Wilder-Smith A, Gubler DJ, Weaver SC, Monath TP, Heymann DL, Scott TW, 2017. Epidemic arboviral diseases: priorities for research and public health. Lancet Infect Dis 17: e101–e106.
Glaesser D, Kester J, Paulose H, Alizadeh A, Valentin B, 2017. Global travel patterns: an overview. J Travel Med 24: tax007.
Quam MB, Sessions O, Kamaraj US, Rocklov J, Wilder-Smith A, 2016. Dissecting Japan’s dengue outbreak in 2014. Am J Trop Med Hyg 94: 409–412.
Quam MB, Wilder-Smith A, 2015. Importation index of dengue to determine the most probable origin of importation. J Travel Med 22: 72.
Quam MB, Khan K, Sears J, Hu W, Rocklov J, Wilder-Smith A, 2015. Estimating air travel-associated importations of dengue virus into Italy. J Travel Med 22: 186–193.
Wilder-Smith A, Quam M, Sessions O, Rocklov J, Liu-Helmersson J, Franco L, Khan K, 2014. The 2012 dengue outbreak in Madeira: exploring the origins. Euro Surveill 19: 20718.
Sessions OM, Khan K, Hou Y, Meltzer E, Quam M, Schwartz E, Gubler DJ, Wilder-Smith A, 2013. Exploring the origin and potential for spread of the 2013 dengue outbreak in Luanda, Angola. Glob Health Action 6: 21822.
Masyeni S, Yohan B, Somia IKA, Myint KSA, Sasmono RT, 2018. Dengue infection in international travellers visiting Bali, Indonesia. J Travel Med 25: tay061.
Perez-Molina JA et al. 2017. 6-year review of +Redivi: a prospective registry of imported infectious diseases in Spain J Travel Med 24: tax035.
Wilder-Smith A, Boggild AK, 2018. Sentinel surveillance in travel medicine: 20 years of GeoSentinel publications (1999–2018). J Travel Med 25: tay139.
Griffiths KM, Savini H, Brouqui P, Simon F, Parola P, Gautret P, 2018. Surveillance of travel-associated diseases at two referral centres in Marseille, France: a 12-year survey. J Travel Med 25: tay007.
Liu-Helmersson J, Quam M, Wilder-Smith A, Stenlund H, Ebi K, Massad E, Rocklöv J, 2016. Climate change and Aedes vectors: 21st century projections for dengue transmission in Europe. EBioMedicine 7: 267–277.
Massad E, Amaku M, Coutinho FAB, Struchiner CJ, Burattini MN, Khan K, Liu-Helmersson J, Rocklöv J, Kraemer MUG, Wilder-Smith A, 2018. Estimating the probability of dengue virus introduction and secondary autochthonous cases in Europe. Sci Rep 8: 4629.
Ximenes R, Amaku M, Lopez LF, Coutinho FA, Burattini MN, Greenhalgh D, Wilder-Smith A, Struchiner CJ, Massad E, 2016. The risk of dengue for non-immune foreign visitors to the 2016 summer Olympic Games in Rio de Janeiro, Brazil. BMC Infect Dis 16: 186.
Massad E, Wilder-Smith A, Ximenes R, Amaku M, Lopez LF, Coutinho FA, Coelho GE, Silva JB Jr., Struchiner CJ, Burattini MN, 2014. Risk of symptomatic dengue for foreign visitors to the 2014 FIFA World Cup in Brazil. Mem Inst Oswaldo Cruz 109: 394–397.
Jentes ES, Lash RR, Johansson MA, Sharp TM, Henry R, Brady OJ, Sotir MJ, Hay SI, Margolis HS, Brunette GW, 2016. Evidence-based risk assessment and communication: a new global dengue-risk map for travellers and clinicians. J Travel Med 23: taw062.
Lalani T et al. 2016. A comparison of compliance rates with anti-vectorial protective measures during travel to regions with dengue or chikungunya activity, and regions endemic for Plasmodium falciparum malaria. J Travel Med 23: taw043.
