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Angelo KM, Ciampaglio K, Richards J, Silva A, Ebelke C, Flaherty GT, Brunette G, Kohl S. Travel Health-Related Preparation Practices of Institutions of Higher Education and Occurrence of Health-Related Events among Undergraduate Students Studying Abroad, 2018-2021. Frontiers (Boston) 2024; 36:418-498. [PMID: 38737532 PMCID: PMC11085015 DOI: 10.36366/frontiers.v36i1.871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Background Knowledge of specific health-related events encountered by students studying abroad and the availability and use of pre-travel healthcare for these students is lacking. Methods Anonymous web-based questionnaires were sent to study abroad offices, student health centers, and undergraduate students after studying abroad at eight institutions of higher education in the United States and Ireland from 2018-2021. Analyses were descriptive; relative risks and 95% confidence intervals were calculated for health-related events. Results One study abroad office required a pre-travel consultation. All student health centers had pre-travel counseling available. Among 686 students, there were 307 infectious and 1,588 non-infectious health-related issues; 12 students (2%) were hospitalized. Duration of travel and timing of a pre-travel consultation impacted the risk of health-related events. Certain mental health conditions were associated with increased risk of alcohol and drug use. Conclusion Future studies should address the optimal timing and best practices to optimize health for students studying abroad.
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Affiliation(s)
- Kristina M. Angelo
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Kaitlyn Ciampaglio
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Julie Richards
- Stanford University, Stanford, CA, United States of America
| | - Anjali Silva
- University of Virginia, Charlottesville, VA, United States of America
| | | | | | - Gary Brunette
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Sarah Kohl
- University of Pittsburgh, Pittsburgh, PA, United States of America
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Bierbrier R, Javelle E, Norman FF, Chen LH, Bottieau E, Schwartz E, Leder K, Angelo KM, Stoney RJ, Libman M, Hamer DH, Huits R, Connor BA, Simon F, Barkati S. Chikungunya infection in returned travellers: results from the geosentinel network, 2005-2020. J Travel Med 2024; 31:taae005. [PMID: 38195993 PMCID: PMC11081466 DOI: 10.1093/jtm/taae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/28/2023] [Accepted: 12/31/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Chikungunya is an important travel-related disease because of its rapid geographical expansion and potential for prolonged morbidity. Improved understanding of the epidemiology of travel-related chikungunya infections may influence prevention strategies including education and vaccination. METHODS We analysed data from travellers with confirmed or probable chikungunya reported to GeoSentinel sites from 2005 to 2020. Confirmed chikungunya was defined as a compatible clinical history plus either virus isolation, positive nucleic acid test or seroconversion/rising titre in paired sera. Probable chikungunya was defined as a compatible clinical history with a single positive serology result. RESULTS 1202 travellers (896 confirmed and 306 probable) with chikungunya were included. The median age was 43 years (range 0-91; interquartile range [IQR]: 31-55); 707 (58.8%) travellers were female. Most infections were acquired in the Caribbean (28.8%), Southeast Asia (22.8%), South Central Asia (14.2%) and South America (14.2%). The highest numbers of chikungunya cases reported to GeoSentinel were in 2014 (28.3%), 2015 (14.3%) and 2019 (11.9%). The most frequent reasons for travel were tourism (n = 592; 49.3%) and visiting friends or relatives (n = 334; 27.7%). The median time to presentation to a GeoSentinel site was 23 days (IQR: 7-52) after symptom onset. In travellers with confirmed chikungunya and no other reported illnesses, the most frequently reported symptoms included musculoskeletal symptoms (98.8%), fever/chills/sweats (68.7%) and dermatologic symptoms (35.5%). Among 917 travellers with information available, 296 (32.3%) had a pretravel consultation. CONCLUSIONS Chikungunya was acquired by international travellers in almost 100 destinations globally. Vector precautions and vaccination where recommended should be integrated into pretravel visits for travellers going to areas with chikungunya or areas with the potential for transmission. Continued surveillance of travel-related chikungunya may help public health officials and clinicians limit the transmission of this potentially debilitating disease by defining regions where protective measures (e.g. pretravel vaccination) should be strongly considered.
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Affiliation(s)
- Rachel Bierbrier
- Division of Dermatology, Department of Medicine, McGill University, Montreal, Quebec, Canada
- The J. D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Quebec, Canada
| | - Emilie Javelle
- Unité Parasitologie et Entomologie, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées (IRBA), Centre National de Référence du Paludisme, 13005 Marseille, France
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, 13284 Marseille, France
| | - Francesca F. Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, CIBERINFEC, IRYCIS, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - Lin Hwei Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Eli Schwartz
- The Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Department of Medicine, Tel-Aviv University, 6997801 Tel Aviv-Yafo, Israel
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University and Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, VIC 3052, Australia
| | - Kristina M. Angelo
- Travelers’ Health Branch, Division of Global Migration and Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Rhett J. Stoney
- Travelers’ Health Branch, Division of Global Migration and Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Michael Libman
- The J. D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Quebec, Canada
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montréal, Quebec, Canada
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA 02218, USA
- Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02218, USA
- Center for Emerging Infectious Disease Policy and Research, Boston University, Boston, MA 02215, USA
- National Emerging Infectious Disease Laboratory, Boston, MA 02218, USA
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy
| | - Bradley A. Connor
- Weill Cornell Medical College and the New York Center for Travel and Tropical Medicine, New York, NY 10022, USA
| | | | - Sapha Barkati
- The J. D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Quebec, Canada
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montréal, Quebec, Canada
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Weitzel T, Brown A, Libman M, Perret C, Huits R, Chen L, Leung D, Leder K, Connor BA, Menéndez MD, Asgeirsson H, Schwartz E, Salvador F, Malvy D, Saio M, Norman FF, Amatya B, Duvingnaud A, Vaughan S, Glynn M, Angelo KM. Intestinal protozoa in returning travellers: a GeoSentinel analysis from 2007 to 2019. J Travel Med 2024:taae010. [PMID: 38245913 DOI: 10.1093/jtm/taae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/04/2023] [Revised: 01/08/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Prolonged diarrhoea is common among returning travellers and is often caused by intestinal protozoa. However, the epidemiology of travel-associated illness caused by protozoal pathogens is not well described. METHODS We analysed records of returning international travellers with illness caused by Giardia duodenalis, Cryptosporidium spp., Cyclospora cayetanensis, or Cystoisospora belli, reported to the GeoSentinel Network during January 2007-December 2019. We excluded records of travellers migrating, with an unascertainable exposure country, or from GeoSentinel sites that were not located in high-income countries. RESULTS There were 2517 cases, 82.3% giardiasis (n = 2072), 11.4% cryptosporidiosis (n = 287), 6.0% cyclosporiasis (n = 150), and 0.3% cystoisosporiasis (n = 8). Overall, most travellers were tourists (64.4%) on long trips (median durations: 18-30 days). Cryptosporidiosis more frequently affected people < 18 years (13.9%) and cyclosporiasis affected people ≥40 years (59.4%). Giardiasis was most frequently acquired in South-Central Asia (45.8%) and Sub-Saharan Africa (22.6%), cryptosporidiosis in Sub-Saharan Africa (24.7%) and South-Central Asia (19.5%), and cyclosporiasis in South East Asia (31.3%) and Central America (27.3%). and cystoisosporiasis in Sub-Saharan Africa (62.5%). Cyclosporiasis cases were reported from countries of uncertain endemicity (e.g. Cambodia) or in countries with no previous evidence of this parasite (e.g. French Guiana). The time from symptom onset to presentation at a GeoSentinel site was the longest among travellers with giardiasis (median: 30 days). Over 14% of travellers with cryptosporidiosis were hospitalized. CONCLUSIONS This analysis provides new insights into the epidemiology and clinical significance of 4 intestinal protozoa that can cause morbidity in international travellers. These data might help optimize pretravel advice and post-travel management of patients with travel-associated prolonged gastrointestinal illnesses. This analysis reinforces the importance of international travel-related surveillance to identify sentinel cases and areas where protozoal infections might be undetected or underreported.
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Affiliation(s)
- Thomas Weitzel
- Travel Medicine Program, Clínica Alemana, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Ashley Brown
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Quebec, Canada
| | - Cecilia Perret
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Lin Chen
- Division of Infectious Diseases, Mount Auburn Hospital, Cambridge, Massachusetts, United States of America
| | - Daniel Leung
- International Travel Clinic, University of Utah Hospital and Clinics, Salt Lake City, Utah, United States of America
| | - Karin Leder
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
| | - Bradley A Connor
- New York Center for Travel and Tropical Medicine, New York, United States of America
| | - Marta Diaz Menéndez
- Tropical Medicine Department, Hospital Universitario La Paz Carlos III, CIBERINFECT, Madrid, Spain
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Eli Schwartz
- The Center of Geographical Medicine and Tropical Diseases, Sheba Medical Center, Tel HaShomer, Israel
- Ramat Gan & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fernando Salvador
- Tropical Medicine Unit, Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Denis Malvy
- Department of Infectious Diseases and Tropical Medicine, Hôpital Pellegrin, Bordeaux, France
| | | | - Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, CIBERINFEC, IRYCIS, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - Bhawana Amatya
- CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal
| | - Alexandre Duvingnaud
- Department of Infectious Diseases and Tropical Medicine, Hôpital Pellegrin, Bordeaux, France
| | - Stephen Vaughan
- Division of Infectious Diseases, University of Calgary, South Health Campus, Calgary, Alberta, Canada
| | - Marielle Glynn
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Heidema S, Stoepker IV, Flaherty G, Angelo KM, Post RAJ, Miller C, Libman M, Hamer DH, van den Heuvel ER, Huits R. From GeoSentinel data to epidemiological insights: a multidisciplinary effort towards artificial intelligence-supported detection of infectious disease outbreaks. J Travel Med 2024:taae013. [PMID: 38236181 DOI: 10.1093/jtm/taae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/11/2024] [Indexed: 01/19/2024]
Affiliation(s)
- Stan Heidema
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Ivo V Stoepker
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gerard Flaherty
- School of Medicine, University of Galway, Galway, Ireland
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Kristina M Angelo
- Division of Global Migration and Health, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard A J Post
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Charles Miller
- Division of Global Migration and Health, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Center for Emerging Infectious Diseases Policy and Research, Boston University, Boston, Massachusetts, USA
| | - Edwin R van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Preventive Medicine and Epidemiology, School of Medicine, Boston University, USA
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
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5
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Huits R, Wallender E, Angelo KM, Libman M, Hamer DH. A Zebra Among the Horses: Clinical Implications of Malaria in the United States. Ann Intern Med 2023; 176:1269-1270. [PMID: 37487212 DOI: 10.7326/m23-1871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Affiliation(s)
- Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy (R.H.)
| | - Erika Wallender
- Malaria Branch and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia (E.W.)
| | - Kristina M Angelo
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (K.M.A.)
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Quebec, Canada (M.L.)
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health; Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine; Center for Emerging Infectious Disease Policy and Research, Boston University; and National Emerging Infectious Disease Laboratory, Boston, Massachusetts (D.H.H.)
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6
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Huits R, Angelo KM, Amatya B, Barkati S, Barnett ED, Bottieau E, Emetulu H, Epelboin L, Eperon G, Medebb L, Gobbi F, Grobusch MP, Itani O, Jordan S, Kelly P, Leder K, Díaz-Menéndez M, Okumura N, Rizwan A, Rothe C, Saio M, Waggoner J, Yoshimura Y, Libman M, Hamer DH, Schwartz E. Clinical Characteristics and Outcomes Among Travelers With Severe Dengue : A GeoSentinel Analysis. Ann Intern Med 2023; 176:940-948. [PMID: 37335991 PMCID: PMC10760980 DOI: 10.7326/m23-0721] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 06/21/2023] Open
Abstract
BACKGROUND Dengue virus is a flavivirus transmitted by Aedes mosquitoes and is an important cause of illness worldwide. Data on the severity of travel-associated dengue illness are limited. OBJECTIVE To describe the epidemiology, clinical characteristics, and outcomes among international travelers with severe dengue or dengue with warning signs as defined by the 2009 World Health Organization classification (that is, complicated dengue). DESIGN Retrospective chart review and analysis of travelers with complicated dengue reported to GeoSentinel from January 2007 through July 2022. SETTING 20 of 71 international GeoSentinel sites. PATIENTS Returning travelers with complicated dengue. MEASUREMENTS Routinely collected surveillance data plus chart review with abstraction of clinical information using predefined grading criteria to characterize the manifestations of complicated dengue. RESULTS Of 5958 patients with dengue, 95 (2%) had complicated dengue. Eighty-six (91%) patients had a supplemental questionnaire completed. Eighty-five of 86 (99%) patients had warning signs, and 27 (31%) were classified as severe. Median age was 34 years (range, 8 to 91 years); 48 (56%) were female. Patients acquired dengue most frequently in the Caribbean (n = 27 [31%]) and Southeast Asia (n = 21 [24%]). Frequent reasons for travel were tourism (46%) and visiting friends and relatives (32%). Twenty-one of 84 (25%) patients had comorbidities. Seventy-eight (91%) patients were hospitalized. One patient died of nondengue-related illnesses. Common laboratory findings and signs were thrombocytopenia (78%), elevated aminotransferase (62%), bleeding (52%), and plasma leakage (20%). Among severe cases, ophthalmologic pathology (n = 3), severe liver disease (n = 3), myocarditis (n = 2), and neurologic symptoms (n = 2) were reported. Of 44 patients with serologic data, 32 confirmed cases were classified as primary dengue (IgM+/IgG-) and 12 as secondary (IgM-/IgG+) dengue. LIMITATIONS Data for some variables could not be retrieved by chart review for some patients. The generalizability of our observations may be limited. CONCLUSION Complicated dengue is relatively rare in travelers. Clinicians should monitor patients with dengue closely for warning signs that may indicate progression to severe disease. Risk factors for developing complications of dengue in travelers need further prospective study. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention, International Society of Travel Medicine, Public Health Agency of Canada, and GeoSentinel Foundation.
