Clinical Characteristics and Outcomes Among Travelers With Severe Dengue : A GeoSentinel Analysis.

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.

[Multi-resistant Enterobacterales and travel]. / Entérobactéries multirésistantes et voyage.

Multi-resistant Enterobacterales (MRE) are on the increase worldwide, with the main mechanism of resistance acquisition being horizontal transfer of plasmids coding for extended-spectrum betalactamase and/or carbapenemase. Low- and middle-income countries are the most affected, but surveillance in low-endemicity countries, such as Switzerland, is essential. International travel is one of the sources of MRE dissemination in the community, with the main risk factors for acquiring MRE being a stay in South or Southeast Asia and the use of antibiotics during travel. Other factors, notably animal and environmental, also explain this increase. Measures encompassing a One Health approach are therefore needed to address this issue.

Les entérobactéries multirésistantes (EMR) sont en augmentation dans le monde, avec comme mécanisme principal d'acquisition de résistance le transfert horizontal de plasmides codant pour une bêtalactamase à spectre étendu et/ou une carbapénèmase. Les pays à bas et moyens revenus sont les plus touchés, mais une surveillance dans les pays à faible endémicité, comme la Suisse, est essentielle. Les voyages internationaux sont l'une des sources de dissémination d'EMR dans la communauté, avec comme facteurs de risque principaux d'acquisition d'EMR un séjour en Asie du Sud ou du Sud-Est et l'utilisation d'antibiotiques durant le voyage. D'autres facteurs, notamment animaliers et environnementaux, expliquent aussi cette augmentation. Ainsi, il est nécessaire que des mesures englobant une approche « One Health ¼ répondent à cette problématique.

[HealthyTravel.ch - The reference website for traveler's health advice]. / HealthyTravel.ch ­ Le site internet de référence pour les conseils de santé aux voyageurs.

The Swiss Expert Committee on Travel Medicine (ECTM) - a body of the Swiss Society of Tropical Medicine and Travel Medicine (FMH) - publishes recommendations and information on travel medicine on the website www.healthytravel.ch in four languages (German, French, Italian, English). HealthyTravel.ch, which has replaced Safetravel.ch, is the reference website for travelers' health advice in Switzerland supported by the Federal Office of Public Health (FOPH). It consists of a free version with basic travel medicine recommendations for the public, and a fee-based PRO version for professionals, containing more detailed information and recommendations. This article provides an overview of the available content and tips on how to make the best use of www.healthytravel.ch.

Le Comité suisse d'experts en médecine des voyages (CFMV), un organe de la Société suisse de médecine tropicale et de médecine des voyages (FMH), publie sur le site internet www.healthytravel.ch des recommandations et des informations sur la médecine des voyages en quatre langues (allemand, français, italien et anglais). HealthyTravel.ch, qui a remplacé le site Safetravel.ch, est le site internet de référence pour les conseils de santé aux voyageurs soutenu par l'Office fédéral de la santé publique (OFSP). Il est composé d'une version gratuite, avec des recommandations de base en matière de médecine des voyages pour le public, et d'une version PRO, payante, pour les professionnels, contenant des informations et des recommandations plus détaillées. Cet article donne un aperçu des contenus disponibles et des conseils d'utilisation optimale du site www.healthytravel.ch.

[Acute diarrhea: updates for primary care medicine in 2023]. / Diarrhées aiguës : nouveautés 2023 pour la médecine de premier recours.

Acute diarrheal disease is a frequent primary care reason for consultation, leading to direct and indirect health costs in high-income countries. Most patients presenting with acute diarrhea will have a favorable clinical course with just a symptomatic treatment. The challenge for the general practitioner is to identify the patients who need paraclinical exams and/or antibiotics. Molecular identification of pathogens in stool samples has developed over the past years and presents both advantages and limitations. Because of increasing microbial resistance to quinolones in Campylobacter and Shigella strains, azithromycin is now the first choice for an empiric antimicrobial therapy. This article will discuss these latest developments in the management of acute diarrhea in the primary care setting.

