Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-30 (of 47 Records) |
Query Trace: Angelo KM[original query] |
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Costs of typhoid vaccination for international travelers from the United States
Joo H , Maskery BA , Francois Watkins LK , Park J , Angelo KM , Halsey ES . Travel Med Infect Dis 2025 102798 In the United States, typhoid vaccination is recommended for international travelers to areas with a recognized risk of typhoid exposure. Using MarketScan® Commercial Database from 2016 through 2022, we estimated typhoid vaccination costs by route (injectable vs. oral) and provider setting (clinic vs. pharmacy). Of 165,930 vaccinated individuals, 99,471 received injectable and 66,459 received oral typhoid vaccines, with 88% and 17% respectively administered at clinics. Average costs for injectable vaccination were $132.91 per person [95% confidence interval (CI): $132.68-$133.13], with clinic and pharmacy costs at $136.38 [95% CI: $136.14-$136.63], and $107.45 [95% CI: $107.13-$107.77] respectively. Oral vaccination costs averaged $81.23 per person [95% CI: $81.14-$81.33], encompassing $86.61 [95% CI: $86.13-$87.10] at clinics and $80.14 [95% CI: $80.09-$80.19] at pharmacies. Out-of-pocket costs comprised 21% and 33% of total costs for injectable and oral vaccinations. These findings may inform clinical decision-making to protect international travelers' health. |
Analysis of monkeypox virus exposures and lesions by anatomic site
Guagliardo SAJ , Smith T , Hamer DH , Huits R , Kozarsky P , Libman M , McCollum AM , Angelo KM . Emerg Infect Dis 2024 30 (11) We used cross-sectional data from 226 patients with monkeypox virus to investigate the association between anatomic exposure site and lesion development. Penile, anorectal, and oral exposures predicted lesion presence at correlating anatomic sites. Exposure site also predicted the first lesion site of the penis and anus. |
Intestinal protozoa in returning travellers: a GeoSentinel analysis from 2007 to 2019
Weitzel T , Brown A , Libman M , Perret C , Huits R , Chen L , Leung DT , Leder K , Connor BA , Menéndez MD , Asgeirsson H , Schwartz E , Salvador F , Malvy D , Saio M , Norman FF , Amatya B , Duvignaud A , Vaughan S , Glynn M , Angelo KM . J Travel Med 2024 31 (4) BACKGROUND: Prolonged diarrhoea is common amongst returning travellers and is often caused by intestinal protozoa. However, the epidemiology of travel-associated illness caused by protozoal pathogens is not well described. METHODS: We analysed records of returning international travellers with illness caused by Giardia duodenalis, Cryptosporidium spp., Cyclospora cayetanensis or Cystoisospora belli, reported to the GeoSentinel Network during January 2007-December 2019. We excluded records of travellers migrating, with an unascertainable exposure country, or from GeoSentinel sites that were not located in high-income countries. RESULTS: There were 2517 cases, 82.3% giardiasis (n = 2072), 11.4% cryptosporidiosis (n = 287), 6.0% cyclosporiasis (n = 150) and 0.3% cystoisosporiasis (n = 8). Overall, most travellers were tourists (64.4%) on long trips (median durations: 18-30 days). Cryptosporidiosis more frequently affected people < 18 years (13.9%) and cyclosporiasis affected people ≥ 40 years (59.4%). Giardiasis was most frequently acquired in South Central Asia (45.8%) and sub-Saharan Africa (22.6%), cryptosporidiosis in sub-Saharan Africa (24.7%) and South-Central Asia (19.5%), cyclosporiasis in South East Asia (31.3%) and Central America (27.3%), and cystoisosporiasis in sub-Saharan Africa (62.5%). Cyclosporiasis cases were reported from countries of uncertain endemicity (e.g. Cambodia) or in countries with no previous evidence of this parasite (e.g. French Guiana). The time from symptom onset to presentation at a GeoSentinel site was the longest amongst travellers with giardiasis (median: 30 days). Over 14% of travellers with cryptosporidiosis were hospitalized. CONCLUSIONS: This analysis provides new insights into the epidemiology and clinical significance of four intestinal protozoa that can cause morbidity in international travellers. These data might help optimize pretravel advice and post-travel management of patients with travel-associated prolonged gastrointestinal illnesses. This analysis reinforces the importance of international travel-related surveillance to identify sentinel cases and areas where protozoal infections might be undetected or underreported. |
Travel health-related preparation practices of institutions of higher education and occurrence of health-related events among undergraduate students studying abroad, 2018-2021
Angelo KM , Ciampaglio K , Richards J , Silva A , Ebelke C , Flaherty GT , Brunette G , Kohl S . Frontiers (Boston) 2024 36 (1) 418-498 BACKGROUND: Knowledge of specific health-related events encountered by students studying abroad and the availability and use of pre-travel healthcare for these students is lacking. METHODS: Anonymous web-based questionnaires were sent to study abroad offices, student health centers, and undergraduate students after studying abroad at eight institutions of higher education in the United States and Ireland from 2018-2021. Analyses were descriptive; relative risks and 95% confidence intervals were calculated for health-related events. RESULTS: One study abroad office required a pre-travel consultation. All student health centers had pre-travel counseling available. Among 686 students, there were 307 infectious and 1,588 non-infectious health-related issues; 12 students (2%) were hospitalized. Duration of travel and timing of a pre-travel consultation impacted the risk of health-related events. Certain mental health conditions were associated with increased risk of alcohol and drug use. CONCLUSION: Future studies should address the optimal timing and best practices to optimize health for students studying abroad. |
From GeoSentinel data to epidemiological insights: a multidisciplinary effort towards artificial intelligence-supported detection of infectious disease outbreaks
Heidema S , Stoepker IV , Flaherty G , Angelo KM , Post RAJ , Miller C , Libman M , Hamer DH , van den Heuvel ER , Huits R . J Travel Med 2024 ![]() The growing complexity of GeoSentinel surveillance data creates opportunities for novel data | science-based outbreak detection methods. Challenges may be overcome by effective | multidisciplinary collaboration. The early signals generated by outbreak detection methods using | GeoSentinel data may influence policymaking, shape public health responses, and contribute to | global disease control strategies |
Chikungunya infection in returned travellers: results from the GEOSENTINEL network, 2005-2020
