Zika beyond the Americas: Travelers as sentinels of Zika virus transmission. A GeoSentinel analysis, 2012 to 2016 (original) (raw)
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Annals of internal medicine, 2016
Zika virus has spread rapidly in the Americas and has been imported into many nonendemic countries by travelers. To describe clinical manifestations and epidemiology of Zika virus disease in travelers exposed in the Americas. Descriptive, using GeoSentinel records. 63 travel and tropical medicine clinics in 30 countries. Ill returned travelers with a confirmed, probable, or clinically suspected diagnosis of Zika virus disease seen between January 2013 and 29 February 2016. Frequencies of demographic, trip, and clinical characteristics and complications. Starting in May 2015, 93 cases of Zika virus disease were reported. Common symptoms included exanthema (88%), fever (76%), and arthralgia (72%). Fifty-nine percent of patients were exposed in South America; 71% were diagnosed in Europe. Case status was established most commonly by polymerase chain reaction (PCR) testing of blood and less often by PCR testing of other body fluids or serology and plaque-reduction neutralization testing...
Journal of Travel Medicine
Introduction International travellers contribute to the rapid spread of Zika virus (ZIKV) and its sentinel identification globally. We describe ZIKV infections among international travellers seen at GeoSentinel sites with a focus on ZIKV acquired in the Americas and the Caribbean, describe countries of exposure and traveller characteristics, and assess ZIKV diagnostic testing by site. Methods Records with an international travel-related diagnosis of confirmed or probable ZIKV from January 2012 through December 2019 reported to GeoSentinel with a recorded illness onset date were included to show reported cases over time. Records from March 2016 through December 2019 with an exposure region of the Americas or the Caribbean were included in the descriptive analysis. A survey was conducted to assess the availability, accessibility and utilization of ZIKV diagnostic tests at GeoSentinel sites. Results GeoSentinel sites reported 525 ZIKV cases from 2012 through 2019. Between 2012 and 2014...
Systematic Hospital-Based Travel Screening to Assess Exposure to Zika Virus1
Emerging Infectious Diseases, 2020
I ncidence of Zika virus (ZIKV) infections rose rapidly in early 2015, and local transmission was confirmed in 84 countries and territories by March 2017 (1). Although ZIKV typically causes mild symptoms (2,3), in utero infection can cause congenital Zika syndrome (4,5). The threat of in utero infection, along with sexual transmission (6,7), led to advisories for women who were pregnant, or might become pregnant, and their partners to avoid travel to countries or areas with ZIKV transmission (7-10). After implementing reactive screening during several global infectious disease outbreaks, including the 2014 Ebola outbreak, Mount Auburn Hospital (Cambridge, Massachusetts, USA) incorporated a standardized screening question regarding international travel into all hospital visits beginning in September 2015. To detect potential travel-associated exposures, patients were asked, "Have you traveled outside of the U.S. within the past 30 days?" Each quarter during November 1, 2015-October 31, 2016, we aggregated deidentified patient data to estimate the proportion of patients with potential ZIKV exposure and the possibility for congenital Zika syndrome. The Study During November 1-December 31, 2016, we retrospectively analyzed deidentified patient demographic, travel destination, and medical services data from the hospital database. We analyzed records from patients admitted as inpatients, and those seen in the emergency department/walk-in center (ED/WIC) and by other services during November 1, 2015-October 31, 2016. We included data from patients who responded "yes" to the travel screening question and provided a travel history and for whom diagnostic data were available. We categorized destination countries according to the World Health Organization 2016 classification for ZIKV transmission (11): category 1, countries that reported outbreaks from 2015 onward; category 2, countries with possible endemic transmission or evidence of local mosquitoborne ZIKV infections in 2016; and category 3, countries with evidence of local mosquitoborne ZIKV infections during or before 2015, but without documentation of cases in 2016, or designated as outbreak terminated. We defined reproductive age as 15-49 years of age for female patients and ≥15 years of age for male patients (12). We extracted records with International Classification of Diseases, 10th Revision, codes applicable to pregnancy, including Z33.1, Z34.91, Z34.92, Z34.93, and Z34.90, and diagnosis descriptions that met the Zika disease case definition (3), which includes fever, rash, arthralgia, conjunctivitis, complication of pregnancy, or Guillain-Barré syndrome. We performed analyses by using IBM SPSS Statistics 17.0 (IBM, https://www.ibm.com). The Mount Auburn Hospital Institutional Review Board determined the activity to be exempt from review and approval. We identified 5,642 patients who reported travel <30 days before their hospital visit. Of 5,004
Emerging Infectious Diseases, 2017
Zika virus has recently been introduced to the Americas and is spreading rapidly. We evaluated the characteristics of US travelers to Zika virus-affected countries who were seen at Global TravEpiNet sites during March 2015-October 2016. Nearly three quarters of travelers were men or women of reproductive age. I n 2014, a total of 30.8 million US residents traveled internationally, and 39% of trips were to the Caribbean, Central America, and South America (the Americas) (1). Travelers to this region are at risk for mosquitoborne illnesses, including Zika virus infection (2). As of November 1, 2016, a total of 49 countries and territories in the Americas have reported Zika virus transmission (3). Zika virus spreads primarily through mosquito bites and sexual contact (2,4,5) and is of particular concern to persons of reproductive age because Zika virus infection in pregnancy can cause microcephaly and brain defects (6,7). We describe the demographics of US travelers to Zika virus-affected countries in the Americas, with a focus on persons of reproductive age. The Study Global TravEpiNet (GTEN), supported by the Centers for Disease Control and Prevention (CDC), is a consortium of US clinical practices providing pretravel healthcare to international travelers. GTEN sites include academic practices, healthcare consortia, health maintenance organizations, Characteristics of US Travelers to Zika Virus-Affected Countries in the Americas,
Surveillance report of Zika virus among Canadian travellers returning from the Americas
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2017
Widespread transmission of Zika virus in the Americas has occurred since late 2015. We examined demographic and travel-related characteristics of returned Canadian travellers with Zika infection acquired in the Americas to illuminate risk factors for acquisition and the clinical spectrum. We analyzed demographic and travel-related data for returned Canadian travellers who presented to a CanTravNet site between October 2015 and September 2016 for care of Zika virus acquired in the Americas. Data were collected with use of the GeoSentinel Surveillance Network data platform. During the study period, 1118 travellers presented to a CanTravNet site after returning from the Americas, 41 (3.7%) of whom had Zika infection. Zika infection from the Americas was diagnosed at CanTravNet sites as often as dengue (n = 41) over the study period. In the first half of the study period, Zika virus burden was borne by people visiting friends and relatives in South America. In the latter half, coinciden...
