RESUMO
BACKGROUND: Chikungunya is an important travel-related disease because of its rapid geographical expansion and potential for prolonged morbidity. Improved understanding of the epidemiology of travel-related chikungunya infections may influence prevention strategies including education and vaccination. METHODS: We analysed data from travellers with confirmed or probable chikungunya reported to GeoSentinel sites from 2005 to 2020. Confirmed chikungunya was defined as a compatible clinical history plus either virus isolation, positive nucleic acid test or seroconversion/rising titre in paired sera. Probable chikungunya was defined as a compatible clinical history with a single positive serology result. RESULTS: 1202 travellers (896 confirmed and 306 probable) with chikungunya were included. The median age was 43 years (range 0-91; interquartile range [IQR]: 31-55); 707 (58.8%) travellers were female. Most infections were acquired in the Caribbean (28.8%), Southeast Asia (22.8%), South Central Asia (14.2%) and South America (14.2%). The highest numbers of chikungunya cases reported to GeoSentinel were in 2014 (28.3%), 2015 (14.3%) and 2019 (11.9%). The most frequent reasons for travel were tourism (n = 592; 49.3%) and visiting friends or relatives (n = 334; 27.7%). The median time to presentation to a GeoSentinel site was 23 days (IQR: 7-52) after symptom onset. In travellers with confirmed chikungunya and no other reported illnesses, the most frequently reported symptoms included musculoskeletal symptoms (98.8%), fever/chills/sweats (68.7%) and dermatologic symptoms (35.5%). Among 917 travellers with information available, 296 (32.3%) had a pretravel consultation. CONCLUSIONS: Chikungunya was acquired by international travellers in almost 100 destinations globally. Vector precautions and vaccination where recommended should be integrated into pretravel visits for travellers going to areas with chikungunya or areas with the potential for transmission. Continued surveillance of travel-related chikungunya may help public health officials and clinicians limit the transmission of this potentially debilitating disease by defining regions where protective measures (e.g. pretravel vaccination) should be strongly considered.
Assuntos
Febre de Chikungunya , Doença Relacionada a Viagens , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Ásia/epidemiologia , Febre de Chikungunya/diagnóstico , Febre de Chikungunya/epidemiologia , América do SulRESUMO
Carbapenem-resistant Pseudomonas aeruginosa (CRPA) producing the Verona integronâencoded metallo-ß-lactamase (VIM) are highly antimicrobial drug-resistant pathogens that are uncommon in the United States. We investigated the source of VIM-CRPA among US medical tourists who underwent bariatric surgery in Tijuana, Mexico. Cases were defined as isolation of VIM-CRPA or CRPA from a patient who had an elective invasive medical procedure in Mexico during January 2018âDecember 2019 and within 45 days before specimen collection. Whole-genome sequencing of isolates was performed. Thirty-eight case-patients were identified in 18 states; 31 were operated on by surgeon 1, most frequently at facility A (27/31 patients). Whole-genome sequencing identified isolates linked to surgeon 1 were closely related and distinct from isolates linked to other surgeons in Tijuana. Facility A closed in March 2019. US patients and providers should acknowledge the risk for colonization or infection after medical tourism with highly drug-resistant pathogens uncommon in the United States.
Assuntos
Farmacorresistência Bacteriana Múltipla , Turismo Médico , Infecções por Pseudomonas , Antibacterianos/uso terapêutico , Proteínas de Bactérias , Carbapenêmicos , Humanos , México/epidemiologia , Testes de Sensibilidade Microbiana , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/genética , Estados Unidos/epidemiologia , beta-Lactamases/genéticaAssuntos
Carbapenêmicos/farmacologia , Integrons , Turismo Médico , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/isolamento & purificação , beta-Lactamases/biossíntese , Adulto , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Estados Unidos/epidemiologiaRESUMO
Leptospirosis is a potentially fatal emerging zoonosis with worldwide distribution and a broad range of clinical presentations and exposure risks. It typically affects vulnerable populations in (sub)tropical countries but is increasingly reported in travelers as well. Diagnostic methods are cumbersome and require further improvement. Here, we describe leptospirosis among travelers presenting to the GeoSentinel Global Surveillance Network. We performed a descriptive analysis of leptospirosis cases reported in GeoSentinel from January 1997 through December 2016. We included 180 travelers with leptospirosis (mostly male; 74%; mostly tourists; 81%). The most frequent region of infection was Southeast Asia (52%); the most common source countries were Thailand (N = 52), Costa Rica (N = 13), Indonesia, and Laos (N = 11 each). Fifty-nine percent were hospitalized; one fatality was reported. We also distributed a supplemental survey to GeoSentinel sites to assess clinical and diagnostic practices. Of 56 GeoSentinel sites, three-quarters responded to the survey. Leptospirosis was reported to have been most frequently considered in febrile travelers with hepatic and renal abnormalities and a history of freshwater exposure. Serology was the most commonly used diagnostic method, although convalescent samples were reported to have been collected infrequently. Within GeoSentinel, leptospirosis was diagnosed mostly among international tourists and caused serious illness. Clinical suspicion and diagnostic workup among surveyed GeoSentinel clinicians were mainly triggered by a classical presentation and exposure history, possibly resulting in underdiagnosis. Suboptimal usage of available diagnostic methods may have resulted in additional missed, or misdiagnosed, cases.