Bierbrier R , Javelle E , Norman FF , Chen LH , Bottieau E , Schwartz E , Leder K , Angelo KM , Stoney R , Libman M , Hamer DH , Huits R , Connor BA , Simon F , Barkati S . J Travel Med 2024 BACKGROUND: Chikungunya is an important travel-related disease because of its rapid geographical expansion and potential for prolonged morbidity. Improved understanding of the epidemiology of travel-related chikungunya infections may influence prevention strategies including education and vaccination. METHODS: We analysed data from travellers with confirmed or probable chikungunya reported to GeoSentinel sites from 2005 to 2020. Confirmed chikungunya was defined as a compatible clinical history plus either virus isolation, positive nucleic acid test, or seroconversion/rising titre in paired sera. Probable chikungunya was defined as a compatible clinical history with a single positive serology result. RESULTS: 1202 travellers (896 confirmed and 306 probable) with chikungunya were included. The median age was 43 years (range 0-91; interquartile range [IQR]: 31-55); 707 (58.8%) travellers were female. Most infections were acquired in the Caribbean (28.8%), Southeast Asia (22.8%), South Central Asia (14.2%) and South America (14.2%). The highest numbers of chikungunya cases reported to GeoSentinel were in 2014 (28.3%), 2015 (14.3%), and 2019 (11.9%). The most frequent reasons for travel were tourism (n = 592; 49.3%) and visiting friends or relatives (n = 334; 27.7%). The median time to presentation to a GeoSentinel site was 23 days (IQR: 7-52) after symptom onset. In travellers with confirmed chikungunya and no other reported illnesses, the most frequently reported symptoms included musculoskeletal symptoms (98.8%), fever/chills/sweats (68.7%), and skin symptoms (35.5%). Among 917 travellers with information available, 296 (32.3%) had a pre-travel consultation. CONCLUSIONS: Chikungunya was acquired by international travellers in almost 100 destinations globally. Vector precautions and vaccination where recommended should be integrated into pretravel visits for travellers going to areas with chikungunya or areas with the potential for transmission.Continued surveillance of travel-related chikungunya may help public health officials and clinicians limit the transmission of this potentially debilitating disease by defining regions where protective measures (e.g. pre-travel vaccination) should be strongly considered. |
A zebra among the horses: Clinical implications of malaria in the United States
Huits R , Wallender E , Angelo KM , Libman M , Hamer DH . Ann Intern Med 2023 176 (9) 1269-1270 On 26 June 2023, the U.S. Centers for Disease Control and Prevention (CDC) issued a Health Alert Network report about locally acquired, mosquito-transmitted Plasmodium vivax malaria. As of 19 July 2023, 7 cases in Florida (Sarasota County) and 1 in Texas (Cameron County) had been reported. Of note, the Texas case is unrelated to the Florida cases. All of the patients received treatment and have recovered. Active surveillance for additional cases by the state health departments and mosquito control measures are ongoing (1). |
Travel-related diagnoses among U.S. nonmigrant travelers or migrants presenting to U.S. GeoSentinel Sites - GeoSentinel Network, 2012-2021
Brown AB , Miller C , Hamer DH , Kozarsky P , Libman M , Huits R , Rizwan A , Emetulu H , Waggoner J , Chen LH , Leung DT , Bourque D , Connor BA , Licitra C , Angelo KM . MMWR Surveill Summ 2023 72 (7) 1-22 PROBLEM/CONDITION: During 2012-2021, the volume of international travel reached record highs and lows. This period also was marked by the emergence or large outbreaks of multiple infectious diseases (e.g., Zika virus, yellow fever, and COVID-19). Over time, the growing ease and increased frequency of travel has resulted in the unprecedented global spread of infectious diseases. Detecting infectious diseases and other diagnoses among travelers can serve as sentinel surveillance for new or emerging pathogens and provide information to improve case identification, clinical management, and public health prevention and response. REPORTING PERIOD: 2012-2021. DESCRIPTION OF SYSTEM: Established in 1995, the GeoSentinel Network (GeoSentinel), a collaboration between CDC and the International Society of Travel Medicine, is a global, clinical-care-based surveillance and research network of travel and tropical medicine sites that monitors infectious diseases and other adverse health events that affect international travelers. GeoSentinel comprises 71 sites in 29 countries where clinicians diagnose illnesses and collect demographic, clinical, and travel-related information about diseases and illnesses acquired during travel using a standardized report form. Data are collected electronically via a secure CDC database, and daily reports are generated for assistance in detecting sentinel events (i.e., unusual patterns or clusters of disease). GeoSentinel sites collaborate to report disease or population-specific findings through retrospective database analyses and the collection of supplemental data to fill specific knowledge gaps. GeoSentinel also serves as a communications network by using internal notifications, ProMed alerts, and peer-reviewed publications to alert clinicians and public health professionals about global outbreaks and events that might affect travelers. This report summarizes data from 20 U.S. GeoSentinel sites and reports on the detection of three worldwide events that demonstrate GeoSentinel's notification capability. RESULTS: During 2012-2021, data were collected by all GeoSentinel sites on approximately 200,000 patients who had approximately 244,000 confirmed or probable travel-related diagnoses. Twenty GeoSentinel sites from the United States contributed records during the 10-year surveillance period, submitting data on 18,336 patients, of which 17,389 lived in the United States and were evaluated by a clinician at a U.S. site after travel. Of those patients, 7,530 (43.3%) were recent migrants to the United States, and 9,859 (56.7%) were returning nonmigrant travelers.Among the recent migrants to the United States, the median age was 28.5 years (range = <19 years to 93 years); 47.3% were female, and 6.0% were U.S. citizens. A majority (89.8%) were seen as outpatients, and among 4,672 migrants with information available, 4,148 (88.8%) did not receive pretravel health information. Of 13,986 diagnoses among migrants, the most frequent were vitamin D deficiency (20.2%), Blastocystis (10.9%), and latent tuberculosis (10.3%). Malaria was diagnosed in 54 (<1%) migrants. Of the 26 migrants diagnosed with malaria for whom pretravel information was known, 88.5% did not receive pretravel health information. Before November 16, 2018, patients' reasons for travel, exposure country, and exposure region were not linked to an individual diagnosis. Thus, results of these data from January 1, 2012, to November 15, 2018 (early period), and from November 16, 2018, to December 31, 2021 (later period), are reported separately. During the early and later periods, the most frequent regions of exposure were Sub-Saharan Africa (22.7% and 26.2%, respectively), the Caribbean (21.3% and 8.4%, respectively), Central America (13.4% and 27.6%, respectively), and South East Asia (13.1% and 16.9%, respectively). Migrants with diagnosed malaria were most frequently exposed in Sub-Saharan Africa (89.3% and 100%, respectively).Among nonmigrant travelers returning to the United States, the median age was 37 years (range = <19 years to 96 years); 55.7% were female, 75.3% were born in the United States, and 89.4% were U.S. citizens. A majority (90.6%) were seen as outpatients, and of 8,967 nonmigrant travelers with available information, 5,878 (65.6%) did not receive pretravel health information. Of 11,987 diagnoses, the most frequent were related to the gastrointestinal system (5,173; 43.2%). The most frequent diagnoses among nonmigrant travelers were acute diarrhea (16.9%), viral syndrome (4.9%), and irritable bowel syndrome (4.1%).Malaria was diagnosed in 421 (3.5%) nonmigrant travelers. During the early (January 1, 2012, to November 15, 2018) and later (November 16, 2018, to December 31, 2021) periods, the most frequent reasons for travel among nonmigrant travelers were tourism (44.8% and 53.6%, respectively), travelers visiting friends and relatives (VFRs) (22.0% and 21.4%, respectively), business (13.4% and 12.3%, respectively), and missionary or humanitarian aid (13.1% and 6.2%, respectively). The most frequent regions of exposure for any diagnosis among nonmigrant travelers during the early and later period were Central America (19.2% and 17.3%, respectively), Sub-Saharan Africa (17.7% and 25.5%, respectively), the Caribbean (13.0% and 10.9%, respectively), and South East Asia (10.4% and 11.2%, respectively).Nonmigrant travelers who had malaria diagnosed were most frequently exposed in Sub-Saharan Africa (88.6% and 95.9% during the early and later period, respectively) and