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Satarvandi D, van der Werff SD, Nauclér P, Hildenwall H, Sondén K. Scoring systems for prediction of malaria and dengue fever in non-endemic areas among travellers arriving from tropical and subtropical areas. Emerg Med J 2024; 41:242-248. [PMID: 38355290 PMCID: PMC10982626 DOI: 10.1136/emermed-2023-213296] [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] [Received: 04/19/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Fever is a common symptom among travellers returning from tropical/subtropical areas to Europe, and promptly distinguishing severe illnesses from self-limiting febrile syndromes is important but can be challenging due to non-specific clinical presentation. METHODS A cross-sectional study enrolled adults and children who sought care during 2015-2020 at Karolinska University Hospital, Stockholm, Sweden with fever within 2 months after returning from travel to a tropical/subtropical area. Data on symptoms and laboratory parameters were prospectively and retrospectively collected. Two separate scoring systems for malaria and dengue were developed based on backward elimination regressions. RESULTS In total, 2113 adults (18-94 years) and 202 children (1-17 years) were included, with 112 (4.8%) confirmed malaria by blood thick smear and 90 (3.9%) PCR/serology dengue-positive cases. Malaria was more likely in a patient who had visited sub-Saharan Africa and presented with combination of thrombocytopenia, anaemia and fever ≥39.5°C. Leucopenia, muscle pain and rash after travelling to Asia or South/Latin America indicated high probability of dengue. Two scoring systems with points between 0 and 7 for prediction of malaria or dengue were created based on the above predictors. Scores ≥3 indicated >80% sensitivity and specificity for malaria and >90% specificity for dengue in children and adults (area under the curve (AUC) for dengue: 0.92 in adults (95% CI 0.90 to 0.95) and 0.95 in children (95% CI 0.88 to 1.0); AUC for malaria: 0.93 in adults (95% CI 0.91 to 0.96) and 0.88 in children (95% CI 0.78 to 0.99)). Internal validation of optimism and overfitting was managed with bootstrap. CONCLUSION The presented scoring systems provide novel tools for structured assessment of patients with tropical fever in a non-endemic area and highlight clinical signs associated with a potential severe aetiology to direct the need for microbial investigation.
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Affiliation(s)
- Donya Satarvandi
- Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Suzanne Desirée van der Werff
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Nauclér
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Hildenwall
- Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Karolinska Institute, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Klara Sondén
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
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Paz-Bailey G, Adams LE, Deen J, Anderson KB, Katzelnick LC. Dengue. Lancet 2024; 403:667-682. [PMID: 38280388 DOI: 10.1016/s0140-6736(23)02576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 11/01/2023] [Accepted: 11/15/2023] [Indexed: 01/29/2024]
Abstract
Dengue, caused by four closely related viruses, is a growing global public health concern, with outbreaks capable of overwhelming health-care systems and disrupting economies. Dengue is endemic in more than 100 countries across tropical and subtropical regions worldwide, and the expanding range of the mosquito vector, affected in part by climate change, increases risk in new areas such as Spain, Portugal, and the southern USA, while emerging evidence points to silent epidemics in Africa. Substantial advances in our understanding of the virus, immune responses, and disease progression have been made within the past decade. Novel interventions have emerged, including partially effective vaccines and innovative mosquito control strategies, although a reliable immune correlate of protection remains a challenge for the assessment of vaccines. These developments mark the beginning of a new era in dengue prevention and control, offering promise in addressing this pressing global health issue.
