BackgroundDengue fever is endemic in tropical and subtropical areas, especially Southeast Asia. International air travel facilitates the spread of dengue across and within borders. To date, no predictive factors have been established for assessing risk of dengue among febrile travelers.MethodsSince 2006, Taiwan has operated a program of infrared thermometer–based non-contact active surveillance at Taoyuan International Airport (TPE). All inbound passengers from dengue-endemic countries who are febrile (tympanic temperature ≥38°C) undergo routine laboratory testing for dengue. We analyzed clinical and epidemiological characteristics of all tested passengers entering Taiwan via TPE in 2011 to identify the predictive factors of dengue infection.ResultsIn 2011, of the 3,719 febrile passengers from dengue-endemic countries, 74 (2.0%) had laboratory-confirmed dengue infection. Multivariable logistic regression analysis revealed that those who were aged ≥60 years (adjusted odds ratio [aOR], 8.7; 95% confidence interval [CI], 2.6–29.6) and had self-reported fever (aOR, 2.5; 95% CI, 1.5–4.1), skin rashes (aOR, 11.0; 95% CI, 3.4–35.1), or a tympanic temperature ≥39°C (aOR, 2.9; 95% CI, 1.7–4.9) were significantly more likely to have dengue (all p values < 0.05). Compared with travelers who stayed in dengue-endemic countries for ≤7 days, those who traveled 8–14, 15–21, 22–28, and ≥29 days were also more likely to be infected (aORs of 10.2, 14.9, 39.0 and 12.0, respectively).ConclusionThese clinical and epidemiological features can facilitate timely recognition and diagnosis of imported dengue in febrile inbound passengers and therefore help prevent domestic transmission of dengue virus.
Dengue fever (DF) is a mosquito-borne disease prevalent in the tropics (e.g., sub-Saharan Africa, Asia, and Central and South America) and a common cause of febrile illness in travelers. The high incidence of imported DF in Taiwan has led to a domestic outbreak. This study explored the risk factors associated with individuals given diagnoses of imported DF at international airports in Taiwan. The results may serve as a reference for DF prevention. In this retrospective study, data from the symptom notification system database of the Taiwan Centers for Disease Control (TCDC) were used. These data concerned travelers who returned to Taiwan from DF-endemic areas with suspected DF symptoms. The epidemiological characteristics of the cases were analyzed, and 28 variables related to DF infection were included in the multivariate logistic regression analysis. In 2018–2019, there were 8656 cases (451 positive and 8205 negative cases). The results revealed DF symptoms and a 16–30-day stay in endemic areas to be independent risk factors and the presence of three respiratory symptoms and <10 days of short-term travel to be protective factors. These results may enable the accurate assessment of symptoms in travelers with DF as well as the risk factors associated with imported DF, lowering the risk of indigenous DF outbreaks caused by imported DF.
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