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Affiliation(s)
- Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy (R.H.)
| | - Kristina M Angelo
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (K.M.A.)
| | - Bhawana Amatya
- CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal (B.A.)
| | - Sapha Barkati
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Quebec, Canada (S.B.)
| | - Elizabeth D Barnett
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts (E.D.B., M.L.)
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium (E.B.)
| | - Hannah Emetulu
- International Society of Travel Medicine, Atlanta, Georgia (H.E., A.R.)
| | - Loïc Epelboin
- Infectious and Tropical Diseases Unit and CIC Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana (L.E.)
| | - Gilles Eperon
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland (G.E.)
| | - Line Medebb
- Aix Marseille University, AP-HM, IHU-Méditerranée Infection, Marseille, France (L.M.)
| | - Federico Gobbi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (F.G.)
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Center, Amsterdam, the Netherlands (M.P.G.)
| | - Oula Itani
- Institut Pasteur, Centre Médical, Centre d'Infectiologie Necker-Pasteur, Paris, France (O.I.)
| | - Sabine Jordan
- Division of Tropical Medicine, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, and Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany (S.J.)
| | - Paul Kelly
- BronxCare Hospital Center, Bronx, New York (P.K.)
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, and Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Victoria, Australia (K.L.)
| | - Marta Díaz-Menéndez
- Tropical Medicine Department, Hospital Universitario La Paz-Carlos III, IdIPAz, and CIBERINFECT, Madrid, Spain (M.D.)
| | - Nobumasa Okumura
- Center Hospital of the National Center for Global Health and Medicine, Shinjuku City, Tokyo, Japan (N.O.)
| | - Aisha Rizwan
- International Society of Travel Medicine, Atlanta, Georgia (H.E., A.R.)
| | - Camilla Rothe
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universität München, Munich, Germany (C.R.)
| | - Mauro Saio
- Doctor's Plaza, Nairobi Hospital, Nairobi, Kenya (M.S.)
| | - Jesse Waggoner
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia (J.W.)
| | | | - Michael Libman
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts (E.D.B., M.L.)
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Section of Infectious Diseases, Boston University School of Medicine, Center for Emerging Infectious Disease Policy and Research, Boston University, and National Emerging Infectious Disease Laboratory, Boston, Massachusetts (D.H.H.)
| | - Eli Schwartz
- The Center of Geographical Medicine and Tropical Diseases, Sheba Medical Center, Tel HaShomer, and Ramat Gan & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (E.S.)
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7
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Brown AB, Miller C, Hamer DH, Kozarsky P, Libman M, Huits R, Rizwan A, Emetulu H, Waggoner J, Chen LH, Leung DT, Bourque D, Connor BA, Licitra C, Angelo KM. Travel-Related Diagnoses Among U.S. Nonmigrant Travelers or Migrants Presenting to U.S. GeoSentinel Sites - GeoSentinel Network, 2012-2021. MMWR Surveill Summ 2023; 72:1-22. [PMID: 37368820 PMCID: PMC10332343 DOI: 10.15585/mmwr.ss7207a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Problem/Condition During 2012-2021, the volume of international travel reached record highs and lows. This period also was marked by the emergence or large outbreaks of multiple infectious diseases (e.g., Zika virus, yellow fever, and COVID-19). Over time, the growing ease and increased frequency of travel has resulted in the unprecedented global spread of infectious diseases. Detecting infectious diseases and other diagnoses among travelers can serve as sentinel surveillance for new or emerging pathogens and provide information to improve case identification, clinical management, and public health prevention and response. Reporting Period 2012-2021. Description of System Established in 1995, the GeoSentinel Network (GeoSentinel), a collaboration between CDC and the International Society of Travel Medicine, is a global, clinical-care-based surveillance and research network of travel and tropical medicine sites that monitors infectious diseases and other adverse health events that affect international travelers. GeoSentinel comprises 71 sites in 29 countries where clinicians diagnose illnesses and collect demographic, clinical, and travel-related information about diseases and illnesses acquired during travel using a standardized report form. Data are collected electronically via a secure CDC database, and daily reports are generated for assistance in detecting sentinel events (i.e., unusual patterns or clusters of disease). GeoSentinel sites collaborate to report disease or population-specific findings through retrospective database analyses and the collection of supplemental data to fill specific knowledge gaps. GeoSentinel also serves as a communications network by using internal notifications, ProMed alerts, and peer-reviewed publications to alert clinicians and public health professionals about global outbreaks and events that might affect travelers. This report summarizes data from 20 U.S. GeoSentinel sites and reports on the detection of three worldwide events that demonstrate GeoSentinel's notification capability. Results During 2012-2021, data were collected by all GeoSentinel sites on approximately 200,000 patients who had approximately 244,000 confirmed or probable travel-related diagnoses. Twenty GeoSentinel sites from the United States contributed records during the 10-year surveillance period, submitting data on 18,336 patients, of which 17,389 lived in the United States and were evaluated by a clinician at a U.S. site after travel. Of those patients, 7,530 (43.3%) were recent migrants to the United States, and 9,859 (56.7%) were returning nonmigrant travelers.Among the recent migrants to the United States, the median age was 28.5 years (range = <19 years to 93 years); 47.3% were female, and 6.0% were U.S. citizens. A majority (89.8%) were seen as outpatients, and among 4,672 migrants with information available, 4,148 (88.8%) did not receive pretravel health information. Of 13,986 diagnoses among migrants, the most frequent were vitamin D deficiency (20.2%), Blastocystis (10.9%), and latent tuberculosis (10.3%). Malaria was diagnosed in 54 (<1%) migrants. Of the 26 migrants diagnosed with malaria for whom pretravel information was known, 88.5% did not receive pretravel health information. Before November 16, 2018, patients' reasons for travel, exposure country, and exposure region were not linked to an individual diagnosis. Thus, results of these data from January 1, 2012, to November 15, 2018 (early period), and from November 16, 2018, to December 31, 2021 (later period), are reported separately. During the early and later periods, the most frequent regions of exposure were Sub-Saharan Africa (22.7% and 26.2%, respectively), the Caribbean (21.3% and 8.4%, respectively), Central America (13.4% and 27.6%, respectively), and South East Asia (13.1% and 16.9%, respectively). Migrants with diagnosed malaria were most frequently exposed in Sub-Saharan Africa (89.3% and 100%, respectively).Among nonmigrant travelers returning to the United States, the median age was 37 years (range = <19 years to 96 years); 55.7% were female, 75.3% were born in the United States, and 89.4% were U.S. citizens. A majority (90.6%) were seen as outpatients, and of 8,967 nonmigrant travelers with available information, 5,878 (65.6%) did not receive pretravel health information. Of 11,987 diagnoses, the most frequent were related to the gastrointestinal system (5,173; 43.2%). The most frequent diagnoses among nonmigrant travelers were acute diarrhea (16.9%), viral syndrome (4.9%), and irritable bowel syndrome (4.1%).Malaria was diagnosed in 421 (3.5%) nonmigrant travelers. During the early (January 1, 2012, to November 15, 2018) and later (November 16, 2018, to December 31, 2021) periods, the most frequent reasons for travel among nonmigrant travelers were tourism (44.8% and 53.6%, respectively), travelers visiting friends and relatives (VFRs) (22.0% and 21.4%, respectively), business (13.4% and 12.3%, respectively), and missionary or humanitarian aid (13.1% and 6.2%, respectively). The most frequent regions of exposure for any diagnosis among nonmigrant travelers during the early and later period were Central America (19.2% and 17.3%, respectively), Sub-Saharan Africa (17.7% and 25.5%, respectively), the Caribbean (13.0% and 10.9%, respectively), and South East Asia (10.4% and 11.2%, respectively).Nonmigrant travelers who had malaria diagnosed were most frequently exposed in Sub-Saharan Africa (88.6% and 95.9% during the early and later period, respectively) and VFRs (70.3% and 57.9%, respectively). Among VFRs with malaria, a majority did not receive pretravel health information (70.2% and 83.3%, respectively) or take malaria chemoprophylaxis (88.3% and 100%, respectively). Interpretation Among ill U.S. travelers evaluated at U.S. GeoSentinel sites after travel, the majority were nonmigrant travelers who most frequently received a gastrointestinal disease diagnosis, implying that persons from the United States traveling internationally might be exposed to contaminated food and water. Migrants most frequently received diagnoses of conditions such as vitamin D deficiency and latent tuberculosis, which might result from adverse circumstances before and during migration (e.g., malnutrition and food insecurity, limited access to adequate sanitation and hygiene, and crowded housing,). Malaria was diagnosed in both migrants and nonmigrant travelers, and only a limited number reported taking malaria chemoprophylaxis, which might be attributed to both barriers to acquiring pretravel health care (especially for VFRs) and lack of prevention practices (e.g., insect repellant use) during travel. The number of ill travelers evaluated by U.S. GeoSentinel sites after travel decreased in 2020 and 2021 compared with previous years because of the COVID-19 pandemic and associated travel restrictions. GeoSentinel detected limited cases of COVID-19 and did not detect any sentinel cases early in the pandemic because of the lack of global diagnostic testing capacity. Public Health Action The findings in this report describe the scope of health-related conditions that migrants and returning nonmigrant travelers to the United States acquired, illustrating risk for acquiring illnesses during travel. In addition, certain travelers do not seek pretravel health care, even when traveling to areas in which high-risk, preventable diseases are endemic. Health care professionals can aid international travelers by providing evaluations and destination-specific advice.Health care professionals should both foster trust and enhance pretravel prevention messaging for VFRs, a group known to have a higher incidence of serious diseases after travel (e.g., malaria and enteric fever). Health care professionals should continue to advocate for medical care in underserved populations (e.g., VFRs and migrants) to prevent disease progression, reactivation, and potential spread to and within vulnerable populations. Because both travel and infectious diseases evolve, public health professionals should explore ways to enhance the detection of emerging diseases that might not be captured by current surveillance systems that are not site based.
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8
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Carmola LR, Turcinovic J, Draper G, Webner D, Putukian M, Silvers-Granelli H, Bombin A, Connor BA, Angelo KM, Kozarsky P, Libman M, Huits R, Hamer DH, Fairley JK, Connor JH, Piantadosi A, Bourque DL. Genomic Epidemiology of a Severe Acute Respiratory Syndrome Coronavirus 2 Outbreak in a US Major League Soccer Club: Was It Travel Related? Open Forum Infect Dis 2023; 10:ofad235. [PMID: 37323423 PMCID: PMC10264064 DOI: 10.1093/ofid/ofad235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/03/2023] [Indexed: 06/17/2023] Open
Abstract
Background Professional soccer athletes are at risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). United States Major League Soccer (MLS) uses protocol-based SARS-CoV-2 testing for identification of individuals with coronavirus disease 2019. Methods Per MLS protocol, fully vaccinated players underwent SARS-CoV-2 real-time polymerase chain reaction testing weekly; unvaccinated players were tested every other day. Demographic and epidemiologic data were collected from individuals who tested positive, and contact tracing was performed. Whole genome sequencing (WGS) was performed on positive specimens, and phylogenetic analyses were used to identify potential transmission patterns. Results In the fall of 2021, all 30 players from 1 MLS team underwent SARS-CoV-2 testing per protocol; 27 (90%) were vaccinated. One player who had recently traveled to Africa tested positive for SARS-CoV-2; within the following 2 weeks, 10 additional players and 1 staff member tested positive. WGS yielded full genome sequences for 10 samples, including 1 from the traveler. The traveler's sample was Delta sublineage AY.36 and was closely related to a sequence from Africa. Nine samples yielded other Delta sublineages including AY.4 (n = 7), AY.39 (n = 1), and B.1.617.2 (n = 1). The 7 AY.4 sequences clustered together; suggesting a common source of infection. Transmission from a family member visiting from England to an MLS player was identified as the potential index case. The other 2 AY.4 sequences differed from this group by 1-3 nucleotides, as did a partial genome sequence from an additional team member. Conclusions WGS is a useful tool for understanding SARS-CoV-2 transmission dynamics in professional sports teams.
