Zoonosis: Update on Existing and Emerging Vector-Borne Illnesses in the USA

  • Sandra Lee WernerEmail author
  • Bhanu Kirthi Banda
  • Christopher Lee Burnsides
  • Alexander James Stuber
Infectious Disease (J Glauser, Section Editor)
Part of the following topical collections:
  1. Infectious Disease


Purpose of review

This review describes mosquito- and tick-borne diseases found in the Western Hemisphere. It focuses on emerging diseases and recent geographic shifts in the presence of disease vectors.

Recent Findings

Mosquito and tick vectors have become more widespread as environmental conditions have become more favorable. Zika recently has emerged as a concern for fetal anomalies. West Nile Virus has become widespread. Lyme disease and other tick-borne diseases are more prevalent in areas previously inhospitable to these ticks.


Healthcare providers must consider the possibility of mosquito- and tick-borne diseases in broader geographic areas and council patients traveling to endemic areas on precautions against these diseases. Treatment for suspected cases of serious tick-borne illnesses should not be delayed pending culture results.


Zoonosis Tick Mosquito Zika Lyme Vector-borne 


Compliance with Ethical Standards

Conflict of Interest

Sandra Lee Werner, Bhanu Kirthi Banda, Christopher Lee Burnsides, and Alexander James Stuber declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    World Health Organization. Vector-borne diseases fact sheet, February 2017. Accessed 10 May 2019.
  2. 2.
    •• Rosenberg R, Lindsey NP, Fischer M, et al. Vital signs: trends in reported vectorborne disease cases—United States and territories, 2004–2016. MMWR Morb Mortal Wkly Rep. 2018;67:496–501. An excellent visual and statistical summary of the large changes in the prevalence of these diseases over 12 years.CrossRefGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention. Selected tickborne diseases reported to the CDC, U.S., 2016.
  4. 4.
    Kuehn BM. Tick bite linked to red meat allergy. JAMA. 2018;319(4):332. Scholar
  5. 5. (2017). Lyme disease | Lyme disease | CDC. [online] Available at: Accessed 23 Apr 2019.
  6. 6.
    Domachowske J. Introduction to clinical infectious diseases: a problem-based approach. 1st ed: Springer International Publishing; 2019.Google Scholar
  7. 7.
    •• Beard C, Eisen R, Barker C, Garofalo J, Hahn M, Hayden M et al. The impacts of climate change on human health in the United States: a scientific assessment. 2016 [cited 23 April 2019]. Available from: Great summary of current and expected impacts of climate change on health in the coming years.
  8. 8.
    Dumic I, Severnini E. “Ticking bomb”: the impact of climate change on the incidence of Lyme disease. Can J Infect Dis Med Microbiol. 2018 [cited 23 April 2019]; 2018:1–10. Available from:
  9. 9.
    Hu L. Lyme disease symptoms and diagnosis (beyond the basics). 2018 [cited 23 April 2019]. Available from:
  10. 10.
    Diagnosis and testing | Lyme disease | CDC [Internet]. 2018 [cited 23 April 2019]. Available from:
  11. 11.
    Dessau R, van Dam A, Fingerle V, Gray J, Hovius J, Hunfeld K et al. To test or not to test? Laboratory support for the diagnosis of Lyme borreliosis: a position paper of ESGBOR, the ESCMID study group for Lyme borreliosis. European Society of Clinical Microbiology and Infectious Diseases [Internet]. 2018 [cited 23 April 2019];24(2): Pages 118–124. Available from:
  12. 12.
    Leeflang M, Ang C, Berkhout J, Bijlmer H, Van Bortel W, Brandenburg A et al. The diagnostic accuracy of serological tests for Lyme borreliosis in Europe: a systematic review and meta-analysis. BMC Infectious Diseases. 2016 [cited 23 April 2019];16(1). Available from:
  13. 13.
    CDC. Babesiosis. 2018 [cited 23 April 2019]. Available from:
  14. 14.
