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Chu SHS, Krishnaswamy S, Cole S, Giles ML. Travel patterns and advice-seeking behaviour of pregnant women in the Australian context: A multicentre cross-sectional analysis. Aust N Z J Obstet Gynaecol 2022; 62:688-694. [PMID: 35383883 DOI: 10.1111/ajo.13526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Travel poses risks to pregnant women, but little data exist describing the travel habits of women during pregnancy or pre-travel recommendations given. AIMS To examine travel patterns of pregnant women including frequency of pre-travel consultation, and advice recalled. MATERIALS AND METHODS Cross-sectional analysis of post-partum women admitted to five Victorian maternity hospitals between 21 May 2019 and 22 April 2020 in Australia. RESULTS Forty-four percent (182/410) of women travelled during pregnancy, 32.9% (135/410) interstate and 19.5% (80/410) internationally. Fifty-five percent travelled for leisure (118/215) and 27% to visit friends/relatives (58/215). Overall, 68.1% (124/182) sought pre-travel advice, primarily from an obstetrician (60.5%, 75/124) or general practitioner (29.8%, 37/124). Only one woman attended a travel clinic. The most common reason for not seeking pre-travel advice was the belief that travel posed no risk (63.4%, 45/71). Pre-travel advice was sought least by those visiting friends/relatives (61.4%, 35/57). Women recalled recommendations regarding travel restrictions by gestational age and venous thromboembolism precautions, but not infectious disease prevention for those to whom it was relevant. Of international travellers, 48.8% (39/80) sought advice from the internet, one-third (13/39) as an alternative to seeing a healthcare provider. CONCLUSIONS Travel is common during pregnancy and women seek pre-travel advice from the healthcare provider they see most often during pregnancy. All pregnant women should be provided with consistent, evidence-based pre-travel advice regardless of whom they consult. Further work is needed to educate and provide resources to maternity care providers to optimise pre-travel counselling.
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Affiliation(s)
- Sandy H S Chu
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | - Sushena Krishnaswamy
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
| | - Stephen Cole
- Institute of Obstetrics and Gynaecology, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
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Immunizing in a Global Society. Prim Care 2020; 47:497-515. [DOI: 10.1016/j.pop.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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3
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Marasinghe DH, Cheaveau J, Meatherall B, Kuhn S, Vaughan S, Zimmer R, Pillai DR. Risk of malaria associated with travel to malaria-endemic areas to visit friends and relatives: a population-based case-control study. CMAJ Open 2020; 8:E60-E68. [PMID: 31992561 PMCID: PMC6996033 DOI: 10.9778/cmajo.20190070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Reports relying on population-based data and using epidemiologic methodologies such as case-control study designs for malaria in travellers and multivariable regression analysis of risk factors are rare. The aim of this study was to investigate the epidemiologic characteristics of travellers who tested positive for malaria after visiting friends and relatives in malaria-endemic areas to determine the risk of malaria associated with such travel. METHODS Using routinely collected data from a population-based laboratory database, we conducted a case-control study of symptomatic people returning from travel to malaria-endemic areas who presented for malaria testing in Calgary from 2013 to 2017. We used a multivariable logistic regression to analyze the association between the presence of malaria and other risk factors. RESULTS There were 251 confirmed malaria cases during the study period, of which 219 were matched to 1129 returning travellers without malaria. Based on the multivariable regression, the odds of a traveller who visited friends and relatives in malariaendemic areas being diagnosed with malaria was 2.82 (95% confidence interval [CI] 1.42-5.92) times greater than that of other travellers to these regions. Adults (odds ratio [OR] 3.62, 95% CI 1.66-8.84), males (OR 2.70, 95% CI 1.56-4.80), travellers to Africa (OR 11.52, 95% CI 6.33-22.05) and those who did not seek pretravel advice (OR 0.38, 95% CI 0.20-0.70) were more likely to be diagnosed with malaria. Although those travelling to visit friends and relatives tended to stay longer in endemic areas than other travellers, visit duration was not associated with an increased likelihood of malaria in the model. The annual incidence of malaria was highest (13.34 per 100 000) in metropolitan wards associated with lower socioeconomic status and immigrant communities. INTERPRETATION Travellers who visited friends and relatives in malaria-endemic areas were less likely than other travellers to these regions to seek pretravel advice, take prophylaxis and have a visit duration less than 2 weeks; travelling to Africa and being male increased the odds of being diagnosed with malaria, independent of other factors. These data suggest that targeted strategies to provide pretravel care to travellers who visit friends and relatives in malaria-endemic areas may aid in reducing the burden of malaria in this population.
