Imported Arbovirus Infections in Spain, 2009-2018

Abstract

To determine the epidemiologic and clinical characteristics of patients in Spain with imported arbovirus infections, we analyzed 22,655 records from a collaborative network for January 2009-December 2018. Among 861 arbovirus infections, 845 were monoinfections (456 [53%] dengue, 280 [32.5%] chikungunya, 109 [12.7%] Zika) and 16 (1.8%) were co-infections. Most patients were travelers (56.3%) or immigrants returning to Spain after visiting friends or relatives (31.3%). Median patient age was 37 years; most (62.3%) were women and some (28.6%) had received pretravel advice. Only 12 patients were immunosuppressed. Six cases (all dengue monoinfections, none in immunosuppressed patients) were severe. Since 2014, nondengue arbovirus infections increased; until 2016, chikungunya and Zika were most common. Imported arbovirus infections (mostly dengue) were frequently diagnosed, although increased chikungunya and Zika virus infections coincided with their introduction and spread in the Americas. A large proportion of cases occurred in women of childbearing age, some despite receipt of pretravel advice.

Keywords: Spain; Zika; arboviruses; chikungunya; dengue; immigration; travel; vector-borne infections; viruses.

Figure

Proportion of arbovirus monoinfections and co-infections, by virus type and year, compared with total number of infections registered in the Red Cooperativa para el Estudio de las Infecciones Importadas por Viajeros e Inmigrantes (+Redivi, http://www.redivi.es) network, Spain, 2009–2018. A) Numbers of arbovirus infections; B) proportion of arbovirus infections compared with total number of infections registered.