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Affiliation(s)
- Ludy R Carmola
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jacquelyn Turcinovic
- Department of Microbiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- National Emerging Infectious Diseases Laboratory, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Program in Bioinformatics, Boston University, Boston, Massachusetts, USA
| | - Garrison Draper
- Department of Sport and Exercise Science, School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
- Player and Health Performance, 6 Philadelphia Union, Chester, Pennsylvania, USA
| | - David Webner
- Player and Health Performance, 6 Philadelphia Union, Chester, Pennsylvania, USA
- Crozer Health, Sports Medicine, Springfield, Pennsylvania, USA
| | | | | | - Andrei Bombin
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bradley A Connor
- Deparment of Medicine, Weill Cornell Medicine and the New York Center for Travel and Tropical Medicine, New York, New York, USA
| | - Kristina M Angelo
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Phyllis Kozarsky
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Davidson H Hamer
- National Emerging Infectious Diseases Laboratory, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Global Health, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Jessica K Fairley
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John H Connor
- Department of Microbiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- National Emerging Infectious Diseases Laboratory, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Program in Bioinformatics, Boston University, Boston, Massachusetts, USA
| | - Anne Piantadosi
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel L Bourque
- Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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9
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Díaz-Menéndez M, Angelo KM, de Miguel Buckley R, Bottieau E, Huits R, Grobusch MP, Gobbi FG, Asgeirsson H, Duvignaud A, Norman FF, Javelle E, Epelboin L, Rothe C, Chappuis F, Martinez GE, Popescu C, Camprubí-Ferrer D, Molina I, Odolini S, Barkati S, Kuhn S, Vaughan S, McCarthy A, Lago M, Libman MD, Hamer DH. Dengue outbreak amongst travellers returning from Cuba-GeoSentinel surveillance network, January-September 2022. J Travel Med 2023; 30:taac139. [PMID: 36573483 PMCID: PMC10166199 DOI: 10.1093/jtm/taac139] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/21/2022] [Accepted: 11/14/2022] [Indexed: 12/28/2022]
Abstract
Increasing numbers of travellers returning from Cuba with dengue virus infection were reported to the GeoSentinel Network from June to September 2022, reflecting an ongoing local outbreak. This report demonstrates the importance of travellers as sentinels of arboviral outbreaks and highlights the need for early identification of travel-related dengue.
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Affiliation(s)
- Marta Díaz-Menéndez
- Tropical Medicine Department, Hospital Universitario La Paz Carlos III, CIBERINFECT, Pso de la Castellana, 261, 28046 Madrid, Spain
| | - Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA
| | - Rosa de Miguel Buckley
- Tropical Medicine Department, Hospital Universitario La Paz Carlos III, CIBERINFECT, Pso de la Castellana, 261, 28046 Madrid, Spain
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, 155 Nationalestraat, Antwerp 2000, Belgium
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via don A. Sempreboni, 5, 37024 Negrar, Verona, Italy
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Center, AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Federico Giovanni Gobbi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via don A. Sempreboni, 5, 37024 Negrar, Verona, Italy
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, 14186 Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Alexandre Duvignaud
- Department of Infectious Diseases and Tropical Medicine, Hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Francesca F Norman
- Unidad de Medicina Tropical-Servicio de Enfermedades Infecciosas-Hospital Ramon y Cajal, C'tra de Calmenar Km. 9,1, Madrid 08001, Spain
| | - Emilie Javelle
- IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille 13005, France
| | - Loïc Epelboin
- Centre Hospitalier Andree Rosemon, Av des flamboyants, Cayenne 97036, France
| | - Camilla Rothe
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universität München, Leopoldstrasse 5, 80802 Munich, Germany
| | - Francois Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, 6 rue Gabrielle Perret Gentil, Geneva 1205, Switzerland
| | - Gabriela Equihua Martinez
- Institute of Tropical Medicine and International Health-Charité-Universitätsmedizin Berlin, Spandauer Damm 130, Berlin 10117, Germany
| | - Corneliu Popescu
- Carol Davila University of Medicine and Pharmacy, Dionisie Lupu St., 37, Sector 2, Bucharest 050474, Romania
- Dr Victor Babes Clinical Hospital and Infectious Diseases, Strada Gheorghe Adam 13, Timișoara 300310, Romania
| | - Daniel Camprubí-Ferrer
- ISGlobal, Hospital Clinic Universitat de Barcelona, Roselló, 132, 08036 Barcelona, Spain
| | - Israel Molina
- Hospital Universitari Vall d'Hebron, P° Vall d'Hebron 119, Barcelona 08035, Spain
| | - Silvia Odolini
- University Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia 25123, Italy
| | - Sapha Barkati
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, 1001 boul Decarie, Montreal, QC H4A 3J1, Canada
| | - Susan Kuhn
- Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada
| | - Stephen Vaughan
- Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada
| | - Anne McCarthy
- The Ottawa Hospital Civic Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Mar Lago
- Tropical Medicine Department, Hospital Universitario La Paz Carlos III, CIBERINFECT, Pso de la Castellana, 261, 28046 Madrid, Spain
| | - Michael D Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, 1001 boul Decarie, Montreal, QC H4A 3J1, Canada
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health; Section of Infectious Diseases, Boston University School of Medicine; Center for Infectious Disease Policy and Research, Boston University; and National Emerging Infectious Disease Laboratory, Crosstown 308, 801 Massachusetts Avenue, Boston, MA 02118, USA
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10
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Beeson A, Styczynski A, Hutson CL, Whitehill F, Angelo KM, Minhaj FS, Morgan C, Ciampaglio K, Reynolds MG, McCollum AM, Guagliardo SAJ. Mpox respiratory transmission: the state of the evidence. Lancet Microbe 2023; 4:e277-e283. [PMID: 36898398 PMCID: PMC9991082 DOI: 10.1016/s2666-5247(23)00034-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/09/2023]
Abstract
The relative contribution of the respiratory route to transmission of mpox (formerly known as monkeypox) is unclear. We review the evidence for respiratory transmission of monkeypox virus (MPXV), examining key works from animal models, human outbreaks and case reports, and environmental studies. Laboratory experiments have initiated MPXV infection in animals via respiratory routes. Some animal-to-animal respiratory transmission has been shown in controlled studies, and environmental sampling studies have detected airborne MPXV. Reports from real-life outbreaks demonstrate that transmission is associated with close contact, and although it is difficult to infer the route of MPXV acquisition in individual case reports, so far respiratory transmission has not been specifically implicated. Based on the available evidence, the likelihood of human-to-human MPXV respiratory transmission appears to be low; however, studies should continue to assess this possibility.
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Affiliation(s)
- Amy Beeson
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ashley Styczynski
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina L Hutson
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Florence Whitehill
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristina M Angelo
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Faisal S Minhaj
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Clint Morgan
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kaitlyn Ciampaglio
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary G Reynolds
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrea M McCollum
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
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11
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Angelo KM, Smith T, Camprubí-Ferrer D, Balerdi-Sarasola L, Díaz Menéndez M, Servera-Negre G, Barkati S, Duvignaud A, Huber KLB, Chakravarti A, Bottieau E, Greenaway C, Grobusch MP, Mendes Pedro D, Asgeirsson H, Popescu CP, Martin C, Licitra C, de Frey A, Schwartz E, Beadsworth M, Lloveras S, Larsen CS, Guagliardo SAJ, Whitehill F, Huits R, Hamer DH, Kozarsky P, Libman M. Epidemiological and clinical characteristics of patients with monkeypox in the GeoSentinel Network: a cross-sectional study. Lancet Infect Dis 2023; 23:196-206. [PMID: 36216018 PMCID: PMC9546520 DOI: 10.1016/s1473-3099(22)00651-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The early epidemiology of the 2022 monkeypox epidemic in non-endemic countries differs substantially from the epidemiology previously reported from endemic countries. We aimed to describe the epidemiological and clinical characteristics among individuals with confirmed cases of monkeypox infection. METHODS We descriptively analysed data for patients with confirmed monkeypox who were included in the GeoSentinel global clinical-care-based surveillance system between May 1 and July 1 2022, across 71 clinical sites in 29 countries. Data collected included demographics, travel history including mass gathering attendance, smallpox vaccination history, social history, sexual history, monkeypox exposure history, medical history, clinical presentation, physical examination, testing results, treatment, and outcomes. We did descriptive analyses of epidemiology and subanalyses of patients with and without HIV, patients with CD4 counts of less than 500 cells per mm3 or 500 cells per mm3 and higher, patients with one sexual partner or ten or more sexual partners, and patients with or without a previous smallpox vaccination. FINDINGS 226 cases were reported at 18 sites in 15 countries. Of 211 men for whom data were available, 208 (99%) were gay, bisexual, or men who have sex with men (MSM) with a median age of 37 years (range 18-68; IQR 32-43). Of 209 patients for whom HIV status was known, 92 (44%) men had HIV infection with a median CD4 count of 713 cells per mm3 (range 36-1659; IQR 500-885). Of 219 patients for whom data were available, 216 (99%) reported sexual or close intimate contact in the 21 days before symptom onset; MSM reported a median of three partners (IQR 1-8). Of 195 patients for whom data were available, 78 (40%) reported close contact with someone who had confirmed monkeypox. Overall, 30 (13%) of 226 patients were admitted to hospital; 16 (53%) of whom had severe illness, defined as hospital admission for clinical care rather than infection control. No deaths were reported. Compared with patients without HIV, patients with HIV were more likely to have diarrhoea (p=0·002), perianal rash or lesions (p=0·03), and a higher rash burden (median rash burden score 9 [IQR 6-21] for patients with HIV vs median rash burden score 6 [IQR 3-14] for patients without HIV; p<0·0001), but no differences were identified in the proportion of men who had severe illness by HIV status. INTERPRETATION Clinical manifestations of monkeypox infection differed by HIV status. Recommendations should be expanded to include pre-exposure monkeypox vaccination of groups at high risk of infection who plan to engage in sexual or close intimate contact. FUNDING US Centers for Disease Control and Prevention, International Society of Travel Medicine.
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Affiliation(s)
- Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Teresa Smith
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA,Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | | | | | - Marta Díaz Menéndez
- Department of Tropical Medicine, Hospital Universitario La Paz Carlos III, CIBERINFECT, Madrid, Spain
| | | | - Sapha Barkati
- J D MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, QC, Canada
| | - Alexandre Duvignaud
- Department of Infectious Diseases and Tropical Medicine, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Kristina L B Huber
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christina Greenaway
- J D MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, QC, Canada,Division of Infectious Disease, Jewish General Hospital, Montreal, QC, Canada
| | - Martin P Grobusch
- Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands,Amsterdam Infection and Immunity, Amsterdam Public Health, Amsterdam, Netherlands
| | - Diogo Mendes Pedro
- Department of Infectious Diseases, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal,Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden,Department of Medicine, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Corneliu Petru Popescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,Dr Victor Babeș Clinical Hospital and Infectious Diseases, Timișoara, Romania
| | - Charlotte Martin
- Department of Infectious Diseases, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Albie de Frey
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eli Schwartz
- Center of Geographical Medicine and Tropical Diseases, Sheba Medical Center, Tel HaShomer, Israel,Ramat Gan and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Susana Lloveras
- Francisco J Muñiz Infectious Disease Hospital, Buenos Aires, Argentina
| | - Carsten S Larsen
- Department of Infectious Disease, Aarhus University Hospital, Aarhus, Denmark
| | - Sarah Anne J Guagliardo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Florence Whitehill
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Section of Infectious Diseases, Boston University School of Medicine, and Center for Infectious Disease Research and Policy and National Emerging Infectious Disease Laboratory, Boston University, Boston, MA, USA
| | | | - Michael Libman
- J D MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, QC, Canada
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12
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Henry RE, Blanton JD, Angelo KM, Pieracci EG, Stauffer K, Jentes ES, Allen J, Glynn M, Brown CM, Friedman CR, Wallace R. A country classification system to inform rabies prevention guidelines and regulations. J Travel Med 2022; 29:6554583. [PMID: 35348741 DOI: 10.1093/jtm/taac046] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 12/15/2021] [Revised: 02/16/2022] [Accepted: 03/25/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Assessing the global risk of rabies exposure is a complicated task requiring individual risk assessments, knowledge of rabies epidemiology, surveillance capacity and accessibility of rabies biologics on a national and regional scale. In many parts of the world, availability of this information is limited and when available is often dispersed across multiple sources. This hinders the process of making evidence-based health and policy recommendations to prevent the introduction and spread of rabies. METHODS CDC conducted a country-by-country qualitative assessment of risk and protective factors for rabies to develop an open-access database of core metrics consisting of the presence of lyssaviruses (specifically canine or wildlife rabies virus variants or other bat lyssaviruses), access to rabies immunoglobulins and vaccines, rabies surveillance capacity and canine rabies control capacity. Using these metrics, we developed separate risk scoring systems to inform rabies prevention guidance for travelers and regulations for the importation of dogs. Both scoring systems assigned higher risk to countries with enzootic rabies (particularly canine rabies), and the risk scoring system for travelers also considered protective factors such as the accessibility of rabies biologics for post-exposure prophylaxis. Cumulative scores were calculated across the assessed metrics to assign a risk value of low, moderate or high. RESULTS A total of 240 countries, territories and dependencies were assessed, for travelers, 116 were identified as moderate to high risk and 124 were low or no risk; for canine rabies virus variant importation, 111 were identified as high-risk and 129 were low or no risk. CONCLUSIONS We developed a comprehensive and easily accessible source of information for assessing the rabies risk for individual countries that included a database of rabies risk and protective factors based on enzootic status and availability of biologics, provided a resource that categorizes risk by country and provided guidance based on these risk categories for travelers and importers of dogs into the United States.
