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Lovey T, Hedrich N, Grobusch MP, Bernhard J, Schagenhauf P, Blanke U, Eperon G, Gautret P, de Frey A, Kuenzli E, Lindner A, Mockenhaupt F, Popescu C, Schnyder JL, de Jong HK, Dauda M, Nishiura H, Al-Tawfiq JA, Parker S, Larsen CS, Vayena E. Surveillance of global, travel-related illness using a novel app: a multivariable, cross-sectional study. BMJ Open 2024; 14:e083065. [PMID: 39067885 PMCID: PMC11287070 DOI: 10.1136/bmjopen-2023-083065] [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: 12/11/2023] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION Current traveller health surveillance is 'top-down'. Mobile-based surveillance could capture infection symptoms in real time. We aimed to evaluate the spectrum of illness in travellers using a mobile app-based system. METHODS This study (ClinicalTrials.gov NCT04672577) used an application called Infection Tracking in Travellers (ITIT) that records travel-related illness symptoms with associated geolocation and weather data. The free ITIT app is available in 14 languages. Participants were recruited globally from April 2022 to July 2023. Participants >18 years of age travelled internationally and provided electronic consent. Incentives included the provision of travel health information imported from the WHO website. Symptoms were recorded with daily pop-up questionnaires and symptom severity was assessed using a Likert scale. Two post-travel questionnaires were administered. Logistic mixed models examined factors relating to symptom presence, and a random forest model examined symptom impact. RESULTS 609 participants were recruited until July 2023. Participants had an average age of 37 years (18-79), and an average travel duration of 26 days (2-281). Most participants were travelling for leisure/tourism (401; 66%), followed by 'visiting friends and relatives' (99; 16%) and business travel (80; 13%). All continents were visited by at least one traveller. Of 470 registered trips, symptoms were reported on 163 trips (35%). Gastrointestinal symptoms were reported on 87 trips (19%) and respiratory symptoms on 81 trips (17%). The most important factors in predicting the presence of symptoms were duration of travel, travelling in winter and high humidity. Diarrhoea, headache and nausea were symptoms with most impact on daily activities. Post-travel questionnaires showed that 12% of surveyed participants experienced symptoms with several episodes of self-treatment. Two diagnoses were recorded: Lyme disease and amoebic dysentery. CONCLUSION The digital tool ITIT successfully captures the spectrum of travel-related illness. This detailed epidemiology is crucial for outbreak detection and for the formulation of travel medicine guidelines. TRIAL REGISTRATION NUMBER NCT04672577.
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Affiliation(s)
- Thibault Lovey
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
| | - Nadja Hedrich
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
| | - Martin Peter Grobusch
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
| | - Julian Bernhard
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
| | - Patricia Schagenhauf
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - The ITIT Global Network
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Ulf Blanke
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Gilles Eperon
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Philippe Gautret
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Albie de Frey
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Esther Kuenzli
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Andreas Lindner
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Frank Mockenhaupt
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Corneliu Popescu
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Jenny L Schnyder
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Hanna K de Jong
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Mohammed Dauda
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Hiroshi Nishiura
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Jaffar A Al-Tawfiq
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Salim Parker
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Carsten Schade Larsen
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
| | - Effy Vayena
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam UMC, Amsterdam, Netherlands
- Charité-Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
- WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Zürich, Switzerland
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