Oropouche Virus Disease Among U.S. Travelers - United States, 2024.

Beginning in late 2023, Oropouche virus was identified as the cause of large outbreaks in Amazon regions with known endemic transmission and in new areas in South America and the Caribbean. The virus is spread to humans by infected biting midges and some mosquito species. Although infection typically causes a self-limited febrile illness, reports of two deaths in patients with Oropouche virus infection and vertical transmission associated with adverse pregnancy outcomes have raised concerns about the threat of this virus to human health. In addition to approximately 8,000 locally acquired cases in the Americas, travel-associated Oropouche virus disease cases have recently been identified in European travelers returning from Cuba and Brazil. As of August 16, 2024, a total of 21 Oropouche virus disease cases were identified among U.S. travelers returning from Cuba. Most patients initially experienced fever, myalgia, and headache, often with other symptoms including arthralgia, diarrhea, nausea or vomiting, and rash. At least three patients had recurrent symptoms after the initial illness, a common characteristic of Oropouche virus disease. Clinicians and public health jurisdictions should be aware of the occurrence of Oropouche virus disease in U.S. travelers and request testing for suspected cases. Travelers should prevent insect bites when traveling, and pregnant persons should consider deferring travel to areas experiencing outbreaks of Oropouche virus disease.

Improving accessibility to radiotherapy services in Cali, Colombia: cross-sectional equity analyses using open data and big data travel times from 2020.

In this study, we evaluated and forecasted the cumulative opportunities for residents to access radiotherapy services in Cali, Colombia, while accounting for traffic congestion, using a new people-centred methodology with an equity focus. Furthermore, we identified 1-2 optimal locations where new services would maximise accessibility. We utilised open data and publicly available big data. Cali is one of South America's cities most impacted by traffic congestion. METHODOLOGY: Using a people-centred approach, we tested a web-based digital platform developed through an iterative participatory design. The platform integrates open data, including the location of radiotherapy services, the disaggregated sociodemographic microdata for the population and places of residence, and big data for travel times from Google Distance Matrix API. We used genetic algorithms to identify optimal locations for new services. We predicted accessibility cumulative opportunities (ACO) for traffic ranging from peak congestion to free-flow conditions with hourly assessments for 6-12 July 2020 and 23-29 November 2020. The interactive digital platform is openly available. PRIMARY AND SECONDARY OUTCOMES: We present descriptive statistics and population distribution heatmaps based on 20-min accessibility cumulative opportunities (ACO) isochrones for car journeys. There is no set national or international standard for these travel time thresholds. Most key informants found the 20-min threshold reasonable. These isochrones connect the population-weighted centroid of the traffic analysis zone at the place of residence to the corresponding zone of the radiotherapy service with the shortest travel time under varying traffic conditions ranging from free-flow to peak-traffic congestion levels. Additionally, we conducted a time-series bivariate analysis to assess geographical accessibility based on economic stratum. We identify 1-2 optimal locations where new services would maximize the 20-min ACO during peak-traffic congestion. RESULTS: Traffic congestion significantly diminished accessibility to radiotherapy services, particularly affecting vulnerable populations. For instance, urban 20-min ACO by car dropped from 91% of Cali's urban population within a 20-min journey to the service during free-flow traffic to 31% during peak traffic for the week of 6-12 July 2020. Percentages represent the population within a 20-min journey by car from their residence to a radiotherapy service. Specific ethnic groups, individuals with lower educational attainment, and residents on the outskirts of Cali experienced disproportionate effects, with accessibility decreasing to 11% during peak traffic compared to 81% during free-flow traffic for low-income households. We predict that strategically adding sufficient services in 1-2 locations in eastern Cali would notably enhance accessibility and reduce inequities. The recommended locations for new services remained consistent in both of our measurements.These findings underscore the significance of prioritising equity and comprehensive care in healthcare accessibility. They also offer a practical approach to optimising service locations to mitigate disparities. Expanding this approach to encompass other transportation modes, services, and cities, or updating measurements, is feasible and affordable. The new approach and data are particularly relevant for planning authorities and urban development actors.

