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Kasamatsu A, Kanou K, Fukusumi M, Arima Y, Omori S, Nakamura H, Sato T, Serizawa Y, Takeda A, Fujikura H, Ikenoue C, Nishiki S, Fujiya Y, Arashiro T, Takahashi T, Shimada T, Suzuki M, Sunagawa T. Epidemiologic Trends and Distributions of Imported Infectious Diseases Among Travelers to Japan Before and During the COVID-19 Pandemic, 2016 to 2021: A Descriptive Study. J Epidemiol 2024; 34:187-194. [PMID: 37331795 PMCID: PMC10918336 DOI: 10.2188/jea.je20230025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Little is known about the trends of imported infectious diseases among travelers to non-endemic countries during the novel coronavirus disease 2019 (COVID-19) pandemic. This article aimed to describe those among travelers to Japan. METHODS This is a descriptive study based on national surveillance data. Imported infectious disease cases were defined as those with a reported overseas source of infection among 15 diseases pre-selected based on the probability and impact of importation. The number of notified cases from April 2016 to March 2021 were described by disease and time of diagnosis. The relative ratio and absolute difference in case counts-both by number and per arrival-were calculated by disease comparing those from the pandemic period (April 2020-March 2021) to the pre-pandemic period (April 2016-March 2020). RESULTS A total of 3,524 imported infectious disease cases were diagnosed during the study period, including 3,439 cases before and 85 cases during the pandemic. The proportionate distribution of diseases changed but notification counts of all 15 diseases decreased during the pandemic. Accounting for arrivals, however, seven diseases showed a two-fold or greater increase, with a notable absolute increase per million arrivals for amebiasis (60.1; 95% confidence interval [CI], 41.5-78.7), malaria (21.7; 95% CI, 10.5-33.0), and typhoid fever (9.3; 95% CI, 1.9-16.8). CONCLUSION The epidemiology of imported infectious diseases changed during the pandemic. While the number of imported infectious disease cases decreased, the number of cases per arrivals increased considerably both in relative and absolute terms for several diseases of public health and clinical importance.
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Affiliation(s)
- Ayu Kasamatsu
- Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan
| | | | | | - Yuzo Arima
- National Institute of Infectious Diseases, Tokyo, Japan
| | - Shun Omori
- Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Tetsuro Sato
- National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Asuka Takeda
- National Institute of Infectious Diseases, Tokyo, Japan
| | | | | | | | | | | | | | - Tomoe Shimada
- National Institute of Infectious Diseases, Tokyo, Japan
| | - Motoi Suzuki
- National Institute of Infectious Diseases, Tokyo, Japan
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McMahon R, Fuchs U, Schneider M, Hadl S, Hochreiter R, Bitzer A, Kosulin K, Koren M, Mader R, Zoihsl O, Wressnigg N, Dubischar K, Buerger V, Eder-Lingelbach S, Jaramillo JC. A randomized, double-blinded Phase 3 study to demonstrate lot-to-lot consistency and to confirm immunogenicity and safety of the live-attenuated chikungunya virus vaccine candidate VLA1553 in healthy adults†. J Travel Med 2024; 31:taad156. [PMID: 38091981 PMCID: PMC10911060 DOI: 10.1093/jtm/taad156] [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: 10/12/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND The global spread of the chikungunya virus (CHIKV) increases the exposure risk for individuals travelling to or living in endemic areas. This Phase 3 study was designed to demonstrate manufacturing consistency between three lots of the single shot live-attenuated CHIKV vaccine VLA1553, and to confirm the promising immunogenicity and safety data obtained in previous trials. METHODS This randomized, double-blinded, lot-to-lot consistency, Phase 3 study, assessed immunogenicity and safety of VLA1553 in 408 healthy adults (18-45 years) in 12 sites across the USA. The primary endpoint was a comparison of the geometric mean titre (GMT) ratios of CHIKV-specific neutralizing antibodies between three VLA1553 lots at 28 days post-vaccination. Secondary endpoints included immunogenicity and safety over 6 months post-vaccination. RESULTS GMTs were comparable between the lots meeting the acceptance criteria for equivalence. The average GMT (measured by 50% CHIKV micro plaque neutralization test; μPRNT50) peaked with 2643 at 28 days post-vaccination and decreased to 709 at 6 months post-vaccination. An excellent seroresponse rate (defined as μPRNT50 titre ≥ 150 considered protective) was achieved in 97.8% of participants at 28 days post-vaccination and still persisted in 96% at 6 months after vaccination. Upon VLA1553 immunization, 72.5% of participants experienced adverse events (AEs), without significant differences between lots (related solicited systemic AE: 53.9% of participants; related solicited local AE: 19.4%). Overall, AEs were mostly mild or moderate and resolved without sequela, usually within 3 days. With 3.9% of participants experiencing severe AEs, 2.7% were classified as related, whereas none of the six reported serious adverse events was related to the administration of VLA1553. CONCLUSIONS All three lots of VLA1553 recapitulated the safety and immunogenicity profiles of a preceding Phase 3 study, fulfilling pre-defined consistency requirements. These results highlight the manufacturability of VLA1553, a promising vaccine for the prevention of CHIKV disease for those living in or travelling to endemic areas.
