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Lovey T, Hasler R, Gautret P, Schlagenhauf P. Travel-related respiratory symptoms and infections in travellers (2000-22): a systematic review and meta-analysis. J Travel Med 2023; 30:taad081. [PMID: 37310895 PMCID: PMC10481419 DOI: 10.1093/jtm/taad081] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Respiratory tract infections (RTIs) are common in travellers due to the year-round or seasonal presence of respiratory pathogen and exposure to crowded environments during the itinerary. No study has systematically examined the burden of RTI infections among travellers. The aim of this systematic review and meta-analysis is to evaluate the prevalence of RTIs and symptoms suggestive of RTIs among travellers according to risk groups and/or geographic region, and to describe the spectrum of RTIs. METHODS The systematic review and meta-analysis was registered in PROSPERO (CRD42022311261). We searched Medline, Embase, Scopus, Cochrane Central, Web of Science, Science Direct and preprint servers MedRxiv, BioRxiv, SSRN and IEEE Xplore on 1 February 2022. Studies reporting RTIs or symptoms suggestive of RTIs in international travellers after 1 January 2000 were eligible. Data appraisal and extraction were performed by two authors, and proportional meta-analyses were used to obtain estimates of the prevalence of respiratory symptoms and RTIs in travellers and predefined risk groups. FINDINGS A total of 429 articles on travellers' illness were included. Included studies reported 86 841 symptoms suggestive of RTIs and 807 632 confirmed RTIs. Seventy-eight percent of reported respiratory symptoms and 60% of RTIs with available location data were acquired at mass gatherings events. Cough was the most common symptom suggestive of respiratory infections, and the upper respiratory tract was the most common site for RTIs in travellers. The prevalence of RTIs and respiratory symptoms suggestive of RTIs were 10% [8%; 14%] and 37% [27%; 48%], respectively, among travellers. Reporting of RTIs in travellers denoted by publication output was found to correlate with global waves of new respiratory infections. INTERPRETATION This study demonstrates a high burden of RTIs among travellers and indicates that travellers' RTIs reflect respiratory infection outbreaks. These findings have important implications for understanding and managing RTIs among travellers.
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Affiliation(s)
- Thibault Lovey
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Hirschengraben 84, 8001 Zürich Switzerland
| | - Robin Hasler
- HFR Fribourg – Cantonal Hospital, 1708 Fribourg, Switzerland
| | | | - Patricia Schlagenhauf
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Hirschengraben 84, 8001 Zürich Switzerland
- Department of Global and Public Health, MilMedBiol Competence Centre, Epidemiology Biostatistics and Prevention Institute, WHO Collaborating Centre for Travellers’ Health, Hirschengraben 84, 8001 Zürich, Switzerland
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Fang LQ, Sun Y, Zhao GP, Liu LJ, Jiang ZJ, Fan ZW, Wang JX, Ji Y, Ma MJ, Teng J, Zhu Y, Yu P, Li K, Tian YJ, Cao WC. Travel-related infections in mainland China, 2014-16: an active surveillance study. Lancet Public Health 2018; 3:e385-e394. [PMID: 30033200 PMCID: PMC7164813 DOI: 10.1016/s2468-2667(18)30127-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/14/2018] [Accepted: 06/18/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Transmission of infection through international travel is a growing health issue, and the frequency of imported infection is increasing in China. We aimed to quantify the total number of infections imported into mainland China by arriving travellers. METHODS We actively surveyed arriving travellers at all 272 international entry-exit ports in mainland China. Suspected cases were detected through fever screening, medical inspection, self-declaration, and reporting by on-board staff. Participants completed a standardised questionnaire with questions about demographics, their travel itinerary (including detailed information about all countries or regions visited), and clinical manifestations. Nasopharyngeal swabs, sputum samples, faecal samples, vomitus, blood, and serum were collected as appropriate for diagnoses. Diagnosis was made by specific laboratory tests according to the national technical guidelines. Infections were classified as respiratory, gastrointestinal, vector-borne, blood-transmitted and sex-transmitted, or mucocutaneous. We divided arriving travellers into two groups: travellers coming from countries other than China, and travellers coming from Hong Kong, Macau, and Taiwan. We integrated surveillance data for 2014-16, calculated incidences of travel-related infections, and compared the frequency of infections among subgroups. FINDINGS Between Jan 1, 2014, and Dec 31, 2016, 22 797 cases were identified among 805 993 392 arriving travellers-an overall incidence of 28·3 per million. 45 pathogens were detected in participants: 18 respiratory (19 662 cases), ten gastrointestinal (189 cases), seven vector-borne (831 cases), seven blood-transmitted and sex-transmitted (1531 cases), and three mucocutaneous (584 cases). Both the overall number and incidence of infection were more than five times higher in 2016 than in 2014. Case numbers and incidences also varied substantially by province, autonomous region, and municipality. Overall, 17 643 (77%) infections were detected by fever screening, but 753 (49%) blood-transmitted and sex-transmitted infections were identified through medical inspection. 