Come Fly With Me : Integration of travel medicine and arbovirus surveillance

The goal of this thesis was to study how existing medical information and health structures can be used for arbovirus surveillance in the Netherlands. To achieve this, we combined and analysed all routine diagnostic data for Dutch travellers for suitability in arbovirus surveillance. We developed diagnostic algorithms to identify possible underdiagnosis of arbovirus infections in travellers. Based on these algorithms, we developed, validated, and applied a multiplex serological protein microarray in a retrospective study in travellers and outbreaks in equines to evaluate its added value in public health surveillance and patient care.
We demonstrated that syndromic studies of existing information can be used to monitor the effectiveness of current arbovirus surveillance methods. Although preliminary, our study also showed that currently available health structures and medical information could provide essential additional information that, if approached appropriately, could improve arbovirus surveillance. To achieve this, serological and syndromic data should be interpreted with a multipathogen perspective. However, our test results were limited to an increase in mainly DENV‐positive patients, with a limited increase in other flavivirus diagnoses.
Nevertheless, application of standardized flavivirus diagnostics performed with RT‐PCR and microarray according to travel history showed potential in the identification of patients with a higher risk of a recent flavivirus infection. Although further optimization of the algorithm is required and thorough cost‐benefit analyses for syndromic multiplex surveillance are not yet available, we showed that existing medical information combined with standardized flavivirus diagnostics and multiplex techniques can be used for arbovirus surveillance in the Netherlands, potentially improve both travellers’ health and surveillance.