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Affiliation(s)
- Ronnie E Henry
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jesse D Blanton
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Kendra Stauffer
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily S Jentes
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica Allen
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marielle Glynn
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Clive M Brown
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Ryan Wallace
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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13
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Balogun O, Brown A, Angelo KM, Hochberg NS, Barnett ED, Nicolini LA, Asgeirsson H, Grobusch MP, Leder K, Salvador F, Chen L, Odolini S, Díaz-Menéndez M, Gobbi F, Connor BA, Libman M, Hamer DH. Acute hepatitis A in international travellers: a GeoSentinel analysis, 2008-2020. J Travel Med 2022; 29:6520887. [PMID: 35134210 PMCID: PMC9383360 DOI: 10.1093/jtm/taac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Non-immune international travellers are at risk of acquiring hepatitis A. Although hepatitis A vaccination is recommended for unvaccinated travellers to high or intermediate hepatitis A virus endemicity, compliance with this recommendation is not universal.The main objective was to describe the demographic and travel characteristics of international travellers infected with hepatitis A during travel. METHODS Available data on travellers with confirmed (positive molecular test) or probable (symptomatic individuals with a single positive IgM test) hepatitis A diagnosed during and after travel from January 2008 to December 2020 were obtained from the GeoSentinel Surveillance Network database. We analysed demographic and travel characteristics of infected travellers. RESULTS Among 254 travellers with hepatitis A (185 confirmed and 69 probable), the median age was 28 years (interquartile range: 19-40), 150 (59%) were male, and among 54 travellers with information available, 53 (98%) were unvaccinated. The most common reasons for travel included tourism (n = 120; 47%) and visiting friends or relatives (VFR; n = 72; 28%). About two-thirds of VFR travellers with hepatitis A (n = 50; 69%) were younger than 20 years old. Hepatitis A was acquired most frequently in South-Central Asia (n = 63; 25%) and sub-Saharan Africa (n = 61; 24%), but 16 travellers (6%) acquired hepatitis A in regions with low endemicity including Western Europe (n = 7; 3%), the Caribbean (n = 6; 2%) and North America (n = 3; 1%). Median duration from illness onset to GeoSentinel site presentation was ~7 days (interquartile range : 4-14 days). Among 88 travellers with information available, 59% were hospitalized. CONCLUSIONS Despite availability of highly effective vaccines, travellers still acquire hepatitis A, even when traveling to low-endemicity destinations. Providing pre-departure hepatitis A vaccine to susceptible travellers is crucial to reducing travel-associated hepatitis A and should be offered to all travellers as part of the pre-travel consultation, regardless of destination.
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Affiliation(s)
- Oluwafemi Balogun
- Bureau of Infectious Disease and Laboratory Services, Massachusetts Department of Public Health, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital and Harvard Medical School
| | - Ashley Brown
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristina M Angelo
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Natasha S Hochberg
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Elizabeth D Barnett
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | | | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital and Karolinska Institutet
| | - Martin P Grobusch
- Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, PO Box 22660, Amsterdam, The Netherlands 1100DD
| | - Karin Leder
- Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Melbourne, Australia Infectious Disease Epidemiology Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain
| | - Lin Chen
- Mount Auburn Hospital, Cambridge, MA, and Harvard Medical School, Boston, 02115, MA, USA
| | - Silvia Odolini
- University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| | - Marta Díaz-Menéndez
- National Referral Unit for Imported Tropical Diseases, Tropical & Travel medicine Unit, Infectious Diseases Department, La Paz- Carlos III University Hospital-IdiPAZ, Paseo de la Castellana, 261 28046 Madrid, Spain
| | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Bradley A Connor
- Weill Cornell Medical College and the New York Center for Travel and Tropical Medicine
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, 1001 Decarie Blvd, Montreal, H4A 3J1, Canada
| | - Davidson H Hamer
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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14
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Eimer J, Patimeteeporn C, Jensenius M, Gkrania-Klotsas E, Duvignaud A, Barnett ED, Hochberg NS, Chen LH, Trigo-Esteban E, Gertler M, Greenaway C, Grobusch MP, Angelo KM, Hamer DH, Caumes E, Asgeirsson H. Multidrug-resistant tuberculosis imported into low-incidence countries-a GeoSentinel analysis, 2008-2020. J Travel Med 2021; 28:6274753. [PMID: 33987682 PMCID: PMC9638878 DOI: 10.1093/jtm/taab069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Early detection of imported multidrug-resistant tuberculosis (MDR-TB) is crucial, but knowledge gaps remain about migration- and travel-associated MDR-TB epidemiology. The aim was to describe epidemiologic characteristics among international travellers and migrants with MDR-TB. METHODS Clinician-determined and microbiologically confirmed MDR-TB diagnoses deemed to be related to travel or migration were extracted from GeoSentinel, a global surveillance network of travel and tropical medicine clinics, from January 2008 through December 2020. MDR-TB was defined as resistance to both isoniazid and rifampicin. Additional resistance to either a fluoroquinolone or a second-line injectable drug was categorized as pre-extensively drug-resistant (pre-XDR) TB, and as extensively drug-resistant (XDR) TB when resistance was detected for both. Sub-analyses were performed based on degree of resistance and country of origin. RESULTS Of 201 patients, 136 had MDR-TB (67.7%), 25 had XDR-TB (12.4%), 23 had pre-XDR TB (11.4%) and 17 had unspecified MDR- or XDR-TB (8.5%); 196 (97.5%) were immigrants, of which 92 (45.8%) originated from the former Soviet Union. The median interval from arrival to presentation was 154 days (interquartile range [IQR]: 10-751 days); 34.3% of patients presented within 1 month after immigration, 30.9% between 1 and 12 months and 34.9% after ≥1 year. Pre-XDR- and XDR-TB patients from the former Soviet Union other than Georgia presented earlier than those with MDR-TB (26 days [IQR: 8-522] vs. 369 days [IQR: 84-827]), while patients from Georgia presented very early, irrespective of the level of resistance (8 days [IQR: 2-18] vs. 2 days [IQR: 1-17]). CONCLUSIONS MDR-TB is uncommon in traditional travellers. Purposeful medical migration may partly explain differences in time to presentation among different groups. Public health resources are needed to better understand factors contributing to cross-border MDR-TB spread and to develop strategies to optimize care of TB-infected patients in their home countries before migration.
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Affiliation(s)
- Johannes Eimer
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- To whom correspondence should be addressed. Tel: +46 8-58580000, Fax: +46 7466380,
| | - Calvin Patimeteeporn
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mogens Jensenius
- Department of Infectious Diseases, Oslo University Hospital, Ullevål, Oslo, Norway
| | | | | | - Elizabeth D. Barnett
- Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, MA, USA
| | - Natasha S. Hochberg
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Lin H. Chen
- Travel Medicine Center - Mt. Auburn Hospital, Cambridge, MA, USA
| | | | - Maximilian Gertler
- Institute of Tropical Medicine and International Health, Berlin, Germany
| | | | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Kristina M. Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Davidson H. Hamer
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Eric Caumes
- Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
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15
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Pandey P, Lee K, Amatya B, Angelo KM, Shlim DR, Murphy H. Health problems in travellers to Nepal visiting CIWEC clinic in Kathmandu - A GeoSentinel analysis. Travel Med Infect Dis 2021; 40:101999. [PMID: 33639265 DOI: 10.1016/j.tmaid.2021.101999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/28/2020] [Revised: 09/21/2020] [Accepted: 02/18/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Nepal has always been a popular international travel destination. There is limited published data, however, on the spectrum of illnesses acquired by travellers to Nepal. METHODS GeoSentinel is a global data collection network of travel and tropical medicine providers that monitors travel-related morbidity. Records for ill travellers with at least one confirmed or probable diagnosis, were extracted from the GeoSentinel database for the CIWEC Clinic Kathmandu site from January 1, 2009 to December 31, 2017. RESULTS A total of 24,271 records were included. The median age was 30 years (range: 0-91); 54% were female. The top 3 system-based diagnoses in travellers were: gastrointestinal (32%), pulmonary (16%), and dermatologic (9%). Altitude illness comprised 9% of all diagnoses. There were 278 vaccine-preventable diseases, most frequently influenza A (41%) and typhoid fever (19%; S. typhi 52 and S. paratyphi 62). Of 64 vector-borne illnesses, dengue was the most frequent (64%), followed by imported malaria (14%). There was a single traveller with Japanese encephalitis. Six deaths were reported. CONCLUSIONS Travellers to Nepal face a wide spectrum of illnesses, particularly diarrhoea, respiratory disease, and altitude illness. Pre-travel consultations for travellers to Nepal should focus on prevention and treatment of diarrhoea and altitude illness, along with appropriate immunizations and travel advice.
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Affiliation(s)
- Prativa Pandey
- CIWEC Hospital and Travel Medicine Center, Lainchaur, Kathmandu, Nepal.
| | - Keun Lee
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Atlanta, GA, USA.
| | - Bhawana Amatya
- CIWEC Hospital and Travel Medicine Center, Lainchaur, Kathmandu, Nepal.
| | - Kristina M Angelo
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Atlanta, GA, USA.
| | - David R Shlim
- Jackson Hole Travel and Tropical, Jackson Hole, WY, USA.
| | - Holly Murphy
- IHA Infectious Diseases Consultants, 5333 McAuley Dr., Ypsilanti, MI, USA.
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16
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Angelo KM. Twenty-five years: GeoSentinel's impact on travel-related surveillance and its vision for the future. J Travel Med 2020; 27:5903799. [PMID: 32914193 PMCID: PMC9617544 DOI: 10.1093/jtm/taaa166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [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: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 01/26/2023]
Abstract
GeoSentinel has been successful in advancing public health and clinical practice since its inception, by informing disease- and population-specific travel medicine topics, provision of healthcare of ill travelers, and pre-travel preparation strategies for healthcare providers. Recent hepatitis E and animal exposures publications reinforce these successes and present questions for the future.
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Affiliation(s)
- Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
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17
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Muehlenbein MP, Angelo KM, Schlagenhauf P, Chen L, Grobusch MP, Gautret P, Duvignaud A, Chappuis F, Kain KC, Bottieau E, Epelboin L, Shaw M, Hynes N, Hamer DH. Traveller exposures to animals: a GeoSentinel analysis. J Travel Med 2020; 27:5716751. [PMID: 31993666 PMCID: PMC7384971 DOI: 10.1093/jtm/taaa010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 12/19/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Human coexistence with other animals can result in both intentional and unintentional contact with a variety of mammalian and non-mammalian species. International travellers are at risk for such encounters; travellers risk injury, infection and possibly death from domestic and wild animal bites, scratches, licks and other exposures. The aim of the present analysis was to understand the diversity and distribution of animal-related exposures among international travellers. METHODS Data from January 2007 through December 2018 from the GeoSentinel Surveillance Network were reviewed. Records were included if the exposure was non-migration travel with a diagnosis of an animal (dog, cat, monkey, snake or other) bite or other exposure (non-bite); records were excluded if the region of exposure was not ascertainable or if another, unrelated acute diagnosis was reported. RESULTS A total of 6470 animal exposures (bite or non-bite) were included. The majority (71%) occurred in Asia. Travellers to 167 countries had at least one report of an animal bite or non-bite exposure. The majority (76%) involved dogs, monkeys and cats, although a wide range of wild and domestic species were involved. Almost two-thirds (62.6%) of 4395 travellers with information available did not report a pretravel consultation with a healthcare provider. CONCLUSIONS Minimizing bites and other animal exposures requires education (particularly during pretravel consultations) and behavioral modification. These should be supplemented by the use of pre-exposure rabies vaccination for travellers to high-risk countries (especially to those with limited access to rabies immunoglobulin), as well as encouragement of timely (in-country) post-exposure prophylaxis for rabies and Macacine alphaherpesvirus 1 (herpesvirus B) when warranted.
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Affiliation(s)
| | - Kristina M Angelo
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia, 30333, USA
| | - Patricia Schlagenhauf
- WHO Collaborating Centre for Travellers' Health University of Zurich, Zurich, Switzerland, Department of Public and Global Health Hirschengraben 84, 8001 Zürich, Switzerland
| | - Lin Chen
- Department of Medicine, Mount Auburn Hospital, 330 Mount Auburn Street, Cambridge, Massachusetts, 02138, USA
| | - Martin P Grobusch
- Department of Infectious Diseases, Division of Internal MEdicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, PO Box 22660, Amsterdam, Netherlands 1100DD
| | - Philippe Gautret
- Méditerranée Infection Foundation, 19-21 Boulevard Jean Moulin, 13005, Marseille, France
| | - Alexandre Duvignaud
- Department of Infectious Diseases and Tropical Medicine , Division of Tropical Medicine and Clinical International Health, Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - François Chappuis
- Department of Primary Care Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - Kevin C Kain
- Department of Medicine, University of Toronto, Toronto General Hospital, MaRS Centre, 101 College St, TMDT 10-360A, Ontario, Canada M5G1L7
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Loïc Epelboin
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier Andree Rosemon, Ave des Flamboyants, 97300 Cayenne, French Guiana
| | - Marc Shaw
- Department of Tropical Medicine and Rehabilitation Services, James Cook University, 1 James Cook Drive, Townsville, Queensland 4811, Australia
| | - Noreen Hynes
- Division of Infectious Diseases, Department of Medicine, John Hopkins University School of Medicine, 1830 E Monument St, Suite 419, Baltimore, Maryland, 21205, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Crosstown 3rd floor, 801 Massachusetts Ave, Boston, Massachusetts, 02118, USA
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18
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Nicolini LAP, Stoney RJ, Della Vecchia A, Grobusch M, Gautret P, Angelo KM, van Genderen PJJ, Bottieau E, Leder K, Asgeirsson H, Leung DT, Connor B, Pandey P, Toscanini F, Gobbi F, Castelli F, Bassetti M, Hamer DH. Travel-related hepatitis E: a two-decade GeoSentinel analysis. J Travel Med 2020; 27:5891692. [PMID: 32789467 PMCID: PMC9494553 DOI: 10.1093/jtm/taaa132] [Citation(s) in RCA: 2] [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] [Received: 06/29/2020] [Revised: 07/27/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatitis E virus (HEV) is widely distributed worldwide and is endemic in developing countries. Travel-related HEV infection has been reported at national levels, but global data are missing. Moreover, the global availability of HEV diagnostic testing has not been explored so far. The aim of this study is to describe the epidemiology of HEV infections in returning travellers and availability of HEV diagnostic testing in the GeoSentinel surveillance network. METHODS This was a multicentre retrospective cross-sectional study. All confirmed and probable HEV travel-related infections reported in the GeoSentinel Network between 1999 and 2018 were evaluated. GeoSentinel sites were asked to complete a survey in 2018 to assess the availability and accessibility of HEV diagnostic procedures (i.e. serology and molecular tests) throughout the study period. RESULTS Overall, 165 travel-related HEV infections were reported, mainly since 2010 (60%) and in tourists (50%). Travellers were exposed to hepatitis E in 27 countries; most travellers (62%) were exposed to HEV in South Asia. One patient was pregnant at the time of HEV infection and 14 had a concomitant gastrointestinal infection. No deaths were reported. In the 51% of patients with information available, there was no pre-travel consultation. Among 44 GeoSentinel sites that responded to the survey, 73% have access to HEV serology at a local level, while 55% could perform (at a local or central level) molecular diagnostics. CONCLUSION Reported access to HEV diagnostic testing is suboptimal among sites that responded to the survey; this could negatively affect diagnosing HEV. Pre-travel consultations before travel to South Asia and other low-income and high-prevalence areas with a focus on food and water precautions could be helpful in preventing hepatitis E infection. Improved HEV diagnostic capacity should be implemented to prevent and correctly diagnose travel-related HEV infection.
