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Yamakawa M, Tsuda T, Wada K, Nagata C, Suzuki E. Diarrhea and related personal characteristics among Japanese university students studying abroad in intermediate- and low-risk countries. PLoS One 2023; 18:e0279426. [PMID: 36827397 PMCID: PMC9956663 DOI: 10.1371/journal.pone.0279426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/06/2022] [Indexed: 02/26/2023] Open
Abstract
Despite an increasing number of students studying abroad worldwide, evidence about health risks while they are abroad is limited. Diarrhea is considered the most common travelers' illness, which would also apply to students studying abroad. We examined diarrhea and related personal characteristics among Japanese students studying abroad. Japanese university students who participated in short-term study abroad programs between summer 2016 and spring 2018 were targeted (n = 825, 6-38 travel days). Based on a 2-week-risk of diarrhea (passing three or more loose or liquid stools per day) among travelers by country, the destination was separated into intermediate- and low-risk countries. After this stratification, the associations between personal characteristics and diarrhea during the first two weeks of their stay were evaluated using logistic regression models. Among participants in intermediate-risk countries, teenagers, males and those with overseas travel experience were associated with an elevated risk of diarrhea; the odds ratios (95% confidence intervals) were 2.42 (1.08-5.43) for teenagers (vs. twenties), 1.93 (1.08-3.45) for males (vs. females) and 2.37 (1.29-4.33) for those with overseas experience (vs. none). Even restricting an outcome to diarrhea during the first week did not change the results substantially. The same tendency was not observed for those in the low-risk countries. Teenage students, males and those with overseas travel experience should be cautious about diarrhea while studying abroad, specifically in intermediate-risk countries.
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Affiliation(s)
- Michiyo Yamakawa
- Department of Epidemiology and Preventive Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- * E-mail:
| | - Toshihide Tsuda
- Department of Human Ecology, Graduate School of Environmental and Life Science, Okayama University, Okayama, Japan
| | - Keiko Wada
- Department of Epidemiology and Preventive Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Chisato Nagata
- Department of Epidemiology and Preventive Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Etsuji Suzuki
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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2
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Linares M, Santos L, Santos J, Juesas C, Górgolas M, Ramos-Rincón JM. Selfie-related deaths using web epidemiological intelligence tool (2008-2021): a cross-sectional study. J Travel Med 2022; 29:6404466. [PMID: 34668557 DOI: 10.1093/jtm/taab170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/05/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022]
Abstract
The quest for extreme selfies killed 379 people since 2008. One in three was a traveller. Falls from height, transport and drowning were the top three causes. Many selfie deaths are the result of tourists taking risks in unfamiliar terrain. Travel medicine practitioners should routinely counsel travellers on responsible self-photography.
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Affiliation(s)
- Manuel Linares
- Fundación iO, Madrid 28045, Spain.,Servicio de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, Madrid 28805, Spain
| | - Laura Santos
- Fundación iO, Madrid 28045, Spain.,Centro de Salud Buenos Aires, Servicio Madrileño de Salud, Madrid 28038, Spain
| | | | | | - Miguel Górgolas
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid 28029, Spain
| | - José-Manuel Ramos-Rincón
- Departamento de Medicina Clínica, Facultad de Medicina, Universidad Miguel Hernández de Elche, Alicante 03202, Spain
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3
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Meng Y, Khan A, Bibi S, Wu H, Lee Y, Chen W. The Effects of COVID-19 Risk Perception on Travel Intention: Evidence From Chinese Travelers. Front Psychol 2021; 12:655860. [PMID: 34335367 PMCID: PMC8322978 DOI: 10.3389/fpsyg.2021.655860] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
This study attempts to assess the relationship between risk perception, risk knowledge, and travel intentions of Chinese leisure travelers during the COVID-19 pandemic in the framework of social contagion and risk communication theories by analyzing a sample of 1,209 travelers through structural equation modeling (SEM) and path analysis. We used the process macro of Hayes to analyze the moderation effects of age, gender, and education between risk perception, media and interpersonal communication, and risk knowledge. It was found that travelers were more concerned about self-efficacy than severity. Risk perception of travelers predicts the information-seeking process of tourists. This process helps travelers to accumulate risk information that influences their travel intentions. Travelers give more importance to interpersonal (contagion) communication in making a traveling decision. Demographic factors influence traveling decision-making; women travelers were found to be more risk resilient than men. Young travelers seek information at low- and old travelers at high-risk levels. Marketing implications also provided.
