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Yuan Q, Chen Y, Liu S, Huang Q, Liao M, Zhou J, Li Z, Li Y. UN peacekeeper health and risk factors --- a systematic scoping review. Glob Health Res Policy 2024; 9:13. [PMID: 38600572 PMCID: PMC11005225 DOI: 10.1186/s41256-024-00351-4] [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: 03/06/2023] [Accepted: 03/31/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Conflicts, natural disasters, and complex emergencies present substantial health challenges to United Nations (UN) peacekeepers deployed in mission areas. This scoping review aims at summarizing previous research on the health of UN peacekeepers and identifies issues for further investigation. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews, we systematically searched Web of Science, PubMed, EMBASE, Scopus and China National Knowledge Infrastructure (CNKI) for English and Chinese literature published from April 1997 to November 2023. A data charting form was developed by two reviewers to extract relevant themes and provided narrative descriptions. RESULTS We screened 1079 de-duplicated records and included 143 studies in this scoping review. There were 112 studies on the health status of UN peacekeepers, with more than half on mental health problems such as stress and anxiety. Many studies explored the health status of UN peacekeepers in African countries deployed from mainly U.S., Canada, U.K., China, Australia and Norway. There were 39 studies on the health risk factors of UN peacekeepers, including natural environmental, social environmental, psychological, behavioral lifestyle, biological factors and health service factors. There were 62 articles on the health protection of UN peacekeepers, mainly based on previous deployment experience, with a lack of theoretical guidance from global health perspectives. This scoping review found that health problems of UN peacekeepers are complicated, and whose impacts are cross-border. Social environmental factors were explored the most among health risk factors. Disease prevention measures, medical and health measures, and psychosocial measures were the main health protection for UN peacekeepers. CONCLUSIONS This scoping review highlighted that health problems of UN peacekeepers were typical global health issues with complicated and cross-border health risk factors. Therefore, comprehensive strategies could be taken from global health perspectives, including multi-phases (before-deployment, during-deployment, and post-deployment), multi-disciplines (public health, medicine, politics, health diplomacy, and others), and multi-levels (the UN, host countries, troop-contributing countries, the UN peacekeeping team, and UN peacekeepers).
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Affiliation(s)
- Quan Yuan
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yong Chen
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shili Liu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qingning Huang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Miaomiao Liao
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiani Zhou
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhaogang Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ying Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China.
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Odigie AE, Stufano A, Schino V, Zarea AAK, Ndiana LA, Mrenoshki D, Ugochukwu ICI, Lovreglio P, Greco G, Pratelli A, Camero M, Tempesta M. West Nile Virus Infection in Occupational Settings-A Systematic Review. Pathogens 2024; 13:157. [PMID: 38392895 PMCID: PMC10892351 DOI: 10.3390/pathogens13020157] [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: 12/20/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND West Nile virus (WNV) is an emerging mosquito-borne neurotropic virus, belonging to the Flaviviridae family and the Orthoflavivirus genus. The effective control of WNV requires a targeted preventive strategy that also needs the identification of the higher-risk populations. Hence, this study focused on a systematic literature review of WNV-acquired infection in work-related settings and the assessment of the exposure risks among different occupational categories. METHODS A comprehensive search was conducted to identify studies until September 2023 in multiple databases such as PubMed/MEDLINE, SCOPUS and Web of Science, according to the PRISMA 2020 statement. Risk of bias of collected papers was assessed by the ROB tool of the National Toxicology Program's Office of Health Assessment and Translation handbook. RESULTS A total of 21 studies were included in the systematic review, out of which seventeen were observational studies and four were case reports. Workers identified as at higher risk for WNV infection were military workers, veterinarians, agricultural workers, farmers, and laboratory workers with contact with infected fluids or aerosols. CONCLUSIONS The identification of higher-risk workers could facilitate active surveillance by occupational physicians, which could improve our understanding of the epidemiology of WNV and, in addition, could help tailor appropriate preventive recommendations, reducing the overall burden of disease in high-risk areas.