ESPAñOL: En este estudio, evaluamos y pronosticamos las oportunidades acumulativas para que los residentes accedan a los servicios de radioterapia en Cali, Colombia, teniendo en cuenta la congestión del tráfico, utilizando una nueva metodología centrada en las personas con un enfoque de equidad. Además, identificamos 1-2 ubicaciones óptimas donde los nuevos servicios maximizarían la accesibilidad. Utilizamos datos abiertos y macrodatos disponibles públicamente. Cali está entre las ciudades Sudamericanas más afectadas por la congestión del tráfico.Metodología: Usando un enfoque centrado en las personas, probamos una plataforma digital basada en la web desarrollada a través de un diseño participativo iterativo. La plataforma integra datos abiertos, incluyendo la ubicación de los servicios de radioterapia, los microdatos sociodemográficos desagregados de la población y los lugares de residencia, y los macrodatos de tiempos de viaje de la API de Google Distance Matrix. Usamos algoritmos genéticos para identificar ubicaciones óptimas para nuevos servicios. Pronosticamos oportunidades acumulativas de accesibilidad (ACO, por sus siglas en inglés) para el tráfico que va desde la congestión máxima hasta condiciones de flujo libre, con evaluaciones horarias hechas del 6 al 12 de julio de 2020 y del 23 al 29 de noviembre de 2020. La plataforma digital interactiva está públicamente disponible.Resultados Primarios y Secundarios: Presentamos estadísticas descriptivas y mapas de calor de la distribución de la población basados en isócronas de ACO de 20 minutos para viajes en coche. No existe un estándar nacional o internacional establecido para estos umbrales de tiempo de viaje. La mayoría de los informantes clave encontraron razonable el umbral de 20 minutos. Estas isócronas conectan el centroide poblacional ponderado de la zona de análisis de tráfico del lugar de residencia con la zona correspondiente del servicio de radioterapia con menor tiempo de viaje bajo condiciones variables de tráfico, que van desde el flujo libre hasta niveles de congestión de tráfico máximo. Además, realizamos un análisis bivariado de series temporales para evaluar la accesibilidad geográfica basada en el estrato económico. Identificamos 1-2 ubicaciones óptimas donde los nuevos servicios maximizarían el ACO de 20 minutos durante la congestión máxima del tráfico.Resultados: La congestión del tráfico redujo significativamente la accesibilidad a los servicios de radioterapia, afectando particularmente a las poblaciones vulnerables. Por ejemplo, el ACO urbano de 20 minutos en coche se redujo del 91% de la población urbana de Cali para viajes de hasta 20 minutos al servicio con flujo libre de tráfico, al 31% cuando hay congestión pico de tráfico durante la semana del 6 al 12 de julio de 2020. Los porcentajes representan la población con viajes de hasta 20 minutos en coche desde la residencia hasta el servicio de radioterapia. Grupos étnicos específicos, individuos con menor nivel educativo y residentes en las afueras de Cali experimentaron efectos desproporcionados, con la accesibilidad disminuyendo al 11% durante el tráfico máximo en comparación con el 81% durante el tráfico de flujo libre para hogares de bajos ingresos. Predecimos que agregar estratégicamente suficientes servicios en 1-2 ubicaciones en el este de Cali mejoraría notablemente la accesibilidad y reduciría las inequidades. Las ubicaciones recomendadas para los nuevos servicios se mantuvieron consistentes en nuestras dos mediciones.Estos hallazgos subrayan la importancia de priorizar la equidad y la atención integral en la accesibilidad a la atención médica. También ofrecen un enfoque práctico para optimizar las ubicaciones de los servicios para mitigar las disparidades. Es factible y accesible expandir este enfoque para abarcar otros modos de transporte, servicios y ciudades, o actualizar las mediciones. El nuevo enfoque y los datos son particularmente relevantes para las autoridades de planificación y los actores del desarrollo urbano.

