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Travel Med Infect Dis. 2020 Jan - Feb;33:101543. doi: 10.1016/j.tmaid.2019.101543. Epub 2019 Dec 2.

Characteristics of Zika virus infection among international travelers: A prospective study from a Spanish referral unit.

Author information

1
Hospital Universitario La Paz-Carlos III, IdiPAZ, National Referral Unit for Tropical and Travel Medicine. Department of Internal Medicine, Spain. Electronic address: clara.crespillo@gmail.com.
2
Hospital Universitario La Paz-Carlos III, IdiPAZ, National Referral Unit for Tropical and Travel Medicine. Department of Internal Medicine, Spain. Electronic address: marta.diaz@salud.madrid.org.
3
Hospital Universitario La Paz-Carlos III, IdiPAZ, National Referral Unit for Tropical and Travel Medicine. Department of Internal Medicine, Spain. Electronic address: elena.trigo@salud.madrid.org.
4
Hospital Universitario La Paz-Carlos III, IdiPAZ, National Referral Unit for Tropical and Travel Medicine. Department of Internal Medicine, Spain. Electronic address: marta.arsuaga@salud.madrid.org.
5
Hospital Universitario La Paz-Carlos III, IdiPAZ, National Referral Unit for Tropical and Travel Medicine. Department of Internal Medicine, Spain. Electronic address: fercalleprieto@gmail.com.
6
Hospital Universitario La Paz-Carlos III, IdiPAZ, National Referral Unit for Tropical and Travel Medicine. Department of Internal Medicine, Spain. Electronic address: mariamar.lago@salud.madrid.org.
7
Hospital Universitario La Paz-Carlos III, IdiPAZ, National Referral Unit for Tropical and Travel Medicine. Department of Internal Medicine, Spain. Electronic address: mconcepcion.ladron@salud.madrid.org.
8
Hospital Universitario La Paz-Carlos III, IdiPAZ, National Referral Unit for Tropical and Travel Medicine. Department of Internal Medicine, Spain. Electronic address: pablo.barreiro@salud.madrid.org.
9
Hospital Universitario La Paz-Carlos III, IdiPAZ, Microbiology, Spain. Electronic address: mdolores.montero@salud.madrid.org.
10
Hospital Universitario La Paz-Carlos III, IdiPAZ, Microbiology and Parasitology, Spain. Electronic address: sgbujalance@salud.madrid.org.
11
Hospital Universitario La Paz-Carlos III, IdiPAZ, Department of Gynecology and Obstetrics, Spain. Electronic address: eantolin@salud.madrid.org.
12
Hospital Universitario La Paz-Carlos III, IdiPAZ, Department of Gynecology and Obstetrics, Spain. Electronic address: mcallefm@gmail.com.
13
National Microbiology Centre, Institute of Health Carlos III, Spain. Electronic address: paz.sanchez@isciii.es.
14
National Microbiology Centre, Institute of Health Carlos III, Biomedical Research Networking Centre for Public Health (CiberESP), Spain. Electronic address: fory@isciii.es.
15
National Microbiology Centre, Institute of Health Carlos III, Biomedical Research Networking Centre for Public Health (CiberESP), Spain. Electronic address: A.VAZQUEZ@isciii.es.
16
Instituto de Investigación Hospital La Paz (IdiPaz), Infectious Diseases Unit, Department of Internal Medicine, Spain. Electronic address: joser.arribas@salud.madrid.org.
17
Hospital Universitario La Paz-Carlos III, IdiPAZ, Microbiology, Spain.
18
Hospital Universitario La Paz-Carlos III, IdiPAZ, Department of Gynecology and Obstetrics, Spain.
19
Ultrasound and Fetal Medicine Section, Department of Gynecology and Obstetrics, Spain.
20
Department of Gynecology and Obstetrics, Spain.
21
Pediatrics Department, Neonatology Unit, Spain.
22
National Referral Unit for Tropical and Travel Medicine, Pediatrics Department, Spain.

Abstract

BACKGROUND:

From the first Zika virus (ZIKV) description, it has progressively widespread worldwide. We analyzed demographic, clinical, microbiologic and travel-related characteristic from returned patients from a ZIKV endemic country in a referral Tropical Medicine Unit.

METHOD:

A prospective cohort study performed in a Spanish referral center with the aim of determining the significant factors associated with confirmed Zika virus (ZIKV) infection.

RESULTS:

817 patients, (56% women, median age 36 [IQR, Interquartile Range: 32-42]) were enrolled. Most had returned from Latin America (n = 486; 59.4%), travelled for tourism (n = 404; 49.4%) and stayed a median of 18 days (IQR: 10-30). 602 (73.6%) presented symptoms, but only 25 (4%) were finally diagnosed with confirmed ZIKV infection (including two pregnant women, without adverse fetal outcomes), 88% (n:22) presented with fever and 92% (n:23) with rash. 56% (n:14) arthralgia and/or myalgia and 28% (n:7) conjunctivitis. The presence of conjunctivitis, fever and rash were associated with an 8.9 (95% CI: 2.2-34.9), 6.4 (95% CI: 1.2-33.3) and 72.3 (95% CI: 9.2-563.5) times greater probability of confirmed ZIKV infection, respectively.

CONCLUSION:

Travel characteristics and clinical presentation may help clinicians to optimize requests for microbiological testing. Diagnosis of arboviriasis in travellers arriving form endemic areas remains a challenge for clinicians, but must be detected for the possible transmission outside endemic areas, where the vector is present.

KEYWORDS:

Arbovirus infections; Endemic disease; Travel medicine; Zika virus

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