Khan Kamran, Bogoch Isaac, Brownstein John S, Miniota Jennifer, Nicolucci Adrian, Hu Wei, Nsoesie Elaine O, Cetron Martin, Creatore Maria Isabella, German Matthew, Wilder-Smith Annelies
Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Canada.
Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Canada; University Health Network, Divisions of Internal Medicine and Infectious Diseases, Toronto, Canada.
PLoS Curr. 2014 Jun 6;6:ecurrents.outbreaks.2134a0a7bf37fd8d388181539fea2da5. doi: 10.1371/currents.outbreaks.2134a0a7bf37fd8d388181539fea2da5.
For the first time, an outbreak of chikungunya has been reported in the Americas. Locally acquired infections have been confirmed in fourteen Caribbean countries and dependent territories, Guyana and French Guiana, in which a large number of North American travelers vacation. Should some travelers become infected with chikungunya virus, they could potentially introduce it into the United States, where there are competent Aedes mosquito vectors, with the possibility of local transmission.
We analyzed historical data on airline travelers departing areas of the Caribbean and South America, where locally acquired cases of chikungunya have been confirmed as of May 12th, 2014. The final destinations of travelers departing these areas between May and July 2012 were determined and overlaid on maps of the reported distribution of Aedes aeygpti and albopictus mosquitoes in the United States, to identify potential areas at risk of autochthonous transmission.
The United States alone accounted for 52.1% of the final destinations of all international travelers departing chikungunya indigenous areas of the Caribbean between May and July 2012. Cities in the United States with the highest volume of air travelers were New York City, Miami and San Juan (Puerto Rico). Miami and San Juan were high travel-volume cities where Aedes aeygpti or albopictus are reported and where climatic conditions could be suitable for autochthonous transmission.
The rapidly evolving outbreak of chikungunya in the Caribbean poses a growing risk to countries and areas linked by air travel, including the United States where competent Aedes mosquitoes exist. The risk of chikungunya importation into the United States may be elevated following key travel periods in the spring, when large numbers of North American travelers typically vacation in the Caribbean.
美洲首次报告了基孔肯雅热疫情。在14个加勒比国家及附属领土、圭亚那和法属圭亚那已确认出现本地感染病例，有大量北美旅行者在这些地方度假。如果一些旅行者感染了基孔肯雅病毒，他们有可能将病毒传入美国，而美国存在传播媒介白纹伊蚊，存在病毒本地传播的可能性。
我们分析了2014年5月12日之前已确认出现基孔肯雅热本地感染病例的加勒比和南美地区航空旅客的历史数据。确定了2012年5月至7月离开这些地区的旅行者的最终目的地，并将其叠加在美国报告的埃及伊蚊和白纹伊蚊分布地图上，以确定存在本地传播风险的潜在地区。
仅美国就占了2012年5月至7月离开加勒比基孔肯雅热流行地区的所有国际旅行者最终目的地的52.1%。美国航空旅客流量最大的城市是纽约市、迈阿密和圣胡安（波多黎各）。迈阿密和圣胡安是航空旅客流量大的城市，报告有埃及伊蚊或白纹伊蚊，且气候条件可能适合本地传播。
加勒比地区迅速演变的基孔肯雅热疫情对包括美国在内的与航空旅行相关的国家和地区构成了越来越大的风险，美国存在传播媒介白纹伊蚊。在春季的关键旅行期之后，基孔肯雅热传入美国的风险可能会增加，因为通常有大量北美旅行者在加勒比地区度假。
