Tropical Diseases, Travel Medicine and Vaccines最新文献

Leptospirosis is a zoonosis of global distribution. The U.S. Centers for Disease Control and Prevention has designated leptospirosis a nationally notifiable disease. There is need to raise awareness of the burden of leptospirosis among health care givers and policy makers in Africa. The aim of this review was to highlight the current situation of leptospirosis in Africa and suggest a One Health approach of addressing its status as a leading zoonosis. In tropical regions, the nonspecific symptoms of fever, myalgia and arthralgia result in misdiagnosis of leptospirosis with malaria, yellow fever, typhoid fever, dengue fever, brucellosis, rickettsiosis, and babesiosis. Urinalysis presents an inexpensive diagnostic aid for leptospirosis. Humans with leptospirosis exhibit proteinuria, glucosuria, pyuria, haematuria and granular casts resulting from acute kidney injury. Therapeutic guidelines for empirical treatment of febrile patients should be considered. Febrile patients who test negative for malaria and yellow fever can benefit from doxycycline, which also treats brucellosis, rickettsiosis and typhoid fever. Control of leptospirosis should also address Leptospira infection in domestic animal reservoirs through vaccination of cattle, sheep, goats, pigs and dogs in endemic areas. Treatment of sick animals with streptomycin eliminates the carrier status, curbing leptospiruria and spread of infection. Rodents are important in transmission of Leptospira to humans in urban slums and rural settings therefore rodent control strategies help in reducing transmission of leptospirosis. Indirect transmission of Leptospira occurs through contact with water, vegetation, or soil contaminated with infected urine. Drinking water should be drawn from protected sources or chlorinated before household use.

Background: The spleen plays a vital role in combating Plasmodium infections, particularly during the erythrocytic stage of the infection. Asplenia may notably affect disease progression and parasite clearance dynamics. More insight is needed as to whether asplenic malaria patients - beyond considerations of parasite load - also face a higher burden of disease caused by malaria-specific manifestations of organ dysfunction and/or metabolic deterioration.

Methods: A case-control study was conducted comparing splenectomized malaria patients with non-splenectomized individuals at comparable parasitemia levels. Control subjects were sourced from the Rotterdam Malaria Cohort Study. Due to the cohort's limited asplenic cases, a systematic literature review identified 13 additional asplenic malaria cases. Each case was matched for age and P. falciparum parasitemia level with 3 control subjects resulting in 45 case-control paired observations.

Findings: The study included a total of 60 P.falciparum malaria patients, comprising 15 splenectomized patients (cases) and 45 non-splenectomized patients (controls). Eleven of 15 cases (73%) met WHO criteria for severe disease, in contrast to 21 of 45 (47%) matched controls. Cases had significantly longer median duration of hospitalizations (10 versus 5.5 days) and higher rates of hemodynamic instability. Splenectomized malaria patients had a significantly 3-fold higher odds of experiencing WHO-defined severe disease malaria (OR 3.14 (95% CI 1.30-7.60)) than matched controls.

Conclusion: The findings of this case-control study suggest that - at comparable levels of parasitemia - P. falciparum malaria infections in asplenic individuals may run a more severe course as compared with individuals who have not undergone splenectomy.

Airports may be high-risk sites for the spread of infectious diseases, including novel respiratory pathogens. While many studies have evaluated the higher burden of COVID-19 among essential workers, few studies have specifically analyzed the links between airport workers and surrounding communities during the COVID-19 pandemic. We used GPS-derived mobility data to estimate work- and travel-related visits from approximately 5000 Boston-area census block groups to Logan International Airport between January 2020 and August 2021. We stratified origin census block groups by their census tract-level Social Vulnerability Index and compared temporal trends and work-related airport visits across Social Vulnerability Index quartiles. Work-related visits to Boston Logan International Airport were more likely to originate from socially vulnerable communities (i.e., in the highest Social Vulnerability Index quartile), including cities that experienced disproportionately high rates of COVID-19 infection early during the COVID-19 pandemic (East Boston, Revere and Chelsea, Massachusetts). These differences persisted across the duration of the observation period. Our findings highlight higher social vulnerability and strong work-related mobility connections with an international travel hub as important overlapping risk factors in these urban communities. Protecting airport workers and their home communities from imported infectious diseases merits further attention as a public health priority.