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Affiliation(s)
- Amienwanlen E. Odigie
- Department of Veterinary Medicine, University of Bari Aldo Moro, SP 62 Casamassima km 3, 70010 Valenzano, Italy; (A.E.O.); (A.A.K.Z.); (L.A.N.); (D.M.); (I.C.I.U.); (G.G.); (A.P.); (M.C.); (M.T.)
- Department of Veterinary Public Health, University of Benin, Benin City 301154, Nigeria
| | - Angela Stufano
- Interdisciplinary Department of Medicine-Section of Occupational Medicine, University of Bari, 70124 Bari, Italy; (V.S.); (P.L.)
| | - Valentina Schino
- Interdisciplinary Department of Medicine-Section of Occupational Medicine, University of Bari, 70124 Bari, Italy; (V.S.); (P.L.)
| | - Aya Attia Koraney Zarea
- Department of Veterinary Medicine, University of Bari Aldo Moro, SP 62 Casamassima km 3, 70010 Valenzano, Italy; (A.E.O.); (A.A.K.Z.); (L.A.N.); (D.M.); (I.C.I.U.); (G.G.); (A.P.); (M.C.); (M.T.)
- Department of Microbiology and Immunology, Veterinary Research Institute, National Research Centre, Dokki 12622, Egypt
| | - Linda A. Ndiana
- Department of Veterinary Medicine, University of Bari Aldo Moro, SP 62 Casamassima km 3, 70010 Valenzano, Italy; (A.E.O.); (A.A.K.Z.); (L.A.N.); (D.M.); (I.C.I.U.); (G.G.); (A.P.); (M.C.); (M.T.)
- Department of Veterinary Microbiology, College of Veterinary Medicine, Michael Okpara University of Agriculture, Umudike 440101, Nigeria
| | - Daniela Mrenoshki
- Department of Veterinary Medicine, University of Bari Aldo Moro, SP 62 Casamassima km 3, 70010 Valenzano, Italy; (A.E.O.); (A.A.K.Z.); (L.A.N.); (D.M.); (I.C.I.U.); (G.G.); (A.P.); (M.C.); (M.T.)
| | - Iniobong C. I. Ugochukwu
- Department of Veterinary Medicine, University of Bari Aldo Moro, SP 62 Casamassima km 3, 70010 Valenzano, Italy; (A.E.O.); (A.A.K.Z.); (L.A.N.); (D.M.); (I.C.I.U.); (G.G.); (A.P.); (M.C.); (M.T.)
- Department of Veterinary Pathology and Microbiology, University of Nigeria, Nsukka 410001, Nigeria
| | - Piero Lovreglio
- Interdisciplinary Department of Medicine-Section of Occupational Medicine, University of Bari, 70124 Bari, Italy; (V.S.); (P.L.)
| | - Grazia Greco
- Department of Veterinary Medicine, University of Bari Aldo Moro, SP 62 Casamassima km 3, 70010 Valenzano, Italy; (A.E.O.); (A.A.K.Z.); (L.A.N.); (D.M.); (I.C.I.U.); (G.G.); (A.P.); (M.C.); (M.T.)
| | - Annamaria Pratelli
- Department of Veterinary Medicine, University of Bari Aldo Moro, SP 62 Casamassima km 3, 70010 Valenzano, Italy; (A.E.O.); (A.A.K.Z.); (L.A.N.); (D.M.); (I.C.I.U.); (G.G.); (A.P.); (M.C.); (M.T.)
| | - Michele Camero
- Department of Veterinary Medicine, University of Bari Aldo Moro, SP 62 Casamassima km 3, 70010 Valenzano, Italy; (A.E.O.); (A.A.K.Z.); (L.A.N.); (D.M.); (I.C.I.U.); (G.G.); (A.P.); (M.C.); (M.T.)
| | - Maria Tempesta
- Department of Veterinary Medicine, University of Bari Aldo Moro, SP 62 Casamassima km 3, 70010 Valenzano, Italy; (A.E.O.); (A.A.K.Z.); (L.A.N.); (D.M.); (I.C.I.U.); (G.G.); (A.P.); (M.C.); (M.T.)