PORTUGUêS: Neste estudo, avaliamos e previmos as oportunidades cumulativas para os residentes acessarem serviços de radioterapia em Cali, Colômbia, levando em consideração o congestionamento do tráfego, utilizando uma nova metodologia centrada nas pessoas com um foco na equidade. Além disso, identificamos 1-2 locais ideais onde os novos serviços poderiam maximizar a acessibilidade. Utilizamos dados abertos e big data disponíveis publicamente. Cali está entre as cidades sulamericanas mais afetadas pela congestionamento do tráfego.Metodologia: Usando uma abordagem centrada em pessoas, testamos uma plataforma digital baseada na web que foi desenvolvida através de um design participativo iterativo. A plataforma integra dados abertos, incluindo a localização dos serviços de radioterapia, microdados sociodemográficos desagregados por população e locais de residência, e big data da API Google Distance Matrix para os tempos de viagem. Utilizamos algoritmos genéticos para identificar locais ideais para novos serviços. Previmos oportunidades cumulativas de acessibilidade (ACO, por suas siglas em inglês) para o tráfego que varia desde o congestionamento máximo até condições de fluxo livre, com avaliações horárias de 6 a 12 de julho de 2020 e de 23 a 29 de novembro de 2020. A plataforma digital interativa está disponível publicamente.Resultados Primários e Secundários: Apresentamos estatísticas descritivas e mapas de calor da distribuição populacional baseados em isócronas de ACO de 20 minutos para viagens de carro. Não existe um padrão nacional ou internacional estabelecido para esses limites de tempo de viagem. A maioria dos entrevistados-chave considerou razoável o limite de 20 minutos. Essas isócronas conectam o centroide ponderado pela população da zona de análise de tráfego no local de residência e sua zona correspondente do serviço de radioterapia com o menor tempo de viagem sob condições variáveis de tráfego (que vão desde fluxo livre até níveis máximos de congestionamento do tráfego). Além disso, realizamos uma análise bivariada de séries temporais para avaliar a acessibilidade geográfica baseada na estratificação econômica. Identificamos 1-2 locais ideais onde os novos serviços maximizariam a ACO de 20 minutos durante o pico de congestionamento do tráfego.Resultados: O congestionamento do tráfego reduziu significativamente a acessibilidade aos serviços de radioterapia, afetando particularmente as populações vulneráveis. Por exemplo, a ACO urbana de 20 minutos de carro foi reduzida de 91% durante um fluxo livre de tráfego, para 31% durante picos de congestionamento de tráfego entre a semana de 6 a 12 de julho de 2020. As porcentagens representam a população com viagens de até 20 minutos de carro de sua residência até o serviço de radioterapia. Grupos étnicos específicos, indivíduos com menor nível educacional e residentes nos arredores de Cali experimentaram resultados desproporcionais, com a acessibilidade diminuindo para 11% durante o tráfego com congestionamento máximo em comparação com 81% durante o fluxo livre de tráfego para domicílios de baixa renda. Prevemos que adicionar estrategicamente serviços suficientes em 1-2 locais no leste de Cali melhoraria significativamente a acessibilidade e reduziria as desigualdades. Os locais recomendados para os novos serviços permaneceram consistentes em ambas medições. Esses resultados ressaltam a importância de priorizar a equidade e o atendimento integral na acessibilidade aos cuidados de saúde. Eles também oferecem uma abordagem prática para otimizar os locais dos serviços a fim de minimizar as desigualdades. A expansão dessa abordagem para abranger outros modos de transporte, serviços e cidades, ou a atualização das medições, é viável e acessível. A nova abordagem e os dados são particularmente relevantes para as autoridades de planejamento e os agentes do desenvolvimento urbano.