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Affiliation(s)
| | | | | | | | | | | | | | - Michael Koren
- Walter Reed Army Institute of Research, Bethesda, MD, USA
| | - Robert Mader
- CRETA GmbH, Campus Vienna Biocenter 3, 1030 Vienna, Austria
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Ren J, Ling F, Liu Y, Sun J. Chikungunya in Zhejiang Province, Southeast China. INFECTIOUS MEDICINE 2023; 2:315-323. [PMID: 38205180 PMCID: PMC10774776 DOI: 10.1016/j.imj.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/04/2023] [Accepted: 11/13/2023] [Indexed: 01/12/2024]
Abstract
Background Chikungunya is emerging and reemerging word-widely in the past decades. It is non-endemic in Zhejiang Province, Southeast China. Aedes albopictus, one of major vectors of chikungunya, is widely-distribution in Zhejiang, and autochthonous transmission is possible after introducing chikungunya virus. Methods Retrospectively collected the epidemiological, clinical and genetic data of chikungunya and conducted the descriptive analysis and gene sequence analysis. Results From 2008 to 2022, 29 chikungunya cases, including 26 overseas imported and 3 local cases, were reported and no cases died of chikungunya. More than half of the imported cases (53.85%) were from Southeast Asia. Seasonal peak of the imported cases was noted between August and September, and 42.31% cases onset in those 2 months. Eight prefecture-level cities and 16 counties reported cases during the study period, with Jinghua (27.59%) and Hangzhou (24.14%) reporting the largest number of cases. The 3 local cases were all reported in Qujiang, Quzhou in 2017. For imported cases, the male-female gender ratio was 2.71:1, 20-30 years old cases (46.15%) and commercial service (42.31%) accounted for the highest proportion. Clinically, fever (100%), fatigue (94.44%), arthralgia (79.17%), headache (71.43%) and erythra (65.22%) were the most common reported symptoms. Eight whole-genome sequences were obtained and belonged to East/Central/South African (ECSA) or Asian genotype. Conclusions With the change of immigration policy, the surveillance of chikungunya should be strengthened and the ability of the case discovery and diagnosis should be improved in Zhejiang in the post-COVID-19 era.