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Affiliation(s)
| | - Laura E Adams
- Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Jacqueline Deen
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Kathryn B Anderson
- Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Leah C Katzelnick
- Viral Epidemiology and Immunity Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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3
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McGuinness SL, Leder K. Dengue severity in travellers: challenges and insights. J Travel Med 2023; 30:taad146. [PMID: 37991398 PMCID: PMC10755200 DOI: 10.1093/jtm/taad146] [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: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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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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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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Avrami S, Hoffman T, Meltzer E, Lustig Y, Schwartz E. Comparison of clinical and laboratory parameters of primary vs secondary dengue fever in travellers. J Travel Med 2023; 30:taad129. [PMID: 37877966 DOI: 10.1093/jtm/taad129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Dengue fever (DF), caused by the dengue virus (DENV), is the most common arboviral disease in travellers worldwide. It is hypothesized that compared with primary DF, secondary DF may result in antibody-dependent enhancement of the immune response, resulting in more severe disease. We aimed to compare clinical and laboratory parameters in travellers with primary and secondary DF to determine whether secondary DF is associated with markers of severe disease. METHODS We conducted a retrospective cohort study, which included all patients diagnosed with DF at the Central Virology Laboratory of the Israeli Ministry of Health during 2008-19. Clinical, laboratory and virological data were extracted from laboratory and patient records. A diagnosis of DENV infection was based on a positive nonstructural protein 1 (NS1) test, polymerase chain reaction or serology testing for immunoglobulin M (IgM) and immunoglobulin G (IgG). Primary and secondary infections were classified based on travel history, NS1 result and IgM/IgG ratio. Severe DF was defined according to WHO classification. RESULTS We identified 245 DF cases: 210 (86%) primary and 35 (14%) secondary. Whilst fever duration was significantly longer in secondary compared with primary infections (6.4 vs 5.3 days, P = 0.027), mean Aspartate aminotransferase levels were significantly higher in primary compared with secondary cases (146 vs 65 U/L, P < 0.001), and no other clinical or laboratory parameter differed significantly between the groups. Of note, only four patients had severe DF, all had primary infections and none died. CONCLUSIONS In a cohort of returning travellers with DF, secondary infection, compared with primary infection, was not associated with a consistent trend towards greater severity of the clinical and laboratory markers examined in this study.
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Affiliation(s)
- Sharon Avrami
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Hoffman
- Infectious Diseases Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Eyal Meltzer
- Internal Medicine Department C, Sheba Medical Center, Ramat Gan, Israel
| | - Yaniv Lustig
- Central Virology Laboratory, Ministry of Health, Tel Hashomer, Israel
| | - Eli Schwartz
- Center of Geographic Medicine and Tropical Disease, Sheba Medical Center, Ramat Gan, Israel
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7
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Amatya B, Schwartz E, Biber A, Erster O, Lustig Y, Pradhan R, Khadka B, Pandey P. Dengue serotype characterization during the 2022 dengue epidemic in Kathmandu, Nepal. J Travel Med 2023; 30:taad034. [PMID: 36971480 DOI: 10.1093/jtm/taad034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/02/2023] [Accepted: 03/24/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Bhawana Amatya
- CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal
| | - Eli Schwartz
- The Center for Travel and Tropical Medicine, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Biber
- The Center for Travel and Tropical Medicine, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oran Erster
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yaniv Lustig
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Bhawani Khadka
- CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal
| | - Prativa Pandey
- CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal
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8
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Desmet S, Henckaerts L, Ombelet S, Damanet B, Vanbrabant P. Imported diseases in travellers presenting to the emergency department after a stay in a malaria-endemic country: a retrospective observational study. Trop Dis Travel Med Vaccines 2023; 9:3. [PMID: 36803441 PMCID: PMC9939251 DOI: 10.1186/s40794-023-00190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 02/06/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND We aimed to investigate the aetiology and outcomes of illnesses in patients presenting to an emergency department after travelling to a malaria-endemic country, in order to raise awareness of both tropical and cosmopolitan diseases. METHODS A retrospective chart review was performed for all patients who underwent blood smear testing for malaria at the Emergency Department of the University Hospitals Leuven from 2017 to 2020. Patient characteristics, results of laboratory and radiological examinations, diagnoses, disease course and outcome were collected and analysed. RESULTS A total of 253 patients were included in the study. The majority of ill travellers returned from Sub-Saharan Africa (68.4%) and Southeast Asia (19.4%). Their diagnoses fell into three major syndrome categories: systemic febrile illness (30.8%), inflammatory syndrome of unknown origin (23.3%) and acute diarrhoea (18.2%). Malaria (15.8%) was the most common specific diagnosis in patients with systemic febrile illness, followed by influenza (5.1%), rickettsiosis (3.2%), dengue (1.6%), enteric fever (0.8%), chikungunya (0.8%) and leptospirosis (0.8%). The presence of hyperbilirubinemia and thrombocytopenia increased the probability of malaria, with a likelihood ratio of 4.01 and 6.03, respectively. Seven patients (2.8%) were treated in the intensive care unit, and none died. CONCLUSION Systemic febrile illness, inflammatory syndrome of unknown origin and acute diarrhoea were the three major syndromic categories in returning travellers presenting to our emergency department after a stay in a malaria-endemic country. Malaria was the most common specific diagnosis in patients with systemic febrile illness. None of the patients died.
