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      Seasonality, Annual Trends, and Characteristics of Dengue among Ill Returned Travelers, 1997–2006

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          Abstract

          Atypical patterns may indicate onset of epidemic activity.

          Abstract

          We examined seasonality and annual trends for dengue cases among 522 returned travelers reported to the international GeoSentinel Surveillance Network. Dengue cases showed region-specific peaks for Southeast Asia (June, September), South Central Asia (October), South America (March), and the Caribbean (August, October). Travel-related dengue exhibited annual oscillations with several epidemics occurring during the study period. In Southeast Asia, annual proportionate morbidity increased from 50 dengue cases per 1,000 ill returned travelers in nonepidemic years to an average of 159 cases per 1,000 travelers during epidemic years. Dengue can thus be added to the list of diseases for which pretravel advice should include information on relative risk according to season. Also, dengue cases detected at atypical times in sentinel travelers may inform the international community of the onset of epidemic activity in specific areas.

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          Spectrum of disease and relation to place of exposure among ill returned travelers.

          David O Freedman, Leisa Weld, Phyllis E. Kozarsky … (2006)
          Approximately 8 percent of travelers to the developing world require medical care during or after travel. Current understanding of morbidity profiles among ill returned travelers is based on limited data from the 1980s. Thirty GeoSentinel sites, which are specialized travel or tropical-medicine clinics on six continents, contributed clinician-based sentinel surveillance data for 17,353 ill returned travelers. We compared the frequency of occurrence of each diagnosis among travelers returning from six developing regions of the world. Significant regional differences in proportionate morbidity were detected in 16 of 21 broad syndromic categories. Among travelers presenting to GeoSentinel sites, systemic febrile illness without localizing findings occurred disproportionately among those returning from sub-Saharan Africa or Southeast Asia, acute diarrhea among those returning from south central Asia, and dermatologic problems among those returning from the Caribbean or Central or South America. With respect to specific diagnoses, malaria was one of the three most frequent causes of systemic febrile illness among travelers from every region, although travelers from every region except sub-Saharan Africa and Central America had confirmed or probable dengue more frequently than malaria. Among travelers returning from sub-Saharan Africa, rickettsial infection, primarily tick-borne spotted fever, occurred more frequently than typhoid or dengue. Travelers from all regions except Southeast Asia presented with parasite-induced diarrhea more often than with bacterial diarrhea. When patients present to specialized clinics after travel to the developing world, travel destinations are associated with the probability of the diagnosis of certain diseases. Diagnostic approaches and empiric therapies can be guided by these destination-specific differences. Copyright 2006 Massachusetts Medical Society.
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            Ecological and immunological determinants of dengue epidemics.

            Helen Wearing, Pejman Rohani (2006)
            The management of infectious diseases is an increasingly important public health issue, the effective implementation of which is often complicated by difficulties in teasing apart the relative roles of extrinsic and intrinsic factors influencing transmission. Dengue, a vector-borne strain polymorphic disease, is one such infection where transmission dynamics are affected by environmental variables as well as immune-mediated serotype interactions. To understand how alternative hypotheses concerning dengue infection and transmission may explain observed multiannual cycles in disease incidence, we adopt a theoretical approach that combines both ecological and immunological mechanisms. We demonstrate that, contrary to perceived wisdom, patterns generated solely by antibody-dependent enhancement or heterogeneity in virus virulence are not consistent with serotype-specific notification data in important ways. Furthermore, to generate epidemics with the characteristic signatures observed in data, we find that a combination of seasonal variation in vector demography and, crucially, a short-lived period of cross-immunity is sufficient. We then show how understanding the persistence and eradication of dengue serotypes critically depends on the alternative assumed mechanisms.
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              Dengue in travelers.

              Eli Schwartz, Annelies Wilder-Smith (2005)
              Article 0 comments Cited 101 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): July 2008
                Volume: 14
                Issue: 7
                Pages: 1081-1088
                Affiliations
                [* ]Chaim Sheba Medical Center, Tel Hashomer, Israel
                [† ]Tel Aviv University, Tel Aviv, Israel
                [‡ ]Statistical Consult, Victoria, British Columbia, Canada
                [§ ]National University Singapore, Singapore
                []University of Munich, Munich, Germany
                [# ]Toronto General Hospital, Toronto, Ontario, Canada
                [** ]University of Toronto, Toronto
                [†† ]University of Melbourne, Parkville, Victoria, Australia
                [‡‡ ]Royal Melbourne Hospital, Parkville
                [§§ ]University of Alabama at Birmingham, Birmingham, Alabama, USA
                Author notes
                Address for correspondence: David O. Freedman, William C. Gorgas Center for Geographic Medicine, Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, 1530 3rd Ave S, BBRB 203, Birmingham, AL 35294-2170, USA; email: freedman@ 123456uab.edu
                Article
                Publisher ID: 07-1412
                DOI: 10.3201/eid1407.071412
                PMC ID: 2600332
                PubMed ID: 18598629
                SO-VID: c6d713bc-ca6f-4763-b724-15bfe82989ed
                History
                Categories
                Subject: Research

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: research,seasonality,sentinel surveillance,dengue,travel
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: research, seasonality, sentinel surveillance, dengue, travel

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