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Maier JD, Anagnostopoulos A, Gazzotti A, Bühler S, Baroutsou V, Hatz C, Puhan MA, Fehr J, Farnham A. The Ready-To-Go Questionnaire predicts health outcomes during travel: a smartphone application-based analysis. J Travel Med 2023; 30:taad117. [PMID: 37669125 PMCID: PMC10755167 DOI: 10.1093/jtm/taad117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND The Ready-To-Go (R2G) Questionnaire is a tool for rapid assessment of health risks for travel consultation. This study aims to assess the utility of the R2G Questionnaire in identifying high-risk travellers and predicting health events and behaviour during travel in the TOURIST2 prospective cohort. METHODS TOURIST2 data were used to calculate the R2G medical and travel risk scores and categorize each participant based on their risk. The TOURIST2 study enrolled 1000 participants from Switzerland's largest travel clinics between 2017 and 2019. Participants completed daily smartphone application surveys before, during and after travel on health events and behaviours. We used regression models to analyse incidence of overall health events and of similar health events grouped into health domains (e.g. respiratory, gastrointestinal, accident/injury). Incidence rate ratios (IRR) are displayed with 95% confidence intervals (95% CI). RESULTS R2G high-risk travellers experienced significantly greater incidence of health events compared to lower-risk travellers (IRR = 1.27, 95% CI: 1.22-1.33). Both the medical and travel scores showed significant positive associations with incidence of health events during travel (IRR = 1.11, 95% CI: 1.07-1.16; IRR = 1.07, 95% CI: 1.03-1.12, respectively), with significant increases in all health domains except skin disorders. Medical and travel risk scores were associated with different patterns in behaviour. Travellers with chronic health conditions accessed medical care during travel more often (IRR = 1.16, 95% CI: 1.03-1.31), had greater difficulty in carrying out planned activities (IRR = -0.04, 95% CI: -0.05, -0.02), and rated their travel experience lower (IRR = -0.04, 95% CI: -0.06, -0.02). Travellers with increased travel-related risks due to planned travel itinerary had more frequent animal contact (IRR = 1.09, 95% CI: 1.01-1.18) and accidents/injuries (IRR = 1.28, 95% CI: 1.15-1.44). CONCLUSIONS The R2G Questionnaire is a promising risk assessment tool that offers a timesaving and reliable means to identify high-risk travellers. Incorporated into travel medicine websites, it could serve as a pre-consultation triage to help travellers self-identify their risk level, direct them to the appropriate medical provider(s), and help practitioners in giving more tailored advice.
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Affiliation(s)
- Julian D Maier
- Department of Public & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Alexia Anagnostopoulos
- Department of Public & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Anna Gazzotti
- Department of Public & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Silja Bühler
- Division of Hygiene and Infectious Diseases, Institute of Hygiene and Environment, Hamburg, Germany
| | - Vasiliki Baroutsou
- Department of Public & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Christoph Hatz
- Department of Public & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Milo A Puhan
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jan Fehr
- Department of Public & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Andrea Farnham
- Department of Public & Global Health, Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Steffen R, Chen LH, Leggat PA. Travel vaccines-priorities determined by incidence and impact. J Travel Med 2023; 30:taad085. [PMID: 37341307 DOI: 10.1093/jtm/taad085] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Infectious disease epidemiology is continuously shifting. While travel has been disrupted by the COVID-19 pandemic and travel-related epidemiological research experienced a pause, further shifts in vaccine-preventable diseases (VPDs) relevant for travellers have occurred. METHODS We conducted a literature search on the epidemiology of travel-related VPD and synthesized data for each disease with a focus on symptomatic cases and on the impact of the respective infection among travellers, considering the hospitalization rate, disease sequela and case fatality rate. We present new data and revised best estimates on the burden of VPD relevant for decisions on priorities in travel vaccines. RESULTS COVID-19 has emerged to be a top travel-related risk and influenza remains high in the ranking with an estimated incidence at 1% per month of travel. Dengue is another commonly encountered infection among international travellers with estimated monthly incidence of 0.5-0.8% among non-immune exposed travellers; the hospitalized proportion was 10 and 22%, respectively, according to two recent publications. With recent yellow fever outbreaks particularly in Brazil, its estimated monthly incidence has risen to >0.1%. Meanwhile, improvements in hygiene and sanitation have led to some decrease in foodborne illnesses; however, hepatitis A monthly incidence remains substantial in most developing regions (0.001-0.01%) and typhoid remains particularly high in South Asia (>0.01%). Mpox, a newly emerged disease that demonstrated worldwide spread through mass gathering and travel, cannot be quantified regarding its travel-related risk. CONCLUSION The data summarized may provide a tool for travel health professionals to prioritize preventive strategies for their clients against VPD. Updated assessments on incidence and impact are ever more important since new vaccines with travel indications (e.g. dengue) have been licensed or are undergoing regulatory review.
