WASHINGTON — Anna Manzanarez was a picture of good health. But about a week after catching what she thought was a bad case of the flu, the 28-year-old waitress from the central California coastal community of Seaside collapsed getting out of the shower.
The next day, despite intensive care at a hospital, she died.
Her death shocked her family, but the discovery of what killed her hit public health officials like a bolt from the blue: She had fallen victim to a virulent form of a mosquito-borne disease that had long ago been eradicated in the U.S. and was once close to being eliminated throughout South America as well.
The disease, dengue fever, is on the march again and beginning to make its presence felt in the U.S., with cases popping up in Texas, Hawaii and Puerto Rico. Last week, top health officials warned that a "widespread appearance" in the continental U.S. is "a real possibility." Officials are forecasting outbreaks along parts of the Mexican border, although California is not seen as being at high risk.
What has raised the new threat for the United States from a disease scientists thought they had conquered in this hemisphere 30 years ago is a combination of globalization and, some think, global warming.
Thus far, cases of dengue fever in North America have tended to be scattered and affect relatively few people. But increased travel to and from South America, where a resurgence has made dengue widespread, is thought to be boosting the disease's spread northward. And some experts suspect climate change is aggravating the problem.
"It's starting to creep up from South America to the Caribbean," Dr. Anthony S. Fauci, head of the National Institute of Allergy and Infectious Diseases, said in an interview. "If it can occur right at the tip of Texas, a disease which maybe people never heard of could actually appear here."
Fauci, who helped lead the government's efforts against AIDS, sounded the alarm on dengue in an article last week in the Journal of the American Medical Assn. He and his science advisor, Dr. David H. Morens, said more than 760,000 cases were reported in the Americas last year, of which some 20,000 involved the virulent form, known as dengue hemorrhagic fever. That is what killed Manzanarez.
Globally, "it ranks among the most serious infections, but most Americans don't even have it on their radar screens," Fauci said.
