{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:13:24Z","timestamp":1783660404681,"version":"3.55.0"},"reference-count":36,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Dengue is a rapidly spreading mosquito-borne viral disease with increasing incidence in Europe, driven by international travel and climate-related expansion of Aedes mosquito habitats. Data on imported dengue in Central Europe remain limited. The aim of this study was to characterize clinical and epidemiological features of imported dengue infections in Austria and identify factors associated with dengue warning signs. A retrospective, single-centre observational study conducted from January 2013 to October 2024. We retrospectively analyzed 175 adults with confirmed travel-associated dengue treated in Vienna, Austria. Demographics, travel history, symptoms, laboratory values, and clinical outcomes were extracted from electronic records. WHO criteria were applied to classify dengue severity. Most infections were acquired in Southeast Asia (72.6%), particularly Thailand. Common symptoms were fever (97.1%), fatigue (97.1%), arthralgia (59.4%), and rash (53.8%). Dengue warning signs were observed in 16% of cases and associated with significantly prolonged leukopenia (p = 0.003), increased hospitalization rates (50.0% vs. 23.8%, p = 0.005), and higher frequencies of vomiting, abdominal pain, mucosal bleeding, and petechiae at first medical contact. Women reported rash, arthralgia, and retro-orbital pain more frequently, while men showed lower platelet counts. No cases of severe dengue or deaths occurred. Dengue should be considered in febrile returning travellers, particularly from Southeast Asia. The presence of warning signs predicts more complicated disease courses and should prompt closer clinical monitoring. These findings underscore the importance of awareness and preparedness for dengue in non-endemic European settings.<\/jats:p>","DOI":"10.3390\/microorganisms14071439","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T16:56:55Z","timestamp":1782838615000},"page":"1439","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the Tropics: Clinical Presentation and Epidemiology of Travel-Associated Dengue Fever in a Non-Endemic European Setting"],"prefix":"10.3390","volume":"14","author":[{"given":"Lena","family":"Dollensky","sequence":"first","affiliation":[{"name":"Medical Faculty, Sigmund Freud Private University, 1020 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2337-6695","authenticated-orcid":false,"given":"Hermann","family":"Laferl","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, 1100 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Groza","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, 1100 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Wenisch","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, 1100 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Zoufaly","sequence":"additional","affiliation":[{"name":"Medical Faculty, Sigmund Freud Private University, 1020 Vienna, Austria"},{"name":"Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, 1100 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Clodi-Seitz","sequence":"additional","affiliation":[{"name":"Medical Faculty, Sigmund Freud Private University, 1020 Vienna, Austria"},{"name":"Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, 1100 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.tmaid.2005.10.001","article-title":"Imported Dengue Fever in Austria 1990\u20132005","volume":"4","author":"Laferl","year":"2006","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"105710","DOI":"10.1016\/j.meegid.2024.105710","article-title":"Dengue Virus: Etiology, Epidemiology, Pathobiology, and Developments in Diagnosis and Control\u2014A Comprehensive Review","volume":"127","author":"Pourzangiabadi","year":"2025","journal-title":"Infect. Genet. Evol."},{"key":"ref_3","unstructured":"(2024, December 05). Dengue. CDC Yellow Book, Available online: https:\/\/wwwnc.cdc.gov\/travel\/yellowbook\/2024\/infections-diseases\/dengue#."