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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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Sundling C, Yman V, Mousavian Z, Angenendt S, Foroogh F, von Horn E, Lautenbach MJ, Grunewald J, Färnert A, Sondén K. Disease-specific plasma protein profiles in patients with fever after traveling to tropical areas. Eur J Immunol 2024; 54:e2350784. [PMID: 38308504 DOI: 10.1002/eji.202350784] [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: 09/21/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/04/2024]
Abstract
Fever is common among individuals seeking healthcare after traveling to tropical regions. Despite the association with potentially severe disease, the etiology is often not determined. Plasma protein patterns can be informative to understand the host response to infection and can potentially indicate the pathogen causing the disease. In this study, we measured 49 proteins in the plasma of 124 patients with fever after travel to tropical or subtropical regions. The patients had confirmed diagnoses of either malaria, dengue fever, influenza, bacterial respiratory tract infection, or bacterial gastroenteritis, representing the most common etiologies. We used multivariate and machine learning methods to identify combinations of proteins that contributed to distinguishing infected patients from healthy controls, and each other. Malaria displayed the most unique protein signature, indicating a strong immunoregulatory response with high levels of IL10, sTNFRI and II, and sCD25 but low levels of sCD40L. In contrast, bacterial gastroenteritis had high levels of sCD40L, APRIL, and IFN-γ, while dengue was the only infection with elevated IFN-α2. These results suggest that characterization of the inflammatory profile of individuals with fever can help to identify disease-specific host responses, which in turn can be used to guide future research on diagnostic strategies and therapeutic interventions.
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Affiliation(s)
- Christopher Sundling
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Victor Yman
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Stockholm South Hospital, Stockholm, Sweden
| | - Zaynab Mousavian
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sina Angenendt
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Fariba Foroogh
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ellen von Horn
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Maximilian Julius Lautenbach
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Grunewald
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Respiratory Medicine Unit, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
| | - Anna Färnert
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Klara Sondén
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Pennino F, Fiorilla C, Sorrentino M, Armonia U, Parisi A, Mirizzi PD, Di Lillo M, De Silva O, Montuori P, Triassi M, Nardone A. Investigating Awareness Regarding Travel-Related Infectious Disease Prevention in a Metropolitan Area. Trop Med Infect Dis 2023; 8:476. [PMID: 37888604 PMCID: PMC10611143 DOI: 10.3390/tropicalmed8100476] [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: 09/26/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
The rise in international travel has led to an increase in travel-related infectious diseases. It is predicted that by 2030, the number of international travelers will reach 1.8 billion, with over 250 million people affected globally. This issue also has an economic impact, as the eradication of travel-related infectious diseases leads to a loss of USD 12 billion in tourism. To understand the association between demographic variables and knowledge, attitude, and behaviors related to travel-related infectious diseases, a cross-sectional survey-based study was conducted among 1191 individuals in the metropolitan city of Naples, Italy. Multiple linear regression was performed over three models. The results revealed that knowledge about travel-related infectious diseases was positively associated with age, female gender, non-smoking habits, being single, and higher education attainment. The attitude towards travel-related infectious diseases was positively associated with being female, non-smoking habits, being single, higher education attainment, and a higher level of knowledge. A statistically significant association was observed between behaviors and non-smoking habits and between higher levels of knowledge and attitudes. To address this issue, public health programs could be implemented to improve behaviors in the general population. Overall, this study provides valuable information about the determinants of knowledge, attitude, and behaviors related to travel-related infectious diseases in the general population.
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Affiliation(s)
- Francesca Pennino
- Department of Public Health, “Federico II” University, Via Sergio Pansini No. 5, 80131 Naples, Italy
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Maulana MR, Yudhastuti R, Lusno MFD, Mirasa YA, Haksama S, Husnina Z. Climate and visitors as the influencing factors of dengue fever in Badung District of Bali, Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2023; 33:924-935. [PMID: 35435067 DOI: 10.1080/09603123.2022.2065249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/07/2022] [Indexed: 06/14/2023]
Abstract
Badung district has recorded the highest dengue fever (DF) in Bali Province. This research presents the distribution of DF in Badung district and analyses its association with climate and visitors. The monthly data of DF, climate and number of visitors during January 2013 to December 2017 were analysed using Poisson Regression. A total of 10,689 new DF cases were notified from January 2013 to December 2017. DF in 2016 was recorded as the heaviest incidence. Monthly DF cases have positive association with average temperature (0.59 (95% CI: 0.56-.62)), precipitation (5.7 x 10-4 (95% CI: 3.8 x 10-4 - 7.6 x 10-4)), humidity (.014 (95% CI: 0.003-.025)) and local visitors (7.40 x 10-6 95% CI: 5.88 x 10-6 : 8.91 x 10-6). Negative association was shown between DF cases with foreign visitors (-2.18 x 10-6 (95% CI: -2.50 x 10-6 : -1.87 x 10-6)). This study underlines the urgency to integrate climate and tourism for DF surveillance.
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Affiliation(s)
- Mochamad Rizal Maulana
- Department of Environmental Health, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Ririh Yudhastuti
- Department of Environmental Health, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- Research Center for Tropical Diseases, Infectious Diseases and Herbal Medicine, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Muhammad Farid Dimjati Lusno
- Department of Environmental Health, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- Research Center for Tropical Diseases, Infectious Diseases and Herbal Medicine, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | | | - Setya Haksama
- Department of Health Administration and Policy, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Zida Husnina
- Department of Environmental Health, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- Research Center for Tropical Diseases, Infectious Diseases and Herbal Medicine, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Acute liver failure in a young patient with dengue shock syndrome: a case report. Ann Med Surg (Lond) 2023; 85:286-290. [PMID: 36845760 PMCID: PMC9949865 DOI: 10.1097/ms9.0000000000000237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/25/2022] [Indexed: 02/28/2023] Open
Abstract
Dengue fever is caused by dengue virus, which has four different serotypes and is transmitted by the Aedes mosquitos. This disease is endemic to Southeast Asian countries, including Nepal. Liver involvement in dengue is a crucial feature, and the effect ranges from an asymptomatic rise in liver enzymes to the development of acute liver failure. Acute liver failure often results in multiorgan dysfunction including hemodynamic instability, renal failure, cerebral edema, and even death because of shock. Prompt diagnosis and management are necessary to prevent complications. However, there is no proven proper treatment for this condition, and the only treatment modality is to prevent the symptoms. We presented the case of a young female with dengue fever who developed a life-threatening acute liver failure because of dengue shock syndrome.
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Matono T, Izumiya H, Koga H, Kaku M, Ohnishi M, Morita M. Epidemiologic and genomic investigations of an unusual increase in Salmonella enterica serovar Paratyphi A infection among travelers returning from Myanmar in 2015. Int J Infect Dis 2022; 125:170-176. [PMID: 36397608 DOI: 10.1016/j.ijid.2022.10.034] [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: 06/24/2022] [Revised: 10/11/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES An unusual increase in Salmonella enterica serovar Paratyphi A infection rate in Japanese travelers returning from Myanmar was observed in 2015. METHODS We analyzed epidemiologic data of returned travelers with enteric fever from 2005-2019. We also analyzed 193 Salmonella Paratyphi A isolates, including 121 isolates with published genomes. RESULTS Annual notification trends showed a rapid increase in Salmonella Paratyphi A infection in travelers returning from Myanmar in 2015: 2-4 cases/100,000 travelers in 2012-2014 and 13 cases/100,000 travelers in 2015 (P <0.001). The genomic analyses revealed that 11 Myanmar-related isolates in 2015 formed a tight cluster in clade 3 with a single nucleotide variant (SNV) distance of 0-11 (primarily 0-7), yielding a wider SNV range than outbreak-associated isolates from Cambodia in 2013 (0-6 SNVs) or China in 2010 (0-5 SNVs). Although all Cambodia-related isolates in 2013 harbored the wild-type gyrA sequence, all Myanmar-related isolates in 2015 had a single, identical mutation (Ser83Phe) in the gyrA gene. CONCLUSION The epidemiologic and molecular investigations suggested an increase in the infection rate with genetically closely related Salmonella Paratyphi A in travelers returning from Myanmar in 2015. Careful monitoring of the infection in Myanmar as an endemic country is warranted, considering the resumption of cross-border travel during the COVID-19 pandemic.
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Affiliation(s)
- Takashi Matono
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan; Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Infectious Diseases, Aso Iizuka Hospital, Iizuka, Japan
| | - Hidemasa Izumiya
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hidenobu Koga
- Clinical Research Support Office, Aso Iizuka Hospital, Iizuka, Japan
| | - Mitsuo Kaku
- Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masatomo Morita
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan.
