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Stoney RJ, Esposito DH, Kozarsky P, Hamer DH, Grobusch MP, Gkrania-Klotsas E, Libman M, Gautret P, Lian Lim P, Leder K, Schwartz E, Sotir MJ, Licitra C. Infectious diseases acquired by international travellers visiting the USA. J Travel Med 2018; 25:5075537. [PMID: 30124885 PMCID: PMC6638561 DOI: 10.1093/jtm/tay053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/26/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND Estimates of travel-related illness have focused predominantly on populations from highly developed countries visiting low- or middle-income countries, yet travel to and within high-income countries is very frequent. Despite being a top international tourist destination, few sources describe the spectrum of infectious diseases acquired among travellers to the USA. METHODS We performed a descriptive analysis summarizing demographic and travel characteristics, and clinical diagnoses among non-US-resident international travellers seen during or after travel to the USA at a GeoSentinel clinic from 1 January 1997 through 31 December 2016. RESULTS There were 1222 ill non-US-resident travellers with 1393 diagnoses recorded during the 20-year analysis period. Median age was 40 (range 0-86 years); 52% were female. Patients visited from 63 countries and territories, most commonly Canada (31%), Germany (14%), France (9%) and Japan (7%). Travellers presented with a range of illnesses; skin and soft tissue infections of unspecified aetiology were the most frequently reported during travel (29 diagnoses, 14% of during-travel diagnoses); arthropod bite/sting was the most frequently reported after travel (173 diagnoses, 15% after-travel diagnoses). Lyme disease was the most frequently reported arthropod-borne disease after travel (42, 4%). Nonspecific respiratory, gastrointestinal and systemic infections were also among the most frequently reported diagnoses overall. Low-frequency illnesses (<2% of cases) made up over half of diagnoses during travel and 41% of diagnoses after travel, including 13 cases of coccidioidomycosis and mosquito-borne infections like West Nile, dengue and Zika virus diseases. CONCLUSIONS International travellers to the USA acquired a diverse array of mostly cosmopolitan infectious diseases, including nonspecific respiratory, gastrointestinal, dermatologic and systemic infections comparable to what has been reported among travellers to low- and middle-income countries. Clinicians should consider the specific health risks when preparing visitors to the USA and when evaluating and treating those who become ill.
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Affiliation(s)
- Rhett J. Stoney
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Douglas H. Esposito
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Phyllis Kozarsky
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | | | - Michael Libman
- Centre for Tropical Diseases, McGill University Health Centre, Montreal, Canada
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Poh Lian Lim
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Infectious Disease Service, Royal Melbourne Hospital at the Doherty Institute, Melbourne, Australia
| | - Eli Schwartz
- Institute of Geographic Medicine and Tropical Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark J. Sotir
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Carmelo Licitra
- Orlando Health Infectious Disease, University of Central Florida College of Medicine, Orlando, FL, USA
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Lash RR, Walker AT, Lee CV, LaRocque R, Rao SR, Ryan ET, Brunette G, Holton K, Sotir MJ. Enabling clinicians to easily find location-based travel health recommendations-is innovation needed? J Travel Med 2018; 25:4999198. [PMID: 29788401 PMCID: PMC5991802 DOI: 10.1093/jtm/tay035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/26/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND The types of place names and the level of geographic detail that patients report to clinicians regarding their intended travel itineraries vary. The reported place names may not match those in published travel health recommendations, making traveler-specific recommendations potentially difficult and time-consuming to identify. Most published recommendations are at the country level; however, subnational recommendations exist when documented disease risk varies within a country, as for malaria and yellow fever. Knowing the types of place names reported during consultations would be valuable for developing more efficient ways of searching and identifying recommendations, hence we inventoried these descriptors and identified patterns in their usage. METHODS The data analyzed were previously collected individual travel itineraries from pretravel consultations performed at Global TravEpiNet (GTEN) travel clinic sites. We selected a clinic-stratified random sample of records from 18 GTEN clinics that contained responses to an open-ended question describing itineraries. We extracted and classified place names into nine types and analyzed patterns relative to common travel-related demographic variables. RESULTS From the 1756 itineraries sampled, 1570 (89%) included one or more place names, totaling 3366 place names. The frequency of different types of place names varied considerably: 2119 (63%) populated place, 336 (10%) tourist destination, 283 (8%) physical geographic area, 206 (6%) vague subnational area, 163 (5%) state, 153 (5%) country, 48 (1%) county, 12 (1%) undefined. CONCLUSIONS The types of place names used by travelers to describe travel itineraries during pretravel consultations were often different from the ones referenced in travel health recommendations. This discrepancy means that clinicians must use additional maps, atlases or online search tools to cross-reference the place names given to the available recommendations. Developing new clinical tools that use geographic information systems technology would make it easier and faster for clinicians to find applicable recommendations for travelers.
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Affiliation(s)
- R Ryan Lash
- Travelers' Health Branch, Division of Global Migration and Quarantine, CDC, Atlanta, GA, USA
| | - Allison Taylor Walker
- Travelers' Health Branch, Division of Global Migration and Quarantine, CDC, Atlanta, GA, USA
| | - C Virginia Lee
- Travelers' Health Branch, Division of Global Migration and Quarantine, CDC, Atlanta, GA, USA
| | - Regina LaRocque
- Massachusetts General Hospital Travelers' Advice and Immunization Center, Cox 5, 55 Fruit Street, Boston, MA 02114, USA.,Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, USA
| | - Sowmya R Rao
- Massachusetts General Hospital Biostatistics Center, 50 Staniford Street, Suite 560, Boston, MA 02114, USA.,Department of Global Health, Boston University, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, Boston, MA 02118, USA
| | - Edward T Ryan
- Massachusetts General Hospital Travelers' Advice and Immunization Center, Cox 5, 55 Fruit Street, Boston, MA 02114, USA.,Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, USA
| | - Gary Brunette
- Travelers' Health Branch, Division of Global Migration and Quarantine, CDC, Atlanta, GA, USA
| | - Kelly Holton
- Travelers' Health Branch, Division of Global Migration and Quarantine, CDC, Atlanta, GA, USA
| | - Mark J Sotir
- Travelers' Health Branch, Division of Global Migration and Quarantine, CDC, Atlanta, GA, USA
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3
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Angelo KM, Barbre K, Shieh WJ, Kozarsky PE, Blau DM, Sotir MJ, Zaki SR. International travelers with infectious diseases determined by pathology results, Centers for Disease Control and Prevention - United States, 1995-2015. Travel Med Infect Dis 2017; 19:8-15. [PMID: 28993223 DOI: 10.1016/j.tmaid.2017.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/02/2017] [Accepted: 10/05/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The failure to consider travel-related diagnoses, the lack of diagnostic capacity for specialized laboratory testing, and the declining number of autopsies may affect the diagnosis and management of travel-related infections. Pre- and post-mortem pathology can help determine causes of illness and death in international travelers. METHODS We conducted a retrospective review of biopsy and autopsy specimens sent to the Infectious Diseases Pathology Branch laboratory (IDPBL) at the Centers for Disease Control and Prevention (CDC) for diagnostic testing from 1995 through 2015. Cases were included if the specimen submitted for diagnosis was from a traveler with prior international travel during the disease incubation period and the cause of illness or death was unknown at the time of specimen submission. RESULTS Twenty-one travelers, six (29%) with biopsy specimens and 15 (71%) with autopsy specimens, met the inclusion criteria. Among the 15 travelers who underwent autopsies, the most common diagnoses were protozoal infections (7 travelers; 47%), including five malaria cases, followed by viral infections (6 travelers; 40%). CONCLUSIONS Biopsy or autopsy specimens can assist in diagnosing infectious diseases in travelers, especially from pathogens not endemic in the U.S. CDC's IDPBL provides a useful resource for clinicians considering infectious diseases in returned travelers.
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Affiliation(s)
- Kristina M Angelo
- Travelers' Health Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA.
| | - Kira Barbre
- Travelers' Health Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Wun-Ju Shieh
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Phyllis E Kozarsky
- Travelers' Health Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA; Department of Medicine, Emory University, Atlanta, USA
| | - Dianna M Blau
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Mark J Sotir
- Travelers' Health Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Sherif R Zaki
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA
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4
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Angelo KM, Kozarsky PE, Ryan ET, Chen LH, Sotir MJ. What proportion of international travellers acquire a travel-related illness? A review of the literature. J Travel Med 2017; 24:3954792. [PMID: 28931136 PMCID: PMC5825178 DOI: 10.1093/jtm/tax046] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2017] [Indexed: 11/12/2022]
Abstract
INTRODUCTION As international travel increases, travellers may be at increased risk of acquiring infectious diseases not endemic in their home countries. Many journal articles and reference books related to travel medicine cite that between 22-64% of international travellers become ill during or after travel; however, this information is minimal, outdated and limited by poor generalizability. We aim to provide a current and more accurate estimate of the proportion of international travellers who acquire a travel-related illness. METHODS We identified studies via PubMed or travel medicine experts, published between January 1, 1976-December 31, 2016 that included the number of international travellers acquiring a travel-related illness. We excluded studies that focused on a single disease or did not determine a rate based on the total number of travellers. We abstracted information on traveller demographics, trip specifics, study enrollment and follow-up and number of ill travellers and their illnesses. RESULTS Of 743 studies, nine met the inclusion criteria. The data sources were from North America (four studies) and Europe (five studies). Most travellers were tourists, the most frequent destination regions were Asia and Africa, and the median trip duration ranged from 8-21 days. Six studies enrolled participants at the travellers' pre-travel consultation. All studies collected data through either extraction from the medical record, weekly diaries, or pre- and post-travel questionnaires. Data collection timeframes varied by study. Between 6-87% of travellers became ill across all studies. Four studies provided the best estimate: between 43-79% of travellers who frequently visited developing nations (e.g. India, Tanzania, and Kenya) became ill; travellers most frequently reported diarrhoea. CONCLUSION This is the most comprehensive assessment available on the proportion of international travellers that develop a travel-related illness. Additional cohort studies would provide needed data to more precisely determine the rates of illness in international travellers. KEYWORDS International travel, travel, illness.
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Affiliation(s)
- Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA
| | - Phyllis E Kozarsky
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA.,Department of Medicine, Emory University, 1364 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Edward T Ryan
- Massachusetts General Hospital Travelers' Advice and Immunization Center, 55 Fruit Street, Boston, MA 02114, USA.,Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Lin H Chen
- Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.,Mount Auburn Hospital, 330 Mt. Auburn St, Cambridge, MA, 02138, USA
| | - Mark J Sotir
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA
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5
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Gershman MD, Sotir MJ. Update: Temporary Total Depletion of U.S. Licensed Yellow Fever Vaccine for Civilian Travelers Addressed by Investigational New Drug Use of Imported Stamaril Vaccine. MMWR Morb Mortal Wkly Rep 2017; 66:780. [PMID: 28749924 PMCID: PMC5657809 DOI: 10.15585/mmwr.mm6629a4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Sanofi Pasteur, the manufacturer of the only yellow fever vaccine (YF-VAX) licensed in the United States, has announced that their stock of YF-VAX is totally depleted as of July 24, 2017. YF-VAX for civilian use will be unavailable for ordering from Sanofi Pasteur until mid-2018, when their new manufacturing facility is expected to be completed. However, YF-VAX might be available at some clinics for several months, until remaining supplies at those sites are exhausted. In anticipation of this temporary total depletion, in 2016, Sanofi Pasteur submitted an expanded access investigational new drug application to the Food and Drug Administration to allow for importation and use of Stamaril. The Food and Drug Administration accepted Sanofi Pasteur's application in October 2016.
