Recent Travel Research Articles

Concurrent Infection With Dengue and Chikungunya Viruses in Humans and Mosquitoes: A Field Survey in Lower Moshi, Tanzania

Introduction: Dengue and Chikungunya have re-emerged as important diseases of global concern. Co-infections with Dengue virus (DENV) and Chikungunya virus (CHIKV) could have serious outcomes if not diagnosed and managed optimally. However, the key focal points for the maintenance of CHIKV and DENV infections and the extent of their co-infection remain poorly understood in many geo-ecologically distinct parts of Tanzania. Objective: We aimed to comparatively examine the prevalence and factors for seropositivity to DENV and CHIKV and their infection rates in humans and mosquitoes Methods: A cross-sectional study was performed in the Lower Moshi area of the Kilimanjaro region from April to July 2020. DENV and CHIKV exposure was determined by detecting IgM to the viruses using enzyme linked immunosorbent assay whereas infection was determined by real time quantitative polymerase chain reaction (RT-qPCR) assay. Results: Insecticide Treated Bed Net (ITN) use (χ2=3.504; p< 0.05), being ≥7 individuals living in the same household (χ2=4.655; p<0.05) and a recent travel to an urban destination (χ2=3.39; p< 0.05) were the only factors associated with CHIKV seropositivity. ITN use was the only factor associated with CHIKV infection (χ2=5.204; p<0.05). A recent travel to an urban destination (χ2=4.401; p< 0.05) was the only factor associated with DENV seropositivity. Five (1.5%) Ae. aegypti pools were positive for CHIKV whereas 1 (0.3%) was positive for DENV. Two Cx. pipiens, pools (1.9%) were positive for CHIKV. None of the Cx. pipiens mosquitoes was positive for DENV. No associations between DENV and CHIKV seropositivity was observed in humans but DENV infection was strongly associated with CHIKV infection (χ2 = 238.45; p<0.01). CHIKV infection was observed to be consistently higher in both, humans and mosquitoes. Conclusion: Detection of DENV and CHIKV in both humans and vector mosquitoes confirms that both viruses are actively circulating in the Lower Moshi area of Kilimanjaro region in Tanzania. Our findings point out the Lower Moshi area as a potential focal point for the maintenance of the two viruses and possibly other vector borne viruses. We call upon sustained active surveillance of arboviruses and other re-emerging infections to be better prepared for possible outbreaks by the viruses.

Evaluation of Stigma Related to Perceived Risk for Coronavirus-19 Transmission Relative to the Other Stigmatized Conditions Opioid Use and Depression.

BackgroundThe coronavirus-19 (COVID-19) pandemic was initially characterized by misinformation and fear related to transmission that has been previously shown to produce stigma toward persons perceived to be at risk for transmission. This study evaluated perceptions toward scenarios with variable levels of perceived risk for COVID-19 acquisition, and compared stigma to COVID-19 to depression and opioid use disorder.MethodsRespondents (N = 280) from the United States completed a web-based survey 6 months after pandemic declaration. Questions included demographics and COVID-19 misconceptions, expected response to hypothetical scenarios with variable risk for COVID-19, and the Attribution Questionnaire-9 for COVID-19, depression, and opioid use disorder.ResultsParticipants had several COVID-19 misconceptions, including that opioids increased immunity (63.6%), persons were more susceptible based upon racial/ethnic background (63.2%), and underlying health conditions did not influence risk (58.9%). Respondents were highly likely (64/100) to assume someone coughing had COVID-19 and the majority (93.5%) recommended quarantining persons with recent travel. However, the majority of respondents (>70% in all cases) also believed they would not change their COVID-19-related behavior when interacting with persons of different racial, ethnic, and age backgrounds. Finally, persons with COVID-19 engendered greater pity, less fear, less blame, less anger, and more willingness to help from respondents relative to persons with opioid use disorder.ConclusionStigma ratings toward persons perceived at risk of transmitting COVID-19, collected soon after the onset of the pandemic, showed less evidence of stigma relative to persons with opioid use disorder despite pronounced misconceptions regarding COVID-19 risk. Data provide a foundation for additional research in this area.

