Dengue and international travel

The increasing number of international travelers makes dengue infection an increasingly important public health problem. Dengue is endemic in most tropical and subtropical areas, which are the destination of an increasing number of travelers. Increasingly high numbers of dengue fever cases have been reported in several surveillance studies, reflecting both the increasing travel morbidity and the expanding geographical distribution of vectors. The true incidence of dengue in travelers may be underestimated owing to the high number of asymptomatic cases, the generalized lack of standardized diagnostic procedures for febrile travelers and the diversity in reporting requirements. Diagnosis of dengue is important in order to differentiate primary and secondary infection and to better address pretravel counseling. Healthcare providers should be aware of dengue infection, better understand its clinical presentation and be skilled in diagnosis and management in returning travelers. Risk factors for dengue include typology and duration of stay, season of travel and epidemic activity at the destination. Travelers may play a role as sentinels in alerting the international community about the onset of epidemics in endemic regions and may be involved in the spread of dengue to nonendemic regions, where the mosquito vectors, Aedes aegypti and/or Aedes albopictus, are present. This highlights the importance of surveillance for dengue, focusing on mosquito control strategies and the need to increase vigilance by health professionals. Dengue is a major vector-borne disease in tropical and subtropical regions. This chapter aims to discuss the challenges of dengue for international travelers, analyzing epidemiological, clinical and diagnostic aspects and focusing on preventive measures and specific risk factors. Physicians should be aware of this issue, in order to improve diagnostic and therapeutic procedures and to enhance their practice in pretravel counseling.