VFRs (70.3% and 57.9%, respectively). Among VFRs with malaria, a majority did not receive pretravel health information (70.2% and 83.3%, respectively) or take malaria chemoprophylaxis (88.3% and 100%, respectively). INTERPRETATION: Among ill U.S. travelers evaluated at U.S. GeoSentinel sites after travel, the majority were nonmigrant travelers who most frequently received a gastrointestinal disease diagnosis, implying that persons from the United States traveling internationally might be exposed to contaminated food and water. Migrants most frequently received diagnoses of conditions such as vitamin D deficiency and latent tuberculosis, which might result from adverse circumstances before and during migration (e.g., malnutrition and food insecurity, limited access to adequate sanitation and hygiene, and crowded housing,). Malaria was diagnosed in both migrants and nonmigrant travelers, and only a limited number reported taking malaria chemoprophylaxis, which might be attributed to both barriers to acquiring pretravel health care (especially for VFRs) and lack of prevention practices (e.g., insect repellant use) during travel. The number of ill travelers evaluated by U.S. GeoSentinel sites after travel decreased in 2020 and 2021 compared with previous years because of the COVID-19 pandemic and associated travel restrictions. GeoSentinel detected limited cases of COVID-19 and did not detect any sentinel cases early in the pandemic because of the lack of global diagnostic testing capacity. PUBLIC HEALTH ACTION: The findings in this report describe the scope of health-related conditions that migrants and returning nonmigrant travelers to the United States acquired, illustrating risk for acquiring illnesses during travel. In addition, certain travelers do not seek pretravel health care, even when traveling to areas in which high-risk, preventable diseases are endemic. Health care professionals can aid international travelers by providing evaluations and destination-specific advice.Health care professionals should both foster trust and enhance pretravel prevention messaging for VFRs, a group known to have a higher incidence of serious diseases after travel (e.g., malaria and enteric fever). Health care professionals should continue to advocate for medical care in underserved populations (e.g., VFRs and migrants) to prevent disease progression, reactivation, and potential spread to and within vulnerable populations. Because both travel and infectious diseases evolve, public health professionals should explore ways to enhance the detection of emerging diseases that might not be captured by current surveillance systems that are not site based. |
Genomic epidemiology of a severe acute respiratory syndrome coronavirus 2 outbreak in a US major league soccer club: Was it travel related
Carmola LR , Turcinovic J , Draper G , Webner D , Putukian M , Silvers-Granelli H , Bombin A , Connor BA , Angelo KM , Kozarsky P , Libman M , Huits R , Hamer DH , Fairley JK , Connor JH , Piantadosi A , Bourque DL . Open Forum Infect Dis 2023 10 (6) ofad235 ![]() ![]() BACKGROUND: Professional soccer athletes are at risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). United States Major League Soccer (MLS) uses protocol-based SARS-CoV-2 testing for identification of individuals with coronavirus disease 2019. METHODS: Per MLS protocol, fully vaccinated players underwent SARS-CoV-2 real-time polymerase chain reaction testing weekly; unvaccinated players were tested every other day. Demographic and epidemiologic data were collected from individuals who tested positive, and contact tracing was performed. Whole genome sequencing (WGS) was performed on positive specimens, and phylogenetic analyses were used to identify potential transmission patterns. RESULTS: In the fall of 2021, all 30 players from 1 MLS team underwent SARS-CoV-2 testing per protocol; 27 (90%) were vaccinated. One player who had recently traveled to Africa tested positive for SARS-CoV-2; within the following 2 weeks, 10 additional players and 1 staff member tested positive. WGS yielded full genome sequences for 10 samples, including 1 from the traveler. The traveler's sample was Delta sublineage AY.36 and was closely related to a sequence from Africa. Nine samples yielded other Delta sublineages including AY.4 (n = 7), AY.39 (n = 1), and B.1.617.2 (n = 1). The 7 AY.4 sequences clustered together; suggesting a common source of infection. Transmission from a family member visiting from England to an MLS player was identified as the potential index case. The other 2 AY.4 sequences differed from this group by 1-3 nucleotides, as did a partial genome sequence from an additional team member. CONCLUSIONS: WGS is a useful tool for understanding SARS-CoV-2 transmission dynamics in professional sports teams. |
Clinical characteristics and outcomes among travelers with severe Dengue : A geosentinel analysis
Huits R , Angelo KM , Amatya B , Barkati S , Barnett ED , Bottieau E , Emetulu H , Epelboin L , Eperon G , Medebb L , Gobbi F , Grobusch MP , Itani O , Jordan S , Kelly P , Leder K , Díaz-Menéndez M , Okumura N , Rizwan A , Rothe C , Saio M , Waggoner J , Yoshimura Y , Libman M , Hamer DH , Schwartz E . Ann Intern Med 2023 176 (7) 940-948 BACKGROUND: Dengue virus is a flavivirus transmitted by Aedes mosquitoes and is an important cause of illness worldwide. Data on the severity of travel-associated dengue illness are limited. OBJECTIVE: To describe the epidemiology, clinical characteristics, and outcomes among international travelers with severe dengue or dengue with warning signs as defined by the 2009 World Health Organization classification (that is, complicated dengue). DESIGN: Retrospective chart review and analysis of travelers with complicated dengue reported to GeoSentinel from January 2007 through July 2022. SETTING: 20 of 71 international GeoSentinel sites. PATIENTS: Returning travelers with complicated dengue. MEASUREMENTS: Routinely collected surveillance data plus chart review with abstraction of clinical information using predefined grading criteria to characterize the manifestations of complicated dengue. RESULTS: Of 5958 patients with dengue, 95 (2%) had complicated dengue. Eighty-six (91%) patients had a supplemental questionnaire completed. Eighty-five of 86 (99%) patients had warning signs, and 27 (31%) were classified as severe. Median age was 34 years (range, 8 to 91 years); 48 (56%) were female. Patients acquired dengue most frequently in the Caribbean (n = 27 [31%]) and Southeast Asia (n = 21 [24%]). Frequent reasons for travel were tourism (46%) and visiting friends and relatives (32%). Twenty-one of 84 (25%) patients had comorbidities. Seventy-eight (91%) patients were hospitalized. One patient died of nondengue-related illnesses. Common laboratory findings and signs were thrombocytopenia (78%), elevated aminotransferase (62%), bleeding (52%), and plasma leakage (20%). Among severe cases, ophthalmologic pathology (n = 3), severe liver disease (n = 3), myocarditis (n = 2), and neurologic symptoms (n = 2) were reported. Of 44 patients with serologic data, 32 confirmed cases were classified as primary dengue (IgM+/IgG-) and 12 as secondary (IgM-/IgG+) dengue. LIMITATIONS: Data for some variables could not be retrieved by chart review for some patients. The generalizability of our observations may be limited. CONCLUSION: Complicated dengue is relatively rare in travelers. Clinicians should monitor patients with dengue closely for warning signs that may indicate progression to severe disease. Risk factors for developing complications of dengue in travelers need further prospective study. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention, International Society of Travel Medicine, Public Health Agency of Canada, and GeoSentinel Foundation. |
Mpox respiratory transmission: the state of the evidence.
