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Dyda A, Broome A, Rawlinson W, Mahimbo A, Saha A, Kefalas B, Seale H, Macintyre CR, Zwar N, Gidding HF, Heywood AE. Measles, mumps, rubella and varicella antibodies among international and domestic university students. J Travel Med 2024; 31:taae004. [PMID: 38195239 DOI: 10.1093/jtm/taae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024]
Abstract
BACKGROUND Vaccine-preventable infections are generally well controlled in Australia. However, gaps in immunity can lead to outbreaks and are important to identify. Young adults are a highly mobile population and a potential source of imported infections. We aimed to evaluate anti- measles, mumps, rubella and varicella (MMR&V) IgG seroprevalence and explore factors relating to antibody seropositivity. METHODS A cross-sectional online survey was conducted among students from a large Australian university to collect demographic, vaccination, infection and travel characteristics. Blood samples were collected to measure MMR&V seroprevalence. Logistic regression was used to identify factors associated with seropositivity. RESULTS Among 804 university students, seroprevalence (positive or equivocal) for measles was 82.3% (95% CI 79.6-84.8%), mumps 79.5% (95% CI 76.7-82.3%), rubella 91.5% (95% CI 89.6-93.5%) and varicella 86.2% (95% CI 84.1-88.8%), with 452 (56.2%, 95% CI 52.8-59.6) seropositive to all four viruses. Varicella seropositivity was highest in the older birth cohort (born 1988-1991). Measles seropositivity was higher for international students compared to domestic students. Among international students, mumps seroprevalence was significantly lower than measles and rubella seroprevalence. International travel in the previous 12 months was reported by 63.1% of students, but only 18.2% of travellers reported seeking pre-travel health advice prior to most recent international travel. CONCLUSIONS Overall, this study suggests immunity to MMR&V is sub-optimal. We found the university student population to be highly mobile and unlikely to seek pre-travel advice; thus, they are a potential source of infection importation. The implementation of university immunization policies could address the gaps identified and our findings can inform the development of targeted vaccination campaigns.
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Affiliation(s)
- Amalie Dyda
- School of Public Health, University of Queensland, Brisbane, QLD 4072, Australia
| | - Audrey Broome
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - William Rawlinson
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, NSW 2031, Australia
| | - Abela Mahimbo
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Amit Saha
- The Kirby Institute, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Bill Kefalas
- UNSW Health Service, University of New South Wales, Sydney, NSW 2052, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - C Raina Macintyre
- The Kirby Institute, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Nicholas Zwar
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4226, Australia
| | - Heather F Gidding
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Anita E Heywood
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
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Lewin B, Qian L, Huang R, Sy LS, Goddard K, Naleway AL, DeSilva M, Daley MF, McNeil MM, Jackson LA, Jacobsen SJ. Travelers and travel vaccines at six health care systems in the Vaccine Safety Datalink. Vaccine 2022; 40:5904-5911. [PMID: 36064668 PMCID: PMC10883331 DOI: 10.1016/j.vaccine.2022.08.023] [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: 06/17/2022] [Revised: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studying the safety of travel vaccines poses challenges since recipients may be traveling during the risk window for adverse events and the identification of a suitable comparison group can also be difficult. The examination of traveler characteristics, travel vaccination patterns, and health care utilization using electronic health record (EHR) data can inform the feasibility of future travel vaccine safety studies. METHODS A retrospective cohort study of health plan members in the Vaccine Safety Datalink Project aged 9 months and older who had a travel-related encounter or received a travel vaccine from 2009 to 2018 was performed. Travel regions visited, travel duration, type of travel vaccine received (typhoid, yellow fever, Japanese encephalitis, rabies, and cholera), and timing of vaccination date before departure date were described. Sociodemographic information, clinical characteristics, and health care utilization were compared between travelers who received travel vaccines and travelers who did not. RESULTS A total of 1,026,822 unique travelers departing from the United States were identified; 612,795 travelers received 898,196 doses of travel vaccines. The most commonly administered travel vaccine was typhoid vaccine and 77% of all travel vaccines were given more than one week prior to departure. Compared with travelers without travel vaccines, travelers with travel vaccines were overall similar but as a group were slightly younger, healthier, and had lower Hispanic representation. Health care utilization dramatically decreased during travel. Outpatient visits decreased from 294.8 visits per 10,000 person-days before travel to 24.2 visits per 10,000 person-days during reported travel dates. CONCLUSIONS Through the EHR information from almost a million travelers, a departure date and duration of travel were successfully captured for the majority of travelers with corresponding health care utilization data. Time after vaccination and prior to departure can potentially be used in the future to compare travelers who receive travel vaccines with travelers who do not receive travel vaccines when looking at adverse events of interest after vaccination.