Goodyer L, Schofield S, 2018. Mosquito repellents for the traveller: does picaridin provide longer protection than DEET? J Travel Med 25 (Suppl 1): S10–S15.
Wilder-Smith A, 2012. Dengue infections in travellers. Paediatr Int Child Health 32: 28–32.
Ratnam I, Leder K, Black J, Torresi J, 2013. Dengue fever and international travel. J Travel Med 20: 384–393.
Gautret P, Schlagenhauf P, Gaudart J, Castelli F, Brouqui P, von Sonnenburg F, Loutan L, Parola P; GeoSentinel Surveillance Network, 2009. Multicenter EuroTravNet/GeoSentinel study of travel-related infectious diseases in Europe. Emerg Infect Dis 15: 1783–1790.
Schwartz E, Weld LH, Wilder-Smith A, von Sonnenburg F, Keystone JS, Kain KC, Torresi J, Freedman DO; GeoSentinel Surveillance Network, 2008. Seasonality, annual trends, and characteristics of dengue among ill returned travelers, 1997–2006. Emerg Infect Dis 14: 1081–1088.
Leder K et al. GeoSentinel Surveillance Network, 2013. GeoSentinel surveillance of illness in returned travelers, 2007–2011. Ann Intern Med 158: 456–468.
Leder K et al. GeoSentinel Surveillance Network, 2013. Travel-associated illness trends and clusters, 2000–2010. Emerg Infect Dis 19: 1049–1073.
Wilson ME, Weld LH, Boggild A, Keystone JS, Kain KC, von Sonnenburg F, Schwartz E; GeoSentinel Surveillance Network, 2007. Fever in returned travelers: results from the GeoSentinel surveillance network. Clin Infect Dis 44: 1560–1568.
Rocklov J, Lohr W, Hjertqvist M, Wilder-Smith A, 2014. Attack rates of dengue fever in Swedish travellers. Scand J Infect Dis 46: 412–417.
Cobelens FG, Groen J, Osterhaus AD, Leentvaar-Kuipers A, Wertheim-van Dillen PM, Kager PA, 2002. Incidence and risk factors of probable dengue virus infection among Dutch travellers to Asia. Trop Med Int Health 7: 331–338.
Wilder-Smith A, Leong WY, 2018. Risk of severe dengue is higher in patients with sickle cell disease: a scoping review. J Travel Med 26: tay136.
Serre N, Franco L, Sulleiro E, Rubio JM, Zarzuela F, Molero F, Tenorio A, 2015. Concurrent infection with dengue type 4 and Plasmodium falciparum acquired in Haiti. J Travel Med 22: 345–347.
Lagi F et al. 2014. Imported dengue fever in Tuscany, Italy, in the period 2006 to 2012. J Travel Med 21: 340–343.
Chen LH et al. GeoSentinel Surveillance Network, 2018. Business travel-associated illness: a GeoSentinel analysis. J Travel Med: tax097 (https://doi.org/10.1093/jtm/tax097).
Lim PL et al. GeoSentinel Surveillance Network, 2012. Expatriates ill after travel: results from the geosentinel surveillance network. BMC Infect Dis 12: 386.
Neuberger A, Turgeman A, Lustig Y, Schwartz E, 2016. Dengue fever among Israeli expatriates in Delhi, 2015: implications for dengue incidence in Delhi, India. J Travel Med 23: tay010.
Heywood AE, Zwar N, 2018. Improving access and provision of pre-travel healthcare for travellers visiting friends and relatives: a review of the evidence. J Travel Med 25: taw003.
Rowe K, Chaves N, Leder K, 2017. Challenges to providing pre-travel care for travellers visiting friends and relatives: an audit of a specialist travel medicine clinic. J Travel Med 24: tax038.
Heywood AE et al. 2016. The contribution of travellers visiting friends and relatives to notified infectious diseases in Australia: state-based enhanced surveillance. Epidemiol Infect 144: 3554–3563.
Barnett ED, MacPherson DW, Stauffer WM, Loutan L, Hatz CF, Matteelli A, Behrens RH, 2010. The visiting friends or relatives traveler in the 21st century: time for a new definition. J Travel Med 17: 163–170.