Beeson A , Styczynski A , Hutson CL , Whitehill F , Angelo KM , Minhaj FS , Morgan C , Ciampaglio K , Reynolds MG , McCollum AM , Guagliardo SAJ . Lancet Microbe 2023 4 (4) e277-e283 ![]() ![]() The relative contribution of the respiratory route to transmission of mpox (formerly known as monkeypox) is unclear. We review the evidence for respiratory transmission of monkeypox virus (MPXV), examining key works from animal models, human outbreaks and case reports, and environmental studies. Laboratory experiments have initiated MPXV infection in animals via respiratory routes. Some animal-to-animal respiratory transmission has been shown in controlled studies, and environmental sampling studies have detected airborne MPXV. Reports from real-life outbreaks demonstrate that transmission is associated with close contact, and although it is difficult to infer the route of MPXV acquisition in individual case reports, so far respiratory transmission has not been specifically implicated. Based on the available evidence, the likelihood of human-to-human MPXV respiratory transmission appears to be low; however, studies should continue to assess this possibility. |
Dengue outbreak among travellers returning from Cuba-GeoSentinel Surveillance Network, January-September 2022
Díaz-Menéndez M , Angelo KM , de Miguel Buckley R , Bottieau E , Huits R , Grobusch MP , Gobbi FG , Asgeirsson H , Duvignaud A , Norman FF , Javelle E , Epelboin L , Rothe C , Chappuis F , Martinez GE , Popescu C , Camprubí-Ferrer D , Molina I , Odolini S , Barkati S , Kuhn S , Vaughan S , McCarthy A , Lago M , Libman MD , Hamer DH . J Travel Med 2023 30 (2) Increasing numbers of travellers returning from Cuba with dengue virus infection were reported to the GeoSentinel Network from June to September 2022, reflecting an ongoing local outbreak. This report demonstrates the importance of travellers as sentinels of arboviral outbreaks and highlights the need for early identification of travel-related dengue. |
Epidemiological and clinical characteristics of patients with monkeypox in the GeoSentinel Network: a cross-sectional study
Angelo KM , Smith T , Camprubí-Ferrer D , Balerdi-Sarasola L , Díaz Menéndez M , Servera-Negre G , Barkati S , Duvignaud A , Huber KLB , Chakravarti A , Bottieau E , Greenaway C , Grobusch MP , Mendes Pedro D , Asgeirsson H , Popescu CP , Martin C , Licitra C , de Frey A , Schwartz E , Beadsworth M , Lloveras S , Larsen CS , Guagliardo SAJ , Whitehill F , Huits R , Hamer DH , Kozarsky P , Libman M . Lancet Infect Dis 2022 23 (2) 196-206 BACKGROUND: The early epidemiology of the 2022 monkeypox epidemic in non-endemic countries differs substantially from the epidemiology previously reported from endemic countries. We aimed to describe the epidemiological and clinical characteristics among individuals with confirmed cases of monkeypox infection. METHODS: We descriptively analysed data for patients with confirmed monkeypox who were included in the GeoSentinel global clinical-care-based surveillance system between May 1 and July 1 2022, across 71 clinical sites in 29 countries. Data collected included demographics, travel history including mass gathering attendance, smallpox vaccination history, social history, sexual history, monkeypox exposure history, medical history, clinical presentation, physical examination, testing results, treatment, and outcomes. We did descriptive analyses of epidemiology and subanalyses of patients with and without HIV, patients with CD4 counts of less than 500 cells per mm(3) or 500 cells per mm(3) and higher, patients with one sexual partner or ten or more sexual partners, and patients with or without a previous smallpox vaccination. FINDINGS: 226 cases were reported at 18 sites in 15 countries. Of 211 men for whom data were available, 208 (99%) were gay, bisexual, or men who have sex with men (MSM) with a median age of 37 years (range 18-68; IQR 32-43). Of 209 patients for whom HIV status was known, 92 (44%) men had HIV infection with a median CD4 count of 713 cells per mm(3) (range 36-1659; IQR 500-885). Of 219 patients for whom data were available, 216 (99%) reported sexual or close intimate contact in the 21 days before symptom onset; MSM reported a median of three partners (IQR 1-8). Of 195 patients for whom data were available, 78 (40%) reported close contact with someone who had confirmed monkeypox. Overall, 30 (13%) of 226 patients were admitted to hospital; 16 (53%) of whom had severe illness, defined as hospital admission for clinical care rather than infection control. No deaths were reported. Compared with patients without HIV, patients with HIV were more likely to have diarrhoea (p=0·002), perianal rash or lesions (p=0·03), and a higher rash burden (median rash burden score 9 [IQR 6-21] for patients with HIV vs median rash burden score 6 [IQR 3-14] for patients without HIV; p<0·0001), but no differences were identified in the proportion of men who had severe illness by HIV status. INTERPRETATION: Clinical manifestations of monkeypox infection differed by HIV status. Recommendations should be expanded to include pre-exposure monkeypox vaccination of groups at high risk of infection who plan to engage in sexual or close intimate contact. FUNDING: US Centers for Disease Control and Prevention, International Society of Travel Medicine. |
A country classification system to inform rabies prevention guidelines and regulations
Henry RE , Blanton JD , Angelo KM , Pieracci EG , Stauffer K , Jentes ES , Allen J , Glynn M , Brown C , Friedman CR , Wallace R . J Travel Med 2022 29 (4) BACKGROUND: Assessing the global risk of rabies exposure is a complicated task requiring individual risk assessments, knowledge of rabies epidemiology, surveillance capacity, and accessibility of rabies biologics on a national and regional scale. In many parts of the world, availability of this information is limited and when available is often dispersed across multiple sources. This hinders the process of making evidence-based health and policy recommendations to prevent the introduction and spread of rabies. METHODS: CDC conducted a country-by-country qualitative assessment of risk and protective factors for rabies to develop an open-access database of core metrics consisting of the presence of Lyssaviruses (specifically canine or wildlife rabies virus variants or other bat Lyssaviruses), access to rabies immunoglobulins and vaccines, rabies surveillance capacity, and canine rabies control capacity. Using these metrics, we developed separate risk scoring systems to inform rabies prevention guidance for travelers and regulations for the importation of dogs. Both scoring systems assigned higher risk to countries with enzootic rabies (particularly canine rabies), and the risk scoring system for travelers also considered protective factors such as the accessibility of rabies biologics for postexposure prophylaxis. Cumulative scores were calculated across the assessed metrics to assign a risk value of low, moderate, or high. RESULTS: A total of 240 countries, territories, and dependencies were assessed, for travelers, 116 were identified as moderate to high risk and 124 were low or no risk; for canine rabies virus variant importation, 111 were identified as high-risk and 129 were low or no risk. CONCLUSIONS: We developed a comprehensive and easily accessible source of information for assessing the rabies risk for individual countries that included a database of rabies risk and protective factors based on enzootic status and availability of biologics, provided a resource that categorizes risk by country, and provided guidance based on these risk categories for travelers and importers of dogs into the United States. |
Multidrug-resistant tuberculosis imported into low-incidence countries-a GeoSentinel analysis, 2008-2020
