The

authors would like to thank Igor Mijolović for the significant assistance in collection of data regarding the type, conditions, and organization of diving. The authors would also like to thank the two anonymous reviewers for their comments and suggestions which helped to strengthen and improve this manuscript. The authors state that they have no conflicts of interest to declare. “
“We would like to thank Drs Arya and Agarwal for their interest in our report on travel-associated dengue infections in the United States. We agree that, in addition to mosquito avoidance practices, travelers can also be given information Seliciclib mouse on the particularities of Aedes aegypti and Aedes albopictus mosquitoes. We also concur that the NS1 point-of-care test can be used to diagnose dengue early in the course of illness.1 The increasing reports of dengue outbreaks globally indicate a need for greater awareness of dengue among physicians in the United States. Once diagnosed, measures can be recommended to prevent secondary transmission to household contacts in areas where vector mosquitoes are present. The

outbreak of dengue in the Florida Keys in 2009 is a potent reminder of the risk of sporadic outbreaks of autochthonous dengue in non-endemic regions. Although difficult to confirm, check details the source of this outbreak was most likely a traveler. We would also like to thank Drs Chen and Wilson for their letter. With dengue being endemic in many popular travel destinations, Fossariinae the risk of transfusion-associated transmission and nosocomial dengue infections may increase in non-endemic countries. Although nosocomial dengue infections are infrequently reported, universal precautions are necessary when caring for travelers returning with febrile illness. Since the time of writing the initial manuscript,2 dengue has been made a nationally notifiable disease in the United States. Physicians are reminded to report all suspected dengue cases to

the Centers for Disease Control and Prevention’s ArboNET surveillance system via their state and local health departments. Through improved surveillance, any periodic reintroductions of dengue can be more rapidly detected and controlled. Hamish P. Mohammed, PhD, *,† Mary M. Ramos, MD, ‡ Aidsa Rivera, MSc, * Michael Johansson, PhD, * Jorge L. Muñoz-Jordan, PhD, * Wellington Sun, MD, § and Kay M. Tomashek, MD * “
“Cruise ship outbreaks of vaccine-preventable diseases (VPD) such as rubella and varicella have been previously associated with introduction and spread among susceptible crew members originating from countries with endemic transmission of these diseases. During February to April 2006, we investigated a cluster of rash illnesses due to measles, rubella, or varicella on a cruise ship sailing from Florida to the Caribbean.