Volume 14, Number 7—July 2008
    
    Research
Seasonality, Annual Trends, and Characteristics of Dengue among Ill Returned Travelers, 1997–2006
Table 1
Dengue and malaria diagnoses as a proportion of all morbidity in ill returned travelers according to region or country of acquisition
| Region* or country of exposure | No. ill returned travelers with dengue | No. ill returned travelers with malaria | Total no. ill returned travelers | Dengue proportionate morbidity† | Malaria proportionate morbidity† | 
|---|---|---|---|---|---|
| Southeast Asia | 264 | 103 | 3,694 | 71 | 28 | 
| Thailand | 154 | 9 | 1,523 | 101 | 5 | 
| Indonesia | 
38 | 
53 | 
652 | 
58 | 
81 | 
| South Central Asia | 90 | 70 | 3,303 | 27 | 21 | 
| India | 
66 | 
57 | 
2,119 | 
31 | 
27 | 
| Caribbean | 
47 | 
14 | 
1,470 | 
32 | 
9 | 
| South America | 40 | 49 | 2,427 | 16 | 20 | 
| Brazil | 
22 | 
12 | 
685 | 
32 | 
18 | 
| Central America | 
37 | 
27 | 
1,867 | 
20 | 
14 | 
| Africa | 25 | 1,216 | 7,231 | 3 | 168 | 
| Sub-Saharan Africa | 
23 | 
1,201 | 
6,201 | 
4 | 
194 | 
| Oceania | 
11 | 
91 | 
303 | 
36 | 
300 | 
| Other‡ or multiple regions of exposure | 7 | 23 | 4,443 | 2 | 5 | 
| Country missing | 
1 | 
12 | 
182 | 
5 | 
66 | 
| Total | 522 | 1,605 | 24,920 | 21 | 64 | 
*Regions defined per (9).
†Proportionate morbidity expressed per 1,000 ill returned travelers seen at GeoSentinel clinics.
‡No cases were acquired in Canada, United States, Western Europe, Japan, or Australia.
References
- Wilder-Smith A, Schwartz E. Dengue in travelers. N Engl J Med. 2005;353:924–32. DOIPubMedGoogle Scholar
 - Lindbäck H, Lindbäck J, Tegnell A, Janzon R, Vene S, Ekdahl K. Dengue fever in travelers to the tropics, 1998 and 1999. Emerg Infect Dis. 2003;9:438–42.PubMedGoogle Scholar
 - Jelinek T, Mühlberger N, Harms G, Corachán M, Grobusch MP, Knobloch J, European Network on Imported Infectious Disease Surveillance. Epidemiology and clinical features of imported dengue fever in Europe: sentinel surveillance data from TropNetEurop. Clin Infect Dis. 2002;35:1047–52. DOIPubMedGoogle Scholar
 - Schwartz E, Mendelson E, Sidi Y. Dengue fever among travelers. Am J Med. 1996;101:516–20. DOIPubMedGoogle Scholar
 - Badiaga S, Barrau K, Brouqui P, Durant J, Malvy D, Janbon F, Infectio-Sud Group. Imported dengue in French university hospitals: a 6-year survey. J Travel Med. 2003;10:286–9.PubMedGoogle Scholar
 - O’Brien DP, Leder K, Matchett E, Brown GV, Torresi J. Illness in returned travelers and immigrants/refugees: the 6-year experience of two Australian infectious diseases units. J Travel Med. 2006;13:145–52. DOIPubMedGoogle Scholar
 - Bottieau E, Clerinx J, Schrooten W, Van den Enden E, Wouters R, Van Esbroeck M, Etiology and outcome of fever after a stay in the tropics. Arch Intern Med. 2006;166:1642–8. DOIPubMedGoogle Scholar
 - Freedman DO, Weld LH, Kozarsky PE, Fisk T, Robins R, von Sonnenburg F, GeoSentinel Surveillance Network. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med. 2006;354:119–30. DOIPubMedGoogle Scholar
 - Wilson ME, Weld LH, Boggild A, Keystone JS, Kain KC, von Sonnenburg F, GeoSentinel Surveillance Network. Fever in returned travelers: results from the GeoSentinel Surveillance Network. Clin Infect Dis. 2007;44:1560–8. DOIPubMedGoogle Scholar
 - Stienlauf S, Segal G, Sidi Y, Schwartz E. Epidemiology of travel-related hospitalization. J Travel Med. 2005;12:136–41.PubMedGoogle Scholar
 - Cobelens FG, Groen J, Osterhaus AD, Leentvaar-Kuipers A, Wertheim-van Dillen PM, Kager PA. Incidence and risk factors of probable dengue virus infection among Dutch travellers to Asia. Trop Med Int Health. 2002;7:331–8. DOIPubMedGoogle Scholar
 - Potasman I, Srugo I, Schwartz E. Dengue seroconversion among Israeli travelers to tropical countries. Emerg Infect Dis. 1999;5:824–7.PubMedGoogle Scholar
 - Freedman DO, Kozarsky PE, Weld LH, Cetron MS. GeoSentinel: the global emerging infections sentinel network of the International Society of Travel Medicine. J Travel Med. 1999;6:94–8. DOIPubMedGoogle Scholar
 - Centers for Disease Control and Prevention. Travel-associated dengue—United States, 2005. MMWR Morb Mortal Wkly Rep. 2006;55:700–2.PubMedGoogle Scholar
 - Centers for Disease Control and Prevention. Travel-associated dengue infections—United States, 2001–2004. MMWR Morb Mortal Wkly Rep. 2005;54:556–8.PubMedGoogle Scholar
 - Centers for Disease Control and Prevention. Imported dengue—United States, 1999 and 2000. MMWR Morb Mortal Wkly Rep. 2002;51:281–3.PubMedGoogle Scholar
 - Rigau-Perez JG, Laufer MK. Dengue-related deaths in Puerto Rico, 1992–1996: diagnosis and clinical alarm signals. Clin Infect Dis. 2006;42:1241–6. DOIPubMedGoogle Scholar
 - Leder K, Black J, O'Brien D, Greenwood Z, Kain KC, Schwartz E, Malaria in travelers: a review of the GeoSentinel surveillance network. Clin Infect Dis. 2004;39:1104–12. DOIPubMedGoogle Scholar
 - World Health Organization Regional Office for South East Asia. Dengue/DHF: seasonal trends of DF/DHF in selected countries in SEA Region. [cited 2007 Oct 26]. Available from http://www.searo.who.int/EN/Section10/Section332_9482.htm
 - Chakravarti A, Kumaria R. Eco-epidemiological analysis of dengue infection during an outbreak of dengue fever, India. Virol J. 2005;2:32 [cited 2008 May 29]. Available from http://www.virologyj.com/content/2/1/32
 - Siqueira JB Jr, Martelli CM, Coelho GE, Simplicio AC, Hatch DL. Dengue and dengue hemorrhagic fever, Brazil, 1981–2002. Emerg Infect Dis. 2005;11:48–53.PubMedGoogle Scholar
 - Genton B, D’Acremont V. Clinical features of malaria in returning travelers and migrants. In: Schlagenhauf P, editor. Travelers’ malaria. Hamilton: BC, Ontario, Canada, Decker; 2001. p. 371–92.