FRANçAIS: Dans cette étude, nous avons évalué et prévu les opportunités cumulées pour les résidents d'accéder aux services de radiothérapie à Cali, en Colombie, tout en tenant compte de la congestion du trafic en utilisant une nouvelle méthodologie centrée sur les personnes avec axée sur l'équité. De plus, nous avons identifié 1 à 2 emplacements optimaux où de nouveaux services maximiseraient l'accessibilité. Nous avons utilisé des données ouvertes et des macrodonnées tenues à disposition du public. Cali est l'une des villes d'Amérique du Sud les plus touchées par la congestion du trafic.Méthodologie: En utilisant une approche centrée sur les personnes, nous avons testé une plateforme numérique basée sur le web développée à travers une conception participative itérative. La plateforme intègre des données ouvertes, y compris la localisation des services de radiothérapie, les microdonnées sociodémographiques désagrégées de la population et les lieux de résidence, ainsi que les mégadonnées des temps de trajet de l'API Google Distance Matrix. Nous avons utilisé des algorithmes génétiques pour identifier les emplacements optimaux pour de nouveaux services. Nous avons prévu les opportunités cumulatives d'accessibilité (ACO, désignant l'acronyme en anglais) pour le trafic allant de la congestion maximale aux conditions de flux libre, avec des évaluations horaires du 6 au 12 juillet 2020 et du 23 au 29 novembre 2020. La plateforme numérique interactive est disponible publiquement.Résultats Primaires et Secondaires: Nous présentons des statistiques descriptives et des cartes thermiques de la distribution de la population basées sur des ACO de 20 minutes pour les trajets en voiture. Il n'existe pas de norme nationale ou internationale établie pour ces seuils de temps de trajet. La majorité des informateurs clés ont trouvé le seuil de 20 minutes raisonnable. Ces isochrones relient le centroïde pondéré par la population de la zone d'analyse du trafic au lieu de résidence à la zone correspondante du service de radiothérapie avec le temps de trajet le plus court sous des conditions de trafic variables allant du flux libre aux niveaux de congestion de trafic maximum. De plus, nous avons réalisé une analyse bivariée des séries chronologiques pour évaluer l'accessibilité géographique en fonction de la stratification économique. Nous avons identifié 1 à 2 emplacements optimaux où de nouveaux services maximiseraient l'ACO de 20 minutes pendant la congestion maximale du trafic.Résultats: La congestion du trafic a considérablement réduit l'accessibilité aux services de radiothérapie, affectant particulièrement les populations vulnérables. Par exemple, l'ACO urbain de 20 minutes en voiture est passé de 91 % de la population urbaine de Cali pour des trajets de jusqu'à 20 minutes vers le service avec un flux de trafic libre à 31 % lors des pics de congestion de trafic pendant la semaine du 6 au 12 juillet 2020. Les pourcentages représentent la population avec des trajets de jusqu'à 20 minutes en voiture depuis la résidence jusqu'au service de radiothérapie. Des groupes ethniques spécifiques, des individus ayant un niveau d'éducation inférieur et des résidents des périphéries de Cali ont subi des effets disproportionnés, avec une accessibilité diminuant à 11 % pendant le trafic maximal par rapport à 81 % pendant le flux de trafic libre pour les ménages à faible revenu. Ajouter suffisamment de services à 1-2 emplacements stratégiques dans l'est de Cali a le potential d'améliorer considérablement l'accessibilité et réduirait les inégalités. Les emplacements recommandés pour les nouveaux services sont restés cohérents dans nos deux mesures. Ces conclusions soulignent l'importance de prioriser l'équité et une prise en charge globale dans le cadre de l'accessibilité aux soins de santé. Elles offrent également une approche pratique pour optimiser les emplacements des services afin de réduire les disparités. Il est faisable et abordable d'étendre cette approche pour inclure d'autres modes de transport, services et villes, ou pour mettre à jour les mesures. La nouvelle approche et les données sont particulièrement pertinentes pour les autorités de planification et les acteurs du développement urbain.

Oropouche fever cases diagnosed in Italy in two epidemiologically non-related travellers from Cuba, late May to early June 2024.

Oropouche fever is caused by Oropouche virus (OROV), transmitted primarily through the bite of infected midges, particularly of the genus Culicoides. The virus is mainly circulating in Central and South America where several countries reported an ongoing outbreak. We report here two imported cases of OROV infection identified in Italy, late May-early June 2024. These cases indicate that in the shadow of a massive dengue outbreak in the Americas, the Oropouche outbreak might be more widespread than previously estimated.

Health care accessibility and mobility in breast cancer: a Latin American perspective.