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Affiliation(s)
- Dewdunee H Marasinghe
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - James Cheaveau
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - Bonnie Meatherall
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - Susan Kuhn
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - Stephen Vaughan
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - Rudolf Zimmer
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - Dylan R Pillai
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta.
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Abstract
Infections are common during travel, and frontline physicians frequently must evaluate sick returned travelers. Sick travelers can be clinically challenging due to the wide range of endemic diseases in different geographic regions. To guide the diagnostic and treatment plan, consideration of endemic and emerging infections in the region of travel, as well as careful review of the travelers' exposures and preventative measures are necessary. Routine laboratory tests and cultures cannot confirm many tropical infections, and pathogen directed testing is typically required. Common tropical infections that can be severe, such as malaria, dengue, and enteric fever, should always be considered in the diagnostic evaluation. Providers should also be vigilant for rare but highly pathogenic emerging infections such as Ebola virus disease and Middle East respiratory syndrome (MERS).
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Affiliation(s)
- Henry M Wu
- Division of Infectious Diseases, Department of Medicine, Emory University, 550 Peachtree St NE, Atlanta, GA 30308, United States.
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5
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Vázquez Villegas J. [«Visiting friends and relatives». New risk group in the primary care consulta]. Aten Primaria 2018; 50:574-575. [PMID: 29983201 PMCID: PMC6836917 DOI: 10.1016/j.aprim.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- José Vázquez Villegas
- Director UCG de La Mojonera, Distrito Sanitario Poniente de Almería, El Ejido, Almería, España; Unidad de Medicina Tropical del Hospital y Distrito Poniente de Almería, El Ejido, Almería, España; Grupo de trabajo de Inequidades en Salud-Salud Internacional semFYC.
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6
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Pai Mangalore R, Johnson DF, Leder K. Travellers visiting friends and relatives: a high-risk, under-recognised group for imported infectious diseases. Intern Med J 2018; 48:759-762. [DOI: 10.1111/imj.13956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 04/29/2018] [Accepted: 04/29/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Rekha Pai Mangalore
- Department of Infectious Diseases; Alfred Health; Melbourne Victoria Australia
| | - Douglas F. Johnson
- Department of Infectious Diseases; Austin Health; Melbourne Victoria Australia
- Department of General Medicine; Austin Health; Melbourne Victoria Australia
| | - Karin Leder
- School of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Victorian Infectious Disease Service; Royal Melbourne Hospital at the Doherty Institute for Infection and Immunity; Melbourne Victoria Australia
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Rodrigues KMDP, Moreira BM. Preventing diseases in round-the-world travelers: a contemporary challenge for travel medicine advice. Rev Soc Bras Med Trop 2018; 51:125-132. [PMID: 29768543 DOI: 10.1590/0037-8682-0418-2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 03/27/2018] [Indexed: 11/22/2022] Open
Abstract
Providing advice for travelers embarking on long-term trips poses a challenge in travel medicine. A long duration of risk exposure is associated with underuse of protective measures and poor adherence to chemoprophylaxis, increasing the chances of acquiring infections. Recently, in our clinic, we observed an increase in the number of travelers undertaking round-the-world trips. These individuals are typically aged around 32 years and quit their jobs to embark on one-to-two-year journeys. Their destinations include countries in two or more continents, invariably Southeast Asia and Indonesia, and mostly involve land travel and visiting rural areas. Such trips involve flexible plans, increasing the challenge, especially with regard to malaria prophylaxis. Advising round-the-world travelers is time-consuming because of the amount of information that must be provided to the traveler. Advisors must develop strategies to commit the traveler to his/her own health, and verify their learnings on disease-prevention measures. Contacting the advisor after the appointment or during the trip can be helpful to clarify unclear instructions or diagnosis made and prescriptions given abroad. Infectious diseases are among the most frequent problems affecting travelers, many of which are preventable by vaccines, medicines, and precautionary measures. The dissemination of counterfeit medicines, particularly antibiotics and antimalarial medicines, emphasizes the need for travelers to carry medicines that they may possibly need on their trip. Additional advice on altitude, scuba diving, and other possible risks may also be given. Considering the difficulties in advising this group, we present a review of the main recommendations on advising these travelers.