Travel Medicine and Infectious Disease, 2019
Background: From the first Zika virus (ZIKV) description, it has progressively widespread worldwide. We analyzed demographic, clinical, microbiologic and travel-related characteristic from returned patients from a ZIKV endemic country in a referral Tropical Medicine Unit. Method: A prospective cohort study performed in a Spanish referral center with the aim of determining the significant factors associated with confirmed Zika virus (ZIKV) infection. Results: 817 patients, (56% women, median age 36 [IQR, Interquartile Range: 32-42]) were enrolled. Most had returned from Latin America (n = 486; 59.4%), travelled for tourism (n = 404; 49.4%) and stayed a median of 18 days (IQR: 10-30). 602 (73.6%) presented symptoms, but only 25 (4%) were finally diagnosed with confirmed ZIKV infection (including two pregnant women, without adverse fetal outcomes), 88% (n:22) presented with fever and 92% (n:23) with rash. 56% (n:14) arthralgia and/or myalgia and 28% (n:7) conjunctivitis. The presence of conjunctivitis, fever and rash were associated with an 8.9 (95% CI: 2.2-34.9), 6.4 (95% CI: 1.2-33.3) and 72.3 (95% CI: 9.2-563.5) times greater probability of confirmed ZIKV infection, respectively. Conclusion: Travel characteristics and clinical presentation may help clinicians to optimize requests for microbiological testing. Diagnosis of arboviriasis in travellers arriving form endemic areas remains a challenge for clinicians, but must be detected for the possible transmission outside endemic areas, where the vector is present.
International Journal of Infectious Diseases, 2019
Background: The incidence rate of Zika virus (ZIKV) infection in travellers from non-endemic areas to the Americas during the ZIKV outbreak in 2016 is unknown. Methods: Belgian adults who planned to travel to South America, Central America, and the Caribbean were recruited prospectively to study the incidence and characteristics of ZIKV. Demographic data and sera were collected at baseline. Participants were trained to collect capillary blood on filter paper (BFP). When ill during travel, the participants completed a questionnaire and they sampled BFP for post-hoc analysis. All symptomatic participants were screened for ZIKV using ZIKV-specific RT-PCR on serum or urine, or BFP, and antibody detection assays (ELISA). Follow-up sera of asymptomatic travellers, obtained at least 20 days post travel, were tested by ZIKV ELISA only. All positive ELISA results were subject to confirmation by virus neutralization testing (VNT). Results: Forty-nine participants completed follow-up: 38 women and 11 men, with a median age of 32 years (range 19-64 years). Travel destinations were countries in South America (n = 20), Central America (n = 24), and the Caribbean (n = 5). The total travel duration was 67.8 person-months. Illness was reported by 24 participants (49.0%). ZIKV infection was confirmed in nine cases, by RT-PCR (n = 5) and by VNT (n = 4). Only one of nine ZIKV cases (11.1%) was asymptomatic. The ZIKV incidence rate was 17.0% (95% confidence interval 7.8-32.2%) per month of travel. Conclusions: The ZIKV incidence rate in adult travellers from non-endemic countries to the epidemic territories during the 2016 outbreak was high. Asymptomatic ZIKV infection was rare in this population.
Infection, 2016
We report 18 cases of confirmed Zika virus (ZIKV) infection in travellers returning to the Netherlands from Surinam (South America, bordering northern Brazil) and the Dominican Republic. In a multi-centre study, we collected epidemiological, virological and clinical characteristics, as well as data on travel history, underlying illness and laboratory results of the 18 imported ZIKV infection cases using a standardised form. Most cases had a self-limiting course of disease, two patients developed complications, one had Guillain-Barré and another had severe thrombocytopenia. Four patients had underlying illness. One of the reported cases was pregnant. Three of 13 patients tested had a weak-positive result for dengue IgM. The majority of patients were born in Suriname and/or visiting friends and relatives (VFR). Providing pre-travel advice among travellers, especially VFR travellers, is needed to enhance the use of preventive measures against ZIKV infection. Further evidence on health ...
Early detection of Zika virus infection among travellers from areas of ongoing transmission in China
Journal of travel medicine, 2016
Nine imported Zika virus (ZIKV) infections (four through temperature monitoring and epidemiological investigation at entry and five by active surveillance tracking of index case contacts during follow-up; from Venezuela [n = 5], Samoa [n = 3] and both Samoa and Fiji [n = 1]) were detected in mainland China from February 1 to 29, 2016. The minimal incubation period lasted 5.2 days, with mean lag time to diagnosis of 2.6 days. Diagnosis relied on positive real-time reverse transcriptase polymerase chain reaction for ZIKV RNA in serum (n = 7), urine (n = 4) or saliva (n = 3), respectively. All cases recovered rapidly without serious complications.