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Affiliation(s)
- Bruno Lewin
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA.
| | - Lei Qian
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA
| | - Runxin Huang
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA
| | - Lina S Sy
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, 1 Kaiser Plaza 16th Floor, Oakland, CA 94612, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Malini DeSilva
- HealthPartners Institute, 8170 33rd Avenue South PO Box 1524, Minneapolis, MN 55440, USA
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, 10065 E. Harvard Suite 300, Denver, CO 8023, USA
| | - Michael M McNeil
- Immunization Safety Office, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA 98101, USA
| | - Steven J Jacobsen
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA
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Chamorro-Tojeiro S, Navas E, Liébana M, de la Roz S, Rodríguez-Domínguez M, Norman FF. Measles initially misdiagnosed as an arboviral disease in a returning traveler. J Travel Med 2022; 29:6440337. [PMID: 34850079 DOI: 10.1093/jtm/taab182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 11/17/2021] [Indexed: 11/13/2022]
Abstract
Vaccine-preventable diseases should be considered in returning travellers presenting with a rash. A patient with measles, probably acquired during an evacuation flight from Afghanistan to the USA, was diagnosed on return from Brazil. Misdiagnosis of highly contagious viral infections such as measles may have significant public health repercussions.
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Affiliation(s)
- Sandra Chamorro-Tojeiro
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS: CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
| | - Enrique Navas
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS: CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
| | - Mónica Liébana
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS: CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
| | - Sandra de la Roz
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS: CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
| | | | - Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS: CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
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4
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Ami N, Eyal N, Asaf B, Chen A, Adi B, Drorit A, Neta P, Hajar D, Stav R, Eli S. Safety of measles, rubella and mumps vaccines in adults: a prospective cohort study. J Travel Med 2021; 28:6295126. [PMID: 34101817 DOI: 10.1093/jtm/taab071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/14/2021] [Accepted: 04/27/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND In recent years, multiple outbreaks of measles associated with vaccine hesitancy occurred in high-income countries, where measles incidence had previously been low. Most safety data about the measles, mumps and rubella (MMR) vaccine are derived from studies conducted among children, whereas evidence regarding the safety profile of the vaccine in adults is scarce. METHODS In 2017, during an outbreak of measles in Europe, Israeli travellers to high-risk locations who were incompletely vaccinated, were urged to complete the two MMR vaccination schedule before their travel. In this prospective cohort study, we analysed adverse events (AEs) of MMR and MMRV (measles, mumps, rubella and varicella) vaccines among these travellers. All participants were followed up using structured questionnaires 2-4 weeks after vaccination. RESULTS Seven hundred and eighty-five adult travellers whose median age was 49.2 years were vaccinated and followed up. Any AEs were reported by 25.2% of all participants; 11.6% reported local AEs, and 18.6% reported systemic AEs, none of which were severe. In general, AEs were much more common among female travellers (19.4% of males vs 30.1% of females (P < 0.001)). Local AEs, overall systemic AEs, headache and arthralgia were much more common among females, whereas rates of general malaise and fever were not statistically different between genders. We did not observe any significant differences in the rates of total, local or systemic AEs between the MMR and MMRV vaccines. Higher rates of systemic AEs were observed among participants who were younger and probably immunized once with MMR compared to older vaccines immunized once to measles only and to those who were never immunized. CONCLUSIONS The current study demonstrated low rates of systemic AEs and no serious AEs following either MMR or MMRV administration. More AEs were reported among females, and rates of AEs were similar after either MMR or MMRV.