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Affiliation(s)
- Yue Meng
- College of Tourism, Sichuan Agricultural University, Chengdu, China
| | - Asif Khan
- Department of Tourism and Hotel Management, School of Management, Zhejiang University, Hangzhou, China.,Department of Tourism and Hospitality, Hazara University, Mansehra, Pakistan
| | - Sughra Bibi
- Guanghua Law School Zhejiang University, Hangzhou, China
| | - Haoyue Wu
- College of Tourism, Sichuan Agricultural University, Chengdu, China
| | - Yao Lee
- Department of Tourism and Hotel Management, School of Management, Zhejiang University, Hangzhou, China
| | - Wenkuan Chen
- College of Tourism, Sichuan Agricultural University, Chengdu, China
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4
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Ariawan IGN, Swedarma KE, Yanti NPED. A Normative Behavior of Pre-Travel Health Consultation and the Associated Factors among Travelers. JURNAL NERS 2021. [DOI: 10.20473/jn.v16i1.21443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Travelers may transmit diseases due to their behavior of travel, consequently travelers should consider preventive measurement through pre-travel health consultation seeking behavior. Pre-travel health consultation is a particular preparation ideally conducted by international travelers to obtain risk assessment and management to prevent the transmission of diseases. This study investigates the relationship of socio-demographic characteristics and itinerary on pre-travel health consultation behavior among international travelers in Badung, Bali.Methods: A descriptive-correlative design using a cross-sectional approach employed 125 participants determined by a purposive sampling technique performed in the ten tourist destinations of Badung Regency. Data collection was conducted on February 15th until March 5th, 2020. Data demography, travel plan, and anonymous questionnaires regarding pre-travel health consultation behavior are used in this research. The Gamma coefficient correlation and Kruskal-Wallis statistic tests were performed in the study for bivariate analysis.Results: The results showed that age (p<0.0001; r=-0.650) and past-travel history to Bali (p=0.004; r=-0.475) were significantly correlated with pre-travel health consultation behavior among international travelers in Badung, Bali. Meanwhile sex, nationality, last education, travel duration, and types of the destination visited were not significantly associated with pre-travel health consultation behavior among international travelers in Badung, Bali (p>0.05).Conclusion: The age and past-travel history to Bali seem to be predictors for travelers to uptake pre-travel health consultation, thus nurses should be able to promote the implementation of pre-travel health consultation by utilizing the media promotion appropriately adjusted to the age of travelers and travel experience.
