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Lovey T, Hedrich N, Grobusch MP, Bernhard J, Schagenhauf P, Blanke U, Eperon G, Gautret P, de Frey A, Kuenzli E, Lindner A, Mockenhaupt F, Popescu C, Schnyder JL, de Jong HK, Dauda M, Nishiura H, Al-Tawfiq JA, Parker S, Larsen CS, Vayena E. Surveillance of global, travel-related illness using a novel app: a multivariable, cross-sectional study. BMJ Open 2024; 14:e083065. [PMID: 39067885 PMCID: PMC11287070 DOI: 10.1136/bmjopen-2023-083065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION Current traveller health surveillance is 'top-down'. Mobile-based surveillance could capture infection symptoms in real time. We aimed to evaluate the spectrum of illness in travellers using a mobile app-based system. METHODS This study (ClinicalTrials.gov NCT04672577) used an application called Infection Tracking in Travellers (ITIT) that records travel-related illness symptoms with associated geolocation and weather data. The free ITIT app is available in 14 languages. Participants were recruited globally from April 2022 to July 2023. Participants >18 years of age travelled internationally and provided electronic consent. Incentives included the provision of travel health information imported from the WHO website. Symptoms were recorded with daily pop-up questionnaires and symptom severity was assessed using a Likert scale. Two post-travel questionnaires were administered. Logistic mixed models examined factors relating to symptom presence, and a random forest model examined symptom impact. RESULTS 609 participants were recruited until July 2023. Participants had an average age of 37 years (18-79), and an average travel duration of 26 days (2-281). Most participants were travelling for leisure/tourism (401; 66%), followed by 'visiting friends and relatives' (99; 16%) and business travel (80; 13%). All continents were visited by at least one traveller. Of 470 registered trips, symptoms were reported on 163 trips (35%). Gastrointestinal symptoms were reported on 87 trips (19%) and respiratory symptoms on 81 trips (17%). The most important factors in predicting the presence of symptoms were duration of travel, travelling in winter and high humidity. Diarrhoea, headache and nausea were symptoms with most impact on daily activities. Post-travel questionnaires showed that 12% of surveyed participants experienced symptoms with several episodes of self-treatment. Two diagnoses were recorded: Lyme disease and amoebic dysentery. CONCLUSION The digital tool ITIT successfully captures the spectrum of travel-related illness. This detailed epidemiology is crucial for outbreak detection and for the formulation of travel medicine guidelines. TRIAL REGISTRATION NUMBER NCT04672577.
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Affiliation(s)
- Thibault Lovey
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
| | - Nadja Hedrich
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
| | - Martin Peter Grobusch
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
| | - Julian Bernhard
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
| | - Patricia Schagenhauf
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - The ITIT Global Network
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Ulf Blanke
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Gilles Eperon
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Philippe Gautret
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Albie de Frey
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Esther Kuenzli
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Andreas Lindner
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Frank Mockenhaupt
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Corneliu Popescu
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Jenny L Schnyder
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Hanna K de Jong
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Mohammed Dauda
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Hiroshi Nishiura
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Jaffar A Al-Tawfiq
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Salim Parker
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Carsten Schade Larsen
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Effy Vayena
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
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Heidema S, Stoepker IV, Flaherty G, Angelo KM, Post RAJ, Miller C, Libman M, Hamer DH, van den Heuvel ER, Huits R. From GeoSentinel data to epidemiological insights: a multidisciplinary effort towards artificial intelligence-supported detection of infectious disease outbreaks. J Travel Med 2024; 31:taae013. [PMID: 38236181 DOI: 10.1093/jtm/taae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/19/2024]
Affiliation(s)
- Stan Heidema
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Ivo V Stoepker
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gerard Flaherty
- School of Medicine, University of Galway, University Road, Galway, H91 TK33, Ireland
- School of Medicine, International Medical University, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Kristina M Angelo
- Division of Global Migration and Health, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA
| | - Richard A J Post
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Charles Miller
- Division of Global Migration and Health, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Room E05.1830, 1001 Boulevard Décarie, Montréal, Québec H4A 3J1, Canada
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Crosstown 308, 801 Massachusetts Avenue, Boston, MA 02118, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Crosstown 308, 801 Massachusetts Avenue, Boston, MA 02118, USA
- Center for Emerging Infectious Diseases Policy and Research, Boston University, 111 Cummington Mall, #104, Boston, MA 02215, USA
| | - Edwin R van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Preventive Medicine and Epidemiology, School of Medicine, Boston University, 72 East Concord Street, Floor L-5, Boston, MA 02218, USA
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024, Via Don A Sempreboni 5, Negrar di Valpolicella, Verona, Italy
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Shiferaw W, Dean JA, Mills D, Lau C, Furuya-Kanamori L. Definition and classification of 'travellers' in research: a bibliometric analysis. J Travel Med 2024; 31:taae048. [PMID: 38501851 PMCID: PMC11149717 DOI: 10.1093/jtm/taae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/07/2024] [Accepted: 03/14/2024] [Indexed: 03/20/2024]
Abstract
Despite the growth in the volume of vulnerable travellers globally, there has been limited research attention, underscoring the need for more evidence as these individuals are susceptible to various travel-related health risks. Additionally, we observed inconsistencies in the definition of travellers and discrepancies in travel-related publications compared to the actual travel volume.