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Riccò M, Zaniboni A, Satta E, Baldassarre A, Cerviere MP, Marchesi F, Peruzzi S. Management and Prevention of Traveler's Diarrhea: A Cross-Sectional Study on Knowledge, Attitudes, and Practices in Italian Occupational Physicians (2019 and 2022). Trop Med Infect Dis 2022; 7:370. [PMID: 36422921 PMCID: PMC9692574 DOI: 10.3390/tropicalmed7110370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 07/29/2023] Open
Abstract
Even though Italian Occupational Physicians (OP) are increasingly involved in the managing of overseas workers, their knowledge, attitudes, and practices (KAP) in travel medicine are mostly undefined. We, therefore, permed a KAP study specifically targeting the management of travelers' diarrhea (TD) by OP. A total of 371 professionals (43.4% males; mean age 40.8 ± 10.9 years) completed in 2 rounds (2019 and 2022) a specifically designed web questionnaire that inquired participating OP on their knowledge status (KS), risk perception, and management of TD through pre- and post-travel advice and interventions. Multivariable odds ratios (aOR) for predictors of a better knowledge status were calculated through regression analysis. Eventually, the majority of participants (53.4%) had participated in the management of cases of TD in the previous months, but only 26.4% were reportedly involved in pre-travel consultations. The overall knowledge status was unsatisfying (potential range: 0-100%, actual average of the sample 59.6% ± 14.6), with substantial uncertainties in the management of antimicrobial treatment. Interestingly, only a small subset of participants had previously prescribed antimicrobial prophylaxis or treatment (3.5% and 1.9%, respectively). Main effectors of a better knowledge status were: having a background qualification in Hygiene and Public Health (aOR 14.769, 95%CI 5.582 to 39.073), having previously managed any case of (aOR 3.107, 95%CI 1.484 to 6.506), and having higher concern on TD, reported by acknowledging high frequency (aOR 8.579, 95%CI 3.383 to 21.756) and severity (aOR 3.386; 95%CI 1.741 to 6.585) of this disorder. As the adherence of participating OP to official recommendations for TD management was unsatisfying, continuous Education on Travel Medicine should be improved by sharing up-to-date official recommendations on appropriate treatment options for TD.
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Affiliation(s)
- Matteo Riccò
- Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Department of Public Health, AUSL-IRCCS di Reggio Emilia, I-42122 Reggio Emilia, Italy
| | - Alessandro Zaniboni
- Department of Medicine and Surgery, University of Parma, I-43126 Parma, Italy
| | - Elia Satta
- Department of Medicine and Surgery, University of Parma, I-43126 Parma, Italy
| | - Antonio Baldassarre
- Department of Experimental and Clinical Medicine, University of Florence, I-50134 Florence, Italy
| | | | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, I-43126 Parma, Italy
| | - Simona Peruzzi
- Laboratorio Analisi Chimico Cliniche e Microbiologiche, Ospedale Civile di Guastalla, AUSL-IRCCS di Reggio Emilia, I-42016 Guastalla, Italy
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9
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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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10
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Metagenomic Sequencing for the Diagnosis of Plasmodium spp. with Different Levels of Parasitemia in EDTA Blood of Malaria Patients—A Proof-of-Principle Assessment. Int J Mol Sci 2022; 23:ijms231911150. [PMID: 36232449 PMCID: PMC9569645 DOI: 10.3390/ijms231911150] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Molecular diagnostic approaches are increasingly included in the diagnostic workup and even in the primary diagnosis of malaria in non-endemic settings, where it is difficult to maintain skillful microscopic malaria detection due to the rarity of the disease. Pathogen-specific nucleic acid amplification, however, bears the risk of overlooking other pathogens associated with febrile illness in returnees from the tropics. Here, we assessed the discriminatory potential of metagenomic sequencing for the identification of different Plasmodium species with various parasitemia in EDTA blood of malaria patients. Overall, the proportion of Plasmodium spp.-specific sequence reads in the assessed samples showed a robust positive correlation with parasitemia (Spearman r = 0.7307, p = 0.0001) and a robust negative correlation with cycle threshold (Ct) values of genus-specific real-time PCR (Spearman r = −0.8626, p ≤ 0.0001). Depending on the applied bioinformatic algorithm, discrimination on species level was successful in 50% (11/22) to 63.6% (14/22) instances. Limiting factors for the discrimination on species level were very low parasitemia, species-depending lacking availability of reliable reference genomes, and mixed infections with high variance of the proportion of the infecting species. In summary, metagenomic sequencing as performed in this study is suitable for the detection of malaria in human blood samples, but the diagnostic detection limit for a reliable discrimination on species level remains higher than for competing diagnostic approaches like microscopy and PCR.
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11
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Hyle EP, Le MH, Rao SR, Mulroy NM, Walker AT, Ryan ET, LaRocque RC. High-risk US international travelers seeking pretravel consultation during the COVID-19 pandemic. Open Forum Infect Dis 2022; 9:ofac399. [PMID: 36000001 PMCID: PMC9384642 DOI: 10.1093/ofid/ofac399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background To assess the implications of coronavirus disease 2019 (COVID-19)–related travel disruptions, we compared demographics and travel-related circumstances of US travelers seeking pretravel consultation regarding international travel at US Global TravEpiNet (GTEN) sites before and after the initiation of COVID-19 travel warnings. Methods We analyzed data in the GTEN database regarding traveler demographics and travel-related circumstances with standard questionnaires in the pre-COVID-19 period (January–December 2019) and the COVID-19 period (April 2020–March 2021), excluding travelers from January to March 2020. We conducted descriptive analyses of differences in demographics, travel-related circumstances, routine and travel-related vaccinations, and medications. Results Compared with 16 903 consultations in the pre-COVID-19 period, only 1564 consultations were recorded at GTEN sites during the COVID-19 period (90% reduction), with a greater proportion of travelers visiting friends and relatives (501/1564 [32%] vs 1525/16 903 [9%]), individuals traveling for >28 days (824/1564 [53%] vs 2522/16 903 [15%]), young children (6 mo–<6 y: 168/1564 [11%] vs 500/16 903 [3%]), and individuals traveling to Africa (1084/1564 [69%] vs 8049/16 903 [48%]). A smaller percentage of vaccine-eligible travelers received vaccines at pretravel consultations during the COVID-19 period than before, except for yellow fever and Japanese encephalitis vaccinations. Conclusions Compared with the pre-COVID-19 period, a greater proportion of travelers during the COVID-19 period were young children, were planning to visit friends and relatives, were traveling for >28 days, or were traveling to Africa, which are circumstances that contribute to high risk for travel-related infections. Fewer vaccine-eligible travelers were administered travel-related vaccines at pretravel consultations. Counseling and vaccination focused on high-risk international travelers must be prioritized during the COVID-19 pandemic.
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Affiliation(s)
- Emily P Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, MA , USA
- Harvard Medical School , Boston, MA , USA
- Travelers’ Advice and Immunization Center, Massachusetts General Hospital , Boston, MA , USA
- Division of Infectious Diseases, Massachusetts General Hospital , Boston, MA , USA
- Department of Medicine, Massachusetts General Hospital , Boston, MA , USA
| | - Mylinh H Le
- Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, MA , USA
| | - Sowmya R Rao
- Department of Global Health, Boston University School of Public Health , Boston, MA , USA
| | - Nora M Mulroy
- Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, MA , USA
| | - Allison T Walker
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention , Atlanta, GA , USA
| | - Edward T Ryan
- Harvard Medical School , Boston, MA , USA
- Travelers’ Advice and Immunization Center, Massachusetts General Hospital , Boston, MA , USA
- Division of Infectious Diseases, Massachusetts General Hospital , Boston, MA , USA
- Department of Medicine, Massachusetts General Hospital , Boston, MA , USA
- Harvard T.H. Chan School of Public Heath , Boston, MA , USA
| | - Regina C LaRocque
- Harvard Medical School , Boston, MA , USA
- Travelers’ Advice and Immunization Center, Massachusetts General Hospital , Boston, MA , USA
- Division of Infectious Diseases, Massachusetts General Hospital , Boston, MA , USA
- Department of Medicine, Massachusetts General Hospital , Boston, MA , USA
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12
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Suryapranata FS, Overbosch FW, Matser A, Grobusch MP, McCall MB, van Rijckevorsel GG, Prins M, Sonder GJ. Malaria in long-term travelers: Infection risks and adherence to preventive measures – A prospective cohort study. Travel Med Infect Dis 2022; 49:102406. [DOI: 10.1016/j.tmaid.2022.102406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/07/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022]
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13
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Neurohr EM, Gabor J, Köhler C. Erkrankungen bei Tropenrückkehrern. MMW Fortschr Med 2022; 164:44-53. [PMID: 35650498 PMCID: PMC9159774 DOI: 10.1007/s15006-022-1077-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Eva-Maria Neurohr
- Institut für Tropenmedizin, Reisemedizin und Humanparasitologie, Universitätsklinikum Tübingen, Innere Medizin IV, Wilhelmstr. 27, 72074 Tübingen, Germany
| | - Julian Gabor
- Institut für Tropenmedizin, Reisemedizin und Humanparasitologie, Universitätsklinikum Tübingen, Innere Medizin IV, Wilhelmstr. 27, 72074 Tübingen, Germany
| | - Carsten Köhler
- Institut für Tropenmedizin, Reisemedizin und Humanparasitologie, Universitätsklinikum Tübingen, Innere Medizin IV, Wilhelmstr. 27, 72074 Tübingen, 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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15
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Multicentric Evaluation of SeeGene Allplex Real-Time PCR Assays Targeting 28 Bacterial, Microsporidal and Parasitic Nucleic Acid Sequences in Human Stool Samples. Diagnostics (Basel) 2022; 12:diagnostics12041007. [PMID: 35454056 PMCID: PMC9032746 DOI: 10.3390/diagnostics12041007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 12/10/2022] Open
Abstract
Prior to the implementation of new diagnostic techniques, a thorough evaluation is mandatory in order to ensure diagnostic reliability. If positive samples are scarcely available, however, such evaluations can be difficult to perform. Here, we evaluated four SeeGene Allplex real-time PCR assays amplifying a total of 28 bacteria, microsporidal and parasitic nucleic acid sequence targets in human stool samples in a multicentric approach. In the assessments with strongly positive samples, sensitivity values ranging between 13% and 100% were recorded for bacteria, between 0% and 100% for protozoa and between 7% and 100% for helminths and microsporidia; for the weakly positive samples, the recorded sensitivity values for bacteria ranged from 0% to 100%; for protozoa, from 0% to 40%; and for helminths and microsporidia, from 0% to 53%. For bacteria, the recorded specificity was in the range between 87% and 100%, while a specificity of 100% was recorded for all assessed PCRs targeting parasites and microsporidia. The intra- and inter-assay variations were generally low. Specifically for some helminth species, the sensitivity could be drastically increased by applying manual nucleic acid extraction instead of the manufacturer-recommended automatic procedure, while such effects were less obvious for the bacteria and protozoa. In summary, the testing with the chosen positive control samples showed varying degrees of discordance between the evaluated Allplex assays and the applied in-house reference assays associated with higher cycle threshold values in the Allplex assays, suggesting that samples with very low pathogen densities might be missed. As the targeted species can occur as harmless colonizers in the gut of individuals in high-endemicity settings as well, future studies should aim at assessing the clinical relevance of the latter hint.
