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Mosquito Exposure and Chikungunya and Dengue Infection Among Travelers During the Chikungunya Outbreak in the Americas
Travelers are at risk for arbovirus infection. We prospectively enrolled 267 Department of Defense beneficiaries traveling to chikungunya-outbreak regions in the Americas between December 2013 and May 2015 and assessed travel characteristics and serologic exposure to chikungunya virus (CHIKV) and dengue virus (DENV). Ten ill-returning travelers were also assessed retrospectively. Self-reported mosquito exposure was common (64% of 198 evaluable travelers saw mosquitoes; 53% of 201 reported ≥ 1 bite). Increased exposure was associated with active-duty travelers (odds ratio [OR] = 2.6 [1.3–5.4] for seeing mosquitoes) or travelers visiting friends and relatives (VFR) (OR = 3.5 [1.0–10.0] for high-intensity bite exposure). Arbovirus infection was defined as seroconversion on plaque reduction neutralization testing (PRNT) of pre- and posttravel sera. For ill subjects enrolled posttravel, infection was defined by a positive convalescent PRNT and/or a positive reverse transcription polymerase chain reaction for CHIKV or DENV. We identified seven cases of arbovirus infection: four with CHIKV, five with DENV, and two with both. The composite attack rate for CHIKV and DENV infection was 3.7% of 108 evaluable, immunologically naïve, prospectively assessed travelers; there was serologic and/or polymerase chain reaction evidence of arbovirus infection in three of four evaluable (three of 10 total) ill-returning travelers. We identified both symptomatic and asymptomatic cases. Military purpose of travel and VFR travel accounted for five of seven cases. Pretravel counseling is important and should target higher risk groups. Given a shared vector between CHIKV, DENV, and Zika virus (ZIKV), this study can also help guide counseling for travelers to ZIKV-outbreak regions.
Author Notes
Financial support: The study was supported by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense (DoD) program executed through the Uniformed Services University of the Health Sciences, the National Institute of Allergy and Infectious Diseases, and National Institutes of Health (NIH), under the Inter-Agency Agreement Y1-AI-5072.
Copyright statement: Some authors are employees of the U.S. Government. This work was prepared as part of their official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person's official duties.
Authors' addresses: David A. Lindholm, San Antonio Military Medical Center, San Antonio, TX, E-mail: david.lindholm@us.af.mil. Todd Myers and Susana Widjaja, Naval Infectious Diseases Diagnostic Laboratory, Silver Spring, MD, E-mails: todd.e.myers.mil@mail.mil and susana.widjaja.ctr@mail.mil. Edward M. Grant, Kalyani Telu, and David R. Tribble, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, E-mails: edward.m.grant@gmail.com, ktelu@idcrp.org, and dtribble@idcrp.org. Tahaniyat Lalani, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, and Naval Medical Center, Portsmouth, VA, E-mail: tlalani@idcrp.org. Jamie Fraser, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, E-mail: jamie.fraser.ctr@usuhs.edu. Mary Fairchok, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, and Madigan Army Medical Center, Tacoma, WA, E-mail: mary.p.fairchok.ctr@mail.mil. Anuradha Ganesan, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, and Walter Reed National Military Medical Center, Bethesda, MD, E-mail: anuradha.ganesan.ctr@mail.mil. Mark D. Johnson, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, and Naval Health Research Center, San Diego, CA, E-mail: mark.d.johnson292.mil@mail.mil. Anjali Kunz, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, and Madigan Army Medical Center, Tacoma, WA, E-mail: anjali.n.kunz.mil@mail.mil. Heather C. Yun, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, and San Antonio Military Medical Center, San Antonio, TX, E-mail: heather.c.yun.mil@mail.mil.