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Affiliation(s)
- Wondimeneh Shiferaw
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
- Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Judith A Dean
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
| | - Deborah Mills
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
- Dr Deb The Travel Doctor, Travel Medicine Alliance, 445 Brisbane, QLD 4006, Australia
| | - Colleen Lau
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
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4
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Bierbrier R, Javelle E, Norman FF, Chen LH, Bottieau E, Schwartz E, Leder K, Angelo KM, Stoney RJ, Libman M, Hamer DH, Huits R, Connor BA, Simon F, Barkati S. Chikungunya infection in returned travellers: results from the geosentinel network, 2005-2020. J Travel Med 2024; 31:taae005. [PMID: 38195993 PMCID: PMC11081466 DOI: 10.1093/jtm/taae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/28/2023] [Accepted: 12/31/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Chikungunya is an important travel-related disease because of its rapid geographical expansion and potential for prolonged morbidity. Improved understanding of the epidemiology of travel-related chikungunya infections may influence prevention strategies including education and vaccination. METHODS We analysed data from travellers with confirmed or probable chikungunya reported to GeoSentinel sites from 2005 to 2020. Confirmed chikungunya was defined as a compatible clinical history plus either virus isolation, positive nucleic acid test or seroconversion/rising titre in paired sera. Probable chikungunya was defined as a compatible clinical history with a single positive serology result. RESULTS 1202 travellers (896 confirmed and 306 probable) with chikungunya were included. The median age was 43 years (range 0-91; interquartile range [IQR]: 31-55); 707 (58.8%) travellers were female. Most infections were acquired in the Caribbean (28.8%), Southeast Asia (22.8%), South Central Asia (14.2%) and South America (14.2%). The highest numbers of chikungunya cases reported to GeoSentinel were in 2014 (28.3%), 2015 (14.3%) and 2019 (11.9%). The most frequent reasons for travel were tourism (n = 592; 49.3%) and visiting friends or relatives (n = 334; 27.7%). The median time to presentation to a GeoSentinel site was 23 days (IQR: 7-52) after symptom onset. In travellers with confirmed chikungunya and no other reported illnesses, the most frequently reported symptoms included musculoskeletal symptoms (98.8%), fever/chills/sweats (68.7%) and dermatologic symptoms (35.5%). Among 917 travellers with information available, 296 (32.3%) had a pretravel consultation. CONCLUSIONS Chikungunya was acquired by international travellers in almost 100 destinations globally. Vector precautions and vaccination where recommended should be integrated into pretravel visits for travellers going to areas with chikungunya or areas with the potential for transmission. Continued surveillance of travel-related chikungunya may help public health officials and clinicians limit the transmission of this potentially debilitating disease by defining regions where protective measures (e.g. pretravel vaccination) should be strongly considered.
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Affiliation(s)
- Rachel Bierbrier
- Division of Dermatology, Department of Medicine, McGill University, Montreal, Quebec, Canada
- The J. D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Quebec, Canada
| | - Emilie Javelle
- Unité Parasitologie et Entomologie, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées (IRBA), Centre National de Référence du Paludisme, 13005 Marseille, France
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, 13284 Marseille, France
| | - Francesca F. Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, CIBERINFEC, IRYCIS, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - Lin Hwei Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Eli Schwartz
- The Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Department of Medicine, Tel-Aviv University, 6997801 Tel Aviv-Yafo, Israel
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University and Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, VIC 3052, Australia
| | - Kristina M. Angelo
- Travelers’ Health Branch, Division of Global Migration and Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Rhett J. Stoney
- Travelers’ Health Branch, Division of Global Migration and Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Michael Libman
- The J. D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Quebec, Canada
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montréal, Quebec, Canada
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA 02218, USA
- Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02218, USA
- Center for Emerging Infectious Disease Policy and Research, Boston University, Boston, MA 02215, USA
- National Emerging Infectious Disease Laboratory, Boston, MA 02218, USA
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy
| | - Bradley A. Connor
- Weill Cornell Medical College and the New York Center for Travel and Tropical Medicine, New York, NY 10022, USA
| | | | - Sapha Barkati
- The J. D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Quebec, Canada
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montréal, Quebec, Canada
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Tozan Y, Headley TY, Javelle E, Gautret P, Grobusch M, de Pijper C, Asgeirsson H, Chen LH, Bourque DL, Menéndez MD, Moro L, Gobbi F, Sánchez-Montalvá A, Connor BA, Matteelli A, Crosato V, Huits R, Libman M, Hamer DH. Impact, healthcare utilization and costs of travel-associated mosquito-borne diseases in international travellers: a prospective study. J Travel Med 2023; 30:taad060. [PMID: 37129519 DOI: 10.1093/jtm/taad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND International travellers frequently acquire infectious diseases whilst travelling, yet relatively little is known about the impact and economic burden of these illnesses on travellers. We conducted a prospective exploratory costing study on adult returning travellers with falciparum malaria, dengue, chikungunya or Zika virus. METHODS Patients were recruited in eight Travel and Tropical Medicine clinics between June 2016 and March 2020 upon travellers' first contact with the health system in their country of residence. The patients were presented with a structured 52-question self-administered questionnaire after full recovery to collect information on patients' healthcare utilization and out-of-pocket costs both in the destination and home country, and about income and other financial losses due to the illness. RESULTS A total of 134 patients participated in the study (malaria, 66; dengue, 51; chikungunya, 8; Zika virus, 9; all fully recovered; median age 40; range 18-72 years). Prior to travelling, 42% of patients reported procuring medical evacuation insurance. Across the four illnesses, only 7% of patients were hospitalized abroad compared with 61% at home. Similarly, 15% sought ambulatory services whilst abroad compared with 61% at home. The average direct out-of-pocket hospitalization cost in the destination country (USD $2236; range: $108-$5160) was higher than the direct out-of-pocket ambulatory cost in the destination country (USD $327; range: $0-$1560), the direct out-of-pocket hospitalization cost at home (USD $35; range: $0-$120) and the direct out-of-pocket ambulatory costs at home (US$45; range: $0-$192). Respondents with dengue or malaria lost a median of USD $570 (Interquartile range [IQR] 240-1140) and USD $240 (IQR 0-600), respectively, due to their illness, whilst those with chikungunya and Zika virus lost a median of USD $2400 (IQR 1200-3600) and USD $1500 (IQR 510-2625), respectively. CONCLUSION Travellers often incur significant costs due to travel-acquired diseases. Further research into the economic impact of these diseases on travellers should be conducted.