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Khatib AN, Carvalho AM, Primavesi R, To K, Poirier V. Navigating the risks of flying during COVID-19: a review for safe air travel. J Travel Med 2020; 27:5976283. [PMID: 33184655 PMCID: PMC7717328 DOI: 10.1093/jtm/taaa212] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
RATIONALE FOR REVIEW With air travel restarting, there has been much discourse about the safety of flying during the pandemic. In travel medicine, risk assessment includes estimating baseline risk to the traveller, recognizing factors that may modify that risk, considering the role of interventions to decrease that risk and accounting for a traveller's perception and tolerance of risk. The goals of this review are to identify the in-flight transmission risks of commercial air travel, provide recommendations about the risks of flying during the pandemic and propose strategies to mitigate the spread of COVID-19. KEY FINDINGS The airline industry has taken a layered approach to increase passenger safety through effective onboard ventilation, extended ventilation at the gate, boarding and deplaning strategies, improved aircraft disinfection and pre-flight screening such as temperature checks and COVID-19 testing. Proximity to an index case may contribute to the risk of transmission more than the seat type or location. The use of face masks has significantly reduced onboard transmission, and mandatory in-flight mask-wearing policies are being enforced. Innovations such as digital health passports may help standardize screening entry requirements at airports and borders, allowing for a safer return to travel. RECOMMENDATIONS In-flight transmission of SARS-CoV-2 is a real risk, which may be minimized by combining mitigation strategies and infection prevention measures including mandatory masking onboard, minimizing unmasked time while eating, turning on gasper airflow in-flight, frequent hand sanitizing, disinfecting high touch surfaces, promoting distancing while boarding and deplaning, limiting onboard passenger movement, implementing effective pre-flight screening measures and enhancing contact tracing capability. Assessing risk is a cornerstone of travel medicine. It is important to evaluate the multiple factors contributing to the cumulative risk of an individual traveller during the COVID-19 pandemic and to employ a multi-pronged approach to reduce that risk.
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Affiliation(s)
- Aisha N Khatib
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Anna-Maria Carvalho
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Robert Primavesi
- Department of Emergency Medicine and Pediatrics, McGill University, Montreal, Canada
| | - Kent To
- Emirates Group Medical Services, Dubai, United Arab Emirates.,Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Vincent Poirier
- Department of Emergency Medicine, McGill University, Montreal, Canada
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Hiranrusme T, Piyaphanee W, Kaewkungwal J, Silachamroon U, Leowattana W, Chatapat L, Matsee W. Risk perception of health problems among travelers visiting a travel clinic in Bangkok, Thailand. Trop Dis Travel Med Vaccines 2020; 6:7. [PMID: 32477584 PMCID: PMC7238588 DOI: 10.1186/s40794-020-00108-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/08/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Effective pre-travel consultations cannot be achieved only through individual risk assessment and advice on vaccinations and chemoprophylaxis. Travelers' perceptions of the risk of health problems represent another key factor in successful risk communication and co-operation with pre-travel advice. The objective of this study was to determine perception of travel-related health risks among Thais and westerners visiting the Thai Travel Clinic for consultation before visiting developing countries. METHODS A novel pictorial scale questionnaire-based study was conducted with both Thai and western travelers who visited the Thai Travel Clinic for pre-travel consultation. All participants were approached before and after completing the consultation, and were asked about their demographic data and perceptions of travel-related health risk. The perceptions of risk before and after consultation were compared using the McNemar test, and were also compared with the actual estimated risk. RESULTS During May to November 2019, 594 travelers (330 Thais and 264 Westerners) were enrolled and completed the pictorial scale questionnaires. Most Thai travelers visited Africa/South America (63%), and 20% had previously received counseling. Westerners were mostly backpackers (37.5%), traveling for > 30 days (71.6%), while 43.6% had previously received counseling. Overall, the westerners (n = 264) changed their risk perceptions slightly after counseling in contrast with the Thais. The change in perception of most health problems was observed statistically significant (p-value < 0.05) after receiving pre-travel consultation among both groups of travelers. Risk perception among western travelers after consultation compared with estimated actual risk showed accurate risk perception toward most of health problems especially in travelers who had previously received counseling in ones' home countries. CONCLUSIONS Risk perception of health problems plays an important role in successful risk communication and their response to pre-travel advices. Differences in risk perceptions were evident between the two groups. Therefore, this highlight the importance of obtaining pre-travel advice in one's home country before travelling. Raised awareness of the risks should be emphasized during consultations for underestimated health risks, especially for rabid animal exposure and sexually transmitted diseases.
