Dengue, chikungunya and Zika in GeoSentinel surveillance of international travellers: a literature review from 1995 to 2020.

INTRODUCTION: GeoSentinel is a global surveillance network of travel medicine providers seeing ill-returned travellers. Much of our knowledge on health problems and infectious encountered by international travellers has evolved as a result of GeoSentinel surveillance, providing geographic and temporal trends in morbidity among travellers while contributing to improved pre-travel advice. We set out to synthesize epidemiological information, clinical manifestations and time trends for dengue, chikungunya and Zika in travellers as captured by GeoSentinel. METHODS: We conducted a systematic literature search in PubMed on international travellers who presented with dengue, chikungunya or Zika virus infections to GeoSentinel sites around the world from 1995 until 2020. RESULTS: Of 107 GeoSentinel publications, 42 articles were related to dengue, chikungunya and/or Zika. The final analyses and synthesis of and results presented here are based on the findings from 27 original articles covering the three arboviral diseases. CONCLUSIONS: Dengue is the most frequent arboviral disease encountered in travellers presenting to GeoSentinel sites, with increasing trends over the past two decades. In Southeast Asia, annual proportionate morbidity increased from 50 dengue cases per 1000 ill returned travellers in non-epidemic years to an average of 159 cases per 1000 travellers during epidemic years. The highest number of travellers with chikungunya virus infections was reported during the chikungunya outbreak in the Americas and the Caribbean in the years 2013-16. Zika was first reported by GeoSentinel already in 2012, but notifications peaked in the years 2016-17 reflecting the public health emergency in the Americas at the time.

Perceptions Pertaining to Clinical Depression in Karachi, Pakistan.

Introduction There is a high prevalence of depression in developing countries, and low mental health literacy has been hypothesized as one of the main causes of increasing rates of mental illness in a population. This study aimed to capture an image of the current attitude and perceptions towards victims of clinical depression in Pakistan and to assess the impact of those beliefs.  Methods A cross-sectional study was conducted with 400 people, chosen through non-probability consecutive sampling, from Karachi, Pakistan. A questionnaire was designed to evaluate the overall perception of depression including its causes, manifestations and treatment options. Descriptive statistics were used and p-values less than 0.05 calculated using the chi-square test were considered significant. Results Most of the participants comprehended depression as a natural feeling of sadness rather than a mental disorder. The vast majority cited increased stress (72.2%) and physical/ emotional trauma (51.3%) as the main causes of depression. The most popularly associated symptoms were sadness (53.3%), irritability (53.3%), inability to perform daily tasks (52.8%), and changes in sleeping patterns (52%). Participants believed depression to be best treated by talking to someone trustworthy (59.5%), praying to God (56.5%) and consulting a psychologist/psychiatrist (52.3%). There was a significant association between the participants' level of education and their perception of clinical depression (p=0.026). Conclusion Our study showed a skewed perception of depression with the majority only acknowledging it as a natural feeling of sadness. However, stress was seen as a major perpetrator and the importance of a good support system was acknowledged by most participants. Level of education was revealed to be the most important factor that influenced these beliefs. Effective community-based programs and policies based on these public views will help develop an accessible and autonomous support system for patients with mental illnesses.

ZikaPLAN: Zika Preparedness Latin American Network.

The ongoing Zika virus (ZIKV) outbreak in Latin America, the Caribbean, and the Pacific Islands has underlined the need for a coordinated research network across the whole region that can respond rapidly to address the current knowledge gaps in Zika and enhance research preparedness beyond Zika. The European Union under its Horizon 2020 Research and Innovation Programme awarded three research consortia to respond to this need. Here we present the ZikaPLAN (Zika Preparedness Latin American Network) consortium. ZikaPLAN combines the strengths of 25 partners in Latin America, North America, Africa, Asia, and various centers in Europe. We will conduct clinical studies to estimate the risk and further define the full spectrum and risk factors of congenital Zika virus syndrome (including neurodevelopmental milestones in the first 3 years of life), delineate neurological complications associated with ZIKV due to direct neuroinvasion and immune-mediated responses in older children and adults, and strengthen surveillance for birth defects and Guillain-Barré Syndrome. Laboratory-based research to unravel neurotropism and investigate the role of sexual transmission, determinants of severe disease, and viral fitness will underpin the clinical studies. Social messaging and engagement with affected communities, as well as development of wearable repellent technologies against Aedes mosquitoes will enhance the impact. Burden of disease studies, data-driven vector control, and vaccine modeling as well as risk assessments on geographic spread of ZIKV will form the foundation for evidence-informed policies. While addressing the research gaps around ZIKV, we will engage in capacity building in laboratory and clinical research, collaborate with existing and new networks to share knowledge, and work with international organizations to tackle regulatory and other bottlenecks and refine research priorities. In this way, we can leverage the ZIKV response toward building a long-term emerging infectious diseases response capacity in the region to address future challenges.