14 305 (73%) cases of respiratory infection and 96 (51%) of gastrointestinal infections were in tourists. Tuberculosis, hepatitis A virus, vector-borne, and blood-transmitted and sex-transmitted infections were common among Chinese labourers who worked abroad. Dengue and malaria were most commonly diagnosed in travellers arriving from Africa. 12 126 (93%) of the 12 985 cases arriving from Hong Kong, Macau, or Taiwan were respiratory infections. Hand, foot, and mouth disease accounted for 2·90% of infections in travellers from Hong Kong, Macau, or Taiwan and 0·31% of infections in international travellers. INTERPRETATION This report is the first to characterise the profile of travel-related infections among arriving travellers in mainland China. Our findings should increase public awareness of the potential risk of imported infections, and help health-care providers to make evidence-based health recommendations to travellers. FUNDING The Natural Science Foundation of China.
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Affiliation(s)
- Li-Qun Fang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; Institute of EcoHealth, Shandong University, Jinan, China
| | - Yu Sun
- Institute of EcoHealth, Shandong University, Jinan, China; University of Chinese Academy of Sciences, Beijing, China
| | - Guo-Ping Zhao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; The Logistics University of the Chinese People's Armed Police Force, Tianjin, China
| | - Li-Juan Liu
- Institute of Health Quarantine, The Chinese Academy of Inspection and Quarantine, Beijing, China
| | - Zhe-Jun Jiang
- Institute of Health Services and Transfusion Medicine, Academy of Military Medical Science, Beijing, China
| | - Zheng-Wei Fan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Jing-Xue Wang
- Institute of Health Services and Transfusion Medicine, Academy of Military Medical Science, Beijing, China
| | - Yang Ji
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Mai-Juan Ma
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; Institute of EcoHealth, Shandong University, Jinan, China
| | - Juan Teng
- State Key Surveillance Laboratory of Vector-borne Infectious Diseases, Hainan Customs District, Haikou, China
| | - Yan Zhu
- International Travel Healthcare Center, Xining Customs District, Xining, China
| | - Ping Yu
- Xi'an Xian Yang Airport Customs House, Xian Yang, China
| | - Kai Li
- International Travel Healthcare Center, Ningxia Customs District, Yinchuan, China
| | - Ying-Jie Tian
- University of Chinese Academy of Sciences, Beijing, China
| | - Wu-Chun Cao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; Institute of EcoHealth, Shandong University, Jinan, China.
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Affiliation(s)
- Doug Fink
- The Hospital for Tropical Diseases, Mortimer Market Centre, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | - Robert Serafino Wani
- Department of Infection, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Victoria Johnston
- The Hospital for Tropical Diseases, Mortimer Market Centre, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
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Abstract
Emerging infectious diseases (EIDs), including West Nile virus, severe acute respiratory syndrome (SARS) and Lyme disease, have had a direct effect within Canada, while many more EIDs such as Zika, chikungunya and Ebola are a threat to Canadians while travelling. Over 75% of EIDs affecting humans are, or were originally, zoonoses (infectious diseases transmitted from animals to humans). There are two main ways by which infectious diseases can emerge: by changes in their geographical ranges and by adaptive emergence, a genetic change in a microorganism that results in it becoming capable of invading a new niche, often by jumping to a new host species such as humans. Diseases can appear to emerge simply because we become capable of detecting and diagnosing them. Management of EID events is a key role of public health globally and a considerable challenge for clinical care. Increasingly, emphasis is being placed on predicting EID occurrence to "get ahead of the curve" - that is, allowing health systems to be poised to respond to them, and public health to be ready to prevent them. Predictive models estimate where and when EIDs may occur and the levels of risk they pose. Evaluation of the internal and external drivers that trigger emergence events is increasingly considered in predicting EID events. Currently, global changes are driving increasing occurrence of EIDs, but our capacity to prevent and deal with them is also increasing. Web-based scanning and analysis methods are increasingly allowing us to detect EID outbreaks, modern genomics and bioinformatics are increasing our ability to identify their genetic and geographical origins, while developments in geomatics and earth observation will enable more real-time tracking of outbreaks. EIDs will, however, remain a key, global public health challenge in a globalized world where demographic, climatic, and other environmental changes are altering the interactions between hosts and pathogen in ways that increase spillover from animals to humans and global spread.