    • Diuk-Wasser M, Vannier E, Krause P. Coinfection by the tick-borne pathogens Babesia microti and Borrelia burgdorferi: ecological, epidemiological and clinical consequences. Trends Parasitol. 2017 [cited 23 April 2019];32(1):30-42. Available from: Highlights the need to consider and potentially treat for more than one tick-borne disease—especially in patients who are sicker than expected.
  15. 15.
    Radolf J, Caimono M, Stevenson B, Hu L. Of ticks, mice and men: understanding the dual-host lifestyle of Lyme disease spirochaetes. Nat Rev Microbiol. 2012 [cited 23 April 2019];10(2):87–99. Available from:
  16. 16.
    Ward S, Stramer S, Szczepiorkowski Z. Assessing the risk of Babesia to the United States blood supply using a risk-based decision-making approach: report of AABB's Ad Hoc Babesia Policy Working Group (original report). Transfusion. 2018 [cited 23 April 2019];58(8):1916–1923. Available from:
  17. 17.
    Zimmer A, Simonsen K. Babesiosis. 2018 [cited 23 April 2019]. Available from:
  18. 18.
    Herwaldt B, McGovern P, Gerwel M, Easton R, MacGregor R. Endemic babesiosis in another eastern state: New Jersey. Emerg Infect Dis. 2003 [cited 23 April 2019];9(2):184–188. Available from:
  19. 19.
    Alvarez De Leon S, Srivastava P, Revelo A, Kadambi A, El Khoury M, Wormser G, et al. Babesiosis as a cause of acute respiratory distress syndrome: a series of eight cases. Postgraduate Medicine. 2018 [cited 23 April 2019];131(2):138–143. Available from:
  20. 20.
    Patel K, Johnson J, Reece R, Mermel L. Babesiosis-associated splenic rupture: case series from a hyperendemic region. Clin Infect Dis. 2018.Google Scholar
  21. 21.
    Fida M, Hamdi A, Saleh O, O’HJ. Babesiosis: retrospective review of 38 cases from Upper Midwest. Open Forum Infect Dis. 2018;5(1).Google Scholar
  22. 22.
    Epidemiology and statistics | Rocky Mountain spotted fever (RMSF) | CDC [Internet]. 2019 [cited 23 April 2019]. Available from:
  23. 23.
    Biggs H, Barton Behravesh C, Bradley K, Dahlgren F, Drexler N, Dumler J, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis—United States. Morb Mortal Wkly Rep. 2016 [cited 26 April 2019];65(2). Available from:
  24. 24.
    For public health officials | Rocky Mountain spotted fever (RMSF) | CDC [Internet]. 2019 [cited 23 April 2019]. Available from:
  25. 25.
    Masters E, Olson G, Weiner S. Rocky Mountain spotted fever a clinician's dilemma. Arch Intern Med. 2003 [cited 23 April 2019];163(7):769–774. Available from:
  26. 26.
    Clinical and laboratory diagnosis | Rocky Mountain spotted fever (RMSF) | CDC. 2018 [cited 23 April 2019]. Available from:
  27. 27.
    Risk factors for fatal outcome from Rocky Mountain spotted fever in a highly endemic area—Arizona, 2002–2011. Clin Infect Dis. 2015 [cited 23 April 2019];60(11):1659–66. Available from:
  28. 28.
    Cross R, Ling C, Day NP, et al. Revisiting doxycycline in pregnancy and early childhood—time to rebuild its reputation? Expert Opin Drug Saf. 2016;15:367–82.CrossRefGoogle Scholar
  29. 29.
  30. 30.
    • Zientek J, Dahlgren F, McQuiston J, Regan J. Self-reported treatment practices by healthcare providers could lead to death from Rocky Mountain spotted fever. J Pediatr. 2014 [cited 23 April 2019];164(2):416–418. Available from: Demonstrates consequences of providers clinging to outdated information and dogma rather than evidence.
  31. 31.
    Barton Behravesh C, Schutze G. Doxycycline can be used in young children without staining teeth. AAP News. 2015 [cited 23 April 2019];36(5). Available from:
  32. 32.
    Todd S, Dahlgren F, Traeger M, Beltrán-Aguilar E, Marianos D, Hamilton C, et al. No visible dental staining in children treated with doxycycline for suspected Rocky Mountain spotted fever. J Pediatr. 2015 [cited 23 April 2019];166(5):1246–1251. Available from:
  33. 33.
    Sexton DJ, McClain MT (2018) Human ehrlichiosis and anaplasmosis. In: UpToDate. Accessed 7 May 2019 Topic last updated: Aug, 30 2018.