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Affiliation(s)
- Mark D Gershman
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Mark J Sotir
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
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6
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Gershman MD, Angelo KM, Ritchey J, Greenberg DP, Muhammad RD, Brunette G, Cetron MS, Sotir MJ. Addressing a Yellow Fever Vaccine Shortage - United States, 2016-2017. MMWR Morb Mortal Wkly Rep 2017; 66:457-459. [PMID: 28472025 PMCID: PMC5687078 DOI: 10.15585/mmwr.mm6617e2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jentes ES, Millman AJ, Decenteceo M, Klevos A, Biggs HM, Esposito DH, McPherson H, Sullivan C, Voorhees D, Watkins J, Anzalone FL, Gaul L, Flores S, Brunette GW, Sotir MJ. Interagency and Commercial Collaboration During an Investigation of Chikungunya and Dengue Among Returning Travelers to the United States. Am J Trop Med Hyg 2017; 96:265-267. [PMID: 27601520 DOI: 10.4269/ajtmh.16-0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/09/2016] [Indexed: 11/07/2022] Open
Abstract
Public health investigations can require intensive collaboration between numerous governmental and nongovernmental organizations. We describe an investigation involving several governmental and nongovernmental partners that was successfully planned and performed in an organized, comprehensive, and timely manner with several governmental and nongovernmental partners.
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Affiliation(s)
- Emily S Jentes
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Alexander J Millman
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michelle Decenteceo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Miami, Florida
| | - Andrew Klevos
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Miami, Florida
| | - Holly M Biggs
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division of Vector-borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Douglas H Esposito
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Jim Watkins
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Miami, Florida
| | | | - Linda Gaul
- Texas Department of State Health Services, Austin, Texas
| | - Sal Flores
- Customs and Border Protection, Miami, Florida
| | - Gary W Brunette
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark J Sotir
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia.
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8
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Lammert SM, Rao SR, Jentes ES, Fairley JK, Erskine S, Walker AT, Hagmann SH, Sotir MJ, Ryan ET, LaRocque RC. Refusal of recommended travel-related vaccines among U.S. international travellers in Global TravEpiNet. J Travel Med 2016; 24:taw075. [PMID: 27799502 PMCID: PMC5091771 DOI: 10.1093/jtm/taw075] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND International travellers are at risk of travel-related, vaccine-preventable diseases. More data are needed on the proportion of travellers who refuse vaccines during a pre-travel health consultation and their reasons for refusing vaccines. METHODS We analyzed data on travellers seen for a pre-travel health consultation from July 2012 through June 2014 in the Global TravEpiNet (GTEN) consortium. Providers were required to indicate one of three reasons for a traveller refusing a recommended vaccine: (1) cost concerns, (2) safety concerns or (3) not concerned with the illness. We calculated refusal rates among travellers eligible for each vaccine based on CDC recommendations current at the time of travel. We used multivariable logistic regression models to examine the effect of individual variables on the likelihood of accepting all recommended vaccines. RESULTS Of 24 478 travellers, 23 768 (97%) were eligible for at least one vaccine. Travellers were most frequently eligible for typhoid (N = 20 092), hepatitis A (N = 12 990) and influenza vaccines (N = 10 539). Of 23 768 eligible travellers, 6573 (25%) refused one or more recommended vaccine(s). Of those eligible, more than one-third refused the following vaccines: meningococcal: 2232 (44%) of 5029; rabies: 1155 (44%) of 2650; Japanese encephalitis: 761 (41%) of 1846; and influenza: 3527 (33%) of 10 539. The most common reason for declining vaccines was that the traveller was not concerned about the illness. In multivariable analysis, travellers visiting friends and relatives (VFR) in low or medium human development countries were less likely to accept all recommended vaccines, compared with non-VFR travellers (OR = 0.74 (0.59-0.95)). CONCLUSIONS Travellers who sought pre-travel health care refused recommended vaccines at varying rates. A lack of concern about the associated illness was the most commonly cited reason for all refused vaccines. Our data suggest more effective education about disease risk is needed for international travellers, even those who seek pre-travel advice.
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Affiliation(s)
- Sara M Lammert
- Travelers' Advice and Immunization Center, Massachusetts General Hospital, Boston, MA, USA
| | - Sowmya R Rao
- Department of Surgery, Boston University Medical Center, Boston, MA, USA
| | - Emily S Jentes
- Division of Global Migration and Quarantine, Travelers' Health Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica K Fairley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Stefanie Erskine
- Division of Global Migration and Quarantine, Travelers' Health Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Allison T Walker
- Division of Global Migration and Quarantine, Travelers' Health Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stefan H Hagmann
- Division of Pediatric Infectious Diseases, Bronx-Lebanon Hospital Center, Bronx, NY
| | - Mark J Sotir
- Division of Global Migration and Quarantine, Travelers' Health Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Edward T Ryan
- Travelers' Advice and Immunization Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA
| | - Regina C LaRocque
- Travelers' Advice and Immunization Center, Massachusetts General Hospital, Boston, MA, USA .,Harvard Medical School, Boston, MA
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9
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Jentes ES, Lash RR, Johansson MA, Sharp TM, Henry R, Brady OJ, Sotir MJ, Hay SI, Margolis HS, Brunette GW. Evidence-based risk assessment and communication: a new global dengue-risk map for travellers and clinicians. J Travel Med 2016; 23:taw062. [PMID: 27625400 PMCID: PMC5345513 DOI: 10.1093/jtm/taw062] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND International travel can expose travellers to pathogens not commonly found in their countries of residence, like dengue virus. Travellers and the clinicians who advise and treat them have unique needs for understanding the geographic extent of risk for dengue. Specifically, they should assess the need for prevention measures before travel and ensure appropriate treatment of illness post-travel. Previous dengue-risk maps published in the Centers for Disease Control and Prevention's Yellow Book lacked specificity, as there was a binary (risk, no risk) classification. We developed a process to compile evidence, evaluate it and apply more informative risk classifications. METHODS We collected more than 839 observations from official reports, ProMED reports and published scientific research for the period 2005-2014. We classified each location as frequent/continuous risk if there was evidence of more than 10 dengue cases in at least three of the previous 10 years. For locations that did not fit this criterion, we classified locations as sporadic/uncertain risk if the location had evidence of at least one locally acquired dengue case during the last 10 years. We used expert opinion in limited instances to augment available data in areas where data were sparse. RESULTS Initial categorizations classified 134 areas as frequent/continuous and 140 areas as sporadic/uncertain. CDC subject matter experts reviewed all initial frequent/continuous and sporadic/uncertain categorizations and the previously uncategorized areas. From this review, most categorizations stayed the same; however, 11 categorizations changed from the initial determinations. CONCLUSIONS These new risk classifications enable detailed consideration of dengue risk, with clearer meaning and a direct link to the evidence that supports the specific classification. Since many infectious diseases have dynamic risk, strong geographical heterogeneities and varying data quality and availability, using this approach for other diseases can improve the accuracy, clarity and transparency of risk communication.
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Affiliation(s)
- Emily S Jentes
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS E-03, Atlanta, GA 30333, USA
| | - R Ryan Lash
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS E-03, Atlanta, GA 30333, USA
| | | | - Tyler M Sharp
- Division of Vector-Borne Diseases, CDC, San Juan, Puerto Rico 00920
| | - Ronnie Henry
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS E-03, Atlanta, GA 30333, USA
| | - Oliver J Brady
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Oxford OX3 7BN, UK
| | - Mark J Sotir
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS E-03, Atlanta, GA 30333, USA
| | - Simon I Hay
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Oxford OX3 7BN, UK Institute for Health Metrics and Evaluation, University of Washington, Seattle, 2301 Fifth Ave., Suite 600 Seattle, WA 98121
| | | | - Gary W Brunette
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS E-03, Atlanta, GA 30333, USA
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10
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Millman AJ, Esposito DH, Biggs HM, Decenteceo M, Klevos A, Hunsperger E, Munoz-Jordan J, Kosoy OI, McPherson H, Sullivan C, Voorhees D, Baron D, Watkins J, Gaul L, Sotir MJ, Brunette G, Fischer M, Sharp TM, Jentes ES. Chikungunya and Dengue Virus Infections Among United States Community Service Volunteers Returning from the Dominican Republic, 2014. Am J Trop Med Hyg 2016; 94:1336-41. [PMID: 26976891 DOI: 10.4269/ajtmh.15-0815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/06/2016] [Indexed: 11/07/2022] Open
Abstract
Chikungunya spread throughout the Dominican Republic (DR) after the first identified laboratory-confirmed cases were reported in April 2014. In June 2014, a U.S.-based service organization operating in the DR reported chikungunya-like illnesses among several staff. We assessed the incidence of chikungunya virus (CHIKV) and dengue virus (DENV) infection and illnesses and evaluated adherence to mosquito avoidance measures among volunteers/staff deployed in the DR who returned to the United States during July-August 2014. Investigation participants completed a questionnaire that collected information on demographics, medical history, self-reported illnesses, and mosquito exposures and avoidance behaviors and provided serum for CHIKV and DENV diagnostic testing by reverse transcription polymerase chain reaction and IgM enzyme-linked immunosorbent assay. Of 102 participants, 42 (41%) had evidence of recent CHIKV infection and two (2%) had evidence of recent DENV infection. Of the 41 participants with evidence of recent CHIKV infection only, 39 (95%) reported fever, 37 (90%) reported rash, and 37 (90%) reported joint pain during their assignment. All attended the organization's health trainings, and 89 (87%) sought a pretravel health consultation. Most (∼95%) used insect repellent; however, only 30% applied it multiple times daily and < 5% stayed in housing with window/door screens. In sum, CHIKV infections were common among these volunteers during the 2014 chikungunya epidemic in the DR. Despite high levels of preparation, reported adherence to mosquito avoidance measures were inconsistent. Clinicians should discuss chikungunya with travelers visiting areas with ongoing CHIKV outbreaks and should consider chikungunya when diagnosing febrile illnesses in travelers returning from affected areas.
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Affiliation(s)
- Alexander J Millman
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Douglas H Esposito
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Holly M Biggs
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Michelle Decenteceo
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Andrew Klevos
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Elizabeth Hunsperger
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Jorge Munoz-Jordan
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Olga I Kosoy
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Heidi McPherson
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Carmen Sullivan
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Dayton Voorhees
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - David Baron
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Jim Watkins
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Linda Gaul
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Mark J Sotir
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Gary Brunette
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Marc Fischer
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Tyler M Sharp
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Emily S Jentes
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
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11
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Sotir MJ, Esposito DH, Barnett ED, Leder K, Kozarsky PE, Lim PL, Gkrania-Klotsas E, Hamer DH, Kuhn S, Connor BA, Pradhan R, Caumes E. Measles in the 21st Century, a Continuing Preventable Risk to Travelers: Data From the GeoSentinel Global Network. Clin Infect Dis 2016; 62:210-2. [PMID: 26400996 PMCID: PMC4822539 DOI: 10.1093/cid/civ839] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/12/2015] [Indexed: 11/13/2022] Open
Abstract
Measles remains a risk for travelers, with 94 measles diagnoses reported to the GeoSentinel network from 2000 to 2014, two-thirds since 2010. Asia was the most common exposure region, then Africa and Europe. Efforts to reduce travel-associated measles should target all vaccine-eligible travelers, including catch-up vaccination of susceptible adults.
