Travel-Associated Zika Virus Disease Acquired in the Americas Through February 2016 A GeoSentinel Analysis
Travel-Associated Zika Virus Disease Acquired in the Americas Through February 2016 A GeoSentinel Analysis
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DOI：
10.7326/m16-1842
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发表时间：
2017-01-17
影响因子：
39.2
通讯作者：
Esposito, Douglas H.
中科院分区：
文献类型：
--
作者：
Hamer, Davidson H.;Barbre, Kira A.;Esposito, Douglas H.
背景资料：寨卡病毒在美洲迅速传播，并已被旅行者输入到许多非流行国家。目的：描述在美洲暴露的旅行者中寨卡病毒病的临床表现和流行病学。设计：描述性，使用GeoSentinel记录。设置：30个国家的63个旅行和热带医学诊所。患者：在2013年1月至2016年2月29日期间被确诊、可能或临床疑似诊断为寨卡病毒病的病返旅客。结果：自2015年5月开始，共报告了93例寨卡病毒病病例。常见的症状包括皮疹（88%）、发热（76%）和关节痛（72%）。59%的患者在南美洲暴露; 71%的患者在欧洲确诊。最常见的是通过血液聚合酶链反应（PCR）检测确定病例状态，较少通过其他体液或血清学PCR检测和空斑减少中和试验确定病例状态。2例患者发生格林-巴利综合征，4例妊娠中3例发生不良结局（小头畸形、主要胎儿神经系统异常和宫内胎儿死亡）。局限性：专业诊所收集的监测数据可能不能代表所有患病返回的旅行者，分母数据不可用。这些监测数据有助于描述美洲旅行者感染寨卡病毒病的临床表现和不良后果，并表明需要全球标准化诊断测试本研究中观察到的严重胎儿并发症突出了孕妇及其伴侣旅行指南和预防措施的重要性。旅行者是全球寨卡病毒传播的哨兵，并可能促进进一步传播。
Background: Zika virus has spread rapidly in the Americas and has been imported into many nonendemic countries by travelers.Objective: To describe clinical manifestations and epidemiology of Zika virus disease in travelers exposed in the Americas.Design: Descriptive, using GeoSentinel records.Setting: 63 travel and tropical medicine clinics in 30 countries.Patients: Ill returned travelers with a confirmed, probable, or clinically suspected diagnosis of Zika virus disease seen between January 2013 and 29 February 2016.Measurements: Frequencies of demographic, trip, and clinical characteristics and complications.Results: Starting in May 2015, 93 cases of Zika virus disease were reported. Common symptoms included exanthema (88%), fever (76%), and arthralgia (72%). Fifty-nine percent of patients were exposed in South America; 71% were diagnosed in Europe. Case status was established most commonly by polymerase chain reaction (PCR) testing of blood and less often by PCR testing of other body fluids or serology and plaque-reduction neutralization testing. Two patients developed Guillain-Barre syndrome, and 3 of 4 pregnancies had adverse outcomes (microcephaly, major fetal neurologic abnormalities, and intrauterine fetal death).Limitation: Surveillance data collected by specialized clinics may not be representative of all ill returned travelers, and denominator data are unavailable.Conclusion: These surveillance data help characterize the clinical manifestations and adverse outcomes of Zika virus disease among travelers infected in the Americas and show a need for global standardization of diagnostic testing. The serious fetal complications observed in this study highlight the importance of travel advisories and prevention measures for pregnant women and their partners. Travelers are sentinels for global Zika virus circulation and may facilitate further transmission.