  34. 34.
    Nichols Heitman K, Dahlgren FS, Drexler NA, et al. Increasing incidence of ehrlichiosis in the United States: a summary of national surveillance of Ehrlichia chaffeensis and Ehrlichia ewingii infections in the United States, 2008-2012. Am J Trop Med Hyg. 2016;94:52–60.CrossRefGoogle Scholar
  35. 35.
    Centers for Disease Control and Prevention. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever rickettsioses, ehrlichiosis, and anaplasmosis—United States: a practical guide for healthcare and public health professionals. MMWR. 2016;65(No. RR-2). Accessed 16 May 2019.Google Scholar
  36. 36.
    Engel J, Bradley K, et al. Revision of the national surveillance case definition for ehrlichiosis (ehrlichiosis/anaplasmosis). Council of State and Territorial Epidemiologists, Infectious Diseases Committee, 2007 Position Statement.
  37. 37.
    Bakken JS, Dumler JS. Human granulocytic anaplasmosis. Infect Dis Clin N Am. 2015;29:341–55.CrossRefGoogle Scholar
  38. 38.
    Centers for Disease Control. Anaplasmosis. Available at
  39. 39.
    Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis—United States: a practical guide for health care and public health professionals. 2016. Cdc-pdf [PDF – 48 pages].Google Scholar
  40. 40.
  41. 41.
    Centers for Disease Control and Prevention. Tickborne relapsing fever—United States, 1990-2011. MMWR Morb Mortal Wkly Rep. 2015;64(03):58–60.Google Scholar
  42. 42.
    Jones JM, Schumacher M, Peoples M, Souders M, et al. Notes from the field: tickborne relapsing fever outbreak at an outdoor education camp—Arizona, 2014. MMWR Wkly. 2015;64(23):651–2.Google Scholar
  43. 43.
    Dworkin MS, Schwan TG, Anderson DE, et al. Tick-borne relapsing fever. Infect Dis Clin N Am. 2008;22:449–68.CrossRefGoogle Scholar
  44. 44.
  45. 45.
    Centers for Disease Control. Tick-borne relapsing fever. In: CDC. 2018. Available at Accessed 7 May 2019.
  46. 46.
    Sexton DJ, McClain MT (2017) Southern tick-associated rash illness (STARI). In: UpToDate. Accessed 7 May 2019 Topic last updated: Jul 24, 2017.
  47. 47.
    Feder HM Jr, Hoss DM, Zemel L, et al. Southern tick-associated rash illness (STARI) in the north: STARI following a tick bite in Long Island, New York. Clin Infect Dis. 2011;53:e142.CrossRefGoogle Scholar
  48. 48.
    Wormser GP, Liveris D, Nowakowski J, Nadelman RB, Holmgren D, Bittker S, et al. Microbiologic evaluation of patients from Missouri with erythema migrans. Clin Infect Dis. 2005;40(3):423–8. Scholar
  49. 49.
    Centers for Disease Control. STARI or Lyme? Available at Updated November 2018. Accessed 15 May 2019.
  50. 50.
    Tularemia. Centers for disease control. Accessed 7 May 2019 Topic last updated: Jan 14, 2019.
  51. 51.
    Pedati C, House J, Hancock-Allen J, Colton L, Bryan K, Ortbahn D, et al. Notes from the field: increase in human cases of tularemia—Colorado, Nebraska, South Dakota, and Wyoming, January-September 2015. MMWR Morb Mortal Wkly Rep. 2015;64:1317–8.CrossRefGoogle Scholar
  52. 52.
    • Nakazawa Y, Williams R, Peterson AT, et al. Climate change effects on plague and tularemia in the United States. Vector Borne Zoonotic Dis. 2007;7:529 Good discussion of effects of warming climate on potentially serious diseases. CrossRefGoogle Scholar
  53. 53.
    Matyas BT, Nieder HS, Telford SR 3rd. Pneumonic tularemia on Martha's Vineyard: clinical, epidemiologic, and ecological characteristics. Ann N Y Acad Sci. 2007;1105:351–77.CrossRefGoogle Scholar
  54. 54.
    Dennis DT, Inglesby TV, Henderson DA, Bartlett JG, Ascher MS, Eitzen E, et al. Tularemia as a biological weapon: medical and public health management. JAMA. 2001;285:2763.CrossRefGoogle Scholar
  55. 55.
    Penn RL. Tularemia: clinical manifestations, diagnosis, treatment, and prevention. In: UpToDate. 2019. Accessed 7 May 2019. Topic last updated: Jan 14, 2019.
