Risk of Dengue in Travelers: Implications for Dengue Vaccination

Wilder‐Smith, Annelies

doi:10.1007/s11908-018-0656-3

Cited by 19 publications

(11 citation statements)

References 107 publications

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“…8 There has been a corresponding increase in dengue reported in European travellers. 9,10 Dengue can occur in tourist travellers, business travellers, migrants and those visiting friends and relatives (VFR), South-South travellers, and pilgrims [11][12][13][14][15][16] ; both in adult 7,17 and pediatric travellers. 18,19 Air travel between dengue-endemic countries and from dengue-endemic countries to non-endemic has increased exponentially, thus, travellers contribute to the global spread of dengue.…”

Section: Introduction and Objectivesmentioning

confidence: 99%

Severe dengue in travellers: pathogenesis, risk and clinical management

Halstead

Wilder‐Smith

2019

Journal of Travel Medicine

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102

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Rationale for review Dengue is a frequent cause of febrile illness among travellers and has overtaken malaria as the leading cause of febrile illness for those traveling to Southeast Asia. The purpose is to review the risk of dengue and severe dengue in travellers with a particular focus on the pathogenesis and clinical management of severe dengue. Risk, pathogenesis and clinical management The risk of travel-acquired dengue depends on destination, season and duration of travel and activities during travel. Seroconversion rates reported in travellers, therefore, vary between <1% and >20%. The most common life-threatening clinical response to dengue infection is the dengue vascular permeability syndrome, epidemiologically linked to secondary infection, but can also occur in primary infection. Tertiary and quaternary infections are usually associated with mild or no disease. Antibody-dependent enhancement, viral factors, age, host factors and clinical experience of the managing physician modulate the risk of progressing to severe dengue. The relative risk of severe dengue in secondary versus primary infection ranges from 2 to 7. The absolute risk of severe dengue in children in highly endemic areas is ~0.1% per year for primary infections and 0.4% for secondary infections. About 2–4% of secondary infections lead to severe dengue. Severe dengue and death are both relatively rare in general travellers but more frequently in those visiting friends and relatives. Clinical management of severe dengue depends on judicious use of fluid rehydration. Conclusions Although dengue is a frequent cause of travel illness, severe dengue and deaths are rare. Nevertheless, dengue infections can interrupt travel and lead to evacuation and major out-of-pocket costs. Dengue is more frequent than many other travel-related vaccine preventable diseases, such as hepatitis A, hepatitis B, rabies, Japanese encephalitis and yellow fever, indicating a need for a dengue vaccine for travellers.

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Section: Introduction and Objectivesmentioning

confidence: 99%

Severe dengue in travellers: pathogenesis, risk and clinical management

Halstead

Wilder‐Smith

2019

Journal of Travel Medicine

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102

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“…Modernisation of the air transportation system accounts for the enhanced movement of DENV by overcoming natural barriers of travel time and geography. As a consequence, the incidence of travel‐associated dengue has also increased . Current evidence indicates dengue as the leading cause of fever in returning travellers from Southeast Asia, and this region is consistently one of the main sources of travel‐acquired infection …”

Section: Introductionmentioning

confidence: 99%

Dengue viruses circulating in Indonesia: A systematic review and phylogenetic analysis of data from five decades

Harapan

Michie

Yohan

et al. 2019

Reviews in Medical Virology

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Although epidemiological and molecular epidemiological (serotype, genotype, and lineage information) data are available for several major cities in Indonesia, there is yet to be a comprehensive national study of dengue in Indonesia over time. This study was conducted to provide a comprehensive epidemiology of circulating dengue viruses (DENV) in Indonesia between 1973 and 2016. This was conducted through a systematic review of the literature and phylogenetic analysis of available DENV sequences. Available data from National Disease Surveillance System have indicated an increasing trend of dengue incidence in Indonesia over the past 50 years. Incidence rates appear to be cyclic, peaking approximately every 6 to 8 years. In contrast, the case fatality rate has decreased approximately by half with each decade since 1980.Over this 50-year time span, serotype shifts, genotype displacement within DENV-1 and DENV-2, and introduction of DENV-1 and DENV-3 genotype from other countries occurred. These events were associated with increased incidence of dengue cases. Our study also provides a valuable national snapshot of DENV genetic diversity in Indonesia that may contribute to development of more effective dengue vaccine compositions for the region.

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“…As the global burden of dengue has increased in recent years, 36 , 37 so has the incidence of dengue among travelers to the tropics. 38 This burden is expected to continue to grow in Asia, Sub-Saharan Africa, and Latin America, with global estimates of more than 50 million febrile illness cases and 2 million hospitalizations per year, 39 further increasing the risk for travelers to these areas. Dengue infection risk in long-term travelers (more than 6 months) and business expatriates (those who reside in another country for occupational purposes, and will return to their country of origin after their assignment is completed) has been associated with increased duration of assignments and local epidemiology of dengue in the destination.…”

Section: Discussionmentioning

confidence: 99%

Dengue Virus Infections among Peace Corps Volunteers in Timor-Leste, 2018–2019

Sánchez-González

Venuto

Poe

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Abstract.Dengue is an ongoing health risk for Peace Corps Volunteers (PCVs) working in the tropics. On May 2019, the Peace Corps Office of Health Services notified the Centers for Disease Control and Prevention (CDC) of a dengue outbreak among PCVs in Timor-Leste. The purpose of this investigation was to identify the clinical, demographic, and epidemiological characteristics of PCVs with dengue and recommend dengue preventive measures. To identify PCVs with dengue and describe disease severity, the medical records of PCVs reporting fever during September 2018–June 2019 were reviewed. To identify factors associated with dengue virus (DENV) infection, we administered a questionnaire on demographics, travel history, and mosquito avoidance behaviors and collected blood specimens to detect the anti-DENV IgM antibody to diagnose recent infection. Of 35 PCVs in-country, 11 (31%) tested positive for dengue (NS1, IgM, PCR), eight requiring hospitalization and medical evacuation. Among 27 (77%) PCVs who participated in the investigation, all reported having been recently bitten by mosquitoes and 56% reported being bitten most often at home; only 16 (59%) reported having screens on bedroom windows. Nearly all (93%) PCVs reported using a bed net every night; fewer (70%) reported using mosquito repellent at least once a day. No behaviors were significantly associated with DENV infection. Raising awareness of dengue risk among PCVs and continuing to encourage mosquito avoidance behavior to prevent dengue is critical. Access to and use of measures to avoid mosquito bites should be improved or implemented. Peace Corps medical officers should continue to receive an annual refresher training on dengue clinical management.

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Risk of Dengue in Travelers: Implications for Dengue Vaccination

Cited by 19 publications

References 107 publications

Severe dengue in travellers: pathogenesis, risk and clinical management

Severe dengue in travellers: pathogenesis, risk and clinical management

Dengue viruses circulating in Indonesia: A systematic review and phylogenetic analysis of data from five decades

Dengue Virus Infections among Peace Corps Volunteers in Timor-Leste, 2018–2019

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