BACKGROUND: Latin America (LATAM) encompasses a vast region with diverse populations. Despite publicly funded health care systems providing universal coverage, significant socioeconomic and ethno-racial disparities persist in health care access across the region. Breast cancer (BC) incidence and mortality rates in Brazil are comparable to those in other LATAM countries, supporting the relevance of Brazilian data, with Brazil's health care policies and expenditures often serving as models for neighboring countries. We evaluated the impact of mobility on oncological outcomes in LATAM by analyzing studies of patients with BC reporting commuting routes or travel distances to receive treatment or diagnosis. METHODS: We searched MEDLINE (PubMed), Embase, Cochrane CENTRAL, LILACS, and Google Scholar databases. Studies eligible for inclusion were randomized controlled trials and observational studies of patients with BC published in English, Portuguese, or Spanish and conducted in LATAM. The primary outcome was the impact of mobility or travel distance on oncological outcomes. Secondary outcomes included factors related to mobility barriers and access to health services. For studies meeting eligibility, relevant data were extracted using standardized forms. Risk of bias was assessed using the Newcastle-Ottawa Scale. Quantitative and qualitative evidence synthesis focused on estimating travel distances based on available data. Heterogeneity across distance traveled or travel time was addressed by converting reported travel time to kilometers traveled and estimating distances for unspecified locations. RESULTS: Of 1142 records identified, 14 were included (12 from Brazil, 1 from Mexico, and 1 from Argentina). Meta-analysis revealed an average travel distance of 77.8 km (95% CI, 49.1-106.48) to access BC-related diagnostic or therapeutic resources. Nonetheless, this average fails to precisely encapsulate the distinct characteristics of each region, where notable variations persist in travel distance, ranging from 88 km in the South to 448 km in the North. CONCLUSION: The influence of mobility and travel distance on access to BC care is multifaceted and should consider the complex interplay of geographic barriers, sociodemographic factors, health system issues, and policy-related challenges. Further research is needed to comprehensively understand the variables impacting access to health services, particularly in LATAM countries, where the challenges women face during treatment remain understudied. TRIAL REGISTRATION: CRD42023446936.

Impact of a teaching hospital-based multidisciplinary telemedicine programme in Southwestern Colombia: a cross-sectional resource analysis.

BACKGROUND: Telemedicine, a method of healthcare service delivery bridging geographic distances between patients and providers, has gained prominence. This modality is particularly advantageous for outpatient consultations, addressing inherent barriers of travel time and cost. OBJECTIVE: We aim to describe economical outcomes towards the implementation of a multidisciplinary telemedicine service in a high-complexity hospital in Latin America, from the perspective of patients. DESIGN: A cross-sectional study was conducted, analysing the institutional data obtained over a period of 9 months, between April 2020 and December 2020. SETTING: A high-complexity teaching hospital located in Cali, Colombia. PARTICIPANTS: Individuals who received care via telemedicine. The population was categorised into three groups based on their place of residence: Cali, Valle del Cauca excluding Cali and Outside of Valle del Cauca. OUTCOME MEASURES: Travel distance, time, fuel and public round-trip cost savings, and potential loss of productivity were estimated from the patient's perspective. RESULTS: A total of 62 258 teleconsultations were analysed. Telemedicine led to a total distance savings of 4 514 903 km, and 132 886 hours. The estimated cost savings were US$680 822 for private transportation and US$1 087 821 for public transportation. Patients in the Outside of Valle del Cauca group experienced an estimated average time savings of 21.2 hours, translating to an average fuel savings of US$149.02 or an average savings of US$156.62 in public transportation costs. Areas with exclusive air access achieved a mean cost savings of US$362.9 per teleconsultation, specifically related to transportation costs. CONCLUSION: Telemedicine emerges as a powerful tool for achieving substantial travel savings for patients, especially in regions confronting geographical and socioeconomic obstacles. These findings underscore the potential of telemedicine to bridge healthcare accessibility gaps in low-income and middle-income countries, calling for further investment and expansion of telemedicine services in such areas.

Challenging diagnosis of Plasmodium ovale malaria in a Colombian traveler: the importance of including P. ovale wallikeri in molecular screening.

This study reports a challenging diagnosis of Plasmodium ovale malaria in a Colombian citizen returning from Cameroon. Initial microscopy screenings conducted at two private hospitals yielded conflicting results, with the first showing negative smears and the second diagnosing P. vivax. Subsequent microscopy examinations at two government laboratories identified P. ovale, although the routine species-specific PCR strategy was negative. PCR confirmation was finally obtained when P. ovale wallikeri primers were used. Although P. ovale is not frequently found in Colombia, there is a clear need to include both P. ovale curtisi and P. ovale wallikeri in the molecular diagnostic strategy. Such need stems primarily from their extended latency period, which affects travelers, the increasing number of African migrants, and the importance of accurately mapping the distribution of Plasmodium species in Colombia.

[Regional inequalities in access to hospital birth in the state of Rio de Janeiro, Brazil: travel networks, distance, and time (2010-2019)]. / Desigualdades regionais no acesso ao parto hospitalar no Estado do Rio de Janeiro, Brasil: redes de deslocamento, distância e tempo (2010-2019).