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Affiliation(s)
- Thanyapat Hiranrusme
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Watcharapong Piyaphanee
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Jaranit Kaewkungwal
- 2Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Udomsak Silachamroon
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Wattana Leowattana
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Lapakorn Chatapat
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Wasin Matsee
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
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7
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Wilder-Smith A, Preet R, Brickley EB, Ximenes RADA, Miranda-Filho DDB, Turchi Martelli CM, Araújo TVBD, Montarroyos UR, Moreira ME, Turchi MD, Solomon T, Jacobs BC, Villamizar CP, Osorio L, de Filipps AMB, Neyts J, Kaptein S, Huits R, Ariën KK, Willison HJ, Edgar JM, Barnett SC, Peeling R, Boeras D, Guzman MG, de Silva AM, Falconar AK, Romero-Vivas C, Gaunt MW, Sette A, Weiskopf D, Lambrechts L, Dolk H, Morris JK, Orioli IM, O'Reilly KM, Yakob L, Rocklöv J, Soares C, Ferreira MLB, Franca RFDO, Precioso AR, Logan J, Lang T, Jamieson N, Massad E. ZikaPLAN: addressing the knowledge gaps and working towards a research preparedness network in the Americas. Glob Health Action 2020; 12:1666566. [PMID: 31640505 PMCID: PMC6818126 DOI: 10.1080/16549716.2019.1666566] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Zika Preparedness Latin American Network (ZikaPLAN) is a research consortium funded by the European Commission to address the research gaps in combating Zika and to establish a sustainable network with research capacity building in the Americas. Here we present a report on ZikaPLAN`s mid-term achievements since its initiation in October 2016 to June 2019, illustrating the research objectives of the 15 work packages ranging from virology, diagnostics, entomology and vector control, modelling to clinical cohort studies in pregnant women and neonates, as well as studies on the neurological complications of Zika infections in adolescents and adults. For example, the Neuroviruses Emerging in the Americas Study (NEAS) has set up more than 10 clinical sites in Colombia. Through the Butantan Phase 3 dengue vaccine trial, we have access to samples of 17,000 subjects in 14 different geographic locations in Brazil. To address the lack of access to clinical samples for diagnostic evaluation, ZikaPLAN set up a network of quality sites with access to well-characterized clinical specimens and capacity for independent evaluations. The International Committee for Congenital Anomaly Surveillance Tools was formed with global representation from regional networks conducting birth defects surveillance. We have collated a comprehensive inventory of resources and tools for birth defects surveillance, and developed an App for low resource regions facilitating the coding and description of all major externally visible congenital anomalies including congenital Zika syndrome. Research Capacity Network (REDe) is a shared and open resource centre where researchers and health workers can access tools, resources and support, enabling better and more research in the region. Addressing the gap in research capacity in LMICs is pivotal in ensuring broad-based systems to be prepared for the next outbreak. Our shared and open research space through REDe will be used to maximize the transfer of research into practice by summarizing the research output and by hosting the tools, resources, guidance and recommendations generated by these studies. Leveraging on the research from this consortium, we are working towards a research preparedness network.
