Characteristics of Zika virus infection among international travelers: A prospective study from a Spanish referral unit

Travel Med Infect Dis. Jan-Feb 2020;33:101543. doi: 10.1016/j.tmaid.2019.101543. Epub 2019 Dec 2.


Background: From the first Zika virus (ZIKV) description, it has progressively widespread worldwide. We analyzed demographic, clinical, microbiologic and travel-related characteristic from returned patients from a ZIKV endemic country in a referral Tropical Medicine Unit.

Method: A prospective cohort study performed in a Spanish referral center with the aim of determining the significant factors associated with confirmed Zika virus (ZIKV) infection.

Results: 817 patients, (56% women, median age 36 [IQR, Interquartile Range: 32-42]) were enrolled. Most had returned from Latin America (n = 486; 59.4%), travelled for tourism (n = 404; 49.4%) and stayed a median of 18 days (IQR: 10-30). 602 (73.6%) presented symptoms, but only 25 (4%) were finally diagnosed with confirmed ZIKV infection (including two pregnant women, without adverse fetal outcomes), 88% (n:22) presented with fever and 92% (n:23) with rash. 56% (n:14) arthralgia and/or myalgia and 28% (n:7) conjunctivitis. The presence of conjunctivitis, fever and rash were associated with an 8.9 (95% CI: 2.2-34.9), 6.4 (95% CI: 1.2-33.3) and 72.3 (95% CI: 9.2-563.5) times greater probability of confirmed ZIKV infection, respectively.

Conclusion: Travel characteristics and clinical presentation may help clinicians to optimize requests for microbiological testing. Diagnosis of arboviriasis in travellers arriving form endemic areas remains a challenge for clinicians, but must be detected for the possible transmission outside endemic areas, where the vector is present.

Keywords: Arbovirus infections; Endemic disease; Travel medicine; Zika virus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Asia
  • Female
  • Humans
  • Latin America
  • Male
  • Middle Aged
  • Pregnancy
  • Prospective Studies
  • Referral and Consultation
  • Spain / epidemiology
  • Spain / ethnology
  • Travel
  • Travel-Related Illness*
  • Young Adult
  • Zika Virus / isolation & purification
  • Zika Virus Infection / diagnosis*
  • Zika Virus Infection / epidemiology