Difficult access to birth care services is associated with infant and neonatal mortality and maternal morbidity and mortality. In this study, data from the Brazilian Unified National Health System (SUS) were used to map the evolution of geographic accessibility to hospital birth of usual risk in the state of Rio de Janeiro, Brazil, corresponding to 418,243 admissions in 2010-2011 and 2018-2019. Travel flows, distances traveled, and intermunicipal travel time between the pregnant women's municipality and hospital location were estimated. An increase from 15.9% to 21.5% was observed in the number of pregnant women who needed to travel. The distance traveled increased from 24.6 to 26km, and the travel time from 76.4 to 96.1 minutes, with high variation between Health Regions (HR). Pregnant women living in HR Central-South traveled more frequently (37.4-48.9%), and those living in the HRs Baía da Ilha Grande and Northwest traveled the largest distances (90.9-132.1km) and took more time to get to the hospital in 2018-2019 (96-137 minutes). The identification of municipalities that received pregnant women from many other municipalities and municipalities that treated a higher number of pregnant women (hubs and attraction poles, respectively) reflected the unavailability and disparities in access to services. Regional inequalities and reduced accessibility highlight the need to adapt supply to demand and review the distribution of birth care services in the state of Rio de Janeiro. This study contributes to research and planning on access to maternal and child health services and can be used as a reference study for other states in the country.

A dificuldade de acesso aos serviços de atenção ao parto está associada à mortalidade infantil e neonatal e à morbimortalidade materna. Neste estudo, dados do Sistema Único de Saúde (SUS) foram utilizados para mapear a evolução da acessibilidade geográfica ao parto hospitalar de risco habitual no Estado do Rio de Janeiro, Brasil, correspondentes a 418.243 internações nos biênios 2010-2011 e 2018-2019. Foram estimados os fluxos de deslocamento, as distâncias percorridas e o tempo de deslocamento intermunicipal entre o município de residência e de internação das gestantes. Houve um crescimento de 15,9% para 21,5% na proporção de gestantes que precisaram se deslocar. A distância percorrida aumentou de 24,6 para 26km, e o tempo de deslocamento de 76,4 para 96,1 minutos, com grande variação entre as Regiões de Saúde (RS). As gestantes residentes na RS Centro Sul se deslocaram mais frequentemente (37,4-48,9%), e as residentes nas RS Baía da Ilha Grande e Noroeste percorreram as maiores distâncias (90,9-132,1km) e levaram mais tempo para chegar ao hospital no último biênio (96-137 minutos). A identificação dos municípios que receberam gestantes de muitos outros municípios e daqueles que atenderam maior volume de gestantes (núcleos e polos de atração, respectivamente) refletiu a indisponibilidade e as disparidades no acesso aos serviços. As desigualdades regionais e a redução da acessibilidade alertam para a necessidade de adequar a oferta à demanda e de revisar a distribuição dos serviços de atenção ao parto no Rio de Janeiro. O estudo contribui para as pesquisas e o planejamento sobre o acesso a serviços de saúde materno-infantil, além de servir como referência para outros estados do país.

La dificultad para acceder a los servicios de atención al parto está asociada con la mortalidad infantil y neonatal, y con la morbimortalidad materna. En este estudio, se utilizaron datos del Sistema Único de Salud (SUS) para mapear la evolución de la accesibilidad geográfica al parto hospitalario de riesgo habitual en el estado de Río de Janeiro, Brasil, correspondiente a 418.243 hospitalizaciones en los bienios 2010-2011 y 2018-2019. Se estimaron los flujos de desplazamiento, las distancias recorridas y el tiempo de desplazamiento intermunicipal entre el municipio de residencia y la hospitalización de las mujeres embarazadas. Hubo un aumento del 15,9% al 21,5% en la proporción de mujeres embarazadas que necesitaron desplazarse. La distancia recorrida aumentó de 24,6 a 26km y el tiempo de desplazamiento de 76,4 a 96,1 minutos, con gran variación entre las Regiones de Salud (RS). Las mujeres embarazadas residentes en la RS Centro Sul se desplazaron con mayor frecuencia (37,4-48,9%), y las residentes en las RS Baía da Ilha Grande y Noroeste recorrieron las mayores distancias (90,9-132,1km) y tardaron más en llegar al hospital en el últimos bienio (96-137 minutos). La identificación de los municipios que recibieron mujeres embarazadas de muchos otros municipios y de aquellos que atendieron a un mayor volumen de mujeres embarazadas (núcleos y polos de atracción, respectivamente) reflejó la indisponibilidad y las disparidades en el acceso a los servicios. Las desigualdades regionales y la reducida accesibilidad alertan sobre la necesidad de adaptar la oferta a la demanda, y de revisar la distribución de los servicios de atención al parto en el estado de Rio de Janeiro. El estudio contribuye a las investigaciones y a la planificación sobre el acceso a los servicios de salud materno-infantil, y puede servir como referencia para otros estados del país.