Eimer J , Patimeteeporn C , Jensenius M , Gkrania-Klotsas E , Duvignaud A , Barnett ED , Hochberg NS , Chen LH , Trigo-Esteban E , Gertler M , Greenaway C , Grobusch MP , Angelo KM , Hamer DH , Caumes E , Asgeirsson H . J Travel Med 2021 28 (6) BACKGROUND: Early detection of imported multidrug-resistant tuberculosis (MDR-TB) is crucial, but knowledge gaps remain about migration- and travel-associated MDR-TB epidemiology. The aim was to describe epidemiologic characteristics among international travelers and migrants with MDR-TB. METHODS: Clinician-determined and microbiologically confirmed MDR-TB diagnoses deemed to be related to travel or migration were extracted from GeoSentinel, a global surveillance network of travel and tropical medicine clinics, from January 2008 through December 2020. MDR-TB was defined as resistance to both isoniazid and rifampicin. Additional resistance to either a fluoroquinolone or a second-line injectable drug was categorized as pre-extensively drug-resistant (pre-XDR) TB, and as extensively drug-resistant (XDR) TB when resistance was detected for both. Sub-analyses were performed based on degree of resistance and country of origin. RESULTS: Of 201 patients, 136 had MDR-TB (67.7%), 25 had XDR-TB (12.4%), 23 had pre-XDR TB (11.4%), and 17 had unspecified MDR- or XDR-TB (8.5%); 196 (97.5%) were immigrants, of which 92 (45.8%) originated from the former Soviet Union. The median interval from arrival to presentation was 154 days (interquartile range [IQR]: 10-751 days); 34.3% of patients presented within 1 month after immigration, 30.9% between 1 and 12 months, and 34.9% after ≥1 year. Pre-XDR- and XDR-TB patients from the former Soviet Union other than Georgia presented earlier than those with MDR-TB (26 days [IQR: 8-522] vs. 369 days [IQR: 84-827]) while patients from Georgia presented very early, irrespectively of the level of resistance (8 days [IQR: 2-18] vs. 2 days [IQR: 1-17]). CONCLUSIONS: MDR-TB is uncommon in traditional travellers. Purposeful medical migration may partly explain differences in time to presentation among different groups. Public health resources are needed to better understand factors contributing to cross-border MDR-TB spread and to develop strategies to optimize care of TB-infected patients in their home countries before migration. |
Traveller exposures to animals: A GeoSentinel analysis
Muehlenbein MP , Angelo KM , Schlagenhauf P , Chen L , Grobusch MP , Gautret P , Duvignaud A , Chappuis F , Kain KC , Bottieau E , Epelboin L , Shaw M , Hynes N , Hamer DH . J Travel Med 2020 27 (7) BACKGROUND: Human coexistence with other animals can result in both intentional and unintentional contact with a variety of mammalian and non-mammalian species. International travellers are at risk for such encounters; travellers risk injury, infection and possibly death from domestic and wild animal bites, scratches, licks and other exposures. The aim of the present analysis was to understand the diversity and distribution of animal-related exposures among international travellers. METHODS: Data from January 2007 through December 2018 from the GeoSentinel Surveillance Network were reviewed. Records were included if the exposure was non-migration travel with a diagnosis of an animal (dog, cat, monkey, snake or other) bite or other exposure (non-bite); records were excluded if the region of exposure was not ascertainable or if another, unrelated acute diagnosis was reported. RESULTS: A total of 6470 animal exposures (bite or non-bite) were included. The majority (71%) occurred in Asia. Travellers to 167 countries had at least one report of an animal bite or non-bite exposure. The majority (76%) involved dogs, monkeys and cats, although a wide range of wild and domestic species were involved. Almost two-thirds (62.6%) of 4395 travellers with information available did not report a pretravel consultation with a healthcare provider. CONCLUSIONS: Minimizing bites and other animal exposures requires education (particularly during pretravel consultations) and behavioral modification. These should be supplemented by the use of pre-exposure rabies vaccination for travellers to high-risk countries (especially to those with limited access to rabies immunoglobulin), as well as encouragement of timely (in-country) post-exposure prophylaxis for rabies and Macacine alphaherpesvirus 1 (herpesvirus B) when warranted. |
Health Problems in Travellers to Nepal Visiting CIWEC Clinic in Kathmandu - A GeoSentinel Analysis
Pandey P , Lee K , Amatya B , Angelo KM , Shlim DR , Murphy H . Travel Med Infect Dis 2021 40 101999 BackgroundNepal has always been a popular international travel destination. There is limited published data, however, on the spectrum of illnesses acquired by travellers to Nepal. MethodsGeoSentinel is a global data collection network of travel and tropical medicine providers that monitors travel-related morbidity. Records for ill travellers with at least one confirmed or probable diagnosis, were extracted from the GeoSentinel database for the CIWEC Clinic Kathmandu site from January 1, 2009 to December 31, 2017. ResultsA total of 24,271 records were included. The median age was 30 years (range: 0-91); 54% were female. The top 3 system-based diagnoses in travellers were: gastrointestinal (32%), pulmonary (16%), and dermatologic (9%). Altitude illness comprised 9% of all diagnoses. There were 278 vaccine-preventable diseases, most frequently influenza A (41%) and typhoid fever (19%; S. typhi 52 and S. paratyphi 62). Of 64 vector-borne illnesses, dengue was the most frequent (64%), followed by imported malaria (14%). There was a single traveller with Japanese encephalitis. Six deaths were reported. ConclusionsTravel lers to Nepal face a wide spectrum of illnesses, particularly diarrhoea, respiratory disease, and altitude illness. Pre-travel consultations for travellers to Nepal should focus on prevention and treatment of diarrhoea and altitude illness, along with appropriate immunizations and travel advice. |
25 years: GeoSentinel's impact on travel-related surveillance and its vision for the future
Angelo KM . J Travel Med 2020 27 (7) GeoSentinel (https://www.istm.org/geosentinel) is an international network of healthcare sites and providers dedicated to the surveillance of infectious and selected non-infectious travel-related health issues among travelers and migrants. Sites provide routine clinical care to ill travelers and contribute demographic, travel and clinical surveillance data to a central electronic database. The GeoSentinel Network tracks travel-related diseases of potential global impact and helps advance the field of travel medicine, by keeping clinicians and public health practitioners up-to-date on the epidemiology and clinical presentation of key travel-related illnesses, thus improving the understanding of the spread of these illnesses across international borders. |
Epidemiological, and clinical characteristics of international travelers with enteric fever and antibiotic resistance profiles of their isolates: A GeoSentinel Analysis