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Affiliation(s)
- Neuberger Ami
- Bruce Rappaport Faculty of Medicine, Technion, HaAliya HaShniya St, Haifa, 3109601, Israel.,Division of Internal Medicine, Rambam Health Care Campus, HaAliya HaShniya St, Haifa, 3109601, Israel.,Unit of Infectious Diseases, Rambam Healthcare Campus, HaAliya HaShniya St, Haifa, 3109601, Israel
| | - Nadir Eyal
- Infectious Diseases Unit, Kaplan Medical Center, Derech Pasternak 1, Rehovot, 7610001, Israel.,Clalit Health Services, Jerusalem District, 9514622, Israel
| | - Biber Asaf
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan, 52621, Israel
| | - Avni Chen
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan, 52621, Israel
| | - Brom Adi
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan, 52621, Israel
| | | | - Petersiel Neta
- Division of Internal Medicine, Rambam Health Care Campus, HaAliya HaShniya St, Haifa, 3109601, Israel.,Unit of Infectious Diseases, Rambam Healthcare Campus, HaAliya HaShniya St, Haifa, 3109601, Israel
| | - Dallashi Hajar
- Bruce Rappaport Faculty of Medicine, Technion, HaAliya HaShniya St, Haifa, 3109601, Israel
| | - Rakedzon Stav
- Division of Internal Medicine, Rambam Health Care Campus, HaAliya HaShniya St, Haifa, 3109601, Israel
| | - Schwartz Eli
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan, 52621, Israel.,Maoz Travel Clinic, Jerusalem, 94622, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, 69978, Israel
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5
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Wilder-Smith A. COVID-19 in comparison with other emerging viral diseases: risk of geographic spread via travel. Trop Dis Travel Med Vaccines 2021; 7:3. [PMID: 33517914 PMCID: PMC7847598 DOI: 10.1186/s40794-020-00129-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/26/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic poses a major global health threat. The rapid spread was facilitated by air travel although rigorous travel bans and lockdowns were able to slow down the spread. How does COVID-19 compare with other emerging viral diseases of the past two decades? RECENT FINDINGS Viral outbreaks differ in many ways, such as the individuals most at risk e.g. pregnant women for Zika and the elderly for COVID-19, their vectors of transmission, their fatality rate, and their transmissibility often measured as basic reproduction number. The risk of geographic spread via air travel differs significantly between emerging infectious diseases. COVID-19 is not associated with the highest case fatality rate compared with other emerging viral diseases such as SARS and Ebola, but the combination of a high reproduction number, superspreading events and a globally immunologically naïve population has led to the highest global number of deaths in the past 20 decade compared to any other pandemic.
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Affiliation(s)
- A 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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Stein-Zamir C, Rishpon S. The National Immunization Technical Advisory Group in Israel. Isr J Health Policy Res 2021; 10:7. [PMID: 33499907 PMCID: PMC7835647 DOI: 10.1186/s13584-021-00442-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
National Immunization Technical Advisory Groups (NITAGs) are defined by the World Health Organization as multidisciplinary groups of health experts who are involved in the development of a national immunization policy. The NITAG has the responsibility to provide independent, evidence-informed advice to the policy makers and national programme managers, on policy issues and questions related to immunization and vaccines.This paper aims to describe the NITAG in Israel. The Israeli NITAG was established by the Ministry of Health in1974. The NITAG's full formal name is "the Advisory Committee on Infectious Diseases and Immunizations in Israel". The NITAG is charged with prioritizing choices while granting maximal significance to the national public health considerations. Since 2007, the full minutes of the NITAG's meetings have been publicly available on the committee's website (at the Ministry of Health website, in Hebrew).According to the National Health Insurance Law, all residents of Israel are entitled to receive universal health coverage. The health services basket includes routine childhood immunizations, as well as several adult and post - exposure vaccinations. The main challenge currently facing the NITAG is establishing a process for introducing new vaccines and updating the vaccination schedule through the annual update of the national health basket. In the context of the annual update, vaccines have to "compete" with multiple medications and technologies which are presented to the basket committee for inclusion in the national health basket. Over the years, the Israeli NITAG's recommendations have proved essential for vaccine introduction and scheduling and for communicable diseases control on a national level. The NITAG has established structured and transparent working processes and a decision framework according to WHO standards, which is evidence-based and country-specific to Israel.The recent global COVID-19 pandemic is a major concern for all countries as well as a challenge for NITAGs. Currently, the NITAGs have a key role in advising both on sustainment of the routine immunization programs and on planning of the COVID-19 vaccination campaigns, with ongoing updates and collaboration with the Ministry of Health and health organizations.
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Affiliation(s)
- Chen Stein-Zamir
- The Israeli NITAG, Jerusalem, Israel.
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel.
