Jakob Peter Cramer

Although the costs of dengue illness to patients and households have been extensively studied in endemic populations, international travelers have not been the focus of costing studies. As globalization and human travel activities intensify, travelers are increasingly at risk for emerging and reemerging infectious diseases, such as dengue. This exploratory study aims to investigate the impact and out-of-pocket costs of dengue illness among travelers. We conducted a prospective study in adult travelers with laboratory-confirmed dengue and recruited patients at travel medicine clinics in eight different countries from December 2013 to December 2015. Using a structured questionnaire, we collected information on patients and their health-care utilization and out-of-pocket expenditures, as well as income and other financial losses they incurred because of dengue illness. A total of 90 patients participated in the study, most of whom traveled for tourism (74%) and visited countries in Asia (82%). Although 22% reported hospitalization and 32% receiving ambulatory care while traveling, these percentages were higher at 39% and 71%, respectively, after returning home. The out-of-pocket direct and indirect costs of dengue illness were US$421 (SD 744) and US$571 (SD 1,913) per episode, respectively, averaging to a total out-of-pocket cost of US$992 (SD 2,052) per episode. The study findings suggest that international travelers incur important direct and indirect costs because of dengue-related illness. This study is the first to date to investigate the impact and out-of-pocket costs of travel-related dengue illness from the patient’s perspective and paves the way for future economic burden studies in this population.

Gesundheitsrisiken beim Besuch der Olympischen und Paralympischen Spiele in Rio de Janeiro im August beziehungsweise September dieses Jahres ergeben sich aus nicht übertragbaren Gefahren wie aus Infektionskrankheiten. Erstere dürften trotz der aktuellen Nachrichtenlage zu viralen Infektionskrankheiten in Brasilien in Bezug auf Besucher der Spiele deutlich relevanter sein. Dabei ergeben sich charakteristische und spezifische Risiken sowohl vor dem Hintergrund des Besuchs einer Massenveranstaltung als auch aufgrund der Örtlichkeit Rio de Janeiro, Brasilien. Dieser Beitrag benennt gesundheitliche Gefahren für den Besucher und diskutiert präventive Maßnahmen. Visiting the Olympic and Paralympic Games in Rio de Janeiro in August and September 2016 is associated with a series of noncommunicable as well as infectious diseases risks. The former is probably by far more relevant in terms of frequency and impact for travelers despite currently circulating news around viral infectious disease transmissions in Brazil. Specific health risks are characteristic for either the setting of a sport mass gathering, the location Rio de Janeiro in Brazil or a combination out of both. This article intends to list potential health risk and to discuss preventive measures for travelers.

In 2004, Plasmodium knowlesi was first recognised as a relevant cause of human malaria in Southeast Asia. Since then, P. knowlesi has been described from all Southeast Asian countries except Laos and has become well-established as the fifth human malaria parasite and the first significant zoonotic Plasmodium species. As countries endemic for P. knowlesi malaria are among the most popular and most highly visited international destinations, travel medicine experts should be aware about disease and risks including prophylactic and therapeutic measures. Between 2005 and 2012, 15 cases of P. knowlesi malaria have been recognised and published in international travellers. Male gender and travel to rural/forested areas with contact to wild monkeys are risk factors for P. knowlesi infection. The present review gives an overview on current literature on the P. knowlesi parasite and summarises recent findings related to epidemiology, diagnostics, treatment and prophylaxis focussing on travellers.

While several anti-malarials are known to affect the electric conduction system of the heart, less is known on the direct effects of Plasmodium falciparum infection. Some earlier studies point to a direct impact of Plasmodium falciparum infection on the electric conduction system of the heart. The aim of this study was to analyse infection- and drug-induced effects on the electric conduction system.

Die Zahl der Fernreisenden mit medikamentöser Immunsuppression dürfte in den kommenden Jahren zunehmen. Insofern ist die Frage nach Gelbfieberimpfungen in dieser Bevölkerungsgruppe für den Reisemediziner von zunehmender praktischer Relevanz. Während eine Gelbfieberimpfung unter einer Behandlung mit stark bis mittelstark wirksamen Immunsuppressiva nicht durchgeführt werden darf, stellen andere Medikamente mit immunsuppressiver Wirkung sowie auch niedriger dosierte, kurzfristige oder lokale Kortisongaben keine generelle Kontraindikation dar. Ob beziehungsweise wann eine Gelbfieberimpfung nach Absetzen der immunsuppressiven Therapie möglich ist, hängt ebenfalls vom eingesetzten Immunsuppressivum ab. Es liegen insgesamt wenig Daten zu Lebendimpfungen unter medikamentöser Immunsuppression vor. Generell ist es ratsam, das Gelbfieberinfektionsrisiko und das Risiko für Nebenwirkungen individuell abzuwägen und gegebenenfalls auch den immunsuppressiv behandelnden Kollegen in eine abschließende Entscheidung einzubinden. The number of international travelers under drug-induced immunosuppression is likely to further increase in the near future. Information on risks and contraindications of the yellow fever-vaccination in this population is, therefore, of practical relevance. While drugs of high and medium immunosuppressive potency are a general contraindication against yellow fever vaccination, this vaccine can be considered in other medications with immunosuppressive efficacy as well as low-dose, short-term or local steroids. If and when yellow fever-vaccination can be given after the immunosuppressive therapy has been stopped also depends on the specific medication. Up to now, little data are available on live attenuated vaccines in patients with medical immunosuppression. Geographical infection risks as well as potential safety issues should be considered. It is advisable to involve the physician who has initiated the immunosuppressive therapy in the final decision.

Background: The present study aimed to evaluate immunogenicity and safety of the 2012/2013 seasonal influenza vaccine (Optaflu®) after the World Health Organization recommended two new strains for the composition. Results: Twenty-one days post-vaccination geometric mean titers (GMTs) against A(H1N1), A(H3N2) and the B strain were 528, 935, and 201 for adults and 272, 681, and 101 for elderly subjects, respectively. The proportion of subjects with a HI titer of ≥ 40 against the three strains A(H1N1), A(H3N2) and B was 98%, 100%, and 98% in adults and 100%, 100%, and 85% in elderly subjects, respectively. Optaflu® met the CHMP criteria of the Committee for Medicinal Products for Human Use (CPMP/BWP/214/96). Pre-vaccination titers indicated seroprotection against the A(H1N1), the A(H3N2) and the B strain in 56%, 86%, and 54% of the adults and in 61%, 85%, and 40% of the elderly with highest titers against the A(H3N2) strain. In the safety analysis injection site pain (37%) and myalgia (31%) were the most common local and systemic reactions. No serious adverse events were recorded. Conclusion: The 2012/2013 seasonal influenza vaccine Optaflu® showed good immunogenicity and an acceptable safety profile in both adults and elderly. Methods: In this trial, 126 subjects (63 adults ≥18 to ≤60 y, 63 elderly ≥61 y) were vaccinated with a single dose Optaflu® containing each of the three virus strains recommended for the 2012/2013 season (A/California/7/2009(H1N1)-like strain, A/Victoria/361/2011(H3N2)-like strain, and B/Wisconsin/1/2010-like strain). Immunogenicity was assessed by hemagglutinin inhibition (HI) and single radial hemolysis (SRH) assays on day 22, the safety profile was investigated throughout the whole study period.