Amoebiasis in Pregnancy: A Review and Update of the Literature

Amoebiasis in Pregnancy: A Review and Update of the Literature

Open AR-Sandbox: A haptic interface for geoscience education and outreach

Abstract Virtual reality concepts have been widely adapted to teach geoscientific content, most notably in virtual field trips—with increased developments due to recent travel restrictions and challenges of field access. On the spectrum between real and fully virtual environments are also combinations of digital and real content in mixed-reality environments. In this category, augmented-reality (AR) sandboxes have been used as a valuable tool for science outreach and teaching due to their intuitive and haptic interaction-enhancing operation. Most of the common AR-sandboxes are limited to the visualization of topography with contour lines and colors, as well as water simulations on the digital terrain surface. We show here how we can get beyond this limitation, through an open-source implementation of an AR-sandbox system with a versatile interface written in the free and cross-platform programming language Python. This implementation allows for creative and novel applications in geosciences education and outreach in general. With a link to a 3-D geomodelling system, we show how we can display geologic subsurface information such as the outcropping lithology, creating an interactive geological map for structural geology classes. The relations of subsurface structures, topography, and outcrop can be explored in a playful and comprehensible way. Additional examples include the visualizations of geophysical fields and the propagation of seismic waves, as well as simulations of Earth surface processes. We further extended the functionality with ArUco-marker detection to enable more precise and flexible interaction with the projected content. In combination, with these developments, we aim to make AR-sandbox systems, with the additional dimension of haptic interactions, accessible to a wider range of geoscientific applications for education and outreach.

Reemergence of yellow fever virus in southeastern Brazil, 2017-2018: What sparked the spread?

BackgroundThe 2017–2018 yellow fever virus (YFV) outbreak in southeastern Brazil marked a reemergence of YFV in urban states that had been YFV-free for nearly a century. Unlike earlier urban YFV transmission, this epidemic was driven by forest mosquitoes. The objective of this study was to evaluate environmental drivers of this outbreak.Methodology/Principal findingsUsing surveillance data from the Brazilian Ministry of Health on human and non-human primate (NHP) cases of YFV, we traced the spatiotemporal progression of the outbreak. We then assessed the epidemic timing in relation to drought using a monthly Standardized Precipitation Evapotranspiration Index (SPEI) and evaluated demographic risk factors for rural or outdoor exposure amongst YFV cases. Finally, we developed a mechanistic framework to map the relationship between drought and YFV. Both human and NHP cases were first identified in a hot, dry, rural area in northern Minas Gerais before spreading southeast into the more cool, wet urban states. Outbreaks coincided with drought in all four southeastern states of Brazil and an extreme drought in Minas Gerais. Confirmed YFV cases had an increased odds of being male (OR 2.6; 95% CI 2.2–3.0), working age (OR: 1.8; 95% CI: 1.5–2.1), and reporting any recent travel (OR: 2.8; 95% CI: 2.3–3.3). Based on this data as well as mosquito and non-human primate biology, we created the “Mono-DrY” mechanistic framework showing how an unusual drought in this region could have amplified YFV transmission at the rural-urban interface and sparked the spread of this epidemic.Conclusions/SignificanceThe 2017–2018 YFV epidemic in Brazil originated in hot, dry rural areas of Minas Gerais before expanding south into urban centers. An unusually severe drought in this region may have created environmental pressures that sparked the reemergence of YFV in Brazil’s southeastern cities.