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Affiliation(s)
- Mark J Sotir
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention
| | - Douglas H Esposito
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention
| | | | - Karin Leder
- Victorian Infectious Disease Service, Royal Melbourne Hospital at the Doherty Institute for Infection and Immunity and School of Public Health and Preventive Medicine, Monash University, Australia
| | - Phyllis E Kozarsky
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia
| | - Poh L Lim
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital and Lee Kong Chian School of Medicine, Singapore
| | - Effrossyni Gkrania-Klotsas
- Department of Infectious Diseases, The Clinical School, and the Medical Research Council Epidemiology Unit, University of Cambridge, United Kingdom
| | - Davidson H Hamer
- Department of Medicine, Boston Medical Center Center for Global Health and Development Department of Global Health, Section of Infectious Diseases, Boston University School of Public Health, Massachusetts
| | - Susan Kuhn
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Canada
| | | | - Rashila Pradhan
- CIWEC Clinic Travel Medicine Center and Hospital, Kathmandu, Nepal
| | - Eric Caumes
- Department of Infectious and Tropical Diseases, Hôpital Pitié-Salpêtrière, University Pierre et Marie Curie, Paris, France
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12
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Stoney RJ, Kozarsky P, Bostick RM, Sotir MJ. International travellers from New Jersey: piloting a travel health module in the 2011 Behavioral Risk Factor Surveillance System survey. J Travel Med 2016; 23:tav015. [PMID: 26782130 PMCID: PMC4843503 DOI: 10.1093/jtm/tav015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND In 2011, the Centers for Disease Control and Prevention and the New Jersey Department of Health used the New Jersey Behavioral Risk Factor Survey (NJBRFS), a state component of the national Behavioral Risk Factor Surveillance System (BRFSS) to pilot a travel health module designed to collect population-based data on New Jersey residents travelling internationally. Our objective was to use this population-based travel health information to serve as a baseline to evaluate trends in US international travellers. METHODS A representative sample of New Jersey residents was identified through a random-digit-dialing method and administered the travel health module, which asked five questions: travel outside of USA during the previous year; destination; purpose; if a healthcare provider was visited before travel and any travel-related illness. Additional health variables from the larger NJBRFS were considered and included in bivariate analyses and multiple logistic regression; weights were assigned to variables to account for survey design complexity. RESULTS Of 4029 participants, 841 (21%) travelled internationally. Top destinations included Mexico (10%), Canada (9%), Dominican Republic (6%), Bahamas (5%) and Italy (5%). Variables positively associated with travel included foreign birth, ≥$75 000 annual household income, college education and no children living in the household. One hundred fifty (18%) of 821 travellers with known destinations went to high-risk countries; 40% were visiting friends and relatives and only 30% sought pre-travel healthcare. Forty-eight (6%) of 837 responding travellers reported travel-related illness; 44% visited high-risk countries. CONCLUSIONS Approximately one in five NJBRFS respondents travelled internationally during the previous year, a sizeable proportion to high-risk destinations. Few reported becoming ill as a result of travel but almost one-half of those ill had travelled to high-risk destinations. Population-based surveillance data on travellers can help document trends in destinations, traveller type and disease prevalence and evaluate the effectiveness of disease prevention programmmes.
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Affiliation(s)
- Rhett J Stoney
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA and
| | - Phyllis Kozarsky
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA and
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mark J Sotir
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA and
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13
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Boggild AK, Esposito DH, Kozarsky PE, Ansdell V, Beeching NJ, Campion D, Castelli F, Caumes E, Chappuis F, Cramer JP, Gkrania-Klotsas E, Grobusch MP, Hagmann SH, Hynes NA, Lim PL, López-Vélez R, Malvy DJ, Mendelson M, Parola P, Sotir MJ, Wu HM, Hamer DH. Differential diagnosis of illness in travelers arriving from Sierra Leone, Liberia, or Guinea: a cross-sectional study from the GeoSentinel Surveillance Network. Ann Intern Med 2015; 162:757-64. [PMID: 25961811 PMCID: PMC4629254 DOI: 10.7326/m15-0074] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The largest-ever outbreak of Ebola virus disease (EVD), ongoing in West Africa since late 2013, has led to export of cases to Europe and North America. Clinicians encountering ill travelers arriving from countries with widespread Ebola virus transmission must be aware of alternate diagnoses associated with fever and other nonspecific symptoms. OBJECTIVE To define the spectrum of illness observed in persons returning from areas of West Africa where EVD transmission has been widespread. DESIGN Descriptive, using GeoSentinel records. SETTING 57 travel or tropical medicine clinics in 25 countries. PATIENTS 805 ill returned travelers and new immigrants from Sierra Leone, Liberia, or Guinea seen between September 2009 and August 2014. MEASUREMENTS Frequencies of demographic and travel-related characteristics and illnesses reported. RESULTS The most common specific diagnosis among 770 nonimmigrant travelers was malaria (n = 310 [40.3%]), with Plasmodium falciparum or severe malaria in 267 (86%) and non-P. falciparum malaria in 43 (14%). Acute diarrhea was the second most common diagnosis among nonimmigrant travelers (n = 95 [12.3%]). Such common diagnoses as upper respiratory tract infection, urinary tract infection, and influenza-like illness occurred in only 26, 9, and 7 returning travelers, respectively. Few instances of typhoid fever (n = 8), acute HIV infection (n = 5), and dengue (n = 2) were encountered. LIMITATION Surveillance data collected by specialist clinics may not be representative of all ill returned travelers. CONCLUSION Although EVD may currently drive clinical evaluation of ill travelers arriving from Sierra Leone, Liberia, and Guinea, clinicians must be aware of other more common, potentially fatal diseases. Malaria remains a common diagnosis among travelers seen at GeoSentinel sites. Prompt exclusion of malaria and other life-threatening conditions is critical to limiting morbidity and mortality. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Andrea K. Boggild
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Douglas H. Esposito
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Phyllis E. Kozarsky
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Vernon Ansdell
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Nicholas J. Beeching
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Daniel Campion
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Francesco Castelli
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Eric Caumes
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Francois Chappuis
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Jakob P. Cramer
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Effrossyni Gkrania-Klotsas
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Martin P. Grobusch
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Stefan H.F. Hagmann
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Noreen A. Hynes
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Poh Lian Lim
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Rogelio López-Vélez
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Denis J.M. Malvy
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Marc Mendelson
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Philippe Parola
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Mark J. Sotir
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Henry M. Wu
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Davidson H. Hamer
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
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14
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Esposito DH, Rosenthal BM, Slesak G, Tappe D, Fayer R, Bottieau E, Brown C, Grobusch MP, Malvy D, von Sonnenburg F, Sotir MJ, Steiner F, Zanger P, Kozarsky PE. Reply to Italiano et al. Clin Infect Dis 2015; 60:1135-6. [PMID: 25537874 DOI: 10.1093/cid/ciu1165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Douglas H Esposito
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin M Rosenthal
- Beltsville Agricultural Research Center, US Department of Agriculture, Beltsville, Maryland
| | | | - Dennis Tappe
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ronald Fayer
- Beltsville Agricultural Research Center, US Department of Agriculture, Beltsville, Maryland
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Clive Brown
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Martin P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Denis Malvy
- Division of Tropical Medicine and Clinical International Health, University Hospital Center, Bordeaux, France
| | | | - Mark J Sotir
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Florian Steiner
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin
| | - Philipp Zanger
- Institute of Tropical Medicine, Eberhard Karls University, Tübingen, Germany
| | - Phyllis E Kozarsky
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia
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15
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Esposito DH, Stich A, Epelboin L, Malvy D, Han PV, Bottieau E, da Silva A, Zanger P, Slesak G, van Genderen PJJ, Rosenthal BM, Cramer JP, Visser LG, Muñoz J, Drew CP, Goldsmith CS, Steiner F, Wagner N, Grobusch MP, Plier DA, Tappe D, Sotir MJ, Brown C, Brunette GW, Fayer R, von Sonnenburg F, Neumayr A, Kozarsky PE. Acute muscular sarcocystosis: an international investigation among ill travelers returning from Tioman Island, Malaysia, 2011-2012. Clin Infect Dis 2014; 59:1401-10. [PMID: 25091309 DOI: 10.1093/cid/ciu622] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Through 2 international traveler-focused surveillance networks (GeoSentinel and TropNet), we identified and investigated a large outbreak of acute muscular sarcocystosis (AMS), a rarely reported zoonosis caused by a protozoan parasite of the genus Sarcocystis, associated with travel to Tioman Island, Malaysia, during 2011-2012. METHODS Clinicians reporting patients with suspected AMS to GeoSentinel submitted demographic, clinical, itinerary, and exposure data. We defined a probable case as travel to Tioman Island after 1 March 2011, eosinophilia (>5%), clinical or laboratory-supported myositis, and negative trichinellosis serology. Case confirmation required histologic observation of sarcocysts or isolation of Sarcocystis species DNA from muscle biopsy. RESULTS Sixty-eight patients met the case definition (62 probable and 6 confirmed). All but 2 resided in Europe; all were tourists and traveled mostly during the summer months. The most frequent symptoms reported were myalgia (100%), fatigue (91%), fever (82%), headache (59%), and arthralgia (29%); onset clustered during 2 distinct periods: "early" during the second and "late" during the sixth week after departure from the island. Blood eosinophilia and elevated serum creatinine phosphokinase (CPK) levels were observed beginning during the fifth week after departure. Sarcocystis nesbitti DNA was recovered from 1 muscle biopsy. CONCLUSIONS Clinicians evaluating travelers returning ill from Malaysia with myalgia, with or without fever, should consider AMS, noting the apparent biphasic aspect of the disease, the later onset of elevated CPK and eosinophilia, and the possibility for relapses. The exact source of infection among travelers to Tioman Island remains unclear but needs to be determined to prevent future illnesses.
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16
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Gaines J, Sotir MJ, Cunningham TJ, Harvey KA, Lee CV, Stoney RJ, Gershman MD, Brunette GW, Kozarsky PE. Health and safety issues for travelers attending the World Cup and Summer Olympic and Paralympic Games in Brazil, 2014 to 2016. JAMA Intern Med 2014; 174:1383-90. [PMID: 24887552 PMCID: PMC4655589 DOI: 10.1001/jamainternmed.2014.2227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
IMPORTANCE Travelers from around the globe will attend the 2014 Fédération Internationale de Football Association (FIFA) World Cup and the 2016 Olympic and Paralympic Games in Brazil. Travelers to these mass gathering events may be exposed to a range of health risks, including a variety of infectious diseases. Most travelers who become ill will present to their primary care physicians, and thus it is important that clinicians are aware of the risks their patients encountered. OBJECTIVE To highlight health and safety concerns for people traveling to these events in Brazil so that health care practitioners can better prepare travelers before they travel and more effectively diagnose and treat travelers after they return. EVIDENCE REVIEW We reviewed both peer-reviewed and gray literature to identify health outcomes associated with travel to Brazil and mass gatherings. Thirteen specific infectious diseases are described in terms of signs, symptoms, and treatment. Relevant safety and security concerns are also discussed. FINDINGS Travelers to Brazil for mass gathering events face unique health risks associated with their travel. CONCLUSIONS AND RELEVANCE Travelers should consult a health care practitioner 4 to 6 weeks before travel to Brazil and seek up-to-date information regarding their specific itineraries. For the most up-to-date information, health care practitioners can visit the Centers for Disease Control and Prevention (CDC) Travelers' Health website (http://wwwnc.cdc.gov/travel) or review CDC's Yellow Book online (http://wwwnc.cdc.gov/travel/page/yellowbook-home-2014).
