To the Editor:
I enjoyed the article by Dr. Rupert and colleagues and recognize its value for family physicians who provide travel advice to patients and their families.1 However, it could be more comprehensive, and I will point out several omissions.
As the authors noted, chikungunya is an increasingly common insect-borne disease in travelers. However, they did not mention Vimkunya, a virus-like particle vaccine recently approved by the US Food and Drug Administration (FDA) for people 12 years and older.2 The vaccine should be considered for adults traveling to areas with reported cases in US travelers within the past 5 years, and those who are at an increased risk for severe disease (particularly with underlying medical conditions) if staying for 6 months or more.3 Destinations with recent or current chikungunya outbreaks include most countries in the Americas, parts of East and Southeast Asia, and parts of Africa.3 Travelers should consult with their family physician before receiving the vaccine if they are immunocompromised, pregnant, or potentially allergic. On August 22, 2025, the FDA suspended use of the live-attenuated chikungunya vaccine Ixchiq due to serious safety concerns about chikungunya-like illness in vaccine recipients, including 21 hospitalizations and 3 deaths.4 Licensing has not been suspended outside the United States.
Although the Centers for Disease Control and Prevention does not recommend dengue vaccination for US travelers, other organizations and countries recommend it in some circumstances.5 The World Health Organization recommends TAK-003 (Qdenga; not available in the United States) in children ages 6 to 16 years in settings with “high dengue transmission intensity,”5 which may apply to patients who are frequent travelers or are relocating or expecting prolonged stays in dengue-endemic regions.
The authors should have referenced Oropouche virus disease, a reemerging febrile infection that is spreading in parts of South America and the Caribbean. It is transmitted through midges and possibly culex mosquitoes and may be vertically transmitted.6
Lastly, in the Water Safety section, the authors should have acknowledged recreational water-borne illnesses in areas with poor water quality, sanitation, and treatment.
Editor’s Note: This letter was sent to the authors of The Pretravel Consultation, who declined to reply.