Hagmann SHF , Angelo KM , Huits R , Plewes K , Eperon G , Grobusch MP , McCarthy A , Libman M , Caumes E , Leung DT , Asgeirsson H , Jensenius M , Schwartz E , Sánchez-Montalvá A , Kelly P , Pandey P , Leder K , Bourque DL , Yoshimura Y , Mockenhaupt FP , van Genderen PJJ , Odolini S , Schlagenhauf P , Connor BA , Hamer DH . Antimicrob Agents Chemother 2020 64 (11) Background. Enteric fever, caused by Salmonella enterica serovar Typhi (S. Typhi) and Paratyphi (S. Paratyphi), is a common travel-related illness. Limited data are available on their antimicrobial resistance (AMR) patterns among travelers. Methods. Records with a culture-confirmed diagnosis seen during or after travel from January 2007 to December 2018 were obtained from GeoSentinel. Traveler demographics and antimicrobial susceptibility data were analyzed. Isolates were classified as 'non-susceptible' if intermediate or resistant, or 'susceptible' in accordance with participating site's national guidelines. Results. A total of 889 travelers (S. Typhi, n=474; S. Paratyphi, n=414; co-infection, n=1) were included; 114 (13%) were children <18 years. Most (41%) traveled to visit friends and relatives (VFRs) and acquired the infection in South Asia (71%). Child travelers with S. Typhi were most frequently VFRs (77%). The median trip duration was 31 days (interquartile range: 18-61 days) and 448 of 691 (65%) had no pre-travel consultation. Of 143 S. Typhi and 75 S. Paratyphi isolates with susceptibility data, non-susceptibility to antibiotics varied (fluoroquinolones: 65% vs 56% respectively; cotrimoxazole: 13% vs 0%; macrolides: 8% vs 16%). Two S. Typhi isolates (1.5%) from India were non-susceptible to 3(rd)-generation cephalosporins. S. Typhi fluoroquinolone non-susceptibility was highest when infection was acquired in South Asia (70 of 90; 78%) and sub-Saharan Africa (6 of 10; 60%). Conclusions. Enteric fever is an important travel-associated illness complicated by AMR. Our data contributes to a better understanding of region-specific AMR helping inform empirical treatment options. Prevention measures need to focus on high-risk travelers including VFRs and children. |
Travel-related hepatitis E: a two decade GeoSentinel analysis
Nicolini LA , Stoney RJ , Vecchia AD , Grobusch M , Gautret P , Angelo KM , van Genderen PJJ , Bottieau E , Leder K , Asgeirsson H , Leung D , Connor B , Pandey P , Toscanini F , Gobbi F , Castelli F , Bassetti M , Hamer DH . J Travel Med 2020 27 (7) BACKGROUND: Hepatitis E virus (HEV) is widely distributed worldwide and is endemic in developing countries. Travel-related HEV infection has been reported at national levels, but global data are missing. Moreover, the global availability of HEV diagnostic testing has not been explored so far. The aim of this study is to describe the epidemiology of hepatitis E virus (HEV) infections in returning travelers and availability of HEV diagnostic testing in the GeoSentinel surveillance network. METHODS: This was a multicenter retrospective cross-sectional study. All confirmed and probable HEV travel-related infections reported in the GeoSentinel Network between 1999 and 2018 were evaluated. GeoSentinel sites were asked to complete a survey in 2018 to assess the availability and accessibility of HEV diagnostic procedures (i.e. serology and molecular tests) throughout the study period. RESULTS: Overall, 165 travel related HEV infections were reported, mainly since 2010 (60%) and in tourists (50%). Travelers were exposed to hepatitis E in 27 countries; most travellers (62%) were exposed to HEV in South Asia. One patient was pregnant at the time of HEV infection and 14 had a concomitant gastrointestinal infection. No deaths were reported. In the 51% of patients with information available, there was no pre-travel consultation. Among 44 GeoSentinel sites that responded to the survey, 73% have access to HEV serology at a local level, while 55% could perform (at a local or central level) molecular diagnostics. CONCLUSION: Reported access to HEV diagnostic testing is suboptimal among sites that responded to the survey; this could negatively affect diagnosing HEV. Pre-travel consultations before travel to South Asia and other low income and high prevalence areas with a focus on food and water precautions could be helpful in preventing hepatitis E infection. Improved HEV diagnostic capacity should be implemented to prevent and correctly diagnose travel-related HEV infection. |
Update on Extensively Drug-Resistant Salmonella Serotype Typhi Infections Among Travelers to or from Pakistan and Report of Ceftriaxone-Resistant Salmonella Serotype Typhi Infections Among Travelers to Iraq - United States, 2018-2019.
Francois Watkins LK , Winstead A , Appiah GD , Friedman CR , Medalla F , Hughes MJ , Birhane MG , Schneider ZD , Marcenac P , Hanna SS , Godbole G , Walblay KA , Wiggington AE , Leeper M , Meservey EH , Tagg KA , Chen JC , Abubakar A , Lami F , Asaad AM , Sabaratnam V , Ikram A , Angelo KM , Walker A , Mintz E . MMWR Morb Mortal Wkly Rep 2020 69 (20) 618-622 ![]() ![]() Ceftriaxone-resistant Salmonella enterica serotype Typhi (Typhi), the bacterium that causes typhoid fever, is a growing public health threat. Extensively drug-resistant (XDR) Typhi is resistant to ceftriaxone and other antibiotics used for treatment, including ampicillin, chloramphenicol, ciprofloxacin, and trimethoprim-sulfamethoxazole (1). In March 2018, CDC began enhanced surveillance for ceftriaxone-resistant Typhi in response to an ongoing outbreak of XDR typhoid fever in Pakistan. CDC had previously reported the first five cases of XDR Typhi in the United States among patients who had spent time in Pakistan (2). These illnesses represented the first cases of ceftriaxone-resistant Typhi documented in the United States (3). This report provides an update on U.S. cases of XDR typhoid fever linked to Pakistan and describes a new, unrelated cluster of ceftriaxone-resistant Typhi infections linked to Iraq. Travelers to areas with endemic Typhi should receive typhoid vaccination before traveling and adhere to safe food and water precautions (4). Treatment of patients with typhoid fever should be guided by antimicrobial susceptibility testing whenever possible (5), and clinicians should consider travel history when selecting empiric therapy. |
Zika among international travelers presenting to GeoSentinel sites, 2012-2019: implications for clinical practice
Angelo KM , Stoney RJ , Brun-Cottan G , Leder K , Grobusch MP , Hochberg N , Kuhn S , Bottieau E , Schlagenhauf P , Chen L , Hynes NA , Perez CP , Mockenhaupt FP , Molina I , Crespillo-Andujar C , Malvy D , Caumes E , Plourde P , Shaw M , McCarthy AE , Piper-Jenks N , Connor BA , Hamer DH , Wilder-Smith A . J Travel Med 2020 27 (4) INTRODUCTION: International travellers contribute to the rapid spread of Zika virus (ZIKV) and its sentinel identification globally. We describe ZIKV infections among international travelers seen at GeoSentinel sites with a focus on ZIKV acquired in the Americas and the Caribbean, describe countries of exposure and traveler characteristics, and assess ZIKV diagnostic testing by site. METHODS: Records with an international travel-related diagnosis of confirmed or probable ZIKV from January 2012 through December 2019 reported to GeoSentinel with a recorded illness onset date, were included to show reported cases over time. Records from March 2016 through December 2019 with an exposure region of the Americas or the Caribbean were included in the descriptive analysis. A survey was conducted to assess the availability, accessibility, and utilization of ZIKV diagnostic tests at GeoSentinel sites. RESULTS: GeoSentinel sites reported 525 ZIKV cases from 2012 through 2019. Between 2012 and 2014, 8 cases were reported; all were acquired in Asia or Oceania. After 2014, most cases were acquired in the Americas or the Caribbean; a large decline in ZIKV cases occurred in 2018-19.Between March 2016 and December 2019, 423 patients acquired ZIKV in the Americas or the Caribbean; peak reporting to these regions occurred in 2016 (330 cases [78%]). The median age was 36 years (range: 3-92); 63% were female. The most frequent region of exposure was the Caribbean (60%). Thirteen travelers were pregnant during or after travel; one had a sexually-acquired ZIKV infection. There was one case of fetal anomaly and two travelers with Guillain-Barre syndrome. GeoSentinel sites reported various challenges to diagnose ZIKV effectively. CONCLUSION: ZIKV should remain a consideration for travelers returning from areas with risk of ZIKV transmission. Travelers should discuss their travel plans with their healthcare providers to ensure ZIKV prevention measures are taken. |