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Affiliation(s)
- Jiangping Ren
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou 310051, China
- Zhejiang Provincial Station of Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Hangzhou 310051, China
| | - Feng Ling
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou 310051, China
- Zhejiang Provincial Station of Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Hangzhou 310051, China
| | - Ying Liu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Jimin Sun
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou 310051, China
- Zhejiang Provincial Station of Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Hangzhou 310051, China
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Ren J, Chen Z, Ling F, Liu Y, Chen E, Shi X, Guo S, Zhang R, Wang Z, Sun J. The epidemiology of Aedes-borne arboviral diseases in Zhejiang, Southeast China: a 20 years population-based surveillance study. Front Public Health 2023; 11:1270781. [PMID: 37942243 PMCID: PMC10629596 DOI: 10.3389/fpubh.2023.1270781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023] Open
Abstract
Objective Aedes-borne arboviral diseases were important public health problems in Zhejiang before the coronavirus disease 2019 (COVID-19) pandemic. This study was conducted to investigate the characteristics and change of the epidemiology of Aedes-borne arboviral diseases in the province. Methods Descriptive analyses were conducted to summarize the epidemiology of Aedes-borne arboviral diseases during 2003-2022. Results A total of 3,125 cases, including 1,968 indigenous cases, were reported during 2003-2022. Approximately three-quarters of imported cases were infected from Southeast Asia. The number of annual imported cases increased during 2013-2019 (R2 = 0.801, p = 0.004) and peaked in 2019. When compared with 2003-2012, all prefecture-level cities witnessed an increase in the annual mean incidence of imported cases in 2013-2019 (0.11-0.42 per 100,000 population vs. 0-0.05 per 100,000 population) but a drastic decrease during 2020-2022 (0-0.03 per 100,000 population). The change in geographical distribution was similar, with 33/91 counties during 2003-2012, 86/91 during 2013-2019, and 14/91 during 2020-2022. The annual mean incidence of indigenous cases in 2013-2019 was 7.79 times that in 2003-2012 (0.44 vs. 0.06 per 100,000 population). No indigenous cases were reported between 2020-2022. Geographical extension of indigenous cases was also noted before 2020-from two counties during 2003-2012 to 44 during 2013-2019. Conclusion Dengue, chikungunya fever, zika disease, and yellow fever are not endemic in Zhejiang but will be important public health problems for the province in the post-COVID-19 era.
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Affiliation(s)
- Jiangping Ren
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
- Zhejiang Provincial Station of Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Hangzhou, China
| | - Zhiping Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Feng Ling
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
- Zhejiang Provincial Station of Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Hangzhou, China
| | - Ying Liu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Enfu Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
- Zhejiang Provincial Station of Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Hangzhou, China
| | - Xuguang Shi
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Song Guo
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Rong Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Zhen Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jimin Sun
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
- Zhejiang Provincial Station of Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Hangzhou, China
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Min KD, Kim SY, Cho YY, Kim S, Yeom JS. Potential applicability of the importation risk index for predicting the risk of rarely imported infectious diseases. BMC Public Health 2023; 23:1776. [PMID: 37700251 PMCID: PMC10496286 DOI: 10.1186/s12889-023-16380-6] [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: 12/27/2022] [Accepted: 07/25/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND There have been many prediction studies for imported infectious diseases, employing air-travel volume or the importation risk (IR) index, which is the product of travel-volume and disease burden in the source countries, as major predictors. However, there is a lack of studies validating the predictability of the variables especially for infectious diseases that have rarely been reported. In this study, we analyzed the prediction performance of the IR index and air-travel volume to predict disease importation. METHODS Rabies and African trypanosomiasis were used as target diseases. The list of rabies and African trypanosomiasis importation events, annual air-travel volume between two specific countries, and incidence of rabies and African trypanosomiasis in the source countries were obtained from various databases. RESULTS Logistic regression analysis showed that IR index was significantly associated with rabies importation risk (p value < 0.001), but the association with African trypanosomiasis was not significant (p value = 0.923). The univariable logistic regression models showed reasonable prediction performance for rabies (area under curve for Receiver operating characteristic [AUC] = 0.734) but poor performance for African trypanosomiasis (AUC = 0.641). CONCLUSIONS Our study found that the IR index cannot be generally applicable for predicting rare importation events. However, it showed the potential utility of the IR index by suggesting acceptable performance in rabies models. Further studies are recommended to explore the generalizability of the IR index's applicability and to propose disease-specific prediction models.
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Affiliation(s)
- Kyung-Duk Min
- College of Veterinary Medicine, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju, 28644, South Korea
| | - Sun-Young Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea.
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea.
| | - Yoon Young Cho
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea
| | - Seyoung Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea
| | - Joon-Sup Yeom
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Mourad O, Makhani L, Chen LH. Chikungunya: An Emerging Public Health Concern. Curr Infect Dis Rep 2022; 24:217-228. [DOI: 10.1007/s11908-022-00789-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/18/2022]
Abstract
Abstract
Purpose of Review
The worldwide spread of chikungunya over the past two decades calls for greater knowledge and awareness of the virus, its route of transmission, methods of diagnosis, and the use of available treatment and prevention measures.