Les diarrhées aiguës sont un motif de consultation fréquent en médecine générale et engendrent des coûts directs et indirects importants dans les pays industrialisés. Les cas sont majoritairement bénins et évoluent de manière favorable avec un traitement symptomatique. Le défi pour le médecin généraliste est d'identifier les patient-e-s nécessitant des examens complémentaires et/ou un traitement antibiotique. Ces dernières années, les examens microbiologiques moléculaires des selles se sont développés ; ils ont des avantages, mais également des limitations. Sur le plan thérapeutique, l'azithromycine est désormais à privilégier comme antibiothérapie empirique en raison de l'accroissement du nombre de souches de Campylobacter et Shigella résistantes aux quinolones. Cet article discute ces nouveautés dans la prise en charge des diarrhées aiguës du point de vue du généraliste.

[Collateral effects of the COVID-19 pandemic on the practice of tropical and travel medicine]. / Effets de la pandémie de Covid-19 sur la pratique de médecine tropicale et des voyages.

Undoubtedly, the COVID-19 pandemic has had impacts in many areas, including travel and by extension on daily practice in tropical and travel medicine. The intercontinental travelers in decline have been replaced by a new population of travelers who previously did not require specific consultations. SARS-CoV-2 has earned its place in the pre-travel consultation in view of the medical and administrative implications. Furthermore, the global health effects of the pandemic are broader than its direct medical consequences and should not be underestimated. The increase in malaria mortality worldwide is just one example. Preventive measures prior to exposure are more important than ever.

Indubitablement, la pandémie de Covid-19 a eu des impacts dans de nombreux domaines, notamment les voyages, et par extension sur la pratique quotidienne en médecine tropicale et des voyages. Les voyageurs intercontinentaux en diminution ont été remplacés par une nouvelle population de voyageurs qui ne nécessitait pas jusqu'alors de consultations particulières. Le SARS-CoV-2 a gagné sa place dans la consultation prévoyage au vu des implications médicales et administratives. Par ailleurs, les effets de la pandémie sur la santé globale sont plus larges que ses conséquences médicales directes et ne devraient pas être sous-estimés. L'augmentation de la mortalité due à la malaria dans le monde n'en est qu'un exemple. Les mesures préventives avant exposition sont plus que jamais d'actualité.

[Tick-borne meningoencephalitis: situation in Switzerland and impact of the Covid pandemic]. / Méningo-encéphalite à tiques : situation en Suisse et impact de la pandémie de Covid-19.

The year 2020 witnessed a record number of reported cases of tick-borne encephalitis in Switzerland. This unprecedented rate of cases, largely explained by the decrease in travel outside of Switzerland as well as favorable conditions for outdoor activities, highlights this severe disease for which there is no treatment yet. Tick-borne ence-phalitis has been progressing in Switzerland for more than 30 years both geographically and in terms of the number of reported cases. Indeed, the outbreaks were localized in the North-East of Switzerland at the beginning of the 2000s until recently affecting the Valais and the Ticino. Vaccination is the most effective way to prevent the disease and thus the long-term sequelae that can be caused by this infection.

L'année 2020 a été témoin d'un record de cas déclarés de méningo-encéphalite à tiques en Suisse. Ce taux de cas encore jamais vu, en grande partie expliqué par la diminution des voyages en dehors de la Suisse ainsi que des conditions favorables à des activités en plein air, met en lumière cette maladie grave pour laquelle il n'existe pas encore de traitement. La méningo-encéphalite à tiques progresse en Suisse depuis plus de 30 ans autant géographiquement qu'au niveau du nombre de cas déclarés. En effet, les foyers étaient localisés au nord-est de la Suisse au début des années 2000 avant de toucher récemment le Valais et le Tessin. La vaccination est le moyen le plus efficace de prévenir la maladie ainsi que les séquelles à long terme pouvant être causées par cette infection.

[Vaccine prevention in patients with rheumatic diseases]. / Prévention vaccinale chez les patients avec des maladies rhumatismales.