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Affiliation(s)
- Sofie Desmet
- grid.410569.f0000 0004 0626 3338Department of General Internal Medicine, KU Leuven, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Liesbet Henckaerts
- grid.410569.f0000 0004 0626 3338Department of General Internal Medicine, KU Leuven, University Hospitals Leuven, Herestraat 49, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Department of Microbiology, Immunology and Transplantation, KU Leuven, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Sien Ombelet
- grid.410569.f0000 0004 0626 3338Department of Laboratory Medicine, KU Leuven, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Benjamin Damanet
- grid.8767.e0000 0001 2290 8069School of Public Health, Free University of Brussels, Brussels, Belgium ,grid.489075.70000 0001 2287 089XNational Institute for Health and Disability Insurance (NIHDI), Brussels, Belgium
| | - Peter Vanbrabant
- Department of General Internal Medicine, KU Leuven, University Hospitals Leuven, Herestraat 49, Leuven, Belgium.
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Serum biomarkers and anti-flavivirus antibodies at presentation as indicators of severe dengue. PLoS Negl Trop Dis 2023; 17:e0010750. [PMID: 36848385 PMCID: PMC9997924 DOI: 10.1371/journal.pntd.0010750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 03/09/2023] [Accepted: 02/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Dengue is the most common vector-borne viral disease worldwide. Most cases are mild, but some evolve into severe dengue (SD), with high lethality. Therefore, it is important to identify biomarkers of severe disease to improve outcomes and judiciously utilize resources. METHODS/PRINCIPAL FINDINGS One hundred forty-five confirmed dengue cases (median age, 42; range <1-91 years), enrolled from February 2018 to March 2020, were selected from an ongoing study of suspected arboviral infections in metropolitan Asunción, Paraguay. Cases included dengue virus types 1, 2, and 4, and severity was categorized according to the 2009 World Health Organization guidelines. Testing for anti-dengue virus IgM and IgG and serum biomarkers (lipopolysaccharide binding protein and chymase) was performed on acute-phase sera in plate-based ELISAs; in addition, a multiplex ELISA platform was used to measure anti-dengue virus and anti-Zika virus IgM and IgG. Complete blood counts and chemistries were performed at the discretion of the care team. Age, gender, and pre-existing comorbidities were associated with SD vs. dengue with/without warning signs in logistic regression with odds ratios (ORs) of 1.07 (per year; 95% confidence interval, 1.03, 1.11), 0.20 (female; 0.05,0.77), and 2.09 (presence; 1.26, 3.48) respectively. In binary logistic regression, for every unit increase in anti-DENV IgG in the multiplex platform, odds of SD increased by 2.54 (1.19-5.42). Platelet count, lymphocyte percent, and elevated chymase were associated with SD in a combined logistic regression model with ORs of 0.99 (1,000/μL; 0.98,0.999), 0.92 (%; 0.86,0.98), and 1.17 (mg/mL; 1.03,1.33) respectively. CONCLUSIONS Multiple, readily available factors were associated with SD in this population. These findings will aid in the early detection of potentially severe dengue cases and inform the development of new prognostics for use in acute-phase and serial samples from dengue cases.
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Ligsay AD, Regencia ZJG, Tambio KJM, Aytona MJM, Generale AJA, Alejandro GJD, Tychuaco JS, De las Llagas LA, Baja ES, Paul REL. Efficacy Assessment of Autodissemination Using Pyriproxyfen-Treated Ovitraps in the Reduction of Dengue Incidence in Parañaque City, Philippines: A Spatial Analysis. Trop Med Infect Dis 2023; 8:66. [PMID: 36668973 PMCID: PMC9864649 DOI: 10.3390/tropicalmed8010066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Dengue is one of the most important vector-borne diseases worldwide and is a significant public health problem in the tropics. Mosquito control continues to be the primary approach to reducing the disease burden and spread of dengue virus (DENV). Aside from the traditional larviciding and adulticiding interventions, autodissemination using pyriproxyfen-treated (AD-PPF) ovitraps is one of the promising methods to complement existing vector control strategies. Our paper assessed the efficacy of AD-PPF in reducing DENV infections in two barangays in Parañaque City. Using saliva samples from the participants from both the control and intervention sites, we collected the seroprevalence data for three months in each of the two years. Spatial analysis was conducted to determine hotspot areas and identify DENV infection distributions across the trial periods. The results showed that the intervention site was identified as having a clustering of DENV infections in Month 0 of Year 1 and shifted to a random dispersion of dengue cases at the end of Month 3 in Year 2. The disappearance of the clustering of the intervention site translates to a decrease in the cases of DENV infection relative to the control site. Furthermore, we also identified that DENV transmission occurred at a small-scale level that did not go beyond 86 m. In conclusion, AD-PPF is suggested to be an effective strategy and may be used as an additional vector control approach, albeit based on this short-term implementation.
