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1.
Emerg Infect Dis ; 22(8): 1340-1347, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27434822

RESUMO

During 2013, the Maryland Department of Health and Mental Hygiene in Baltimore, MD, USA, received report of 2 Maryland residents whose surgical sites were infected with rapidly growing mycobacteria after cosmetic procedures at a clinic (clinic A) in the Dominican Republic. A multistate investigation was initiated; a probable case was defined as a surgical site infection unresponsive to therapy in a patient who had undergone cosmetic surgery in the Dominican Republic. We identified 21 case-patients in 6 states who had surgery in 1 of 5 Dominican Republic clinics; 13 (62%) had surgery at clinic A. Isolates from 12 (92%) of those patients were culture-positive for Mycobacterium abscessus complex. Of 9 clinic A case-patients with available data, all required therapeutic surgical intervention, 8 (92%) were hospitalized, and 7 (78%) required ≥3 months of antibacterial drug therapy. Healthcare providers should consider infection with rapidly growing mycobacteria in patients who have surgical site infections unresponsive to standard treatment.


Assuntos
Turismo Médico , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium abscessus , Adolescente , Adulto , Surtos de Doenças , República Dominicana/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/economia , Cirurgia Plástica/efeitos adversos , Infecção da Ferida Cirúrgica , Estados Unidos/epidemiologia , Adulto Jovem
2.
Clin Infect Dis ; 59(10): 1401-10, 2014 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-25091309

RESUMO

BACKGROUND: Through 2 international traveler-focused surveillance networks (GeoSentinel and TropNet), we identified and investigated a large outbreak of acute muscular sarcocystosis (AMS), a rarely reported zoonosis caused by a protozoan parasite of the genus Sarcocystis, associated with travel to Tioman Island, Malaysia, during 2011-2012. METHODS: Clinicians reporting patients with suspected AMS to GeoSentinel submitted demographic, clinical, itinerary, and exposure data. We defined a probable case as travel to Tioman Island after 1 March 2011, eosinophilia (>5%), clinical or laboratory-supported myositis, and negative trichinellosis serology. Case confirmation required histologic observation of sarcocysts or isolation of Sarcocystis species DNA from muscle biopsy. RESULTS: Sixty-eight patients met the case definition (62 probable and 6 confirmed). All but 2 resided in Europe; all were tourists and traveled mostly during the summer months. The most frequent symptoms reported were myalgia (100%), fatigue (91%), fever (82%), headache (59%), and arthralgia (29%); onset clustered during 2 distinct periods: "early" during the second and "late" during the sixth week after departure from the island. Blood eosinophilia and elevated serum creatinine phosphokinase (CPK) levels were observed beginning during the fifth week after departure. Sarcocystis nesbitti DNA was recovered from 1 muscle biopsy. CONCLUSIONS: Clinicians evaluating travelers returning ill from Malaysia with myalgia, with or without fever, should consider AMS, noting the apparent biphasic aspect of the disease, the later onset of elevated CPK and eosinophilia, and the possibility for relapses. The exact source of infection among travelers to Tioman Island remains unclear but needs to be determined to prevent future illnesses.


Assuntos
Ilhas , Sarcocistose/epidemiologia , Viagem , Adolescente , Adulto , Idoso , Biópsia , Criança , Pré-Escolar , Surtos de Doenças , Eosinófilos , Feminino , Geografia , Humanos , Contagem de Leucócitos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Músculos/parasitologia , Músculos/patologia , Músculos/ultraestrutura , Vigilância em Saúde Pública , Fatores de Risco , Sarcocystis/genética , Sarcocystis/isolamento & purificação , Sarcocistose/diagnóstico , Sarcocistose/transmissão , Adulto Jovem
3.
MMWR Morb Mortal Wkly Rep ; 63(9): 201-2, 2014 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-24598597

RESUMO

In August 2013, the Maryland Department of Health and Mental Hygiene (MDHMH) was notified of two persons with rapidly growing nontuberculous mycobacterial (RG-NTM) surgical-site infections. Both patients had undergone surgical procedures as medical tourists at the same private surgical clinic (clinic A) in the Dominican Republic the previous month. Within 7 days of returning to the United States, both sought care for symptoms that included surgical wound abscesses, clear fluid drainage, pain, and fever. Initial antibiotic therapy was ineffective. Material collected from both patients' wounds grew Mycobacterium abscessus exhibiting a high degree of antibiotic resistance characteristic of this organism.


