Imported Arbovirus Infections in Spain, 2009-2018

Imported infectious diseases in migrants from Latin America: A retrospective study from a referral centre for tropical diseases in Spain, 2017-2022

INTRODUCTION

Detecting imported diseases by migrants and individuals visiting friends and relatives (VFR) is key in the prevention and management of emergent infectious diseases acquired abroad.

METHODS

Retrospective descriptive study on migrants and VFR from Central and South America between 2017 and 2022 attended at a National Referral Centre for Tropical Diseases in Madrid, Spain. Demographic characteristics, syndromes and confirmed travel-related diagnoses were obtained from hospital patient medical records.

RESULTS

1654 cases were registered, median age of 42 years, 69.1% were female, and 55.2% were migrants. Most cases came from Bolivia (49.6%), followed by Ecuador (12.9%). Health screening while asymptomatic (31.6%) was the main reason for consultation, followed by Chagas disease follow-up (31%). Of those asymptomatic at screening, 47,2% were finally diagnosed of any disease, mainly Chagas disease (19,7%) and strongyloidiasis (10,2%) CONCLUSION: Our study emphasizes the importance of proactive health screening to detect asymptomatic conditions in migrants and VFR, enabling timely intervention and improved health outcomes. By understanding the unique health profiles of immigrant populations, targeted public health interventions can be devised to safeguard the well-being of these vulnerable groups.

Chikungunya in Zhejiang Province, Southeast China

Background

Chikungunya is emerging and reemerging word-widely in the past decades. It is non-endemic in Zhejiang Province, Southeast China. Aedes albopictus, one of major vectors of chikungunya, is widely-distribution in Zhejiang, and autochthonous transmission is possible after introducing chikungunya virus.

Methods

Retrospectively collected the epidemiological, clinical and genetic data of chikungunya and conducted the descriptive analysis and gene sequence analysis.

Results

From 2008 to 2022, 29 chikungunya cases, including 26 overseas imported and 3 local cases, were reported and no cases died of chikungunya. More than half of the imported cases (53.85%) were from Southeast Asia. Seasonal peak of the imported cases was noted between August and September, and 42.31% cases onset in those 2 months. Eight prefecture-level cities and 16 counties reported cases during the study period, with Jinghua (27.59%) and Hangzhou (24.14%) reporting the largest number of cases. The 3 local cases were all reported in Qujiang, Quzhou in 2017. For imported cases, the male-female gender ratio was 2.71:1, 20-30 years old cases (46.15%) and commercial service (42.31%) accounted for the highest proportion. Clinically, fever (100%), fatigue (94.44%), arthralgia (79.17%), headache (71.43%) and erythra (65.22%) were the most common reported symptoms. Eight whole-genome sequences were obtained and belonged to East/Central/South African (ECSA) or Asian genotype.

Conclusions

With the change of immigration policy, the surveillance of chikungunya should be strengthened and the ability of the case discovery and diagnosis should be improved in Zhejiang in the post-COVID-19 era.

The Others: A Systematic Review of the Lesser-Known Arboviruses of the Insular Caribbean

The Caribbean enjoys a long-standing eminence as a popular tourist destination; however, over the years it has also amassed the sobriquet "arbovirus hotspot". As the planet warms and vectors expand their habitats, a cognizant working knowledge of the lesser-known arboviruses and the factors that influence their emergence and resurgence becomes essential. The extant literature on Caribbean arboviruses is spread across decades of published literature and is quite often difficult to access, and, in some cases, is obsolete. Here, we look at the lesser-known arboviruses of the insular Caribbean and examine some of the drivers for their emergence and resurgence. We searched the scientific literature databases PubMed and Google Scholar for peer-reviewed literature as well as scholarly reports. We included articles and reports that describe works resulting in serological evidence of the presence of arboviruses and/or arbovirus isolations in the insular Caribbean. Studies without serological evidence and/or arbovirus isolations as well as those including dengue, chikungunya, Zika, and yellow fever were excluded. Of the 545 articles identified, 122 met the inclusion criteria. A total of 42 arboviruses were identified in the literature. These arboviruses and the drivers that affect their emergence/resurgence are discussed.

Chikungunya: risks for travellers

RATIONALE FOR REVIEW

Chikungunya outbreaks continue to occur, with changing epidemiology. Awareness about chikungunya is low both among the at-risk travellers and healthcare professionals, which can result in underdiagnosis and underreporting. This review aims to improve awareness among healthcare professionals regarding the risks of chikungunya for travellers.

KEY FINDINGS

Chikungunya virus transmission to humans occurs mainly via daytime-active mosquitoes, Aedes aegypti and Aedes albopictus. The areas where these mosquitoes live is continuously expanding, partly due to climate changes. Chikungunya is characterized by an acute onset of fever with joint pain. These symptoms generally resolve within 1-3 weeks but at least one-third of the patients suffer from debilitating rheumatologic symptoms for months to years. Large outbreaks in changing regions of the world since the turn of the 21st century (e.g. Caribbean, La Réunion; currently Brazil, India) have resulted in growing numbers of travellers importing chikungunya, mainly to Europe and North America. Viremic travellers with chikungunya infection have seeded chikungunya clusters (France, United States of America) and outbreaks (Italy in 2007 and 2017) in non-endemic countries where Ae. albopictus mosquitoes are present. Community preventive measures are important to prevent disease transmission by mosquitoes. Individual preventive options are limited to personal protection measures against mosquito bites, particularly the daytime-active mosquitos that transmit the chikungunya virus. Candidate vaccines are on the horizon and regulatory authorities will need to assess environmental and host risk factors for persistent sequelae, such as obesity, age (over 40 years), and history of arthritis or inflammatory rheumatologic disease to determine which populations should be targeted for these chikungunya vaccines.