Recent Findings
Chikungunya virus infection, an Aedes mosquito-borne febrile disease, has spread from Africa and Asia to Europe and the Americas and from the tropics and subtropics to temperate regions. International travel is a pivotal influence in the emergence of chikungunya as a global public health threat, as evidenced by a growing number of published reports on travel-related chikungunya infections. The striking features of chikungunya are arthralgia and arthritis, and the disease is often mistaken for dengue. Although mortality is low, morbidity can be profound and persistent. Current treatment for chikungunya is supportive; chikungunya vaccines and therapeutics are in development. Travelers planning to visit areas where the mosquito vectors are present should be advised on preventive measures.
Summary
Chikungunya is an emerging disease in the Americas. Frequent travel, the presence of at least two competent mosquito species, and a largely naïve human population in the Western Hemisphere create a setting conducive to future outbreaks. Awareness of the disease and its manifestations is critical to effectively and safely manage and limit its impact. Vaccines in late-stage clinical trials offer a new pathway to prevention.
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Dickens BL, Koo JR, Lim JT, Sun H, Clapham HE, Wilder-Smith A, Cook AR. Strategies at points of entry to reduce importation risk of COVID-19 cases and reopen travel. J Travel Med 2020; 27:5897021. [PMID: 32841354 PMCID: PMC7499710 DOI: 10.1093/jtm/taaa141] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND With more countries exiting lockdown, public health safety requires screening measures at international travel entry points that can prevent the reintroduction or importation of the severe acute respiratory syndrome-related coronavirus-2. Here, we estimate the number of cases captured, quarantining days averted and secondary cases expected to occur with screening interventions. METHODS To estimate active case exportation risk from 153 countries with recorded coronavirus disease-2019 cases and deaths, we created a simple data-driven framework to calculate the number of infectious and upcoming infectious individuals out of 100 000 000 potential travellers from each country, and assessed six importation risk reduction strategies; Strategy 1 (S1) has no screening on entry, S2 tests all travellers and isolates test-positives where those who test negative at 7 days are permitted entry, S3 the equivalent but for a 14 day period, S4 quarantines all travellers for 7 days where all are subsequently permitted entry, S5 the equivalent for 14 days and S6 the testing of all travellers and prevention of entry for those who test positive. RESULTS The average reduction in case importation across countries relative to S1 is 90.2% for S2, 91.7% for S3, 55.4% for S4, 91.2% for S5 and 77.2% for S6. An average of 79.6% of infected travellers are infectious upon arrival. For the top 100 exporting countries, an 88.2% average reduction in secondary cases is expected through S2 with the 7-day isolation of test-positives, increasing to 92.1% for S3 for 14-day isolation. A substantially smaller reduction of 30.0% is expected for 7-day all traveller quarantining, increasing to 84.3% for 14-day all traveller quarantining. CONCLUSIONS The testing and isolation of test-positives should be implemented provided good testing practices are in place. If testing is not feasible, quarantining for a minimum of 14 days is recommended with strict adherence measures in place.
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Affiliation(s)
- Borame L Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 1E Kent Ridge Rd, Singapore 117549
| | - Joel R Koo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 1E Kent Ridge Rd, Singapore 117549
| | - Jue Tao Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 1E Kent Ridge Rd, Singapore 117549
| | - Haoyang Sun
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 1E Kent Ridge Rd, Singapore 117549
| | - Hannah E Clapham
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 1E Kent Ridge Rd, Singapore 117549
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK.,Heidelberg Institute of Global Health, University of Heidelberg, Im Neuenheimer Feld 365, R. 004, 69120 Heidelberg, Germany
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 1E Kent Ridge Rd, Singapore 117549
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Osman S, Preet R. Dengue, chikungunya and Zika in GeoSentinel surveillance of international travellers: a literature review from 1995 to 2020. J Travel Med 2020; 27:6007546. [PMID: 33258476 DOI: 10.1093/jtm/taaa222] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION GeoSentinel is a global surveillance network of travel medicine providers seeing ill-returned travellers. Much of our knowledge on health problems and infectious encountered by international travellers has evolved as a result of GeoSentinel surveillance, providing geographic and temporal trends in morbidity among travellers while contributing to improved pre-travel advice. We set out to synthesize epidemiological information, clinical manifestations and time trends for dengue, chikungunya and Zika in travellers as captured by GeoSentinel. METHODS We conducted a systematic literature search in PubMed on international travellers who presented with dengue, chikungunya or Zika virus infections to GeoSentinel sites around the world from 1995 until 2020. RESULTS Of 107 GeoSentinel publications, 42 articles were related to dengue, chikungunya and/or Zika. The final analyses and synthesis of and results presented here are based on the findings from 27 original articles covering the three arboviral diseases. CONCLUSIONS Dengue is the most frequent arboviral disease encountered in travellers presenting to GeoSentinel sites, with increasing trends over the past two decades. In Southeast Asia, annual proportionate morbidity increased from 50 dengue cases per 1000 ill returned travellers in non-epidemic years to an average of 159 cases per 1000 travellers during epidemic years. The highest number of travellers with chikungunya virus infections was reported during the chikungunya outbreak in the Americas and the Caribbean in the years 2013-16. Zika was first reported by GeoSentinel already in 2012, but notifications peaked in the years 2016-17 reflecting the public health emergency in the Americas at the time.