Complex cutaneous leishmaniasis in a pediatric patient.

Cutaneous leishmaniasis (CL), a parasitic infection caused by Leishmania protozoa and transmitted by sandfly bites, can be classified into Old World and New World subtypes. We report a case of a 2-year-old female who developed complex CL after travel to Panama. Ultimately, successful treatment required two rounds of liposomal amphotericin B. We report this case for its challenging clinical course and management.

Cutaneous myiasis caused by Dermatobia hominis (Diptera: Oestridae) in a Polish traveller to South America - a case report.

Myiasis, an infestation caused by dipteran larvae, commonly known as maggots, is one of the most common parasitic skin disorders in the tropical regions. Authors report a case of cutaneous myiasis caused by Dermatobia hominis (Diptera: Oestridae) in a Polish traveller returning from a self-organized trip to South America. Species biology, prophylaxis, and medical implications of this tropical parasitosis are discussed.

Persistence of dengue serotype 2 viral RNA in blood cells of a returned traveler with dengue fever.

Dengue virus (DENV) is one of the most significant vector-borne pathogens worldwide. In this report, we describe clinical features and laboratory detection of dengue in a 45-year-old traveler to Nicaragua on return home to the United States in 2019. Clinical presentation was mild, with rash, headache, and fatigue, with only low-grade transient fever. Infection dynamics were documented by serology and PCR of serially collected body fluids. DENV serotype 2 was detected in whole blood 1 day after symptoms emerged, with viral RNA isolated to the red cell fraction, and remained detectable through day 89. DENV-2 RNA was detected in serum only on day 4, and IgM was undetectable on day 4 but evident by day 13. Viral RNA was also detected in urine. This report of DENV-2 RNA persistence in blood cells but only transient appearance in serum, supports the potential diagnostic value of whole blood over serum for PCR and opportunity of an expanded testing window. Informed testing approaches can improve diagnostic accuracy and inform strategies that preserve individual and public health.

Safety of helicopter transport in patients with acute coronary syndrome.

BACKGROUND: ST-elevation myocardial infarction (STEMI) systems of care have reduced inter-hospital transfer times and facilitated timely reperfusion goals. Helicopters may be an option when land transportation is not feasible; however, the safety of air transport in patients with acute coronary syndrome (ACS) is a factor to consider. OBJETIVES: The aim of this study was to evaluate the safety of helicopter transport for patients with ACS. METHODS: Prospective, observational, and descriptive study including patients diagnosed with ACS within the STEMI network of a metropolitan city transferred by helicopter to a large cardiovascular center to undergo percutaneous coronary intervention. The primary outcome of the study was the incidence of air-travel-related complications defined as IV dislodgement, hypoxia, arrhythmia, angina, anxiety, bleeding, and hypothermia. Secondary outcomes included the individual components of the primary outcome. RESULTS: A total of 106 patients were included in the study; the mean age was 54 years and 84.9% were male. The most frequent diagnosis was STEMI after successful fibrinolysis (51.8%), followed by STEMI with failed fibrinolysis (23.7%) and non-reperfused STEMI (9.4%). Five patients (4.7%) developed at least one complication: IV dislodgement (1.8%) and hypoxemia (1.8%) in two patients and an episode of angina during flight (0.9%). A flight altitude of > 10,000 ft was not associated with complications. CONCLUSIONS: The results of this study suggest that helicopter transportation is safe in patients undergoing acute coronary syndrome, despite the altitude of a metropolitan area.