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Affiliation(s)
| | - Raman Preet
- Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | | | - Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco , Recife , Brasil.,Departamento de Medicina Interna, Universidade de Pernambuco , Recife , Brasil
| | | | | | | | | | | | - Marília Dalva Turchi
- Instituto de Patologia Tropical e Saúde Publica, Universidade Federal de Goiás , Goiânia , Brasil
| | - Tom Solomon
- Institute of Infection and Global Health, The University of Liverpool , Liverpool , UK
| | - Bart C Jacobs
- Departments of Neurology and Immunology, Erasmus Universitair Medisch Centrum Rotterdam , The Netherlands
| | | | | | | | - Johan Neyts
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute of Medical Research , Leuven , Belgium
| | - Suzanne Kaptein
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute of Medical Research , Leuven , Belgium
| | - Ralph Huits
- Institute of Tropical Medicine , Antwerp , Belgium
| | | | - Hugh J Willison
- Institute of Infection, Immunity & Inflammation, University of Glasgow , Glasgow , UK
| | - Julia M Edgar
- Institute of Infection, Immunity & Inflammation, University of Glasgow , Glasgow , UK
| | - Susan C Barnett
- Institute of Infection, Immunity & Inflammation, University of Glasgow , Glasgow , UK
| | | | - Debi Boeras
- London School of Hygiene & Tropical Medicine , London , UK
| | | | - Aravinda M de Silva
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill , NC , USA
| | - Andrew K Falconar
- London School of Hygiene & Tropical Medicine , London , UK.,Departmento del Medicina, Fundacion Universidad del Norte , Barranquilla , Colombia
| | - Claudia Romero-Vivas
- Departmento del Medicina, Fundacion Universidad del Norte , Barranquilla , Colombia
| | | | - Alessandro Sette
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology , La Jolla , CA , USA.,Department of Medicine, University of California San Diego , La Jolla , CA , USA
| | - Daniela Weiskopf
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology , La Jolla , CA , USA
| | - Louis Lambrechts
- Insect-Virus Interactions Unit, Institut Pasteur, UMR2000, CNRS , Paris , France
| | - Helen Dolk
- Maternal Fetal and Infant Research Centre, Institute of Nursing and Health Research, Ulster University , Newtownabbey , UK
| | - Joan K Morris
- Population Health Research Institute, St George's, University of London , London , UK
| | - Ieda M Orioli
- Associação Técnico-Científica Estudo Colaborativo Latino Americano de Malformações Congênitas (ECLAMC) no Departmento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | | | - Laith Yakob
- London School of Hygiene & Tropical Medicine , London , UK
| | - Joacim Rocklöv
- Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | - Cristiane Soares
- Hospital Federal dos Servidores do Estado , Rio de Janeiro , Brazil
| | | | | | - Alexander R Precioso
- Instituto Butantan , Brazil.,Pediatrics Department, Medical School of University of Sao Paulo , Sao Paulo , Brazil
| | - James Logan
- London School of Hygiene & Tropical Medicine , London , UK
| | - Trudie Lang
- The Global Health Network, Masters and Scholars of the University of Oxford , Oxford , UK
| | - Nina Jamieson
- The Global Health Network, Masters and Scholars of the University of Oxford , Oxford , UK
| | - Eduardo Massad
- Fundacao de Apoio a Universidade de Sao Paulo , Sao Paulo , Brazil.,School of Applied Mathematics, Fundacao Getulio Vargas , Rio de Janeiro , Brazil
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8
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Boggild AK, Caumes E, Grobusch MP, Schwartz E, Hynes NA, Libman M, Connor BA, Chakrabarti S, Parola P, Keystone JS, Nash T, Showler AJ, Schunk M, Asgeirsson H, Hamer DH, Kain KC. Cutaneous and mucocutaneous leishmaniasis in travellers and migrants: a 20-year GeoSentinel Surveillance Network analysis. J Travel Med 2019; 26:5540646. [PMID: 31553455 PMCID: PMC7353840 DOI: 10.1093/jtm/taz055] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) may be emerging among international travellers and migrants. Limited data exist on mucocutaneous leishmaniasis (MCL) in travellers. We describe the epidemiology of travel-associated CL and MCL among international travellers and immigrants over a 20-year period through descriptive analysis of GeoSentinel data. METHODS Demographic and travel-related data on returned international travellers diagnosed with CL or MCL at a GeoSentinel Surveillance Network site between 1 September 1997 and 31 August 2017 were analysed. RESULTS A total of 955 returned travellers or migrants were diagnosed with travel-acquired CL (n = 916) or MCL during the study period, of whom 10% (n = 97) were migrants. For the 858 non-migrant travellers, common source countries were Bolivia (n = 156, 18.2%) and Costa Rica (n = 97, 11.3%), while for migrants, they were Syria (n = 34, 35%) and Afghanistan (n = 22, 22.7%). A total of 99 travellers (10%) acquired their disease on trips of ≤ 2 weeks. Of 274 cases for which species identification was available, Leishmania Viannia braziliensis was the most well-represented strain (n = 117, 42.7%), followed by L. major (n = 40, 14.6%) and L. V. panamensis (n = 38, 13.9%). Forty cases of MCL occurred, most commonly in tourists (n = 29, 72.5%) and from Bolivia (n = 18, 45%). A total of 10% of MCL cases were acquired in the Old World. CONCLUSIONS Among GeoSentinel reporting sites, CL is predominantly a disease of tourists travelling mostly to countries in Central and South America such as Bolivia where risk of acquiring L. V. braziliensis and subsequent MCL is high. The finding that some travellers acquired leishmaniasis on trips of short duration challenges the common notion that CL is a disease of prolonged travel. Migrants from areas of conflict and political instability, such as Afghanistan and Syria, were well represented, suggesting that as mass migration of refugees continues, CL will be increasingly encountered in intake countries.
