title: Mosquito Exposure and Chikungunya and Dengue Infection Among Travelers During the Chikungunya Outbreak in the Americas.
abstract: AbstractTravelers are at risk for arbovirus infection. We prospectively enrolled 267 Department of Defense beneficiaries traveling to chikungunya-outbreak regions in the Americas between December 2013 and May 2015 and assessed travel characteristics and serologic exposure to chikungunya virus (CHIKV) and dengue virus (DENV). Ten ill-returning travelers were also assessed retrospectively. Self-reported mosquito exposure was common (64% of 198 evaluable travelers saw mosquitoes; 53% of 201 reported ≥ 1 bite). Increased exposure was associated with active-duty travelers (odds ratio [OR] = 2.6 [1.3-5.4] for seeing mosquitoes) or travelers visiting friends and relatives (VFR) (OR = 3.5 [1.0-10.0] for high-intensity bite exposure). Arbovirus infection was defined as seroconversion on plaque reduction neutralization testing (PRNT) of pre- and posttravel sera. For ill subjects enrolled posttravel, infection was defined by a positive convalescent PRNT and/or a positive reverse transcription polymerase chain reaction for CHIKV or DENV. We identified seven cases of arbovirus infection: four with CHIKV, five with DENV, and two with both. The composite attack rate for CHIKV and DENV infection was 3.7% of 108 evaluable, immunologically naïve, prospectively assessed travelers; there was serologic and/or polymerase chain reaction evidence of arbovirus infection in three of four evaluable (three of 10 total) ill-returning travelers. We identified both symptomatic and asymptomatic cases. Military purpose of travel and VFR travel accounted for five of seven cases. Pretravel counseling is important and should target higher risk groups. Given a shared vector between CHIKV, DENV, and Zika virus (ZIKV), this study can also help guide counseling for travelers to ZIKV-outbreak regions.
authors.affiliation: San Antonio Military Medical Center, San Antonio, Texas.
authors.forename: David A
authors.initials: DA
authors.lastname: Lindholm
authors.affiliation: Naval Infectious Diseases Diagnostic Laboratory, Silver Spring, Maryland.
authors.forename: Todd
authors.initials: T
authors.lastname: Myers
authors.affiliation: Naval Infectious Diseases Diagnostic Laboratory, Silver Spring, Maryland.
authors.forename: Susana
authors.initials: S
authors.lastname: Widjaja
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Grant
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Kalyani
authors.initials: K
authors.lastname: Telu
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland.|Naval Medical Center, Portsmouth, Virginia.
authors.forename: Tahaniyat
authors.initials: T
authors.lastname: Lalani
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland.
authors.forename: Jamie
authors.initials: J
authors.lastname: Fraser
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland.|Madigan Army Medical Center, Tacoma, Washington.
authors.forename: Mary
authors.initials: M
authors.lastname: Fairchok
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland.|Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Ganesan
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.|Naval Health Research Center, San Diego, California.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Johnson
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.|Madigan Army Medical Center, Tacoma, Washington.
authors.forename: Anjali
authors.initials: A
authors.lastname: Kunz
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: David R
authors.initials: DR
authors.lastname: Tribble
authors.affiliation: San Antonio Military Medical Center, San Antonio, Texas.|Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Heather C
authors.initials: HC
authors.lastname: Yun
mesh_terms: D000328:Adult; D000569:Americas / Q000453:epidemiology; D000818:Animals; D065632:Chikungunya Fever / Q000453:epidemiology*; D009033:Culicidae; D003625:Data Collection; D003715:Dengue / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D013997:Time Factors; D014195:Travel