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16
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Herrick T. Health Care of the International Traveler. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Bergquist SH, Marcus M, Meng Q, Fei T, Robichaux C, Roberts DL, Moore RH. Association Between Business Travel, Health-Related Behaviors, and Adiposity. J Occup Environ Med 2021; 63:839-846. [PMID: 34091579 DOI: 10.1097/jom.0000000000002278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the associations between frequency of business travel and health behaviors and adiposity. METHODS Retrospective cross-sectional analysis of de-identified electronic medical records from 795 corporate physical exams. RESULTS Business travel frequency demonstrates a curvilinear relationship with body mass index and body composition in men and women, with domestic and international travel. Linear and quadratic term beta coefficients indicate stronger associations between the sum of domestic and international travel and BMI, body fat percentage, and visceral adipose tissue in women than men, after accounting for age, exercise, and sleep. Based on our male sample population, international travel frequency has a greater influence on adiposity than summed (mostly domestic) travel. CONCLUSIONS Frequent business travel adversely affects body composition, with differences by gender and type of travel.
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Affiliation(s)
- Sharon H Bergquist
- Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia (Dr Bergquist and Dr Roberts); Departments of Epidemiology, Environmental Health and Pediatrics, Rollins School of Public Health and School of Medicine, Emory University, Atlanta, Georgia (Dr Marcus); Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory Biostatistics Collaboration Core, Emory University, Atlanta, Georgia (Ms Meng, Mr Fei, and Dr Moore); Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, Georgia (Mr Robichaux)
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18
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Histopathology of non-IBD colitis practical recommendations from pathologists of IG-IBD Group. Dig Liver Dis 2021; 53:950-957. [PMID: 33712395 DOI: 10.1016/j.dld.2021.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 12/11/2022]
Abstract
Pathologists are often called upon to diagnose colitides that differ from the two main forms of inflammatory bowel disease (IBD). These non-IBD colitides include infectious colitis, microscopic colitis, ischemic colitis, eosinophilic colitis, autoimmune enterocolitis, segmental colitis associated with diverticulosis, drug-induced colitis, radiation colitis and diversion colitis. The diagnosis of these different disease entities relies on the histopathological examination of endoscopic biopsies of the gastrointestinal tract. This paper reviews the main histomorphological characteristics of the various Non-IBD colitides.
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19
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Huits R, Schwartz E. Fatal outcomes of imported dengue fever in adult travelers from non-endemic areas are associated with primary infections. J Travel Med 2021; 28:6137752. [PMID: 33590860 DOI: 10.1093/jtm/taab020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/28/2021] [Accepted: 02/04/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The case-fatality rate of dengue in travelers is low. Secondary dengue virus (DENV) infections are considered a risk factor for fatal outcome in endemic populations; however, the impact of secondary infections on mortality in travelers has not been studied systematically. We performed a descriptive analysis of case reports of dengue fatalities in travelers. METHODS We searched Medline for clinical case reports, using the free terms and MeSH headings: 'Dengue' OR 'Severe Dengue' AND 'Travel-Related Illness' OR 'travel' AND 'Mortality' OR 'Fatal Outcome'. We analyzed case reports of fatal dengue in returning travelers published from 1995 to 2020, with the objective to detail risk factors for dengue mortality in this population. We verified the authors' classifications of primary or secondary dengue infections; infections were considered as primary by absence of anti-DENV immunoglobulin (Ig)G or by IgM-to-IgG ratios greater than or equal to 1.8 in the first 7 days post symptom onset. RESULTS We identified nine detailed reports of dengue with fatal outcome among travelers from non-endemic countries. Eight fatalities were female. The median age was 32 years (range 21-63). Out of nine fatal cases, seven travelers had a primary DENV infection, one had a secondary infection and, in one, these data were not reported. The infecting DENV serotypes were DENV-1 (n = 2), DENV-2 (n = 2) and DENV-3 (n = 3); DENV-1 or 2 (n = 1) and in one case, the serotype could not be determined. CONCLUSIONS Dengue-related deaths in travelers are rare. Most dengue cases in travelers are primary infections. Contrary to prevailing conceptions, we found that fatal outcomes of dengue in travelers from non-endemic countries were reported mainly with primary DENV infections. We alert health care providers that primary DENV infections are not always harmless and that in adult travelers from non-endemic countries, primary infections may contribute more to dengue-related mortality than secondary infections.
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Affiliation(s)
- Ralph Huits
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, B-20000 Antwerp, Belgium
| | - Eli Schwartz
- The Center for Travel and Tropical Medicine, Sheba Medical Center, Ramat Gan, 52621, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
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20
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Villanacci V, Reggiani-Bonetti L, Leoncini G, Parente P, Cadei M, Albarello L, Mandelli G, Caputo A. Histopathology of Non-IBD Colitis. A practical approach from the Italian Group for the study of the gastrointestinal tract (GIPAD). Pathologica 2021; 113:54-65. [PMID: 33686310 PMCID: PMC8138693 DOI: 10.32074/1591-951x-234] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/12/2022] Open
Abstract
Non-IBD colitides (NIBDC) are intestinal diseases clinically and endoscopically overlapping with Inflammatory Bowel Diseases (IBD), sometimes with a similar histological picture. NIBDC include entities such as infectious colitis, ischemic colitis, pseudomembranous colitis, eosinophilic colitis, autoimmune enterocolitis, segmental colitis associated with diverticulosis, drug-induced colitis, radiation-induced colitis, diversion colitis, and microscopic colitis, this last including two entities: collagenous and lymphocytic colitis. The knowledge of the most useful histological features and the main clinical data for each entity is mandatory in daily clinical practice, for correct pathological diagnosis and clinical management.
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Affiliation(s)
| | - Luca Reggiani-Bonetti
- Department of Diagnostic, Clinic and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Paola Parente
- Unit of Pathology, Fondazione IRCCS Ospedale Casa Sollievo Della Sofferenza, San Giovanni Rotondo (FG), Italy
| | - Moris Cadei
- Institute of Pathology, Spedali Civili, Brescia, Italy
| | - Luca Albarello
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | - Alessandro Caputo
- University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, Salerno, Italy
- Correspondence Alessandro Caputo University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, via San Leonardo 1, 84131 Salerno, Italy E-mail:
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21
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Vermeulen TD, Reimerink J, Reusken C, Giron S, de Vries PJ. Autochthonous dengue in two Dutch tourists visiting Département Var, southern France, July 2020. ACTA ACUST UNITED AC 2021; 25. [PMID: 33006305 PMCID: PMC7531074 DOI: 10.2807/1560-7917.es.2020.25.39.2001670] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report dengue virus (DENV) infection in two Dutch tourists who visited Département Var, southern France, in July and August 2020. As some autochthonous dengue cases have occurred in Europe in recent years, awareness among physicians and public health experts about possible intermittent presence of DENV in southern Europe is important to minimise delay in diagnosis and treatment. Quick diagnosis can lead to timely action to contain the spread of vector-borne diseases and minimise transmission.
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Affiliation(s)
| | - Johan Reimerink
- Centrum voor infectieziektenbestrijding, Rijks Instituut voor Volksgezondheid en Milieu (RIVM), Bilthoven, the Netherlands
| | - Chantal Reusken
- Centrum voor infectieziektenbestrijding, Rijks Instituut voor Volksgezondheid en Milieu (RIVM), Bilthoven, the Netherlands
| | - Sandra Giron
- Santé publique France (French National Public Health Agency), Marseille, France
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22
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Abstract
PURPOSE OF REVIEW Societal lockdowns in response to the COVID-19 pandemic have led to unprecedented disruption to daily life across the globe. A collateral effect of these lockdowns may be a change to transmission dynamics of a wide range of infectious diseases that are all highly dependent on rates of contact between humans. With timing, duration and intensity of lockdowns varying country-to-country, the wave of lockdowns in 2020 present a unique opportunity to observe how changes in human contact rates, disease control and surveillance affect dengue virus transmission in a global natural experiment. We explore the theoretical basis for the impact of lockdowns on dengue transmission and surveillance then summarise the current evidence base from country reports. RECENT FINDINGS We find considerable variation in the intensity of dengue epidemics reported so far in 2020 with some countries experiencing historic low levels of transmission while others are seeing record outbreaks. Despite many studies warning of the risks of lockdown for dengue transmission, few empirically quantify the impact and issues such as the specific timing of the lockdowns and multi-annual cycles of dengue are not accounted for. In the few studies where such issues have been accounted for, the impact of lockdowns on dengue appears to be limited. SUMMARY Studying the impact of lockdowns on dengue transmission is important both in how we deal with the immediate COVID-19 and dengue crisis, but also over the coming years in the post-pandemic recovery period. It is clear lockdowns have had very different impacts in different settings. Further analyses might ultimately allow this unique natural experiment to provide insights into how to better control dengue that will ultimately lead to better long-term control.
