۱٫ Introduction

۲٫ Methods

۳٫ Results

۴٫ Discussion

Appendix A. Supplementary data

References

Abstract

Background: From the first Zika virus (ZIKV) description, it has progressively widespread worldwide. We analyzed demographic, clinical, microbiologic and travel-related characteristic from returned patients from a ZIKV endemic country in a referral Tropical Medicine Unit.

Method: A prospective cohort study performed in a Spanish referral center with the aim of determining the significant factors associated with confirmed Zika virus (ZIKV) infection

Results: 817 patients, (56% women, median age 36 [IQR, Interquartile Range: 32–۴۲]) were enrolled. Most had returned from Latin America (n = 486; 59.4%), travelled for tourism (n = 404; 49.4%) and stayed a median of 18 days (IQR: 10–۳۰). ۶۰۲ (۷۳٫۶%) presented symptoms, but only 25 (4%) were finally diagnosed with confirmed ZIKV infection (including two pregnant women, without adverse fetal outcomes), 88% (n:22) presented with fever and 92% (n:23) with rash. 56% (n:14) arthralgia and/or myalgia and 28% (n:7) conjunctivitis. The presence of conjunctivitis, fever and rash were associated with an 8.9 (95% CI: 2.2–۳۴٫۹), ۶٫۴ (۹۵% CI: 1.2–۳۳٫۳) and 72.3 (95% CI: 9.2–۵۶۳٫۵) times greater probability of confirmed ZIKV infection, respectively

Conclusion: Travel characteristics and clinical presentation may help clinicians to optimize requests for microbiological testing. Diagnosis of arboviriasis in travellers arriving form endemic areas remains a challenge for clinicians, but must be detected for the possible transmission outside endemic areas, where the vector is present.

Introduction

Zika virus (ZIKV) disease has emerged as one of the greatest public health threats worldwide, attracting media attention for its significance and repercussions. The shortage of reported cases in Africa and Asia since its first isolation in Uganda in 1947 [1] led to an initial lack of information about the disease. Characterization of patients during the outbreaks on Yap Island (2007) [2]and French Polynesia (2013) [3] enabled description of the primary characteristics of the disease. A more complete spectrum of ZIKV disease, however, including new routes of infection and associated complications, has been outlined while the infection has explosively spread across Americas since 2015 [4–۶].

The growing numbers of investigators, publications and funded projects related to ZIKV infection in recent years reflect the importance of the disease for the scientific community. The identification of novel pathways in fetal microcephaly [7] and the development of a preventive ZIKV vaccine [8] are some examples of the exponential increase in ZIKV research. However, and despite the evident advances achieved, there are still areas of ignorance.

Diagnosis of ZIKV remains a challenge due to serologic cross-reactions and clinical similarity of ZIKV infection with other flaviviruses, e.g. dengue.This fact, together with limited access to diagnostic tests in endemic countries, has led to underdiagnosis in many cases, making it difficult to estimate the real risk of infection for both the endemic population and travelers [5].