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Affiliation(s)
- Joanna Gaines
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Mark J Sotir
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Timothy J Cunningham
- Epidemiology and Surveillance Branch, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Kira A Harvey
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - C Virginia Lee
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Rhett J Stoney
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Mark D Gershman
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Gary W Brunette
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Phyllis E Kozarsky
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia3Emory University School of Medi
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Balaban V, Warnock E, Ramana Dhara V, Jean-Louis LA, Sotir MJ, Kozarsky P. Health risks, travel preparation, and illness among public health professionals during international travel. Travel Med Infect Dis 2014; 12:349-54. [DOI: 10.1016/j.tmaid.2014.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/13/2014] [Accepted: 01/15/2014] [Indexed: 11/25/2022]
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Harvey K, Jentes ES, Charles M, Johnson KJ, Petersen B, Lamias MJ, Blanton JD, Sotir MJ, Brunette GW. Possible rabies exposures in Peace Corps volunteers, 2011. Am J Trop Med Hyg 2014; 90:902-7. [PMID: 24639304 DOI: 10.4269/ajtmh.13-0521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We surveyed Peace Corps Medical Officers (PCMOs) to determine the frequency of and responses to possible rabies exposures of U.S. Peace Corps volunteers (PCVs). Surveys were sent to 56 PCMOs serving in countries with moderate or high rabies vaccine recommendations from the U.S. Centers for Disease Control and Prevention (CDC), of which 38 (68%) responded. Thirty-seven PCMOs reported that, of 4,982 PCVs, 140 (3%) experienced possible rabies exposures. Of these, 125 (89%) had previously received rabies vaccination, 129 (92%) presented with adequately cleansed wounds, and 106 (76%) were deemed to require and were given post-exposure prophylaxis (PEP). Of 35 respondents, 30 (86%) reported that rabies vaccine was always accessible to PCVs in their country within 24 hours. Overall, the Peace Corps is successful at preventing and treating possible rabies exposures. However, this study identified a few gaps in policy implementation. The Peace Corps should continue and strengthen efforts to provide education, preexposure vaccination, and PEP to PCVs.
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Affiliation(s)
- Kira Harvey
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Office of Medical Services, Peace Corps, Washington, District of Columbia; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Office of Informatics, Centers for Disease Control and Prevention, Atlanta, Georgia
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Stoney RJ, Jentes ES, Sotir MJ, Kozarsky P, Rao SR, LaRocque RC, Ryan ET. Pre-travel preparation of US travelers going abroad to provide humanitarian service, Global TravEpiNet 2009-2011. Am J Trop Med Hyg 2014; 90:553-559. [PMID: 24445203 PMCID: PMC3945703 DOI: 10.4269/ajtmh.13-0479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 12/23/2013] [Indexed: 11/07/2022] Open
Abstract
We analyzed characteristics of humanitarian service workers (HSWs) seen pre-travel at Global TravEpiNet (GTEN) practices during 2009-2011. Of 23,264 travelers, 3,663 (16%) travelers were classified as HSWs. Among HSWs, 1,269 (35%) travelers were medical workers, 1,298 (35%) travelers were non-medical service workers, and 990 (27%) travelers were missionaries. Median age was 29 years, and 63% of travelers were female. Almost one-half (49%) traveled to 1 of 10 countries; the most frequent destinations were Haiti (14%), Honduras (8%), and Kenya (6%). Over 90% of travelers were vaccinated for or considered immune to hepatitis A, typhoid, and yellow fever. However, for hepatitis B, 292 (29%) of 990 missionaries, 228 (18%) of 1,298 non-medical service workers, and 76 (6%) of 1,269 medical workers were not vaccinated or considered immune. Of HSWs traveling to Haiti during 2010, 5% of travelers did not receive malaria chemoprophylaxis. Coordinated efforts from HSWs, HSW agencies, and clinicians could reduce vaccine coverage gaps and improve use of malaria chemoprophylaxis.
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Affiliation(s)
- Rhett J. Stoney
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Center for Healthcare Organization and Implementation Research (CHOIR), Bedford Veteran Affairs Medical Center, Bedford, Massachusetts; Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Dolan SB, Jentes ES, Sotir MJ, Han P, Blanton JD, Rao SR, LaRocque RC, Ryan ET. Pre-exposure rabies vaccination among US international travelers: findings from the global TravEpiNet consortium. Vector Borne Zoonotic Dis 2014; 14:160-7. [PMID: 24359420 PMCID: PMC3928762 DOI: 10.1089/vbz.2013.1381] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People who travel to areas with high rabies endemicity and have animal contact are at increased risk for rabies exposure. We examined characteristics of international travelers queried regarding rabies vaccination during pretravel consultations at Global TravEpiNet (GTEN) practices during 2009-2010. MATERIAL AND METHODS We performed bivariate and multivariable analyses of data collected from 18 GTEN clinics. Travel destinations were classified by strength level of rabies vaccination recommendation. RESULTS Of 13,235 travelers, 226 (2%) reported previous rabies vaccination, and 406 (3%) received rabies vaccine at the consultation. Common travel purposes for these 406 travelers were leisure (26%), research/education (17%), and nonmedical service work (14%). Excluding the 226 who were previously vaccinated, 8070 (62%) of 13,009 travelers intended to visit one or more countries with a strong recommendation for rabies vaccination; 1675 (21%) of these 8070 intended to travel for 1 month or more. Among these 1675 travelers, 145 (9%) were vaccinated, 498 (30%) declined vaccination, 832 (50%) had itineraries that clinicians determined did not indicate vaccination, and 200 (12%) remained unvaccinated for other reasons. In both bivariate and multivariate analyses, travelers with trip durations >6 months versus 1-3 months (adjusted odds ratio [OR]=4.9 [95% confidence interval [CI] 2.1, 11.4]) and those traveling for "research/education" or to "provide medical care" (adjusted OR=5.1 [95% CI 1.9, 13.7] and 9.5 [95% CI 2.2, 40.8], respectively), compared with leisure travelers, were more likely to receive rabies vaccination. CONCLUSIONS Few travelers at GTEN clinics received rabies vaccine, although many planned trips 1 month long or more to a strong-recommendation country. Clinicians often determined that vaccine was not indicated, and travelers often declined vaccine when it was offered. The decision to vaccinate should take into account the strength of the vaccine recommendation at the destination country, duration of stay, availability of postexposure prophylaxis, potential for exposure to animals, and likelihood of recurrent travel to high-risk destinations.
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Affiliation(s)
- Samantha B. Dolan
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily S. Jentes
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark J. Sotir
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pauline Han
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jesse D. Blanton
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sowmya R. Rao
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
- Center for Health Quality, Outcomes and Economic Research, Bedford VA Medical Center, Bedford, Massachusetts
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Hagmann S, LaRocque RC, Rao SR, Jentes ES, Sotir MJ, Brunette G, Ryan ET. Pre-Travel Health Preparation of Pediatric International Travelers: Analysis From the Global TravEpiNet Consortium. J Pediatric Infect Dis Soc 2013; 2:327-34. [PMID: 26619495 DOI: 10.1093/jpids/pit023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 03/07/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Children frequently travel internationally. Health-related data on such children are limited. We sought to investigate the demographics, health characteristics, and preventive interventions of outbound US international pediatric travelers. METHODS We analyzed data from 32 099 travelers presenting for pre-travel healthcare at the Global TravEpiNet (GTEN), a national consortium of 19 travel clinics, from January 1, 2009 to June 6, 2012. RESULTS A total of 3332 (10%) of all GTEN travelers were children (<18 years of age). These children traveled mostly for leisure (36%) or to visit friends or relatives (VFR) (36%). Most popular destination regions were Africa (41%), Southeast Asia (16%), Central America (16%), and the Caribbean (16%). Compared with children traveling for leisure, VFR children were more likely to present <14 days before departure for pre-travel consultation (44% vs 28%), intended to travel for 28 days or longer (70% vs 22%), and to travel to Africa (62% vs 32%). Nearly half of the pediatric travelers (46%) received at least 1 routine vaccine, and most (83%) received at least 1 travel-related vaccine. Parents or guardians of one third of the children (30%) refused at least 1 recommended travel-related vaccine. Most pediatric travelers visiting a malaria-endemic country (72%) received a prescription for malaria chemoprophylaxis. CONCLUSIONS Ten percent of travelers seeking pre-travel healthcare at GTEN sites are children. VFR-travel, pre-travel consultation close to time of departure, and refusal of recommended vaccines may place children at risk for travel-associated illness. Strategies to engage pediatric travelers in timely, pre-travel care and improve acceptance of pre-travel healthcare interventions are needed.
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Affiliation(s)
- Stefan Hagmann
- Division of Pediatric Infectious Diseases, Bronx Lebanon Hospital Center, and Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Regina C LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, and Department of Medicine, Harvard Medical School, Boston
| | - Sowmya R Rao
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, and Center for Health Quality, Outcomes and Economic Research, Veterans Administration Medical Center, Bedford, Massachusetts
| | - Emily S Jentes
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark J Sotir
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gary Brunette
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, and Department of Medicine, Harvard Medical School, Boston
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Mues KE, Esposito DH, Han PV, Jentes ES, Sotir MJ, Brown C. Analyzing GeoSentinel surveillance data: a comparison of methods to explore acute gastrointestinal illness among international travelers. Clin Infect Dis 2013; 58:546-54. [PMID: 24253244 DOI: 10.1093/cid/cit746] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
GeoSentinel is a global surveillance network of travel medicine clinics that collect data from ill international travelers. Analyses have relied on proportionate morbidity calculations, but proportionate morbidity cannot estimate disease risk because healthy travelers are not included in the denominator. The authors evaluated the use of a case-control design, controlling for GeoSentinel site and date of clinic visit, to calculate a reporting odds ratio (ROR). The association between region of travel and acute gastrointestinal illness was evaluated. All analyses found that the association with acute gastrointestinal illness was greatest among those who traveled to North Africa and South-Central Asia. There was consistency in the magnitude of the ROR and proportionate morbidity ratio (PMR) in regions such as the Caribbean. However, in other regions, the matched ROR was noticeably different than the PMR. The case-control ROR may be preferred for single-disease/syndrome analytical studies using GeoSentinel surveillance data or other surveillance data.