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Sulyok M, Rückle T, Roth A, Mürbeth RE, Chalon S, Kerr N, Samec SS, Gobeau N, Calle CL, Ibáñez J, Sulyok Z, Held J, Gebru T, Granados P, Brückner S, Nguetse C, Mengue J, Lalremruata A, Sim BKL, Hoffman SL, Möhrle JJ, Kremsner PG, Mordmüller B. DSM265 for Plasmodium falciparum chemoprophylaxis: a randomised, double blinded, phase 1 trial with controlled human malaria infection. THE LANCET. INFECTIOUS DISEASES 2017; 17:636-644. [PMID: 28363637 PMCID: PMC5446410 DOI: 10.1016/s1473-3099(17)30139-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/05/2017] [Accepted: 02/16/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND A drug for causal (ie, pre-erythrocytic) prophylaxis of Plasmodium falciparum malaria with prolonged activity would substantially advance malaria control. DSM265 is an experimental antimalarial that selectively inhibits the parasite dihydroorotate dehydrogenase. DSM265 shows in vitro activity against liver and blood stages of P falciparum. We assessed the prophylactic activity of DSM265 against controlled human malaria infection (CHMI). METHODS At the Institute of Tropical Medicine, Eberhard Karls University (Tübingen, Germany), healthy, malaria-naive adults were allocated to receive 400 mg DSM265 or placebo either 1 day (cohort 1A) or 7 days (cohort 2) before CHMI by direct venous inoculation (DVI) of 3200 aseptic, purified, cryopreserved P falciparum sporozoites (PfSPZ Challenge; Sanaria Inc, Rockville, MD, USA). An additional group received daily atovaquone-proguanil (250-100 mg) for 9 days, starting 1 day before CHMI (cohort 1B). Allocation to DSM265, atovaquone-proguanil, or placebo was randomised by an interactive web response system. Allocation to cohort 1A and 1B was open-label, within cohorts 1A and 2, allocation to DSM265 and placebo was double-blinded. All treatments were given orally. Volunteers were treated with an antimalarial on day 28, or when parasitaemic, as detected by thick blood smear (TBS) microscopy. The primary efficacy endpoint was time-to-parasitaemia, assessed by TBS. All participants receiving at least one dose of chemoprophylaxis or placebo were considered for safety, those receiving PfSPZ Challenge for efficacy analyses. Log-rank test was used to compare time-to-parasitemia between interventions. The trial was registered with ClinicalTrials.gov, number NCT02450578. FINDINGS 22 participants were enrolled between Oct 23, 2015, and Jan 18, 2016. Five participants received 400 mg DSM265 and two participants received placebo 1 day before CHMI (cohort 1A), six participants received daily atovaquone-proguanil 1 day before CHMI (cohort 1B), and six participants received 400 mg DSM265 and two participants received placebo 7 days before CHMI (cohort 2). Five of five participants receiving DSM265 1 day before CHMI and six of six in the atovaquone-proguanil cohort were protected, whereas placebo recipients (two of two) developed malaria on days 11 and 14. When given 7 days before CHMI, three of six volunteers receiving DSM265 became TBS positive on days 11, 13, and 24. The remaining three DSM265-treated, TBS-negative participants of cohort 2 developed transient submicroscopic parasitaemia. Both participants receiving placebo 7 days before CHMI became TBS positive on day 11. The only possible DSM265-related adverse event was a moderate transient elevation in serum bilirubin in one participant. INTERPRETATION A single dose of 400 mg DSM265 was well tolerated and had causal prophylactic activity when given 1 day before CHMI. Future trials are needed to investigate further the use of DSM265 for the prophylaxis of malaria. FUNDING Global Health Innovative Technology Fund, Wellcome Trust, Bill & Melinda Gates Foundation through Medicines for Malaria Venture, and the German Center for Infection Research.