Imported malaria in children: A 13 years retrospective study

Malaria is not endemic in Italy, however every year about 600-700 imported cases are detected in people born or living in Italy who return from a stay in their country of origin (visiting friends and relatives – VFR). Children account for 20% of this population and they have an higher risk of severe disease. Socio-economic problems and deficiencies in the doctor-patient relationship often lead to a lack of awareness of the importance of prophylaxis, making the category of VFRs at increased risk of disease. The aim of this study is to analyze the characteristics of pediatric imported malaria, with a specific focus on prevention and risk factors for severe malaria.All malaria cases diagnosed from 2007 to 2019 in Ospedale Infantile Regina Margherita in Turin were retrospectively observed. Epidemiological and clinical data were described.A total of 72 patients were reported: 98.6% had African origins and 73.6% traveled as VFRs. Plasmodium falciparum was the species most commonly isolated (94.4%). Twenty-four patients (33.3%) underwent chemoprophylaxis and never appropriately. Patients not undergoing prophylaxis and those undergoing incomplete prophylaxis showed not statistically significant difference in term of disease severity (p = 0.26). Nineteen cases were considered severe, including 3 with cerebral malaria. High levels of parasitemia were statistically significantly correlated with severe anemia (p = 0.049) and severe thrombocytopenia (p = 0.036). In 25% of cases the first diagnosis was incorrect. The therapeutic use of artemisinin derivatives has resulted in a significant shortening of the parasitemia clearance time compared to the use of other drugs (p < 0.001).Families have to be educated about the serious implications of a malaria infection and the importance of a correct and complete prophylaxis. Clinicians should always consider malaria in the differential diagnoses in patients with fever and a history of a recent travel to an endemic area. Prompt diagnosis and use of appropriate drugs, according to the latest guidelines, could guarantee a better outcome for patients.

How to have sex in a pandemic: the development of strategies to prevent COVID-19 transmission in sexual encounters among gay and bisexual men in Australia

Although many studies reported on decreases in sexual partner numbers among gay and bisexual-identifying men in the early period of the COVID-19 pandemic, few studies have explored COVID-19 risk-reduction strategies. Drawing on free-text responses in an online survey (from April to July 2020), we describe the ways in which men sought to minimise the risk of COVID-19 in sexual encounters. Partner selection was an important strategy, in particular, restricting sex to men they already knew. Accounts also indicate how participants assessed risk from potential sex partners based on symptoms, residential location, recent travel, work role, and number of other sexual contacts. Less common were in situ practices, such as avoiding kissing. Participants’ responses provide insight into creative community-based responses in the early months of the pandemic, some of which have resonances with early responses to HIV. Findings are discussed in relation to the concepts of ‘lay epidemiology’ and ‘counterpublic health’. In particular, we examine how risks and health are experienced and valued in relation to local knowledges, meanings, and practices; and how practices emerge in response to dominant public health discourses that produce an idealised public based on (hetero)normative assumptions.

Identification of the First SARS-CoV-2 Lineage B.1.1.529 Virus Detected in Europe.

ABSTRACTWe report the complete genome sequence of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant (lineage B.1.1.529) from a Belgian patient with a history of recent travel to Egypt. At the time of writing, this genome constituted the first confirmed case of an infection with the Omicron variant in Europe.

18-Year-Old Man With Chest Pain

A previously healthy 18-year-old man presented with chest pain that awoke him. The pain was described as constant, grade 2/10, left-sided chest pressure without radiation or correlation with exertion. This was preceded by 1 day of nausea, vomiting, and fever to 102℉. He did not have dyspnea, diaphoresis, palpitations, edema, orthopnea, risk factors for venous thromboembolism, recent travel, acute life stressors, trauma, or known connective tissue disorders. He did not have any chronic medical conditions and was not taking any medications as an outpatient.

