This year, the World Health Organization (WHO) announced the Global Arbovirus Initiative (GLAI).1 This timely and important initiative will collate resources focusing on the detection, prevention, and control of emerging and re-emerging arboviruses. Arboviruses spread via the bite of infected arthropods (eg, mosquitoes), and people who travel to or live in areas where certain arboviruses are commonly found are at increased risk for arboviral infection. It’s imperative that physicians help patients in these areas understand their exposure risk and make recommendations to protect against infection, including the use of available prophylactic (vaccine) and non-pharmaceutical interventions.
Arboviruses are a growing global health threat with the potential to spread to non-endemic countries due to a combination of climate change and increased global travel and trade following the ease in COVID-19-related restrictions. The timing of the initiative coincides with rising global temperatures, which encourage the expansion of breeding grounds for vectors that carry arboviral diseases such as yellow fever, dengue, Zika, and chikungunya. These arboviruses thrive in areas in which an estimated 3.9 billion people live.1 Although arboviruses are not endemic in the United States they present a threat to our patients, especially those eager to get out and see the world.
The GLAI will focus on epidemic- and pandemic-level preparedness for high-risk arboviral pathogens. Despite global attention and awareness of infectious diseases’ ability to upend our lives being at an all-time high, many are experiencing fatigue from the COVID-19 pandemic and the outbreak of monkeypox.2 Are we prepared for the next outbreak?
Unlike COVID-19 or monkeypox, however, arboviral diseases like dengue, yellow fever, Zika, and chikungunya are carried by mosquitos. Mosquitos are known to be the deadliest insects in the world, responsible for the deaths of an estimated 1 million people globally every year.4 Endemic in tropical and subtropical areas, arboviruses have flown under the radar in the United States. The COVID-19 pandemic and monkeypox outbreak have shown that when viruses are inserted into non-endemic areas they can wreak havoc on a population with no preexisting immunity.3 With global travel and international trade rapidly increasing, the risk for foreign viruses being introduced into non-endemic areas is high.
What can infectious disease (ID) providers do in light of this emerging threat?
First, we can stay informed about arboviral disease activity in endemic countries and aware of any local transmission. As a tropical disease specialist, I generally focus pre-travel health consultations on malaria prophylaxis and how to acquire safe water. We as providers need to do a better job of counseling our patients on mosquito precautions, travel immunizations (including yellow fever, and others, as they become available), and pregnancy implications (Zika).
Second, we need to understand the signs and symptoms of diseases that require more urgent evaluation. This can be achieved by educating non-ID providers to recognize arboviral diseases.
Emergency medicine physicians in particular must have some familiarity with arboviral diseases to order the correct diagnostic tests. Patients who present with symptoms suggestive of an arboviral infection often experience delays in acquiring an ID referral. To mitigate this, ID providers can work with their hospitals to create a tropical disease panel based on symptoms and travel destinations that would help identify patients with arboviral diseases. This panel also may help in the management of patients who report recent travel to key tropical destinations plus symptoms of fever, as it can indicate the need for further testing, including appropriate blood work, and inform providers of any available treatment options.
Last, we need to monitor for outbreaks — particularly those that occur in popular warm-weather travel destinations. While this relates to tropical destinations outside of the United States, we also need to keep an eye on places like south Florida where we’ve already seen outbreaks of Zika and now dengue, which are caused by Aedes mosquitoes — named in the WHO report — and are of particular concern.
Travel medicine and ID providers must keep arboviruses on their radar to help stay ahead of the next potential outbreak. Vaccine development and programs, especially access in resource limited nations, will be an important component of disease prevention and outbreak control in the future. In the meantime, appropriate pre-travel counseling and post-travel response are our best bets in preventing outbreaks before they have a chance to begin.
- World Health Organization. Global arborvirus initiative. Published March 31, 2022. Accessed August 17, 2022.
- World Health Organization. WHO Director-General declares the ongoing monkeypox outbreak a public health emergency of international concern. Published July 23, 2022. Accessed August 17, 2022.
- U.S. Department of Health and Human Services. Biden-Harris administration bolsters monkeypox response; HHS secretary Becerra declares public health emergency. Published August 4, 2022. Accessed August 17, 2022.
- American Mosquito Control Association. Mosquito-borne diseases. Accessed August 17, 2022.