Assuntos
Surtos de Doenças , Turismo Médico , Infecções por Mycobacterium/epidemiologia , Mycobacterium/classificação , Procedimentos de Cirurgia Plástica/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Adolescente , Adulto , Centers for Disease Control and Prevention, U.S. , República Dominicana , Feminino , Humanos , Pessoa de Meia-Idade , Mycobacterium/isolamento & purificação , Infecções por Mycobacterium/etiologia , Infecção da Ferida Cirúrgica/etiologia , Estados Unidos/epidemiologia , Adulto Jovem
5.
Am J Trop Med Hyg ; 96(2): 265-267, 2017 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-27601520

RESUMO

Public health investigations can require intensive collaboration between numerous governmental and nongovernmental organizations. We describe an investigation involving several governmental and nongovernmental partners that was successfully planned and performed in an organized, comprehensive, and timely manner with several governmental and nongovernmental partners.


Assuntos
Febre de Chikungunya/epidemiologia , Dengue/epidemiologia , Relações Interinstitucionais , Parcerias Público-Privadas , Viagem , Febre de Chikungunya/etiologia , Vírus Chikungunya , Dengue/etiologia , Vírus da Dengue , República Dominicana , Humanos , Prática de Saúde Pública , Estados Unidos
6.
J Travel Med ; 23(6)2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27625400

RESUMO

BACKGROUND: International travel can expose travellers to pathogens not commonly found in their countries of residence, like dengue virus. Travellers and the clinicians who advise and treat them have unique needs for understanding the geographic extent of risk for dengue. Specifically, they should assess the need for prevention measures before travel and ensure appropriate treatment of illness post-travel. Previous dengue-risk maps published in the Centers for Disease Control and Prevention's Yellow Book lacked specificity, as there was a binary (risk, no risk) classification. We developed a process to compile evidence, evaluate it and apply more informative risk classifications. METHODS: We collected more than 839 observations from official reports, ProMED reports and published scientific research for the period 2005-2014. We classified each location as frequent/continuous risk if there was evidence of more than 10 dengue cases in at least three of the previous 10 years. For locations that did not fit this criterion, we classified locations as sporadic/uncertain risk if the location had evidence of at least one locally acquired dengue case during the last 10 years. We used expert opinion in limited instances to augment available data in areas where data were sparse. RESULTS: Initial categorizations classified 134 areas as frequent/continuous and 140 areas as sporadic/uncertain. CDC subject matter experts reviewed all initial frequent/continuous and sporadic/uncertain categorizations and the previously uncategorized areas. From this review, most categorizations stayed the same; however, 11 categorizations changed from the initial determinations. CONCLUSIONS: These new risk classifications enable detailed consideration of dengue risk, with clearer meaning and a direct link to the evidence that supports the specific classification. Since many infectious diseases have dynamic risk, strong geographical heterogeneities and varying data quality and availability, using this approach for other diseases can improve the accuracy, clarity and transparency of risk communication.


Assuntos
Dengue/diagnóstico , Dengue/prevenção & controle , Prática Clínica Baseada em Evidências/organização & administração , Viagem , Sudeste Asiático/epidemiologia , Dengue/epidemiologia , Vírus da Dengue , Humanos , Medicina de Viagem/métodos , Clima Tropical
7.
Am J Trop Med Hyg ; 90(5): 902-7, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24639304

RESUMO

We surveyed Peace Corps Medical Officers (PCMOs) to determine the frequency of and responses to possible rabies exposures of U.S. Peace Corps volunteers (PCVs). Surveys were sent to 56 PCMOs serving in countries with moderate or high rabies vaccine recommendations from the U.S. Centers for Disease Control and Prevention (CDC), of which 38 (68%) responded. Thirty-seven PCMOs reported that, of 4,982 PCVs, 140 (3%) experienced possible rabies exposures. Of these, 125 (89%) had previously received rabies vaccination, 129 (92%) presented with adequately cleansed wounds, and 106 (76%) were deemed to require and were given post-exposure prophylaxis (PEP). Of 35 respondents, 30 (86%) reported that rabies vaccine was always accessible to PCVs in their country within 24 hours. Overall, the Peace Corps is successful at preventing and treating possible rabies exposures. However, this study identified a few gaps in policy implementation. The Peace Corps should continue and strengthen efforts to provide education, preexposure vaccination, and PEP to PCVs.


