Imported Arbovirus Infections in Spain, 2009–2018

I n recent decades, pathogenic flaviviruses (yellow fever virus, dengue [DENV], and Zika [ZIKV]) and the alphavirus chikungunya (CHIKV) have become the most common agents of emerging arbovirus diseases among humans.Their geographic distribution, epidemiologic patterns, and modes of transmission overlap considerably, and because of increased human travel and migration, outbreaks have been reported in non-arbovirus-endemic areas.Proposed drivers of virus epidemics include factors that may affect vector distribution, such as climate change, wars/social change, and poverty (decreased vector control measures) (1).Although some factors are unlikely to occur in non-arbovirus-endemic settings, such as Europe, emergence of these infectious diseases in these regions may result from viremic persons with imported infections and presence of competent Aedes albopictus mosquitoes (2).In nontropical areas, the potential international threat of these viruses is increased by the possibility of nonvectorborne transmission, such as transfusional, sexual, and vertical transmission (with possible severe fetal damage) (3).Travelers are at high risk for infection by vectorborne diseases and may contribute to the spread of imported diseases in non-disease-endemic areas (4).Our objective with this study was to describe the epidemiologic and clinical characteristics of patients in Spain with a confirmed diagnosis of imported arbovirus infection.For data, we used the Red Cooperativa para el Estudio de las Infecciones Importadas por Viajeros e Inmigrantes (+Redivi) network (http:// www.redivi.es), a specialized network for imported infectious diseases in Spain. MethodsWe based our analysis on a cohort included in the +Redivi network.The network initially comprised 4 centers; however, new centers have been included over the years.Currently, +Redivi comprises 22 health centers (1 primary care center and 21 hospitals, specialized and not specialized in travel medicine) in 8 regions of Spain that share a common online database in which new cases of imported infections are registered.A unique data collection sheet is used to gather information about patient demographics, trip characteristics (destination, return date, duration, type of traveler), receipt of pretravel advice, receipt of antimalaria antiprophylaxis (when applicable), reason for consultation, and final diagnosis variables.Because