- The Hebrew University of Jerusalem, Faculty of Medicine, Braun School of Public and Community Medicine, Jerusalem, Israel.
| | - Shmuel Rishpon
- The Israeli NITAG, Jerusalem, Israel
- Haifa District Health Office, Ministry of Health, Haifa, Israel
- School of Public Health, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
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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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8
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Wilder-Smith A. End of year editorial: hot topics in travel medicine. J Travel Med 2020; 27:5991847. [PMID: 33225360 PMCID: PMC7717345 DOI: 10.1093/jtm/taaa215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/09/2023]
Abstract
COVID-19 will reshape travel medicine, in particular in relation to business travellers and the use of digital technologies. Although the hot topic in travel medicine was the COVID-19 pandemic, travel-associated measles, yellow fever and rabies deserve some special attention.
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Affiliation(s)
- Annelies Wilder-Smith
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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Hamer DH, Rizwan A, Freedman DO, Kozarsky P, Libman M. GeoSentinel: past, present and future†. J Travel Med 2020; 27:taaa219. [PMID: 33247586 PMCID: PMC7799014 DOI: 10.1093/jtm/taaa219] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
RATIONALE FOR REVIEW In response to increased concerns about emerging infectious diseases, GeoSentinel, the Global Surveillance Network of the International Society of Travel Medicine in partnership with the US Centers for Disease Control and Prevention (CDC), was established in 1995 in order to serve as a global provider-based emerging infections sentinel network, conduct surveillance for travel-related infections and communicate and assist global public health responses. This review summarizes the history, past achievements and future directions of the GeoSentinel Network. KEY FINDINGS Funded by the US CDC in 1996, GeoSentinel has grown from a group of eight US-based travel and tropical medicine centers to a global network, which currently consists of 68 sites in 28 countries. GeoSentinel has provided important contributions that have enhanced the ability to use destination-specific differences to guide diagnosis and treatment of returning travelers, migrants and refugees. During the last two decades, GeoSentinel has identified a number of sentinel infectious disease events including previously unrecognized outbreaks and occurrence of diseases in locations thought not to harbor certain infectious agents. GeoSentinel has also provided useful insight into illnesses affecting different traveling populations such as migrants, business travelers and students, while characterizing in greater detail the epidemiology of infectious diseases such as typhoid fever, leishmaniasis and Zika virus disease. CONCLUSIONS Surveillance of travel- and migration-related infectious diseases has been the main focus of GeoSentinel for the last 25 years. However, GeoSentinel is now evolving into a network that will conduct both research and surveillance. The large number of participating sites and excellent geographic coverage for identification of both common and illnesses in individuals who have traversed international borders uniquely position GeoSentinel to make important contributions of travel-related infectious diseases in the years to come.
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Affiliation(s)
- 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 Disease, Department of Medicine, Boston University School of Medicine, Crosstown 308, 801 Massachusetts Avenue, Boston, MA 02118, USA
- National Emerging Infectious Disease Laboratory, Boston University, Crosstown 308, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Aisha Rizwan
- GeoSentinel, International Society of Travel Medicine, 11720 Amber Park Drive, Suite 160, Alpharetta, GA 30009, USA
| | - David O Freedman
- Division of Infectious Diseases, University of Alabama at Birmingham, 1720 2nd Ave S, BBRB 201, Birmingham, AL 35294 2170, USA
| | - Phyllis Kozarsky
- Division of Infectious Diseases (Emerita), Department of Medicine, Emory University, 2500 Peachtree Road NW, Suite 505, Atlanta, GA 30305, USA
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Room E05.1830, 1001 Boulevard Décarie, Montréal, Québec H4A 3J1, Canada
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10
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Wilder-Smith A, Osman S. Public health emergencies of international concern: a historic overview. J Travel Med 2020; 27:6025447. [PMID: 33284964 PMCID: PMC7798963 DOI: 10.1093/jtm/taaa227] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 12/19/2022]
Abstract
RATIONALE The International Health Regulations (IHR) have been the governing framework for global health security since 2007. Declaring public health emergencies of international concern (PHEIC) is a cornerstone of the IHR. Here we review how PHEIC are formally declared, the diseases for which such declarations have been made from 2007 to 2020 and justifications for such declarations. KEY FINDINGS Six events were declared PHEIC between 2007 and 2020: the 2009 H1N1 influenza pandemic, Ebola (West African outbreak 2013-2015, outbreak in Democratic Republic of Congo 2018-2020), poliomyelitis (2014 to present), Zika (2016) and COVID-19 (2020 to present). Poliomyelitis is the longest PHEIC. Zika was the first PHEIC for an arboviral disease. For several other emerging diseases a PHEIC was not declared despite the fact that the public health impact of the event was considered serious and associated with potential for international spread. RECOMMENDATIONS The binary nature of a PHEIC declaration is often not helpful for events where a tiered or graded approach is needed. The strength of PHEIC declarations is the ability to rapidly mobilize international coordination, streamline funding and accelerate the advancement of the development of vaccines, therapeutics and diagnostics under emergency use authorization. The ultimate purpose of such declaration is to catalyse timely evidence-based action, to limit the public health and societal impacts of emerging and re-emerging disease risks while preventing unwarranted travel and trade restrictions.