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Affiliation(s)
- Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, Department of Public and Global Health, Division of Infectious Diseases, World Health Organization Collaborating Centre for Travelers' Health, University of Zurich, Zurich 8001, Switzerland
- Division of Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Houston, TX 77030, USA
| | - Lin H Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
- Faculty of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Peter A Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland 4810, Australia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
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García-Marín NM, Marrero GA, Guerra-Neira A, Rivera-Deán A. Profiles of travelers to intermediate-high health risk areas following the reopening of borders in the COVID-19 crisis: A clustering approach. Travel Med Infect Dis 2023; 54:102607. [PMID: 37353065 PMCID: PMC10284617 DOI: 10.1016/j.tmaid.2023.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/15/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND The reactivation of international travel in 2021 has created a new scenario in which the profile of the traveler to medium-high health risk areas may well have changed. However, few studies have analyzed this new profile since the reopening of borders in that year. METHODS We designed an ad hoc questionnaire that was administered face-to-face by our medical team during appointments with 330 travelers in the second half of 2021. Information was collected on the following topics: sociodemographic and socioeconomic status; type of travel and previous travel experience; health status and risk perception (of COVID-19 and tropical infectious diseases). Using all features simultaneously, an unsupervised machine learning approach (k-means) is implemented to characterize groups of travelers. Pairwise chi-squared tests were performed to identify key features that showed statistically significant differences between clusters. RESULTS The travelers were clustered into seven groups. We associated the clusters with different intensities of perceived risk of acquiring COVID-19 and tropical infectious diseases on the trip. The perceived risk of both diseases was low in the group "middle or lower middle class young inexperienced male tourist" but high in the group "middle or lower middle-class young with children inexperienced business traveler". CONCLUSIONS Broadening our knowledge of the profiles of travelers to intermediate-high health risk areas would help to tailor the health advice provided by practitioners to their characteristics and type of travel. In a changing health context, the k-means approach supposes a flexible statistical method that calculates travelers' profiles and can be easily adapted to process new information.
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Affiliation(s)
- Nidia M García-Marín
- International Vaccination Center at Santa Cruz de Tenerife, Spanish Ministry of Health, Spain; University of La Laguna, Research Center of Social Inequality and Governance (CEDESOG), Spain
| | - Gustavo A Marrero
- University of La Laguna, Department of Economics, Spain; University of La Laguna, Research Center of Social Inequality and Governance (CEDESOG), Spain; University of La Laguna, IUDR, Spain.
| | - Ana Guerra-Neira
- International Vaccination Center at Santa Cruz de Tenerife, Spanish Ministry of Health, Spain; University of La Laguna, Research Center of Social Inequality and Governance (CEDESOG), Spain
| | - Almudena Rivera-Deán
- International Vaccination Center at Santa Cruz de Tenerife, Spanish Ministry of Health, Spain; University of La Laguna, Research Center of Social Inequality and Governance (CEDESOG), Spain
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Infection tracking in travellers using a mobile app (ITIT): The pilot study. Travel Med Infect Dis 2022; 52:102526. [PMID: 36563891 DOI: 10.1016/j.tmaid.2022.102526] [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: 11/10/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Current surveillance of travellers' health captures only a small proportion of illness events. We aimed to evaluate the usability and feasibility of using an app to enable travellers to self-report illness. METHOD This pilot study assesses a novel mobile application called Infection Tracking in Travellers (ITIT) that records travel-related symptoms with associated geolocation and weather data. Participants were recruited in three Swiss travel clinics between December 2021 and March 2022. A feedback survey was used to examine app ease of use, and data from the app was used to examine travel and illness patterns as a proof-of-concept for the larger ITIT study. RESULTS Participants were recruited from Zürich, Basel, and Geneva, with 37 individuals completing a total of 394 questionnaires in 116 locations in Asia, Africa, the Americas, and Europe. Illness symptoms were reported by 41% of participants, 67% of which were respiratory. The post travel questionnaire showed that all participants found the app easy to use and 63% said they would recommend it to others. Several users provided suggestions for improved usability. CONCLUSION The app fulfilled its function as a research tool linking infection symptoms with geolocation and climate data.
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Vicente de la Cruz MDLM, Giesen C, Díaz-Menéndez M. International travels and transmission of multidrug resistant Neisseria gonorrhoeae in Europe: A systematic review. Travel Med Infect Dis 2022; 49:102401. [PMID: 35850441 DOI: 10.1016/j.tmaid.2022.102401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/02/2022] [Accepted: 07/08/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The increase of gonococcal infection cases in Europe and rises in Neisseria gonorrhoeae antibiotic resistance (AMR) have become an urgent concern globally. In the last few years international tourism has increased, which might contribute to the spread of different strains of multiresistant gonococcal infections. This study aimed at assessing the effect of international travel on the transmission of multidrug resistant N. gonorrhoeae in the European Union and associated European countries. METHOD We conducted a systematic review and searched PubMed, Scopus, Embase and CENTRAL between January 1, 2010 and June 30, 2021 for gonococcal infection, antibiotic resistance and international travel. Articles were screened in title, abstract and keywords. The quality of the articles was assessed using a pre-designed tool. Individual, travel related and susceptibility to antimicrobials data were collected. RESULTS A total of 18 studies met our criteria, of which 88.9% concluded that international travel directly influences the transmission of multidrug resistant N. gonorrhoeae from the country of travel to the country of return. Travelers mainly visited South East Asian countries (66.7%) and returned to the UK (38.9%). Half of the included studies reported ciprofloxacin resistant strains and the most frequently prescribed drug used for treatment was ceftriaxone. CONCLUSIONS International travels might be an important factor in the spread of multi-resistant sexually transmitted infections (STIs). There is a need to strengthen AMR surveillance in international travelers for prompt investigation and notification of drug resistance in STIs.
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Affiliation(s)
| | - Christine Giesen
- Preventive Medicine Unit, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes (Madrid), Spain.
| | - Marta Díaz-Menéndez
- National Referral Centre for Tropical Diseases. Hospital Universitario La Paz-Carlos III, Madrid, Spain, CIBERINFEC
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