English

A 15-year-old female patient came with complaint of pain in the left hypochondriac region from past 2 months, which was dull aching, intermittent, aggravated on taking deep breaths, and relieved at rest. Patient also gave history of early satiety. No history of trauma, vomiting, altered bowel habits, fever, night sweats, and weight loss. The patient denied history of any recent travel. On physical examination, a firm nontender mass of size 20×15 cm was palpated in the left hypochondriac region extending to the epigastric, umbilical and left lumbar region with medial border at 5cm right lateral to the umbilicus and finger insinuation was not possible below the left costal margin. The patient underwent ultrasound abdomen which showed large well defined cystic lesion measuring 20X19X30cm, volume 5000-5700cc occupying the left hypochondrium, lumbar, epigastric and umbilical regions with irregular trabeculated wall and internal echoes within. It was seen causing mass effect in the form of posterior displacement of bilateral kidneys, spleen and inferior displacement of bowel loops. Features were suggestive of probable large mesenteric cyst. Computed tomography (CT) of abdomen and pelvis with oral and intravenous contrast was done which showed a large thin-walled abdominal cystic lesion measuring 19x18x22cm of volume approximately 3500- 4000cc occupying the left hypochondrium, epigastric region, umbilical region, reaching up to the lumbar region. It was seen arising from spleen with thinned out splenic parenchyma along its superior, lateral and inferior aspect (claw sign). Anteriorly it was extending to the anterior abdominal wall and abutting the recti muscles. Mass effect was noted on liver and right kidney with displacement of the organs (Figure 1: a, b).

Undetected Omicron Transmission in Romania-Report of the First Detected Case of Locally Acquired Omicron Infection and Complete Epidemiological Investigation.

The occurrence of the omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has importantly impacted surveillance and diagnosis, and has changed the therapeutic landscape of coronavirus disease 2019 (COVID-19). We present the first documented case of locally acquired SARS-CoV-2 omicron variant in Romania in a patient with no recent travel outside the country. We also present the full results of the epidemiological investigation that led to the identification of the index case in a co-worker who had developed mild symptoms shortly after returning from the UK and who had undergone multiple rapid antigen tests with negative results prior to being tested by RT-PCR. We highlight potential lessons learned and describe further directions for actionable research and development in the field of COVID-19.

The Brief Case: Streptococcus intermedius Brain Abscesses in an Otherwise Healthy Young Man Diagnosed by 16S rRNA Gene Sequencing.

A previously healthy 26-year-old man presented to the emergency department (ED) after he developed chest discomfort, right arm weakness, and malaise that progressed over the next 9 days to include headache, nausea, and vomiting. He had no significant past medical history, no history of alcohol, intravenous or intranasal drug use, no exposure to livestock, wild animals, or cats, no known exposure to contaminated food or water, and no recent travel. He had one female sexual partner.

A case report of Salmonella enterica serovar Corvallis from environmental isolates from Cambodia and clinical isolates in the UK.

Salmonella enterica subspecies enterica serovar Corvallis (S. Corvallis) has been identified as a human pathogen and as a food contaminant. Diarrhoeal disease is a common diagnosis in tourists visiting Southeast Asia, often with unknown aetiology. However, numerous public health institutes have identified Salmonella as a common causative agent when consuming contaminated food and water. Genomic data from environmental isolates from a Cambodian informal market were uploaded to the National Center for Biotechnology Information (NCBI) platform, allowing the novel sequences to be compared to global whole-genome sequence archives. The comparison revealed that two human clinical isolates from England and four of the environmental isolates were closely related, with an average single nucleotide polymorphism (SNP) difference of 1 (0–3 SNPs). A maximum-likelihood tree based on core SNPs was generated comparing the 4 isolates recovered from a Cambodian informal market with 239 isolates of S. Corvallis received from routine surveillance of human salmonellosis in England and confirmed the close relationship. In addition, the environmental isolates clustered into a broader phylogenetic group within the S. Corvallis population containing 68 additional human isolates, of which 42 were from patients who reported recent international travel, almost exclusively to Southeast Asia. The environmental isolates of S. Corvallis isolated from an informal market in Cambodia are concerning for public health due to their genetic similarity to isolates (e.g. clinical isolates from the UK) with known human virulence and pathogenicity. This study emphasizes the benefits of global and public data sharing of pathogen genomes.