Rabinowicz S, Schwartz E, 2017. Morbidity among Israeli paediatric travellers. J Travel Med 24: tax062.
Poddighe D, Bonomelli I, Giardinetti S, Nedbal M, Bruni P, 2016. Paediatric dengue fever diagnosed through parents’ epidemiologic report and preventive strategy during the acute phase of infection. J Travel Med 23: tav013.
Hagmann S, Neugebauer R, Schwartz E, Perret C, Castelli F, Barnett ED, Stauffer WM; GeoSentinel Surveillance Network, 2010. Illness in children after international travel: analysis from the GeoSentinel Surveillance Network. Pediatrics 125: e1072–e1080.
Olanwijitwong J, Piyaphanee W, Poovorawan K, Lawpoolsri S, Chanthavanich P, Wichainprasast P, Tantawichien T, 2017. Health problems among Thai tourists returning from India. J Travel Med 24: tax013.
Heywood AE, Lopez-Velez R, 2018. Reducing infectious disease inequities among migrants. J Travel Med 26: tay131.
Sadarangani SP, Lim PL, Vasoo S, 2017. Infectious diseases and migrant worker health in Singapore: a receiving country’s perspective. J Travel Med 24: tax014.
Barnett ED, Weld LH, McCarthy AE, So H, Walker PF, Stauffer W, Cetron M; GeoSentinel Surveillance Network, 2013. Spectrum of illness in international migrants seen at GeoSentinel clinics in 1997–2009, part 1: US-bound migrants evaluated by comprehensive protocol-based health assessment. Clin Infect Dis 56: 913–924.
Wilder-Smith A, Ooi EE, Horstick O, Wills B, 2019. Dengue. Lancet 393: 350–363.
Schwartz E, Mendelson E, Sidi Y, 1996. Dengue fever among travelers. Am J Med 101: 516–520.
Jelinek T, Ericsson CD, Steffen R, 2000. Dengue fever in international travelers. Clin Infect Dis 31: 144–147.
Streit JA, Yang M, Cavanaugh JE, Polgreen PM, 2011. Upward trend in dengue incidence among hospitalized patients, United States. Emerg Infect Dis 17: 914–916.
Jensenius M, Gundersen SG, Vene S, Bruu AL, 1997. Dengue fever imported to Norway. Serologically confirmed cases 1991–96. Tidsskr Nor Laegeforen 117: 4230–4233.
Ramos JM, Tello A, Alzamora A, Ramon ML, 2015. Optic neuritis in a traveler returning from Dominican Republic to Spain with dengue virus infection. J Travel Med 22: 133–135.
Kobayashi K, Hikone M, Sakamoto N, Iwabuchi S, Kashiura M, Takasaki T, Fujita H, Ohnishi K, 2015. Dengue-associated hemophagocytic syndrome in a Japanese traveler: a case report. J Travel Med 22: 64–66.
Tozan Y, Ratanawong P, Sewe MO, Wilder-Smith A, Kittayapong P, 2017. Household costs of hospitalized dengue illness in semi-rural Thailand. PLoS Negl Trop Dis 11: e0005961.
Thalagala N, Tissera H, Palihawadana P, Amarasinghe A, Ambagahawita A, Wilder-Smith A, Shepard DS, Tozan Y, 2016. Costs of dengue control activities and hospitalizations in the public health sector during an epidemic year in urban Sri Lanka. PLoS Negl Trop Dis 10: e0004466.
Shepard DS, Undurraga EA, Halasa YA, Stanaway JD, 2016. The global economic burden of dengue: a systematic analysis. Lancet Infect Dis 16: 935–941.
Shepard DS, Undurraga EA, Halasa YA, 2013. Economic and disease burden of dengue in southeast Asia. PLoS Negl Trop Dis 7: e2055.
World Tourism Organization and Global Tourism Economy Research Centre (UNTWO/GTERC), 2017. Annual Report on Tourism Trends, 2017 Edition – Executive Summary. Madrid, Spain: UNWTO.
