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. 2017 Oct 3;12(10):e0185689.
doi: 10.1371/journal.pone.0185689. eCollection 2017.

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

Karin Leder  1   2 , Martin P Grobusch  3 , Philippe Gautret  4 , Lin H Chen  5   6 , Susan Kuhn  7 , Poh Lian Lim  8   9 , Johnnie Yates  10 , Anne E McCarthy  11   12 , Camilla Rothe  13 , Yasuyuki Kato  14 , Emmanuel Bottieau  15 , Kristina Huber  16 , Eli Schwartz  17   18 , William Stauffer  19 , Denis Malvy  20 , Marc T M Shaw  21 , Christophe Rapp  22 , Lucille Blumberg  23 , Mogens Jensenius  24 , Perry J J van Genderen  25 , Davidson H Hamer  26   27 ; GeoSentinel Surveillance Network
Affiliations

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

Karin Leder et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

Competing Interests: KL is funded by a NHMRC Fellowship, GNT 1084351. Unrelated to this manuscript, she has received research funding and travel support from GlaxoSmithKline. LHC is an advisor for Shoreland, Inc. and has received speaker travel support and honorarium from GSK. DHH has served as a consultant to Inovio Pharmaceuticals. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Place of exposure and place of diagnosis (arrows) of GeoSentinel Zika patients from Africa (green dot), Asia (red dots), and the Pacific (blue dots)—Circular arrows indicate cases in international travelers who contracted Zika while abroad and were diagnosed in the country of exposure while traveling.
Linear arrows indicate cases in international travelers who contracted Zika while abroad and had their diagnosis confirmed on returning to their home country.—Base map is available free of charge from http://www.histgeo.ac-aix-marseille.fr/ancien_site/carto/.
Fig 2
Fig 2. Temporal association of endemic and exported cases with travel notices by international authorities for selected countries in Africa.
Fig 3
Fig 3. Temporal association of endemic and exported cases with travel notices by international authorities for selected countries in Asia.
Fig 4
Fig 4. Temporal association of endemic and exported cases with travel notices by international authorities for selected countries in the Pacific.
See this image and copyright information in PMC

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