Patients with inflammatory rheumatologic diseases are at increased risk for infectious complications, including SARS-CoV-2, which represent one of the leading causes of death in this population. This risk is due to both the numerous comorbidities of this patient's group and the immunosuppressive therapies they receive. Vaccination reduces the incidence, complications, and mortality from infections. For patients receiving immunosuppressors, exacerbation of underlying diseases is rarely observed after immunization and only live-attenuated vaccines are contraindicated. A vaccination history and updated vaccination plan should be part of the clinical follow-up of patients with inflammatory rheumatism.

Les patients souffrant de maladies rhumatologiques inflammatoires sont plus à risque de complications infectieuses, y compris avec le SARS-CoV-2, qui représentent l'une des premières causes de mortalité dans cette population. Ce risque est attribuable à la fois aux nombreuses comorbidités de ces patients et aux thérapies immunosuppressives qu'ils reçoivent. La vaccination diminue l'incidence, les complications et la mortalité dues aux infections. Pour les patients recevant des immunosuppresseurs, une exacerbation significative des maladies sous-jacentes n'est qu'exception nellement observée après vaccination et seuls les vaccins vivants atténués sont en principe contre-indiqués. Une anamnèse vaccinale et une mise à jour du plan vaccinal doivent faire partie du suivi clinique de patients souffrant d'un rhumatisme inflammatoire.

[Parasite screening for immunosuppressed traveler]. / Dépistage parasitaire chez le voyageur immunosupprimé.

Before starting immunosuppressive therapy, it is important to screen for latent tuberculosis and, in case of particular exposures (e.g. travel, origin,…), for parasitosis such as amoebiasis, echinococcosis, strongyloidiasis and American trypanosomiasis. The Division of Tropical and Humanitarian Medicine of the Geneva University Hospitals has developed an algorithm to identify which screening is recommended according to exposure. Analysis of this practice shows that the most frequently detected latent disease is tuberculosis, followed by strongyloidiasis. For the latter, as the sensitivity of the serological test is reduced due to immunosuppression, the algorithm combine antibody testing with parasitological (Baermann and culture) and molecular (PCR) stool testing.

Avant le début d'un traitement immunosuppresseur, il est important d'effectuer un dépistage pour la tuberculose latente et, en cas d'expositions particulières (par exemple, voyage, origine…), de parasitoses comme l'amibiase, l'échinococcose, la strongyloïdiase et la trypanosomiase américaine. Le service de médecine tropicale et humanitaire des HUG a développé un algorithme pour identifier quel dépistage est recommandé en fonction de l'exposition. L'analyse de cette pratique montre que la maladie latente la plus fréquemment détectée est la tuberculose, suivie de la strongyloïdiase. Pour cette dernière, la sensibilité du test sérologique étant amoindrie à cause de l'immunosuppression, l'algorithme combine la recherche d'anticorps avec un test parasitologique (Baermann et culture) et moléculaire (PCR) des selles.

Epidemiological and Clinical Characteristics of International Travelers with Enteric Fever and Antibiotic Resistance Profiles of Their Isolates: a GeoSentinel Analysis.

Enteric fever, caused by Salmonella enterica serovar Typhi (S Typhi) and S. enterica serovar Paratyphi (S Paratyphi), is a common travel-related illness. Limited data are available on the antimicrobial resistance (AMR) patterns of these serovars among travelers. Records of travelers 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 nonsusceptible if intermediate or resistant or as susceptible in accordance with the participating site's national guidelines. A total of 889 travelers (S Typhi infections, n = 474; S Paratyphi infections, n = 414; coinfection, n = 1) were included; 114 (13%) were children of <18 years old. Most individuals (41%) traveled to visit friends and relatives (VFRs) and acquired the infection in South Asia (71%). Child travelers with S Typhi infection were most frequently VFRs (77%). The median trip duration was 31 days (interquartile range, 18 to 61 days), and 448 of 691 travelers (65%) had no pretravel consultation. Of 143 S Typhi and 75 S Paratyphi isolates for which there were susceptibility data, nonsusceptibility to antibiotics varied (fluoroquinolones, 65% and 56%, respectively; co-trimoxazole, 13% and 0%; macrolides, 8% and 16%). Two S Typhi isolates (1.5%) from India were nonsusceptible to third-generation cephalosporins. S Typhi fluoroquinolone nonsusceptibility was highest when infection was acquired in South Asia (70 of 90 isolates; 78%) and sub-Saharan Africa (6 of 10 isolates; 60%). Enteric fever is an important travel-associated illness complicated by AMR. Our data contribute to a better understanding of region-specific AMR, helping to inform empirical treatment options. Prevention measures need to focus on high-risk travelers including VFRs and children.