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Affiliation(s)
- Katherine E Mues
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta
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Adachi K, Coleman MS, Khan N, Jentes ES, Arguin P, Rao SR, LaRocque RC, Sotir MJ, Brunette G, Ryan ET, Meltzer MI. Economics of malaria prevention in US travelers to West Africa. Clin Infect Dis 2013; 58:11-21. [PMID: 24014735 PMCID: PMC3864498 DOI: 10.1093/cid/cit570] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background. Pretravel health consultations help international travelers manage travel-related illness risks through education, vaccination, and medication. This study evaluated costs and benefits of that portion of the health consultation associated with malaria prevention provided to US travelers bound for West Africa. Methods. The estimated change in disease risk and associated costs and benefits resulting from traveler adherence to malaria chemoprophylaxis were calculated from 2 perspectives: the healthcare payer's and the traveler's. We used data from the Global TravEpiNet network of US travel clinics that collect de-identified pretravel data for international travelers. Disease risk and chemoprophylaxis effectiveness were estimated from published medical reports. Direct medical costs were obtained from the Nationwide Inpatient Sample and published literature. Results. We analyzed 1029 records from January 2009 to January 2011. Assuming full adherence to chemoprophylaxis regimens, consultations saved healthcare payers a per-traveler average of $14 (9-day trip) to $372 (30-day trip). For travelers, consultations resulted in a range of net cost of $20 (9-day trip) to a net savings of $32 (30-day trip). Differences were mostly driven by risk of malaria in the destination country. Conclusions. Our model suggests that healthcare payers save money for short- and longer-term trips, and that travelers save money for longer trips when travelers adhere to malaria recommendations and prophylactic regimens in West Africa. This is a potential incentive to healthcare payers to offer consistent pretravel preventive care to travelers. This financial benefit complements the medical benefit of reducing the risk of malaria.
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Harvey K, Esposito DH, Han P, Kozarsky P, Freedman DO, Plier DA, Sotir MJ. Surveillance for travel-related disease--GeoSentinel Surveillance System, United States, 1997-2011. MMWR Surveill Summ 2013; 62:1-23. [PMID: 23863769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PROBLEM/CONDITION In 2012, the number of international tourist arrivals worldwide was projected to reach a new high of 1 billion arrivals, a 48% increase from 674 million arrivals in 2000. International travel also is increasing among U.S. residents. In 2009, U.S. residents made approximately 61 million trips outside the country, a 5% increase from 1999. Travel-related morbidity can occur during or after travel. Worldwide, 8% of travelers from industrialized to developing countries report becoming ill enough to seek health care during or after travel. Travelers have contributed to the global spread of infectious diseases, including novel and emerging pathogens. Therefore, surveillance of travel-related morbidity is an essential component of global public health surveillance and will be of greater importance as international travel increases worldwide. REPORTING PERIOD September 1997-December 2011. DESCRIPTION OF SYSTEM GeoSentinel is a clinic-based global surveillance system that tracks infectious diseases and other adverse health outcomes in returned travelers, foreign visitors, and immigrants. GeoSentinel comprises 54 travel/tropical medicine clinics worldwide that electronically submit demographic, travel, and clinical diagnosis data for all patients evaluated for an illness or other health condition that is presumed to be related to international travel. Clinical information is collected by physicians with expertise or experience in travel/tropical medicine. Data collected at all sites are entered electronically into a database, which is housed at and maintained by CDC. The GeoSentinel network membership program comprises 235 additional clinics in 40 countries on six continents. Although these network members do not report surveillance data systematically, they can report unusual or concerning diagnoses in travelers and might be asked to perform enhanced surveillance in response to specific health events or concerns. RESULTS During September 1997-December 2011, data were collected on 141,789 patients with confirmed or probable travel-related diagnoses. Of these, 23,006 (16%) patients were evaluated in the United States, 10,032 (44%) of whom were evaluated after returning from travel outside of the United States (i.e., after-travel patients). Of the 10,032 after-travel patients, 4,977 (50%) were female, 4,856 (48%) were male, and 199 (2%) did not report sex; the median age was 34 years. Most were evaluated in outpatient settings (84%), were born in the United States (76%), and reported current U.S. residence (99%). The most common reasons for travel were tourism (38%), missionary/volunteer/research/aid work (24%), visiting friends and relatives (17%), and business (15%). The most common regions of exposure were Sub-Saharan Africa (23%), Central America (15%), and South America (12%). Fewer than half (44%) reported having had a pretravel visit with a health-care provider. Of the 13,059 diagnoses among the 10,032 after-travel patients, the most common diagnoses were acute unspecified diarrhea (8%), acute bacterial diarrhea (5%), postinfectious irritable bowel syndrome (5%), giardiasis (3%), and chronic unknown diarrhea (3%). The most common diagnostic groupings were acute diarrhea (22%), nondiarrheal gastrointestinal (15%), febrile/systemic illness (14%), and dermatologic (12%). Among 1,802 patients with febrile/systemic illness diagnoses, the most common diagnosis was Plasmodium falciparum malaria (19%). The rapid communication component of the GeoSentinel network has allowed prompt responses to important health events affecting travelers; during 2010 and 2011, the notification capability of the GeoSentinel network was used in the identification and public health response to East African trypanosomiasis in Eastern Zambia and North Central Zimbabwe, P. vivax malaria in Greece, and muscular sarcocystosis on Tioman Island, Malaysia. INTERPRETATION The GeoSentinel Global Surveillance System is the largest repository of provider-based data on travel-related illness. Among ill travelers evaluated in U.S. GeoSentinel sites after returning from international travel, gastrointestinal diagnoses were most frequent, suggesting that U.S. travelers might be exposed to unsafe food and water while traveling internationally. The most common febrile/systemic diagnosis was P. falciparum malaria, suggesting that some U.S. travelers to malarial areas are not receiving or using proper malaria chemoprophylaxis or mosquito-bite avoidance measures. The finding that fewer than half of all patients reported having made a pretravel visit with a health-care provider indicates that a substantial portion of U.S. travelers might not be following CDC travelers' health recommendations for international travel. PUBLIC HEALTH ACTION GeoSentinel surveillance data have helped researchers define an evidence base for travel medicine that has informed travelers' health guidelines and the medical evaluation of ill international travelers. These data suggest that persons traveling internationally from the United States to developing countries remain at risk for illness. Health-care providers should help prepare travelers properly for safe travel and provide destination-specific medical evaluation of returning ill travelers. Training for health-care providers should focus on preventing and treating a variety of travel-related conditions, particularly traveler's diarrhea and malaria.
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Affiliation(s)
- Kira Harvey
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Disease, CDC, USA
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Taylor EV, Nguyen TA, Machesky KD, Koch E, Sotir MJ, Bohm SR, Folster JP, Bokanyi R, Kupper A, Bidol SA, Emanuel A, Arends KD, Johnson SA, Dunn J, Stroika S, Patel MK, Williams I. Multistate outbreak of Escherichia coli O145 infections associated with romaine lettuce consumption, 2010. J Food Prot 2013; 76:939-44. [PMID: 23726187 DOI: 10.4315/0362-028x.jfp-12-503] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Non-O157 Shiga toxin-producing Escherichia coli (STEC) can cause severe illness, including hemolytic uremic syndrome (HUS). STEC O145 is the sixth most commonly reported non-O157 STEC in the United States, although outbreaks have been infrequent. In April and May 2010, we investigated a multistate outbreak of STEC O145 infection. Confirmed cases were STEC O145 infections with isolate pulsed-field gel electrophoresis patterns indistinguishable from those of the outbreak strain. Probable cases were STEC O145 infections or HUS in persons who were epidemiologically linked. Case-control studies were conducted in Michigan and Ohio; food exposures were analyzed at the restaurant, menu, and ingredient level. Environmental inspections were conducted in implicated food establishments, and food samples were collected and tested. To characterize clinical findings associated with infections, we conducted a chart review for case patients who sought medical care. We identified 27 confirmed and 4 probable cases from five states. Of these, 14 (45%) were hospitalized, 3 (10%) developed HUS, and none died. Among two case-control studies conducted, illness was significantly associated with consumption of shredded romaine lettuce in Michigan (odds ratio [OR] = undefined; 95% confidence interval [CI] = 1.6 to undefined) and Ohio (OR = 10.9; 95% CI = 3.1 to 40.5). Samples from an unopened bag of shredded romaine lettuce yielded the predominant outbreak strain. Of 15 case patients included in the chart review, 14 (93%) had diarrhea and abdominal cramps and 11 (73%) developed bloody diarrhea. This report documents the first foodborne outbreak of STEC O145 infections in the United States. Current surveillance efforts focus primarily on E. coli O157 infections; however, non-O157 STEC can cause similar disease and outbreaks, and efforts should be made to identify both O157 and non-O157 STEC infections. Providers should test all patients with bloody diarrhea for both non-O157 and O157 STEC.
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Affiliation(s)
- E V Taylor
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Leder K, Torresi J, Libman MD, Cramer JP, Castelli F, Schlagenhauf P, Wilder-Smith A, Wilson ME, Keystone JS, Schwartz E, Barnett ED, von Sonnenburg F, Brownstein JS, Cheng AC, Sotir MJ, Esposito DH, Freedman DO. GeoSentinel surveillance of illness in returned travelers, 2007-2011. Ann Intern Med 2013; 158:456-68. [PMID: 23552375 PMCID: PMC4629801 DOI: 10.7326/0003-4819-158-6-201303190-00005] [Citation(s) in RCA: 338] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND International travel continues to increase, particularly to Asia and Africa. Clinicians are increasingly likely to be consulted for advice before travel or by ill returned travelers. OBJECTIVE To describe typical diseases in returned travelers according to region, travel reason, and patient demographic characteristics; describe the pattern of low-frequency travel-associated diseases; and refine key messages for care before and after travel. DESIGN Descriptive, using GeoSentinel records. SETTING 53 tropical or travel disease units in 24 countries. PATIENTS 42 173 ill returned travelers seen between 2007 and 2011. MEASUREMENTS Frequencies of demographic characteristics, regions visited, and illnesses reported. RESULTS Asia (32.6%) and sub-Saharan Africa (26.7%) were the most common regions where illnesses were acquired. Three quarters of travel-related illness was due to gastrointestinal (34.0%), febrile (23.3%), and dermatologic (19.5%) diseases. Only 40.5% of all ill travelers reported pretravel medical visits. The relative frequency of many diseases varied with both travel destination and reason for travel, with travelers visiting friends and relatives in their country of origin having both a disproportionately high burden of serious febrile illness and very low rates of advice before travel (18.3%). Life-threatening diseases, such as Plasmodium falciparum malaria, melioidosis, and African trypanosomiasis, were reported. LIMITATIONS Sentinel surveillance data collected by specialist clinics do not reflect healthy returning travelers or those with mild or self-limited illness. Data cannot be used to infer quantitative risk for illness. CONCLUSION Many illnesses may have been preventable with appropriate advice, chemoprophylaxis, or vaccination. Clinicians can use these 5-year GeoSentinel data to help tailor more efficient pretravel preparation strategies and evaluate possible differential diagnoses of ill returned travelers according to destination and reason for travel. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Karin Leder
- Victorian Infectious Disease Service, Royal Melbourne Hospital, Monash University, Austin Hospital, Melbourne University.