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Affiliation(s)
- S Osman
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, 90185, Sweden
| | - R Preet
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, 90185, Sweden
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9
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Daon Y, Thompson RN, Obolski U. Estimating COVID-19 outbreak risk through air travel. J Travel Med 2020; 27:5851816. [PMID: 32502274 PMCID: PMC7313812 DOI: 10.1093/jtm/taaa093] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Substantial limitations have been imposed on passenger air travel to reduce transmission of severe acute respiratory syndrome coronavirus 2 between regions and countries. However, as case numbers decrease, air travel will gradually resume. We considered a future scenario in which case numbers are low and air travel returns to normal. Under that scenario, there will be a risk of outbreaks in locations worldwide due to imported cases. We estimated the risk of different locations acting as sources of future coronavirus disease 2019 outbreaks elsewhere. METHODS We use modelled global air travel data and population density estimates from locations worldwide to analyse the risk that 1364 airports are sources of future coronavirus disease 2019 outbreaks. We use a probabilistic, branching-process-based approach that considers the volume of air travelers between airports and the reproduction number at each location, accounting for local population density. RESULTS Under the scenario we model, we identify airports in East Asia as having the highest risk of acting as sources of future outbreaks. Moreover, we investigate the locations most likely to cause outbreaks due to air travel in regions that are large and potentially vulnerable to outbreaks: India, Brazil and Africa. We find that outbreaks in India and Brazil are most likely to be seeded by individuals travelling from within those regions. We find that this is also true for less vulnerable regions, such as the United States, Europe and China. However, outbreaks in Africa due to imported cases are instead most likely to be initiated by passengers travelling from outside the continent. CONCLUSIONS Variation in flight volumes and destination population densities creates a non-uniform distribution of the risk that different airports pose of acting as the source of an outbreak. Accurate quantification of the spatial distribution of outbreak risk can therefore facilitate optimal allocation of resources for effective targeting of public health interventions.
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Affiliation(s)
- Yair Daon
- School of Public Health, Tel Aviv University, Tel Aviv, Israel
- Porter School of the Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Robin N Thompson
- Mathematical Institute, University of Oxford, Oxford, UK
- Christ Church, University of Oxford, Oxford, UK
| | - Uri Obolski
- School of Public Health, Tel Aviv University, Tel Aviv, Israel
- Porter School of the Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
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Maljkovic Berry I, Rutvisuttinunt W, Sippy R, Beltran-Ayala E, Figueroa K, Ryan S, Srikanth A, Stewart-Ibarra AM, Endy T, Jarman RG. The origins of dengue and chikungunya viruses in Ecuador following increased migration from Venezuela and Colombia. BMC Evol Biol 2020; 20:31. [PMID: 32075576 PMCID: PMC7031975 DOI: 10.1186/s12862-020-1596-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/11/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In recent years, Ecuador and other South American countries have experienced an increase in arboviral diseases. A rise in dengue infections was followed by introductions of chikungunya and Zika, two viruses never before seen in many of these areas. Furthermore, the latest socioeconomic and political instability in Venezuela and the mass migration of its population into the neighboring countries has given rise to concerns of infectious disease spillover and escalation of arboviral spread in the region. RESULTS We performed phylogeographic analyses of dengue (DENV) and chikungunya (CHIKV) virus genomes sampled from a surveillance site in Ecuador in 2014-2015, along with genomes from the surrounding countries. Our results revealed at least two introductions of DENV, in 2011 and late 2013, that initially originated from Venezuela and/or Colombia. The introductions were subsequent to increases in the influx of Venezuelan and Colombian citizens into Ecuador, which in 2013 were 343% and 