Increased risk of chikungunya infection in travellers to Thailand during ongoing outbreak in tourist areas: cases imported to Europe and the Middle East, early 2019.

We report nine travellers with confirmed chikungunya virus infection, returning from tourist areas of Thailand to Sweden, Switzerland, the United Kingdom, Romania, Israel and France, diagnosed in January and February 2019. These sentinel tourists support the intensification of chikungunya virus circulation in Thailand and highlight the potential for importation to areas at risk of local transmission.

[Diphtheria: new clinical presentations of an old disease]. / Diphtérie†: nouvelle présentation clinique d'une ancienne maladie.

Diphtheria is reappearing in a typical cutaneous form where pre-existing skin lesions (wounds or insect bites) become pustular and turn into painful non-healing ulcers. This form is more common among migrants and disadvantaged populations. Lesions can be caused by strains of toxigenic and non-toxigenic Corynebacteria and among them the famous Corynebacterium diphtheriae. In this paper we review diphtheria's clinical presentations and pathogenesis, as well as methods of diagnosis, treatment and prevention.

La diphtérie réapparaît sous une forme cutanée typique : des lésions préexistantes (plaies ou piqûres d'insectes) deviennent pustuleuses et se transforment rapidement en ulcères douloureux ne cicatrisant pas. Ce tableau se retrouve plus fréquemment chez les migrants, mais aussi au sein de populations défavorisées, et chez des voyageurs en retour de zones d'endémie. Les lésions peuvent être causées par des souches de corynébactéries toxinogènes ou non, et parfois liées à d'autres espèces que le fameux Corynebacterium diphtheriae. Cet article rappelle les présentations cliniques, le rôle des pathogènes ou de leurs toxines ainsi que les méthodes de diagnostic, traitement et prévention.

[Zika virus†: update of the practical guidelines]. / Virus Zika†: mise à jour des recommandations.

Since the outbreak in Latin America and the Caribbean (LAC) region in 2015-2017, the Zika virus (ZIKV) is present in most of tropical and sub-tropical countries. Herd immunity in LAC is now high and the number of cases is reduced. Consequently, the risk for a traveller to be infected is now considered to be low. The epidemiological change and the new published evidences have led to a revision of travel recommendations. Through practical cases, we present here the guidelines updated in April 2019 by the Swiss Expert Committee of Travel Medicine.

Depuis son introduction en Amérique en 2015-2017, le virus Zika est présent dans la plupart des pays tropicaux et subtropicaux. L'immunité de groupe dans les pays en Amérique latine est dorénavant élevée et le nombre de cas déclarés a diminué. Par conséquent, le risque pour un voyageur de s'infecter est généralement considéré maintenant comme faible. Les modifications épidémiologiques et les nouvelles évidences publiées ont permis une révision des recommandations aux voyageurs. Par l'intermédiaire de cas illustratifs, nous présentons les recommandations reconnues en avril 2019 par le Comité suisse des experts de médecine des voyages.

Area of exposure and treatment challenges of malaria in Eritrean migrants: a GeoSentinel analysis.