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LaRocque RC, Deshpande BR, Rao SR, Brunette GW, Sotir MJ, Jentes ES, Ryan ET. Pre-travel health care of immigrants returning home to visit friends and relatives. Am J Trop Med Hyg 2012; 88:376-380. [PMID: 23149585 PMCID: PMC3583333 DOI: 10.4269/ajtmh.2012.12-0460] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Immigrants returning home to visit friends and relatives (VFR travelers) are at higher risk of travel-associated illness than other international travelers. We evaluated 3,707 VFR and 17,507 non-VFR travelers seen for pre-travel consultation in Global TravEpiNet during 2009–2011; all were traveling to resource-poor destinations. VFR travelers more commonly visited urban destinations than non-VFR travelers (42% versus 30%, P < 0.0001); 54% of VFR travelers were female, and 18% of VFR travelers were under 6 years old. VFR travelers sought health advice closer to their departure than non-VFR travelers (median days before departure was 17 versus 26, P < 0.0001). In multivariable analysis, being a VFR traveler was an independent predictor of declining a recommended vaccine. Missed opportunities for vaccination could be addressed by improving the timing of pre-travel health care and increasing the acceptance of vaccines. Making pre-travel health care available in primary care settings may be one step to this goal.
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Affiliation(s)
- Regina C. LaRocque
- *Address correspondence to Regina C. LaRocque, Travelers' Advice and Immunization Center, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA 02114. E-mail:
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Gaffga NH, Barton Behravesh C, Ettestad PJ, Smelser CB, Rhorer AR, Cronquist AB, Comstock NA, Bidol SA, Patel NJ, Gerner-Smidt P, Keene WE, Gomez TM, Hopkins BA, Sotir MJ, Angulo FJ. Outbreak of salmonellosis linked to live poultry from a mail-order hatchery. N Engl J Med 2012; 366:2065-73. [PMID: 22646629 DOI: 10.1056/nejmoa1111818] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Outbreaks of human salmonella infections are increasingly associated with contact with live poultry, but effective control measures are elusive. In 2005, a cluster of human salmonella Montevideo infections with a rare pattern on pulsed-field gel electrophoresis (the outbreak strain) was identified by PulseNet, a national subtyping network. METHODS In cooperation with public health and animal health agencies, we conducted multistate investigations involving patient interviews, trace-back investigations, and environmental testing at a mail-order hatchery linked to the outbreak in order to identify the source of infections and prevent additional illnesses. A case was defined as an infection with the outbreak strain between 2004 and 2011. RESULTS From 2004 through 2011, we identified 316 cases in 43 states. The median age of the patient was 4 years. Interviews were completed with 156 patients (or their caretakers) (49%), and 36 of these patients (23%) were hospitalized. Among the 145 patients for whom information was available, 80 (55%) had bloody diarrhea. Information on contact with live young poultry was available for 159 patients, and 122 of these patients (77%) reported having such contact. A mail-order hatchery in the western United States was identified in 81% of the trace-back investigations, and the outbreak strain was isolated from samples collected at the hatchery. After interventions at the hatchery, the number of human infections declined, but transmission continued. CONCLUSIONS We identified a prolonged multistate outbreak of salmonellosis, predominantly affecting young children and associated with contact with live young poultry from a mail-order hatchery. Interventions performed at the hatchery reduced, but did not eliminate, associated human infections, demonstrating the difficulty of eliminating salmonella transmission from live poultry.
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Affiliation(s)
- Nicholas H Gaffga
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Dailey NJM, Lee N, Fleischauer AT, Moore ZS, Alfano-Sobsey E, Breedlove F, Pierce A, Ledford S, Greene S, Gómez GA, Talkington DF, Sotir MJ, Hall AJ, Sweat D. Clostridium perfringens Infections Initially Attributed to Norovirus, North Carolina, 2010. Clin Infect Dis 2012; 55:568-70. [DOI: 10.1093/cid/cis441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Sharp TM, Pillai P, Hunsperger E, Santiago GA, Anderson T, Vap T, Collinson J, Buss BF, Safranek TJ, Sotir MJ, Jentes ES, Munoz-Jordan JL, Arguello DF. A cluster of dengue cases in American missionaries returning from Haiti, 2010. Am J Trop Med Hyg 2012; 86:16-22. [PMID: 22232444 DOI: 10.4269/ajtmh.2012.11-0427] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Dengue is an acute febrile illness caused by four mosquito-borne dengue viruses (DENV-1 to -4) that are endemic throughout the tropics. After returning from a 1-week missionary trip to Haiti in October of 2010, 5 of 28 (18%) travelers were hospitalized for dengue-like illness. All travelers were invited to submit serum specimens and complete questionnaires on pre-travel preparations, mosquito avoidance practices, and activities during travel. DENV infection was confirmed in seven (25%) travelers, including all travelers that were hospitalized. Viral sequencing revealed closest homology to a 2007 DENV-1 isolate from the Dominican Republic. Although most (88%) travelers had a pre-travel healthcare visit, only one-quarter knew that dengue is a risk in Haiti, and one-quarter regularly used insect repellent. This report confirms recent DENV transmission in Haiti. Travelers to DENV-endemic areas should receive dengue education during pre-travel health consultations, follow mosquito avoidance recommendations, and seek medical care for febrile illness during or after travel.
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Affiliation(s)
- Tyler M Sharp
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Esposito DH, Han PV, Kozarsky PE, Walker PF, Gkrania-Klotsas E, Barnett ED, Libman M, McCarthy AE, Field V, Connor BA, Schwartz E, MacDonald S, Sotir MJ. Characteristics and spectrum of disease among ill returned travelers from pre- and post-earthquake Haiti: The GeoSentinel experience. Am J Trop Med Hyg 2012; 86:23-8. [PMID: 22232445 DOI: 10.4269/ajtmh.2012.11-0430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
To describe patient characteristics and disease spectrum among foreign visitors to Haiti before and after the 2010 earthquake, we used GeoSentinel Global Surveillance Network data and compared 1 year post-earthquake versus 3 years pre-earthquake. Post-earthquake travelers were younger, predominantly from the United States, more frequently international assistance workers, and more often medically counseled before their trip than pre-earthquake travelers. Work-related stress and upper respiratory tract infections were more frequent post-earthquake; acute diarrhea, dengue, and Plasmodium falciparum malaria were important contributors of morbidity both pre- and post-earthquake. These data highlight the importance of providing destination- and disaster-specific pre-travel counseling and post-travel evaluation and medical management to persons traveling to or returning from a disaster location, and evaluations should include attention to the psychological wellbeing of these travelers. For travel to Haiti, focus should be on mosquito-borne illnesses (dengue and P. falciparum malaria) and travelers' diarrhea.
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Affiliation(s)
- Douglas H Esposito
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Atlanta, Georgia, USA.
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LaRocque RC, Rao SR, Lee J, Ansdell V, Yates JA, Schwartz BS, Knouse M, Cahill J, Hagmann S, Vinetz J, Connor BA, Goad JA, Oladele A, Alvarez S, Stauffer W, Walker P, Kozarsky P, Franco-Paredes C, Dismukes R, Rosen J, Hynes NA, Jacquerioz F, McLellan S, Hale D, Sofarelli T, Schoenfeld D, Marano N, Brunette G, Jentes ES, Yanni E, Sotir MJ, Ryan ET. Global TravEpiNet: a national consortium of clinics providing care to international travelers--analysis of demographic characteristics, travel destinations, and pretravel healthcare of high-risk US international travelers, 2009-2011. Clin Infect Dis 2011; 54:455-62. [PMID: 22144534 DOI: 10.1093/cid/cir839] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND International travel poses a risk of destination-specific illness and may contribute to the global spread of infectious diseases. Despite this, little is known about the health characteristics and pretravel healthcare of US international travelers, particularly those at higher risk of travel-associated illness. METHODS We formed a national consortium (Global TravEpiNet) of 18 US clinics registered to administer yellow fever vaccination. We collected data regarding demographic and health characteristics, destinations, purpose of travel, and pretravel healthcare from 13235 international travelers who sought pretravel consultation at these sites from January 2009 through January 2011. RESULTS The destinations and itineraries of Global TravEpiNet travelers differed from those of the overall population of US international travelers. The majority of Global TravEpiNet travelers were visiting low- or lower-middle-income countries, and Africa was the most frequently visited region. Seventy-five percent of travelers were visiting malaria-endemic countries, and 38% were visiting countries endemic for yellow fever. Fifty-nine percent of travelers reported ≥1 medical condition. Atovaquone/proguanil was the most commonly prescribed antimalarial drug, and most travelers received an antibiotic for self-treatment of travelers' diarrhea. Hepatitis A and typhoid were the most frequently administered vaccines. CONCLUSIONS Data from Global TravEpiNet provide insight into the characteristics and pretravel healthcare of US international travelers who are at increased risk of travel-associated illness due to itinerary, purpose of travel, or existing medical conditions. Improved understanding of this epidemiologically significant population may help target risk-reduction strategies and interventions to limit the spread of infections related to global travel.
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Affiliation(s)
- Regina C LaRocque
- Travelers' Advice and Immunization Center, Massachusetts General Hospital, Boston, USA.
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Wright AP, Gould LH, Mahon B, Sotir MJ, Tauxe RV. Overview of the impact of epidemic-assistance investigations of foodborne and other enteric disease outbreaks, 1946-2005. Am J Epidemiol 2011; 174:S23-35. [PMID: 22135391 DOI: 10.1093/aje/kwr308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Epidemic-assistance investigations (Epi-Aids) in response to outbreaks of foodborne and other enteric pathogens have identified novel pathogens, clinical syndromes, and sequelae; described new reservoirs and vehicles of transmission; evaluated existing prevention strategies; and identified deficiencies in the food safety systems on local, national, and international levels. Since the first Epi-Aid was issued in 1946, approximately 23% (1,023 of 4,484 for which investigations were initiated) of all Epi-Aids have been related to foodborne or other enteric diseases. Epi-Aid results have yielded valuable insights into the epidemiology of these pathogens and have molded prevention strategies for detecting, responding to, and preventing future outbreaks. New challenges, brought about in part by centralization and globalization of the food supply, will continue to emerge. The need for Epi-Aids of such outbreaks undoubtedly will persist as an integral part of future public health response efforts, prevention strategies, and training programs.
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Affiliation(s)
- Ashton P Wright
- Atlanta Research and Education Foundation, 723 Cramer Avenue, Lexington, KY 40502, USA.
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Harris JR, Neil KP, Behravesh CB, Sotir MJ, Angulo FJ. Recent multistate outbreaks of human salmonella infections acquired from turtles: a continuing public health challenge. Clin Infect Dis 2010; 50:554-9. [PMID: 20085463 DOI: 10.1086/649932] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The federal ban in the United States on the sale of turtles with shell lengths <4 inches that was established in 1975 has reduced the number of turtle-associated human Salmonella infections during subsequent years, especially among children. Although numerous sporadic turtle-associated Salmonella infections in humans have been reported since the ban went into effect, outbreaks were not reported until recently. Since 2006, 3 multistate outbreaks of turtle-associated Salmonella infections have been documented in the United States. This review examines the history of turtle-associated human Salmonella infections in the United States and discusses reasons why an increase in turtle-associated salmonellosis may be occurring and how challenges in enforcement of the ban affect disease control. Additional steps should be considered by the public health community, state governments, and enforcement agencies to prevent turtle-associated Salmonella infections in humans.
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Affiliation(s)
- Julie R Harris
- Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA30309, USA.