Wilder-Smith A, 2018. Serostatus-dependent performance of the first licensed dengue vaccine: implications for travellers. J Travel Med 25: tay057.
Batchelor T, 2018. Timing of administration of dengue vaccine in travellers with a recent confirmed dengue infection. J Travel Med 25: tay092.
Wilder-Smith A et al. 2019. Deliberations of the strategic advisory group of experts on immunization on the use of CYD-TDV dengue vaccine. Lancet Infect Dis 19: e31–e38.
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Although the costs of dengue illness to patients and households have been extensively studied in endemic populations, international travelers have not been the focus of costing studies. As globalization and human travel activities intensify, travelers are increasingly at risk for emerging and reemerging infectious diseases, such as dengue. This exploratory study aims to investigate the impact and out-of-pocket costs of dengue illness among travelers. We conducted a prospective study in adult travelers with laboratory-confirmed dengue and recruited patients at travel medicine clinics in eight different countries from December 2013 to December 2015. Using a structured questionnaire, we collected information on patients and their health-care utilization and out-of-pocket expenditures, as well as income and other financial losses they incurred because of dengue illness. A total of 90 patients participated in the study, most of whom traveled for tourism (74%) and visited countries in Asia (82%). Although 22% reported hospitalization and 32% receiving ambulatory care while traveling, these percentages were higher at 39% and 71%, respectively, after returning home. The out-of-pocket direct and indirect costs of dengue illness were US$421 (SD 744) and US$571 (SD 1,913) per episode, respectively, averaging to a total out-of-pocket cost of US$992 (SD 2,052) per episode. The study findings suggest that international travelers incur important direct and indirect costs because of dengue-related illness. This study is the first to date to investigate the impact and out-of-pocket costs of travel-related dengue illness from the patient’s perspective and paves the way for future economic burden studies in this population.
Disclosure: L. C. reports personal fees from Shoreland, Inc. and Valneva, Inc., outside the submitted work.
Authors’ addresses: Yesim Tozan, College of Global Public Health, New York University, New York, NY, E-mail: tozan@nyu.edu. Tyler Y. Headley, Department of Political Science, NYU Abu Dhabi, Abu Dhabi, United Arab Emirates, E-mail: tyler.headley@nyu.edu. Maquines Odhiambo Sewe, Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå Center for Global Health Research, Umeå University, Umeå, Sweden, E-mail: maquines.sewe@umu.se. Eli Schwartz, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel, E-mail: eli.schwartz@sheba.health.gov.il. Tamar Shemesh, Sheba Medical Center, Institute of Tropical and Travel Medicine, Ramat-Gan, Israel, E-mail: tamarshem@gmail.com. Jakob P. Cramer, Kirsten A. Eberhardt, and Michael Ramharter, Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I Dep of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, E-mails: cramer@bni-hamburg.de, k.eberhardt@bnitm.de, and ramharter@bnitm.de. Nicole Harrison, Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria, E-mail: nicole.harrison@meduniwien.ac.at. Karin Leder, School of Public Health and Preventive Medicine, Monash University and Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, Australia, E-mail: karin.leder@monash.edu. Andrea Angheben, Centre for Tropical Diseases, IRCCS Hospital Sacro Cuore – Don Calabria, Verona, Italy, E-mail: andrea.angheben@sacrocuore.it. Christoph Hatz, Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland, E-mail: christoph.hatz@swisstph.ch. Andreas Neumayr, Swiss Tropical and Public Health Institute, Basel, Switzerland, E-mail: andreas.neumayr@swisstph.ch. Lin Hwei Chen, Travel Medicine Center, Mount Auburn Hospital, and Department of Medicine, Harvard Medical School, Boston, MA, E-mail: lin-hwei_chen@hms.harvard.edu. Cornelis A. De Pijper and Martin P. Grobusch, Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, E-mails: c.a.depijper@amc.uva.nl and m.p.grobusch@amc.uva.nl. Annelies Wilder-Smith, Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden, Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany, and Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mail: wilder-smith@uni-heidelberg.de.