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Affiliation(s)
- Oliver Brady
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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23
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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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24
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Abstract
Introduction Dengue fever is endemic in more than 100 countries. Early indicators of prognosis are vital to reduce the fatality rate associated with dengue fever. The objective of this study is to investigate the value of a complete blood count (CBC) in determining the prognosis of dengue fever. Methodology This was a retrospective study of all patients admitted to Chigateri General and Bapuji hospitals, Davangere over two months. Fifty-six patients were included in the study. Medical records were accessed to obtain data on the clinical profile and laboratory investigations. Results Thrombocytopenia was the most common hematological feature, in 50 cases (~90%), followed by leukopenia in 43 cases (~76%). The duration of hospital stay ranged from two to seven days. Interestingly, the percentage of lymphocytes in the differential leukocyte count at the time of admission showed a significant negative correlation with the duration of hospital stay (p=0.028). Also, three distinct trends were observed in the sequence of recovery of platelets and white blood cells (WBCs). Discussion A repertoire of prognostic indicators have been described to predict the course and outcome of dengue fever: liver enzymes, interleukins 4 and 10, tumor necrosis factor α (TNFα), some proteases, soluble adhesion molecules, the surface area of atypical lymphocytes, high fluorescent lymphocyte counts, immature granulocytes and immature platelet factor (IPF). However, these markers are not routinely employed due to financial constraints and lack of infrastructure. The percentage of lymphocytes in the differential leukocyte count performed at the time of admission predicted the length of hospital stay. The higher the percentage of lymphocytes, the faster the recovery from dengue and shorter the duration of stay in the hospital. This is particularly important in remote areas with limited laboratory facilities. High-risk patients can be referred to a higher centre before they develop complications of the disease. Conclusion The complete blood count can function as an early indicator of prognosis in dengue fever even in areas where sophisticated biomedical infrastructure is lacking. The lymphocyte percentage on admission could significantly predict the length of hospital stay.
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Affiliation(s)
- Amogh Ananda Rao
- Internal Medicine, Jagadguru Jayadeva Murugarajendra Medical College, Davangere, IND
| | - Raaju R U
- Internal Medicine, Jagadguru Jayadeva Murugarajendra Medical College, Davangere, IND
| | - Siddharth Gosavi
- Internal Medicine, Jagadguru Jayadeva Murugarajendra Medical College, Davangere, IND
| | - Sanjana Menon
- Internal Medicine, Jagadguru Jayadeva Murugarajendra Medical College, Davangere, IND
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Ricco M, Gualerzi G, Ranzieri S. Personal beliefs and misconceptions, not evidence guide general practitioners in the managing of travelers' diarrhea: Results from a pilot study (North-Western Italy, 2019). Infect Dis Now 2020; 51:266-272. [PMID: 33160008 DOI: 10.1016/j.medmal.2020.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/27/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The present study aims to characterize knowledge, attitudes and practices in a sample of general practitioners (GPs) on management of travelers' diarrhea (TD). METHODS A total of 158 GPs (44.3% males; mean age 40.2±12.4 years) completed a web questionnaire on antibiotic prophylaxis (AP) and/or an antibiotic treatment (AT) in TD cases. Participants were inquired on knowledge status (KS), risk perception and effectively applied recommendations for AP/AT through a specifically designed questionnaire. Multivariate odds ratios (OR) for predictors of AP/AT were calculated through regression analysis. RESULTS All in all, while 15 (9.5%) participants recommended AP for TD, 61 of them (39.4%) recommended AT. KS was largely unsatisfying as participants extensively ignored the most recent AP/AT recommendations. Acknowledgment of TD as a severe disorder was predictive for recommendation of AP (OR 37.843, 95%CI 4.752-301.4). As for AT, it was relatively elevated in GPs≥10 years (OR 2.653, 95%CI 1.169-6.019), but more rarely reported in participants with higher KS (OR 0.056, 95%CI 0.021-0.153). CONCLUSIONS Adherence of GPs to official recommendations for TD management was unsatisfying, particularly in older participants. Continuous Education of GPs should be improved by sharing up-to-date official recommendations on AT/AP for TD.
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Affiliation(s)
- Matteo Ricco
- IRCCS-AUSL di Reggio Emilia; Service for Health and Safety in the Workplace, Department of Public Health, Via Amendola n.2, 42122 Reggio Emilia (RE), Italy.
| | - Giovanni Gualerzi
- Department of Medicine and Surgery; School of Medicine, University of Parma, Via Gramsci n.14, Parma (PR), Italy
| | - Silvia Ranzieri
- Department of Medicine and Surgery, School of Occupational Medicine, University of Parma, Via Gramsci n.14, Parma (PR), Italy
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Abstract
PURPOSE OF REVIEW The first dengue vaccine (Dengvaxia) was endorsed by the European Medicine Agency and the US Food and Drug Administration. Given the excess risk of severe dengue in seronegative vaccinees, use is restricted to seropositive individuals. Dengvaxia confers high protection against severe dengue in seropositive vaccinees. RECENT FINDINGS With increasing global travel, the probability of travelers being seropositive increases. Such seropositive travelers may be at increased risk of severe dengue as a result of a second dengue infection during repeat travel. Nevertheless, the use of Dengvaxia in travelers requires a careful analysis of all the factors. Seropositive travelers only present a minority of all travelers. A validated rapid diagnostic test to screen for dengue serostatus is not yet available. Such a test should be highly specific to avoid inadvertent vaccination of seronegative individuals. The three-dose regimen precludes the use in most travelers who tend to present at travel clinics less than 6 weeks prior to departure. Furthermore, questions about potential sub-optimal immunogenicity in seropositives in nonendemic settings, and the need and timing of boosters remain unanswered. SUMMARY Although there could potentially be substantial protection against severe dengue in seropositive travelers, Dengvaxia is far from an ideal travel vaccine.
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Schmid N, Ciurea A, Gabay C, Hasler P, Fehr J, Müller R, Villiger P, Walker U, Hatz C, Bühler S. Travel patterns, risk behaviour and health problems of travellers with rheumatic diseases compared to controls: A multi-centre, observational study. Travel Med Infect Dis 2020; 38:101818. [PMID: 32712263 DOI: 10.1016/j.tmaid.2020.101818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with chronic conditions travel around the world more than ever. Only few studies have examined travel patterns and health outcomes of patients with rheumatic diseases during international travel. METHOD We conducted a multi-centre prospective cohort study in Switzerland, in which we studied the immunogenicity and safety of vaccinations in patients with rheumatic diseases and travellers without rheumatic diseases (controls). Participants who travelled internationally received questionnaires 1 and 13 weeks post-travel. We compared travel patterns, risk behaviours, and travel-associated problems during and after the trips in both groups. RESULTS 274 participants returned post-travel questionnaires (65 rheumatic patients, 209 controls). Controls more frequently travelled to subtropical/tropical destinations and stayed longer abroad. 64% of all participants experienced health problems during travel (74% rheumatic patients vs. 62% controls, P = 0.11). Pre-travel, patients reported a higher susceptibility to gastrointestinal infections . During travel, a higher percentage of rheumatic patients cancelled the day programme due to health problems (13% vs. 4%, P = 0.024). The main problems in rheumatic patients occurred due to the underlying rheumatic diseases, or were of psychological nature. Although not statistically significant, infectious disease symptoms (rhinitis, cough) occurred more frequently in controls. When only considering subtropical/tropical destinations, rheumatic patients more frequently had gastrointestinal problems during travel - and skin infections after the trip. CONCLUSIONS This study does not support the notion that patients with rheumatic diseases should avoid international travel for an increased risk of infections. In patients with subtropical/tropical destinations, however, gastrointestinal problems may be increased during travel - and skin infections post-travel.