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Affiliation(s)
- Annelies Wilder-Smith
- Global Health and Epidemiology, University of Umea, 901 87 Umea, Sweden.,Heidelberg Institute of Global Health, University of Heidelberg, Im Neuenheimer Feld 365, 6900 Heidelberg, Germany
| | - Sarah Osman
- Global Health and Epidemiology, University of Umea, 901 87 Umea, Sweden
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11
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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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12
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Dickens BL, Koo JR, Lim JT, Sun H, Clapham HE, Wilder-Smith A, Cook AR. Strategies at points of entry to reduce importation risk of COVID-19 cases and reopen travel. J Travel Med 2020; 27:taaa141. [PMID: 32841354 PMCID: PMC7499710 DOI: 10.1093/jtm/taaa141] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND With more countries exiting lockdown, public health safety requires screening measures at international travel entry points that can prevent the reintroduction or importation of the severe acute respiratory syndrome-related coronavirus-2. Here, we estimate the number of cases captured, quarantining days averted and secondary cases expected to occur with screening interventions. METHODS To estimate active case exportation risk from 153 countries with recorded coronavirus disease-2019 cases and deaths, we created a simple data-driven framework to calculate the number of infectious and upcoming infectious individuals out of 100 000 000 potential travellers from each country, and assessed six importation risk reduction strategies; Strategy 1 (S1) has no screening on entry, S2 tests all travellers and isolates test-positives where those who test negative at 7 days are permitted entry, S3 the equivalent but for a 14 day period, S4 quarantines all travellers for 7 days where all are subsequently permitted entry, S5 the equivalent for 14 days and S6 the testing of all travellers and prevention of entry for those who test positive. RESULTS The average reduction in case importation across countries relative to S1 is 90.2% for S2, 91.7% for S3, 55.4% for S4, 91.2% for S5 and 77.2% for S6. An average of 79.6% of infected travellers are infectious upon arrival. For the top 100 exporting countries, an 88.2% average reduction in secondary cases is expected through S2 with the 7-day isolation of test-positives, increasing to 92.1% for S3 for 14-day isolation. A substantially smaller reduction of 30.0% is expected for 7-day all traveller quarantining, increasing to 84.3% for 14-day all traveller quarantining. CONCLUSIONS The testing and isolation of test-positives should be implemented provided good testing practices are in place. If testing is not feasible, quarantining for a minimum of 14 days is recommended with strict adherence measures in place.
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Affiliation(s)
- Borame L Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 1E Kent Ridge Rd, Singapore 117549
| | - Joel R Koo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 1E Kent Ridge Rd, Singapore 117549
| | - Jue Tao Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 1E Kent Ridge Rd, Singapore 117549
| | - Haoyang Sun
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 1E Kent Ridge Rd, Singapore 117549
| | - Hannah E Clapham
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 1E Kent Ridge Rd, Singapore 117549
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Im Neuenheimer Feld 365, R. 004, 69120 Heidelberg, Germany
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 1E Kent Ridge Rd, Singapore 117549
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Kutsuna S, Asai Y, Yamamoto K, Shirano M, Konishi K, Asaoka T, Yamato M, Katsuragi Y, Yamamoto Y, Sahara T, Tamiya A, Nakamura-Uchiyama F, Sakamoto N, Kosaka A, Washino T, Hase R, Mito H, Kurita T, Shinohara K, Shimizu T, Kodama F, Nagasaka A, Ogawa T, Kasahara K, Yoshimura Y, Tachikawa N, Yokota K, Yuka Murai NS, Sakamaki I, Hasegawa C, Yoshimi Y, Toyoda K, Mitsuhashi T, Ohmagari N. Epidemiological trends of imported infectious diseases in Japan: Analysis of imported 2-year infectious disease registry data. J Infect Chemother 2020; 27:632-638. [PMID: 33309629 DOI: 10.1016/j.jiac.2020.