Barriers to malaria prevention among immigrant travelers in the United States who visit friends and relatives in sub-Saharan Africa: A cross-sectional, multi-setting survey of knowledge, attitudes, and practices
Volkman HR , Walz EJ , Wanduragala D , Schiffman E , Frosch A , Alpern JD , Walker PF , Angelo KM , Coyle C , Mohamud MA , Mwangi E , Haizel-Cobbina J , Nchanji C , Johnson RS , Ladze B , Dunlop SJ , Stauffer WM . PLoS One 2020 15 (3) e0229565 BACKGROUND: Despite achievements in the reduction of malaria globally, imported malaria cases to the United States by returning international travelers continue to increase. Immigrants to the United States from sub-Saharan Africa (SSA) who then travel back to their homelands to visit friends and relatives (VFRs) experience a disproportionate burden of malaria illness. Various studies have explored barriers to malaria prevention among VFRs and non-VFRs-travelers to the same destinations with other purpose for travel-but few employed robust epidemiologic study designs or performed comparative analyses of these two groups. To better quantify the key barriers that VFRs face to implement effective malaria prevention measures, we conducted a comprehensive community-based, cross-sectional, survey to identify differences in malaria prevention knowledge, attitudes, and practices (KAP) among VFRs and others traveling to Africa and describe the differences between VFRs and other types of international travelers. METHODS AND FINDINGS: Three distinct populations of travelers with past or planned travel to malaria-endemic countries of SSA were surveyed: VFRs diagnosed with malaria as reported through a state health department; members of the general VFR population (community); and VFR and non-VFR travelers presenting to a travel health clinic, both before their pretravel consultation and again, after return from travel. A Community Advisory Board of African immigrants and prior qualitative research informed survey development and dissemination. Across the three groups, 489 travelers completed surveys: 351 VFRs and 138 non-VFRs. VFRs who reported taking antimalarials on their last trip rated their concern about malaria higher than those who did not. Having taken five or more trips to SSA was reported more commonly among VFRs diagnosed with malaria than community VFRs (44.0% versus 20.4%; p = 0.008). Among travel health clinic patients surveyed before and after travel, VFR travelers were less successful than non-VFRs in adhering to their planned use of antimalarials (82.2% versus 98.7%; p = 0.001) and employing mosquito bite avoidance techniques (e.g., using bed nets: 56.8% versus 81.8%; p = 0.009). VFRs who visited the travel health clinic were more likely than VFR respondents from the community to report taking an antimalarial (83.0% versus 61.9%; p = 0.009), or to report bite avoidance behaviors (e.g., staying indoors when mosquitoes were out: 80.9% versus 59.5%; p = 0.009). CONCLUSIONS: We observed heterogeneity in malaria prevention behaviors among VFRs and between VFR and non-VFR traveler populations. Although VFRs attending the travel health clinic appear to demonstrate better adherence to malaria prevention measures than VFR counterparts surveyed in the community, specialized pretravel care is not sufficient to ensure chemoprophylaxis use and bite avoidance behaviors among VFRs. Even when seeking specialized pretravel care, VFRs experience greater barriers to the use of malaria prevention than non-VFRs. Addressing access to health care and upstream barrier reduction strategies that make intended prevention more achievable, affordable, easier, and resonant among VFRs may improve malaria prevention intervention effectiveness. |
Putting guidance into practice: Interpretation of the oral cholera vaccine recommendations for U.S. travelers
Conners EE , Angelo KM , Walker AT . Am J Trop Med Hyg 2020 102 (3) 491-493 The American Committee on Immunization Practices recommends the use of the oral cholera vaccine (OCV) in international travelers aged 18-64 years who visit areas of active cholera transmission. CDC Travelers' Health Branch currently tracks areas of active cholera transmission and posts this information on their country-specific destination web pages at https://wwwnc.cdc.gov/travel/destinations/list. Lessons learned from a webinar conducted among health care providers have led to improvements in how CDC shares information on the OCV. Here, we summarize the major considerations for providers offering the OCV to U.S. travelers and indicate where they can find more information. |
Heritage and Genealogy Travel Health Concerns in the Era of In-home DNA Testing.
Angelo KM , Breiman J , Wu HM , Nemhauser J , Walker AT . J Travel Med 2020 27 (4) ![]() Over 1000 companies offer in-home DNA testing kits. These kits enable customers to learn about their genetic history simply by submitting a saliva sample or cheek swab. Customers typically receive an electronic copy of DNA results in 6–8 weeks.1 The most affordable in-home DNA testing kits are for ancestry and genealogy only, providing a geographically based percentage of genealogy, relatedness to other individuals and possible links to ancestors and family members through testing autosomal DNA genetic variants.2 These tests are not without their limitations, however, as they cannot correctly identify distant ancestors for some populations, there are associated cost and privacy issues and emotional or social consequences.3 A secondary effect of in-home ancestry DNA testing is a novel trend in ancestry or genealogy travel (also known as heritage travel) inspired by in home DNA testing results.4 |
International mass gatherings and travel-associated illness: A GeoSentinel cross-sectional, observational study
Gautret P , Angelo KM , Asgeirsson H , Duvignaud A , van Genderen PJJ , Bottieau E , Chen LH , Parker S , Connor BA , Barnett ED , Libman M , Hamer DH . Travel Med Infect Dis 2019 32 101504 BACKGROUND: Travelers to international mass gatherings may be exposed to conditions which increase their risk of acquiring infectious diseases. Most existing data come from single clinical sites seeing returning travelers, or relate to single events. METHODS: Investigators evaluated ill travelers returning from a mass gathering, and presenting to a GeoSentinel site between August 2015 and April 2019, and collected data on the nature of the event and the relation between final diagnoses and the mass gathering. RESULTS: Of 296 ill travelers, 51% were female and the median age was 54 years (range: 1-88). Over 82% returned from a religious mass gathering, most frequently Umrah or Hajj. Only 3% returned from the Olympics in Brazil or South Korea. Other mass gatherings included other sporting events, cultural or entertainment events, and conferences. Respiratory diseases accounted for almost 80% of all diagnoses, with vaccine preventable illnesses such as influenza and pneumonia accounting for 26% and 20% of all diagnoses respectively. This was followed by gastrointestinal illnesses, accounting for 4.5%. Sixty-three percent of travelers reported having a pre-travel encounter with a healthcare provider. CONCLUSIONS: Despite this surveillance being limited to patients presenting to GeoSentinel sites, our findings highlight the importance of respiratory diseases at mass gatherings, the need for pre-travel consultations before mass gatherings, and consideration of vaccination against influenza and pneumococcal disease.. |
Multidrug-Resistant Salmonella I 4,[5],12:i:- and Salmonella Infantis Infections Linked to Whole Roasted Pigs from a Single Slaughter and Processing Facility.