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Affiliation(s)
- Nathan Schmid
- Department of Public Health & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Cem Gabay
- Division of Rheumatology, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Paul Hasler
- Division of Rheumatology, University Department of Medicine, University of Basel Medical Faculty, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Jan Fehr
- Department of Public Health & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Rüdiger Müller
- Division of Rheumatology, University Department of Medicine, University of Basel Medical Faculty, Cantonal Hospital Aarau, Aarau, Switzerland; Division of Rheumatology, Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Peter Villiger
- Department of Rheumatology and Clinical Immunology/Allergology, University Hospital of Bern, Bern, Switzerland
| | - Ulrich Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Christoph Hatz
- Department of Public Health & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Department of Medicine and Diagnostics, Swiss Tropical and Public Health Institute, Basel, Switzerland; Department of Infectious Diseases and Hospital Hygiene, Cantonal Hospital St. Gallen, Switzerland; University of Basel, Switzerland
| | - Silja Bühler
- Department of Public Health & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Sari SYI, Adelwin Y, Rinawan FR. Land Use Changes and Cluster Identification of Dengue Hemorrhagic Fever Cases in Bandung, Indonesia. Trop Med Infect Dis 2020; 5:tropicalmed5020070. [PMID: 32370258 PMCID: PMC7344608 DOI: 10.3390/tropicalmed5020070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/04/2020] [Accepted: 04/24/2020] [Indexed: 11/17/2022] Open
Abstract
Dengue Hemorrhagic Fever (DHF) in Indonesia has increased steadily with Bandung as a hyper-endemic area holding a high number of cases for years. This study aimed to identify cluster areas and their correlation with land use changes which was indicated by changes of Normalized Difference Vegetation Index (NDVI). Hospital surveillance of 28,327 cases during 2008–2013 was geo-coded into sub-district levels and analyzed to find cluster areas over time and space using SaTScan and ArcGIS. Spearman correlation was used to analyze NDVI with Incidence Rate (IR) in each area. IR of DHF cases tended to increase over 6 years during high precipitation period. Cases were concentrated in several cluster areas in 2009 then moved to eastern part of the city in 2013. NDVI had negative correlation with IR in 2008 (r = −0.258; p = 0.001) and positive correlation in 2012 (r = 0.193; p = 0.017). Clear geographical pattern by cluster identification overtime is beneficial for targeting appropriate vector-control program.
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29
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Tozan Y, Headley TY, Sewe MO, Schwartz E, Shemesh T, Cramer JP, Eberhardt KA, Ramharter M, Harrison N, Leder K, Angheben A, Hatz C, Neumayr A, Chen LH, De Pijper CA, Grobusch MP, Wilder-Smith A. A Prospective Study on the Impact and Out-of-Pocket Costs of Dengue Illness in International Travelers. Am J Trop Med Hyg 2020; 100:1525-1533. [PMID: 30994088 DOI: 10.4269/ajtmh.18-0780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Although the costs of dengue illness to patients and households have been extensively studied in endemic populations, international travelers have not been the focus of costing studies. As globalization and human travel activities intensify, travelers are increasingly at risk for emerging and reemerging infectious diseases, such as dengue. This exploratory study aims to investigate the impact and out-of-pocket costs of dengue illness among travelers. We conducted a prospective study in adult travelers with laboratory-confirmed dengue and recruited patients at travel medicine clinics in eight different countries from December 2013 to December 2015. Using a structured questionnaire, we collected information on patients and their health-care utilization and out-of-pocket expenditures, as well as income and other financial losses they incurred because of dengue illness. A total of 90 patients participated in the study, most of whom traveled for tourism (74%) and visited countries in Asia (82%). Although 22% reported hospitalization and 32% receiving ambulatory care while traveling, these percentages were higher at 39% and 71%, respectively, after returning home. The out-of-pocket direct and indirect costs of dengue illness were US$421 (SD 744) and US$571 (SD 1,913) per episode, respectively, averaging to a total out-of-pocket cost of US$992 (SD 2,052) per episode. The study findings suggest that international travelers incur important direct and indirect costs because of dengue-related illness. This study is the first to date to investigate the impact and out-of-pocket costs of travel-related dengue illness from the patient's perspective and paves the way for future economic burden studies in this population.
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Affiliation(s)
- Yesim Tozan
- New York University College of Global Public Health, New York, New York.,New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Tyler Y Headley
- New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Maquines Odhiambo Sewe
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden
| | - Eli Schwartz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tamar Shemesh
- Sheba Medical Center, Institute of Tropical and Travel Medicine, Ramat-Gan, Israel
| | - Jakob P Cramer
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kirsten A Eberhardt
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Harrison
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University and Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, Australia
| | - Andrea Angheben
- Centre for Tropical Diseases, IRCCS Hospital Sacro Cuore-Don Calabria, Verona, Italy
| | - Christoph Hatz
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Lin Hwei Chen
- Mount Auburn Hospital, Cambridge, and Harvard Medical School, Boston, Massachusetts
| | - Cornelis A De Pijper
- Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Martin P Grobusch
- Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Heidelberg Global Health Institute, University of Heidelberg, Heidelberg, Germany.,Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden
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30
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Health Care of the International Traveler. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_9-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Redondo-Bravo L, Ruiz-Huerta C, Gomez-Barroso D, Sierra-Moros MJ, Benito A, Herrador Z. Imported dengue in Spain: a nationwide analysis with predictive time series analyses. J Travel Med 2019; 26:5585496. [PMID: 31608405 PMCID: PMC6927315 DOI: 10.1093/jtm/taz072] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Of febrile illnesses in Europe, dengue is second only to malaria as a cause of travellers being hospitalized. Local transmission has been reported in several European countries, including Spain. This study assesses the evolution of dengue-related admissions in Spain in terms of time, geographical distribution and individuals' common characteristics; it also creates a predictive model to evaluate the risk of local transmission. METHODS This is a retrospective study using the Hospital Discharge Records Database from 1997 to 2016. We calculated hospitalization rates and described clinical characteristics. Spatial distribution and temporal behaviour were also assessed, and a predictive time series model was created to estimate expected cases in the near future. Figures for resident foreign population, Spanish residents' trips to endemic regions and the expansion of Aedes albopictus were also evaluated. RESULTS A total of 588 dengue-related admissions were recorded: 49.6% were women, and the mean age was 34.3 years. One person died (0.2%), 82% presented with mild-to-moderate dengue and 7-8% with severe dengue. We observed a trend of steady and consistent increase in incidence (P < 0.05), in parallel with the increase in trips to dengue-endemic regions. Most admissions occurred during the summer, showing significant seasonality with 3-year peaks. We also found important regional differences. According to the predictive time series analysis, a continuing increase in imported dengue incidence can be expected in the near future, which, in the worst case scenario (upper 95% confidence interval), would mean an increase of 65% by 2025. CONCLUSION We present a nationwide study based on hospital, immigration, travel and entomological data. The constant increase in dengue-related hospitalizations, in combination with wider vector distribution, could imply a higher risk of autochthonous dengue transmission in the years to come. Strengthening the human and vector surveillance systems is a necessity, as are improvements in control measures, in the education of the general public and in fostering their collaboration in order to reduce the impact of imported dengue and to prevent the occurrence of autochthonous cases.
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Affiliation(s)
- Lidia Redondo-Bravo
- Servicio de Medicina Preventiva, Hospital Universitario la Paz, Madrid, Spain
| | - Claudia Ruiz-Huerta
- Servicio de Medicina Preventiva, Hospital Universitario de la Cruz Roja, Madrid, Spain
| | - Diana Gomez-Barroso
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII in Spanish), Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María José Sierra-Moros
- Centro de Coordinación de Alertas y Emergencias Sanitarias, Dirección General de Salud Pública, Calidad e Innovación, Ministerio de Sanidad, Consumo y Bienestar Social, Madrid, Spain
| | - Agustín Benito
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III (ISCIII in Spanish), Madrid, Spain.,Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain
| | - Zaida Herrador
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III (ISCIII in Spanish), Madrid, Spain.,Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain
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Halstead S, Wilder-Smith A. Severe dengue in travellers: pathogenesis, risk and clinical management. J Travel Med 2019; 26:5551100. [PMID: 31423536 DOI: 10.1093/jtm/taz062] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/14/2022]
Abstract
RATIONALE FOR REVIEW Dengue is a frequent cause of febrile illness among travellers and has overtaken malaria as the leading cause of febrile illness for those traveling to Southeast Asia. The purpose is to review the risk of dengue and severe dengue in travellers with a particular focus on the pathogenesis and clinical management of severe dengue. RISK, PATHOGENESIS AND CLINICAL MANAGEMENT The risk of travel-acquired dengue depends on destination, season and duration of travel and activities during travel. Seroconversion rates reported in travellers, therefore, vary between <1% and >20%. The most common life-threatening clinical response to dengue infection is the dengue vascular permeability syndrome, epidemiologically linked to secondary infection, but can also occur in primary infection. Tertiary and quaternary infections are usually associated with mild or no disease. Antibody-dependent enhancement, viral factors, age, host factors and clinical experience of the managing physician modulate the risk of progressing to severe dengue. The relative risk of severe dengue in secondary versus primary infection ranges from 2 to 7. The absolute risk of severe dengue in children in highly endemic areas is ~0.1% per year for primary infections and 0.4% for secondary infections. About 2-4% of secondary infections lead to severe dengue. Severe dengue and death are both relatively rare in general travellers but more frequently in those visiting friends and relatives. Clinical management of severe dengue depends on judicious use of fluid rehydration. CONCLUSIONS Although dengue is a frequent cause of travel illness, severe dengue and deaths are rare. Nevertheless, dengue infections can interrupt travel and lead to evacuation and major out-of-pocket costs. Dengue is more frequent than many other travel-related vaccine preventable diseases, such as hepatitis A, hepatitis B, rabies, Japanese encephalitis and yellow fever, indicating a need for a dengue vaccine for travellers.
