Cecilia Perret

Illness in Children After International Travel: Analysis From the GeoSentinel Surveillance Network

OBJECTIVE: By using a large, multicenter database, we investigated the characteristics and morbidities of 1591 children returning from 218 global destinations and presenting for care in 19 countries. METHODS: Data reported to the GeoSentinel Surveillance Network between January 1997 and November 2007 were analyzed, to assess demographic features, travel characteristics, and clinical diagnoses of ill pediatric travelers. Data were compared between children and adults and among 3 pediatric age groups (0–5 years, 6–11 years, and 12–17 years). RESULTS: Children were predominantly tourist travelers returning from Asia, sub-Saharan Africa, or Latin America. Compared with adults, children disproportionately presented within 7 days after return, required hospitalization, lacked pretravel health advice, and had traveled for the purpose of visiting friends and relatives. Diarrhea (28%), dermatologic conditions (25%), systemic febrile illnesses (23%), and respiratory disorders (11%) accounted for the majority of diagnoses reported for children. No fatalities were reported. Diarrhea occurred disproportionately among children after exposure to the Middle East/North Africa, dermatologic conditions after exposure to Latin America, systemic febrile illnesses after exposure to sub-Saharan Africa or Asia, and respiratory disorders after exposure to Europe or North America. The proportionate morbidity rates of travel-associated diseases differed among the pediatric age groups and between children and adults. CONCLUSIONS: The health care utilization patterns before and after travel and the profiles of travel-associated health problems differed between children and adults. Health professionals providing pretravel advice need to consider destination- and age-specific susceptibility to travel-related morbidities and develop prevention strategies accordingly.

Anaplasma platys in Dogs, Chile

We conducted a 16S rRNA nested PCR for the genus Ehrlichia and Ehrlichia spp. with blood samples from 30 ill dogs in Chile. Phylogenetic analysis was performed by using groESL gene amplification. We identified Anaplasma platys as 1 of the etiologic agents of canine ehrlichiosis.

Travel-associated Zika virus disease acquired in the americas through February 2016: A GeoSentinel analysis

Background Zika virus has spread rapidly in the Americas and has been imported into many nonendemic countries by travelers. Objective To describe clinical manifestations and epidemiology of Zika virus disease in travelers exposed in the Americas. Design Descriptive, using GeoSentinel records. Setting 63 travel and tropical medicine clinics in 30 countries. Patients Ill returned travelers with a confirmed, probable, or clinically suspected diagnosis of Zika virus disease seen between January 2013 and 29 February 2016. Measurements Frequencies of demographic, trip, and clinical characteristics and complications. Results Starting in May 2015, 93 cases of Zika virus disease were reported. Common symptoms included exanthema (88%), fever (76%), and arthralgia (72%). Fifty-nine percent of patients were exposed in South America; 71% were diagnosed in Europe. Case status was established most commonly by polymerase chain reaction (PCR) testing of blood and less often by PCR testing of other body fluids or serology and plaque-reduction neutralization testing. Two patients developed Guillain-Barré syndrome, and 3 of 4 pregnancies had adverse outcomes (microcephaly, major fetal neurologic abnormalities, and intrauterine fetal death). Limitation Surveillance data collected by specialized clinics may not be representative of all ill returned travelers, and denominator data are unavailable. Conclusion These surveillance data help characterize the clinical manifestations and adverse outcomes of Zika virus disease among travelers infected in the Americas and show a need for global standardization of diagnostic testing. The serious fetal complications observed in this study highlight the importance of travel advisories and prevention measures for pregnant women and their partners. Travelers are sentinels for global Zika virus circulation and may facilitate further transmission. Primary Funding Source Centers for Disease Control and Prevention, International Society of Travel Medicine, and Public Health Agency of Canada.

Dengue-1 Virus Isolation during First Dengue Fever Outbreak on Easter Island, Chile

Dengue virus was detected for the first time in Chile, in an outbreak of dengue fever on Easter Island. The virus was isolated in tissue culture and characterized by reverse transcription–polymerase chain reaction as being dengue type 1.

Sensitivity and Kinetics of an NS1-Based Zika Virus Enzyme-Linked Immunosorbent Assay in Zika Virus-Infected Travelers from Israel, the Czech Republic, Italy, Belgium, Germany, and Chile

ABSTRACT Serological diagnosis of Zika virus is challenging due to high cross-reactivity of Zika virus with other flavivirus antibodies. Recently, a Zika NS1-based enzyme-linked immunosorbent assay (ELISA) was developed and shown to be highly specific for Zika antibody detection; however, sensitivity was evaluated for only a small number of confirmed Zika-infected patients. In this study, we measured the sensitivity and kinetics of Zika IgM and IgG antibodies using the Zika NS1-based ELISA in 105 samples from 63 returning travelers infected with Zika virus (proven by PCR or neutralization assay) from Israel, Czech Republic, Italy, Belgium, Germany, and Chile. Zika virus IgM was detected from 2 to 42 days post-symptom onset (PSO) with an overall sensitivity of 79% in the first month and 68% until 2 months PSO, while IgG antibodies were detected from 5 days to 3 years PSO with 79% sensitivity. Interestingly, significant differences in IgM sensitivity and IgM detection period were observed between Israeli and European/Chilean Zika-infected travelers, adding to the complexity of Zika infection diagnosis and suggesting that other diagnostic methods should be complemented to reduce false-negative results.