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"h4661","DOI":"10.1136\/bmj.h4661","article-title":"Dengue Fever","volume":"351","author":"Kularatne","year":"2015","journal-title":"BMJ"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1038\/nature12060","article-title":"The Global Distribution and Burden of Dengue","volume":"496","author":"Bhatt","year":"2013","journal-title":"Nature"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1111\/1469-0691.12189","article-title":"Public Health Significance of Invasive Mosquitoes in Europe","volume":"19","author":"Schaffner","year":"2013","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1016\/S1473-3099(14)70834-5","article-title":"Dengue and Dengue Vectors in the WHO European Region: Past, Present, and Scenarios for the Future","volume":"14","author":"Schaffner","year":"2014","journal-title":"Lancet Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"6973","DOI":"10.1038\/s41598-022-10977-4","article-title":"Impact of Temperature on Dengue and Chikungunya Transmission by the Mosquito Aedes albopictus","volume":"12","author":"Mercier","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1089\/vbz.2011.0814","article-title":"A Review of the Invasive Mosquitoes in Europe: Ecology, Public Health Risks, and Control Options","volume":"12","author":"Medlock","year":"2012","journal-title":"Vector-Borne Zoonotic Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2708","DOI":"10.1098\/rsif.2012.0138","article-title":"Suitability of European Climate for the Asian Tiger Mosquito Aedes albopictus: Recent Trends and Future Scenarios","volume":"9","author":"Caminade","year":"2012","journal-title":"J. R. Soc. Interface"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"17852","DOI":"10.1038\/s41598-019-54395-5","article-title":"Estimating the Risk of Arbovirus Transmission in Southern Europe Using Vector Competence Data","volume":"9","author":"Mariconti","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S66","DOI":"10.1016\/S0929-693X(09)75304-7","article-title":"Actualit\u00e9s 2008 Sur La Pr\u00e9sence Du Moustique Tigre Aedes albopictus En France M\u00e9tropolitaine","volume":"16","author":"Delaunay","year":"2009","journal-title":"Arch. P\u00e9diatrie"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/j.0269-283X.2004.00513.x","article-title":"Critical Review of the Vector Status of Aedes albopictus","volume":"18","author":"Gratz","year":"2004","journal-title":"Med. Vet. Entomol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.tmaid.2013.07.006","article-title":"Chikungunya and Dengue Autochthonous Cases in Europe, 2007\u20132012","volume":"11","author":"Tomasello","year":"2013","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Semenza, J.C., Sudre, B., Miniota, J., Rossi, M., Hu, W., Kossowsky, D., Suk, J.E., Van Bortel, W., and Khan, K. (2014). International Dispersal of Dengue through Air Travel: Importation Risk for Europe. PLoS Negl. Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0003278"},{"key":"ref_16","unstructured":"(2025, June 23). Meldepflichtige Krankheiten-STATISTIK AUSTRIA-Die Informationsmanager. Available online: https:\/\/www.statistik.at\/statistiken\/bevoelkerung-und-soziales\/gesundheit\/gesundheitszustand\/meldepflichtige-krankheiten."},{"key":"ref_17","unstructured":"World Health Organization (2009). Dengue Guidelines for Diagnosis, Treatment, Prevention and Control, World Health Organization."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.epidem.2009.06.003","article-title":"Assessing the Risk of Importing Dengue and Chikungunya Viruses to the European Union","volume":"1","author":"Seyler","year":"2009","journal-title":"Epidemics"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Guzman, M.G., Jaenisch, T., Gaczkowski, R., Hang, V.T.T., Sekaran, S.D., Kroeger, A., Vazquez, S., Ruiz, D., Martinez, E., and Mercado, J.C. (2010). Multi-Country Evaluation of the Sensitivity and Specificity of Two Commercially-Available NS1 ELISA Assays for Dengue Diagnosis. PLoS Negl. Trop. Dis., 4.","DOI":"10.1371\/journal.pntd.0000811"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1093\/infdis\/jiw103","article-title":"Performance of Dengue Diagnostic Tests in a Single-Specimen Diagnostic Algorithm","volume":"214","author":"Hunsperger","year":"2016","journal-title":"J. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1016\/S1473-3099(20)30601-0","article-title":"Risk Predictors of Progression to Severe Disease during the Febrile Phase of Dengue: A Systematic Review and Meta-Analysis","volume":"21","author":"Sangkaew","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"903","DOI":"10.3201\/eid1005.030495","article-title":"Increase in Imported Dengue, Germany, 2001\u20132002","volume":"10","author":"Frank","year":"2004","journal-title":"Emerg. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.tmaid.2015.06.005","article-title":"Dengue Fever in Czech Travellers: A 10-Year Retrospective Study in a Tertiary Care Centre","volume":"14","author":"Maixner","year":"2016","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"tax015","DOI":"10.1093\/jtm\/tax015","article-title":"Imported Dengue Fever in East London: A 6-Year Retrospective Observational Study","volume":"24","author":"Riddell","year":"2017","journal-title":"J. Travel Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.actatropica.2003.11.004","article-title":"Dengue Virus Infection in Travellers Returning to Berlin, Germany: Clinical, Laboratory, and Diagnostic Aspects","volume":"90","author":"Teichmann","year":"2004","journal-title":"Acta Trop."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.tmaid.2016.01.007","article-title":"Clinical Features and Laboratory Findings of Dengue Fever in German Travellers: A Single-Centre, Retrospective Analysis","volume":"14","author":"Tavakolipoor","year":"2016","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Ara\u00fajo, J.L.B., Bomfim, R., Sampaio Filho, C.I.N., Cavalcanti, L.P.G., Lima Neto, A.S., Andrade, J.S., and Furtado, V. (2024). The Impact of COVID-19 Mobility Restrictions on Dengue Transmission in Urban Areas. PLoS Negl. Trop. Dis., 18.","DOI":"10.1371\/journal.pntd.0012644"},{"key":"ref_28","unstructured":"(2025, June 23). STATcube\u2014Tabellenansicht. Available online: https:\/\/statcube.at\/statistik.at\/ext\/statcube\/jsf\/tableView\/tableView.xhtml."},{"key":"ref_29","first-page":"243","article-title":"Imported Dengue Fever: A 16-Years Retrospective Analysis in Milan (Italy) and a Brief Review of the European Literature","volume":"28","author":"Pagani","year":"2020","journal-title":"Infez. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.22207\/JPAM.17.3.34","article-title":"A Retrospective Seroprevalence Study of Dengue, Chikungunya and Co-Infection Virus: A Hospital Based Study from Theni, Tamil Nadu","volume":"17","author":"Gopinath","year":"2023","journal-title":"J. Pure Appl. Microbiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1111\/jtm.12144","article-title":"Imported Dengue Fever in Tuscany, Italy, in the Period 2006 to 2012","volume":"21","author":"Lagi","year":"2014","journal-title":"J. Travel Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Ahmad, M.H., Ibrahim, M.I., Mohamed, Z., Ismail, N., Abdullah, M.A., Shueb, R.H., and Shafei, M.N. (2018). The Sensitivity, Specificity and Accuracy of Warning Signs in Predicting Severe Dengue, the Severe Dengue Prevalence and Its Associated Factors. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15092018"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e34053","DOI":"10.1016\/j.heliyon.2024.e34053","article-title":"Age, Gender, and Infectious Status-Wise Assessments of Hematological Parameters among Patients with Dengue Infection","volume":"10","author":"Zeb","year":"2024","journal-title":"Heliyon"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Bodinayake, C.K., Tillekeratne, L.G., Nagahawatte, A., Devasiri, V., Kodikara Arachchi, W., Strouse, J.J., Sessions, O.M., Kurukulasooriya, R., Uehara, A., and Howe, S. (2018). Evaluation of the WHO 2009 Classification for Diagnosis of Acute Dengue in a Large Cohort of Adults and Children in Sri Lanka during a Dengue-1 Epidemic. PLoS Negl. Trop. Dis., 12.","DOI":"10.1371\/journal.pntd.0006258"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1097\/INF.0000000000004326","article-title":"The Value of Warning Signs from the WHO 2009 Dengue Classification in Detecting Severe Dengue in Children","volume":"43","author":"Karyanti","year":"2024","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_36","first-page":"4447","article-title":"Clinical Data Analysis of Dengue Fever Severity Identification","volume":"8","author":"Zainee","year":"2021","journal-title":"Biomed. Res. Ther."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/7\/1439\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:21:44Z","timestamp":1783657304000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/7\/1439"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,30]]},"references-count":36,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["microorganisms14071439"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms14071439","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,30]]}}}