TY - JOUR
T1 - Chikungunya resurgence in the Maldives and risk for importation via tourists to Europe in 2019–2020
T2 - A GeoSentinel case series
AU - Dudouet, Pierre
AU - Gautret, Philippe
AU - Larsen, Carsten Schade
AU - Díaz-Menéndez, Marta
AU - Trigo, Elena
AU - von Sonnenburg, Frank
AU - Gobbi, Federico
AU - Grobusch, Martin P.
AU - Malvy, Denis
AU - Field, Vanessa
AU - Asgeirsson, Hilmir
AU - Souto, Inés Oliveira
AU - Hamer, Davidson H.
AU - Parola, Philippe
AU - Javelle, Emilie
N1 - Funding Information:
In 2007, the Maldivian government, with support from the World Health Organization, started a large vector-control program. Since then the number of cases drastically decreased, but the surveillance was effective only until 2014. The Maldives is a large archipelago of 1190 islands, spread out over an area of 298 square kilometers with an estimated population around 530,000 inhabitants, making long-term implementation of individual and collective vector-control strategies, and epidemiologic surveillance challenging. The situation on the Maldives might be viewed best from the ?one-health perspective? proposed in 2018 by Carla Mavian and colleagues [19]. Their size and the lack of resources induce more trade, facilitating the importation of vectors and introduction and establishment of viruses [20]. Frequent human migration between the Maldives and chikungunya-endemic countries, including travel to Sri Lanka and India, increase the risk of CHIKV re-introduction and spread [21]. Moreover, the unstable geological structure exposes the island chains to natural storms, hurricanes and cyclones, which can result in mass destruction and an abundant vegetation, which complicates vector-control strategies. Certain ecosystems could be more subject to large and recurrent arboviral outbreaks, as seen with dengue in the Fiji Islands [22]. From a historical perspective, CHIKV transmission also spontaneously ceased in some territories as for example in Bangkok; and it has been suggested that CHIKV endemicity requires very high populations of Ae. aegypti [23].
Publisher Copyright:
© 2020 Elsevier Ltd
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Background: Chikungunya virus (CHIKV) is an arthropod-borne virus mainly transmitted in tropical areas by Aedes spp. mosquitoes. It has been responsible for small-to-large outbreaks in temperate areas including southern Europe and North America. Past outbreaks in 2006 on the islands of Maldives, as well as on other islands in the Indian Ocean and in Southeast Asia, demonstrated for the first time the capacity of CHIKV to disseminate through travel and transcontinental commerce, and revealed the major socio-economic impact of CHIKV epidemics. Recently, CHIKV has been circulating in highly touristic areas including the Maldives, where 1736 cases were notified by the Health Protection Agency during 2019. Case series: Among EuroTravNet/GeoSentinel patient records, eight CHIKV-confirmed cases imported the Maldives to France, Germany, Denmark, Italy and Spain were identified between February 2019 and February 2020; exceeding the total number of CHIKV infections travel-acquired in Maldives reported to this surveillance network during the previous 10 years. Conclusions: The prevention and control of CHIKV introduction into naïve areas colonised by competent vectors is crucial. CHIKV outbreaks must be detected and reported in a timely manner. This must lead to adapted health information for international travellers and to prompt management of suspected imported cases. Conversely, travellers make for excellent sentinels and increased reports of imported cases might reflect a change in the level of endemicity or even herald an outbreak. Feedback to the local health authorities and matching this with local epidemiological surveillance data may lead to health benefits for the local population.
AB - Background: Chikungunya virus (CHIKV) is an arthropod-borne virus mainly transmitted in tropical areas by Aedes spp. mosquitoes. It has been responsible for small-to-large outbreaks in temperate areas including southern Europe and North America. Past outbreaks in 2006 on the islands of Maldives, as well as on other islands in the Indian Ocean and in Southeast Asia, demonstrated for the first time the capacity of CHIKV to disseminate through travel and transcontinental commerce, and revealed the major socio-economic impact of CHIKV epidemics. Recently, CHIKV has been circulating in highly touristic areas including the Maldives, where 1736 cases were notified by the Health Protection Agency during 2019. Case series: Among EuroTravNet/GeoSentinel patient records, eight CHIKV-confirmed cases imported the Maldives to France, Germany, Denmark, Italy and Spain were identified between February 2019 and February 2020; exceeding the total number of CHIKV infections travel-acquired in Maldives reported to this surveillance network during the previous 10 years. Conclusions: The prevention and control of CHIKV introduction into naïve areas colonised by competent vectors is crucial. CHIKV outbreaks must be detected and reported in a timely manner. This must lead to adapted health information for international travellers and to prompt management of suspected imported cases. Conversely, travellers make for excellent sentinels and increased reports of imported cases might reflect a change in the level of endemicity or even herald an outbreak. Feedback to the local health authorities and matching this with local epidemiological surveillance data may lead to health benefits for the local population.
KW - Arbovirus
KW - GeoSentinel
KW - Outbreak
KW - Tourism
KW - Travel
KW - Vector-borne disease
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U2 - 10.1016/j.tmaid.2020.101814
DO - 10.1016/j.tmaid.2020.101814
M3 - Article
C2 - 32619732
AN - SCOPUS:85088020986
VL - 36
JO - Travel Medicine and Infectious Disease
JF - Travel Medicine and Infectious Disease
SN - 1477-8939
M1 - 101814
ER -