Background: Malaria during pregnancy poses significant risks to both the mother and the developing fetus. For pregnant women, the infection can result in severe illness and even death. Parasite sequestration in the placenta can cause maternal anemia and increase the risk of mortality both during and after childbirth. Malaria is also a major contributor to stillbirths and preterm births. Infected placental tissue can impede fetal growth, resulting in low birth weight, which is linked to delayed growth and cognitive development in the child. Furthermore, malaria during pregnancy remains a major contributor to perinatal, neonatal, and infant mortality.

Objectives: To review the epidemiological patterns of malaria in pregnancy and its impact on maternal and neonatal health, and to analyze the availability and effectiveness of drug treatment options.

Methods: Relevant articles published only in English were searched using electronic databases such as PubMed, Web of Science, Scopus, and Pro-Quest. Keywords including "'malaria in pregnancy", "placental malaria", "congenital malaria", "treatment options", and "nutrition intervention and intermittent preventive treatment" were used in combination. Of the total of 4,486 articles identified, 139 articles were ultimately included. Whereas, others were excluded due to duplication, irrelevant abstract, title, and quality assessment.

Results: From 139 included studies, 47 focused on epidemiology of malaria in pregnancy, 58 on its impact and 16 on treatment options and 18 on nutrition intervention and intermittent treatment. Plasmodium falciparum is the leading cause of complications in pregnant women and is primarily found in Africa, while P.vivax is recognized as an emerging global threat, and causing serious consequences. Other species, such as P.knowlesi, P.ovale, and P.malariae are less common. Malaria prevalence in pregnancy can reach 60% in sub-Saharan Africa and 36% globally, with placental malaria affecting up to 28% of cases. The disease causes serious complications such as maternal anemia, premature birth, and low birth weight, severe anemia and increased maternal and infant mortality. Prevention strategies like intermittent preventive treatment (IPTp), insecticide-treated nets (ITNs) and Indoor residual spray (IRS) are essential. Early diagnosis and treatment can reverse adverse effects on placental and congenital function. Artesunate is recommended for severe malaria in all trimesters. Even resistance to chloroquine reported in some areas, it is the drug of choice for uncomplicated P.vivax infections.

Conclusions: Malaria during pregnancy significantly impacts maternal and fetal health, leading to anemia, growth restriction, preterm birth, and neonatal death. Infants born to mothers with malaria are more likely to contract the disease. Further research and improved treatment strategies are

The emergence of messenger RNA (mRNA) vaccines has marked a seminal shift in the field of immunization, heralding an era characterized by unprecedented speed and efficacy in the face of infectious diseases. The global crisis caused by the COVID-19 pandemic catalyzed the rapid development and deployment of two leading mRNA vaccines, Comirnaty and SpikeVax, showcasing not only the technological promise of mRNA, but also its transformative potential in public health strategies. This study seeks to provide an in-depth exploration of the foundational elements of mRNA vaccine technology, elucidate its unique advantages over traditional vaccine platforms, analyze the existing challenges that public health officials face, and envision future applications that extend far beyond current expectations. Through this exploration, we advocate for the integration of mRNA technology into existing public health frameworks to enhance global health security and adaptability in the face of emerging infectious threats.

Background: Sexually transmitted infections are on the rise in older populations globally, including among older travellers. International retirement migrants are older people who have retired from the workforce and travel abroad seasonally, typically during the winter months in their home countries. The transnational nature of this practice may challenge public health efforts to control the spread of sexually transmitted infection and encourage treatment. This study focuses on Yuma, Arizona, a popular destination for Canadian international retirement migrants who winter in the United States, to examine the sexual health risks associated with their seasonal travel.