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Affiliation(s)
- Antonio D. Ligsay
- The Graduate School, University of Santo Tomas España Blvd., Manila 1008, Philippines
- Clinical Research Section, St. Luke’s College of Medicine—William H. Quasha Memorial, 279 E. Rodriguez Sr. Ave, Quezon City 1112, Philippines
- Department of Biological Sciences, College of Science, University of Santo Tomas España Blvd., Manila 1008, Philippines
| | - Zypher Jude G. Regencia
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, 623 Pedro Gil St., Ermita, Manila 1000, Philippines
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Pedro Gil Street, Taft Ave, Ermita, Manila 1000, Philippines
| | - Kristan Jela M. Tambio
- Clinical Research Section, St. Luke’s College of Medicine—William H. Quasha Memorial, 279 E. Rodriguez Sr. Ave, Quezon City 1112, Philippines
| | - Michelle Joyce M. Aytona
- Clinical Research Section, St. Luke’s College of Medicine—William H. Quasha Memorial, 279 E. Rodriguez Sr. Ave, Quezon City 1112, Philippines
| | - Alain Jason A. Generale
- Clinical Research Section, St. Luke’s College of Medicine—William H. Quasha Memorial, 279 E. Rodriguez Sr. Ave, Quezon City 1112, Philippines
| | - Grecebio Jonathan D. Alejandro
- The Graduate School, University of Santo Tomas España Blvd., Manila 1008, Philippines
- Department of Biological Sciences, College of Science, University of Santo Tomas España Blvd., Manila 1008, Philippines
| | - Jacquiline S. Tychuaco
- The Graduate School, University of Santo Tomas España Blvd., Manila 1008, Philippines
- Department of Biology, College of Science, Polytechnic University of the Philippines, Anonas St., Santa Mesa, Manila 1016, Philippines
| | - Lilian A. De las Llagas
- Department of Parasitology, College of Public Health, University of the Philippines Manila 625 Pedro Gil St., Ermita, Manila 1000, Philippines
| | - Emmanuel S. Baja
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, 623 Pedro Gil St., Ermita, Manila 1000, Philippines
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Pedro Gil Street, Taft Ave, Ermita, Manila 1000, Philippines
| | - Richard Edward L. Paul
- Institut Pasteur, Université de Paris, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 2000, Ecology and Emergence of Arthropod-Borne Pathogens Unit, 75015 Paris, France
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Trojánek M, Grebenyuk V, Manďáková Z, Sojková N, Zelená H, Roháčová H, Stejskal F. Epidemiology of dengue, chikungunya and Zika virus infections in travellers: A 16-year retrospective descriptive study at a tertiary care centre in Prague, Czech Republic. PLoS One 2023; 18:e0281612. [PMID: 36809441 PMCID: PMC9942961 DOI: 10.1371/journal.pone.0281612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 01/26/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION This study aims to describe the epidemiological characteristics of imported cases of dengue (DEN), chikungunya (CHIK), and Zika virus (ZIKV) infections in Czech travellers. MATERIALS AND METHODS This single-centre descriptive study has retrospectively analysed data of patients with laboratory confirmed DEN, CHIK, and ZIKV infections diagnosed at the Department of Infectious, Parasitic and Tropical Diseases of the University Hospital Bulovka in Prague, Czech Republic from 2004 to 2019. RESULTS The study included a total of 313 patients with DEN, 30 with CHIK, and 19 with ZIKV infections. Most patients travelled as tourists:263 (84.0%), 28 (93.3%), and 17 (89.5%), respectively (p = 0.337). The median duration of stay was 20 (IQR 14-27), 21 (IQR 14-29), and 15 days (IQR 14-43), respectively (p = 0.935). Peaks of imported DEN and ZIKV infections were noted in 2016, and in 2019 in the case of CHIK infection. Most cases of DEN and CHIKV infections were acquired in Southeast Asia:212 (67.7%) and 15 (50%), respectively, while ZIKV infection was most commonly imported from the Caribbean (11; 57,9%). CONCLUSIONS Arbovirus infections represent an increasingly significant cause of illness in Czech travellers. Comprehensive knowledge of the specific epidemiological profile of these diseases is an essential prerequisite for good travel medicine practice.