CONCLUSIONS/RECOMMENDATIONS

Travellers planning to visit destinations with active CHIKV circulation should be advised about the risk for chikungunya, prevention strategies, the disease manifestations, possible chronic rheumatologic sequelae, and if symptomatic, seek medical evaluation and report potential exposures.

Antibody seropositivity and endemicity of chikungunya and Zika viruses in Nigeria

Mosquito-borne infections are of global health concern because of their rapid spread and upsurge, which creates a risk for coinfections. chikungunya virus (CHIKV), an arbovirus disease transmitted by Aedes aegypti or A. albopictus, and malaria, a parasitic disease transmitted by Anopheles gambiae, are prevalent in Nigeria and neighbouring countries, but their burden and possible coinfections are poorly understood. In this study, we investigated the antibody seropositivity and endemicity of chikungunya and Zika viruses (ZIKV) in three regions of Nigeria. A cross-sectional sero-survey was conducted on 871 participants. Samples were collected from outpatients by simple random sampling. Analyses of the samples were performed using recomLine Tropical Fever for the presence of antibody serological marker IgG immunoblot with CHIKV VLP (virus like particle), ZIKV NS1 and ZIKV Equad according to manufacturers’ instructions and malaria RDT for malaria parasite. There was a significantly higher antibody seropositivity against CHIKV in the central region than in the northern and southern regions (69.5%, 291/419), while ZIKV-seropositivity (22.4%, 34/152) and CHIKV-ZIKV co-circulating antibody seropositivity (17.8%, 27/152) were notably higher in the southern region than in the central and northern regions. This investigation revealed an unexpectedly high antibody seropositivity and concealed endemicity of CHIKV and ZIKV in three Nigerian regions. The seropositivity of detectable antibodies differed among the three geographical locations.

Chikungunya: An Emerging Public Health Concern

Purpose of Review

The worldwide spread of chikungunya over the past two decades calls for greater knowledge and awareness of the virus, its route of transmission, methods of diagnosis, and the use of available treatment and prevention measures.

Recent Findings

Chikungunya virus infection, an Aedes mosquito-borne febrile disease, has spread from Africa and Asia to Europe and the Americas and from the tropics and subtropics to temperate regions. International travel is a pivotal influence in the emergence of chikungunya as a global public health threat, as evidenced by a growing number of published reports on travel-related chikungunya infections. The striking features of chikungunya are arthralgia and arthritis, and the disease is often mistaken for dengue. Although mortality is low, morbidity can be profound and persistent. Current treatment for chikungunya is supportive; chikungunya vaccines and therapeutics are in development. Travelers planning to visit areas where the mosquito vectors are present should be advised on preventive measures.

Summary

Chikungunya is an emerging disease in the Americas. Frequent travel, the presence of at least two competent mosquito species, and a largely naïve human population in the Western Hemisphere create a setting conducive to future outbreaks. Awareness of the disease and its manifestations is critical to effectively and safely manage and limit its impact. Vaccines in late-stage clinical trials offer a new pathway to prevention.

The threat of mosquito-borne arboviral disease in Spain: A bibliographic review

Over the last two decades there has been an increase in outbreaks of arboviral diseases, being Spain at high risk for disease emergence. This paper reviews the current evidence regarding the transmissibility, disease epidemiology, control strategies and mosquito-borne disease drivers and maintaining factors in Spain. There is risk of autochthonous cases and outbreaks in Spain due to recent transmission occurrence. Recently, there has been an expansion of Aedes Albopticus, a vector for Dengue, Zika and Chikungunya; and Cullex spp., vector for West Nile Virus, already endemic in Spain. Their establishment has been facilitated by climate and environmental drivers. If climate change projections are to be met, an increase in disease transmission is to be expected, as well as the re-establishment of other vectors such as Aedes Aegypti. Our review supports the need to understand the threat of these emerging diseases and implement preventive strategies in order to minimise their impact.

Maternal Infection and Adverse Pregnancy Outcomes among Pregnant Travellers: Results of the International Zika Virus in Pregnancy Registry

In this multicentre cohort study, we evaluated the risks of maternal ZIKV infections and adverse pregnancy outcomes among exposed travellers compared to women living in areas with ZIKV circulation (residents). The risk of maternal infection was lower among travellers compared to residents: 25.0% (n = 36/144) versus 42.9% (n = 309/721); aRR 0.6; 95% CI 0.5-0.8. Risk factors associated with maternal infection among travellers were travelling during the epidemic period (i.e., June 2015 to December 2016) (aOR 29.4; 95% CI 3.7-228.1), travelling to the Caribbean Islands (aOR 3.2; 95% CI 1.2-8.7) and stay duration >2 weeks (aOR 8.7; 95% CI 1.1-71.5). Adverse pregnancy outcomes were observed in 8.3% (n = 3/36) of infected travellers and 12.7% (n = 39/309) of infected residents. Overall, the risk of maternal infections is lower among travellers compared to residents and related to the presence of ongoing outbreaks and stay duration, with stays <2 weeks associated with minimal risk in the absence of ongoing outbreaks.