214% higher than in 2009, respectively. However, we show that Venezuela has historically been an important source of DENV dispersal in this region, even before the massive exodus of its population, suggesting already established paths of viral distribution. Like DENV, CHIKV was introduced into Ecuador at multiple time points in 2013-2014, but unlike DENV, these introductions were associated with the Caribbean. Our findings indicated no direct CHIKV connection between Ecuador, Colombia, and Venezuela as of 2015, suggesting that CHIKV was, at this point, not following the paths of DENV spread. CONCLUSION Our results reveal that Ecuador is vulnerable to arbovirus import from many geographic locations, emphasizing the need of continued surveillance and more diversified prevention strategies. Importantly, increase in human movement along established paths of viral dissemination, combined with regional outbreaks and epidemics, may facilitate viral spread and lead to novel virus introductions. Thus, strengthening infectious disease surveillance and control along migration routes and improving access to healthcare for the vulnerable populations is of utmost importance.
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Affiliation(s)
- Irina Maljkovic Berry
- Viral Diseases Branch, Walter Reed Army institute of Research, Silver Spring, MD, USA.
| | - Wiriya Rutvisuttinunt
- Viral Diseases Branch, Walter Reed Army institute of Research, Silver Spring, MD, USA
| | - Rachel Sippy
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Efrain Beltran-Ayala
- Department of Medicine, Technical University of Machala, Machala, El Oro, Ecuador
| | - Katherine Figueroa
- Viral Diseases Branch, Walter Reed Army institute of Research, Silver Spring, MD, USA
| | - Sadie Ryan
- Quantitative Disease Ecology and Conservation (QDEC) Lab, Department of Geography, University of Florida, Gainesville, FL, USA.,Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Abhinaya Srikanth
- Viral Diseases Branch, Walter Reed Army institute of Research, Silver Spring, MD, USA
| | - Anna M Stewart-Ibarra
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA.,Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.,Department of Montevideo, InterAmerican Institute for Global Change Research (IAI), Montevideo, Uruguay
| | - Timothy Endy
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.,Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Richard G Jarman
- Viral Diseases Branch, Walter Reed Army institute of Research, Silver Spring, MD, USA
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Werner SL, Banda BK, Burnsides CL, Stuber AJ. Zoonosis: Update on Existing and Emerging Vector-Borne Illnesses in the USA. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2019; 7:91-106. [PMID: 32288973 PMCID: PMC7102350 DOI: 10.1007/s40138-019-00189-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This review describes mosquito- and tick-borne diseases found in the Western Hemisphere. It focuses on emerging diseases and recent geographic shifts in the presence of disease vectors. RECENT FINDINGS Mosquito and tick vectors have become more widespread as environmental conditions have become more favorable. Zika recently has emerged as a concern for fetal anomalies. West Nile Virus has become widespread. Lyme disease and other tick-borne diseases are more prevalent in areas previously inhospitable to these ticks. SUMMARY Healthcare providers must consider the possibility of mosquito- and tick-borne diseases in broader geographic areas and council patients traveling to endemic areas on precautions against these diseases. Treatment for suspected cases of serious tick-borne illnesses should not be delayed pending culture results.
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Affiliation(s)
- Sandra Lee Werner
- MetroHealth/Cleveland Clinic/CWRU Emergency Medicine Residency Program, Department of Emergency Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109 USA
| | - Bhanu Kirthi Banda
- MetroHealth/Cleveland Clinic/CWRU Emergency Medicine Residency Program, Department of Emergency Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109 USA
| | - Christopher Lee Burnsides
- MetroHealth/Cleveland Clinic/CWRU Emergency Medicine Residency Program, Department of Emergency Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109 USA
| | - Alexander James Stuber
- MetroHealth/Cleveland Clinic/CWRU Emergency Medicine Residency Program, Department of Emergency Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109 USA
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