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García-Carrasco JM, Muñoz AR, Olivero J, Segura M, Real R. An African West Nile virus risk map for travellers and clinicians. Travel Med Infect Dis 2022; 52:102529. [PMID: 36549415 DOI: 10.1016/j.tmaid.2022.102529] [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: 06/09/2022] [Revised: 11/21/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Abstract
International travellers are exposed to pathogens not commonly found in their countries of residence, including West Nile virus (WNV). Due to the difficulty of its diagnosis, little is known about its distribution in Africa. Understanding the geographic extent of risk of WNV infections is a necessity for both travellers and clinicians who advise and treat them, since there is no human vaccine. To date, there is no risk map for WNV infections in humans in Africa. Having a high-resolution risk map for the virus could be of relevance before the trip, to take preventive measures, and after the trip, for appropriate diagnosis of the disease. Virus detection in humans along the African continent were collected from official reports, and published scientific research for the period 1940 to 2020, and then geo-referenced in order to use biogeographical modelling for WNV. Models were based on fuzzy logic and machine learning algorithms and were designed to identify the environmental drivers that explain the distribution of human cases and to locate favourable areas for infections. We elaborated a high-resolution risk map for WNV infections that highlights favourable areas for infections in Africa. Although WNV infections are widely spread across Africa, the risk of the disease is not homogenously distributed. Popular tourist destinations such as Morocco, Tunisia, and South Africa, are high-risk areas for WNV infection.
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Affiliation(s)
- José-María García-Carrasco
- Biogeography, Diversity and Conservation Lab, Department of Animal Biology, Faculty of Sciences, University of Málaga, 29071, Málaga, Spain.
| | - Antonio-Román Muñoz
- Biogeography, Diversity and Conservation Lab, Department of Animal Biology, Faculty of Sciences, University of Málaga, 29071, Málaga, Spain.
| | - Jesús Olivero
- Biogeography, Diversity and Conservation Lab, Department of Animal Biology, Faculty of Sciences, University of Málaga, 29071, Málaga, Spain.
| | - Marina Segura
- International Vaccination Center of Malaga, Maritime Port of Malaga, Ministry of Health, Consumption and Social Welfare, Government of Spain, Malaga, Spain.
| | - Raimundo Real
- Biogeography, Diversity and Conservation Lab, Department of Animal Biology, Faculty of Sciences, University of Málaga, 29071, Málaga, Spain.
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Biswas JS, Lentaigne J, Burns DS, Osborne JC, Simpson AJ, Hutley EJ, Hill NE, Bailey MS. Undifferentiated febrile illnesses in South Sudan: a case series from Operation TRENTON from June to August 2017. BMJ Mil Health 2020; 167:358-361. [PMID: 32094218 DOI: 10.1136/jramc-2019-001238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 11/03/2022]
Abstract
Undifferentiated febrile illnesses present diagnostic and treatment challenges in the Firm Base, let alone in the deployed austere environment. We report a series of 14 cases from Operation TRENTON in South Sudan in 2017 that coincided with the rainy season, increased insect numbers and a Relief in Place. The majority of patients had headaches, myalgia, arthralgia and back pain, as well as leucopenia and thrombocytopenia. No diagnoses could be made in theatre, despite a sophisticated deployed laboratory being available, and further testing in the UK, including next-generation sequencing, was unable to establish an aetiology. Such illnesses are very likely to present in tropical environments, where increasing numbers of military personnel are being deployed, and clinicians must be aware of the non-specific presentation and treatment, as well as the availability of Military Infection Reachback services to assist in the management of these cases.