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Affiliation(s)
- Scott Halstead
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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Herrador Z, Fernández-Martinez B, Quesada-Cubo V, Diaz-Garcia O, Cano R, Benito A, Gómez-Barroso D. Imported cases of malaria in Spain: observational study using nationally reported statistics and surveillance data, 2002-2015. Malar J 2019; 18:230. [PMID: 31291951 PMCID: PMC6617927 DOI: 10.1186/s12936-019-2863-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/03/2019] [Indexed: 12/04/2022] Open
Abstract
Background Malaria was eliminated in Spain in 1964. Since then, more than 10,000 cases of malaria have been reported, mostly in travellers and migrants, making it the most frequently imported disease into this country. In order to improve knowledge on imported malaria cases characteristics, the two main malaria data sources were assessed: the national surveillance system and the hospital discharge database (CMBD). Methods Observational study using prospectively gathered surveillance data and CMBD records between 2002 and 2015. The average number of hospitalizations per year was calculated to assess temporal patterns. Socio-demographic, clinical and travel background information were analysed. Bivariate and multivariable statistical methods were employed to evaluate hospitalization risk, fatal outcome, continent of infection and chemoprophylaxis failure and their association with different factors. Results A total of 9513 malaria hospital discharges and 7421 reported malaria cases were identified. The number of reported cases was below the number of hospitalizations during the whole study period, with a steady increase trend in both databases since 2008. Males aged 25–44 were the most represented in both data sources. Most frequent related co-diagnoses were anaemia (20.2%) and thrombocytopaenia (15.4%). The risks of fatal outcome increased with age and were associated with the parasite species (Plasmodium falciparum). The main place of infection was Africa (88.9%), particularly Equatorial Guinea (33.2%). Most reported cases were visiting friends and relatives (VFRs) and immigrants (70.2%). A significant increased likelihood of hospitalization was observed for children under 10 years (aOR:2.7; 95% CI 1.9–3.9), those infected by Plasmodium vivax (4.3; 95% CI 2.1–8.7) and travellers VFRs (1.4; 95% CI 1.1–1.7). Only 4% of cases reported a correct regime of chemoprophylaxis. Being male, over 15 years, VFRs, migrant and born in an endemic country were associated to increased risk of failure in preventive chemotherapy. Conclusions The joint analysis of two data sources allowed for better characterization of imported malaria profile in Spain. Despite the availability of highly effective preventive measures, the preventable burden from malaria is high in Spain. Pre-travel advice and appropriately delivered preventive messages needs to be improved, particularly in migrants and VFRs.
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Affiliation(s)
- Zaida Herrador
- National Centre for Tropical Medicine, Health Institute Carlos III (ISCIII), 28029, Madrid, Spain. .,Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain.
| | - Beatriz Fernández-Martinez
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Oliva Diaz-Garcia
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Rosa Cano
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Agustín Benito
- National Centre for Tropical Medicine, Health Institute Carlos III (ISCIII), 28029, Madrid, Spain.,Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain
| | - Diana Gómez-Barroso
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Wiemer D, Frickmann H, Krüger A. [Dengue fever : Symptoms, epidemiology, entomology, pathogen diagnosis and prevention]. Hautarzt 2019; 68:1011-1020. [PMID: 29147722 PMCID: PMC7096031 DOI: 10.1007/s00105-017-4073-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dengueinfektionen gehören zu den häufigsten Ursachen fieberhafter Erkrankungen im tropischen Umfeld. Die Infektion wird durch ein Flavivirus verursacht, das durch Aedes-Moskitos übertragen wird. Hauptüberträger für Dengueviren sind die weltweit in den Tropen verbreiteten Aedes-aegypti-Stechmücken. Da diese einerseits tagaktiv und andererseits sog. „container breeder“ sind, bedarf es besonderer Vorbeugungs- und Bekämpfungsmaßnahmen. Die Schwere der Symptomatik variiert und kann vom milden grippeähnlichen klinischen Bild bis hin zu schweren Hämorrhagien und Schock reichen. Zu den häufigsten Symptomen bei Reisenden gehören Fieber, Muskelschmerzen, Kopfschmerzen und Hautausschlag. Zur Diagnostik kommen, in Abhängigkeit vom Stadium der Infektion, patientennah einsetzbare Schnellteste oder – in der virämischen Phase – molekulare Erregerdirektnachweise infrage. Die serologische Diagnostik ist aufgrund von serologischen Kreuzreaktionen mit anderen Flaviviren hinsichtlich ihrer Interpretation anspruchsvoll.
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Affiliation(s)
- D Wiemer
- Fachbereich Tropenmedizin am Bernhard-Nocht Institut, Bundeswehrkrankenhaus Hamburg, Bernhard-Nocht Str. 74, 20359, Hamburg, Deutschland
| | - H Frickmann
- Fachbereich Tropenmedizin am Bernhard-Nocht Institut, Bundeswehrkrankenhaus Hamburg, Bernhard-Nocht Str. 74, 20359, Hamburg, Deutschland.
| | - A Krüger
- Fachbereich Tropenmedizin am Bernhard-Nocht Institut, Bundeswehrkrankenhaus Hamburg, Bernhard-Nocht Str. 74, 20359, Hamburg, Deutschland
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Joshi S, Adhikary R, Beena HB, Bhavana MV, Bhalwar R. Trends in antibiotic susceptibility of enteric fever isolates from South India, 2002–2013. Med J Armed Forces India 2019; 75:81-85. [DOI: 10.1016/j.mjafi.2018.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 08/07/2018] [Indexed: 10/28/2022] Open
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36
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Wilder-Smith A. Risk of Dengue in Travelers: Implications for Dengue Vaccination. Curr Infect Dis Rep 2018; 20:50. [DOI: 10.1007/s11908-018-0656-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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37
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Salzer HJF, Stoney RJ, Angelo KM, Rolling T, Grobusch MP, Libman M, López-Vélez R, Duvignaud A, Ásgeirsson H, Crespillo-Andújar C, Schwartz E, Gautret P, Bottieau E, Jordan S, Lange C, Hamer DH. Epidemiological aspects of travel-related systemic endemic mycoses: a GeoSentinel analysis, 1997-2017. J Travel Med 2018; 25:5067362. [PMID: 30085265 PMCID: PMC6628256 DOI: 10.1093/jtm/tay055] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/15/2018] [Indexed: 11/13/2022]
Abstract
Background International travel has increased in the past few decades, placing more travellers at risk of acquiring systemic endemic mycoses. There are limited published data on systemic endemic mycoses among international travellers. We report epidemiological characteristics of non-migrant, international travellers who acquired systemic endemic mycoses during travel. Methods We analysed records of non-migrant international travellers with a confirmed diagnosis of histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, blastomycosis or talaromycosis reported from 1997 through 2017 to GeoSentinel, a global surveillance network now consisting of 70 travel or tropical medicine centres in 31 countries. Results Sixty-nine records met the inclusion criteria. Histoplasmosis was most frequently reported; the 51 travellers with histoplasmosis had the lowest median age (30 years; range: 8-85) and shortest median duration of travel (12 days; range: 5-154). Coccidioidomycosis was reported in 14 travellers; travellers with coccidioidomycosis were older (median 62 years; range: 22-78) and had the longest median number of days between return from travel and presentation to a GeoSentinel site (55 days; range: 17-273). Almost all travellers with coccidioidomycosis were exposed in the USA. Other systemic endemic mycoses were less frequently reported, including blastomycosis (three travellers) and talaromycosis (one traveller). Conclusions Although relatively rare, systemic endemic mycoses should be considered as potential travel-related infections in non-migrant international travellers. Epidemiological exposures should be used to guide diagnostic evaluations and treatment.
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Affiliation(s)
- Helmut J. F. Salzer
- Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Rhett J. Stoney
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Kristina M. Angelo
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Thierry Rolling
- Section of Infectious Diseases and Tropical Medicine, 1st Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Michael Libman
- J. D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramon y Cajal University Hospital, Madrid, Spain
| | | | - Hilmir Ásgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Clara Crespillo-Andújar
- National Referral Unit for Tropical and Travel Medicine, Department of Internal Medicine, Hospital Universitario La Paz-Carlos III, Madrid, Spain
| | - Eli Schwartz
- The Center for Geographic Medicine and Internal Medicine ‘C’ Chaim Sheba Medical Center, Tel HaShomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philippe Gautret
- Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sabine Jordan
- Section of Infectious Diseases and Tropical Medicine, 1st Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Lange
- Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
- International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
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Amaku M, Coutinho FAB, Armstrong M, Massad E. A Note on the Risk of Infections Invading Unaffected Regions. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2018; 2018:6289681. [PMID: 30073032 PMCID: PMC6057402 DOI: 10.1155/2018/6289681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/27/2018] [Accepted: 06/07/2018] [Indexed: 11/23/2022]
Abstract
We present two probabilistic models to estimate the risk of introducing infectious diseases into previously unaffected countries/regions by infective travellers. We analyse two distinct situations, one dealing with a directly transmitted infection (measles in Italy in 2017) and one dealing with a vector-borne infection (Zika virus in Rio de Janeiro, which may happen in the future). To calculate the risk in the first scenario, we used a simple, nonhomogeneous birth process. The second model proposed in this paper provides a way to calculate the probability that local mosquitoes become infected by the arrival of a single infective traveller during his/her infectiousness period. The result of the risk of measles invasion of Italy was of 93% and the result of the risk of Zika virus invasion of Rio de Janeiro was of 22%.