Methods: Utilizing a qualitative case study approach, this research involved semi-structured interviews conducted remotely with key informants in Yuma (n = 10) who held various health care and administrative roles. Participants provided insights into sexual health risks based on their extensive interactions with Canadian seasonal migrants and their knowledge of the social dynamics within retirement communities. Interviews were transcribed verbatim, coded using NVivo software, and thematically analyzed to identify risk factors for sexually transmitted infections among Canadian international retirement migrants wintering in Yuma.

Results: Findings revealed three main risks that may contribute to exposure to sexually transmitted infections and potential transmission: social dynamics within tight-knit retirement migrant communities that facilitate unsafe sexual practices (i.e., risky practices); barriers to accessing diagnostic services, such as costs and lack of established local care (i.e., risky care access); and challenges in following standard treatment and public health protocols due to logistical difficulties in ensuring follow-up (i.e., risky treatment decisions). Key informants noted that lifestyle choices, including the use of alcohol and drugs, can exacerbate these risks. Health care access barriers driven by travel health insurance and mobility limitations further complicate the diagnosis and treatment of sexually transmitted infections for Canadian international retirement migrants while abroad.

Conclusions: This study highlights the complex interplay of social behaviours and health care barriers that heighten the risk of sexually transmitted infection transmission among Canadian retirement migrants in the transnational context of Yuma. Extended diagnostic and treatment services, comprehensive sexual health education in pre- and post-travel consultations, as well as inclusive travel health insurance coverage could significantly improve the sexual health outcomes for this population.

Background: Mosquito-borne viral (MBV) infections caused by dengue virus (DENV), Rift Valley fever virus (RVFV), West Nile virus (WNV), and chikungunya virus (CHIKV) pose a significant global public health concern. The aim of this systematic review is to summarise the reported prevalence data for these viruses in Gulf countries.

Methods: A web search in four electronic databases (Scopus, PubMed, Google Scholar, and Web of Science) was conducted, and forty-four eligible studies were fulfilled the selection criteria and were therefore included in this study. The Pooled prevalence of MBVs was estimated using a random-effects model. The heterogeneity was assessed using Cochrane Q test and I² test, while publication bias was evaluated using Egger's test.

Results: Using meta-analysis of proportions, the pooled prevalence of MBVs in Gulf countries among 34,367 human and 19,062 Animal samples was estimated to be 22.5% (95% CI: 13.7-31.4) and 11.6% (95% CI: 0.5 - 22.7%), respectively. In human, DENV was the most predominant virus reported in 19 studies, with an overall pooled prevalence of 32.4%, followed by RVFV in 9 studies, with an infection rate of 10.1%, while WNV and CHIKV were only reported in two studies, with overall prevalence rates of 6.4% and 2.4%, respectively. On the other hand, the overall prevalence of WNV and RVFV in animals was estimated to be 27.7% and 1.5%, respectively.

Conclusion: This review revealed that MBVs are highly prevalent among humans in Gulf countries but relatively low in animals. As a result, additional therapeutic and preventive measures are required. However, the study highlights the need for further studies and surveillance to precisely monitor the burden of these viruses in the region.

Background: Travel-related psychiatric disorders range from anxiety disorders to mood disorders, substance abuse, and psychosis. Various travel-associated factors such as dehydration, time shifts, changes in social structures or stress factors are discussed for these disorders. There is a lack of knowledge concerning the quality and outcome of psychiatric treatment in travelers hospitalized abroad. This study is the first to compare outcome of treatment in psychiatric travelers to domestic patients.

Methods: We analyzed electronic health records of travelers in the Psychiatric University Hospital Zurich from January 2013 to December 2020. Each traveler was matched with one Swiss national and one migrant using propensity score matching.

Results: Travelers showed inferior CGI-I scores at discharge (F(2,969) = 5.72; p = 0.003). The length of stay was shorter (F(2,969) = 38.74:p < 0.001) for travelers (9.69 ± 14.31) than for Swiss nationals (24.69 ± 29.42) and migrants (24.74 ± 28.62). The transfer rate to another hospital was higher (X²(2,972) = 50.85: p < 0.001) for travelers (79, 29.4%) than for Swiss nationals (25, 7.7%) or migrants (26, 8.0%).