Ecotourism, eudaimonia, and sustainability insights

ABSTRACT Since ecotourism was popularized in the late 1980s, a focus in scholarly writings on the topic has been its dual in situ mandate of biodiversity conservation and community development. As visitor education ­­gained attention, so too did research on how nature-based aspects of ecotourist experiences influence ex situ pro-environmental. Yet, researchers have largely neglected culture-based aspects of ecotourism experiences, overlooking the role that experience with communities, people, and local culture have on visitor outcomes, thus bypassing other important sustainability-related outcomes (e.g. systems thinking, humanitarianism). The purpose of this psychological assessment of recent traveler experiences is to explore the distinct influence of the natural and cultural aspects of travel on traveler’s understanding of sustainability, and whether these influences are because of particular affective experiences during travel. This study supports the proposal that both nature and cultural-based experiences contribute to sustainability insights by fostering meaning and self-discovery (i.e. eudaimonia). Our findings suggest that the positive contribution that natural and cultural components of tourism makes toward sustainability insights may be enhanced when eudaimonic experiences are incorporated into tourism experiences. This work thus implies that more explicit incorporation of eudaimonic elements into the design of (eco-) tourism experiences will increase visitors’ sustainability insights.

A Sensitive and Rapid Wastewater Test for SARS-COV-2 and Its Use for the Early Detection of a Cluster of Cases in a Remote Community.

ABSTRACTThroughout the coronavirus disease 2019 (COVID-19) pandemic, wastewater surveillance has been used to monitor trends in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevalence in the community. A major challenge in establishing wastewater surveillance programs, especially in remote areas, is the need for a well-equipped laboratory for sample analysis. Currently, no options exist for rapid, sensitive, mobile, and easy-to-use wastewater tests for SARS-CoV-2. The performance of the GeneXpert system, which offers cartridge-based, rapid molecular clinical testing for SARS-CoV-2 in a portable platform, was evaluated using wastewater as the input. The GeneXpert demonstrated a SARS-CoV-2 limit of detection in wastewater below 32 copies/mL with a sample processing time of less than an hour. Using wastewater samples collected from multiple sites across Canada during February and March 2021, a high overall agreement (97.8%) was observed between the GeneXpert assay and laboratory-developed tests regarding the presence or absence of SARS-CoV-2. Additionally, with the use of centrifugal filters, the detection threshold of the GeneXpert system was improved to <10 copies/mL in wastewater. Finally, to support on-site wastewater surveillance, GeneXpert testing was implemented in Yellowknife, a remote community in Northern Canada, where its use successfully alerted public health authorities to undetected transmission of COVID-19. The identification of SARS-CoV-2 in wastewater triggered clinical testing of recent travelers and identification of new COVID-19 cases/clusters. Taken together, these results suggest that GeneXpert is a viable option for surveillance of SARS-CoV-2 in wastewater in locations that do not have access to established testing laboratories.IMPORTANCE Wastewater-based surveillance is a powerful tool that provides an unbiased measure of COVID-19 prevalence in a community. This work describes a sensitive wastewater rapid test for SARS-CoV-2 based on a widely distributed technology, the GeneXpert. The advantages of an easy-to-use wastewater test for SARS-CoV-2 are clear: it supports surveillance in remote communities, improves access to testing, and provides faster results allowing for an immediate public health response. The application of wastewater rapid testing in a remote community facilitated the detection of a COVID-19 cluster and triggered public health action, clearly demonstrating the utility of this technology. Wastewater surveillance will become increasingly important in the postvaccination pandemic landscape as individuals with asymptomatic/mild infections continue transmitting SARS-CoV-2 but are unlikely to be tested.

75-Year-Old Woman With Abdominal Pain and Constipation

A 75-year-old woman presented to the emergency department with a 1-year history of worsening loose stools and abdominal discomfort. Over the course of the year, the patient had experienced regular cycles of liquid stool followed by constipation for the next few days. She had recently started taking loperamide on the days she had diarrhea as recommended by her primary care provider. She denied hematochezia, melena, nocturnal stooling, weight loss, or recent travel. She had a normal screening colonoscopy 4 years prior.

Feeding Intolerance in a 3-month-old.

Feeding Intolerance in a 3-month-old.

