Identifying and Managing Vector-Borne Diseases in Migrants and Recent Travelers in the Emergency Department

Recognition and treatment of neglected tropical and vector-borne diseases is paramount as travel and immigration resume after a brief lull during the COVID-19 pandemic. These patients often present initially to the emergency department, and increasing physician knowledge of symptoms and treatment can reduce morbidity and mortality. This paper aims to summarize typical presentations of common tropical diseases, both neglected and vector borne, and provide the emergency physician with a diagnostic pathway based on current recommendations.

Co-circulation of ZIKV, CHIKV, and DENV is increasingly common in many countries throughout Caribbean and the Americas, requiring that patients be tested for each virus upon presentation. Dengvaxia is now approved as a vaccine against dengue in pediatric and young adult patients. A malaria vaccine, RTS,S/AS01, is currently in phase 3 trials and has been approved as a short-term vaccine by WHO for children in regions with high transmission risk after showing a 30% reduction in severe malaria. Mayaro is currently a neglected arbovirus that presents similarly to Chikungunya and is continuing to spread throughout the Americas at a rapid rate, gaining more attention after the 2016 Zika outbreak.

Emergency physicians should consider internationally acquired illnesses to appropriately identify which patients require admission among well-appearing febrile immigrants or recent travelers presenting to the emergency department. Identifying symptomatology and understanding the appropriate workup and treatment for tropically acquired diseases will assist in recognizing severe complications with prompt treatment.