{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T09:17:53Z","timestamp":1769505473054,"version":"3.49.0"},"reference-count":24,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Arboviral infections, including dengue (DNV), chikungunya (CHIKV), and Zika (ZIKV), impact both travelers and native populations of endemic regions. We sought to assess the disease burden of arboviral infections in the Military Health System, the validity of arboviral diagnostic codes, and the role of pretravel counseling on insect avoidance precautions. We searched for diagnostic codes consistent with arboviral infection and grouped them into DNV, CHIKV, ZIKV, Japanese encephalitis virus (JEV), and Other. Demographic data were evaluated. A subset of charts in each category were reviewed for diagnostic validity and travel characteristics. In all, 10,547 unique subjects carried 17,135 arboviral diagnostic codes, including 1,606 subjects (15.2%) coded for DNV, 230 (2.2%) for ZIKV, 65 (0.6%) for CHIKV, and 4,317 (40.9%) for JEV. A chart review was performed on 807 outpatient charts, yielding outpatient diagnostic code positive predictive values of 60.5% (DNV), 15.3% (ZIKV), and 64.5% (CHIKV); there were no valid cases of JEV. Dengue represented the greatest burden of arboviral infections with 2.2 cases per 100,000 military healthcare enrollees over the 2012\u20132019 fiscal years. More than 80% of subjects with arboviral infection did not have documented pretravel counseling. Arboviral infections represent a significant disease burden in young travelers to endemic regions. After adjustment for diagnostic validity, DNV represented the greatest burden. Diagnostic codes for ZIKV and JEV overestimate the burden of these diseases. Low rates of pretravel visits represent an opportunity for increased emphasis on insect exposure precautions.<\/jats:p>","DOI":"10.4269\/ajtmh.22-0684","type":"journal-article","created":{"date-parts":[[2023,4,10]],"date-time":"2023-04-10T13:37:49Z","timestamp":1681133869000},"page":"1007-1013","source":"Crossref","is-referenced-by-count":5,"title":["The Burden of Arboviral Infections in the Military Health System 2012\u20132019"],"prefix":"10.4269","volume":"108","author":[{"given":"Trevor","family":"Wellington","sequence":"first","affiliation":[{"name":"Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland;"},{"name":"Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, Maryland;"},{"name":"1st Area Medical Laboratory, Aberdeen Proving Grounds, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie A.","family":"Fraser","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda, Maryland;"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huai-Ching","family":"Kuo","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda, Maryland;"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick W.","family":"Hickey","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Lindholm","sequence":"additional","affiliation":[{"name":"Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland;"},{"name":"Infectious Disease Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet","first-page":"350","article-title":"Dengue","volume":"393","author":"Wilder-Smith","year":"2019"},{"key":"b2","series-title":"J Travel Med","first-page":"tay044","article-title":"Zika in travellers 1947-2017: a systematic review","volume":"25","author":"Wilder-Smith","year":"2018"},{"key":"b3","series-title":"Mem Inst Oswaldo Cruz","first-page":"523","article-title":"Chikungunya virus: clinical aspects and treatment \u2013 a review","volume":"112","author":"Cunha","year":"2017"},{"key":"b4","series-title":"Expert Rev Vaccines","first-page":"143","article-title":"A review of the economic evidence of Aedes-borne arboviruses and Aedes-borne arboviral disease prevention and control strategies","volume":"19","author":"Thompson","year":"2020"},{"key":"b5","series-title":"Ann Intern Med","first-page":"456","article-title":"GeoSentinel Surveillance Network. GeoSentinel surveillance of illness in returned travelers, 2007\u20132011","volume":"158","author":"Leder","year":"2013"},{"key":"b6","series-title":"Lancet Infect Dis","first-page":"712","article-title":"The global burden of dengue: an analysis from the Global Burden of Disease Study 2013","volume":"16","author":"Stanaway","year":"2016"},{"key":"b7","series-title":"Popul Health Metr","first-page":"1","article-title":"Measuring the burden of arboviral diseases: the spectrum of morbidity and mortality from four prevalent infections","volume":"9","author":"Labeaud","year":"2011"},{"key":"b8","year":"2022"},{"key":"b9","series-title":"J Infect Dis","first-page":"1873","article-title":"The double-edged sword of military response to societal disruptions: a systematic review of the evidence for military personnel as pathogen transmitters","volume":"220","author":"Zemke","year":"2019"},{"key":"b10","series-title":"Am J Trop Med Hyg","first-page":"903","article-title":"Mosquito exposure and chikungunya and dengue infection among travelers during the chikungunya outbreak in the Americas","volume":"96","author":"Lindholm","year":"2017"},{"key":"b11","series-title":"J Travel Med","first-page":"taw043","article-title":"A comparison of compliance rates with anti-vectorial protective measures during travel to regions with dengue or chikungunya activity, and regions endemic for Plasmodium falciparum malaria","volume":"23","author":"Lalani","year":"2016"},{"key":"b12","series-title":"J Travel Med","first-page":"253","article-title":"Use of medical chemoprophylaxis and antimosquito precautions in Danish malaria patients and their traveling companions","volume":"7","author":"M\u00f8lle","year":"2000"},{"key":"b13","year":"2020"},{"key":"b14","series-title":"MSMR","first-page":"8","article-title":"Surveillance for vector-borne diseases among active and reserve component service members, U.S. Armed Forces, 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