Assuntos
Peace Corps , Raiva/prevenção & controle , Voluntários/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Profilaxia Pós-Exposição , Vacina Antirrábica/uso terapêutico , Inquéritos e Questionários , Estados Unidos , Vacinação
8.
J Travel Med ; 21(1): 62-6, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24267775
9.
JAMA Intern Med ; 174(8): 1383-90, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24887552

RESUMO

IMPORTANCE: Travelers from around the globe will attend the 2014 Fédération Internationale de Football Association (FIFA) World Cup and the 2016 Olympic and Paralympic Games in Brazil. Travelers to these mass gathering events may be exposed to a range of health risks, including a variety of infectious diseases. Most travelers who become ill will present to their primary care physicians, and thus it is important that clinicians are aware of the risks their patients encountered. OBJECTIVE: To highlight health and safety concerns for people traveling to these events in Brazil so that health care practitioners can better prepare travelers before they travel and more effectively diagnose and treat travelers after they return. EVIDENCE REVIEW: We reviewed both peer-reviewed and gray literature to identify health outcomes associated with travel to Brazil and mass gatherings. Thirteen specific infectious diseases are described in terms of signs, symptoms, and treatment. Relevant safety and security concerns are also discussed. FINDINGS: Travelers to Brazil for mass gathering events face unique health risks associated with their travel. CONCLUSIONS AND RELEVANCE: Travelers should consult a health care practitioner 4 to 6 weeks before travel to Brazil and seek up-to-date information regarding their specific itineraries. For the most up-to-date information, health care practitioners can visit the Centers for Disease Control and Prevention (CDC) Travelers' Health website (http://wwwnc.cdc.gov/travel) or review CDC's Yellow Book online (http://wwwnc.cdc.gov/travel/page/yellowbook-home-2014).


Assuntos
Acidentes de Trânsito , Controle de Doenças Transmissíveis , Crime , Seguro Saúde , Estresse Psicológico , Viagem , Brasil , Humanos , Medicina de Viagem
10.
Am J Trop Med Hyg ; 91(4): 694-698, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25070999

RESUMO

Few data regarding the use of Japanese encephalitis (JE) vaccine in clinical practice are available. We identified 711 travelers at higher risk and 7,578 travelers at lower risk for JE who were seen at US Global TravEpiNet sites from September of 2009 to August of 2012. Higher-risk travelers were younger than lower-risk travelers (median age = 29 years versus 40 years, P < 0.001). Over 70% of higher-risk travelers neither received JE vaccine during the clinic visit nor had been previously vaccinated. In the majority of these instances, clinicians determined that the JE vaccine was not indicated for the higher-risk traveler, which contradicts current recommendations of the Advisory Committee on Immunization Practices. Better understanding is needed of the clinical decision-making regarding JE vaccine in US travel medicine practices.


Assuntos
Vírus da Encefalite Japonesa (Espécie)/imunologia , Encefalite Japonesa/prevenção & controle , Doenças Endêmicas/prevenção & controle , Vacinas contra Encefalite Japonesa/administração & dosagem , Viagem , Adolescente , Adulto , Idoso , Demografia , Encefalite Japonesa/epidemiologia , Feminino , Fidelidade a Diretrizes , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Medição de Risco , Medicina de Viagem , Estados Unidos/epidemiologia , Vacinação , Adulto Jovem
11.
Am J Trop Med Hyg ; 88(2): 376-380, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23149585

RESUMO

Immigrants returning home to visit friends and relatives (VFR travelers) are at higher risk of travel-associated illness than other international travelers. We evaluated 3,707 VFR and 17,507 non-VFR travelers seen for pre-travel consultation in Global TravEpiNet during 2009-2011; all were traveling to resource-poor destinations. VFR travelers more commonly visited urban destinations than non-VFR travelers (42% versus 30%, P < 0.0001); 54% of VFR travelers were female, and 18% of VFR travelers were under 6 years old. VFR travelers sought health advice closer to their departure than non-VFR travelers (median days before departure was 17 versus 26, P < 0.0001). In multivariable analysis, being a VFR traveler was an independent predictor of declining a recommended vaccine. Missed opportunities for vaccination could be addressed by improving the timing of pre-travel health care and increasing the acceptance of vaccines. Making pre-travel health care available in primary care settings may be one step to this goal.