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Affiliation(s)
- Andrea K Boggild
- Tropical Disease Unit, Division of Infectious Diseases, University Health Network-Toronto General Hospital, Toronto, Canada.,Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Eric Caumes
- Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), 75013, Paris, France
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Academic Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Centre de Recherches Médicales en Lambaréné (CERMEL), Lambaréné, Gabon
| | - Eli Schwartz
- Institute of Geographic Medicine and Tropical Diseases, Sheba Medical Center Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noreen A Hynes
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Bloomberg School Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal Canada
| | - Bradley A Connor
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Sumontra Chakrabarti
- Tropical Disease Unit, Division of Infectious Diseases, University Health Network-Toronto General Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Trillium Health Partners, Mississauga, Canada
| | - Philippe Parola
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Jay S Keystone
- Tropical Disease Unit, Division of Infectious Diseases, University Health Network-Toronto General Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Theodore Nash
- Clinical Parasitology Section, Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Adrienne J Showler
- Tropical Disease Unit, Division of Infectious Diseases, University Health Network-Toronto General Hospital, Toronto, Canada.,Georgetown University, Washington, DC
| | - Mirjam Schunk
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
| | - Kevin C Kain
- Tropical Disease Unit, Division of Infectious Diseases, University Health Network-Toronto General Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,SAR Laboratories, Sandra Rotman Centre for Global Health, Toronto, Canada
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10
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Halstead S, Wilder-Smith A. Severe dengue in travellers: pathogenesis, risk and clinical management. J Travel Med 2019; 26:5551100. [PMID: 31423536 DOI: 10.1093/jtm/taz062] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/14/2022]
Abstract
RATIONALE FOR REVIEW Dengue is a frequent cause of febrile illness among travellers and has overtaken malaria as the leading cause of febrile illness for those traveling to Southeast Asia. The purpose is to review the risk of dengue and severe dengue in travellers with a particular focus on the pathogenesis and clinical management of severe dengue. RISK, PATHOGENESIS AND CLINICAL MANAGEMENT The risk of travel-acquired dengue depends on destination, season and duration of travel and activities during travel. Seroconversion rates reported in travellers, therefore, vary between <1% and >20%. The most common life-threatening clinical response to dengue infection is the dengue vascular permeability syndrome, epidemiologically linked to secondary infection, but can also occur in primary infection. Tertiary and quaternary infections are usually associated with mild or no disease. Antibody-dependent enhancement, viral factors, age, host factors and clinical experience of the managing physician modulate the risk of progressing to severe dengue. The relative risk of severe dengue in secondary versus primary infection ranges from 2 to 7. The absolute risk of severe dengue in children in highly endemic areas is ~0.1% per year for primary infections and 0.4% for secondary infections. About 2-4% of secondary infections lead to severe dengue. Severe dengue and death are both relatively rare in general travellers but more frequently in those visiting friends and relatives. Clinical management of severe dengue depends on judicious use of fluid rehydration. CONCLUSIONS Although dengue is a frequent cause of travel illness, severe dengue and deaths are rare. Nevertheless, dengue infections can interrupt travel and lead to evacuation and major out-of-pocket costs. Dengue is more frequent than many other travel-related vaccine preventable diseases, such as hepatitis A, hepatitis B, rabies, Japanese encephalitis and yellow fever, indicating a need for a dengue vaccine for travellers.