Kawakami V , Bottichio L , Lloyd J , Carleton H , Leeper M , Olson G , Li Z , Kissler B , Angelo KM , Whitlock L , Sinatra J , Defibaugh-Chavez S , Bicknese A , Kay M , Wise ME , Basler C , Duchin J . J Food Prot 2019 82 (9) 1615-1624 ![]() ![]() We describe two outbreaks of multidrug-resistant (MDR) Salmonella I 4,[5],12:i:- infection, occurring in 2015 to 2016, linked to pork products, including whole roaster pigs sold raw from a single Washington slaughter and processing facility (establishment A). Food histories from 80 ill persons were compared with food histories reported in the FoodNet 2006 to 2007 survey of healthy persons from all 10 U.S. FoodNet sites who reported these exposures in the week before interview. Antimicrobial susceptibility testing and whole genome sequencing were conducted on selected clinical, food, and environmental isolates. During 2015, a total of 192 ill persons were identified from five states; among ill persons with available information, 30 (17%) of 180 were hospitalized, and none died. More ill persons than healthy survey respondents consumed pork (74 versus 43%, P < 0.001). Seventeen (23%) of 73 ill persons for which a response was available reported attending an event where whole roaster pig was served in the 7 days before illness onset. All 25 clinical isolates tested from the 2015 outbreak and a subsequent 2016 smaller outbreak (n = 15) linked to establishment A demonstrated MDR. Whole genome sequencing of clinical, environmental, and food isolates (n = 69) collected in both investigations revealed one clade of highly related isolates, supporting epidemiologic and traceback data that establishment A as the source of both outbreaks. These investigations highlight that whole roaster pigs, an uncommon food vehicle for MDR Salmonella I 4,[5],12:i:- outbreaks, will need further attention from food safety researchers and educators for developing science-based consumer guidelines, specifically with a focus on the preparation process. |
Epidemiological aspects of travel-related systemic endemic mycoses: a GeoSentinel analysis, 1997-2017
Salzer HJF , Stoney RJ , Angelo KM , Rolling T , Grobusch MP , Libman M , Lopez-Velez R , Duvignaud A , Asgeirsson H , Crespillo-Andujar C , Schwartz E , Gautret P , Bottieau E , Jordan S , Lange C , Hamer DH . J Travel Med 2018 25 (1) Background: International travel has increased in the past few decades, placing more travellers at risk of acquiring systemic endemic mycoses. There are limited published data on systemic endemic mycoses among international travellers. We report epidemiological characteristics of non-migrant, international travellers who acquired systemic endemic mycoses during travel. Methods: We analysed records of non-migrant international travellers with a confirmed diagnosis of histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, blastomycosis or talaromycosis reported from 1997 through 2017 to GeoSentinel, a global surveillance network now consisting of 70 travel or tropical medicine centres in 31 countries. Results: Sixty-nine records met the inclusion criteria. Histoplasmosis was most frequently reported; the 51 travellers with histoplasmosis had the lowest median age (30 years; range: 8-85) and shortest median duration of travel (12 days; range: 5-154). Coccidioidomycosis was reported in 14 travellers; travellers with coccidioidomycosis were older (median 62 years; range: 22-78) and had the longest median number of days between return from travel and presentation to a GeoSentinel site (55 days; range: 17-273). Almost all travellers with coccidioidomycosis were exposed in the USA. Other systemic endemic mycoses were less frequently reported, including blastomycosis (three travellers) and talaromycosis (one traveller). Conclusions: Although relatively rare, systemic endemic mycoses should be considered as potential travel-related infections in non-migrant international travellers. Epidemiological exposures should be used to guide diagnostic evaluations and treatment. |
Spread of measles in Europe and implications for US travelers
Angelo KM , Gastanaduy PA , Walker AT , Patel M , Reef S , Lee CV , Nemhauser J . Pediatrics 2019 144 (1) From January 2018 to June 2018, World Health Organization (WHO) European Region countries reported >41 000 measles cases, including 37 deaths, a record high since the 1990s. Low vaccination coverage in previous years is the biggest contributing factor to the increase in cases. The Ukraine reported the majority of cases, but France, Georgia, Greece, Italy, the Russian Federation, and Serbia also reported high case counts. Europe is the most common travel destination worldwide and is widely perceived as being without substantial infectious disease risks. For this reason, travelers may not consider the relevance of a pretravel health consultation, including vaccination, in their predeparture plans. Measles is highly contagious, and the record number of measles cases in the WHO European Region not only puts unvaccinated and inadequately vaccinated travelers at risk but also increases the risk for nontraveling US residents who come into close contact with returned travelers who are ill. The US Centers for Disease Control and Prevention encourage US travelers to be aware of measles virus transmission in Europe and receive all recommended vaccinations, including for measles, before traveling abroad. Health care providers must maintain a high degree of suspicion for measles among travelers returning from Europe or people with close contact with international travelers who present with a febrile rash illness. The current WHO European Region outbreak should serve to remind health care providers to stay current with the epidemiology of highly transmissible diseases, such as measles, through media, WHO, and Centers for Disease Control and Prevention reports and encourage measles vaccination for international travelers. |
The rise in travel-associated measles infections - GeoSentinel, 2015-2019
Angelo KM , Libman M , Gautret P , Barnett E , Grobusch MP , Hagmann SHF , Gobbi F , Schwartz E , van Genderen PJJ , Asgeirsson H , Hamer DH . J Travel Med 2019 26 (6) Measles remains a global threat to human health. In 2018, the World Health Organization (WHO) reported over 328,000 measles cases among 184 WHO member states, with the European Region reporting the most cases (25.6%) (1). From January to March 2019, reported cases rose 300% in comparison to the same months in 2018 (2). Low vaccination coverage for measles is presumed to be responsible for this recent increase (3–5). International travelers to measles-affected countries are at risk for infection and may contribute to disease importation (3, 4). |
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