Spatial distribution of Zika in Honduras during 2016-2017 using geographic information systems (GIS) - Implications for public health and travel medicine.

BACKGROUND: Zika virus (ZIKV) infection has significantly affected Latin America in 2015-2017. Most studies have been reported from Brazil and Colombia, and only a few from Central America. For these reasons, we analyzed the incidence, incidence rates and evolution of cases in Honduras from 2016 to 2017. METHODS: Using epidemiological weeks (EW) surveillance data on the ZIKV epidemics in Honduras, we estimated incidence rates (cases/100,000 population), and developed maps at national, departmental and municipal levels. RESULTS: From 1 January 2016 to 31 December 2017, a total of 32,607 cases of ZIKV were reported (98.5% in 2016 for an incidence rate of 36.85 cases/100,000 pop; 1% confirmed by RT-PCR). The highest peak was reached on the EW 6°, 2016 (2559 cases; 29.34 cases/100,000 pop). The department with the highest number of cases and incidence rate was Cortés (13,128 cases, 791.08 cases/100,000 pop in 2016). DISCUSSION: The pattern and evolution of ZIKV infection in Honduras have been similar to that which occurred for chikungunya in 2015. As previously reported, infection with chikungunya involved predominantly the central and capital area of the country, reaching incidences there >750 cases/100,000 pop. Studies using geographical information systems linked with clinical disease characteristics are necessary to attain accurate epidemiological data for public health systems. Such information is also useful for assessment of risk for travelers who visit specific areas in a destination country.

Pharmacotherapy follow-up: Role in active malaria surveillance in a travel medicine centre outside the transmission area in Brazil.

WHAT IS KNOWN AND OBJECTIVE: Malaria is a potentially severe disease, widespread in tropical and subtropical areas. Apart from parasite drug resistance, which receives the largest share of attention, several factors directly influence the response to antimalarial treatment such as incorrect doses, adverse drug events, lack of adherence to treatment, drug quality and drug-drug interactions. Pharmacotherapy follow-up can be used to monitor and improve the effectiveness of treatment, prevent drug-related problems and ensure patient safety. The aim of this study was to describe the results of the implementation of pharmacotherapy follow-up of patients with malaria seen at a reference centre for malaria diagnosis and treatment (CPD-Mal) located in the city of Rio de Janeiro, an area without malaria transmission. METHODS: A descriptive study was conducted from January 2009 to September 2013 at the Instituto Nacional de Infectologia Evandro Chagas (INI) of the Fundação Oswaldo Cruz (Fiocruz). All malaria patients enrolled in the study were treated according to the Brazilian Malaria Therapy Guidelines. Data collected during pharmacotherapy follow-up were recorded in a standardized form. The variables included were age, gender, comorbidities, antimalarials and concomitant medications used, adverse drug reactions (ADR), clinical and parasitological cure times, and treatment outcomes classified as success, recurrence (recrudescence or relapse); and lost to follow-up. The ADR were classified by severity (DAIDS-NIH), organ system affected (WHO-ART) and likelihood to be caused by drugs (Naranjo scale). RESULTS AND DISCUSSION: One hundred thirteen cases of malaria were included. Patients were aged between 13 and 66 years and the majority of them (75.2%) were male. Ninety-four ADR were observed, most classified as mild (85.1%), related to disorders of the gastrointestinal system (63.8%), such as nausea and vomiting, and assessed as "possibly" caused by the antimalarial drugs (91.5%). The majority of clinical (90.9%) and parasitological (87.1%) cure occurred less than 72 hours after treatment initiation. Pharmacotherapy follow-up of malaria treatment by surveillance activities is therefore important regarding information about treatment outcomes as well as patient safety, resulting in better patient care and reducing the chance of relapses. The results underscore its use as a tool for monitoring adherence and drug resistance outside an endemic area. WHAT IS NEW AND CONCLUSION: Pharmacotherapy follow-up should be considered a useful malaria surveillance tool that can be developed by reference centres for comprehensive health care assistance and monitoring of therapeutic resistance.

Travel to Brazil: analysis of data from the Boston Area Travel Medicine Network (BATMN) and relevance to travelers attending world cup and olympics.

We describe travelers who were evaluated pre-travel to Brazil from March 2008 through July 2010 in the Boston area. Of 599 Brazil travelers, 71%, 58%, and 50% received vaccines for yellow fever (YF), typhoid, and hepatitis A, respectively. Fewer received influenza and hepatitis B vaccines (14%, 11%). A total of 60% traveled during Brazil's peak influenza season, and one fourth visited during peak dengue transmission. The 2014 World Cup and 2016 Olympics include events throughout Brazil. Travelers should seek pre-travel assessment including YF and malaria risk; travelers should be vaccinated against influenza, be up to date on other routine vaccines, and be prepared to protect themselves against mosquitoes.

Yellow fever vaccination: is one dose always enough?

In March 2013, the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunisation (SAGE) considered a number of issues in order to update the WHO Position Paper on Yellow Fever (2003). A key conclusion of this review was that a single dose of yellow fever (YF) vaccine appears to confer life-long protection against YF disease, and that a booster dose of YF vaccine is not needed to maintain immunity. While the efficacy of YF vaccine in the majority of vaccine recipients is not in doubt, the WHO announcement is somewhat surprising as there are some limitations in the evidence base, but more importantly, this announcement is not accompanied by any imminent change in the International Health Regulations 2005. The tension between what is considered best clinical practice and the law will be difficult to reconcile for many health professionals, travellers, and the travel industry, in an area of travel medicine that is already subject to debate and confusion. This commentary reviews the recent WHO announcement, and considers the practical implications for health professionals providing YF vaccine to international travellers.

Quality of travel health advice in a French travel medicine and vaccine center: a prospective observational study.

BACKGROUND: The number of international trips undertaken by French citizens is rising and we wished to assess the appropriateness of advices given to travelers in a vaccine and travel medicine center in France. METHODS: We conducted a 3-month prospective study in one center in Paris where prescriptions and advice to travelers are given by trained physicians in travel medicine who have access to a computerized decision support system (Edisan). A questionnaire was used to record trip characteristics, patients' demographics, and prescriptions. Main outcome measure was the adequacy of prescriptions for malaria prophylaxis, yellow fever, and hepatitis A vaccines to French guidelines. RESULTS: A total of 730 subjects were enrolled in this study, with a median age of 28 years. Travel destinations were sub-Saharan Africa (58%), Asia (21%), and South America (18%). Among the 608 patients (83%) traveling to malaria-endemic areas, malaria prophylaxis was in accordance with guidelines in 578/608 patients (95.1%, 95% CI: 93-96.5), and doxycycline was the regimen of choice (48%). Inappropriate malaria prophylaxis was given to eight patients, one of whom developed plasmodium falciparum malaria. All 413 patients (100%, 95% CI: 99-100) traveling to yellow fever-endemic areas who needed vaccination were correctly vaccinated. However, three patients received yellow fever vaccination without indication. Also, 442 of 454 patients (97.4%, 95% CI: 95.4-98.5) eligible to receive hepatitis A vaccination were immunized. CONCLUSION: Appropriate advice for malaria prophylaxis, yellow fever, and hepatitis A vaccinations was provided in a travel medicine and vaccine center where trained physicians used a computerized decision support system. Even in this setting, however, errors can occur and professional practices should be regularly assessed to improve health care.