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/30/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The epidemiology of infectious diseases in Japan remains undefined despite the increasing tourism. GeoSentinel, an epidemiological surveillance system for reporting imported infectious diseases, has only two participating facilities in Japan. Although the number of infectious diseases is reported by the National Institute of Infectious Diseases, there is no detailed clinical information about these cases. Therefore, we established J-RIDA (Japan Registry for Infectious Diseases from Abroad) to clarify the status of imported infectious diseases in Japan and provide detailed information. METHODS J-RIDA was started as a registry of imported infectious diseases. Case registration began in October 2017. Between October 2017 and September 2019, 15 medical institutions participated in this clinical study. The registry collected information about the patient's age, sex, nationality, chief complaint, consultation date, date of onset, whether visit was made to a travel clinic before travel, blood test results (if samples were collected), travel history, and final diagnosis. RESULTS Of the 3046 cases included in this study, 46.7% to Southeast Asia, 13.0% to Africa, 13.7% to East Asia, 11.5% to South Asia, 7.5% to Europe, 3.8% to Central and South America, 4.6% to North America, 3.9% to Oceania, and 2.8% to Central and west Asia. More than 85% of chief complaints were fever and general symptoms, gastrointestinal symptoms, respiratory symptoms, or dermatologic problems. The most common diseases were travelers' diarrhea, animal bite, upper respiratory infection, influenza, and dengue fever. CONCLUSIONS We summarized two-year cases registered in Japan's imported infectious disease registry. These results will significantly contribute to the epidemiology in Japan.
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Affiliation(s)
- Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Yusuke Asai
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Michinori Shirano
- Osaka City General Hospital, 2-13-22, Miyakojima-hondori Miyakojima-ku, Osaka, 534-0021, Japan
| | - Keiji Konishi
- Osaka City General Hospital, 2-13-22, Miyakojima-hondori Miyakojima-ku, Osaka, 534-0021, Japan
| | - Tomohiro Asaoka
- Osaka City General Hospital, 2-13-22, Miyakojima-hondori Miyakojima-ku, Osaka, 534-0021, Japan
| | - Masaya Yamato
- Rinku General Medical Center, Rinku Ourai Kita 2-23, Izumisanoshi, Osaka, 598-8577, Japan
| | - Yukiko Katsuragi
- Rinku General Medical Center, Rinku Ourai Kita 2-23, Izumisanoshi, Osaka, 598-8577, Japan
| | - Yudai Yamamoto
- Rinku General Medical Center, Rinku Ourai Kita 2-23, Izumisanoshi, Osaka, 598-8577, Japan
| | - Toshinori Sahara
- Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, 3F 2-5 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Aya Tamiya
- Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, 3F 2-5 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Fukumi Nakamura-Uchiyama
- Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, 3F 2-5 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Naoya Sakamoto
- Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Atsushi Kosaka
- Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Takuya Washino
- Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Ryota Hase
- Japanese Red Cross Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba, 286-8523, Japan
| | - Haruki Mito
- Japanese Red Cross Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba, 286-8523, Japan
| | - Takashi Kurita
- Japanese Red Cross Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba, 286-8523, Japan
| | - Koh Shinohara
- Kyoto City Hospital, 1-2 Mibuhigashitakadacho, Nakagyo Ward, Kyoto, 604-8845, Japan
| | - Tsunehiro Shimizu
- Kyoto City Hospital, 1-2 Mibuhigashitakadacho, Nakagyo Ward, Kyoto, 604-8845, Japan
| | - Fumihiro Kodama
- Sapporo City General Hospital, Kita 1 Nishi 2, Chuo-ku, Sapporo, 060-8611, Japan
| | - Atsushi Nagasaka
- Sapporo City General Hospital, Kita 1 Nishi 2, Chuo-ku, Sapporo, 060-8611, Japan
| | - Taku Ogawa
- Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kei Kasahara
- Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yukihiro Yoshimura
- Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishimachi, Kanagawa-ku, Yokohama City, Kanagawa, 221-0855, Japan
| | - Natsuo Tachikawa
- Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishimachi, Kanagawa-ku, Yokohama City, Kanagawa, 221-0855, Japan
| | - Kyoko Yokota
- Kagawa Prefectural Central Hospital, 1-2-1, Asahicho, Takamatsu, Kagawa, 760-0065, Japan
| | - N S Yuka Murai
- Kagawa Prefectural Central Hospital, 1-2-1, Asahicho, Takamatsu, Kagawa, 760-0065, Japan
| | - Ippei Sakamaki
- Toyama University Hospital, 2630 Sugitani, Toyama-shi, Toyama, 930-0194, Japan
| | - Chihiro Hasegawa