Conclusions: Psychiatric treatments of hospitalized travelers showed a lower symptom improvement while presenting a more severe overall condition at discharge. Length of stay was shorter compared to domestic patients. Admission of travelers was initiated involuntarily more frequently. This most closely reflects the theory that travelers are typically hospitalized in severe emergencies and are promptly discharged or repatriated after an initial treatment response has been achieved.

Background: Thailand, a major tourist destination, exhibits variations in sanitation and food safety practices that can lead to cases of travelers' diarrhea (TD) caused by a plethora of pathogens. This systematic review synthesizes data on the pathogens associated with TD in Thailand, providing valuable insights into pathogen diversity and distribution, traveler profiles, and geographical regions of concern.

Methods: This systematic review followed the PRISMA guidelines and was registered in PROSPERO (CRD42022346014). A comprehensive search was conducted across PubMed, Embase, Scopus, MEDLINE, and Journals@Ovid databases. The search included terms related to "diarrhea," "travelers," and "Thailand," without restrictions on publication date. Eligible studies focused on travelers to Thailand who developed diarrhea with identified specific pathogens. Data was extracted and synthesized using a narrative approach. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist.

Results: A total of 15 studies met the eligibility criteria, identifying that pathogens related to TD in Thailand were bacteria, particularly enterotoxigenic Escherichia coli (ETEC) (80%), followed by Campylobacter jejuni (33.3%) and Salmonella spp. (40%). Viral pathogens such as rotavirus and norovirus were also notable, with Giardia spp. being the most identified parasite. Pathogen distribution varied across different regions of Thailand, with tourism hubs such as Bangkok, Chiang Mai, Phuket, and Krabi reporting a broader range of infections.

Conclusions: This systematic review highlights the diverse range of pathogens associated with TD in Thailand, with bacterial pathogens, specifically ETEC, being the predominant cause in most studies. The findings underscore the importance of preventive measures, such as improved hygiene practices and food safety awareness, especially in high-risk tourist areas. Further research is needed to understand better the risk factors contributing to TD and to develop targeted interventions for prevention.

Background: Vaccination against COVID-19 has been the primary public health measure implemented to limit the spread of the disease. However, there is still considerable scope for improvement in vaccine coverage, particularly in sub-Saharan African countries. The factors influencing the acceptance or reluctance of the COVID-19 vaccine have been widely studied, but there is a gap in the literature with regard to dynamic populations, particularly travelers, who are one of the priority target groups for vaccination. This study assessed the perceptions, attitudes and practices regarding the COVID-19 vaccine, and explored factors associated with vaccination status among travelers.

Methods: A cross-sectional survey was conducted at several points of entry (PoEs) selected for six survey sites (N'djili airport, Ngobila beach, Lufu, Boma, Moanda, and Kananga), located in three provinces of the Democratic Republic of the Congo (Kinshasa, Kongo Central and Kasaï Central), from February 20 to March 05, 2023. The data were summarized and logistic regression models were performed to assess factors associated with vaccination status.

Results: A total of 2742 travelers were included in this survey. Of these, 54% had received at least one dose of COVID-19 vaccine. Multivariable logistic regression analyses revealed that that several factors were significantly associated with vaccination status. These included age (under 60 years), marital status (single), occupation (other than healthcare worker), mode of travel (other than airplane), and poor perceptions of the vaccine. The most frequently cited reasons for vaccination among respondents who had received the vaccine were the prevention of COVID-19 infection and the ease of travel. In contrast, unvaccinated participants expressed greater concern about the safety and effectiveness of the vaccine, as well as vaccine-related side effects. Furthermore, travel disruption and inappropriate vaccination sites have been identified as significant obstacles to the acceptance of vaccination at the PoEs.

Conclusions: It is essential that awareness initiatives address concerns and misconceptions about vaccine safety and effectiveness. The influence of social media platforms may be harnessed for the dissemination of accurate information from the most trusted information sources, including healthcare professionals, to the target population. In addition, accompanying measures should be considered to facilitate vaccination compliance at different PoEs.