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Affiliation(s)
| | - Rhett J Stoney
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrea Della Vecchia
- Department of Health Sciences, University of Genova, Genova, Italy.,Internal Medicine Unit, Hôpitaux Iris Sud, Bruxelles, Belgium
| | - Martin Grobusch
- Tropical Medicine at the Amsterdam Medical Center, Amsterdam, The Netherlands
| | | | - Kristina M Angelo
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, The Netherlands
| | - Karin Leder
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
| | - Hilmir Asgeirsson
- Clinic of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel T Leung
- International Travel Clinic, University of Utah Hospital and Clinics, Salt Lake City, UT, USA
| | - Bradley Connor
- The New York Center for Travel and Tropical Medicine, New York City, USA
| | - Prativa Pandey
- The CIWEC Clinic Travel Medicine Center, Lainchaur, KTM, Nepal
| | - Federica Toscanini
- Infectious Diseases, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Francesco Castelli
- Clinica di Malattie Infettive e Tropicali, University of Brescia, Brescia, Italy
| | - Matteo Bassetti
- Infectious Diseases, Ospedale Policlinico San Martino-IRCCS, Genova, Italy.,Department of Health Sciences, University of Genova, Genova, Italy
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,National Emerging Infectious Diseases Laboratory, Boston University, Boston, MA, USA
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19
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Angelo KM, Stoney RJ, Brun-Cottan G, Leder K, Grobusch MP, Hochberg N, Kuhn S, Bottieau E, Schlagenhauf P, Chen L, Hynes NA, Perez CP, Mockenhaupt FP, Molina I, Crespillo-Andújar C, Malvy D, Caumes E, Plourde P, Shaw M, McCarthy AE, Piper-Jenks N, Connor BA, Hamer DH, Wilder-Smith A. Zika among international travellers presenting to GeoSentinel sites, 2012-2019: implications for clinical practice. J Travel Med 2020; 27:5824831. [PMID: 32330261 PMCID: PMC7604850 DOI: 10.1093/jtm/taaa061] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 02/18/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION International travellers contribute to the rapid spread of Zika virus (ZIKV) and its sentinel identification globally. We describe ZIKV infections among international travellers seen at GeoSentinel sites with a focus on ZIKV acquired in the Americas and the Caribbean, describe countries of exposure and traveller characteristics, and assess ZIKV diagnostic testing by site. METHODS Records with an international travel-related diagnosis of confirmed or probable ZIKV from January 2012 through December 2019 reported to GeoSentinel with a recorded illness onset date were included to show reported cases over time. Records from March 2016 through December 2019 with an exposure region of the Americas or the Caribbean were included in the descriptive analysis. A survey was conducted to assess the availability, accessibility and utilization of ZIKV diagnostic tests at GeoSentinel sites. RESULTS GeoSentinel sites reported 525 ZIKV cases from 2012 through 2019. Between 2012 and 2014, eight cases were reported, and all were acquired in Asia or Oceania. After 2014, most cases were acquired in the Americas or the Caribbean, a large decline in ZIKV cases occurred in 2018-19.Between March 2016 and December 2019, 423 patients acquired ZIKV in the Americas or the Caribbean, peak reporting to these regions occurred in 2016 [330 cases (78%)]. The median age was 36 years (range: 3-92); 63% were female. The most frequent region of exposure was the Caribbean (60%). Thirteen travellers were pregnant during or after travel; one had a sexually acquired ZIKV infection. There was one case of fetal anomaly and two travellers with Guillain-Barré syndrome. GeoSentinel sites reported various challenges to diagnose ZIKV effectively. CONCLUSION ZIKV should remain a consideration for travellers returning from areas with risk of ZIKV transmission. Travellers should discuss their travel plans with their healthcare providers to ensure ZIKV prevention measures are taken.
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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
| | - Rhett J Stoney
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA
| | - Gaelle Brun-Cottan
- Department of Medicine, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Karin Leder
- School of Public Health and Preventive Medicine, Victorian Infectious Disease Service, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Monash University, 300 Grattan St, Parkville 3050, Australia
| | - Martin P Grobusch
- Center for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Natasha Hochberg
- Department of Pediatrics, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Susan Kuhn
- Department of Pediatrics, Alberta Health Services, 10101 Southport Rd SW, Calgary AB T2W 3N2, Canada
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Kronenburgstraat 43, 2000 Antwerp, Belgium
| | - Patricia Schlagenhauf
- WHO Collaborating Centre for Travellers' Health, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Rämistrasse 71, 8006 Zurich, Switzerland
| | - Lin Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge and Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Noreen A Hynes
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| | - Cecilia Perret Perez
- School of Medicine, Universidad Catolica de Chile, Av Libertador Bernardo O'Higgins 340, Santiago, Santiago Metropolitan, Chile
| | - Frank P Mockenhaupt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Tropical Medicine and International Health, Augustenburger Pl. 1, 13353 Berlin, Germany
| | - Israel Molina
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, PROSICS, Campus de la UAB, Plaça Cívica, 08193, Barcelona, Spain
| | - Clara Crespillo-Andújar
- National Referral Unit for Tropical and Travel Medicine, Department of Internal Medicine, University Hospital La Paz-Carlos III, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Denis Malvy
- Department for Infectious Diseases and Tropical Medicine, University Hospital Centre of Bordeaux, and Inserm 1219, University of Bordeaux, 146 Rue Léo Saignat, 33076 Bordeaux, France
| | - Eric Caumes
- Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Pierre Plourde
- University of Manitoba, 66 Chancellors Cir, Winnipeg MB R3T 2N2, Canada
| | - Marc Shaw
- James Cook University, 1 James Cook Dr, Douglas, Townsville 4811, Australia.,Worldwise Travellers' Health Centres, 18 Saint Marks Road, Remuera, Auckland 1050, New Zealand
| | - Anne E McCarthy
- Department of Medicine, Ottawa Hospital, University of Ottawa, 75 Laurier Ave E, Ottawa K1N 6N5, Canada
| | | | - Bradley A Connor
- The New York Center for Travel and Tropical Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA.,Section of Infectious Diseases, Department of Medicine, Boston Medical Center, One Boston Medical Center Pl, Boston, MA 02118, USA
| | - Annelies Wilder-Smith
- Department of Epidemiology and Global Health, University of Umea, Petrus Laestadius Väg, 901 87, Umeå, Sweden.,Department for Disease Control, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
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Angelo KM, Breiman J, Wu HM, Nemhauser J, Walker AAT. Heritage and genealogy travel health concerns in the era of in-home DNA testing. J Travel Med 2020; 27:5704419. [PMID: 31943044 PMCID: PMC7358109 DOI: 10.1093/jtm/taaa004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 11/12/2022]
Abstract
Highlight
The rise of in-home DNA testing has led to a novel trend in heritage travel, these travelers may be inexperienced and visit areas lacking tourism infrastructure, which may put them at higher risk of infection and injury. Healthcare providers must identify heritage travelers and inform them about travel-associated health risks.
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Affiliation(s)
- Kristina M Angelo
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, 1600 Clifton Rd, Atlanta, GA 30329, USA.,Emory University, Emory TravelWell Center, 550 Peachtree St. NE, Atlanta, GA 30308, USA
| | - Jennifer Breiman
- Emory University, Emory TravelWell Center, 550 Peachtree St. NE, Atlanta, GA 30308, USA
| | - Henry M Wu
- Emory University, Emory TravelWell Center, 550 Peachtree St. NE, Atlanta, GA 30308, USA
| | - Jeffrey Nemhauser
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - And Allison T Walker
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, 1600 Clifton Rd, Atlanta, GA 30329, USA
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21
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François Watkins LK, Winstead A, Appiah GD, Friedman CR, Medalla F, Hughes MJ, Birhane MG, Schneider ZD, Marcenac P, Hanna SS, Godbole G, Walblay KA., Wiggington AE, Leeper M, Meservey EH, Tagg KA, Chen JC, Abubakar A, Lami F, Asaad AM, Sabaratnam V, Ikram A, Angelo KM, Walker A, Mintz E. Update on Extensively Drug-Resistant Salmonella Serotype Typhi Infections Among Travelers to or from Pakistan and Report of Ceftriaxone-Resistant Salmonella Serotype Typhi Infections Among Travelers to Iraq - United States, 2018-2019. MMWR Morb Mortal Wkly Rep 2020; 69:618-622. [PMID: 32437343 PMCID: PMC7357342 DOI: 10.15585/mmwr.mm6920a2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Conners EE, Angelo KM, Walker AT. Putting Guidance into Practice: Interpretation of the Oral Cholera Vaccine Recommendations for U.S. Travelers. Am J Trop Med Hyg 2020; 102:491-493. [PMID: 31971151 DOI: 10.4269/ajtmh.19-0511] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The American Committee on Immunization Practices recommends the use of the oral cholera vaccine (OCV) in international travelers aged 18-64 years who visit areas of active cholera transmission. CDC Travelers' Health Branch currently tracks areas of active cholera transmission and posts this information on their country-specific destination web pages at https://wwwnc.cdc.gov/travel/destinations/list. Lessons learned from a webinar conducted among health care providers have led to improvements in how CDC shares information on the OCV. Here, we summarize the major considerations for providers offering the OCV to U.S. travelers and indicate where they can find more information.
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Affiliation(s)
- Erin E Conners
- Epidemic Intelligence Service Officer Assigned to the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, CDC, Atlanta, Georgia
| | - Kristina M Angelo
- Travelers' Health Branch, Division of Global Migration and Quarantine, CDC, Atlanta, Georgia
| | - Allison T Walker
- Travelers' Health Branch, Division of Global Migration and Quarantine, CDC, Atlanta, Georgia
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23
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Volkman HR, Walz EJ, Wanduragala D, Schiffman E, Frosch A, Alpern JD, Walker PF, Angelo KM, Coyle C, Mohamud MA, Mwangi E, Haizel-Cobbina J, Nchanji C, Johnson RS, Ladze B, Dunlop SJ, Stauffer WM. Barriers to malaria prevention among immigrant travelers in the United States who visit friends and relatives in sub-Saharan Africa: A cross-sectional, multi-setting survey of knowledge, attitudes, and practices. PLoS One 2020; 15:e0229565. [PMID: 32163426 PMCID: PMC7067457 DOI: 10.1371/journal.pone.0229565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 10/21/2019] [Accepted: 02/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite achievements in the reduction of malaria globally, imported malaria cases to the United States by returning international travelers continue to increase. Immigrants to the United States from sub-Saharan Africa (SSA) who then travel back to their homelands to visit friends and relatives (VFRs) experience a disproportionate burden of malaria illness. Various studies have explored barriers to malaria prevention among VFRs and non-VFRs-travelers to the same destinations with other purpose for travel-but few employed robust epidemiologic study designs or performed comparative analyses of these two groups. To better quantify the key barriers that VFRs face to implement effective malaria prevention measures, we conducted a comprehensive community-based, cross-sectional, survey to identify differences in malaria prevention knowledge, attitudes, and practices (KAP) among VFRs and others traveling to Africa and describe the differences between VFRs and other types of international travelers. METHODS AND FINDINGS Three distinct populations of travelers with past or planned travel to malaria-endemic countries of SSA were surveyed: VFRs diagnosed with malaria as reported through a state health department; members of the general VFR population (community); and VFR and non-VFR travelers presenting to a travel health clinic, both before their pretravel consultation and again, after return from travel. A Community Advisory Board of African immigrants and prior qualitative research informed survey development and dissemination. Across the three groups, 489 travelers completed surveys: 351 VFRs and 138 non-VFRs. VFRs who reported taking antimalarials on their last trip rated their concern about malaria higher than those who did not. Having taken five or more trips to SSA was reported more commonly among VFRs diagnosed with malaria than community VFRs (44.0% versus 20.4%; p = 0.008). Among travel health clinic patients surveyed before and after travel, VFR travelers were less successful than non-VFRs in adhering to their planned use of antimalarials (82.2% versus 98.7%; p = 0.001) and employing mosquito bite avoidance techniques (e.g., using bed nets: 56.8% versus 81.8%; p = 0.009). VFRs who visited the travel health clinic were more likely than VFR respondents from the community to report taking an antimalarial (83.0% versus 61.9%; p = 0.009), or to report bite avoidance behaviors (e.g., staying indoors when mosquitoes were out: 80.9% versus 59.5%; p = 0.009). CONCLUSIONS We observed heterogeneity in malaria prevention behaviors among VFRs and between VFR and non-VFR traveler populations. Although VFRs attending the travel health clinic appear to demonstrate better adherence to malaria prevention measures than VFR counterparts surveyed in the community, specialized pretravel care is not sufficient to ensure chemoprophylaxis use and bite avoidance behaviors among VFRs. Even when seeking specialized pretravel care, VFRs experience greater barriers to the use of malaria prevention than non-VFRs. Addressing access to health care and upstream barrier reduction strategies that make intended prevention more achievable, affordable, easier, and resonant among VFRs may improve malaria prevention intervention effectiveness.