 - World Health Organization. Country list: yellow fever vaccination requirements and recommendations; and malaria situation. In: International travel and health: situation as of 1 January 2007. Geneva: World Health Organization; 2007.
 - Halstead SB, Jacobson J. Japanese encephalitis. Adv Virus Res. 2003;61:103–38. DOIPubMedGoogle Scholar
 - Cummings DA, Irizarry RA, Huang NE, Endy TP, Nisalak A, Ungchusak K, Travelling waves in the occurrence of dengue haemorrhagic fever in Thailand. Nature. 2004;427:344–7. DOIPubMedGoogle Scholar
 - Wearing HJ, Rohani P. Ecological and immunological determinants of dengue epidemics. Proc Natl Acad Sci U S A. 2006;103:11802–7. DOIPubMedGoogle Scholar
 - Bartley LM, Donnelly CA, Garnett GP. The seasonal pattern of dengue in endemic areas: mathematical models of mechanisms. Trans R Soc Trop Med Hyg. 2002;96:387–97. DOIPubMedGoogle Scholar
 - Schwartz E, Moskovitz A, Potasman I, Peri G, Grossman Z, Alkan ML. Changing epidemiology of dengue fever in travelers to Thailand. Eur J Clin Microbiol Infect Dis. 2000;19:784–6. DOIPubMedGoogle Scholar
 - Freedman DO, Kozarsky P, Schwartz E. Thailand: out of season dengue outbreak in travellers to Koh Phangan. ProMed. April 26, 2002.[cited 2008 May 19]. Available from: http://www.promedmail.org, archive number: 20020426.4039.
 - Frank C, Schöneberg I, Krause G, Claus H, Ammon A, Stark K. Increase in imported dengue, Germany, 2001–2002. Emerg Infect Dis. 2004;10:903–6.PubMedGoogle Scholar
 - Centers for Disease Control and Prevention. Transmission of malaria in resort areas—Dominican Republic, 2004. MMWR Morb Mortal Wkly Rep. 2005;53:1195–8.PubMedGoogle Scholar
 - Centers for Disease Control and Prevention. Malaria—Great Exuma, Bahamas, May–June 2006. MMWR Morb Mortal Wkly Rep. 2006;55:1013–6.PubMedGoogle Scholar
 
1In addition to the authors, members of the GeoSentinel Surveillance Network who contributed data are: Elizabeth Barnett, Boston University, Boston, Massachusetts, USA; Graham Brown, Royal Melbourne Hospital, Parkville, Victoria, Australia; Giampiero Carosi and Francesco Castelli, University of Brescia, Brescia, Italy; Lin Chen and Mary Wilson, Harvard University, Cambridge, Massachusetts, USA; Bradley Connor, Cornell University, New York, New York, USA; Jean Delmont and Philippe Parola, Hôpital Nord, Marseille, France; Devon Hale and Stefanie Gelman, University of Utah, Salt Lake City, Utah, USA; Elaine Jong and Jean Haulman, University of Washington, Seattle, Washington, USA; Phyllis Kozarsky and Carlos Franco, Emory University, Atlanta, Georgia, USA; Carmelo Licitra, Orlando Regional Health Center, Orlando, Florida, USA; Louis Loutan and Francois Chappuis, University of Geneva, Geneva, Switzerland; Poh Lian Lim, Tan Tock Seng Hospital, Singapore; Michael Lynch, Fresno International Travel Medical Center, Fresno, California, USA; Susan McLellan, Tulane University, New Orleans, Louisiana, USA; Prativa Pandey, CIWEC Clinic Travel Medicine Center, Kathmandu, Nepal; Cecilia Perret, Pontificia Universidad Católica de Chile, Santiago, Chile; Bradley Sack and Robin McKenzie, Johns Hopkins University, Baltimore, Maryland, USA; Hiroko Sagara, Yokohama Municipal Citizen's Hospital, Yokohama, Japan; Marc Shaw, Worldwise Travellers Health and Vaccination Centre, Auckland, New Zealand; Robert Steffan and Patricia Schlagenhauf, University of Zurich, Zurich, Switzerland; William Stauffer and Patricia Walker, University of Minnesota, Minneapolis, Minnesota, USA; and Murray Wittner, Albert Einstein School of Medicine, Bronx, New York, USA.