Seroprevalence of dengue, Japanese encephalitis and Zika among long-term expatriates in Thailand

Author:

Kitro Amornphat1232,Imad Hisham Ahmed4567,Pisutsan Phimphan4589,Matsee Wasin4589,Sirikul Wachiranun1210,Sapbamrer Ratana1232,Rapheal Erica11,Fernandez Stefan12,Cotrone Thomas S12,Farmer Aaron R12,Hunsawong Taweewun12,Silachamroon Udomsak45,Chatapat Lapakorn4589,Olanwijitwong Jutarmas89,Salee Parichat1314,Anderson Kathryn B1516,Piyaphanee Watcharapong4589ORCID

Affiliation:

1. Department of Community Medicine , Faculty of Medicine, , Chiang Mai 50200 , Thailand

2. Chiang Mai University , Faculty of Medicine, , Chiang Mai 50200 , Thailand

3. Environmental and Occupational Medicine Excellence Center , Faculty of Medicine, , Chiang Mai 50200 , Thailand

4. Department of Clinical Tropical Medicine , Faculty of Tropical Medicine, , Bangkok 10400 , Thailand

5. Mahidol University , Faculty of Tropical Medicine, , Bangkok 10400 , Thailand

6. Center for Infectious Disease Education and Research , Department of Viral Infections, Research Institute for Microbial Diseases, , Osaka, Suita 565-0871 , Japan

7. Osaka University , Department of Viral Infections, Research Institute for Microbial Diseases, , Osaka, Suita 565-0871 , Japan

8. Thai Travel Clinic , Hospital for Tropical Diseases, Faculty of Tropical Medicine, , Bangkok 10400 , Thailand

9. Mahidol University , Hospital for Tropical Diseases, Faculty of Tropical Medicine, , Bangkok 10400 , Thailand

10. Center of Data Analytics and Knowledge Synthesis for Health Care, Chiang Mai University , Chiang Mai 50200 , Thailand

11. School of Public Health, University of Minnesota , Minnesota, MN 55414 , USA

12. Department of Virology, US Army Medical Directorate of the Armed Force Research Institute of Medical Sciences , Bangkok 10400 , Thailand

13. Division of Infectious Diseases and Tropical Medicine , Department of Medicine, Faculty of Medicine, , Chiang Mai 50200 , Thailand

14. Chiang Mai University , Department of Medicine, Faculty of Medicine, , Chiang Mai 50200 , Thailand

15. Institute for Global Health and Translational Science, SUNY Upstate Medical University , Syracuse, NY 13210 , USA

16. Department of Microbiology and Immunology, SUNY Upstate Medical University , Syracuse, NY 13210 , USA

Abstract

Abstract Background Travel to Southeast Asia increases the likelihood of acquiring mosquito-borne Flavivirus infections such as dengue (DENV), Japanese encephalitis (JEV) and Zika viruses (ZIKV). Expatriates are long-term travellers who have a higher risk of mosquito-borne illness at their destination country. The purpose of this study was to evaluate the seroprevalence of DENV, JEV and ZIKV infections and the determinants contributing to seropositivity among expatriates living in Thailand. Methods A cross-sectional study was performed from December 2017 to February 2020. Expatriates from non-Flavivirus endemic countries were recruited. 5 mL of blood was collected for DENV 1–4, JEV and ZIKV antibody testing by plaque reduction neutralization test (PRNT50). Individuals with vaccination histories or diagnoses for dengue, Japanese encephalitis, yellow fever and tick-borne encephalitis were excluded. Results Among 254 participants, most participants (83.1%) were male, the mean age was 65 years and the median duration of stay in Thailand was 6 years. Seroprevalence rate of any Flavivirus, non-specific DENV, DENV1–4, JEV and ZIKV were 34.3, 30.7, 20.5, 18.1, 18.9, 10.6, 4.7 and 2.8%, respectively. The presence of neutralizing antibodies against DENV1–4 positively correlates with the duration of stay in Thailand. DENV seropositivity was associated with living in urban areas (aOR 2.75, 95% CI 1.36–5.57). Expatriates were unlikely to have detectable anti-JEV antibodies regardless of time spent in a JEV-endemic area. No risk factors were identified that were significantly associated with JEV or ZIKV seropositivity. Only 48.4% received pre-travel counselling services, while only 18.9% visited a travel medicine specialist. Conclusions A high proportion (34.3%) of long-term expatriates living in Thailand were seropositive for flavivirus, mainly from dengue (30.7%). To minimize risk, travel medicine practitioners should provide adequate pre-travel health risk information on mosquito-borne flavivirus infection and offer advice on mosquito bite prevention strategies. Dengue vaccine might be considered in high-risk travellers such as long-term expatriate.

Funder

Center for Global Health and Social Responsibility

University of Minnesota

Publisher

Oxford University Press (OUP)

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