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36
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Johnson DKH, Staples JE, Sotir MJ, Warshauer DM, Davis JP. Tickborne Powassan virus infections among Wisconsin residents. WMJ 2010; 109:91-97. [PMID: 20443328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Powassan virus (POWV) is a tickborne Flavivirus that causes a rare but potentially life-threatening illness. The first reported case of POWV infection in a Wisconsin resident occurred in 2003. Enhanced surveillance and testing detected 2 additional cases. METHODS Patient specimens with a positive or equivocal immunoglobulin M (IgM) antibody to an arbovirus were sent from commercial laboratories to the Wisconsin State Laboratory of Hygiene and forwarded to the Centers for Disease Control and Prevention (CDC) for confirmatory testing. Patients with laboratory confirmed POWV infections were interviewed to obtain demographic, clinical, and epidemiologic information. RESULTS POWV infections were confirmed in 3 adult Wisconsin residents in 2003, 2006, and 2007; illness onsets occurred during May and June. Two patients were hospitalized and all survived. One patient had a dual infection with POWV and Anaplasma phaghocytophilum. Specimens from all 3 patients were initially reported as positive for IgM antibody to either St Louis encephalitis or California serogroup viruses; POWV-specific antibody was detected during confirmatory testing at the CDC. Each patient had exposures to known or likely tick habitats in different counties within 30 days before illness onset. CONCLUSIONS These are the first diagnosed human POWV infections in Wisconsin. Because all 3 patients were initially identified as having other arboviral infections using commercial screening kits, routine confirmatory testing is essential for proper diagnosis of most arboviral infections. Wisconsin residents should be educated regarding risks of acquiring and ways to prevent POWV infection and other tickborne diseases when spending time outdoors.
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Affiliation(s)
- Diep K Hoang Johnson
- Bureau of Communicable Diseases and Emergency Response, Wisconsin Division of Public Health, Madison, WI 53701-2659, USA.
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Sotir MJ, Hoang Johnson DK, Davis JP. Travel-associated Dengue illnesses among Wisconsin residents, 2002-2008. WMJ 2009; 108:447-452. [PMID: 20131686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Dengue infections in humans can result in self-limited illness or conditions that can be severe and life-threatening. Persons traveling to many tropical regions are at risk for dengue infection. This report retrospectively summarizes travel-associated dengue cases occurring among Wisconsin residents from 2002 through 2008. METHODS We used a surveillance case definition based on the Centers for Disease Control and Prevention (CDC) 1996 dengue illness case definition. Detection of dengue-specific IgM antibody in serum specimens was used for laboratory confirmation of dengue. Clinical and travel histories, mosquito exposure, and repellent use were obtained from patients by interview using arbovirus-specific data collection forms. RESULTS During 2002-2008, 32 travel-associated dengue illnesses were reported among Wisconsin residents; none met the case criteria of dengue hemorrhagic fever or dengue shock syndrome. Fever (100%), headache (90%), and myalgia (87%) were the most frequently reported signs and symptoms. Nine (28%) patients were hospitalized; no deaths occurred. Onsets in 25 (81%) of 31 patients with reported travel histories occurred after return to Wisconsin. Eighteen (56%) of the 32 patients were female; median age was 35.5 years (range 12 to 68 years). Patients most frequently reported travel to Mexico/Central America (45%) or the Caribbean Islands (39%). Cases occurred during all months. Reported mosquito exposure was high among patients (85%), but consistent repellent use was low (6%). CONCLUSIONS Dengue illnesses occur in travelers to dengue-endemic tropical areas. Travelers to these areas must take precautions to prevent mosquito bites. Clinicians should consider dengue in travelers who develop febrile illnesses with headache or myalgia within 2 weeks of their return. Arboviral diseases, including dengue, are reportable in Wisconsin.
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Affiliation(s)
- Mark J Sotir
- Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison, USA.
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Harris JR, Bergmire-Sweat D, Schlegel JH, Winpisinger KA, Klos RF, Perry C, Tauxe RV, Sotir MJ. Multistate outbreak of Salmonella infections associated with small turtle exposure, 2007-2008. Pediatrics 2009; 124:1388-94. [PMID: 19841114 DOI: 10.1542/peds.2009-0272] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Turtle-associated salmonellosis was increasingly recognized in the United States during the 1960s, leading to a federal ban in 1975 on the sale of turtles <4 inches in carapace length (small turtles). Although sporadic reports of turtle-associated Salmonella are frequent, outbreaks are rare. In September 2007, several patients with Salmonella enterica serotype Paratyphi B var Java infections reported recent turtle exposure. We conducted an investigation to determine the source and extent of the infections. PATIENTS AND METHODS Patients with Salmonella Paratyphi B var Java infections with a specific pulsed-field gel electrophoresis pattern (outbreak strain) and illness onset between May 2007 and January 2008, were compared with healthy controls. Reptile exposure and awareness of a Salmonella-reptile link were assessed. Turtle size and purchase information were collected. RESULTS We identified 107 patients with outbreak-strain infections. The median patient age was 7 years; 33% were hospitalized. Forty-seven (60%) of 78 patients interviewed reported exposure to turtles during the week before illness; 41 (87%) were small turtles, and 16 (34%) were purchased in a retail pet store. In the case-control study, 72% of 25 patients reported turtle exposure during the week before illness compared with 4% of 45 controls (matched odds ratio [mOR]: 40.9 [95% confidence interval (CI): 6.9-unbounded]). Seven (32%) of 22 patients versus 11 (28%) of 39 controls reported knowledge of a link between reptile exposure and Salmonella infection (mOR: 1.3 [95% CI: 0.4-4.6]). CONCLUSIONS We observed a strong association between turtle exposure and Salmonella infections in this outbreak. Small turtles continue to be sold and pose a health risk, especially to children; many people remain unaware of the link between Salmonella infection and reptile contact.
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Affiliation(s)
- Julie R Harris
- Centers for Disease Control and Prevention, Atlanta, Georgia 30309, USA.
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Salmon DA, Sotir MJ, Pan WK, Berg JL, Omer SB, Stokley S, Hopfensperger DJ, Davis JP, Halsey NA. Parental vaccine refusal in Wisconsin: a case-control study. WMJ 2009; 108:17-23. [PMID: 19326630 PMCID: PMC6359894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Successful immunization programs have diminished parental fear of diseases and increased fear of vaccines. Children with nonmedical exemptions to school immunization requirements are at increased risk of acquiring and transmitting disease. We explored differences in vaccine attitudes, beliefs, and information sources among parents of exempt and vaccinated children. METHODS Self-administered surveys were mailed to 780 parents of children with nonmedical exemptions (cases) and 1491 parents of fully-vaccinated children (controls). RESULTS Vaccines most often refused by exempt children were varicella (49%) and hepatitis B (30%). The most common reason for claiming exemptions was vaccine might cause harm (57%). Parents of vaccinated children were less likely than parents of exempt children to report concern about vaccine safety, question the need for immunization, and oppose immunization requirements. Nearly 25% of parents of vaccinated children reported that children get more immunizations than are good for them and 34% expressed concern that children's immune systems could be weakened by too many immunizations. Both groups received information from health care professionals; parents of exempt children were more likely to also consult other sources. CONCLUSIONS Our findings support the need for improved methods to communicate vaccine safety information. Further studies to explore vaccine safety concerns among parents are needed.
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Affiliation(s)
- Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Hinten SR, Beckett GA, Gensheimer KF, Pritchard E, Courtney TM, Sears SD, Woytowicz JM, Preston DG, Smith RP, Rand PW, Lacombe EH, Holman MS, Lubelczyk CB, Kelso PT, Beelen AP, Stobierski MG, Sotir MJ, Wong S, Ebel G, Kosoy O, Piesman J, Campbell GL, Marfin AA. Increased recognition of Powassan encephalitis in the United States, 1999-2005. Vector Borne Zoonotic Dis 2009; 8:733-40. [PMID: 18959500 DOI: 10.1089/vbz.2008.0022] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Powassan virus (POWV) disease is a rare human disease caused by a tick-borne encephalitis group flavivirus maintained in a transmission cycle between Ixodes cookei and other ixodid ticks and small and medium-sized mammals. During 1958-1998, only 27 POWV disease cases (mostly Powassan encephalitis) were reported from eastern Canada and the northeastern United States (average, 0.7 cases per year). During 1999-2005, nine cases (described herein) of serologically confirmed POWV disease were reported in the United States (average, 1.3 cases per year): four from Maine, two from New York, and one each from Michigan, Vermont, and Wisconsin. The Michigan and Wisconsin cases are the first ever reported from the north-central United States. Of these nine patients, 5 (56%) were men, the median age was 69 years (range: 25-91 years), and 6 (67%) had onset during May-July. All but one patient developed encephalitis with acute onset of profound muscle weakness, confusion, and other severe neurologic signs. In one case, no neurologic symptoms were present but the presence of pleocytosis, an elevated cerebrospinal fluid (CSF) protein concentration, and POWV-specific immunoglobulin M in CSF suggested neuroinvasion. All patients recovered from their acute disease, but most had long-term neurologic sequelae. Periresidential ecologic investigations were performed in three cases, including tests of local mammals and ticks for evidence of POWV infection. Woodchucks (Marmota monax), striped skunks (Mephitis mephitis), and a raccoon (Procyon lotor) collected at two of the Maine case-patients' residences had neutralizing antibody titers to POWV. I. cookei were found on woodchucks and skunks and questing in grassy areas of one of these residences; all were negative for POWV. Although POWV disease is rare, it is probably under-recognized, and it causes significant morbidity, and thus is an additional tick-borne emerging infectious disease entity. Because no vaccine or specific therapy is available, the basis of prevention is personal protection from ticks (or "tick hygiene") and reduced exposure to peridomestic wild mammals.
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Affiliation(s)
- Steven R Hinten
- Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, U.S. Public Health Service, Department of Health and Human Services, Fort Collins, Colorado 80522, USA
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Abstract
We conducted a retrospective study of Salmonella Newport infections among Wisconsin residents during 2003-2005. Multidrug resistance prevalence was substantially greater in Wisconsin than elsewhere in the United States. Persons with multidrug-resistant infections were more likely than persons with susceptible infections to report exposure to cattle, farms, and unpasteurized milk.
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Affiliation(s)
- Amy E Karon
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
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Sotir MJ, Cappozzo DL, Warshauer DM, Schmidt CE, Monson TA, Berg JL, Zastrow JA, Gabor GW, Davis JP. A Countywide Outbreak of Pertussis. ACTA ACUST UNITED AC 2008; 162:79-85. [DOI: 10.1001/archpediatrics.2007.7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Croft DR, Sotir MJ, Williams CJ, Kazmierczak JJ, Wegner MV, Rausch D, Graham MB, Foldy SL, Wolters M, Damon IK, Karem KL, Davis JP. Occupational risks during a monkeypox outbreak, Wisconsin, 2003. Emerg Infect Dis 2007; 13:1150-7. [PMID: 17953084 PMCID: PMC2828073 DOI: 10.3201/eid1308.061365] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We determined factors associated with occupational transmission in Wisconsin during the 2003 outbreak of prairie dog--associated monkeypox virus infections. Our investigation included active contact surveillance, exposure-related interviews, and a veterinary facility cohort study. We identified 19 confirmed, 5 probable, and 3 suspected cases. Rash, headache, sweats, and fever were reported by > 80% of patients. Occupationally transmitted infections occurred in 12 veterinary staff, 2 pet store employees, and 2 animal distributors. The following were associated with illness: working directly with animal care (p = 0.002), being involved in prairie dog examination, caring for an animal within 6 feet of an ill prairie dog (p = 0.03), feeding an ill prairie dog (p = 0.002), and using an antihistamine (p = 0.04). Having never handled an ill prairie dog (p = 0.004) was protective. Veterinary staff used personal protective equipment sporadically. Our findings underscore the importance of standard veterinary infection-control guidelines.