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Affiliation(s)
- Yesim Tozan
- School of Global Public Health, New York University, New York, NY, United States
| | - Tyler Y Headley
- New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Emilie Javelle
- Unité Parasitologie et Entomologie, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées (IRBA), Marseille, France
- Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France
- IHU Méditerranée Infection, Marseille, France
| | - Philippe Gautret
- Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France
- IHU Méditerranée Infection, Marseille, France
| | - Martin Grobusch
- Center for Tropical and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis de Pijper
- Center for Tropical and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Lin H Chen
- Harvard Medical School, Boston, MA, United States
- Travel Medicine Center-Mt. Auburn Hospital, Cambridge, MA, United States
| | - Daniel L Bourque
- Harvard Medical School, Boston, MA, United States
- Travel Medicine Center-Mt. Auburn Hospital, Cambridge, MA, United States
| | - Marta D Menéndez
- Hospital Universitario La Paz-Carlos IIIl, IdiPaz, CIBERIfect, Madrid, Spain
| | - Lucia Moro
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Federico Gobbi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Adrián Sánchez-Montalvá
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bradley A Connor
- Weill Cornell Medicine and the New York Center for Travel and Tropical Medicine, New York, NY, United States
| | - Alberto Matteelli
- Clinic of Infectious and Tropical Diseases, University of Brescia and District Health Department, Brescia, Italy
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
| | - Verena Crosato
- Clinic of Infectious and Tropical Diseases, University of Brescia and District Health Department, Brescia, Italy
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, Montreal, Quebec, Canada
| | - Davidson H Hamer
- J.D. MacLean Centre for Tropical Diseases, Montreal, Quebec, Canada
- Boston University School of Public Health and Center for Emerging Infectious Diseases, Boston, MA, United States
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6
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Steffen R, Chen LH, Leggat PA. Travel vaccines-priorities determined by incidence and impact. J Travel Med 2023; 30:taad085. [PMID: 37341307 DOI: 10.1093/jtm/taad085] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Infectious disease epidemiology is continuously shifting. While travel has been disrupted by the COVID-19 pandemic and travel-related epidemiological research experienced a pause, further shifts in vaccine-preventable diseases (VPDs) relevant for travellers have occurred. METHODS We conducted a literature search on the epidemiology of travel-related VPD and synthesized data for each disease with a focus on symptomatic cases and on the impact of the respective infection among travellers, considering the hospitalization rate, disease sequela and case fatality rate. We present new data and revised best estimates on the burden of VPD relevant for decisions on priorities in travel vaccines. RESULTS COVID-19 has emerged to be a top travel-related risk and influenza remains high in the ranking with an estimated incidence at 1% per month of travel. Dengue is another commonly encountered infection among international travellers with estimated monthly incidence of 0.5-0.8% among non-immune exposed travellers; the hospitalized proportion was 10 and 22%, respectively, according to two recent publications. With recent yellow fever outbreaks particularly in Brazil, its estimated monthly incidence has risen to >0.1%. Meanwhile, improvements in hygiene and sanitation have led to some decrease in foodborne illnesses; however, hepatitis A monthly incidence remains substantial in most developing regions (0.001-0.01%) and typhoid remains particularly high in South Asia (>0.01%). Mpox, a newly emerged disease that demonstrated worldwide spread through mass gathering and travel, cannot be quantified regarding its travel-related risk. CONCLUSION The data summarized may provide a tool for travel health professionals to prioritize preventive strategies for their clients against VPD. Updated assessments on incidence and impact are ever more important since new vaccines with travel indications (e.g. dengue) have been licensed or are undergoing regulatory review.
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Affiliation(s)
- Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, Department of Public and Global Health, Division of Infectious Diseases, World Health Organization Collaborating Centre for Travelers' Health, University of Zurich, Zurich 8001, Switzerland
- Division of Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Houston, TX 77030, USA
| | - Lin H Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
- Faculty of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Peter A Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland 4810, Australia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
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7
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Barnett ED, Wheelock AB, MacLeod WB, McCarthy AE, Walker PF, Coyle CM, Greenaway CA, Castelli F, López-Vélez R, Gobbi FG, Trigo E, Grobusch MP, Gautret P, Hamer DH, Kuhn S, Stauffer WM. Infections with long latency in international refugees, immigrants, and migrants seen at GeoSentinel sites, 2016-2018. Travel Med Infect Dis 2023; 56:102653. [PMID: 37852594 PMCID: PMC10760402 DOI: 10.1016/j.tmaid.2023.102653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The continued increase in global migration compels clinicians to be aware of specific health problems faced by refugees, immigrants, and migrants (RIM). This analysis aimed to characterize RIM evaluated at GeoSentinel sites, their migration history, and infectious diseases detected through screening and diagnostic workups. METHODS A case report form was used to collect data on demographics, migration route, infectious diseases screened, test results, and primary infectious disease diagnosis for RIM patients seen at GeoSentinel sites. Descriptive statistics were performed. RESULTS Between October 2016 and November 2018, 5,319 RIM patients were evaluated at GeoSentinel sites in 19 countries. Africa was the region of birth for 2,436 patients (46 %), followed by the Americas (1,644, 31 %), and Asia (1,098, 21 %). Tuberculosis (TB) was the most common infection screened and reported as positive (853/2,273, 38 % positive by any method). TB, strongyloidiasis, and hepatitis B surface antigen positivity were observed across all migration administrative categories and regions of birth. Chagas disease was reported only among RIM patients from the Americas (393/394, 100 %) and schistosomiasis predominantly in those from Africa (480/510, 94 %). TB infection (694/5,319, 13 %) and Chagas disease (524/5,319, 10 %) were the leading primary infectious disease diagnoses. CONCLUSIONS Several infections of long latency (e.g. TB, hepatitis B, and strongyloidiasis) with potential for long-term sequelae were seen among RIM patients across all migration administrative categories and regions of origin. Obtaining detailed epidemiologic information from RIM patients is critical to optimize detection of diseases of individual and public health importance, particularly those with long latency periods.
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Affiliation(s)
- Elizabeth D Barnett
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Alyse B Wheelock
- Section of Preventive Medicine and Epidemiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - William B MacLeod
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Anne E McCarthy
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Patricia F Walker
- Department of Medicine, University of Minnesota, HealthPartners Institute, Minnesota, USA
| | - Christina M Coyle
- Department of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christina A Greenaway
- SMBD Jewish General Hospital, Division of Infectious Diseases, McGill University, Montreal, Quebec, Canada
| | - Francesco Castelli
- University Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Lombardy, Italy
| | - Rogelio López-Vélez
- Ramón y Cajal Institute for Health Research, Ramón y Cajal University Hospital, Madrid, Spain
| | - Federico G Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Elena Trigo
- Department of Internal Medicine, National Referral Unit for Imported Tropical Diseases, High Level Isolation Unit, Hospital Universitario La Paz-Carlos III, IdiPAZ, Madrid, Spain
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Philippe Gautret
- VITROME, Aix Marseille University, IRD, AP-HM, SSA, Marseille, France; Institut Méditerranée Infection, Marseille, France
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Susan Kuhn
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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8
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Yamakawa M, Tanaka Y, Tokinobu A, Tsuda T. Preparedness for measles among Japanese travellers to India after the COVID-19 pandemic. J Travel Med 2023; 30:taad086. [PMID: 37369004 DOI: 10.1093/jtm/taad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 06/29/2023]
Abstract
After the Coronavirus Disease of 2019 pandemic, over half of Japanese budget travellers to India did not adequately prepare for measles. Most of those who visited a clinic for travel vaccination missed the opportunity to get vaccinated against measles. For the summer, urgent efforts to ensure travellers’ preparation for measles are required.