BACKGROUND: Recent reports highlight malaria as a frequent diagnosis in migrants who originate from Eritrea. A descriptive analysis of GeoSentinel cases of malaria in Eritrean migrants was done together with a literature review to elucidate key attributes of malaria in this group with a focus on possible areas of acquisition of malaria and treatment challenges. RESULTS: A total of 146 cases were identified from the GeoSentinel database from 1999 through September 2017, with a marked increase in 2014 and 2015. All patients originated from Eritrea and the main reporting GeoSentinel sites were in Norway, Switzerland, Sweden, Israel and Germany. The majority of patients (young adult males) were diagnosed with malaria following arrival in the host country. All patients had a possible exposure in Eritrea, but may have been exposed in documented transit countries including Ethiopia, Sudan and possibly Libya in detention centres. Most infections were due to Plasmodium vivax (84.2%), followed by Plasmodium falciparum (8.2%). Two patients were pregnant, and both had P. vivax malaria. Some 31% of the migrants reported having had malaria while in transit. The median time to onset of malaria symptoms post arrival in the host country was 39 days. Some 66% of patients were hospitalized and nine patients had severe malaria (according to WHO criteria), including five due to P. vivax. CONCLUSIONS: The 146 cases of mainly late onset, sometimes severe, P. vivax malaria in Eritrean migrants described in this multi-site, global analysis reflect the findings of single-centre analyses identified in the literature search. Host countries receiving asylum-seekers from Eritrea need to be prepared for large surges in vivax and, to a lesser extent, falciparum malaria, and need to be aware and prepared for glucose-6-phosphate dehydrogenase deficiency testing and primaquine treatment, which is difficult to procure and mainly unlicensed in Europe. There is an urgent need to explore the molecular epidemiology of P. vivax in Eritrean asylum-seekers, to investigate the area of acquisition of P. vivax along common transit routes and to determine whether there has been re-introduction of malaria in areas, such as Libya, where malaria is considered eliminated, but where capable vectors and Plasmodium co-circulate.

Travel-Associated Zika Virus Disease Acquired in the Americas Through February 2016: A GeoSentinel Analysis.

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

[The immunosuppressed traveler : vaccination guidelines]. / Voyageur immunosupprimé : recommandations vaccinales.

The number of immunosuppressed travelers has exponentially increased in the past few years. This is a positive development as these patients, owing to much improved management, are now in a condition allowing them to plan activities abroad comparable to healthy persons. However, pre-travel consultation and vaccinations are particularly important to reduce the risks and/or the complications of travel-related diseases. Although we already published a review on this topic in 2013, the recent increase of immunosuppressive agents available in Switzerland justifies this update.

Depuis quelques années, le nombre de voyageurs immunosupprimés ne fait qu'augmenter. Nous pouvons bien entendu nous en réjouir, puisque ces patients bénéficient de traitements efficaces qui leur permettent dorénavant d'envisager une vie et des activités comparables à un individu sain. Si nous voulons conserver ce bénéfice, il est nécessaire de préparer et vacciner au mieux ces patients afin de diminuer leurs risques de pathologies infectieuses liées au voyage ou à l'expatriation dans des zones tropicales. En 2013, nous avions déjà publié une revue sur le sujet, et une réactualisation semblait nécessaire au vu du nombre croissant de traitements immunosuppresseurs disponibles sur le marché suisse.

Zika virus: practical guidelines. / Virus Zika : recommandations pratiques.

Zika virus suddenly emerged in Latin America in 2015­2016. Congenital malformations have been observed in infected pregnant women, causing a major public health impact in affected countries, particularly in Brazil. In addition, sexual transmission of Zika virus has been well documented. This led to the development of prevention strategies and recommendations for travellers visiting at risk countries. These documents are regularly amended depending on the evolution of scientific knowledge, the epidemiologic trends and the national and international guidelines. Through practical cases, we present here the guidelines developed by the Geneva University Hospitals.

Le virus Zika a émergé brusquement en 2015­2016 en Amérique latine. Lors de cette épidémie, des complications fœtales ont pu être observées avec des conséquences majeures sur la santé publique de ces pays, en particulier au Brésil. De plus, une transmission par voie sexuelle du virus a été bien documentée. Il a ainsi été nécessaire de développer des stratégies de prévention et des recommandations pour les voyageurs visitant des pays à risque. Ces documents sont évolutifs en fonction des connaissances scientifiques, de l'épidémiologie de la maladie et des recommandations nationales et internationales. Par l'intermédiaire de cas illustratifs, nous présentons les recommandations utilisées aux Hôpitaux universitaires de Genève.

[Fever and rash in the adult patient]. / Exanthème fébrile chez l'adulte.

Fever with rash is a frequent reason for consultation. A detailed medical history and thorough physical examination are essential since laboratory tests often lack specificity. Certain infectious and non-infectious causes are considered medical emergencies and must always be investigated upon initial evaluation. In the case of a history of recent travel the differential diagnosis has to be broadened but it should not be forgotten that resurgent « childhood ¼ viral diseases like measles can be acquired while traveling.