Fatal Yellow Fever in Travelers to Brazil, 2018

Yellow fever virus is a mosquito-borne flavivirus that causes yellow fever, an acute infectious disease that occurs in South America and sub-Saharan Africa. Most patients with yellow fever are asymptomatic, but among the 15% who develop severe illness, the case fatality rate is 20%-60%. Effective live-attenuated virus vaccines are available that protect against yellow fever (1). An outbreak of yellow fever began in Brazil in December 2016; since July 2017, cases in both humans and nonhuman primates have been reported from the states of São Paulo, Minas Gerais, and Rio de Janeiro, including cases occurring near large urban centers in these states (2). On January 16, 2018, the World Health Organization updated yellow fever vaccination recommendations for Brazil to include all persons traveling to or living in Espírito Santo, São Paulo, and Rio de Janeiro states, and certain cities in Bahia state, in addition to areas where vaccination had been recommended before the recent outbreak (3). Since January 2018, 10 travel-related cases of yellow fever, including four deaths, have been reported in international travelers returning from Brazil. None of the 10 travelers had received yellow fever vaccination.

Fuente de infección de Bordetella pertussis en lactantes hospitalizados por coqueluche

Background Despite pertussis vaccination, very young infants have the highest rates of morbidity and mortality caused by the microorganism. Aim To determine the source of Pertussis infection in infants aged six months or less in Chile. Material and methods Twenty six household contacts of 10 young infants hospitalized with confirmed Pertussis were studied for the presence of Bordetella Pertussis by polymerase chain reaction (PCR). Clinical and demographic data were analyzed. Results Respiratory symptoms were present in 20 (77%) contacts, being cough the most common. Pertussis cases were identified in every household and in 18 (72%) of the household members. four members with B.pertussis were asymptomatic. Source of infection was identified in 80% (8/10) of the infant cases with ages ranging from 6 to 62 years. Half of primary cases had positive PCR and their cough duration was significantly shorter compared to primary cases with negative PCR. Conclusions B. pertussis transmission to young infants occurred mainly within the household where adults are generally the source of the infection. Risk factors for infant infection are the same as in developed countries. Therefore, the same strategies, such as routine vaccination in adolescents and adults or cocoon strategy, will help to prevent this disease in infants.

Brotes de salmonelosis y el tamaño y rol del Estado en Chile

Resumen Durante el ano 2011 dos brotes de infecciones por Salmonella afectaron la Region Metropolitana (RM) de Chile: uno de fi ebre tifoidea y otro de gastroenteritis por Salmonella serotipo Enteritidis, infecciones que habian declinado en los ultimos anos. Se analizan las probables causas de esta reemergencia. Para el desarrollo de este trabajo se consultaron sitios web gubernamentales y de las Naciones Unidas. Las tasas de fi ebre tifoidea han declinado progresivamente hasta tasas muy bajas siendo la actual cercana a un caso por 100.000 habitantes, disminucion asociada a las mejorias en las condiciones de vida de la poblacion que se expresa por el indice de desarrollo humano alcanzado. El brote del ano 2011 estuvo asociado a un clon predominante que afecto al sector occidente de la RM y donde el unico factor de riesgo involucrado fue el consumo de verduras adquiridas en distintas ferias libres del mismo sector, sin lograr la identifi cacion del sitio de origen. Aunque la notifi cacion de esta enfermedad se ha optimizado en los ultimos anos, al igual que la capacidad de tipifi cacion molecular por parte del Laboratorio de Referencia (ISP), este brote se produce en forma coincidente con un bajo numero de fi scalizaciones alimentarias en la RM (la mas baja de Chile), explicado probablemente por el bajo numero de personal en la reparticion responsable en relacion al tamano de la poblacion. En el caso de las infecciones porUNLABELLED During year 2011 two outbreaks of Salmonella infection captured media attention in the Metropolitan Area (MA) in Chile: one of typhoid fever associated to Salmonella serotype Typhi, and the other, of gastroenteritis related to Salmonella serotype Enteritidis, both with decreasing or stable rates in the previous years. The aim of this work is to analyze probable causes of their reemergence. METHODS Several government websites were searched looking for epidemiological data. RESULTS Typhoid fever rates have declined to current values of 1 case per 100.000 habitants, a decreased associated to improvements in the human development index. The typhoid outbreak was associated to a predominant clone within the MA. The only risk factor identified was consumption of raw vegetables acquired in open fairs, but without identifying a common source. Despite improvements in disease notification and molecular epidemiology capabilities, this outbreak is coincidental with a reduced number of food inspection visits in the MA, probably explained by the limited personnel available for this task. In the case of Salmonella Enteritidis, rates have increased twice since 1998 (5.3 to 10.7 per 100.000 habitants) with an important increase in the number of outbreaks linked to this agent (7 to 31 annual outbreaks) since year 2005. Persistence of this problem is probably associated to the low surveillance of poultry farms made by the Chilean state, to the absence of a cold chain during collection, distribution and selling of eggs, and to the lack of an educational program directed to the population. The recent regulation that bans home-made mayonnaise in restaurant or fast food stores is an important advance that requires further evaluation. CONCLUSIONS The persistence and reemergence of different kind of Salmonellosis in Chile suggests chronic problems on the size and role of the Chilean state regarding food safety.

Age as risk factor for death from pandemic (H1N1) 2009, Chile.

Pandemic (H1N1) 2009 affected Chile during the winter of 2009. The hospitalization rate was 0.56% overall and 3.47% for persons >60 years of age at risk for severe disease and death independent of concurrent conditions. Age >60 years was the major risk factor for death from pandemic (H1N1) 2009.

Recomendaciones para viajeros chilenos a la Copa Mundial de la FIFA 2014 en Brasil

Este articulo proporciona una serie de precauciones a observar y vacunas recomendadas para viajeros chilenos que asistiran a la Copa Mundial de Futbol 2014 en Brasil. Su proposito es ayudar a los medicos a preparar a los visitantes a este masivo evento y resume las recomendaciones utiles para evitar enfermedades infecciosas, teniendo en consideracion las circunstancias y disponibilidad en Chile.