title: Sentinel surveillance of imported dengue via travellers to Europe 2012 to 2014: TropNet data from the DengueTools Research Initiative.
abstract: We describe the epidemiological pattern and genetic characteristics of 242 acute dengue infections imported to Europe by returning travellers from 2012 to 2014. The overall geographical pattern of imported dengue (South-east Asia > Americas > western Pacific region > Africa) remained stable compared with 1999 to 2010. We isolated the majority of dengue virus genotypes and epidemic lineages causing outbreaks and epidemics in Asia, America and Africa during the study period. Travellers acted as sentinels for four unusual dengue outbreaks (Madeira, 2012-13; Luanda, 2013; Dar es Salaam, 2014; Tokyo, 2014). We were able to characterise dengue viruses imported from regions where currently no virological surveillance data are available. Up to 36% of travellers infected with dengue while travelling returned during the acute phase of the infection (up to 7 days after symptom onset) or became symptomatic after returning to Europe, and 58% of the patients with acute dengue infection were viraemic when seeking medical care. Epidemiological and virological data from dengue-infected international travellers can add an important layer to global surveillance efforts. A considerable number of dengue-infected travellers are viraemic after arrival back home, which poses a risk for dengue introduction and autochthonous transmission in European regions where suitable mosquito vectors are prevalent.
authors.affiliation: Department of Medicine and Diagnostics, Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Neumayr
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Muñoz
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Medical Centre of the Ludwig-Maximilian-University (LMU), Munich, Germany.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Schunk
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bottieau
authors.affiliation: Department of Internal Medicine I, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
authors.forename: Jakob
authors.initials: J
authors.lastname: Cramer
authors.affiliation: Travel Medicine Unit, Department of Infectious Diseases, Amedeo di Savoia Hospital- ASLTO2, Torino, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Calleri
authors.affiliation: National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain.
authors.forename: Rogelio
authors.initials: R
authors.lastname: López-Vélez
authors.affiliation: Centre for Tropical Diseases, Sacro Cuore - Don Calabria Hospital, Negrar, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Angheben
authors.affiliation: University of Basel, Switzerland.|Clinical Research Unit, Department of Medicine and Diagnostics, Swiss Tropical and Public Health Institute, Basel, Switzerland.|Department of Infectious Diseases and Respiratory Medicine, Charité University Medical Center, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zoller
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Leo
authors.initials: L
authors.lastname: Visser
authors.affiliation: Tropical Medicine and International Health Unit Vall d'Hebron-Drassanes. PROSICS. Hospital Vall d'Hebron. Institut Català de la Salut, Barcelona, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Serre-Delcor
authors.affiliation: Infectious Disease Service & Department of Ambulatory Care, University Hospital, Lausanne, Switzerland.
authors.forename: Blaise
authors.initials: B
authors.lastname: Genton
authors.affiliation: University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Castelli
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Marjan
authors.initials: M
authors.lastname: Van Esbroeck
authors.affiliation: University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Matteelli
authors.affiliation: Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland.
authors.forename: Laurence
authors.initials: L
authors.lastname: Rochat
authors.affiliation: Microbiology Department, Hospital Vall d´Hebron. PROSICS Barcelona. Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Sulleiro
authors.affiliation: Department of Infectious Diseases and Respiratory Medicine, Charité University Medical Center, Berlin, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Kurth
authors.affiliation: Centre for Tropical Diseases, Sacro Cuore - Don Calabria Hospital, Negrar, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Gobbi
authors.affiliation: National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain.
authors.forename: Francesca
authors.initials: F
authors.lastname: Norman
authors.affiliation: Travel Medicine Unit, Department of Infectious Diseases, Amedeo di Savoia Hospital- ASLTO2, Torino, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Torta
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Clerinx
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Medical Centre of the Ludwig-Maximilian-University (LMU), Munich, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Poluda
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Martinez
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Antonia
authors.initials: A
authors.lastname: Calvo-Cano
authors.affiliation: National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain.
authors.forename: Maria Paz
authors.initials: MP
authors.lastname: Sanchez-Seco
authors.affiliation: Institute of Public Health, University of Heidelberg, Germany.|Department of Global Health and Epidemiology, Umea University, Umea, Sweden.
authors.forename: Annelies
authors.initials: A
authors.lastname: Wilder-Smith
authors.affiliation: Department of Medicine and Diagnostics, Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hatz
authors.affiliation: National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain.|Gorgas Memorial Institute, Panama, Panama.
authors.forename: Leticia
authors.initials: L
authors.lastname: Franco
authors.affiliation: http://www.tropnet.net/.
mesh_terms: D000349:Africa / Q000453:epidemiology; D000569:Americas / Q000453:epidemiology; D001210:Asia, Southeastern / Q000453:epidemiology; D003715:Dengue / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission*; D003716:Dengue Virus / Q000235:genetics / Q000302:isolation & purification*; D004196:Disease Outbreaks; D005060:Europe / Q000453:epidemiology; D005838:Genotype; D006801:Humans; D015994:Incidence; D010802:Phylogeny; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods; D018571:Sentinel Surveillance; D014195:Travel; D057236:Travel Medicine / Q000379:methods
keywords: Dengue; Europe; Surveillance; importation; travel; travellers