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Affiliation(s)
- Karis Maria de Pinho Rodrigues
- Departamento de Medicina Preventiva, Centro de Informação em Saúde para Viajantes (Cives), Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Beatriz Meurer Moreira
- Instituto de Microbiologia Paulo de Goés, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Lee TK, Hutter JN, Masel J, Joya C, Whitman TJ. Guidelines for the prevention of travel-associated illness in older adults. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2017; 3:10. [PMID: 28883980 PMCID: PMC5531015 DOI: 10.1186/s40794-017-0054-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/15/2017] [Indexed: 01/30/2023]
Abstract
International travel to the developing world is becoming more common in elderly patients (defined here as individuals greater than 65 years old). When providing pre-travel counseling, providers must appreciate the changing physiology, comorbidities, immunity and pharmacokinetics associated with the aging process to prepare elderly patients for the stressors of international travel. These guidelines present an evidence-based approach to pre-travel counseling, immunization, and pharmacology concerns unique to elderly patients seeking care in a travel clinic setting.
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Affiliation(s)
- Tida K Lee
- Infectious Diseases Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889 USA.,Naval Medical Research Center, Silver Spring, MD USA
| | - Jack N Hutter
- Infectious Diseases Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889 USA
| | - Jennifer Masel
- Infectious Diseases Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889 USA
| | - Christie Joya
- Infectious Diseases Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889 USA
| | - Timothy J Whitman
- Infectious Diseases Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889 USA
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Jaeger VK, Tschudi N, Rüegg R, Hatz C, Bühler S. The elderly, the young and the pregnant traveler -- A retrospective data analysis from a large Swiss Travel Center with a special focus on malaria prophylaxis and yellow fever vaccination. Travel Med Infect Dis 2015; 13:475-84. [PMID: 26526774 DOI: 10.1016/j.tmaid.2015.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/12/2015] [Accepted: 10/05/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Vulnerable individuals such as elderly, children/adolescents and pregnant/breastfeeding women increasingly travel overseas. We describe the travel and vaccination patterns of these groups at the largest Travel Clinic in Switzerland especially focusing on travel to yellow fever and malaria-endemic countries, and yellow fever vaccination (YFV) and malaria medications. METHOD An analysis of pre-travel visits between 2010 and 2012 at the Travel Clinic of the University of Zurich, was performed assessing differences between the elderly, young and middle-aged travelers as well as between pregnant/breastfeeding and other female travelers. RESULTS Overall, the vulnerable groups did not differ from other travelers regarding their travel patterns. YFV was the most often administered vaccine to elderly travelers; half of them received it for the first time. More than 30% of children/adolescents received YFV, but no child below six months was vaccinated. 80% of young travelers and a similar percentage of pregnant women went to malaria-endemic regions. Twenty-five pregnant/breastfeeding women traveled to YF endemic areas. CONCLUSIONS Travel patterns of vulnerable travelers are comparable to those of other travelers. In view of the limited data on malaria medications and precautions against YFV during pregnancy and at the extreme ages of life, giving travel advice to these groups is challenging.
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Affiliation(s)
- Veronika K Jaeger
- Department of Rheumatology, Basel University Hospital, Petersgraben 4, 4031 Basel, Switzerland; Swiss Tropical and Public Health Institute, Department of Medicine and Diagnostics, Socinstrasse 57, 4051 Basel, Switzerland.
| | - Nadine Tschudi
- Department of Public Health, Division of Infectious Diseases/Travel Clinic, Epidemiology, Biostatistics and Prevention Institute, Hirschengraben 84, 8001 Zurich, Switzerland.
| | - Rolanda Rüegg
- Department of Public Health, Division of Infectious Diseases/Travel Clinic, Epidemiology, Biostatistics and Prevention Institute, Hirschengraben 84, 8001 Zurich, Switzerland.
| | - Christoph Hatz
- Swiss Tropical and Public Health Institute, Department of Medicine and Diagnostics, Socinstrasse 57, 4051 Basel, Switzerland; Department of Public Health, Division of Infectious Diseases/Travel Clinic, Epidemiology, Biostatistics and Prevention Institute, Hirschengraben 84, 8001 Zurich, Switzerland.
| | - Silja Bühler
- Department of Public Health, Division of Infectious Diseases/Travel Clinic, Epidemiology, Biostatistics and Prevention Institute, Hirschengraben 84, 8001 Zurich, Switzerland.