- Nagoya City East Medical Center, 1-2-23 Wakamizu, Chikusa-ku, Nagoya-city, Aichi, 464-8547, Japan
| | - Yusuke Yoshimi
- Japanese Red Cross Nagoya Daini Hospital, 9, Myokencho, Nagoya, Aichi, 466-8650, Japan
| | - Kazuhiro Toyoda
- Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tatsuro Mitsuhashi
- Aomori Prefectural Central Hospital, Higashi Tukurimiti 2-1-1, Aomori, 030-8553, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
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Modelling the test, trace and quarantine strategy to control the COVID-19 epidemic in the state of São Paulo, Brazil. Infect Dis Model 2020; 6:46-55. [PMID: 33235942 PMCID: PMC7677040 DOI: 10.1016/j.idm.2020.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 02/06/2023] Open
Abstract
Testing for detecting the infection by SARS-CoV-2 is the bridge between the lockdown and the opening of society. In this paper we modelled and simulated a test-trace-and-quarantine strategy to control the COVID-19 outbreak in the State of São Paulo, Brasil. The State of São Paulo failed to adopt an effective social distancing strategy, reaching at most 59% in late March and started to relax the measures in late June, dropping to 41% in 08 August. Therefore, São Paulo relies heavily on a massive testing strategy in the attempt to control the epidemic. Two alternative strategies combined with economic evaluations were simulated. One strategy included indiscriminately testing the entire population of the State, reaching more than 40 million people at a maximum cost of 2.25 billion USD, that would reduce the total number of cases by the end of 2020 by 90%. The second strategy investigated testing only symptomatic cases and their immediate contacts – this strategy reached a maximum cost of 150 million USD but also reduced the number of cases by 90%. The conclusion is that if the State of São Paulo had decided to adopt the simulated strategy on April the 1st, it would have been possible to reduce the total number of cases by 90% at a cost of 2.25 billion US dollars for the indiscriminate strategy but at a much smaller cost of 125 million US dollars for the selective testing of symptomatic cases and their contacts.
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15
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Angelo KM. Twenty-five years: GeoSentinel's impact on travel-related surveillance and its vision for the future. J Travel Med 2020; 27:5903799. [PMID: 32914193 PMCID: PMC9617544 DOI: 10.1093/jtm/taaa166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 01/26/2023]
Abstract
GeoSentinel has been successful in advancing public health and clinical practice since its inception, by informing disease- and population-specific travel medicine topics, provision of healthcare of ill travelers, and pre-travel preparation strategies for healthcare providers. Recent hepatitis E and animal exposures publications reinforce these successes and present questions for the future.
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Affiliation(s)
- Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
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16
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Murray HW. The Pretravel Consultation: Recent Updates. Am J Med 2020; 133:916-923.e2. [PMID: 32179056 DOI: 10.1016/j.amjmed.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
Estimates suggest that 43%-79% of international travelers may develop travel-related illnesses. Most such illnesses are considered mild and self-limited; however, some are life-threatening. The pretravel consultation is aimed at assessing risks for a range of illnesses, communicating these risks, and then providing individualized recommendations and interventions to minimize or manage such risks. The effective consultation is predicated on a well-prepared clinician and motivated traveler, understanding the traveler's perception of, and tolerance for, risk, and providing education applicable to the actual itinerary. Integral to the clinician's preparation is regular review of up-to-date trip-specific recommendations; country-specific information and recommendations are readily available and can now be efficiently accessed. From the infectious diseases perspective, immunizations, malaria chemoprophylaxis, insect repellent use, and travelers' diarrhea and its self-management are cornerstones of the consultation. This review focuses primarily on updating these 4 topics with recently published information relevant to adult travelers.
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Affiliation(s)
- Henry W Murray
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY.