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Affiliation(s)
- Marcos Amaku
- School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Margaret Armstrong
- School of Applied Mathematics, Fundação Getúlio Vargas, Rio de Janeiro, Brazil
| | - Eduardo Massad
- School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- School of Applied Mathematics, Fundação Getúlio Vargas, Rio de Janeiro, Brazil
- College of Natural and Life Sciences, The University of Derby, Derby, UK
- London School of Hygiene and Tropical Medicine, London, UK
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Wilder-Smith A, Chang CR, Leong WY. Zika in travellers 1947-2017: a systematic review. J Travel Med 2018; 25:5054972. [PMID: 30016469 DOI: 10.1093/jtm/tay044] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 06/21/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Travellers contributed substantially to the rapid spread of Zika virus (ZIKV). They act as sentinel and may unmask ongoing ZIKV transmission in countries where outbreaks have not yet been reported. Our objectives were to (i) describe the burden of ZIKV infections in international travellers over time; (ii) estimate the proportion of birth defects as a result of maternal ZIKV infection in travellers; (iii) track the extent of sexual transmission; (iv) summarize ZIKV infections in returning travellers as reported by the GeoSentinel network; and (v) identify countries without reports on local ZIKV transmission where travellers served as sentinel. METHODS We performed a systematic review from 1947 to April 2017 on travel-associated ZIKV infections. We also compared published reports on autochthonous ZIKV transmission in Asia with published reports on exportations from travellers in Asia. RESULTS Of 314 papers that fit the inclusion criteria, 61 were eligible for final analysis. There was an exponential increase in the number of reported ZIKV infected travellers from the years 2013 to 2016, which declined in 2017. Amongst pregnant women with ZIKV infection, (5%) resulted in a fetus or infant with ZIKV-associated birth defects. An estimated 1% of the total number of ZIKV cases reported in the USA and Europe were acquired through sexual transmission. Through the GeoSentinel network, five countries (Indonesia, Philippines, Thailand, Vietnam, Cameroon) were identified as sentinel markers where ZIKV was exported despite the absence of reported local transmission. CONCLUSIONS Mobility patterns and travel volumes can help to identify the most likely origin of importation, and also in predicting further propagation. Studies on pregnant returning travellers have contributed to a better understanding of the risk estimates of congenital Zika syndrome/microcephaly as a result of maternal ZIKV infection, and the relative contribution of sexual transmisison.
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Affiliation(s)
- Annelies Wilder-Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Global Health and Epidemiology, University of Umea, Umea, Sweden.,London School of Hygiene and Tropical Medicine, Department of Disease Control, London, UK
| | - Chui Rhong Chang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Wei Yee Leong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Odeniran PO, Ademola IO, Jegede HO. A review of wildlife tourism and meta-analysis of parasitism in Africa's national parks and game reserves. Parasitol Res 2018; 117:2359-2378. [PMID: 29948206 DOI: 10.1007/s00436-018-5958-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 06/05/2018] [Indexed: 12/14/2022]
Abstract
The recent increase of parasitic diseases associated with wildlife tourism can be traced to human contact with wildlife and intense modification of wildlife habitat. The continental estimates of parasitic diseases among visited wildlife-tourists and mammalian wildlife present in conservation areas are lacking; therefore, a general review was necessary to provide insights into Africa's parasitic disease burden and transmission between humans and wildlife. A two-step analysis was conducted with searches in Ovid MEDLINE, EMBASE, PubMed, Web of Science and Global Health. All diseases reported without prevalence were grouped and analysed as categorical data while meta-analysis of prevalence rates of parasitic diseases in wildlife from national parks and reserves in Africa was conducted. Only 4.7% of the tourist centres reported routine wildlife diagnosis for parasitic diseases. Disease intensity shows that cryptosporidiosis and seven other parasitic diseases were observed in both human and wildlife; however, no significant difference in intensity between human and wildlife hosts was observed. Schistosomiasis intensity reports showed a significant increase (P < 0.05) while entamoebiasis showed a significant decrease (P < 0.05) in humans as compared to wildlife. Visiting tourists were more infected with malaria, while wildlife was more infected with parasitic gastroenteritis (PGE). The meta-analysis of wildlife revealed the highest prevalence of PGE with mixed parasites and lowest prevalence of Giardia spp. at 99.9 and 5.7%, respectively. The zoonotic and socioeconomic impact of some of these parasites could pose a severe public threat to tourism. Pre- and post-travel clinical examinations are important for tourists while routine examination, treatment and rational surveillance are important for these animals to improve wildlife tourism.
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Affiliation(s)
- Paul Olalekan Odeniran
- Department of Veterinary Parasitology and Entomology, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Isaiah Oluwafemi Ademola
- Department of Veterinary Parasitology and Entomology, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
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Barros JM, Duggan J, Rebholz-Schuhmann D. Disease mentions in airport and hospital geolocations expose dominance of news events for disease concerns. J Biomed Semantics 2018; 9:18. [PMID: 29895320 PMCID: PMC5996486 DOI: 10.1186/s13326-018-0186-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 05/25/2018] [Indexed: 11/26/2022] Open
Abstract
Background In recent years, Twitter has been applied to monitor diseases through its facility to monitor users’ comments and concerns in real-time. The analysis of tweets for disease mentions should reflect not only user specific concerns but also disease outbreaks. This requires the use of standard terminological resources and can be focused on selected geographic locations. In our study, we differentiate between hospital and airport locations to better distinguish disease outbreaks from background mentions of disease concerns. Results Our analysis covers all geolocated tweets over a 6 months time period, uses SNOMED-CT as a standard medical terminology, and explores language patterns (as well as MetaMap) to identify mentions of diseases in reference to the geolocation of tweets. Contrary to our expectation, hospital and airport geolocations are not suitable to collect significant portions of tweets concerned with disease outcomes. Overall, geolocated tweets exposed a large number of messages commenting on disease-related news articles. Furthermore, the geolocated messages exposed an over-representation of non-communicable diseases in contrast to infectious diseases. Conclusions Our findings suggest that disease mentions on Twitter not only serve the purpose to share personal statements but also to share concerns about news articles. In particular, our assumption about the relevance of hospital and airport geolocations for an increased frequency of diseases mentions has not been met. To further address the linguistic cues, we propose the study of health forums to understand how a change in medium affects the language applied by the users. Finally, our research on the language use may provide essential clues to distinguish complementary trends in the use of language in Twitter when analysing health-related topics.
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Affiliation(s)
- Joana M Barros
- Insight Centre for Data Analytics, Data Science Institute, NUI Galway, Lower Dangan, Galway, Ireland.
| | - Jim Duggan
- School of Computer Science, NUI Galway, University Road, Galway, Ireland
| | - Dietrich Rebholz-Schuhmann
- Insight Centre for Data Analytics, Data Science Institute, NUI Galway, Lower Dangan, Galway, Ireland.,ZB MED, University Cologne, Gleueler Str. 60, Cologne, 50931, Germany
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Saathoff AD. Retail clinics: Preparing patients to travel abroad. Nursing 2018; 48:67-68. [PMID: 29794634 DOI: 10.1097/01.nurse.0000532742.95753.5d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Angela D Saathoff
- Angela D. Saathoff is an NP at CVS Pharmacy Minute Clinic in King George, Va., and adjunct professor at Bryant & Stratton College in North Chesterfield, Va
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German travelers' preferences for travel vaccines assessed by a discrete choice experiment. Vaccine 2018; 36:969-978. [PMID: 29338877 DOI: 10.1016/j.vaccine.2018.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/22/2017] [Accepted: 01/04/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Many travelers to regions with endemic infectious diseases do not follow health authorities' recommendations regarding vaccination against vaccine-preventable infectious diseases, before traveling. The determinants of individual travelers' decisions to vaccinate before traveling are largely unknown. This study aimed to provide this information using a discrete choice experiment (DCE) administered to four types of German travelers: (1) business travelers; (2) travelers visiting friends and relatives (VFR); (3) leisure travelers; and (4) backpackers. METHODS A DCE survey was developed, pretested and administered online. It included a series of choice questions in which respondents chose between two hypothetical vaccines, each characterized by four disease attributes with varying levels describing the of risk, health impact, curability and transmissibility of the disease they would prevent (described with four disease attributes with varying levels of risk, health impact, curability and transmissibility), and varying levels of four vaccine attributes (duration of protection, number of doses required, time required for vaccination, and vaccine cost). A random-parameters logit model was used to estimate the importance weights each traveler type placed on the various attribute levels. These weights were used to calculate mean monetary equivalents (MMEs) of changes in each attribute (holding all others constant) and of hypothetical disease-vaccine combinations. RESULTS All traveler types' choices indicated that they attached the greatest importance to the risk and health impact of disease and to the vaccine cost whereas the other disease and vaccine attributes were less important for their decisions about travel vaccines. An option of not choosing any of the vaccine-pairs presented was rarely selected indicating that travelers' generally prefer to be vaccinated rather than not. The MMEs of changes in vaccine attributes indicated a very high variability between the individual travelers within each type. CONCLUSIONS The travelers' responses indicated strong preferences for selecting vaccination rather than opting out of vaccination, and disease risk, health impact and vaccine cost were the most important features for vaccine choice.
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Slavik T, Lauwers GY. Navigating the jungles of tropical infectious gastrointestinal pathology: a pattern-based approach to the endoscopic biopsy. Virchows Arch 2018; 472:135-147. [PMID: 28589386 PMCID: PMC7087759 DOI: 10.1007/s00428-017-2166-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/17/2017] [Accepted: 05/30/2017] [Indexed: 12/22/2022]
Abstract
International travels and global human migration have had the unforeseen consequence of increasing the exposure of histopathologists in developed countries to the pathology of tropical infectious disease. The gastrointestinal tract (GIT) is often the primary site of infection due to the faecal-oral route of transmission and the high risk of exposure to contaminated water, food or soil when travelling to these regions. Whilst current microbiologic techniques are far more sensitive than histology in detecting infectious pathogens, the histopathologist nonetheless retains a pivotal role in diagnosing tropical GIT disease. This role entails evaluating endoscopic biopsies for any characteristic inflammatory pattern, identifying pathogens which may be present and excluding other look-alike pathologies. Recent advances in commercially available diagnostic modalities, including molecular techniques, have further broadened the scope of the histopathologist's armamentarium. This review outlines a practical pattern-based approach to diagnosing tropical GIT infections in endoscopic material, so as to assist pathologists less familiar with this spectrum of pathology.