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Affiliation(s)
- Michiyo Yamakawa
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Yuko Tanaka
- Graduate School of Engineering, Nagoya Institute of Technology, Gokiso-cho, Showa-ku, Nagoya 466-8555, Japan
| | - Akiko Tokinobu
- Center for Diversity and Inclusion, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Toshihide Tsuda
- Department of Human Ecology, Graduate School of Environmental and Life Science, Okayama University, 3-1-1 Tsushima-naka, Kita-ku, Okayama 700-8530, Japan
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9
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Seers T, Rothe C, Hamer DH, Denny S, Spindler R, Schwartz E, Johnston V. Zika virus infection in European travellers returning from Thailand in 2022: A GeoSentinel case series. Trop Med Int Health 2023; 28:576-579. [PMID: 37269191 DOI: 10.1111/tmi.13900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Zika virus is a mosquito-borne flavivirus which caused major epidemics in the Pacific and the Americas between 2013 and 2015. International travellers have previously acted as a sentinel population for Zika virus transmission in endemic areas, where local transmission may be incompletely captured by local surveillance systems. We report five recent European travellers returning from Thailand with Zika virus infection, highlighting the risk of ongoing endemic transmission in this popular tourist destination.
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Affiliation(s)
- Timothy Seers
- Hospital for Tropical Diseases, University College London Hospitals, London, UK
| | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, LMU University Medical Centre, Munich, Germany
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, USA
- Section of Infectious Diseases, Boston University School of Medicine, Boston, USA
- National Emerging Infectious Disease Laboratory, Boston, USA
| | - Sarah Denny
- Hospital for Tropical Diseases, University College London Hospitals, London, UK
| | - Rahel Spindler
- Division of Infectious Diseases and Tropical Medicine, LMU University Medical Centre, Munich, Germany
| | - Eli Schwartz
- Center for Geographic Medicine, Sheba Medical Center, Tel Ha-Shomer and Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Victoria Johnston
- Hospital for Tropical Diseases, University College London Hospitals, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
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10
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Piyaphanee W, Stoney RJ, Asgeirsson H, Appiah GD, Díaz-Menéndez M, Barnett ED, Gautret P, Libman M, Schlagenhauf P, Leder K, Plewes K, Grobusch MP, Huits R, Mavunda K, Hamer DH, Chen LH. Healthcare seeking during travel: an analysis by the GeoSentinel surveillance network of travel medicine providers. J Travel Med 2023; 30:taad002. [PMID: 36637429 PMCID: PMC10979637 DOI: 10.1093/jtm/taad002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND International travellers may seek care abroad to address health problems that arise during their trip or plan healthcare outside their country of residence as medical tourists. METHODS Data were collected on travellers evaluated at GeoSentinel Network sites who reported healthcare during travel. Both unplanned and planned healthcare were analysed, including the reason and nature of healthcare sought, characteristics of the treatment provided and outcomes. Travellers that presented for rabies post-exposure prophylaxis were described elsewhere and were excluded from detailed analysis. RESULTS From May 2017 through June 2020, after excluding travellers obtaining rabies post-exposure prophylaxis (n= 415), 1093 travellers reported care for a medical or dental issue that was an unanticipated part of the travellers' planned itinerary (unplanned healthcare). Travellers who sought unplanned healthcare abroad had frequent diagnoses of acute diarrhoea, dengue, falciparum malaria and unspecified viral syndrome, and obtained care in 131 countries. Thirty-four (3%) reported subsequent deterioration and 230 (21%) reported no change in condition; a third (n = 405; 37%) had a pre-travel health encounter. Forty-one travellers had sufficient data on planned healthcare abroad for analysis. The most common destinations were the US, France, Dominican Republic, Belgium and Mexico. The top reasons for their planned healthcare abroad were unavailability of procedure at home (n = 9; 19%), expertise abroad (n = 9; 19%), lower cost (n = 8; 17%) and convenience (n = 7; 15%); a third (n = 13; 32%) reported cosmetic or surgical procedures. Early and late complications occurred in 14 (33%) and 4 (10%) travellers, respectively. Four travellers (10%) had a pre-travel health encounter. CONCLUSIONS International travellers encounter health problems during travel that often could be prevented by pre-travel consultation. Travellers obtaining planned healthcare abroad can experience negative health consequences associated with treatments abroad, for which pre-travel consultations could provide advice and potentially help to prevent complications.