Assuntos
Controle de Doenças Transmissíveis/métodos , Atenção à Saúde , Diretrizes para o Planejamento em Saúde , Saúde Pública , Viagem/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos de Coortes , Emigrantes e Imigrantes , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Vacinação/estatística & dados numéricos , Adulto Jovem
12.
J Travel Med ; 20(3): 148-58, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23577860

RESUMO

BACKGROUND: Rabies, which is globally endemic, poses a risk to international travelers. To improve recommendations for travelers, we assessed the global availability of rabies vaccine (RV) and rabies immune globulin (RIG). METHODS: We conducted a 20-question online survey, in English, Spanish, and French, distributed via e-mail to travel medicine providers and other clinicians worldwide from February 1 to March 30, 2011. Results were compiled according to the region. RESULTS: Among total respondents, only 190 indicated that they provided traveler postexposure care. Most responses came from North America (38%), Western Europe (19%), Australia and South and West Pacific Islands (11%), East and Southeast Asia (8%), and Southern Africa (6%). Approximately one third of 187 respondents stated that patients presented with wounds from an animal exposure that were seldom or never adequately cleansed. RIG was often or always accessible for 100% (n = 5) of respondents in the Middle East and North Africa; 94% (n = 17) in Australia and South and West Pacific Islands; 20% (n = 1) in Tropical South America; and 56% (n = 5) in Eastern Europe and Northern Asia. Ninety-one percent (n = 158) of all respondents reported that RV was often or always accessible. For all regions, 35% (n = 58) and 26% (n = 43) of respondents felt that the cost was too high for RIG and RV, respectively. CONCLUSION: The availability of RV and RIG varied by geographic region. All travelers should be informed that RIG and RV might not be readily available at their destination and that travel health and medical evacuation insurance should be considered prior to departure. Travelers should be educated to avoid animal exposures; to clean all animal bites, licks, and scratches thoroughly with soap and water; and to seek medical care immediately, even if overseas.


Assuntos
Mordeduras e Picadas , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Imunização Passiva/métodos , Vacina Antirrábica/uso terapêutico , Raiva , Viagem , Animais , Mordeduras e Picadas/etiologia , Mordeduras e Picadas/terapia , Vetores de Doenças , Doenças Endêmicas , Primeiros Socorros/métodos , Pesquisas sobre Atenção à Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Internacionalidade , Avaliação das Necessidades , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/estatística & dados numéricos , Raiva/epidemiologia , Raiva/prevenção & controle , Inquéritos e Questionários , Medicina de Viagem/métodos
13.
Lancet Infect Dis ; 12(1): 66-74, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22192131

RESUMO

We assess risks of communicable diseases that are associated with mass gatherings (MGs), outline approaches to risk assessment and mitigation, and draw attention to some key challenges encountered by organisers and participants. Crowding and lack of sanitation at MGs can lead to the emergence of infectious diseases, and rapid population movement can spread them across the world. Many infections pose huge challenges to planners of MGs; however, these events also provide an opportunity to engage in public health action that will benefit host communities and the countries from which participants originate.


Assuntos
Surtos de Doenças/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Saúde Pública , Aglomeração , Doenças Transmitidas por Alimentos/prevenção & controle , Saúde Global , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Cooperação Internacional , Islamismo , Gestão de Riscos , Saneamento , Arábia Saudita , Viagem
14.
J Travel Med ; 19(2): 92-5, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22414033