Wilder-Smith A, Gubler DJ, Weaver SC, Monath TP, Heymann DL, Scott TW, 2017. Epidemic arboviral diseases: priorities for research and public health. Lancet Infect Dis 17: e101–e106.
Glaesser D, Kester J, Paulose H, Alizadeh A, Valentin B, 2017. Global travel patterns: an overview. J Travel Med 24: tax007.
Quam MB, Sessions O, Kamaraj US, Rocklov J, Wilder-Smith A, 2016. Dissecting Japan’s dengue outbreak in 2014. Am J Trop Med Hyg 94: 409–412.
Quam MB, Wilder-Smith A, 2015. Importation index of dengue to determine the most probable origin of importation. J Travel Med 22: 72.
Quam MB, Khan K, Sears J, Hu W, Rocklov J, Wilder-Smith A, 2015. Estimating air travel-associated importations of dengue virus into Italy. J Travel Med 22: 186–193.
Wilder-Smith A, Quam M, Sessions O, Rocklov J, Liu-Helmersson J, Franco L, Khan K, 2014. The 2012 dengue outbreak in Madeira: exploring the origins. Euro Surveill 19: 20718.
Sessions OM, Khan K, Hou Y, Meltzer E, Quam M, Schwartz E, Gubler DJ, Wilder-Smith A, 2013. Exploring the origin and potential for spread of the 2013 dengue outbreak in Luanda, Angola. Glob Health Action 6: 21822.
Masyeni S, Yohan B, Somia IKA, Myint KSA, Sasmono RT, 2018. Dengue infection in international travellers visiting Bali, Indonesia. J Travel Med 25: tay061.
Perez-Molina JA et al. 2017. 6-year review of +Redivi: a prospective registry of imported infectious diseases in Spain J Travel Med 24: tax035.
Wilder-Smith A, Boggild AK, 2018. Sentinel surveillance in travel medicine: 20 years of GeoSentinel publications (1999–2018). J Travel Med 25: tay139.
Griffiths KM, Savini H, Brouqui P, Simon F, Parola P, Gautret P, 2018. Surveillance of travel-associated diseases at two referral centres in Marseille, France: a 12-year survey. J Travel Med 25: tay007.
Liu-Helmersson J, Quam M, Wilder-Smith A, Stenlund H, Ebi K, Massad E, Rocklöv J, 2016. Climate change and Aedes vectors: 21st century projections for dengue transmission in Europe. EBioMedicine 7: 267–277.
Massad E, Amaku M, Coutinho FAB, Struchiner CJ, Burattini MN, Khan K, Liu-Helmersson J, Rocklöv J, Kraemer MUG, Wilder-Smith A, 2018. Estimating the probability of dengue virus introduction and secondary autochthonous cases in Europe. Sci Rep 8: 4629.
Ximenes R, Amaku M, Lopez LF, Coutinho FA, Burattini MN, Greenhalgh D, Wilder-Smith A, Struchiner CJ, Massad E, 2016. The risk of dengue for non-immune foreign visitors to the 2016 summer Olympic Games in Rio de Janeiro, Brazil. BMC Infect Dis 16: 186.
Massad E, Wilder-Smith A, Ximenes R, Amaku M, Lopez LF, Coutinho FA, Coelho GE, Silva JB Jr., Struchiner CJ, Burattini MN, 2014. Risk of symptomatic dengue for foreign visitors to the 2014 FIFA World Cup in Brazil. Mem Inst Oswaldo Cruz 109: 394–397.
Jentes ES, Lash RR, Johansson MA, Sharp TM, Henry R, Brady OJ, Sotir MJ, Hay SI, Margolis HS, Brunette GW, 2016. Evidence-based risk assessment and communication: a new global dengue-risk map for travellers and clinicians. J Travel Med 23: taw062.
Lalani T et al. 2016. A comparison of compliance rates with anti-vectorial protective measures during travel to regions with dengue or chikungunya activity, and regions endemic for Plasmodium falciparum malaria. J Travel Med 23: taw043.