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Affiliation(s)
- Milan Trojánek
- Department of Infectious Diseases, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Infectious Diseases, University Hospital Bulovka, Prague, Czech Republic
- Department of Infectious Diseases and Travel Medicine, University Hospital Motol, Prague, Czech Republic
| | - Vyacheslav Grebenyuk
- Department of Infectious Diseases, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Infectious Diseases, University Hospital Bulovka, Prague, Czech Republic
- Department of Infectious Diseases and Travel Medicine, University Hospital Motol, Prague, Czech Republic
- * E-mail:
| | - Zdenka Manďáková
- Department of Epidemiology of Infectious Diseases, National Institute of Public Health, Prague, Czech Republic
| | - Naděžda Sojková
- Department of Clinical Microbiology, University Hospital Bulovka, Prague, Czech Republic
| | - Hana Zelená
- National Reference Laboratory for Arboviruses, Institute of Public Health in Ostrava, Czech Republic
| | - Hana Roháčová
- Department of Infectious Diseases, University Hospital Bulovka, Prague, Czech Republic
| | - František Stejskal
- Department of Infectious Diseases, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Infectious Diseases, University Hospital Bulovka, Prague, Czech Republic
- Institute of Immunology and Microbiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Infectious Diseases, Regional Hospital Liberec, Liberec, Czech Republic
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Sousa SCD, Silva TAMD, Soares AN, Carneiro M, Barbosa DS, Bezerra JMT. Factors associated with deaths from dengue in a city in a metropolitan region in Southeastern Brazil: a case-control study. Rev Soc Bras Med Trop 2022; 55:e0043. [PMID: 36169487 DOI: 10.1590/0037-8682-0043-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/01/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Dengue is a public health problem in Brazil. Therefore, this study aimed to analyze factors associated with deaths from dengue in residents of the municipality of Contagem, Metropolitan Region of Belo Horizonte, state of Minas Gerais, Brazil, during the 2016 epidemic. METHODS To determine the factors associated with deaths due to dengue, we used a logistic regression model (univariate and multivariable) in which the response variable (outcome) was death due to dengue. Independent variables analyzed included demographic variables and those related to symptoms, treatment, hospitalization, testing, comorbidities, and case history. RESULTS The factors associated with dengue deaths in the final multivariable model [p < 0.05; 95% confidence interval (CI)] were age (OR = 1.07; 95%CI 1.03-1.11) and presence of bleeding (OR = 8.55; 95%CI 1.21-59.92). CONCLUSIONS The results showed that age and the presence of bleeding factors increased the risk of dengue death. These findings indicate that warning signs of dengue should be routinely monitored, and patients should be instructed to seek medical attention when they occur. It is also emphasized that the parameters and epidemiological conditions of dengue patients need to be continuously investigated to avoid a fatal outcome.