  56. 56.
    •• Fatmi SS, Zehra R, Carpenter DO. Powassan virus—a new reemerging tick-borne disease. Front Publ Health. 2017;5:342. A re-emergent disease that must be considered in the differential of tick-borne diseases.CrossRefGoogle Scholar
  57. 57.
    Centers for Disease Control. Powassan virus. Available at Updated December 4, 2018. Accessed 16 May 2019.
  58. 58.
    Frost HM, Schotthoefer AM, Thomm AM, Dupuis AP, Kehl SC, Kramer L, et al. Serologic evidence of Powassan virus infection in patients with suspected Lyme disease. Emerg Infect Dis. 2017;23(8):1384–8. Scholar
  59. 59.
    • Centers for Disease Control. Heartland virus. Available at Updated October 22, 2018. Accessed 10 May 2019. An emerging pathogen with potential fatal outcomes.
  60. 60.
    • Centers for Disease Control. Bourbon virus. Available at Updated January 24, 2019. Accessed 10 May 2019. An emerging pathogen with potential fatal outcomes.
  61. 61.
    Savage HM, Godsey MS, Panella NA, et al. Surveillance for heartland virus (Bunyaviridae: Phlebovirus) in Missouri during 2014: first detection of virus in adults of Amblyomma americanum (Acari: Ioxodidae). J Med Entomol. 2016;53(3):607–12.CrossRefGoogle Scholar
  62. 62.
    Kosoy OI, Lambert AJ, Hawkinson DJ, Pastula DM, Goldsmith CS, Hunt DC, et al. Novel Thogotovirus species associated with febrile illness and death, United States, 2014. Emerg Infect Dis. 2015;21(5):760–4.Google Scholar
  63. 63.
    Muehlenbachs A, Fata CR, Lambert AJ, Paddock CD, Velez JO, Blau DM, et al. Heartland virus associated death in Tennessee. Clin Infect Dis. 2014;59(6):845–50.CrossRefGoogle Scholar
  64. 64.
    •• Moreno MJ, Turell M. History of mosquito-borne diseases in the United States and implications for new pathogens. Emerg Infec Dis. 2018;24(5):821–5. Well researched and sheds light on potential increase in vector-borne pathogens. CrossRefGoogle Scholar
  65. 65.
    Kraemer MUG, Reiner RC Jr, Brady OJ, Messing JP, et al. Past and future spread of the arbovirus vectors Aedes aegypti and Aedes albopictus. Nat Microbiol. 2019;4(5):854–63.CrossRefGoogle Scholar
  66. 66.
    Center for Disease Control and Prevention. West Nile virus statistics and maps. Available at
  67. 67.
    Hayes EB, Komar N, Nasci RS, Montgomery SP, O'Leary DR, Campbell GL. Epidemiology and transmission dynamics of West Nile virus disease. Emerg Infect Dis. 2005;11(8):1167–73. Accessed 16 May 2019.
  68. 68.
    • Yeung MW, Shing E, Nelder M, Sander B. Epidemiologic and clinical parameters of West Nile virus infections in humans: a scoping review. BMC Infect Dis. 2017;17(1):609. Published 2017 Sep 6. Accessed 16 May 2019. Comprehensive review of this now widespread pathogen.
  69. 69.
    US Department of Health and Human Services, Public Health Services, Centers for Disease Control, West Nile virus in the United States: guidelines for surveillance, Prev Control. 2013. 16 May 2019.
  70. 70.
    Centers for Disease Control and Prevention. West Nile virus therapeutics, a review of the literature. February 2018. For health care providers. Available at Accessed 16 May 2019.
  71. 71.
    Scherwitzl I, Mongkolsapaja J, Screaton G. Recent advances in human flavivirus vaccines. Curr Opin Virol. 2017;23:95–101. Scholar
  72. 72.
    •• Petersen L, Jamieson D, Powers A, Honein M. Zika virus. New Engl J Med. 2016;74:1552–63. Great introduction to this emerging disease. CrossRefGoogle Scholar
  73. 73.
    Eggo RM, Kucharski AJ. Expected duration of adverse pregnancy outcomes after zika epidemic. Emerg Infect Dis. 2018;24(1):127–30. Scholar
  74. 74.
    Mutebi J, Hughes HR, Burkhalter KL, et al. Zika virus MB16-23 in mosquitoes, Miami-Dade County, Florida, USA, 2016. Emerg Infect Dis. 2018;24(4):808–10. Scholar
  75. 75.