Goodyer L, Schofield S, 2018. Mosquito repellents for the traveller: does picaridin provide longer protection than DEET? J Travel Med 25 (Suppl 1): S10–S15.
Wilder-Smith A, 2012. Dengue infections in travellers. Paediatr Int Child Health 32: 28–32.
Ratnam I, Leder K, Black J, Torresi J, 2013. Dengue fever and international travel. J Travel Med 20: 384–393.
Gautret P, Schlagenhauf P, Gaudart J, Castelli F, Brouqui P, von Sonnenburg F, Loutan L, Parola P; GeoSentinel Surveillance Network, 2009. Multicenter EuroTravNet/GeoSentinel study of travel-related infectious diseases in Europe. Emerg Infect Dis 15: 1783–1790.
Schwartz E, Weld LH, Wilder-Smith A, von Sonnenburg F, Keystone JS, Kain KC, Torresi J, Freedman DO; GeoSentinel Surveillance Network, 2008. Seasonality, annual trends, and characteristics of dengue among ill returned travelers, 1997–2006. Emerg Infect Dis 14: 1081–1088.
Leder K et al. GeoSentinel Surveillance Network, 2013. GeoSentinel surveillance of illness in returned travelers, 2007–2011. Ann Intern Med 158: 456–468.
Leder K et al. GeoSentinel Surveillance Network, 2013. Travel-associated illness trends and clusters, 2000–2010. Emerg Infect Dis 19: 1049–1073.
Wilson ME, Weld LH, Boggild A, Keystone JS, Kain KC, von Sonnenburg F, Schwartz E; GeoSentinel Surveillance Network, 2007. Fever in returned travelers: results from the GeoSentinel surveillance network. Clin Infect Dis 44: 1560–1568.
Rocklov J, Lohr W, Hjertqvist M, Wilder-Smith A, 2014. Attack rates of dengue fever in Swedish travellers. Scand J Infect Dis 46: 412–417.
Cobelens FG, Groen J, Osterhaus AD, Leentvaar-Kuipers A, Wertheim-van Dillen PM, Kager PA, 2002. Incidence and risk factors of probable dengue virus infection among Dutch travellers to Asia. Trop Med Int Health 7: 331–338.
Wilder-Smith A, Leong WY, 2018. Risk of severe dengue is higher in patients with sickle cell disease: a scoping review. J Travel Med 26: tay136.
Serre N, Franco L, Sulleiro E, Rubio JM, Zarzuela F, Molero F, Tenorio A, 2015. Concurrent infection with dengue type 4 and Plasmodium falciparum acquired in Haiti. J Travel Med 22: 345–347.
Lagi F et al. 2014. Imported dengue fever in Tuscany, Italy, in the period 2006 to 2012. J Travel Med 21: 340–343.
Chen LH et al. GeoSentinel Surveillance Network, 2018. Business travel-associated illness: a GeoSentinel analysis. J Travel Med: tax097 (https://doi.org/10.1093/jtm/tax097).
Lim PL et al. GeoSentinel Surveillance Network, 2012. Expatriates ill after travel: results from the geosentinel surveillance network. BMC Infect Dis 12: 386.
Neuberger A, Turgeman A, Lustig Y, Schwartz E, 2016. Dengue fever among Israeli expatriates in Delhi, 2015: implications for dengue incidence in Delhi, India. J Travel Med 23: tay010.
Heywood AE, Zwar N, 2018. Improving access and provision of pre-travel healthcare for travellers visiting friends and relatives: a review of the evidence. J Travel Med 25: taw003.
Rowe K, Chaves N, Leder K, 2017. Challenges to providing pre-travel care for travellers visiting friends and relatives: an audit of a specialist travel medicine clinic. J Travel Med 24: tax038.
Heywood AE et al. 2016. The contribution of travellers visiting friends and relatives to notified infectious diseases in Australia: state-based enhanced surveillance. Epidemiol Infect 144: 3554–3563.
Barnett ED, MacPherson DW, Stauffer WM, Loutan L, Hatz CF, Matteelli A, Behrens RH, 2010. The visiting friends or relatives traveler in the 21st century: time for a new definition. J Travel Med 17: 163–170.