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Affiliation(s)
- Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rhett J. Stoney
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Unit of Infectious Diseases, Department of Medicine Huddinge, Stockholm Sweden
| | - Grace D. Appiah
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marta Díaz-Menéndez
- Tropical and Travel Medicine Unit, RICET, Hospital La Paz-Carlos III, Madrid, Spain
| | - Elizabeth D. Barnett
- Section of Pediatric Infectious Diseases, Boston Medical Center; Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille; IHU-Méditerranée Infection, Marseille, France
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
| | - Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers’ Health, Zürich, Switzerland
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University; Victorian Infectious Disease Service, Royal Melbourne Hospital at the Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Katherine Plewes
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ralph Huits
- Department of Infectious Tropical diseases and Microbiology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | | | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine; Center for Emerging Infectious Diseases Research and Policy, Boston University, Boston, MA, USA
| | - Lin H. Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge; Harvard Medical School, Boston, MA, USA
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11
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Grobusch MP, Weld L, Schnyder JL, Larsen CS, Lindner AK, Popescu CP, Huits R, Goorhuis A, Gautret P, Schlagenhauf P. COVID-19 impact on EuroTravNet infectious diseases sentinel surveillance in Europe. Travel Med Infect Dis 2023; 53:102583. [PMID: 37207977 DOI: 10.1016/j.tmaid.2023.102583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/19/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND The COVID-19 pandemic resulted in a sharp decline of post-travel patient encounters at the European sentinel surveillance network (EuroTravNet) of travellers' health. We report on the impact of COVID-19 on travel-related infectious diseases as recorded by EuroTravNet clinics. METHODS Travelers who presented between January 1, 2019 and September 30, 2021 were included. Comparisons were made between the pre-pandemic period (14 months from January 1, 2019 to February 29, 2020); and the pandemic period (19 months from March 1, 2020 to September 30, 2021). RESULTS Of the 15,124 visits to the network during the 33-month observation period, 10,941 (72%) were during the pre-pandemic period, and 4183 (28%) during the pandemic period. Average monthly visits declined from 782/month (pre-COVID-19 era) to 220/month (COVID-19 pandemic era). Among non-migrants the top-10 countries of exposure changed after onset of the COVID-19 pandemic; destinations such as Italy and Austria, where COVID-19 exposure peaked in the first months, replaced typical travel destinations in Asia (Thailand, Indonesia, India). There was a small decline in migrant patients reported, with little change in the top countries of exposure (Bolivia, Mali). The three top diagnoses with the largest overall decreases in relative frequency were acute gastroenteritis (-5.3%), rabies post-exposure prophylaxis (-2.8%), and dengue (-2.6%). Apart from COVID-19 (which rose from 0.1% to 12.7%), the three top diagnoses with the largest overall relative frequency increase were schistosomiasis (+4.9%), strongyloidiasis (+2.7%), and latent tuberculosis (+2.4%). CONCLUSIONS A marked COVID-19 pandemic-induced decline in global travel activities is reflected in reduced travel-related infectious diseases sentinel surveillance reporting.
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Affiliation(s)
- Martin P Grobusch
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Leisa Weld
- Statistical Consultant, Geneva, Switzerland
| | - Jenny L Schnyder
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Andreas K Lindner
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
| | - Corneliu Petru Popescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - A Goorhuis
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Philippe Gautret
- IHU Méditerranée Infection, And Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Patricia Schlagenhauf
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
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12
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Posen HJ, Wong W, Farrar DS, Campigotto A, Chan T, Barker KR, Hagmann SHF, Ryan ET, LaRocque RC, Earl AM, Worby CJ, Castelli F, Fumadó VP, Britton PN, Libman M, Hamer DH, Morris SK. Travel-associated extensively drug-resistant typhoid fever: a case series to inform management in non-endemic regions. J Travel Med 2023; 30:6651791. [PMID: 35904457 DOI: 10.1093/jtm/taac086] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/29/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Extensively drug-resistant (XDR) typhoid fever is a threat to travelers to Pakistan. We describe a multicontinental case series of travel-acquired XDR typhoid fever to demonstrate the global spread of the problem and encourage preventive interventions as well as appropriate empiric antimicrobial use. METHODS Cases were extracted from the GeoSentinel database, microbiologic laboratory records of two large hospitals in Toronto, Canada, and by invitation to TropNet sites. All isolates were confirmed XDR Salmonella enterica serovar Typhi (Salmonella typhi), with resistance to ampicillin, ceftriaxone, ciprofloxacin and trimethoprim-sulfamethoxazole. RESULTS Seventeen cases were identified in Canada (10), USA (2), Spain (2), Italy (1), Australia (1) and Norway (1). Patients under 18 years represented 71% (12/17) of cases, and all patients travelled to Pakistan to visit friends or relatives. Only one patient is known to have been vaccinated. Predominant symptoms were fever, abdominal pain, vomiting and diarrhoea. Antimicrobial therapy was started on Day 1 of presentation in 75% (12/16) of patients, and transition to a carbapenem or azithromycin occurred a median of 2 days after blood culture was drawn. Antimicrobial susceptibilities were consistent with the XDR S. typhi phenotype, and whole genome sequencing on three isolates confirmed their belonging to the XDR variant of the H58 clade. CONCLUSIONS XDR typhoid fever is a particular risk for travelers to Pakistan, and empiric use of a carbapenem or azithromycin should be considered. Pre-travel typhoid vaccination and counseling are necessary and urgent interventions, especially for visiting friends and relatives travelers. Ongoing sentinel surveillance of XDR typhoid fever is needed to understand changing epidemiology.
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Affiliation(s)
- H Joshua Posen
- Department of Paediatrics, Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
| | - Waison Wong
- Department of Paediatric Infectious Diseases and Immunology, Alder Hey Children's Hospital, Liverpool, UK
| | - Daniel S Farrar
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Aaron Campigotto
- Department of Paediatric Laboratory Medicine, Division of Microbiology, Hospital for Sick Children, Toronto, ON, Canada
| | - Tiffany Chan
- Division of Infectious Diseases, Trillium Health Partners, Mississauga, ON, Canada
| | - Kevin R Barker
- Division of Microbiology, Department of Laboratory Medicine and Genetics, Trillium Health Partners, Mississauga, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stefan H F Hagmann
- Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center/Northwell Health, New Hyde Park, NY, USA
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine/Hofstra Northwell, New Hempstead, NY, USA
| | - Edward T Ryan
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Regina C LaRocque
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Ashlee M Earl
- Infectious Disease and Microbiome Program, Broad Institute (Cambridge Massachusetts), MA, USA
| | - Colin J Worby
- Infectious Disease and Microbiome Program, Broad Institute (Cambridge Massachusetts), MA, USA
| | - Francesco Castelli
- Department of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
- ASST Spedali Civili, Brescia, Italy
| | - Victoria Pérez Fumadó
- Infectious Diseases Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain
| | - Philip N Britton
- Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Quebec
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Center for Emerging Infectious Diseases Research and Policy, Boston University, Boston, MA, USA
| | - Shaun K Morris
- Department of Paediatrics, Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, ON, Canada
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Abstract
PURPOSE OF REVIEW Dengue vaccine development is a high public health priority. To date, no dengue vaccine is in widespread use. Here we review the challenges in dengue development and the latest results for the second-generation dengue vaccines. RECENT FINDINGS The biggest hurdle is the immunological interaction between the four antigenically distinct dengue serotypes. The advantages of second-generation dengue vaccines are the inclusion of nonstructural proteins of the dengue backbone and a more convenient dosing with reduced numbers of doses needed. SUMMARY Although dengue-primed individuals can already benefit from vaccination with the first licensed dengue vaccine CYD-TDV, the public health need for the dengue-naive population has not yet been met. The urgent need remains to identify correlates of both protection and enhancement; until such correlates have been identified, all second-generation dengue vaccines still need to go through full phase 3 trials. The 5-year efficacy and safety data for both second-generation dengue vaccines are imminent.
