Syndromic Approach to Arboviral Diagnostics for Global Travelers as a Basis for Infectious Disease Surveillance |
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| Authors: | Natalie B Cleton Chantal B E M Reusken Jiri F P Wagenaar Elske E van der Vaart Johan Reimerink Annemiek A van der Eijk Marion P G Koopmans |
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| Institution: | 1 Erasmus Medical Centre, Rotterdam, The Netherlands, ; 2 National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands, ; 3 University of Reading, Reading, Berkshire, United Kingdom, ; Emory University, UNITED STATES, |
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| Abstract: | BackgroundArboviruses have overlapping geographical distributions and can cause symptoms that coincide with more common infections. Therefore, arbovirus infections are often neglected by travel diagnostics. Here, we assessed the potential of syndrome-based approaches for diagnosis and surveillance of neglected arboviral diseases in returning travelers.MethodTo map the patients high at risk of missed clinical arboviral infections we compared the quantity of all arboviral diagnostic requests by physicians in the Netherlands, from 2009 through 2013, with a literature-based assessment of the travelers’ likely exposure to an arbovirus.Results2153 patients, with travel and clinical history were evaluated. The diagnostic assay for dengue virus (DENV) was the most commonly requested (86%). Of travelers returning from Southeast Asia with symptoms compatible with chikungunya virus (CHIKV), only 55% were tested. For travelers in Europe, arbovirus diagnostics were rarely requested. Over all, diagnostics for most arboviruses were requested only on severe clinical presentation.ConclusionTravel destination and syndrome were used inconsistently for triage of diagnostics, likely resulting in vast under-diagnosis of arboviral infections of public health significance. This study shows the need for more awareness among physicians and standardization of syndromic diagnostic algorithms. |
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