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Affiliation(s)
- Hannah R Volkman
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Emily J Walz
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St Paul, MN, United States of America
| | | | | | - Anne Frosch
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
- Hennepin Healthcare, Minneapolis, MN, United States of America
| | | | - Patricia F Walker
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
- HealthPartners Institute, Bloomington, MN, United States of America
| | - Kristina M Angelo
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Christina Coyle
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States of America
| | - Mimi A Mohamud
- Minnesota Department of Health, St Paul, MN, United States of America
| | - Esther Mwangi
- Minnesota Department of Health, St Paul, MN, United States of America
| | | | - Comfort Nchanji
- Minnesota Department of Health, St Paul, MN, United States of America
| | - Rebecca S Johnson
- Sierra Leone Community in Minnesota, Minneapolis, MN, United States of America
| | - Baninla Ladze
- Minnesota Cameroon Community, Minneapolis, MN, United States of America
| | - Stephen J Dunlop
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
- Hennepin Healthcare, Minneapolis, MN, United States of America
| | - William M Stauffer
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
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24
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Gautret P, Angelo KM, Asgeirsson H, Duvignaud A, van Genderen PJJ, Bottieau E, Chen LH, Parker S, Connor BA, Barnett ED, Libman M, Hamer DH. International mass gatherings and travel-associated illness: A GeoSentinel cross-sectional, observational study. Travel Med Infect Dis 2019; 32:101504. [PMID: 31707112 PMCID: PMC7110217 DOI: 10.1016/j.tmaid.2019.101504] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 09/11/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Travelers to international mass gatherings may be exposed to conditions which increase their risk of acquiring infectious diseases. Most existing data come from single clinical sites seeing returning travelers, or relate to single events. METHODS Investigators evaluated ill travelers returning from a mass gathering, and presenting to a GeoSentinel site between August 2015 and April 2019, and collected data on the nature of the event and the relation between final diagnoses and the mass gathering. RESULTS Of 296 ill travelers, 51% were female and the median age was 54 years (range: 1-88). Over 82% returned from a religious mass gathering, most frequently Umrah or Hajj. Only 3% returned from the Olympics in Brazil or South Korea. Other mass gatherings included other sporting events, cultural or entertainment events, and conferences. Respiratory diseases accounted for almost 80% of all diagnoses, with vaccine preventable illnesses such as influenza and pneumonia accounting for 26% and 20% of all diagnoses respectively. This was followed by gastrointestinal illnesses, accounting for 4.5%. Sixty-three percent of travelers reported having a pre-travel encounter with a healthcare provider. CONCLUSIONS Despite this surveillance being limited to patients presenting to GeoSentinel sites, our findings highlight the importance of respiratory diseases at mass gatherings, the need for pre-travel consultations before mass gatherings, and consideration of vaccination against influenza and pneumococcal disease.
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Affiliation(s)
- Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France and IHU-Méditerranée Infection, Marseille, France.
| | - Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, GA, USA
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Alexandre Duvignaud
- Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health, CHU Bordeaux, Bordeaux, France
| | - Perry J J van Genderen
- Department of Medical Microbiology and Infectious Diseases, University Hospital Erasmus Medical Centre, Rotterdam, the Netherlands
| | | | - Lin H Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital and Harvard Medical School, MA, USA
| | - Salim Parker
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Bradley A Connor
- Weill Cornell Medical College, New York, USA; New York Center for Travel and Tropical Medicine, New York, USA
| | | | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA, USA
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25
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Angelo KM, Libman M, Gautret P, Barnett E, Grobusch MP, Hagmann SHF, Gobbi F, Schwartz E, van Genderen PJJ, Asgeirsson H, Hamer DH. The rise in travel-associated measles infections-GeoSentinel, 2015-2019. J Travel Med 2019; 26:5520738. [PMID: 31218359 PMCID: PMC6816286 DOI: 10.1093/jtm/taz046] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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] [Received: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 11/14/2022]
Abstract
The global threat of measles in recent years affects international travelers, and is acquired in both endemic and outbreak settings. The number of measles cases reported to GeoSentinel has risen each year since 2015 and demonstrates a high median age, short travel duration, and low measles vaccination coverage.
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Affiliation(s)
- Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta GA, USA
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
| | - Philippe Gautret
- University Hospital Institute Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - Elizabeth Barnett
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, USA
| | - Martin P Grobusch
- Center for Tropical and Travel Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Stefan H F Hagmann
- Steven and Alexandria Cohen Children's Medical Center of New York, Northwell Health, New York, USA
| | - Federico Gobbi
- Department of Infectious and Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Eli Schwartz
- Center for Travel Medicine and Tropical Diseases, Sheba Medical Center, Tel HaShomer, Israel
| | - Perry J J van Genderen
- Department of Medical Microbiology and Infectious Diseases, University Hospital Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hilmer Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston MA, USA.,Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Boston MA, USA
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Kawakami V, Bottichio L, Lloyd J, Carleton H, Leeper M, Olson G, Li Z, Kissler B, Angelo KM, Whitlock L, Sinatra J, Defibaugh-Chavez S, Bicknese A, Kay M, Wise ME, Basler C, Duchin J. Multidrug-Resistant Salmonella I 4,[5],12:i:- and Salmonella Infantis Infections Linked to Whole Roasted Pigs from a Single Slaughter and Processing Facility. J Food Prot 2019; 82:1615-1624. [PMID: 31441688 PMCID: PMC6957080 DOI: 10.4315/0362-028x.jfp-19-048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We describe two outbreaks of multidrug-resistant (MDR) Salmonella I 4,[5],12:i:- infection, occurring in 2015 to 2016, linked to pork products, including whole roaster pigs sold raw from a single Washington slaughter and processing facility (establishment A). Food histories from 80 ill persons were compared with food histories reported in the FoodNet 2006 to 2007 survey of healthy persons from all 10 U.S. FoodNet sites who reported these exposures in the week before interview. Antimicrobial susceptibility testing and whole genome sequencing were conducted on selected clinical, food, and environmental isolates. During 2015, a total of 192 ill persons were identified from five states; among ill persons with available information, 30 (17%) of 180 were hospitalized, and none died. More ill persons than healthy survey respondents consumed pork (74 versus 43%, P < 0.001). Seventeen (23%) of 73 ill persons for which a response was available reported attending an event where whole roaster pig was served in the 7 days before illness onset. All 25 clinical isolates tested from the 2015 outbreak and a subsequent 2016 smaller outbreak (n = 15) linked to establishment A demonstrated MDR. Whole genome sequencing of clinical, environmental, and food isolates (n = 69) collected in both investigations revealed one clade of highly related isolates, supporting epidemiologic and traceback data that establishment A as the source of both outbreaks. These investigations highlight that whole roaster pigs, an uncommon food vehicle for MDR Salmonella I 4,[5],12:i:- outbreaks, will need further attention from food safety researchers and educators for developing science-based consumer guidelines, specifically with a focus on the preparation process.
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Affiliation(s)
- Vance Kawakami
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CSELS.,Communicable Disease Epidemiology and Immunization Section, Public Health-Seattle & King County, 401 5th Avenue, Seattle, Washington 98104
| | - Lyndsay Bottichio
- Outbreak Response and Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID
| | - Jennifer Lloyd
- Communicable Disease Epidemiology and Immunization Section, Public Health-Seattle & King County, 401 5th Avenue, Seattle, Washington 98104
| | - Heather Carleton
- Enteric Diseases Laboratory Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30333
| | - Molly Leeper
- Enteric Diseases Laboratory Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30333
| | - Gina Olson
- Public Health Laboratories, Washington State Department of Health, 1610 N.E. 150th Street, Shoreline, Washington 98155
| | - Zhi Li
- Public Health Laboratories, Washington State Department of Health, 1610 N.E. 150th Street, Shoreline, Washington 98155
| | - Bonnie Kissler
- Food Safety and Inspection Service, U.S. Department of Agriculture, 100 Alabama Street S.W., Atlanta, Georgia 30303
| | - Kristina M Angelo
- Outbreak Response and Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID
| | - Laura Whitlock
- Outbreak Response and Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID
| | - Jennifer Sinatra
- Food Safety and Inspection Service, U.S. Department of Agriculture, 100 Alabama Street S.W., Atlanta, Georgia 30303
| | - Stephanie Defibaugh-Chavez
- Food Safety and Inspection Service, U.S. Department of Agriculture, 1400 Independence Avenue S.W., Washington, DC 20250
| | - Amelia Bicknese
- Enteric Diseases Laboratory Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30333
| | - Meagan Kay
- Communicable Disease Epidemiology and Immunization Section, Public Health-Seattle & King County, 401 5th Avenue, Seattle, Washington 98104
| | - Matthew E Wise
- Outbreak Response and Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID
| | - Collin Basler
- Outbreak Response and Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID
| | - Jeff Duchin
- Communicable Disease Epidemiology and Immunization Section, Public Health-Seattle & King County, 401 5th Avenue, Seattle, Washington 98104.,Department of Epidemiology, School of Public Health, University of Washington, 1959 N.E. Pacific Street, Seattle, Washington 98195, USA
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27
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Angelo KM, Gastañaduy PA, Walker AT, Patel M, Reef S, Lee CV, Nemhauser J. Spread of Measles in Europe and Implications for US Travelers. Pediatrics 2019; 144:peds.2019-0414. [PMID: 31209161 PMCID: PMC6657509 DOI: 10.1542/peds.2019-0414] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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] [Accepted: 04/01/2019] [Indexed: 11/24/2022] Open
Abstract
From January 2018 to June 2018, World Health Organization (WHO) European Region countries reported >41 000 measles cases, including 37 deaths, a record high since the 1990s. Low vaccination coverage in previous years is the biggest contributing factor to the increase in cases. The Ukraine reported the majority of cases, but France, Georgia, Greece, Italy, the Russian Federation, and Serbia also reported high case counts. Europe is the most common travel destination worldwide and is widely perceived as being without substantial infectious disease risks. For this reason, travelers may not consider the relevance of a pretravel health consultation, including vaccination, in their predeparture plans. Measles is highly contagious, and the record number of measles cases in the WHO European Region not only puts unvaccinated and inadequately vaccinated travelers at risk but also increases the risk for nontraveling US residents who come into close contact with returned travelers who are ill. The US Centers for Disease Control and Prevention encourage US travelers to be aware of measles virus transmission in Europe and receive all recommended vaccinations, including for measles, before traveling abroad. Health care providers must maintain a high degree of suspicion for measles among travelers returning from Europe or people with close contact with international travelers who present with a febrile rash illness. The current WHO European Region outbreak should serve to remind health care providers to stay current with the epidemiology of highly transmissible diseases, such as measles, through media, WHO, and Centers for Disease Control and Prevention reports and encourage measles vaccination for international travelers.
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Affiliation(s)
- Kristina M. Angelo
- Traveiers’ Health Branch, Division of Global Migration and Quarantine, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul A. Gastañaduy
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison T. Walker
- Traveiers’ Health Branch, Division of Global Migration and Quarantine, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manisha Patel
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan Reef
- Accelerated Disease Control and Vaccine Preventable Diseases Surveillance Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - C. Virginia Lee
- Traveiers’ Health Branch, Division of Global Migration and Quarantine, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey Nemhauser
- Traveiers’ Health Branch, Division of Global Migration and Quarantine, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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28
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Angelo KM, Petersen BW, Hamer DH, Schwartz E, Brunette G. Monkeypox transmission among international travellers-serious monkey business? J Travel Med 2019; 26:taz002. [PMID: 30657959 PMCID: PMC6682460 DOI: 10.1093/jtm/taz002] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/07/2019] [Accepted: 01/16/2019] [Indexed: 11/13/2022]
Affiliation(s)
- Kristina M. Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brett W. Petersen
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 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
| | - Eli Schwartz
- Center for Geographical Medicine, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gary Brunette
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
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29
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Walz EJ, Volkman HR, Adedimeji AA, Abella J, Scott LA, Angelo KM, Gaines J, Coyle CM, Dunlop SJ, Wilson D, Biah AP, Wanduragala D, Stauffer WM. Barriers to malaria prevention in US-based travellers visiting friends and relatives abroad: a qualitative study of West African immigrant travellers†. J Travel Med 2019; 26:5270163. [PMID: 30602033 PMCID: PMC6679970 DOI: 10.1093/jtm/tay163] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 11/08/2018] [Revised: 12/26/2018] [Accepted: 12/29/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Over half of malaria cases reported in the USA occur among people travelling to visit friends and relatives (VFRs), predominantly to West Africa. Few studies have queried VFR travellers directly on barriers to seeking pre-travel care. We aim to describe the knowledge, attitudes and practices of VFRs travelling to malaria-endemic countries from the USA. With these findings, we aim to design interventions to encourage preventive behaviours before and during travel. METHODS Sixteen focus groups were held in two US metropolitan areas with West African immigrant populations: Minneapolis-St. Paul, MN, and New York City, NY. A total of 172 people from 13 African countries participated. Focus group discussions were audio-recorded and transcribed, and modified grounded theory analysis was performed. Participants reviewed themes to verify intent of statements. RESULTS Participants described the high cost of provider visits and chemoprophylaxis, challenges in advocating for themselves in healthcare settings and concerns about offending or inconveniencing hosts as barriers to malaria prevention. Cultural barriers to accessing pre-travel care included competing priorities when trip planning, such as purchasing gifts for family, travel logistics and safety concerns. When participants sought pre-travel care, most consulted their primary care provider. Participants expressed low confidence in US providers' knowledge and training about malaria and other tropical diseases. CONCLUSION Barriers to pre-travel care for VFR travellers are multifaceted and extend beyond their perception of disease risk. Only some barriers previously reported in anecdotal and qualitative literature were supported in our findings. Future interventions should be aimed at barriers identified by individual communities and involve primary and travel specialist healthcare providers. Additional work is needed to address systems-level barriers to accessing care and establishing community-based programs to support West African VFR traveller health.