    Sasmono R, Dhenni R, Yohan B, et al. Zika virus seropositivity in 1–4-year-old children, Indonesia, 2014. Emerg Infect Dis. 2018;24(9):1740–3. Scholar
  76. 76.
    Hart CE, Roundy CM, Azar SR, Huang JH, Yun R, Reynolds E, et al. Zika virus vector competency of mosquitoes, Gulf Coast, United States. Emerg Infect Dis. 2017;23(3):559–60. Scholar
  77. 77.
    Krow-Lucal ER, Novosad SA, Dunn AC, Brent CR, Savage HM, Faraji A, et al. Zika virus infection in patient with no known risk factors, Utah, USA, 2016. Emerg Infect Dis. 2017;23(8):1260–7. Scholar
  78. 78.
    World Health Organization. Zika virus fact sheet. Accessed 30 March 2019.
  79. 79.
    Krow-Lucal ER, Biggerstaff BJ, Staples J. Estimated incubation period for Zika virus disease. Emerg Infect Dis. 2017;23(5):841–5. Scholar
  80. 80.
    Wahnich A, Clark S, Bloch D, Kubinson H, Hrusa G, Liu D, et al. Surveillance for mosquito borne transmission of Zika virus, New York City, NY, USA, 2016. Emerg Infect Dis. 2018;24(5):827–34. Scholar
  81. 81.
    Peña F, Pimentel R, Khosla S, Mehta SD, Brito MO. Zika virus epidemic in pregnant women, Dominican Republic, 2016–2017. Emerg Infect Dis. 2019;25(2):247–55. Scholar
  82. 82.
    Boyer Chammard T, Schepers K, Breurec S, Messiaen T, Destrem AL, Mahevas M, et al. Severe thrombocytopenia after Zika virus infection, Guadeloupe, 2016. Emerg Infect Dis. 2017;23(4):696–8. Scholar
  83. 83.
    Howard A, Visintine J, Fergie J, Deleon M. Two infants with presumed congenital Zika syndrome, Brownsville, Texas, USA, 2016–2017. Emerg Infect Dis. 2018;24(4):625–30. Scholar
  84. 84.
    Sousa AQ, Cavalcante D, Franco LM, et al. Postmortem findings for 7 neonates with congenital Zika virus infection. Emerg Infect Dis. 2017;23(7):1164–7. Scholar
  85. 85.
    Barcellos C, Xavier D, Pavão A, et al. Increased hospitalizations for neuropathies as indicators of Zika virus infection, according to health information system data, Brazil. Emerg Infect Dis. 2016;22(11):1894–9. Scholar
  86. 86.
    Bhatnagar J, Rabeneck DB, Martines RB, Reagan-Steiner S, Ermias Y, Estetter LBC, et al. Zika virus RNA replication and persistence in brain and placental tissue. Emerg Infect Dis. 2017;23(3):405–14. Scholar
  87. 87.
    Subissi L, Dub T, Besnard M, Mariteragi-Helle T, Nhan T, Lutringer-Magnin D, et al. Zika virus infection during pregnancy and effects on early childhood development, French Polynesia, 2013–2016. Emerg Infect Dis. 2018;24(10):1850–8. Scholar
  88. 88.
    Sotelo JR, Sotelo AB, Sotelo F, et al. Persistence of Zika virus in breast milk after infection in late stage of pregnancy. Emerg Infect Dis. 2017;23(5):854–6. Scholar
  89. 89.
    Safronetz D, Sloan A, Stein DR, Mendoza E, Barairo N, Ranadheera C, et al. Evaluation of 5 commercially available Zika virus immunoassays. Emerg Infect Dis. 2017;23(9):1577–80. Scholar
  90. 90.
    Murray KO, Gorchakov R, Carlson AR, Berry R, Lai L, Natrajan M, et al. Prolonged detection of Zika virus in vaginal secretions and whole blood. Emerg Infect Dis. 2017;23(1):99–101. Scholar
  91. 91.
    Burkhalter KL, Savage HM. Detection of Zika virus in desiccated mosquitoes by real-time reverse transcription PCR and plaque assay. Emerg Infect Dis. 2017;23(4):680–1. Scholar
  92. 92.
    Griffin I, Martin SW, Fischer M, Chambers TV, Kosoy O, Falise A, et al. Zika virus IgM detection and neutralizing antibody profiles 12–19 months after illness onset. Emerg Infect Dis. 2019;25(2):299–303. Scholar
  93. 93.
    Mansuy J, Mengelle C, Pasquier C, et al. Zika virus infection and prolonged viremia in whole-blood specimens. Emerg Infect Dis. 2017;23(5):863–5. Scholar
  94. 94.
    Harrower J, Kiedrzynski T, Baker S, Upton A, Rahnama F, Sherwood J, et al. Sexual transmission of Zika virus and persistence in semen, New Zealand, 2016. Emerg Infect Dis. 2016;22(10):1855–7. Scholar
  95. 95.