Assuntos
Leptospira/patogenicidade , Leptospirose/epidemiologia , Doença Relacionada a Viagens , Viagem/estatística & dados numéricos , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Costa Rica/epidemiologia , Doxiciclina/uso terapêutico , Feminino , Humanos , Incidência , Indonésia/epidemiologia , Laos/epidemiologia , Leptospira/efeitos dos fármacos , Leptospira/isolamento & purificação , Leptospirose/diagnóstico , Leptospirose/tratamento farmacológico , Leptospirose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Vigilância de Evento Sentinela , Inquéritos e Questionários , Tailândia/epidemiologiaRESUMO
BACKGROUND: In 2011, the Centers for Disease Control and Prevention and the New Jersey Department of Health used the New Jersey Behavioral Risk Factor Survey (NJBRFS), a state component of the national Behavioral Risk Factor Surveillance System (BRFSS) to pilot a travel health module designed to collect population-based data on New Jersey residents travelling internationally. Our objective was to use this population-based travel health information to serve as a baseline to evaluate trends in US international travellers. METHODS: A representative sample of New Jersey residents was identified through a random-digit-dialing method and administered the travel health module, which asked five questions: travel outside of USA during the previous year; destination; purpose; if a healthcare provider was visited before travel and any travel-related illness. Additional health variables from the larger NJBRFS were considered and included in bivariate analyses and multiple logistic regression; weights were assigned to variables to account for survey design complexity. RESULTS: Of 4029 participants, 841 (21%) travelled internationally. Top destinations included Mexico (10%), Canada (9%), Dominican Republic (6%), Bahamas (5%) and Italy (5%). Variables positively associated with travel included foreign birth, ≥$75 000 annual household income, college education and no children living in the household. One hundred fifty (18%) of 821 travellers with known destinations went to high-risk countries; 40% were visiting friends and relatives and only 30% sought pre-travel healthcare. Forty-eight (6%) of 837 responding travellers reported travel-related illness; 44% visited high-risk countries. CONCLUSIONS: Approximately one in five NJBRFS respondents travelled internationally during the previous year, a sizeable proportion to high-risk destinations. Few reported becoming ill as a result of travel but almost one-half of those ill had travelled to high-risk destinations. Population-based surveillance data on travellers can help document trends in destinations, traveller type and disease prevalence and evaluate the effectiveness of disease prevention programmmes.
Assuntos
Sistema de Vigilância de Fator de Risco Comportamental , Conhecimentos, Atitudes e Prática em Saúde , Internacionalidade , Viagem/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bahamas , Canadá , República Dominicana , Feminino , Humanos , Itália , Modelos Logísticos , Masculino , México , Pessoa de Meia-Idade , New Jersey , Fatores de Risco , Inquéritos e Questionários , Adulto JovemRESUMO
IMPORTANCE: Travelers from around the globe will attend the 2014 Fédération Internationale de Football Association (FIFA) World Cup and the 2016 Olympic and Paralympic Games in Brazil. Travelers to these mass gathering events may be exposed to a range of health risks, including a variety of infectious diseases. Most travelers who become ill will present to their primary care physicians, and thus it is important that clinicians are aware of the risks their patients encountered. OBJECTIVE: To highlight health and safety concerns for people traveling to these events in Brazil so that health care practitioners can better prepare travelers before they travel and more effectively diagnose and treat travelers after they return. EVIDENCE REVIEW: We reviewed both peer-reviewed and gray literature to identify health outcomes associated with travel to Brazil and mass gatherings. Thirteen specific infectious diseases are described in terms of signs, symptoms, and treatment. Relevant safety and security concerns are also discussed. FINDINGS: Travelers to Brazil for mass gathering events face unique health risks associated with their travel. CONCLUSIONS AND RELEVANCE: Travelers should consult a health care practitioner 4 to 6 weeks before travel to Brazil and seek up-to-date information regarding their specific itineraries. For the most up-to-date information, health care practitioners can visit the Centers for Disease Control and Prevention (CDC) Travelers' Health website (http://wwwnc.cdc.gov/travel) or review CDC's Yellow Book online (http://wwwnc.cdc.gov/travel/page/yellowbook-home-2014).