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Affiliation(s)
- Emily J Walz
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Hannah R Volkman
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Adebola A Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Jilliane Abella
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA
| | | | - Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joanna Gaines
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina M Coyle
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA
| | | | - David Wilson
- African Career and Education Resources, Inc., Brooklyn Park, MN, USA
| | - Arthur P Biah
- Minnesota Department of Health, St. Paul, MN, USA.,Liberian Health Initiative, Minneapolis, MN, USA
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30
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Chatham-Stephens K, Medalla F, Hughes M, Appiah GD, Aubert RD, Caidi H, Angelo KM, Walker AT, Hatley N, Masani S, Nash J, Belko J, Ryan ET, Mintz E, Friedman CR. Emergence of Extensively Drug-Resistant Salmonella Typhi Infections Among Travelers to or from Pakistan - United States, 2016-2018. MMWR Morb Mortal Wkly Rep 2019; 68:11-13. [PMID: 30629573 PMCID: PMC6342547 DOI: 10.15585/mmwr.mm6801a3] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Walz EJ, Wanduragala D, Adedimeji AA, Volkman HR, Gaines J, Angelo KM, Boumi AE, Coyle C, Dunlop SJ, Stauffer WM. Community-based participatory research in travel medicine to identify barriers to preventing malaria in VFR travellers. J Travel Med 2019; 26:5238695. [PMID: 30535124 PMCID: PMC6628254 DOI: 10.1093/jtm/tay148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/10/2018] [Indexed: 11/14/2022]
Affiliation(s)
- Emily J Walz
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN, USA
| | | | - Adebola A Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Hannah R Volkman
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Joanna Gaines
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ama E Boumi
- Minnesota Department of Human Services, St Paul, MN, USA
| | - Christina Coyle
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA
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Angelo KM, Haulman J, Terry A, Leung D, Chen LH, Barnett E, Hagmann S, Hynes N, Connor B, Anderson S, Hamer D. 966. Infectious Diseases among US Resident Student Travelers after Return to the United States: A GeoSentinel Analysis, 2007–2017. Open Forum Infect Dis 2018. [PMCID: PMC6253059 DOI: 10.1093/ofid/ofy209.082] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background The number of US students studying abroad has more than tripled over the past 20 years. As study abroad programs diversify their destinations, more students are traveling to developing regions, increasing their risk of infectious diseases. Few data exist describing infections acquired by US students while traveling internationally. We describe the spectrum of disease among students who have returned from international travel and suggest how to reduce illness among these travelers. Methods GeoSentinel is a global network of travel and tropical medicine providers that monitors travel-related morbidity. Records of US resident student travelers, 17–24 years old, who returned to the United States and were given a confirmed travel-related diagnosis at one of 15 US GeoSentinel sites during 2007–2017. Those without ascertainable exposure regions were excluded. Records were analyzed to describe demographic and travel characteristics and diagnoses. Results There were 432 students included. The median age was 21 years; 69% were female. Over 70% had a pretravel consultation with a healthcare provider. The most common exposure region was sub-Saharan Africa (112 travelers; 26%); the most common exposure countries were India (44 students; 11%), Ecuador (28; 7%), Ghana (25; 6%), and China (24; 6%). Students presented to a GeoSentinel site a median of 8 days (range: 0–181) after travel; 98% were outpatients. The most common diagnosis categories were gastrointestinal (45%) and dermatologic (17%). Of 581 confirmed diagnoses, diarrheal illnesses were most common (165; 28%). Thirty-one (7%) students had a vector-borne disease; 14 (41%) of these were diagnosed with malaria (13 had a pretravel consultation) and 11 (32%) with dengue. Two students were diagnosed with acute HIV. Three had a vaccine-preventable disease (two typhoid; one hepatitis A). Conclusion Students experienced travel-related infections despite a large proportion receiving pretravel consultations. Students (especially those traveling to a less developed region) should receive specific pretravel instructions (including suggestions for behavioral modification, vaccination, and medication prophylaxis when applicable) to prevent gastrointestinal, vector-borne, sexually transmitted, and vaccine-preventable diseases. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | - Anne Terry
- University of Washington, Seattle, Washington
| | - Daniel Leung
- Division of Infectious Diseases, University of Utah, Salt Lake City, Utah
| | - Lin H Chen
- Harvard School of Medicine, Cambridge, Massachusetts
| | - Elizabeth Barnett
- Pediatric Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - Stefan Hagmann
- Steven and Alexandra Cohen Children’s Medical Center of New York, New Hyde Park, New York
| | - Noreen Hynes
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Bradley Connor
- New York Center for Travel and Tropical Medicine, New York, New York
| | | | - Davidson Hamer
- Boston University School of Public Health, Boston, Massachusetts
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Gautret P, Angelo KM, Asgeirsson H, Lalloo DG, Shaw M, Schwartz E, Libman M, Kain KC, Piyaphanee W, Murphy H, Leder K, Vincelette J, Jensenius M, Waggoner J, Leung D, Borwein S, Blumberg L, Schlagenhauf P, Barnett ED, Hamer DH. Rabies post-exposure prophylaxis started during or after travel: A GeoSentinel analysis. PLoS Negl Trop Dis 2018; 12:e0006951. [PMID: 30422981 PMCID: PMC6258561 DOI: 10.1371/journal.pntd.0006951] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 09/07/2018] [Revised: 11/27/2018] [Accepted: 10/26/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recent studies demonstrate that rabies post-exposure prophylaxis (RPEP) in international travelers is suboptimal, with only 5-20% of travelers receiving rabies immune globulin (RIG) in the country of exposure when indicated. We hypothesized that travelers may not be receiving RIG appropriately, and practices may vary between countries. We aim to describe the characteristics of travelers who received RIG and/or RPEP during travel. METHODOLOGY/PRINCIPAL FINDINGS We conducted a multi-center review of international travelers exposed to potentially rabid animals, collecting information on RPEP administration. Travelers who started RPEP before (Group A) and at (Group B) presentation to a GeoSentinel clinic during September 2014-July 2017 were included. We included 920 travelers who started RPEP. About two-thirds of Group A travelers with an indication for rabies immunoglobulin (RIG) did not receive it. Travelers exposed in Indonesia were less likely to receive RIG in the country of exposure (relative risk: 0.30; 95% confidence interval: 0.12-0.73; P = 0.01). Travelers exposed in Thailand [Relative risk (RR) 1.38, 95% Confidence Interval (95% CI): 1.0-1.8; P = 0.02], Sri Lanka (RR 3.99, 95% CI: 3.99-11.9; P = 0.013), and the Philippines (RR 19.95, 95% CI: 2.5-157.2; P = 0.01), were more likely to receive RIG in the country of exposure. CONCLUSIONS/SIGNIFICANCE This analysis highlights gaps in early delivery of RIG to travelers and identifies specific countries where travelers may be more or less likely to receive RIG. More detailed country-level information helps inform risk education of international travelers regarding appropriate rabies prevention.
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Affiliation(s)
- Philippe Gautret
- Institut Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - Kristina M. Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, and Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - David G. Lalloo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Marc Shaw
- Public Health and Tropical Medicine Department, James Cook University, Townsville, Australia, and WORLDWISE Travellers Health Centres of New Zealand
| | - Eli Schwartz
- The Center of Geographical Medicine, Sheba Medical Center, Tel HaShomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
| | - Kevin C. Kain
- Tropical Disease Unit, UHN-Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Holly Murphy
- CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal
| | - Karin Leder
- School of Epidemiology and Preventive Medicine, Monash University, and Victorian Infectious Disease Service, Royal Melbourne Hospital at the Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Jean Vincelette
- Clinique Santé-voyage, Fondation du CHUM, Université de Montréal, Montreal, Canada
| | - Mogens Jensenius
- Department of Infectious Diseases - Oslo University Hospital, Oslo, Norway
| | - Jesse Waggoner
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Daniel Leung
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Sarah Borwein
- TravelSafe Medical Centre - Central Health Medical Practice, Hong Kong, China
| | | | - Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers’ Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Switzerland
| | - Elizabeth D. Barnett
- Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, and Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health and Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
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Salzer HJF, Stoney RJ, Angelo KM, Rolling T, Grobusch MP, Libman M, López-Vélez R, Duvignaud A, Ásgeirsson H, Crespillo-Andújar C, Schwartz E, Gautret P, Bottieau E, Jordan S, Lange C, Hamer DH. Epidemiological aspects of travel-related systemic endemic mycoses: a GeoSentinel analysis, 1997-2017. J Travel Med 2018; 25:5067362. [PMID: 30085265 PMCID: PMC6628256 DOI: 10.1093/jtm/tay055] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/15/2018] [Indexed: 11/13/2022]
Abstract
Background International travel has increased in the past few decades, placing more travellers at risk of acquiring systemic endemic mycoses. There are limited published data on systemic endemic mycoses among international travellers. We report epidemiological characteristics of non-migrant, international travellers who acquired systemic endemic mycoses during travel. Methods We analysed records of non-migrant international travellers with a confirmed diagnosis of histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, blastomycosis or talaromycosis reported from 1997 through 2017 to GeoSentinel, a global surveillance network now consisting of 70 travel or tropical medicine centres in 31 countries. Results Sixty-nine records met the inclusion criteria. Histoplasmosis was most frequently reported; the 51 travellers with histoplasmosis had the lowest median age (30 years; range: 8-85) and shortest median duration of travel (12 days; range: 5-154). Coccidioidomycosis was reported in 14 travellers; travellers with coccidioidomycosis were older (median 62 years; range: 22-78) and had the longest median number of days between return from travel and presentation to a GeoSentinel site (55 days; range: 17-273). Almost all travellers with coccidioidomycosis were exposed in the USA. Other systemic endemic mycoses were less frequently reported, including blastomycosis (three travellers) and talaromycosis (one traveller). Conclusions Although relatively rare, systemic endemic mycoses should be considered as potential travel-related infections in non-migrant international travellers. Epidemiological exposures should be used to guide diagnostic evaluations and treatment.
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Affiliation(s)
- Helmut J. F. Salzer
- Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Rhett J. Stoney
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Kristina M. Angelo
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Thierry Rolling
- Section of Infectious Diseases and Tropical Medicine, 1st Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - 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
- J. D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramon y Cajal University Hospital, Madrid, Spain
| | | | - Hilmir Ásgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Clara Crespillo-Andújar
- National Referral Unit for Tropical and Travel Medicine, Department of Internal Medicine, Hospital Universitario La Paz-Carlos III, Madrid, Spain
| | - Eli Schwartz
- The Center for Geographic Medicine and Internal Medicine ‘C’ Chaim Sheba Medical Center, Tel HaShomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philippe Gautret
- Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sabine Jordan
- Section of Infectious Diseases and Tropical Medicine, 1st Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Lange
- Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
- International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - 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
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Marano N, Angelo KM, Merrill RD, Cetron MS. Expanding travel medicine in the 21st century to address the health needs of the world's migrants. J Travel Med 2018; 25:5076821. [PMID: 30137586 PMCID: PMC6519702 DOI: 10.1093/jtm/tay067] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 07/03/2018] [Accepted: 08/16/2018] [Indexed: 11/14/2022]
Abstract
The body of knowledge needed to effectively practice travel medicine has expanded since the 1990s, as migrants begin to comprise an increasing proportion of the world's population. We describe the unique needs of migrants and provide resources available to migration health practitioners. As the number of the world's migrants grows, collaboration across disciplines is key to achieving high-quality migration health practices.