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Affiliation(s)
- Jason S Biswas
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK .,Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - J Lentaigne
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - D S Burns
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - J C Osborne
- Rare and Imported Pathogens Laboratory, Public Health England Porton, Salisbury, UK
| | - A J Simpson
- Rare and Imported Pathogens Laboratory, Public Health England Porton, Salisbury, UK
| | - E J Hutley
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK
| | - N E Hill
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - M S Bailey
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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Nyaruaba R, Mwaliko C, Mwau M, Mousa S, Wei H. Arboviruses in the East African Community partner states: a review of medically important mosquito-borne Arboviruses. Pathog Glob Health 2019; 113:209-228. [PMID: 31664886 DOI: 10.1080/20477724.2019.1678939] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Mosquito-borne diseases, including arbovirus-related diseases, make up a large proportion of infectious disease cases worldwide, causing a serious global public health burden with over 700,000 deaths annually. Mosquito-borne arbovirus outbreaks can range from global to regional. In the East African Community (EAC) region, these viruses have caused a series of emerging and reemerging infectious disease outbreaks. Member states in the EAC share a lot in common including regional trade and transport, some of the factors highlighted to be the cause of mosquito-borne arbovirus disease outbreaks worldwide. In this review, characteristics of 24 mosquito-borne arboviruses indigenous to the EAC are reviewed, including lesser or poorly understood viruses, like Batai virus (BATV) and Ndumu virus (NDUV), which may escape their origins under perfect conditions to establish a foothold in new geographical locations. Factors that may influence the future spread of these viruses within the EAC are addressed. With the continued development observed in the EAC, strategies should be developed by the Community in improving mosquito and mosquito-borne arbovirus surveillance to prevent future outbreaks.
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Affiliation(s)
- Raphael Nyaruaba
- Key Laboratory of Special Pathogens and Biosafety, Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, Hubei, China.,International college, University of Chinese Academy of Sciences, Beijing, China
| | - Caroline Mwaliko
- Key Laboratory of Special Pathogens and Biosafety, Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, Hubei, China.,International college, University of Chinese Academy of Sciences, Beijing, China
| | - Matilu Mwau
- Center for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Samar Mousa
- Key Laboratory of Special Pathogens and Biosafety, Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, Hubei, China.,International college, University of Chinese Academy of Sciences, Beijing, China
| | - Hongping Wei
- Key Laboratory of Special Pathogens and Biosafety, Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, Hubei, China
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Chikungunya Virus Infections in Military Deployments in Tropical Settings-A Narrative Minireview. Viruses 2019; 11:v11060550. [PMID: 31197085 PMCID: PMC6631184 DOI: 10.3390/v11060550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 01/13/2023] Open
Abstract
Chikungunya fever is a vector-borne viral disease in subtropical and tropical areas of endemicity. Apart from the burden on local populations, chikungunya virus infection also poses a risk for travelers and, in particular, soldiers during prolonged deployment-associated outdoor activities. The absence of rapid diagnostic tests makes surveillance challenging during military deployments in war and crisis zones with restricted medical infrastructure. Consequently, both historical and up-to-date surveillance data from battlefields are scarce. From several studies and postdeployment assessments, some information on the epidemiology of chikungunya virus infections in deployed military personnel is nevertheless available. The few published data homogeneously suggest a low infection risk in the endemic setting. During outbreaks, however, the infection risk of military personnel is comparable to that of the local population. Infection clusters of soldiers without pronounced outdoor activity have been reported under such circumstances as well. In spite of efforts focusing on the development of a chikungunya virus vaccine, no licensed product is available so far.
