Zika among international travellers presenting to GeoSentinel sites, 2012–2019: implications for clinical practice

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.

The global trends and regional differences in incidence of Zika virus infection and implications for Zika virus infection prevention

“…A study predicted that a large portion of tropical and subtropical regions globally have suitable environmental conditions with over 2.17 billion people inhabiting these areas [41], raised concerns about the high risk of introducing and establishing new autochthonous transmission in these areas [4]. These travel-related ZIKV infections can be reduced by the following: a) travellers should discuss their travel plans with their healthcare providers to ensure that prevention measures are taken [42,43]; b) ZIKV infection should remain a consideration for travellers returning from the ZIKV outbreak area [42]; and c) avoidance of the primarily daytime-biting Aedes mosquitos both during and after travel [43].…”

Public health emergencies of international concern: a historic overview

“… 49 , 50 Although Zika virus has disappeared as a public health problem, sporadic cases still occur in the Americas and in travellers. 51 , 52 …”

The legacy of ZikaPLAN: a transnational research consortium addressing Zika

“…A literature review of the GeoSentinel publications related to Zika showed that Zika was first reported by GeoSentinel already in 2012, and notifications peaked in the years 2016–17 reflecting the public health emergency in the Americas at the time [ 86 ]. GeoSentinel sites reported 525 ZIKV cases from 2012 through 2019 with a clear decline in travellers after the 2016 outbreak [ 87 ]. Main countries of exposure were the Caribbean Islands and Latin America.…”