ANTECEDENTES: Los sistemas de atención de IAMCEST han reducido los tiempos de transferencia interhospitalaria y han facilitado las metas de reperfusión oportuna. Los helicópteros pueden ser una opción cuando el transporte terrestre no es factible; sin embargo, la seguridad del transporte aéreo en pacientes con síndrome coronario agudo (SICA) es un factor a considerar. OBJETIVOS: Evaluar la seguridad del transporte en helicóptero para pacientes con SICA. MÉTODOS: Estudio prospectivo, observacional, descriptivo. Se incluyeron pacientes con diagnóstico de SICA dentro de la red IAMCEST en metrópolis extensa, trasladados en helicóptero a un centro cardiovascular. El resultado primario del estudio fue la incidencia de complicaciones relacionadas con los viajes aéreos definidas cómo desalojo de catéter intravenoso, hipoxia, arritmia, angina, ansiedad, sangrado e hipotermia. RESULTADOS: Total de 106 pacientes; la edad media fue de 54 años y 84,9% eran hombres. La altitud media de vuelo fue de 10,100 pies y la distancia media de vuelo fue de 50,0 km. El diagnóstico más frecuente fue IAMCEST tras fibrinolisis exitosa (51,8%), seguido de IAMCEST con fibrinolisis fallida (23,7%). Cinco pacientes (4,7%) desarrollaron una complicación: desalojo IV (1,8%) e hipoxemia (1,8%) en dos pacientes y un episodio de angina durante el vuelo (0,9%). Una altitud de vuelo mayor de 10,000 pies no se asoció a complicaciones. CONCLUSIONES: Los resultados de este estudio sugieren que el transporte en helicóptero es seguro en pacientes con SICA, incluso en altitudes > 10,000 pies.

Intestinal protozoa in returning travellers: a GeoSentinel analysis from 2007 to 2019.

BACKGROUND: Prolonged diarrhoea is common amongst returning travellers and is often caused by intestinal protozoa. However, the epidemiology of travel-associated illness caused by protozoal pathogens is not well described. METHODS: We analysed records of returning international travellers with illness caused by Giardia duodenalis, Cryptosporidium spp., Cyclospora cayetanensis or Cystoisospora belli, reported to the GeoSentinel Network during January 2007-December 2019. We excluded records of travellers migrating, with an unascertainable exposure country, or from GeoSentinel sites that were not located in high-income countries. RESULTS: There were 2517 cases, 82.3% giardiasis (n = 2072), 11.4% cryptosporidiosis (n = 287), 6.0% cyclosporiasis (n = 150) and 0.3% cystoisosporiasis (n = 8). Overall, most travellers were tourists (64.4%) on long trips (median durations: 18-30 days). Cryptosporidiosis more frequently affected people < 18 years (13.9%) and cyclosporiasis affected people ≥ 40 years (59.4%). Giardiasis was most frequently acquired in South Central Asia (45.8%) and sub-Saharan Africa (22.6%), cryptosporidiosis in sub-Saharan Africa (24.7%) and South-Central Asia (19.5%), cyclosporiasis in South East Asia (31.3%) and Central America (27.3%), and cystoisosporiasis in sub-Saharan Africa (62.5%). Cyclosporiasis cases were reported from countries of uncertain endemicity (e.g. Cambodia) or in countries with no previous evidence of this parasite (e.g. French Guiana). The time from symptom onset to presentation at a GeoSentinel site was the longest amongst travellers with giardiasis (median: 30 days). Over 14% of travellers with cryptosporidiosis were hospitalized. CONCLUSIONS: This analysis provides new insights into the epidemiology and clinical significance of four intestinal protozoa that can cause morbidity in international travellers. These data might help optimize pretravel advice and post-travel management of patients with travel-associated prolonged gastrointestinal illnesses. This analysis reinforces the importance of international travel-related surveillance to identify sentinel cases and areas where protozoal infections might be undetected or underreported.

[Pretravel medical consultation]. / Reisemedizinische Beratung.

Many patients seek pretravel advice during routine consultations in a general practice so that basic knowledge of travel medicine is warranted. Using the example of trips to Bali, Peru and Tanzania, the most relevant topics of a pretravel consultation for these popular destinations are depicted. These include vaccinations, malaria prevention and recommendations on exposure prophylaxis for insect bites. Furthermore, special risk situations, such as travel to high altitudes or freshwater contact are discussed. In special cases, the advice of an expert in travel medicine is needed.