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Affiliation(s)
- Nina Marano
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca D Merrill
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Martin S Cetron
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Angelo KM, Haulman NJ, Terry AC, Leung DT, Chen LH, Barnett ED, Hagmann SHF, Hynes NA, Connor BA, Anderson S, McCarthy A, Shaw M, Van Genderen PJJ, Hamer DH. Illness among US resident student travellers after return to the USA: a GeoSentinel analysis, 2007-17. J Travel Med 2018; 25:5078557. [PMID: 30202952 PMCID: PMC6503850 DOI: 10.1093/jtm/tay074] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/20/2018] [Indexed: 11/12/2022]
Abstract
Background The number of US students studying abroad more than tripled during the past 20 years. As study abroad programmes' destinations diversify, students increasingly travel to resource-limited countries, placing them at risk for infectious diseases. Data describing infections acquired by US students while travelling internationally are limited. We describe illnesses among students who returned from international travel and suggest how to prevent illness among these travellers. Methods GeoSentinel is a global surveillance network of travel and tropical medicine providers that monitors travel-related morbidity. This study included the records of US resident student international travellers, 17-24 years old, who returned to the USA, had a confirmed travel-related illness at one of 15 US GeoSentinel sites during 2007-17 and had a documented exposure region. Records were analysed to describe demographic and travel characteristics and diagnoses. Results The study included 432 students. The median age was 21 years; 69% were female. More than 70% had a pre-travel consultation with a healthcare provider. The most common exposure region was sub-Saharan Africa (112; 26%). Students were most commonly exposed in India (44; 11%), Ecuador (28; 7%), Ghana (25; 6%) and China (24; 6%). The median duration of travel abroad was 40 days (range: 1-469) and presented to a GeoSentinel site a median of 8 days (range: 0-181) after travel; 98% were outpatients. Of 581 confirmed diagnoses, the most common diagnosis category was gastrointestinal (45%). Acute diarrhoea was the most common gastrointestinal diagnosis (113 of 261; 43%). Thirty-one (7%) students had vector-borne diseases [14 (41%) malaria and 11 (32%) dengue]. Three had vaccine-preventable diseases (two typhoid; one hepatitis A); two had acute human immunodeficiency virus infection. Conclusions Students experienced travel-related infections, despite the majority having a pre-travel consultation. US students should receive pre-travel advice, vaccinations and chemoprophylaxis to prevent gastrointestinal, vector-borne, sexually transmitted and vaccine-preventable infections.
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Affiliation(s)
- Kristina M. Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - N. Jean Haulman
- Hall Health Center, University of Washington, Seattle, WA 98195, USA
| | - Anne C. Terry
- Hall Health Center, University of Washington, Seattle, WA 98195, USA
| | - Daniel T. Leung
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Lin H. Chen
- Division of Infectious Diseases, Mt. Auburn Hospital, Cambridge, MA 02138, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Elizabeth D. Barnett
- Department of Pediatrics, Section of Infectious Diseases, Boston Medical Center, Boston, MA 02138, USA
| | - Stefan H. F. Hagmann
- Division of Pediatric Infectious Disease, Steven and Alexandra Cohen Children’s Medical Center of New York, New Hyde Park, NY 11557, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Noreen A. Hynes
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Bradley A. Connor
- New York Center for Travel and Tropical Medicine, New York, NY 10022, USA
- Weill Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Susan Anderson
- Department of Medicine/Infectious Diseases, Stanford University, Palo Alto, CA 94305, USA
| | - Anne McCarthy
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Marc Shaw
- James Cook University, Queensland, Australia
- Worldwise Travellers’ Health Centres, Auckland, New Zealand
| | | | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA
- Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, MA 02118, USA
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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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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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Angelo KM, Libman M, Caumes E, Hamer DH, Kain KC, Leder K, Grobusch MP, Hagmann SH, Kozarsky P, Lalloo DG, Lim PL, Patimeteeporn C, Gautret P, Odolini S, Chappuis F, Esposito DH. Malaria after international travel: a GeoSentinel analysis, 2003-2016. Malar J 2017; 16:293. [PMID: 28728595 PMCID: PMC5520359 DOI: 10.1186/s12936-017-1936-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/13/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND More than 30,000 malaria cases are reported annually among international travellers. Despite improvements in malaria control, malaria continues to threaten travellers due to inaccurate perception of risk and sub-optimal pre-travel preparation. METHODS Records with a confirmed malaria diagnosis after travel from January 2003 to July 2016 were obtained from GeoSentinel, a global surveillance network of travel and tropical medicine providers that monitors travel-related morbidity. Records were excluded if exposure country was missing or unascertainable or if there was a concomitant acute diagnosis unrelated to malaria. Records were analyzed to describe the demographic and clinical characteristics of international travellers with malaria. RESULTS There were 5689 travellers included; 325 were children <18 years. More than half (53%) were visiting friends and relatives (VFRs). Most (83%) were exposed in sub-Saharan Africa. The median trip duration was 32 days (interquartile range 20-75); 53% did not have a pre-travel visit. More than half (62%) were hospitalized; children were hospitalized more frequently than adults (73 and 62%, respectively). Ninety-two per cent had a single Plasmodium species diagnosis, most frequently Plasmodium falciparum (4011; 76%). Travellers with P. falciparum were most frequently VFRs (60%). More than 40% of travellers with a trip duration ≤7 days had Plasmodium vivax. There were 444 (8%) travellers with severe malaria; 31 children had severe malaria. Twelve travellers died. CONCLUSION Malaria remains a serious threat to international travellers. Efforts must focus on preventive strategies aimed on children and VFRs, and chemoprophylaxis access and preventive measure adherence should be emphasized.
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Affiliation(s)
- Kristina M. Angelo
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E03, Atlanta, GA 30329 USA
| | - Michael Libman
- McGill University Centre for Tropical Diseases, Montreal, Canada
| | - Eric Caumes
- Service des Maladies Infectieuses et Tropicales, GH Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
| | - Davidson H. Hamer
- Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, MA USA
| | - Kevin C. Kain
- Tropical Disease Unit, University of Toronto, Toronto, Canada
| | - Karin Leder
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Martin P. Grobusch
- Center for Tropical and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Stefan H. Hagmann
- Steven and Alexandra Cohen Children’s Medical Center of New York, New Hyde Park, New York, NY USA
| | - Phyllis Kozarsky
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E03, Atlanta, GA 30329 USA
- Department of Medicine, Emory University, Atlanta, GA USA
| | | | - Poh-Lian Lim
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Calvin Patimeteeporn
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E03, Atlanta, GA 30329 USA
| | - Philippe Gautret
- Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes, Aix Marseille Université, Tropical IHU-Méditerranée Infection, Marseillle, France
| | - Silvia Odolini
- Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| | | | - Douglas H. Esposito
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E03, Atlanta, GA 30329 USA
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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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Angelo KM, Reynolds J, Karp BE, Hoekstra RM, Scheel CM, Friedman C. Antimicrobial Resistance Among Nontyphoidal Salmonella Isolated From Blood in the United States, 2003-2013. J Infect Dis 2016; 214:1565-1570. [PMID: 27609807 DOI: 10.1093/infdis/jiw415] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [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: 07/09/2016] [Accepted: 08/29/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Salmonella causes an estimated 100 000 antimicrobial-resistant infections annually in the United States. Salmonella antimicrobial resistance may result in bacteremia and poor outcomes. We describe antimicrobial resistance among nontyphoidal Salmonella blood isolates, using data from the National Antimicrobial Resistance Monitoring System. METHODS Human nontyphoidal Salmonella isolates from 2003 to 2013 were classified as fully susceptible, resistant to ≥1 antimicrobial agent, or resistant to a first-line agent. Logistic regression was used to compare resistance patterns, serotypes, and patient characteristics for Salmonella isolated from blood versus stool and to determine resistance trends over time. RESULTS Approximately 20% of blood isolates had antimicrobial resistance to a first-line treatment agent. Bacteremia was associated with male sex, age ≥65 years, and specific serotypes. Blood isolates were more likely to be resistant to ≥1 agent for serotypes Enteritidis, Javiana, Panama, and Typhimurium. Blood isolates were most commonly resistant to tetracycline (19%), and more likely resistant to a first-line agent (odds ratio, 1.81; 95% confidence interval, 1.56-2.11) than stool isolates. Ceftriaxone resistance increased in blood isolates from 2003 to 2013 (odd ratio, 1.12; 95% confidence interval, 1.02-1.22). CONCLUSIONS Resistance to first-line treatment agents in patients with Salmonella bacteremia is a concern for public health and for informing clinical decisions. Judicious antimicrobial use is crucial to limit resistance.
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Affiliation(s)
- Kristina M Angelo
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jared Reynolds
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Beth E Karp
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert Michael Hoekstra
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christina M Scheel
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cindy Friedman
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Angelo KM, Jackson KA, Wong KK, Hoekstra RM, Jackson BR. Assessment of the Incubation Period for Invasive Listeriosis. Clin Infect Dis 2016; 63:1487-1489. [PMID: 27535950 DOI: 10.1093/cid/ciw569] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 05/24/2016] [Accepted: 08/04/2016] [Indexed: 12/24/2022] Open
Abstract
We characterized incubation periods among outbreak-associated listeriosis cases, using a simulation model to account for patients with multiple exposure dates. The median was 11 days; 90% of cases occurred within 28 days, and incubation periods varied by clinical manifestation.
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Affiliation(s)
- Kristina M Angelo
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kelly A Jackson
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen K Wong
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert M Hoekstra
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brendan R Jackson
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Greiner AL, Angelo KM, McCollum AM, Mirkovic K, Arthur R, Angulo FJ. Addressing contact tracing challenges-critical to halting Ebola virus disease transmission. Int J Infect Dis 2015; 41:53-5. [PMID: 26546808 DOI: 10.1016/j.ijid.2015.10.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 09/07/2015] [Revised: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Delayed and ineffective contact tracing contributed to the extensive transmission of Ebola virus disease (EVD) in the 2014-2015 West African outbreak. Understanding and addressing the challenges to implementing and managing contact tracing is essential to stopping EVD transmission and preventing large-scale EVD outbreaks in the future. METHODS Interviews were conducted with United States Centers for Disease Control and Prevention staff members engaged in contact tracing activities in the affected West African countries of Sierra Leone, Guinea, Liberia, Senegal, Nigeria, and Mali from September through December 2014. Two staff members from each country were interviewed. The five most frequently cited contact tracing challenges were identified. RESULTS Challenges have been evident in every step of the contact tracing process from implementation to management, including identifying, locating, and enrolling contact-persons, as well as managing personnel and ensuring contact tracing performance. Common themes observed in all of the affected West African countries have included fear, stigma, and community misperceptions regarding EVD. Countries that have overcome these challenges, ensuring immediate and comprehensive contact tracing, have been successful in halting EVD transmission. CONCLUSIONS Addressing challenges to contact tracing implementation and management in the West African EVD outbreak is essential to stopping ongoing transmission.
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Affiliation(s)
- Ashley L Greiner
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Road NE,Atlanta, GA 30333, USA.
| | - Kristina M Angelo
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Road NE,Atlanta, GA 30333, USA
| | - Andrea M McCollum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kelsey Mirkovic
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Road NE,Atlanta, GA 30333, USA
| | - Ray Arthur
- International Task Force, 2014 Ebola Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Frederick J Angulo
- High-risk Unaffected Countries Team, International Task Force, 2014 Ebola Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Angelo KM, Chu A, Anand M, Nguyen TA, Bottichio L, Wise M, Williams I, Seelman S, Bell R, Fatica M, Lance S, Baldwin D, Shannon K, Lee H, Trees E, Strain E, Gieraltowski L. Outbreak of Salmonella Newport infections linked to cucumbers--United States, 2014. MMWR Morb Mortal Wkly Rep 2015; 64:144-7. [PMID: 25695319 PMCID: PMC4584703] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In August 2014, PulseNet, the national molecular subtyping network for foodborne disease surveillance, detected a multistate cluster of Salmonella enterica serotype Newport infections with an indistinguishable pulse-field gel electrophoresis (PFGE) pattern (XbaI PFGE pattern JJPX01.0061). Outbreaks of illnesses associated with this PFGE pattern have previously been linked to consumption of tomatoes harvested from Virginia's Eastern Shore in the Delmarva region and have not been linked to cucumbers or other produce items. To identify the contaminated food and find the source of the contamination, CDC, state and local health and agriculture departments and laboratories, and the Food and Drug Administration (FDA) conducted epidemiologic, traceback, and laboratory investigations. A total of 275 patients in 29 states and the District of Columbia were identified, with illness onsets occurring during May 20-September 30, 2014. Whole genome sequencing (WGS), a highly discriminating subtyping method, was used to further characterize PFGE pattern JJPX01.0061 isolates. Epidemiologic, microbiologic, and product traceback evidence suggests that cucumbers were a source of Salmonella Newport infections in this outbreak. The epidemiologic link to a novel outbreak vehicle suggests an environmental reservoir for Salmonella in the Delmarva region that should be identified and mitigated to prevent future outbreaks.
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Affiliation(s)
- Kristina M. Angelo
- Epidemic Intelligence Service, CDC
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Alvina Chu
- Maryland Department of Health and Mental Hygiene
| | | | - Thai-An Nguyen
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Lyndsay Bottichio
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Matthew Wise
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Ian Williams
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | | | | | | | | | | | - Kyle Shannon
- Maryland Department of Health and Mental Hygiene
| | - Hannah Lee
- Maryland Department of Health and Mental Hygiene
| | - Eija Trees
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | | | - Laura Gieraltowski
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
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Angelo KM, Nnedu ON. Rare manifestations of coccidioidomycosis. J La State Med Soc 2013; 165:137-139. [PMID: 24015425] [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
Involvement of the central nervous system and extrapulmonary sites by Coccidioides immitis is reported primarily in patients with cell-mediated immune deficiency. We present a case of a patient with no prior history of immunosuppression who presented to a public hospital in New Orleans with disseminated Coccidioides infection.
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