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10
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Cardona-Ospina JA, Salazar-Vargas CE, Barreto-Moreno JJ, Muñoz-Gaviria S, García-Sánchez T, Rodríguez-Morales AJ. Flying and pregnant?--Regulations of the main airlines in Latin America. Travel Med Infect Dis 2015. [PMID: 26195190 DOI: 10.1016/j.tmaid.2015.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jaime Andrés Cardona-Ospina
- Research Group Public Health and Infection, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
| | | | - Juan José Barreto-Moreno
- School of Medicine, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
| | - Sthefany Muñoz-Gaviria
- School of Medicine, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
| | - Tatiana García-Sánchez
- School of Medicine, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
| | - Alfonso J Rodríguez-Morales
- Research Group Public Health and Infection, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; School of Medicine, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; Comission of Publication and Teaching, Sociedad Latinoamericana de Medicina del Viajero, Pereira, Risaralda, Colombia; Committe on Travel Medicine, Asociación Panamericana de Infectología (API), Quito, Ecuador.
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11
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Ebola virus disease in nonendemic countries. J Formos Med Assoc 2015; 114:384-98. [PMID: 25882189 PMCID: PMC7135111 DOI: 10.1016/j.jfma.2015.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/22/2015] [Accepted: 01/24/2015] [Indexed: 12/20/2022] Open
Abstract
The 2014 West African outbreak of Ebola virus disease was unprecedented in its scale and has resulted in transmissions outside endemic countries. Clinicians in nonendemic countries will most likely face the disease in returning travelers, either among healthcare workers, expatriates, or visiting friends and relatives. Clinical suspicion for the disease must be heightened for travelers or contacts presenting with compatible clinical syndromes, and strict infection control measures must be promptly implemented to minimize the risk of secondary transmission within healthcare settings or in the community. We present a concise review on human filoviral disease with an emphasis on issues that are pertinent to clinicians practicing in nonendemic countries.
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Bühler S, Rüegg R, Steffen R, Hatz C, Jaeger VK. A profile of travelers--an analysis from a large swiss travel clinic. J Travel Med 2014; 21:324-31. [PMID: 24934830 DOI: 10.1111/jtm.12139] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 03/19/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Globally, the Swiss have one of the highest proportions of the population traveling to tropical and subtropical countries. Large travel clinics serve an increasing number of customers with specific pre-travel needs including uncommon destinations and preexisting medical conditions. This study aims to identify health characteristics and travel patterns of travelers seeking advice in the largest Swiss travel clinic so that tailored advice can be delivered. METHODS A descriptive analysis was performed on pre-travel visits between July 2010 and August 2012 at the Travel Clinic of the Institute of Social and Preventive Medicine, University of Zurich, Switzerland. RESULTS A total of 22,584 travelers sought pre-travel advice. Tourism was the main reason for travel (17,875, 81.5%), followed by visiting friends and relatives (VFRs; 1,715, 7.8%), traveling for business (1,223, 5.6%), and "other reasons" (ie, volunteer work, pilgrimage, study abroad, and emigration; 1,112, 5.1%). The main travel destination was Thailand. In the VFR group, the highest proportions of traveling children (258, 15.1%) and of pregnant or breastfeeding women (23, 3.9%) were observed. Mental disorders were more prominent in VFRs (93, 5.4%) and in travel for "other reasons" (63, 5.7%). The latter stayed for the longest periods abroad; 272 (24.9%) stayed longer than 6 months. VFR travelers received the highest percentage of yellow fever vaccinations (523, 30.5%); in contrast, rabies (269, 24.2%) and typhoid vaccinations (279, 25.1%) were given more often to the "other travel reasons" group. CONCLUSIONS New insights into the characteristics of a selected and large population of Swiss international travelers results in improved understanding of the special needs of an increasingly diverse population and, thus, in targeted preventive advice and interventions.
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Affiliation(s)
- Silja Bühler
- Division of Epidemiology and Prevention of Communicable Diseases, Travel Clinic, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
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Calleri G, Castelli F, El Hamad I, Gobbi F, Matteelli A, Napoletano G, Romi R, Rossanese A. New Italian guidelines for malaria prophylaxis in travellers to endemic areas. Infection 2013; 42:239-50. [DOI: 10.1007/s15010-013-0563-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 11/14/2013] [Indexed: 11/28/2022]
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