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Chikungunya virus infection prevalence in Africa: a contemporaneous systematic review and meta-analysis. Public Health 2018; 166:79-88. [PMID: 30468973 DOI: 10.1016/j.puhe.2018.09.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/20/2018] [Accepted: 09/27/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The (re)emergence of chikungunya virus (CHIKV) in Africa requires better knowledge on the epidemiology of CHIKV infection in the continent for efficient public health strategies. We aimed to describe the epidemiology of CHIKV infection in Africa, a neglected tropical disease (NTD). STUDY DESIGN This was a systematic review with meta-analysis of studies reporting CHIKV infection prevalence. We searched Embase, PubMed, Africa Journal Online and Global Index Medicus to identify observational studies published from January 2000 to September 2017. METHODS We used a random-effect model to pool the prevalence of CHIKV infections reported with their 95% confidence interval (CI). Heterogeneity was assessed via the Chi-squared test on Cochran's Q statistic. Review registration is in PROSPERO CRD42017080395. RESULTS A total of 39 studies (37,881 participants; 18 countries) were included. No study was reported from Southern Africa. Thirty-two (82.0%), seven (18.0%) and no studies had low, moderate and high risk of bias, respectively. Outside outbreak periods, the pooled immunoglobulin M (IgM) and immunoglobulin G (IgG) seroprevalence was 9.7% (95% CI 3.0-19.6; 16 studies) and 16.4% (95% CI 9.1-25.2; 23 studies), respectively. The IgM seroprevalence was lower in Northern Africa, and there was no difference for IgG prevalence across regions in Africa. The IgM and IgG seroprevalences were not different between acute and non-acute febrile participants. The seroprevalence was not associated with GPS coordinates (latitude, longitude and altitude). CONCLUSIONS Although considered a NTD, we find high prevalence of CHIKV infection in Africa. As such, chikungunya fever should deserve more attention from healthcare providers, researchers, policymakers and stakeholders from many sectors.
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Burns DS, Riley MR, Mason A, Bailey MS. UK Role 4 military infectious diseases and tropical medicine cases in 2005-2013. J ROY ARMY MED CORPS 2017; 164:77-82. [PMID: 29279320 DOI: 10.1136/jramc-2017-000815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Infectious diseases are a frequent cause of morbidity among British troops. The aim of this paper is to describe the spectrum of infectious diseases seen when UK service personnel are evacuated for definitive care to the Role 4 Medical Treatment Facility based at Birmingham Heartlands Hospital. METHOD A retrospective analysis of all military patients presenting with infectious diseases and treated at Birmingham Heartlands Hospital between 14 April 2005 and 31 December 2013 was undertaken. RESULTS During this period, 502 patients were identified. Infections originated in 49 countries, most commonly Afghanistan (46% cases), the UK (10% cases) and Belize (9% of cases). The most common presentations were dermatological conditions, gastroenterological illnesses and undifferentiated fevers. CONCLUSION UK service personnel in significant numbers continue to suffer a wide range of infectious diseases, acquired throughout the globe, which often require specialist tertiary infection services to diagnose and manage. Future prospective data collection is recommended to identify trends, which in turn will inform military training needs and future research priorities in the Defence Medical Services (DMS) and allows development of appropriate policies and clinical guidelines for management of DMS personnel with infectious diseases.
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Affiliation(s)
- Daniel S Burns
- Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK.,Army Medical Directorate, Former Army Staff College, Camberley, UK
| | - M R Riley
- Army Medical Directorate, Former Army Staff College, Camberley, UK
| | - A Mason
- Army Medical Directorate, Former Army Staff College, Camberley, UK
| | - M S Bailey
- Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK.,Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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Humphrey JM, Cleton NB, Reusken CBEM, Glesby MJ, Koopmans MPG, Abu-Raddad LJ. Urban Chikungunya in the Middle East and North Africa: A systematic review. PLoS Negl Trop Dis 2017. [PMID: 28651007 PMCID: PMC5501693 DOI: 10.1371/journal.pntd.0005707] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The epidemiology of Chikungunya virus (CHIKV) in the Middle
East and North Africa (MENA) is not well characterized despite increasing
recognition of its expanding infection and disease burden in recent
years. Methodology / Principal findings Following Cochrane Collaboration guidelines and reporting our findings
following PRISMA guidelines, we systematically reviewed records describing
the human prevalence and incidence, CHIKV prevalence/infection rates in
vectors, outbreaks, and reported cases for CHIKV across the MENA region. We
identified 29 human seroprevalence measures, one human incidence study, one
study reporting CHIKV infection rates in Aedes, and nine
outbreaks and case reports/series reported in the MENA from 1970–2015.