Clinical Characteristics of 40 Patients Infected With the SARS-CoV-2 Omicron Variant in Korea.

Since severe acute respiratory syndrome-coronavirus-2 variant B.1.1.529 (omicron) was first reported to the World Health Organization on November 24, 2021, the cases of the omicron variant have been detected in more than 90 countries over the last month. We investigated the clinical and epidemiological characteristics of the first 40 patients with the omicron variant who had been isolated at the National Medical Center in South Korea during December 4–17, 2021. The median age of the patients was 39.5 years. Twenty-two patients (55%) were women. Seventeen patients (42.5%) were fully vaccinated, and none were reinfected with the omicron. Eighteen (45%) had recent international travel history. Half of the patients (19, 47.5%) were asymptomatic, while the others had mild symptoms. Six patients (15%) showed lung infiltrations on chest image; however, none required supplemental oxygen. These mild clinical features are consistent with recent case reports on the omicron variant from other countries.

Clinical Presentations of Lassa Fever in Non-Endemic Parts of the World: A Systematic Review

Background: Lassa fever cases outside Africa are seen as imported cases of Lassa fever. Timely diagnosis of imported Lassa fever is important for timely intervention necessary to reduce the morbidity and mortality associated with Lassa fever, and this requires the knowledge of the clinical manifestations of Lassa fever. Purpose: This review was done to see how clinical diagnosis of imported Lassa fever can be facilitated based on the clinical presentations of imported cases of Lassa fever in Lassa fever non-endemic region. Methods: The relevant articles for the review were obtained from the databases of PubMed and Google Scholar. Results: The clinical presentations of the imported Lassa fever cases consisted of multisystem involvement and were similar to those of Lassa fever patients who were treated in the Lassa fever endemic region. Conclusions: History of recent travel to, or residence in, Lassa fever endemic region is an important clue for clinical diagnosis of Lassa fever. The 2011 CDC surveillance case definition and the modified Khan case definition for Lassa fever may aid clinical diagnosis of Lassa fever. Any clinically suspected case of Lassa fever should have a laboratory confirmation.

Primary Contacts Identification for COVID-19 Carriers from Surveillance Videos

COVID-19 (Coronavirus disease of 2019) is caused by SARS-CoV2 (Severe Acute Respiratory Syndrome Coronavirus 2) and it was first diagnosed in December 2019 in China. As of 25th Aug 2021, there are 165 million confirmed COVID-19 positive cases and 4.4 million deaths globally. As of today, though there are approved COVID-19 vaccine candidates only 4 billion doses have been administered. Until 100% of the population is safe, no one is safe. Even though these vaccines can provide protection against getting seriously ill and dying from the disease, it does not provide 100% protection from getting infected and passing it on to others. The more the virus spreads; it has more opportunity to mutate. So, it is mandatory to follow all precautions like maintaining social distance, wearing mask, washing hands frequently irrespective of whether a person is vaccinated or not. To prevent spread of the virus, contact tracing based on social distance also becomes equally important. The work proposes a solution that can help with contact tracing/identification, knowing the infected persons recent travel history (even within the city) for few days before being assessed positive. While the person would be able to give the known contacts with whom he/she has interacted with, he/she will not be aware of who all were in proximity if he/she had been in public places. The proposed solution is to get the CCTV (Closed-Circuit Television) video clips from those public places for the specific date and time and identify the people who were in proximity—i.e., not followed the safe distance to the infected person. The approach uses YOLO V3 (You Only Look Once) which uses darknet framework for people detection. Once the infected person is located from the video frames, the distance from that person to the other people in the frame is found, to check if there is a violation of social distance guideline. If there is, then the people violating the distance are extracted and identified using Facial detection and recognition algorithms. Two different solutions for Face detection and Recognition are implemented and results compared—Dlib based models and OpenCV (Open Source Computer Vision Library) based models. The solutions were studied for two different CCTV footages and the results for Dlib based models were better than OpenCV based models for the studied videos.