Syndromic Approach to Arboviral Diagnostics for Global Travelers as a Basis for Infectious Disease Surveillance

Background: arboviruses have overlapping geographical distributions and can cause symptoms that coincide with more common infections. therefore,arbovirus infections are often neglected by travel diagnostics. here,we assessed the potential of syndrome-based approaches for diagnosis and surveillance of neglected arboviral diseases in returning travelers. method: to map the patients high at risk of missed clinical arboviral infections we compared the quantity of all arboviral diagnostic requests by physicians in the netherlands,from 2009 through 2013,with a literature-based assessment of the travelers’ likely exposure to an arbovirus. results: 2153 patients,with travel and clinical history were evaluated. the diagnostic assay for dengue virus (denv) was the most commonly requested (86%). of travelers returning from southeast asia with symptoms compatible with chikungunya virus (chikv),only 55% were tested. for travelers in europe,arbovirus diagnostics were rarely requested. over all,diagnostics for most arboviruses were requested only on severe clinical presentation. conclusion: travel destination and syndrome were used inconsistently for triage of diagnostics,likely resulting in vast under-diagnosis of arboviral infections of public health significance. this study shows the need for more awareness among physicians and standardization of syndromic diagnostic algorithms. © 2015 cleton et al.