U.S. health officials have warned doctors to be on the alert for dengue as case numbers reach more than nine million in the Americas, according to the Pan American Health Organization (PAHO).
There have been three times the number of cases reported in the continental U.S. this year compared to last year.
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The virus, which is spread by mosquitoes, has been surging worldwide and the World Health Organization declared an emergency in December.
More than nine million cases have been reported across 43 countries according to PAHO, twice as high as the total number of cases for 2023, and more than the total yearly cases for any previously recorded year.
Dengue remains less common in the continental U.S., and most infections have been picked up by travelers abroad.
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There is no evidence of a current outbreak in the continental U.S., but officials warn local mosquitoes can post a threat.
The Centers for Disease Control and Prevention advised doctors to know the symptoms of dengue, ask questions about where patients recently traveled and consider ordering dengue tests when appropriate.
So far there have been nearly 1,500 locally acquired U.S. cases this year, most in Puerto Rico.
There were 3,000 cases in the U.S. states and territories last year. This was the worst in a decade, and included more infections that occurred locally.
Most cases were in Puerto Rico, with around 180 in Florida, Texas and California.
Puerto Rico declared a public health emergency in March.
Many infected people do not feel sick, whilst some experience headache, fever and symptoms similar to the flu.
Serious cases include bleeding, shock and death, and repeated infections can be especially dangerous.
"We're currently seeing increases in the cases due to dengue 2 and dengue 3, for which the population has very little immunity," said Dr. Gabriela Paz-Bailey, the Puerto-Rico-based chief of the CDC's dengue branch.
There is no widely available medicine for treating dengue, and vaccines have proven a challenge.
U.S. officials in 2021 recommended a vaccine made by Sanofi. However, because the vaccine is recommended only for children ages 9 to 16 who have laboratory evidence of an earlier dengue infection, it has not been widely used.
As of last month, only around 140 children had been vaccinated in Puerto Rico.
Other vaccines are not currently licensed in the US.
The spread of dengue has been exacerbated by climate change as the warm weather mosquito has expanded its reach, say experts.
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