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Affiliation(s)
- Donita R Croft
- Wisconsin Department of Health and Family Services, Madison, Wisconsin, USA.
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Sotir MJ, Glaser LC, Fox PE, Doering M, Geske DA, Warshauer DM, Davis JP. Endemic human mosquito-borne disease in Wisconsin residents, 2002-2006. WMJ 2007; 106:185-90. [PMID: 17844707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
INTRODUCTION West Nile virus (WNV) and La Crosse virus (LAC) are the primary mosquito-borne arboviruses associated with human disease in Wisconsin. We examined WNV and LAC human illness surveillance data collected during 2002 through 2006. METHODS ELISA-based tests developed by the Centers for Disease Control and Prevention (CDC) were used to detect acute WNV and LAC infection in patient sera or cerebral spinal fluid. Public health personnel conducted patient follow-up using standard arbovirus reporting forms. CDC/Council of State and Territorial Epidemiologists definitions were used to determine cases. RESULTS From 2002 through 2006, 114 confirmed human cases of WNV illness were reported in Wisconsin residents; 82% of illness onsets occurred during August or September. Median age of WNV case patients was 51 years, 49% reported neuroinvasive disease, 56% were hospitalized, and 7 cases were fatal. Confirmed LAC illnesses declined from a high of 27 cases during 2003 to a low of 3 cases during 2005 and 2006. Most LAC illnesses occurred in residents of Western Wisconsin; median age of LAC cases was 9 years. Mean annual incidences of reported confirmed WNV illnesses calculated for high, medium, and low population density groupings were very similar (range: 0.40-0.46 cases/100,000 population). CONCLUSIONS Humans are at risk for mosquito-borne diseases in Wisconsin. Protection and prevention measures are important statewide, especially during July through September when the risk is greatest.
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Affiliation(s)
- Mark J Sotir
- Bureau of Communicable Diseases and Preparedness, Wisconsin Division of Public Health, Madison, WI 53702, USA
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Sotir MJ, Cappozzo DL, Warshauer DM, Schmidt CE, Monson TA, Berg JL, Zastrow JA, Gabor GW, Davis JP. Evaluation of Polymerase Chain Reaction and Culture for Diagnosis of Pertussis in the Control of a County-Wide Outbreak Focused among Adolescents and Adults. Clin Infect Dis 2007; 44:1216-9. [PMID: 17407041 DOI: 10.1086/513432] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 01/15/2007] [Indexed: 11/03/2022] Open
Abstract
During a large pertussis outbreak, culture and polymerase chain reaction (PCR) were used to identify 149 case patients; of these case patients, 79 had positive PCR and culture results, 59 had positive PCR results and negative culture results, 11 had negative PCR results and positive culture results (10 PCR-negative, culture-positive specimens were collected < or = 14 days after illness onset). PCR and culture of samples obtained < or = 2 weeks after illness onset and PCR of samples obtained > 2 weeks after illness onset proved to be most diagnostically useful.
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Affiliation(s)
- Mark J Sotir
- Wisconsin Division of Public Health, Madison, WI 53702, USA.
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Gerner-Smidt P, Kincaid J, Kubota K, Hise K, Hunter SB, Fair MA, Norton D, Woo-Ming A, Kurzynski T, Sotir MJ, Head M, Holt K, Swaminathan B. Molecular surveillance of shiga toxigenic Escherichia coli O157 by PulseNet USA. J Food Prot 2005; 68:1926-31. [PMID: 16161697 DOI: 10.4315/0362-028x-68.9.1926] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PulseNet USA is the national molecular subtyping network system for foodborne disease surveillance. Sixty-four public health and food regulatory laboratories participate in PulseNet USA and routinely perform pulsed-field gel electrophoresis of Shiga toxigenic Escherichia coli isolated from humans, food, water, and the environment on a real-time basis. Clusters of infection are detected in three ways within this system: through rapidly alerting the participants in the electronic communication forum, the PulseNet Web conference; through cluster analysis by the database administrators at the coordinating center at the Centers for Disease Control and Prevention of the patterns uploaded to the central server by the participants; and by matching profiles of strains from nonhuman sources with recent human uploads to the national server. The strengths, limitations, and scope for future improvements of PulseNet are discussed with examples from 2002. In that year, notices of 30 clusters of Shiga toxigenic E. coli O157 infections were posted on the Web conference, 26 of which represented local outbreaks, whereas four were multistate outbreaks. Another 27 clusters were detected by central cluster detection performed at the Centers for Disease Control and Prevention, of which five represented common source outbreaks confirmed after finding an isolate with the outbreak pattern in the implicated food. Ten food isolates submitted without suspicion of an association to human disease matched human isolates in the database, and an epidemiologic link to human cases was established for six of them.
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Affiliation(s)
- Peter Gerner-Smidt
- Centers for Disease Control and Prevention, National Center of Infectious Diseases, Division of Bacterial and Mycotic Diseases, Foodborne and Diarrheal Diseases Branch, Atlanta, Georgia 30333, USA.
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Sotir MJ, Ahrabi-Fard S, Croft DR, Kazmierczak J, Monson TA, Wegner MV, Davis JP. Meningococcal disease incidence and mortality in Wisconsin, 1993-2002. WMJ 2005; 104:38-44. [PMID: 15966631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Neisseria meningitidis is a major cause of sepsis and meningitis in children and young adults in the United States. To examine recent epidemiologic features of meningococcal disease in Wisconsin, we evaluated Wisconsin case surveillance data collected during 1993-2002. Surveillance data for cases with onsets during this time were analyzed; statistical trends were assessed. Mortality was examined with regard to age, sex, serogroup, college student status, and young adult status by unadjusted and adjusted analyses. During 1993-2002, 462 cases of meningococcal disease were reported in Wisconsin; 55% of case patients were aged < 19 years. The annual incidence was 0.9 cases per 100,000 persons per year, and incidence was highest among children aged <2 years. Two seasonal peaks in cases were observed during January-April and September-October. The annual mortality rate during the 10-year interval was 0.09 deaths per 100,000 persons per year. Adjusted analysis indicated that serogroup C infection, young adult, and college student status (but not sex) were associated with mortality. Meningococcal disease remains uncommon and sporadic in Wisconsin. Incidence and mortality rates are highest among young children, but young adults who acquire the disease appear to be at an increased mortality risk.
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Affiliation(s)
- Mark J Sotir
- Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison, WI 53701-2659, USA.
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Reed KD, Melski JW, Graham MB, Regnery RL, Sotir MJ, Wegner MV, Kazmierczak JJ, Stratman EJ, Li Y, Fairley JA, Swain GR, Olson VA, Sargent EK, Kehl SC, Frace MA, Kline R, Foldy SL, Davis JP, Damon IK. The detection of monkeypox in humans in the Western Hemisphere. N Engl J Med 2004; 350:342-50. [PMID: 14736926 DOI: 10.1056/nejmoa032299] [Citation(s) in RCA: 587] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND During May and June 2003, an outbreak of febrile illness with vesiculopustular eruptions occurred among persons in the midwestern United States who had had contact with ill pet prairie dogs obtained through a common distributor. Zoonotic transmission of a bacterial or viral pathogen was suspected. METHODS We reviewed medical records, conducted interviews and examinations, and collected blood and tissue samples for analysis from 11 patients and one prairie dog. Histopathological and electron-microscopical examinations, microbiologic cultures, and molecular assays were performed to identify the etiologic agent. RESULTS The initial Wisconsin cases evaluated in this outbreak occurred in five males and six females ranging in age from 3 to 43 years. All patients reported having direct contact with ill prairie dogs before experiencing a febrile illness with skin eruptions. We found immunohistochemical or ultrastructural evidence of poxvirus infection in skin-lesion tissue from four patients. Monkeypox virus was recovered in cell cultures of seven samples from patients and from the prairie dog. The virus was identified by detection of monkeypox-specific DNA sequences in tissues or isolates from six patients and the prairie dog. Epidemiologic investigation suggested that the prairie dogs had been exposed to at least one species of rodent recently imported into the United States from West Africa. CONCLUSIONS Our investigation documents the isolation and identification of monkeypox virus from humans in the Western Hemisphere. Infection of humans was associated with direct contact with ill prairie dogs that were being kept or sold as pets.
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Affiliation(s)
- Kurt D Reed
- Department of Pathology, Marshfield Clinic, Marshfield, Wisc, USA.
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Larsen NM, Biddle CL, Sotir MJ, White N, Parrott P, Blumberg HM. Risk of tuberculin skin test conversion among health care workers: occupational versus community exposure and infection. Clin Infect Dis 2002; 35:796-801. [PMID: 12228815 DOI: 10.1086/342333] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2001] [Revised: 04/23/2002] [Indexed: 11/04/2022] Open
Abstract
A prospective observational cohort study to assess rates of and risk factors for tuberculin skin test (TST) conversion among health care workers (HCWs) was conducted at an urban hospital located in a high tuberculosis-incidence area in 1994-1998. All hospital employees undergoing required testing every 6 months were included. A total of 69 (1.2%) of 5773 susceptible employees had a documented TST conversion (overall rate, 0.38 per 100 person-years worked). No significant difference existed in conversion rates among employees with frequent, limited, or no patient contact. HCWs with a TST conversion lived in zip codes with higher tuberculosis case rates (P< or =.05). In multivariate analysis, TST conversion was associated with history of bacille Calmette-Guérin vaccination (relative risk [RR], 11.63), annual salary <$20,000 (RR, 3.67), and increasing age. In the setting of an effective tuberculosis infection-control program, TST conversion rates were low, and risk of conversion among HCWs was associated most strongly with nonoccupational factors.
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Affiliation(s)
- Nina M Larsen
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA
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Sotir MJ, Parrott P, Metchock B, Bock NN, McGowan JE, Ray SM, Miller LP, Blumberg HM. Tuberculosis in the inner city: impact of a continuing epidemic in the 1990s. Clin Infect Dis 1999; 29:1138-44. [PMID: 10524954 DOI: 10.1086/313453] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Tuberculosis cases have recently declined in the United States, renewing interest in disease elimination. We examined the epidemiology of tuberculosis from 1991 through 1997 at an inner-city public hospital and assessed population-based tuberculosis rates by ZIP code in the 8 metropolitan Atlanta counties. During the 7 years, 1378 new patients had tuberculosis diagnosed at our hospital (mean, 197 patients/year), accounting for 25% of tuberculosis cases in Georgia. Coinfection with human immunodeficiency virus (HIV) was common, but a significant decrease in the proportion of HIV-infected patients with tuberculosis was noted over time. Most patients were members of a minority group (93%) and were born in the United States (96%). Two inner-city ZIP code areas had annual tuberculosis rates >120 cases per 100,000 persons, and 8 ZIP code areas had annual rates of 47-88 cases per 100,000 persons between 1993 and 1997, compared with the annual national average of 8.7 cases per 100,000 persons. Our hospital continues to care for large numbers of tuberculosis patients, and rates of tuberculosis remain high in the inner city. These data mandate a concentration of efforts and resources in urban locations if tuberculosis control and elimination is to be achieved in the United States.
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Affiliation(s)
- M J Sotir
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30303, USA
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