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Affiliation(s)
- Selma Costa de Sousa
- Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Parasitologia, Belo Horizonte, MG, Brasil
| | | | - Aleida Nazareth Soares
- Faculdade Santa Casa BH, Programa de Pós-Graduação Stricto Sensu em Medicina-Biomedicina, Belo Horizonte, MG, Brasil
| | - Mariângela Carneiro
- Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Parasitologia, Belo Horizonte, MG, Brasil.,Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Infectologia e Medicina Tropical, Belo Horizonte, MG, Brasil.,Universidade Federal de Ouro Preto, Núcleo de Pesquisas em Ciências Biológicas, Programa de Pós-Graduação em Ciências Biológicas, Ouro Preto, MG, Brasil
| | - David Soeiro Barbosa
- Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Parasitologia, Belo Horizonte, MG, Brasil
| | - Juliana Maria Trindade Bezerra
- Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Parasitologia, Belo Horizonte, MG, Brasil.,Universidade Estadual do Maranhão, Centro de Estudos Superiores de Lago da Pedra, Curso de Licenciatura em Ciências Biológicas, Lago da Pedra, MA, Brasil.,Universidade Estadual do Maranhão, Centro de Ciências Agrárias, Programa de Pós-Graduação em Ciência Animal, São Luís, MA, Brasil
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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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Meltzer E, Sharon A, Lustig Y, Schwartz E. Incidence of dengue fever in Israeli travelers 2008-2019. Travel Med Infect Dis 2022; 48:102330. [PMID: 35447321 DOI: 10.1016/j.tmaid.2022.102330] [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: 10/31/2021] [Revised: 03/28/2022] [Accepted: 04/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND . Dengue virus (DENV) is a frequent travel-related infection, but longitudinal data on its incidence is limited. We aimed to study temporal trends of travel-related DENV burden and its geographical sources. METHODS . All cases of laboratory-confirmed DENV infection diagnosed at the Central Virology Laboratory of the Israeli Ministry of Health during 2008-2019 were evaluated. Numbers of Israeli tourist-entries to DENV endemic countries were available from the UN World Tourist Organization (UNWTO) database. DENV attack rates were calculated as cases per 100,000 traveler-entries. In addition, for Thailand and India incidence rates were calculated, using the average duration of stay reported in diagnosed DENV cases. RESULTS . During 2008-2019, 425 Israeli travelers were diagnosed with DENV: 80.3%, 12.8% and 6.9% were acquired in Asia, America and Africa respectively. The average global DENV attack rate increased from 2.5 cases per 100,000 tourist-entries in 2008 to 10.7 cases per 100,000 tourist-entries in 2019. Region-specific DENV attack rates were 4.4, 3.2 and 2.1 cases per 100,000 tourist-entries to Asia, Africa, and America respectively. The highest number of DENV cases were reported from Thailand and India; DENV incidence rates increased from 94.5 to 142.2 cases per 100,000 travel-years, and from 49.3 to 90.4 cases per 100,000 travel-years for Thailand and India respectively. CONCLUSION . Among Israeli travelers, worldwide DENV attack-rates have quadrupled during 2008-2019, reflecting both a growing DENV burden in Asia, but also the emergence of Africa as an important source of DENV. The need to protect travelers through vaccination remains urgent.
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Affiliation(s)
- Eyal Meltzer
- From the Center for Geographic Medicine and Department of Medicine C, Israel; The Sheba Medical Center, Tel Hashomer, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Avrami Sharon
- The Sheba Medical Center, Tel Hashomer, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Lustig
- The Central Virology Laboratory, Ministry of Health, Israel
| | - Eli Schwartz
- From the Center for Geographic Medicine and Department of Medicine C, Israel; The Sheba Medical Center, Tel Hashomer, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
Despite COVID-19-related disruptions in controlling dengue, efforts need to be maintained to prevent vector-borne diseases during this pandemic. Although travel restrictions brought a global halt to mobility and therefore also a substantial decline of imported and travel-associated dengue, dengue will become dominant again in travel medicine as soon as international travel resumes.
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Affiliation(s)
- Annelies Wilder-Smith
- Institute of Social and Preventive Medicine, University of Bern, Switzerland.,Heidelberg Institute of Global Health, University of Heidelberg Germany
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Vellere I, Di Lauria N, Mantella A, Cavallo A, Bresci S, Bartoloni A, Zammarchi L. Atypical imported severe primary dengue presenting with neutrophilic leukocytosis and cardiac tamponade in a young female traveler. J Travel Med 2021; 28:6274744. [PMID: 33987662 DOI: 10.1093/jtm/taab074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/14/2022]
Abstract
We report an atypical imported severe primary dengue presenting with neutrophilic leukocytosis, elevated inflammatory markers, myopericarditis and cardiac tamponade. Dengue Fever (DF) cannot be excluded in patients presenting with neutrophilic leukocytosis and elevated inflammatory markers which may anticipate severe dengue with myocardial involvement.
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Affiliation(s)
- Iacopo Vellere
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Nicoletta Di Lauria
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Antonia Mantella
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Annalisa Cavallo
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Silvia Bresci
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
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