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Affiliation(s)
- Annelies Wilder-Smith
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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14
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Abstract
Purpose of Review West Nile virus (WNV) is an arbovirus transmitted by mosquitos of the genus Culex. Manifestations of WNV infection range from asymptomatic to devastating neuroinvasive disease leading to flaccid paralysis and death. This review examines WNV epidemiology and ecology, with an emphasis on travel-associated infection. Recent Findings WNV is widespread, including North America and Europe, where its range has expanded in the past decade. Rising temperatures in temperate regions are predicted to lead to an increased abundance of Culex mosquitoes and an increase in their ability to transmit WNV. Although the epidemiologic patterns of WNV appear variable, its geographic distribution most certainly will continue to increase. Travelers are at risk for WNV infection and its complications. Literature review identified 39 cases of documented travel-related WNV disease, the majority of which resulted in adverse outcomes, such as neuroinvasive disease, prolonged recovery period, or death. Summary The prediction of WNV risk is challenging due to the complex interactions of vector, pathogen, host, and environment. Travelers planning to visit endemic areas should be advised regarding WNV risk and mosquito bite prevention. Evaluation of ill travelers with compatible symptoms should consider the diagnosis of WNV for those visiting in endemic areas as well as for those returning from destinations with known WNV circulation.
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Travel in the Time of COVID: A Review of International Travel Health in a Global Pandemic. Curr Infect Dis Rep 2022; 24:129-145. [PMID: 35965881 PMCID: PMC9361911 DOI: 10.1007/s11908-022-00784-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/03/2022]
Abstract
Abstract
Purpose of Review
This review critically considers the impact of the COVID-19 pandemic on global travel and the practice of travel medicine, highlights key innovations that have facilitated the resumption of travel, and anticipates how travel medicine providers should prepare for the future of international travel.
Recent Findings
Since asymptomatic transmission of the virus was first recognized in March 2020, extensive efforts have been made to characterize the pattern and dynamics of SARS-CoV-2 transmission aboard commercial aircraft, cruise ships, rail and bus transport, and in mass gatherings and quarantine facilities. Despite the negative impact of further waves of COVID-19 driven by the more transmissible Omicron variant, rapid increases of international tourist arrivals are occurring and modeling anticipates further growth. Mitigation of spread requires an integrated approach that combines masking, physical distancing, improving ventilation, testing, and quarantine. Vaccines and therapeutics have played a significant role in reopening society and accelerating the resumption of travel and further therapeutic innovation is likely.
Summary
COVID-19 is likely to persist as an endemic infection, and surveillance will assume an even more important role. The pandemic has provided an impetus to advance technology for telemedicine, to adopt mobile devices and GPS in contact tracing, and to apply digital applications in research. The future of travel medicine should continue to harness these novel platforms in the clinical, research, and educational arenas.
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16
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Wegrzyn RD, Appiah GD, Morfino R, Milford SR, Walker AT, Ernst ET, Darrow WW, Li SL, Robison K, MacCannell D, Dai D, Girinathan BP, Hicks AL, Cosca B, Woronoff G, Plocik AM, Simen BB, Moriarty L, Guagliardo SAJ, Cetron MS, Friedman CR. Early Detection of Severe Acute Respiratory Syndrome Coronavirus 2 Variants Using Traveler-based Genomic Surveillance at 4 US Airports, September 2021-January 2022. Clin Infect Dis 2022; 76:e540-e543. [PMID: 35686436 PMCID: PMC9214179 DOI: 10.1093/cid/ciac461] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022] Open
Abstract
We enrolled arriving international air travelers in a severe acute respiratory syndrome coronavirus 2 genomic surveillance program. We used molecular testing of pooled nasal swabs and sequenced positive samples for sublineage. Traveler-based surveillance provided early-warning variant detection, reporting the first US Omicron BA.2 and BA.3 in North America.
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Affiliation(s)
- Renee D Wegrzyn
- Correspondence: C. R. Friedman, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop: H16-4, Atlanta, GA 30333 ()
| | - Grace D Appiah
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Allison Taylor Walker
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | | | - Duncan MacCannell
- Office of Advanced Molecular Detection, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dongjuan Dai
- Ginkgo Bioworks, Inc, Boston, Massachusetts, USA
| | | | | | - Bryan Cosca
- Ginkgo Bioworks, Inc, Boston, Massachusetts, USA
| | | | | | | | - Leah Moriarty
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Anne J Guagliardo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Martin S Cetron
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Balogun O, Brown A, Angelo KM, Hochberg NS, Barnett ED, Nicolini LA, Asgeirsson H, Grobusch MP, Leder K, Salvador F, Chen L, Odolini S, Díaz-Menéndez M, Gobbi F, Connor BA, Libman M, Hamer DH. Acute hepatitis A in international travellers: a GeoSentinel analysis, 2008-2020. J Travel Med 2022; 29:6520887. [PMID: 35134210 PMCID: PMC9383360 DOI: 10.1093/jtm/taac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Non-immune international travellers are at risk of acquiring hepatitis A. Although hepatitis A vaccination is recommended for unvaccinated travellers to high or intermediate hepatitis A virus endemicity, compliance with this recommendation is not universal.The main objective was to describe the demographic and travel characteristics of international travellers infected with hepatitis A during travel. METHODS Available data on travellers with confirmed (positive molecular test) or probable (symptomatic individuals with a single positive IgM test) hepatitis A diagnosed during and after travel from January 2008 to December 2020 were obtained from the GeoSentinel Surveillance Network database. We analysed demographic and travel characteristics of infected travellers. RESULTS Among 254 travellers with hepatitis A (185 confirmed and 69 probable), the median age was 28 years (interquartile range: 19-40), 150 (59%) were male, and among 54 travellers with information available, 53 (98%) were unvaccinated. The most common reasons for travel included tourism (n = 120; 47%) and visiting friends or relatives (VFR; n = 72; 28%). About two-thirds of VFR travellers with hepatitis A (n = 50; 69%) were younger than 20 years old. Hepatitis A was acquired most frequently in South-Central Asia (n = 63; 25%) and sub-Saharan Africa (n = 61; 24%), but 16 travellers (6%) acquired hepatitis A in regions with low endemicity including Western Europe (n = 7; 3%), the Caribbean (n = 6; 2%) and North America (n = 3; 1%). Median duration from illness onset to GeoSentinel site presentation was ~7 days (interquartile range : 4-14 days). Among 88 travellers with information available, 59% were hospitalized. CONCLUSIONS Despite availability of highly effective vaccines, travellers still acquire hepatitis A, even when traveling to low-endemicity destinations. Providing pre-departure hepatitis A vaccine to susceptible travellers is crucial to reducing travel-associated hepatitis A and should be offered to all travellers as part of the pre-travel consultation, regardless of destination.