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Affiliation(s)
- Mihály Sulyok
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany.
| | | | - Alexandra Roth
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Raymund E Mürbeth
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | | | - Nicola Kerr
- Medicines for Malaria Venture, Geneva, Switzerland
| | | | | | - Carlos Lamsfus Calle
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Javier Ibáñez
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Zita Sulyok
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Jana Held
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Tamirat Gebru
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Patricia Granados
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Sina Brückner
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Christian Nguetse
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Juliana Mengue
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Albert Lalremruata
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | | | | | | | - Peter G Kremsner
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Benjamin Mordmüller
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
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Nontraditional infectious diseases surveillance systems. Infect Dis (Lond) 2017. [DOI: 10.1002/9781119085751.ch2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Affiliation(s)
- Guy E Thwaites
- From the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (G.E.T., N.P.J.D.); Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (G.E.T.); and the Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (N.P.J.D.)
| | - Nicholas P J Day
- From the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (G.E.T., N.P.J.D.); Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (G.E.T.); and the Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (N.P.J.D.)
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The revised dengue fever classification in German travelers: clinical manifestations and indicators for severe disease. Infection 2014; 43:21-8. [PMID: 25421705 DOI: 10.1007/s15010-014-0688-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The number of dengue cases imported to Germany has increased significantly in recent years. Among returning travelers, dengue is now a frequent cause of hospitalization. The aim of this study was to determine the proportion of patients with severe disease hospitalized in a European, non-endemic country applying the revised 2009 WHO classification system and to determine predictors of severe disease. METHODS A retrospective single-center analysis of clinical data from 56 patients, 31 (55 %) women and 25 (45 %) men, between 14 and 70 years of age treated in a tertiary care hospital between 1996 and 2010 was conducted. RESULTS Thirty-nine patients (69.6 %) presented with dengue fever without warning signs, 11 (19.6 %) with warning signs and 6 (10.7 %) with signs for severe dengue fever. Two patients (4 %) developed dengue shock syndrome. Non-European descent (p = 0.001), plasma protein level <6.5 mg/dl (p = 0.001), platelets <30/nl (p = 0.017) and activated partial thromboplastin time (aPTT) >44 s (p = 0.003) were associated with severe disease. CONCLUSIONS A significant proportion of patients hospitalized with symptomatic imported dengue fever in Germany have evidence of severe disease. Simple routine laboratory parameters such as complete blood count, plasma protein level and aPTT are helpful tools for identifying adult patients at risk for severe disease.
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Díaz-Menéndez M, Pérez-Molina JA, Serre N, Treviño B, Torrús D, Matarranz M, Martín E, Rojo-Marcos G, Aguilera P, Rico A, Suárez-García I, López-Vélez R. Infecciones importadas por inmigrantes y viajeros: resultados de la Red Cooperativa para el estudio de las Enfermedades Importadas por Inmigrantes y Viajeros +Redivi. Enferm Infecc Microbiol Clin 2012; 30:528-34. [DOI: 10.1016/j.eimc.2012.01.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 01/23/2012] [Accepted: 01/24/2012] [Indexed: 11/25/2022]
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Paredes-Paredes M, Flores-Figueroa J, Dupont HL. Advances in the treatment of travelers' diarrhea. Curr Gastroenterol Rep 2012; 13:402-7. [PMID: 21773708 DOI: 10.1007/s11894-011-0208-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Diarrhea is the most common complaint reported by travelers from industrialized countries visiting developing nations. High-risk areas for travelers' diarrhea (TD) include South Asia, Sub-Saharan Africa, and Latin America, while moderate-risk areas include Southeast Asia, Middle East, Oceania and the Caribbean. Bacterial pathogens are the major cause of TD. Recent advances in the therapy for diarrhea include a better understanding of the potential benefit of symptomatic and antimicrobial therapy. The mainstay of treatment includes antibacterial therapy with one of three drugs, a fluoroquinolone, rifaximin, or azithromycin. Probiotics have been used in preliminary studies for both treatment and prevention of TD, but more studies are needed with these biologic agents. The aim of this review is to identify the recent advances in the therapy of TD and to provide recommendations for treatment during international travel.
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