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17
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Al-Abri S, Al-Lamki S, Petersen E, Al-Mandhari A. The Future Importance of Travel Health in the Middle East: Oman's opportunity to enhance its services. Sultan Qaboos Univ Med J 2020; 20:e121-e124. [PMID: 32655903 PMCID: PMC7328843 DOI: 10.18295/squmj.2020.20.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/08/2020] [Accepted: 05/06/2020] [Indexed: 01/26/2023] Open
Affiliation(s)
- Seif Al-Abri
- Directorate General of Disease Surveillance and Control, Primary Health Care, Ministry of Health, Oman
| | | | - Eskild Petersen
- Directorate General of Disease Surveillance and Control, Primary Health Care, Ministry of Health, Oman
| | - Ahmed Al-Mandhari
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
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18
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Leong WY, Wilder-Smith AB. Measles Resurgence in Europe: Migrants and Travellers are not the Main Drivers. J Epidemiol Glob Health 2019; 9:294-299. [PMID: 31854172 PMCID: PMC7310798 DOI: 10.2991/jegh.k.191007.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/24/2019] [Indexed: 12/14/2022] Open
Abstract
Measles is a highly transmissible viral infection that may lead to serious illness, lifelong complications, and death. As there is no animal reservoir for measles, measles resurgence is due to human movement of viremic persons. Therefore, some have blamed the enormous migration into Europe in the past 5 years for the measles resurgence in this region. We set out to determine the main driver for measles resurgence in Europe by assessing vaccine coverage rates and economic status in European countries, number of migrants, and travel volumes. Data on measles vaccine coverage rates with two vaccine doses of measles, mumps and rubella (MMR) [Measles Containing Vaccine (MCV)2] and total number of measles cases in 2017 for Europe, including Eastern European countries, were obtained, in addition to Gross Domestic Product (GDP), and number of migrants and tourist arrivals. The outcome measured, incidence of measles per 100,000, was log transformed and subsequently analyzed using multiple linear regression, along with predictor variables: number of international migrants, GDP per capita, tourist arrivals, and vaccine coverage. The final model was interpreted by exponentiating the regression coefficients. Incidence of measles was highest in Romania (46.1/100,000), followed by Ukraine (10.8/100,000) and Greece (8.7/100,000). MCV2 coverage in these countries is less than 84%, with lowest coverage rate (75%) reported in Romania. Only vaccine coverage appears to be the significant predictor in the model (p < 0.001) for incidence of measles even after adjusting for international migrants, international tourist arrivals, and GDP per capita. With one unit increase in vaccination coverage, the incidence of measles decreased by 18% [95% confidence interval (CI): 10-25]. Our results showed that number of migrants and international tourist arrivals into any of the European countries were not the drivers for increased measles cases. Countries with high vaccine coverage rates regardless of economic status did not experience a resurgence of measles, even if the number of migrants or incoming travellers was high. The statistically significant sole driver was vaccine coverage rates. These analyses reemphasize the importance of strategies to improve national measles vaccination to achieve coverage greater than 95%.
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Affiliation(s)
- Wei-Yee Leong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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19
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No measles cases during the 2019 Hajj. THE LANCET. INFECTIOUS DISEASES 2019; 19:1169-1170. [DOI: 10.1016/s1473-3099(19)30542-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/11/2019] [Indexed: 11/23/2022]
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20
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21
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Pre-vaccination screening strategies for the use of the CYD-TDV dengue vaccine: A meeting report. Vaccine 2019; 37:5137-5146. [PMID: 31377079 DOI: 10.1016/j.vaccine.2019.07.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 12/28/2022]
Abstract
The first licensed dengue vaccine, CYD-TDV (Dengvaxia) is efficacious in seropositive individuals, but increases the risk for severe dengue in seronegative persons about two years after administration of the first dose. For countries considering the introduction of Dengvaxia, WHO recommends a pre-vaccination screening strategy whereby only persons with evidence of a past dengue infection would be vaccinated. Policy-makers need to consider the risk-benefit of vaccination strategies based on such screening tests, the optimal age to introduce the vaccine, communication and implementation strategies. To address these questions, the Global Dengue and Aedes-transmitted diseases Consortium (GDAC) organized a 3-day workshop in January 2019 with country representatives from Asia and Latin America. The meeting discussions highlighted many challenges in introducing Dengvaxia, in terms of screening test characteristics, costs of such tests combined with a 3-dose schedule, logistics, achieving high coverage rates, vaccine confidence and communication; more challenges than for any other vaccine introduction programme. A screening test would require a high specificity to minimize individual risk, and at the same time high sensitivity to maximize individual and population benefit. The underlying seroprevalence dependent positive predictive value is the best indicator for an acceptable safety profile of a pre-vaccination screening strategy. The working groups discussed many possible implementation strategies. Addressing the bottlenecks in school-based vaccine introduction for Dengvaxia will also benefit other vaccines such as HPV and booster doses for tetanus and pertussis. Levels of public trust are highly variable and context specific, and understanding of population perceptions and concerns is essential to tailor interventions, monitor and mitigate risks.
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