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Affiliation(s)
- Oluwafemi Balogun
- Bureau of Infectious Disease and Laboratory Services, Massachusetts Department of Public Health, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital and Harvard Medical School
| | - Ashley Brown
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristina M Angelo
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Natasha S Hochberg
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Elizabeth D Barnett
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | | | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital and Karolinska Institutet
| | - Martin P Grobusch
- Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, PO Box 22660, Amsterdam, The Netherlands 1100DD
| | - Karin Leder
- Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Melbourne, Australia Infectious Disease Epidemiology Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain
| | - Lin Chen
- Mount Auburn Hospital, Cambridge, MA, and Harvard Medical School, Boston, 02115, MA, USA
| | - Silvia Odolini
- University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| | - Marta Díaz-Menéndez
- National Referral Unit for Imported Tropical Diseases, Tropical & Travel medicine Unit, Infectious Diseases Department, La Paz- Carlos III University Hospital-IdiPAZ, Paseo de la Castellana, 261 28046 Madrid, Spain
| | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Bradley A Connor
- Weill Cornell Medical College and the New York Center for Travel and Tropical Medicine
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, 1001 Decarie Blvd, Montreal, H4A 3J1, Canada
| | - Davidson H Hamer
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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18
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Farnham A, Baroutsou V, Hatz C, Fehr J, Kuenzli E, Blanke U, Puhan MA, Bühler S. Travel behaviours and health outcomes during travel: Profiling destination-specific risks in a prospective mHealth cohort of swiss travellers. Travel Med Infect Dis 2022; 47:102294. [PMID: 35247578 DOI: 10.1016/j.tmaid.2022.102294] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 02/01/2022] [Accepted: 02/28/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND We used a mobile application to determine the incidence of health events and risk behaviours during travel by country and identify which health risks are significantly elevated during travel compared with at home. METHOD TOURIST2 is a prospective cohort study of 1000 adult travellers from Switzerland to Thailand, India, China, Tanzania, Brazil and Peru, planning travel of ≤4 weeks between 09/2017 and 04/2019. The incidence rate ratio (IRR) in each country was calculated. RESULTS All countries had significantly higher incidence of health events than at home. The most elevated symptoms were sunburn, itching from mosquitoes, and gastrointestinal disorders (e.g. vomiting, diarrhoea), corresponding with universally high food/drink risk behaviours. Peru had the highest incidence of both overall negative health events and severe health events (172.0/1000 travel-days). Traffic accidents were significantly higher in Peru (IRR: 2.4, 1.2, 4.7), although incidence of transportation risk was highest in India and Thailand. In Tanzania, incidence of negative mental health events was significantly lower than at home, although it was elevated in other countries. Sexual risk behaviours were high in Brazil. CONCLUSIONS Our study improves the understanding of the non-infectious disease related health challenges travellers face and provides evidence for more personalised traveller support.
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Affiliation(s)
- Andrea Farnham
- Department of Public Health & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001, Zurich, Switzerland; Swiss Tropical and Public Health Institute, CH-4123, Basel, Switzerland; University of Basel, CH-4004, Basel, Switzerland.
| | - Vasiliki Baroutsou
- Department of Public Health & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001, Zurich, Switzerland; Department of Clinical Research, Faculty of Medicine, University of Basel, 4055, Basel, Switzerland
| | - Christoph Hatz
- Department of Public Health & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001, Zurich, Switzerland; Swiss Tropical and Public Health Institute, CH-4123, Basel, Switzerland; University of Basel, CH-4004, Basel, Switzerland
| | - Jan Fehr
- Department of Public Health & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001, Zurich, Switzerland
| | - Esther Kuenzli
- Department of Public Health & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001, Zurich, Switzerland; Swiss Tropical and Public Health Institute, CH-4123, Basel, Switzerland; University of Basel, CH-4004, Basel, Switzerland
| | - Ulf Blanke
- ETH Zurich, Swiss Federal Institute of Technology, 8092, Zurich, Switzerland
| | - Milo A Puhan
- Department of Public Health & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001, Zurich, Switzerland
| | - Silja Bühler
- Department of Public Health & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001, Zurich, Switzerland; Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, 20359, Hamburg, Germany; Division of Hygiene and Infectious Diseases, Institute of Hygiene and Environment, 20539, Hamburg, Germany
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19
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Clinical accuracy of malaria loop-mediated isothermal amplification assay as a stand-alone screening tool at a non-endemic Northern California regional health system. Diagn Microbiol Infect Dis 2022; 103:115680. [DOI: 10.1016/j.diagmicrobio.2022.115680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/18/2022] [Accepted: 03/04/2022] [Indexed: 11/17/2022]
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20
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Wilder-Smith A, Brickley EB, Ximenes RADA, Miranda-Filho DDB, Turchi Martelli CM, Solomon T, Jacobs BC, Pardo CA, Osorio L, Parra B, Lant S, Willison HJ, Leonhard S, Turtle L, Ferreira MLB, de Oliveira Franca RF, Lambrechts L, Neyts J, Kaptein S, Peeling R, Boeras D, Logan J, Dolk H, Orioli IM, Neumayr A, Lang T, Baker B, Massad E, Preet R. The legacy of ZikaPLAN: a transnational research consortium addressing Zika. Glob Health Action 2021; 14:2008139. [PMID: 35377284 PMCID: PMC8986226 DOI: 10.1080/16549716.2021.2008139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Global health research partnerships with institutions from high-income countries and low- and middle-income countries are one of the European Commission's flagship programmes. Here, we report on the ZikaPLAN research consortium funded by the European Commission with the primary goal of addressing the urgent knowledge gaps related to the Zika epidemic and the secondary goal of building up research capacity and establishing a Latin American-European research network for emerging vector-borne diseases. Five years of collaborative research effort have led to a better understanding of the full clinical spectrum of congenital Zika syndrome in children and the neurological complications of Zika virus infections in adults and helped explore the origins and trajectory of Zika virus transmission. Individual-level data from ZikaPLAN`s cohort studies were shared for joint analyses as part of the Zika Brazilian Cohorts Consortium, the European Commission-funded Zika Cohorts Vertical Transmission Study Group, and the World Health Organization-led Zika Virus Individual Participant Data Consortium. Furthermore, the legacy of ZikaPLAN includes new tools for birth defect surveillance and a Latin American birth defect surveillance network, an enhanced Guillain-Barre Syndrome research collaboration, a de-centralized evaluation platform for diagnostic assays, a global vector control hub, and the REDe network with freely available training resources to enhance global research capacity in vector-borne diseases.