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Affiliation(s)
- Tomas Slavik
- Ampath Pathology Laboratories, Pretoria, South Africa.
- Department of Anatomical Pathology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
- , Private Bag X9, Highveld Park, Centurion, Pretoria, 0067, South Africa.
| | - Gregory Y Lauwers
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Griffiths KM, Savini H, Brouqui P, Simon F, Parola P, Gautret P. Surveillance of travel-associated diseases at two referral centres in Marseille, France: a 12-year survey. J Travel Med 2018; 25:4965003. [PMID: 29672709 PMCID: PMC7107586 DOI: 10.1093/jtm/tay007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 01/14/2018] [Accepted: 01/24/2018] [Indexed: 11/13/2022]
Abstract
Background With increasing international travel and historically high numbers of residents visiting friends and relatives overseas, travel-associated illnesses are frequent in Marseille, France. We report the changing epidemiology of travel-related illnesses over a 12-year period. Methods A single site GeoSentinel surveillance analysis was undertaken for 3460 ill returned travellers presenting to two public hospitals in Marseille, France from March 2003 to October 2015, with travel-related illnesses. Demographic characteristics, travel history, presenting symptoms and information on pre-travel consultations were collected. Results There was a predominance of travel to sub-Saharan Africa, in particular to Comoros archipelago. Tourism was the main reason for travel (1591/3460, 46%), followed by visiting friends or relatives (VFR) (895/3460, 26%), with a mean duration of 29 days; 35% (1212/3460) of travellers reported a pre-travel health consultation. The most common syndromic diagnoses were febrile systemic illness (1343, 39%), dermatologic (716, 21%), gastrointestinal (340, 10%) and respiratory/ear-nose-throat (331, ENT) (10%). Hospitalization rates were highest amongst travellers from sub-Saharan Africa (858/ 1632, 53%), and VFR (573/ 895, 64%, P < 0.001). Frequent diagnoses included malaria (797, 23%), dengue (96, 2.77%) and chikungunya (75, 2.17%), reflecting global trends. Comparison of two periods (2003-10 to 2011-15) demonstrated an increase in chikungunya and decrease in malaria and influenza-like illness. We report an increase in ill travellers from the Caribbean, Middle East and South-East Asia. Conclusion Surveillance of travellers provides relevant sentinel information on the changing epidemiology of infectious diseases across the globe, most notably for malaria, dengue and chikungunya. We demonstrate the use of travel surveillance in improving pre-travel consultation needs and to address autochthonous vector-borne viral risks.
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Affiliation(s)
- Karolina M Griffiths
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Hélène Savini
- Department of Tropical Medicine and Infectious Diseases, Laveran Military Teaching Hospital, Marseille, France
| | - Philippe Brouqui
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Fabrice Simon
- Department of Tropical Medicine and Infectious Diseases, Laveran Military Teaching Hospital, Marseille, France
| | - Philippe Parola
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
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Wilder-Smith A, Boggild AK. Sentinel Surveillance in Travel Medicine: 20 Years of GeoSentinel Publications (1999-2018). J Travel Med 2018; 25:5227422. [PMID: 30508133 DOI: 10.1093/jtm/tay139] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/29/2018] [Indexed: 11/13/2022]
Affiliation(s)
- Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Andrea K Boggild
- Tropical Disease Unit, Toronto General Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Public Health Ontario Laboratory, Toronto, Canada
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Rosselló J, Santana-Gallego M, Awan W. Infectious disease risk and international tourism demand. Health Policy Plan 2017; 32:538-548. [PMID: 28104695 DOI: 10.1093/heapol/czw177] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 11/12/2022] Open
Abstract
Context For some countries, favourable climatic conditions for tourism are often associated with favourable conditions for infectious diseases, with the ensuing development constraints on the tourist sectors of impoverished countries where tourism's economic contribution has a high potential. This paper evaluates the economic implications of eradication of Malaria, Dengue, Yellow Fever and Ebola on the affected destination countries focusing on the tourist expenditures. Methods A gravity model for international tourism flows is used to provide an estimation of the impact of each travel-related disease on international tourist arrivals. Next the potential eradication of these diseases in the affected countries is simulated and the impact on tourism expenditures is estimated. Findings The results show that, in the case of Malaria, Dengue, Yellow Fever and Ebola, the eradication of these diseases in the affected countries would result in an increase of around 10 million of tourist worldwide and a rise in the tourism expenditure of 12 billion dollars. Conclusion By analysing the economic benefits of the eradication of Dengue, Ebola, Malaria, and Yellow Fever for the tourist sector-a strategic economic sector for many of the countries where these TRD are present-this paper explores a new aspect of the quantification of health policies which should be taken into consideration in future international health assessment programmes. It is important to note that the analysis is only made of the direct impact of the diseases' eradication and consequently the potential multiplicative effects of a growth in the GDP, in terms of tourism attractiveness, are not evaluated. Consequently, the economic results can be considered to be skeleton ones.
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Affiliation(s)
- Jaume Rosselló
- Departament d'Economia Aplicada, Universitat de les Illes Balears, 07122 Palma de Mallorca, Spain.,Griffith Institute for Tourism, Griffith University, Gold Coast Campus, Business 2 Building (G27), 58 Parklands Drive, Southport, QLD 4222, Australia
| | - Maria Santana-Gallego
- Departament d'Economia Aplicada, Universitat de les Illes Balears, 07122 Palma de Mallorca, Spain
| | - Waqas Awan
- Department of Business Administration, School of Business Administration, Shaheed Benazir Bhutto University, Shaheed, Benazirabad, Sindh, Pakistan
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Norman FF, López-Polín A, Salvador F, Treviño B, Calabuig E, Torrús D, Soriano-Arandes A, Ruíz-Giardín JM, Monge-Maillo B, Pérez-Molina JA, Perez-Ayala A, García M, Rodríguez A, Martínez-Serrano M, Zubero M, López-Vélez R. Imported malaria in Spain (2009-2016): results from the +REDIVI Collaborative Network. Malar J 2017; 16:407. [PMID: 29017499 PMCID: PMC5635489 DOI: 10.1186/s12936-017-2057-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/06/2017] [Indexed: 11/15/2022] Open
Abstract
Background Imported malaria is a frequent diagnosis in travellers and migrants. The objective of this study was to describe the epidemiological and clinical characteristics of patients diagnosed with imported malaria within a Spanish collaborative network registering imported diseases (+REDIVI). In addition, the possible association between malaria and type of case, gender, age or area of exposure was explored. Methods Cases of imported malaria were identified among all cases registered in the +REDIVI database during the period October 2009–October 2016. Demographic, epidemiological and clinical characteristics were analysed. Results In total, 11,816 cases of imported infectious diseases were registered in +REDIVI’s database between October 2009 and October 2016. Immigrants seen for the first time after migration accounted for 60.2% of cases, 21.0% of patients were travellers, and 18.8% were travellers/immigrants visiting friends and relatives (VFRs). There were 850 cases of malaria (850/11,816, 7.2%). Malaria was significantly more frequent in men than in women (56.8% vs 43.2%) and in VFR-immigrants (52.6%) as compared to travellers (21.3%), immigrants (20.7%) and VFR-travellers (5.4%) (p < 0.001). Although this data was not available for most patients with malaria, only a minority (29/217, 13.4%) mentioned correct anti-malarial prophylaxis. Sub-Saharan Africa was found to be the most common region of acquisition of malaria. Most common reason for consultation after travel was a febrile syndrome although an important proportion of immigrants were asymptomatic and presented only for health screening (27.3%). Around 5% of travellers presented with severe malaria. The most prevalent species of Plasmodium diagnosed was Plasmodium falciparum (81.5%). Malaria due to Plasmodium ovale/Plasmodium vivax was frequent among travellers (17%) and nearly 5% of all malaria cases in immigrants were caused by Plasmodium malariae. Conclusions Malaria was among the five most frequent diagnoses registered in +REDIVI’s database. Some significant differences were found in the distribution of malaria according to gender, type of case, species. Among all malaria cases, the most frequent diagnosis was P. falciparum infection in VFR-immigrant men.
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Affiliation(s)
- Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9,100, 28034, Madrid, Spain.
| | - Ana López-Polín
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9,100, 28034, Madrid, Spain
| | - Fernando Salvador
- Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Begoña Treviño
- Unitat Medicina Tropical i Salut Internacional Vall d'Hebron-Drassanes, PROSICS Barcelona, Barcelona, Spain
| | - Eva Calabuig
- La Fe de Valencia University Hospital, Valencia, Spain
| | | | - Antonio Soriano-Arandes
- Unitat Medicina Tropical i Salut Internacional Vall d'Hebron-Drassanes, PROSICS Barcelona, Barcelona, Spain
| | | | - Begoña Monge-Maillo
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9,100, 28034, Madrid, Spain
| | - Jose-Antonio Pérez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9,100, 28034, Madrid, Spain
| | | | | | | | | | | | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9,100, 28034, Madrid, Spain
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