Europe. Prompt international travel allows travelers to return while they are in their viremic phase, notably 4 to 5 days after the onset of symptoms. The mosquitoes get infected after feed on a viremic person, and consequently can transmit the virus into susceptible local population[2]. Autochthonous dengue transmissions in Europe, where Aedes albopictus is the dominant vector, was reported in Veneto region in Italy, Catalonia Spain, southern France, and Adriatic coast in Croatia[3]. The presence of such competent vectors is progressively making dengue fever an emerging public health issue in Europe. For the first time, we report a viremic dengue fever imported into the Republic of North Macedonia.