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Affiliation(s)
- Annelies Wilder-Smith
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Tom Solomon
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | - Bart C Jacobs
- Departments of Neurology and Immunology, Erasmus Universitair Medisch Centrum Rotterdam, The Netherlands
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | | - Suzannah Lant
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | - Hugh J Willison
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Sonja Leonhard
- Departments of Neurology and Immunology, Erasmus Universitair Medisch Centrum Rotterdam, The Netherlands
| | - Lance Turtle
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | | | | | - Louis Lambrechts
- Insect-Virus Interactions Unit, Institut Pasteur, UMR2000, CNRS, 75015 Paris, France
| | - Johan Neyts
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Suzanne Kaptein
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Rosanna Peeling
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - James Logan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, Institute for Nursing and Health Research, Ulster University, Ulster, United Kingdom
| | - Ieda M Orioli
- RELAMC and ECLAMC at Genetics Department, Federal University of Rio de Janeiro, Brazil
| | - Andreas Neumayr
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Trudie Lang
- The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Bonny Baker
- The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Eduardo Massad
- School of Medicine, University of Sao Paulo and Fundacao Getulio Vargas, Sao Paulo, Brazil
| | - Raman Preet
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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21
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Abstract
PURPOSE OF REVIEW Antimicrobial resistance (AMR) in bacteria poses a major risk to global public health, with many factors contributing to the observed increase in AMR. International travel is one recognized contributor. The purpose of this review is to summarize current knowledge regarding the acquisition, carriage and spread of AMR bacteria by international travelers. RECENT FINDINGS Recent studies have highlighted that travel is an important risk factor for the acquisition of AMR bacteria, with approximately 30% of studied travelers returning with an acquired AMR bacterium. Epidemiological studies have shown there are three major risk factors for acquisition: travel destination, antimicrobial usage and travelers' diarrhea (TD). Analyses have begun to illustrate the AMR genes that are acquired and spread by travelers, risk factors for acquisition and carriage of AMR bacteria, and local transmission of imported AMR organisms. SUMMARY International travel is a contributor to the acquisition and dissemination of AMR organisms globally. Efforts to reduce the burden of AMR organisms should include a focus on international travelers. Routine genomic surveillance would further elucidate the role of international travel in the global spread of AMR bacteria.
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Affiliation(s)
- Sushmita Sridhar
- Division of Infectious Diseases, Massachusetts General Hospital
- Department of Medicine, Harvard Medical School
| | - Sarah E. Turbett
- Division of Infectious Diseases, Massachusetts General Hospital
- Department of Medicine, Harvard Medical School
- Department of Pathology
| | - Jason B. Harris
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital
- Department of Medicine, Harvard Medical School
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22
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Volpedo G, Huston RH, Holcomb EA, Pacheco-Fernandez T, Gannavaram S, Bhattacharya P, Nakhasi HL, Satoskar AR. From infection to vaccination: reviewing the global burden, history of vaccine development, and recurring challenges in global leishmaniasis protection. Expert Rev Vaccines 2021; 20:1431-1446. [PMID: 34511000 DOI: 10.1080/14760584.2021.1969231] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Leishmaniasis is a major public health problem and the second most lethal parasitic disease in the world due to the lack of effective treatments and vaccines. Even when not lethal, leishmaniasis significantly affects individuals and communities through life-long disabilities, psycho-sociological trauma, poverty, and gender disparity in treatment. AREAS COVERED This review discusses the most relevant and recent research available on Pubmed and GoogleScholar highlighting leishmaniasis' global impact, pathogenesis, treatment options, and lack of effective control strategies. An effective vaccine is necessary to prevent morbidity and mortality, lower health care costs, and reduce the economic burden of leishmaniasis for endemic low- and middle-income countries. Since there are several forms of leishmaniasis, a pan-Leishmania vaccine without geographical restrictions is needed. This review also focuses on recent advances and common challenges in developing prophylactic strategies against leishmaniasis. EXPERT OPINION Despite advances in pre-clinical vaccine research, approval of a human leishmaniasis vaccine still faces major challenges - including manufacturing of candidate vaccines under Good Manufacturing Practices, developing well-designed clinical trials suitable in endemic countries, and defined correlates of protection. In addition, there is a need to explore Challenge Human Infection Model to avoid large trials because of fluctuating incidence and prevalence of leishmanasis.
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Affiliation(s)
- Greta Volpedo
- Departments of Pathology and Microbiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Ryan H Huston
- Departments of Pathology and Microbiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Erin A Holcomb
- Departments of Pathology and Microbiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Thalia Pacheco-Fernandez
- Departments of Pathology and Microbiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Sreenivas Gannavaram
- Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Parna Bhattacharya
- Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Hira L Nakhasi
- Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Abhay R Satoskar
- Departments of Pathology and Microbiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
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