In 2013, 23 cases were reported in Martin County, Florida. This illustrates the importance of awareness of dengue among physicians outside endemic areas. The index case in this outbreak was diagnosed after returning home to New York from a visit to Key West. Dengue reemerged in Florida in 2009-2010, however, with 27 locally acquired cases in Key West. Outbreaks of dengue also occurred in Laredo, Texas, in 1998. The last recorded epidemic in the southeastern United States occurred in Louisiana in 1945. The last dengue epidemic in Florida (in the Tampa and Miami areas) occurred in 1934-1935 and affected an estimated 15,000 people of the population of 135,000 in Miami. Puerto Rico has experienced several seasonal outbreaks since 2015, with more significant transmission occurring from August to November.
Most dengue cases in US citizens occur in Puerto Rico, the US Virgin Islands, Guam, and Samoa.
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