Rabinowicz S, Schwartz E, 2017. Morbidity among Israeli paediatric travellers. J Travel Med 24: tax062.
Poddighe D, Bonomelli I, Giardinetti S, Nedbal M, Bruni P, 2016. Paediatric dengue fever diagnosed through parents’ epidemiologic report and preventive strategy during the acute phase of infection. J Travel Med 23: tav013.
Hagmann S, Neugebauer R, Schwartz E, Perret C, Castelli F, Barnett ED, Stauffer WM; GeoSentinel Surveillance Network, 2010. Illness in children after international travel: analysis from the GeoSentinel Surveillance Network. Pediatrics 125: e1072–e1080.
Olanwijitwong J, Piyaphanee W, Poovorawan K, Lawpoolsri S, Chanthavanich P, Wichainprasast P, Tantawichien T, 2017. Health problems among Thai tourists returning from India. J Travel Med 24: tax013.
Heywood AE, Lopez-Velez R, 2018. Reducing infectious disease inequities among migrants. J Travel Med 26: tay131.
Sadarangani SP, Lim PL, Vasoo S, 2017. Infectious diseases and migrant worker health in Singapore: a receiving country’s perspective. J Travel Med 24: tax014.
Barnett ED, Weld LH, McCarthy AE, So H, Walker PF, Stauffer W, Cetron M; GeoSentinel Surveillance Network, 2013. Spectrum of illness in international migrants seen at GeoSentinel clinics in 1997–2009, part 1: US-bound migrants evaluated by comprehensive protocol-based health assessment. Clin Infect Dis 56: 913–924.
Wilder-Smith A, Ooi EE, Horstick O, Wills B, 2019. Dengue. Lancet 393: 350–363.
Schwartz E, Mendelson E, Sidi Y, 1996. Dengue fever among travelers. Am J Med 101: 516–520.
Jelinek T, Ericsson CD, Steffen R, 2000. Dengue fever in international travelers. Clin Infect Dis 31: 144–147.
Streit JA, Yang M, Cavanaugh JE, Polgreen PM, 2011. Upward trend in dengue incidence among hospitalized patients, United States. Emerg Infect Dis 17: 914–916.
Jensenius M, Gundersen SG, Vene S, Bruu AL, 1997. Dengue fever imported to Norway. Serologically confirmed cases 1991–96. Tidsskr Nor Laegeforen 117: 4230–4233.
Ramos JM, Tello A, Alzamora A, Ramon ML, 2015. Optic neuritis in a traveler returning from Dominican Republic to Spain with dengue virus infection. J Travel Med 22: 133–135.
Kobayashi K, Hikone M, Sakamoto N, Iwabuchi S, Kashiura M, Takasaki T, Fujita H, Ohnishi K, 2015. Dengue-associated hemophagocytic syndrome in a Japanese traveler: a case report. J Travel Med 22: 64–66.
Tozan Y, Ratanawong P, Sewe MO, Wilder-Smith A, Kittayapong P, 2017. Household costs of hospitalized dengue illness in semi-rural Thailand. PLoS Negl Trop Dis 11: e0005961.
Thalagala N, Tissera H, Palihawadana P, Amarasinghe A, Ambagahawita A, Wilder-Smith A, Shepard DS, Tozan Y, 2016. Costs of dengue control activities and hospitalizations in the public health sector during an epidemic year in urban Sri Lanka. PLoS Negl Trop Dis 10: e0004466.
Shepard DS, Undurraga EA, Halasa YA, Stanaway JD, 2016. The global economic burden of dengue: a systematic analysis. Lancet Infect Dis 16: 935–941.
Shepard DS, Undurraga EA, Halasa YA, 2013. Economic and disease burden of dengue in southeast Asia. PLoS Negl Trop Dis 7: e2055.
World Tourism Organization and Global Tourism Economy Research Centre (UNTWO/GTERC), 2017. Annual Report on Tourism Trends, 2017 Edition – Executive Summary. Madrid, Spain: UNWTO.
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