RESUMO

BACKGROUND: Infectious disease specialists who evaluate international travelers before or after their trips need skills to prevent, recognize, and treat an increasingly broad range of infectious diseases. Wide variation exists in training and percentage effort among providers of this care. In parallel, there may be variations in approach to pre-travel consultation and the types of travel-related illness encountered. Aggregate information from travel-medicine providers may reveal practice patterns and novel trends in infectious illness acquired through travel. METHODS: The 1,265 members of the Infectious Disease Society of America's Emerging Infections Network were queried by electronic survey about their training in travel medicine, resources used, pre-travel consultations, and evaluation of ill-returning travelers. The survey also captured information on whether any of 10 particular conditions had been diagnosed among ill-returning travelers, and if these diagnoses were perceived to be changing in frequency. RESULTS: A majority of respondents (69%) provided both pre-travel counseling and post-travel evaluations, with significant variation in the numbers of such consultations. A majority of all respondents (61%) reported inadequate training in travel medicine during their fellowship years. However, a majority of recent graduates (55%) reported adequate preparation. Diagnoses of malaria, traveler's diarrhea, and typhoid fever were reported by the most respondents (84, 71, and 53%, respectively). CONCLUSIONS: The percent effort dedicated to pre-travel evaluation and care of the ill-returning traveler vary widely among infectious disease specialists, although a majority participate in these activities. On the basis of respondents' self-assessment, recent fellowship training is reported to equip graduates with better skills in these areas than more remote training. Ongoing monitoring of epidemiologic trends of travel-related illness is warranted.


Assuntos
Doenças Transmissíveis , Padrões de Prática Médica , Sociedades Médicas , Medicina de Viagem , Viagem , Medicina Tropical , Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/terapia , Consultores , Educação Médica Continuada/organização & administração , Educação Médica Continuada/normas , Pesquisas sobre Atenção à Saúde , Humanos , Avaliação das Necessidades , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Desenvolvimento de Pessoal/métodos , Inquéritos e Questionários , Medicina de Viagem/educação , Medicina de Viagem/métodos , Medicina Tropical/educação , Medicina Tropical/métodos , Estados Unidos
15.
J Travel Med ; 18(6): 430-3, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22017724

RESUMO

Typhoid fever continues to be an important concern for travelers visiting many parts of the world. This communication provides updated guidance for pre-travel typhoid vaccination from the US Centers for Disease Control and Prevention (CDC) and describes the methodology for assigning country-specific recommendations.


Assuntos
Centers for Disease Control and Prevention, U.S. , Surtos de Doenças/prevenção & controle , Guias de Prática Clínica como Assunto , Viagem , Febre Tifoide/prevenção & controle , Vacinas Tíficas-Paratíficas/farmacologia , Vacinação/normas , Europa (Continente)/etnologia , Humanos , Oriente Médio/etnologia , Fatores de Risco , Febre Tifoide/etnologia , Estados Unidos/epidemiologia
16.
Vaccine ; 26(48): 6077-82, 2008 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-18809449

RESUMO

Yellow fever (YF) vaccine has been used for prevention of YF since 1937 with over 500 million doses administered. However, rare reports of severe adverse events following vaccination have raised concerns about the vaccine's safety. We reviewed reports of adverse events following YF vaccination reported to the U.S. Vaccine Adverse Event Reporting System (VAERS) from 2000 to 2006. We used estimates of age and sex distribution of administered doses obtained from a 2006 survey of authorized vaccine providers to calculate age- and sex-specific reporting rates of all serious adverse events (SAE), anaphylaxis, YF vaccine-associated neurotropic disease, and YF vaccine-associated viscerotropic disease. Reporting rates of SAEs were substantially higher in males and in persons aged > or =60 years. These findings reinforce the generally acceptable safety profile of YF vaccine, but highlight the importance of physician and traveler education regarding the risks and benefits of YF vaccination, particularly for travelers > or =60 years of age. Vaccination should be limited to persons traveling to areas where the risk of YF is expected to exceed the risk of serious adverse events after vaccination, or if not medically contraindicated, where national regulations require proof of vaccination to prevent introduction of YF.


Assuntos
Vacina contra Febre Amarela/efeitos adversos , Adolescente , Adulto , Sistemas de Notificação de Reações Adversas a Medicamentos , Idoso , Anafilaxia/epidemiologia , Criança , Pré-Escolar , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância de Produtos Comercializados , Medição de Risco , Fatores Sexuais , Estados Unidos/epidemiologia , Vacinação/efeitos adversos , Febre Amarela/prevenção & controle , Adulto Jovem
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