    Müller JA, Harms M, Schubert A, Jansen S, Michel D, Mertens T, et al. Inactivation and environmental stability of Zika virus. Emerg Infect Dis. 2016;22(9):1685–7. Scholar
  96. 96.
    Nürnberger C, Bodmer BS, Fiedler AH, Gabriel G, Mühlebach MD. A measles virus-based vaccine candidate mediates protection against Zika virus in an allogeneic mouse pregnancy model. J Virol. 2019;93(3):e01485–18. Scholar
  97. 97.
    Zhan Y, Deng Y, Huang B, Song Q, Wang W, Yang Y, et al. Humoral and cellular immunity against both ZIKV and poxvirus is elicited by a two-dose regimen using DNA and non-replicating vaccinia virus-based vaccine candidates. Vaccine. 2019;37(15):2122–30. Scholar
  98. 98.
    Leta S, Beyene TJ, De Clercq EM, Amenu K, Kraemer MUG, Revie CW. Global risk mapping for major diseases transmitted by Aedes aegypti and Aedes albopictus. Int J Infect Dis. 2018;67:25–35. Scholar
  99. 99.
    Waterman SH, Margolis HS, Sejvar JJ. Surveillance for dengue and dengue-associated neurologic syndromes in the United States. Am J Trop Med Hyg. 2015;92(5):996–8. Scholar
  100. 100.
    • Guarner J, Hale GL. Four human diseases with significant public health impact caused by mosquito-borne flaviviruses: West Nile, Zika, dengue and yellow fever. Semin Diagn Pathol. 2019;36:170–6. Excellent intro/review of these emerging diseases.CrossRefGoogle Scholar
  101. 101.
    Centers for Disease Control. Dengue. Available at Updated on May 3, 2019. Accessed 22 May 2019.
  102. 102.
    Fist FDA-approved vaccine for the prevention of dengue disease in endemic regions. Press release. May 1, 2019.
  103. 103.
    Kendra JA, Advani VM, et al. Functional and structural characterization of the chikungunya virus translational recoding signals. J Biol Chem. 2018;293(45):17536–45. Scholar
  104. 104.
    Powers, AM, Endy, TP. Ch 36: viral febrile illnesses and emerging pathogens. Hunter's tropical medicine and emerging infectious disease, 10th edn. Canada: Elsevier Inc. 2020. Accessed 5/7/2019.Google Scholar
  105. 105.
    Nasserie T, Brent SE, Tuite AR, Moineddin R, Yong JHE, Miniota J, et al. Association between air travel and importation of chikungunya into the United States. J Travel Med. 2019; 10.1093/jtm/taz028.Google Scholar
  106. 106.
    Ward CE, Chapman JI. Chikungunya in children: a clinical review. Pediatr Emerg Care. 2018;34(7):510–5. Scholar
  107. 107.
    Liu LE, Dehning M, Phipps A, Swienton RE, Harris CA, Klein KR. Clinical update on dengue, chikungunya, and Zika: what we know at the time of article submission. Disaster Med Public Health Prep. 2017 Jun;11(3):290–9. Scholar
  108. 108.
    Alvarez MF, Bolívar-Mejía A, Rodriguez-Morales AJ, Ramirez-Vallejo E. Cardiovascular involvement and manifestations of systemic chikungunya virus infection: a systematic review. F1000Res. 2017;6:390. Scholar
  109. 109.
    •• Kamal M, et al. Mapping the global potential distributions of two arboviral vectors Aedes aegypti and Ae. albopictus under changing climate. PLoS ONE. 2018. Scary picture of where the mosquitos are headed.
  110. 110.
    Dora EG, Rossi SL, Weaver SC, Tucker SN, Mateo R. An adjuvanted adenovirus 5-based vaccine elicits neutralizing antibodies and protects mice against chikungunya virus-induced footpad swelling. Vaccine. 2019.
  111. 111.
    • Fernandes JN, Moise IK, Maranto GL, Beier JC. Revamping mosquito-borne disease control to tackle future threats. Trends Parasitol. 2018;34(5):359–68. Motivation for public action to prevent future outbreaks. CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Sandra Lee Werner
    • 1
    Email author
  • Bhanu Kirthi Banda
    • 1
  • Christopher Lee Burnsides
    • 1
  • Alexander James Stuber
    • 1
  1. 1.MetroHealth/Cleveland Clinic/CWRU Emergency Medicine Residency Program, Department of Emergency MedicineMetroHealth Medical CenterClevelandUSA

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