Overall, anti-CHIKV antibody or reports of autochthonous transmission were
identified from 10 of 23 countries in the MENA region (Djibouti, Egypt,
Iraq, Iran, Kuwait, Pakistan, Saudi Arabia, Somalia, Sudan, and Yemen), with
seroprevalence measures among general populations (median 1.0%, range 0–43%)
and acute febrile illness populations (median 9.8%, range 0–30%). Sudan
reported the highest number of studies (n = 11) and the highest
seroprevalence among general populations (median 12%, range 0–43%) and
undifferentiated acute febrile illness populations (median 18%, range
10–23%). CHIKV outbreaks were reported from Djibouti, Pakistan, Sudan, and
Yemen. Conclusions / Significance Seroprevalence studies and outbreak reports suggest endemic transmission of
urban cycle CHIKV in at least the Red Sea region and Pakistan. However,
indications of seroprevalence despite a low quantity of CHIKV epidemiologic
research from the region suggests that CHIKV transmission is currently
underrecognized. Chikungunya virus (CHIKV) is an alphavirus whose principal
vectors are the Aedes aegypti and Aedes
albopictus mosquitoes. Though long endemic to Asia and Africa,
detection of CHIKV has recently been reported throughout the Western Hemisphere,
including much of South America and the Caribbean. In the Middle East and North
Africa (MENA), the epidemiology of CHIKV remains poorly characterized despite
recent reports of outbreaks and novel transmission in the Arabian Peninsula. To
better understand existing data describing the epidemiology of urban CHIKV in
the MENA region, we conducted a systematic review of human prevalence studies
and incidence studies; CHIKV detections, prevalence, and infection rates in
Aedes; and reported CHIKV outbreaks, case series, and case
reports from the region. A total of 29 seroprevalence studies were identified
through our search, with anti-CHIKV antibodies and/or outbreaks detected in
Djibouti, Egypt, Iraq, Iran, Kuwait, Pakistan, Saudi Arabia, Somalia, Sudan, and
Yemen. Sudan reported the highest number of studies (n = 11) and the highest
seroprevalence among all studies. The epidemiology of urban CHIKV in other MENA
countries is less well characterized, suggesting underascertainment of cases and
the need for further research.
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Affiliation(s)
- John M. Humphrey
- Division of Infectious Diseases, Department of Medicine, Weill Cornell
Medicine, New York, New York, United States of America
- * E-mail:
| | - Natalie B. Cleton
- Viroscience department, Erasmus University Medical Centre, Rotterdam, The
Netherlands
- National Institute for Public Health and the Environment (RIVM),
Bilthoven, The Netherlands
| | | | - Marshall J. Glesby
- Division of Infectious Diseases, Department of Medicine, Weill Cornell
Medicine, New York, New York, United States of America
- Department of Healthcare Policy and Research, Weill Cornell Medicine,
Cornell University, New York, New York, United States of
America
| | - Marion P. G. Koopmans
- Viroscience department, Erasmus University Medical Centre, Rotterdam, The
Netherlands
- National Institute for Public Health and the Environment (RIVM),
Bilthoven, The Netherlands
| | - Laith J. Abu-Raddad
- Department of Healthcare Policy and Research, Weill Cornell Medicine,
Cornell University, New York, New York, United States of
America
- Infectious Disease Epidemiology Group, Weill Cornell Medicine in Qatar,
Cornell University, Qatar Foundation, Education City, Doha,
Qatar
- College of Public Health, Hamad bin Khalifa University, Qatar Foundation,
Education City, Doha, Qatar
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