Zika beyond the Americas: travelers as sentinels of Zika virus transmission. A GeoSentinel analysis, 2012 to 2016

Leder, Karin, Grobusch, Martin P., Gautret, Philippe, Chen, Lin H., Kuhn, Susan, Lim, Poh Lian, Yates, Johnnie, McCarthy, Anne E., Rothe, Camilla, Kato, Yasuyuki, Bottieau, Emmanuel, Huber, Kristina, Schwartz, Eli, Stauffer, William, Malvy, Denis, Shaw, Marc T.M., Rapp, Christophe, Blumberg, Lucille, Jensenius, Mogens, van Genderen, Perry J.J., Hamer, Davidson H., and GeoSentinel Surveillance Network, (2017) Zika beyond the Americas: travelers as sentinels of Zika virus transmission. A GeoSentinel analysis, 2012 to 2016. PLoS One, 12 (10). e0185689.

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Background: Zika virus (ZIKV) was first isolated in Africa; decades later, caused large outbreaks in the Pacific, and is considered endemic in Asia. We aim to describe ZIKV disease epidemiology outside the Americas, the importance of travelers as sentinels of disease transmission, and discrepancies in travel advisories from major international health organizations.

Methods and findings: This descriptive analysis using GeoSentinel Surveillance Network records involves sixty-four travel and tropical medicine clinics in 29 countries. Ill returned travelers with a confirmed or probable diagnosis of ZIKV disease acquired in Africa, Asia and the Pacific seen between 1 January 2012 and 31 December 2016 are included, and the frequencies of demographic, trip, and diagnostic characteristics described. ZIKV was acquired in Asia (18), the Pacific (10) and Africa (1). For five countries (Indonesia, Philippines, Thailand, Vietnam, Cameroon), GeoSentinel patients were sentinel markers of recent Zika activity. Additionally, the first confirmed ZIKV infection acquired in Kiribati was reported to GeoSentinel (2015), and a probable case was reported from Timor Leste (April 2016), representing the only case known to date. Review of Zika situation updates from major international health authorities for country risk classifications shows heterogeneity in ZIKV country travel advisories.

Conclusions: Travelers are integral to the global spread of ZIKV, serving as sentinel markers of disease activity. Although GeoSentinel data are collected by specialized clinics and do not capture all imported cases, we show that surveillance of imported infections by returned travelers augments local surveillance system data regarding ZIKV epidemiology and can assist with risk categorization by international authorities. However, travel advisories are variable due to risk uncertainties.

Item ID: 51615
Item Type: Article (Research - C1)
ISSN: 1932-6203
Additional Information:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funders: Centers for Disease Control and Prevention (CDCP), International Society of Travel Medicine (ISTM), Public Health of Canada, National Health and Medical Research Council (NHMRC)
Projects and Grants: CDCP / ISTM U50CK00189, NHMRC Fellowship GNT1084351
Date Deposited: 22 Nov 2017 07:45
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320211 Infectious diseases @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920109 Infectious Diseases @ 100%
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