Zika beyond the Americas: Travelers as sentinels of Zika virus transmission. A GeoSentinel analysis, 2012 to 2016

Karin Leder (1) , Martin P. Grobusch , Philippe Gautret (2) , Lin H. Chen , Susan Kuhn , Poh Lian Lim (3, 4) , Johnnie Yates , Anne E. Mccarthy , Camilla Rothe , Yasuyuki Kato , Emmanuel Bottieau , Kristina Huber , Eli Schwartz (5) , William Stauffer , Denis Malvy (6) , Marc T. M. Shaw , Christophe Rapp (7, 8) , Lucille Blumberg , Mogens Jensenius , Perry J. J. Van Genderen , Davidson H. Hamer , Geosentinel Surveillance Network

1 Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
2 URMITE - Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes
3 IMRB - Institut Mondor de Recherche Biomédicale
4 INSERM U955, équipe 3
5 PPSM - Laboratoire de Photophysique et Photochimie Supramoléculaires et Macromoléculaires
6 UREN - Unité de Recherche en Epidémiologie Nutritionnelle
7 HIA Begin - Hôpital d'Instruction des Armées Begin [Saint-Mandé, France]
8 CMETE - Centre de vaccination Paris et centre médical bilans de santé

Background Zika virus (ZIKV) was first isolated in Africa; decades later, caused large outbreaks in the Pacific, and is considered endemic in Asia. We aim to describe ZIKV disease epidemiology outside the Americas, the importance of travelers as sentinels of disease transmission, and discrepancies in travel advisories from major international health organizations. Methods and findings This descriptive analysis using GeoSentinel Surveillance Network records involves sixty-four travel and tropical medicine clinics in 29 countries. Ill returned travelers with a confirmed or probable diagnosis of ZIKV disease acquired in Africa, Asia and the Pacific seen between 1 January 2012 and 31 December 2016 are included, and the frequencies of demographic, trip, and diagnostic characteristics described. ZIKV was acquired in Asia (18), the Pacific (10) and Africa (1). For five countries (Indonesia, Philippines, Thailand, Vietnam, Cameroon), GeoSentinel patients were sentinel markers of recent Zika activity. Additionally, the first confirmed ZIKV infection acquired in Kiribati was reported to GeoSentinel (2015), and a probable case was reported from Timor Leste (April 2016), representing the only case known to date. Review of Zika situation updates from major international health authorities for country risk classifications shows heterogeneity in ZIKV country travel advisories. Conclusions Travelers are integral to the global spread of ZIKV, serving as sentinel markers of disease activity. Although GeoSentinel data are collected by specialized clinics and do not capture all imported cases, we show that surveillance of imported infections by returned travelers augments local surveillance system data regarding ZIKV epidemiology and can assist with risk categorization by international authorities. However, travel advisories are variable due to risk uncertainties.

Mots clés: Zika virus; Outpatients; Asia; Blood; Diagnostic medicine; Serology; Epidemiology; Urine

Domaines: Médecine humaine et pathologie

Karin Leder, Martin P. Grobusch, Philippe Gautret, Lin H. Chen, Susan Kuhn, et al.. Zika beyond the Americas: Travelers as sentinels of Zika virus transmission. A GeoSentinel analysis, 2012 to 2016. PLoS ONE, 2017, 12 (10), ⟨10.1371/journal.pone.0185689⟩. ⟨hal-01730465⟩