L'exanthème fébrile est un motif fréquent de consultations. Une anamnèse détaillée et un status minutieux sont les clés pour poser le diagnostic car les examens de laboratoire sont souvent peu spécifiques. Certaines causes infectieuses et non infectieuses représentent des urgences et doivent toujours être évoquées et recherchées lors de l'évaluation initiale. L'élément « retour de voyage ¼ élargit le diagnostic différentiel, mais ne doit pas faire oublier que certains « exanthèmes infantiles ¼ comme la rougeole peuvent aussi être acquis en voyageant.

Partnerships in global health and collaborative governance: lessons learnt from the Division of Tropical and Humanitarian Medicine at the Geneva University Hospitals.

BACKGROUND: In 2007 the "Crisp Report" on international partnerships increased interest in Northern countries on the way their links with Southern partners operated. Since its establishment in 2007 the Division of Tropical and Humanitarian Medicine at the Geneva University Hospitals has developed a variety of partnerships. Frameworks to assess these partnerships are needed and recent attention in the field of public management on collaborative governance may provide a useful approach for analyzing international collaborations. METHODS: Projects of the Division of Tropical and Humanitarian Medicine were analyzed by collaborators within the Division using the model proposed by Emerson and colleagues for collaborative governance, which comprises different components that assess the collaborative process. RESULTS: International projects within the Division of Tropical and Humanitarian Medicine can be divided into four categories: Human resource development; Humanitarian response; Neglected Tropical Diseases and Noncommunicable diseases. For each of these projects there was a clear leader from the Division of Tropical and Humanitarian Medicine as well as a local counterpart. These individuals were seen as leaders both due to their role in establishing the collaboration as well as their technical expertise. Across these projects the actual partners vary greatly. This diversity means a wide range of contributions to the collaboration, but also complexity in managing different interests. A common definition of the collaborative aims in each of the projects is both a formal and informal process. Legal, financial and administrative aspects of the collaboration are the formal elements. These can be a challenge based on different administrative requirements. Friendship is part of the informal aspects and helps contribute to a relationship that is not exclusively professional. CONCLUSION: Using collaborative governance allows the complexity of managing partnerships to be presented. The framework used highlights the process of establishing collaborations, which is an element often negated by other more traditional models used in international partnerships. Applying the framework to the projects of the Division of Tropical and Humanitarian Medicine highlights the importance of shared values and interests, credibility of partners, formal and informal methods of management as well as friendship.

[Plasmodium vivax, a parasite coming out of the shadows]. / Plasmodium vivax, un parasite qui sort de l'ombre.

Since 2007, the incidence and mortality of malaria caused by Plasmodium falciparum have declined. However, this trend has not been seen with Plasmodium vivax which has biological features. Severe vivax malaria is increasingly reported in endemic countries even though P. vivax has been thought of as a benign disease. Diagnosis is challenging: the usual rapid diagnostic tests are less sensitive in detecting P. vivax and there is no test for the detection of the dormant forms (hypnozoites). The treatment of the acute phase is an artemisinin based combination, e.g. artemetherlumefantrine. Primaquine, which is the only currently available treatment against hypnozoites for the prevention of relapses, may trigger acute haemolytic anaemia in individuals with G6PD deficiency.

[Zika virus : a review]. / Virus Zika : mise au point.

Since early 2015, the Zika virus epidemic has spread rapidly through South America and the Caribbean and the first cases of local transmission have just been reported in Florida. Maternal infection during pregnancy can cause serious birth defects. Pregnant women and their partners should avoid travelling to areas of Zika epidemic.

Depuis le début de l'année 2015, l'épidémie de virus Zika s'est répandue rapidement en Amérique du Sud et dans les Caraïbes et récemment les premiers cas de transmission autochtone ont été déclarés en Floride. Une infection maternelle au cours de la grossesse peut être responsable de graves malformations fœtales. Le voyage dans les zones d'épidémie est déconseillé aux femmes enceintes et à leur partenaire.