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Affiliation(s)
- Scott Halstead
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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Mesquita EC, Varela MC, Brasil PEAAD, Correa DF, Tuyama M, Carvalho FD, Neves EDS, Cerbino-Neto J, Lemos ADSD, Costa MDD. Addressing travelers' perception of risk in pre-travel care: Reports from a travel clinic in Rio de Janeiro, Brazil. Rev Soc Bras Med Trop 2019; 52:e20180514. [PMID: 31141055 DOI: 10.1590/0037-8682-0514-2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/20/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Travel medicine is aimed at promoting health risk reduction. However, travelers' perception of risk is subjective and may influence implementation of recommendations. This study reports on travelers' perception of risk, pre-travel characteristics, and recommended interventions. METHODS This is a descriptive cross-sectional study. RESULTS This study included 111 individuals. Most travelers (74%) perceived their risk as low. Significant differences in travel-related risk perception between practitioners and travelers were observed (Gwet's agreement coefficient [AC1] 0.23; standard error 0.10; 95% confidence interval 0.02-0.44). CONCLUSIONS Future studies should investigate the relationship between travelers' perception of risk and implementation of recommendations.
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Affiliation(s)
- Emersom Cicilini Mesquita
- Laboratório de Pesquisa em Imunização e Vigilância em Saúde, Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro, RJ, Brasil
| | - Margareth Catoia Varela
- Laboratório de Pesquisa em Imunização e Vigilância em Saúde, Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro, RJ, Brasil
| | | | - Danusa Ferreira Correa
- Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Mari Tuyama
- Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Flavio de Carvalho
- Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Elizabeth de Souza Neves
- Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - José Cerbino-Neto
- Laboratório de Pesquisa em Imunização e Vigilância em Saúde, Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro, RJ, Brasil
| | - Alberto Dos Santos de Lemos
- Laboratório de Pesquisa em Imunização e Vigilância em Saúde, Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro, RJ, Brasil
| | - Marcellus Dias da Costa
- Laboratório de Pesquisa em Imunização e Vigilância em Saúde, Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro, RJ, Brasil
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12
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Sanftenberg L, Kramer M, Esser S, Schelling J. Insights into needs of business travelers to China from calls to a medical assistance provider. Heliyon 2019; 5:e01237. [PMID: 30815606 PMCID: PMC6378333 DOI: 10.1016/j.heliyon.2019.e01237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/24/2019] [Accepted: 02/11/2019] [Indexed: 11/24/2022] Open
Abstract
Background Although 17.5% of German travelers were business travelers in the years 2011–2013, little is known about their pathologies. Recent publications indicate that infections are the primary health issue in general travelers. Our aim was to investigate whether business travelers from Germany to China also primarily suffer from infections. Methods From 2011 to 2013, 587 calls for service of German business travelers to China were collected by a medical assistance provider. 482 of these calls were evaluated regarding demographics, reported diseases and conditions and the type of service provided by the medical assistance company. Results The most common reasons for calls for service were “factors influencing health status and contact with health service” (18.8%), “injury and poisoning” (16.0%) as well as “symptoms, signs, and ill-defined conditions” (13.7%). Most patients asked for “medical advice” (37.8%), referral to “outpatient care” (25.1%) or “inpatient care” (16.6%). “Evacuation and/or repatriation” was required mainly due to “injury and poisoning” (n = 12), “diseases of the circulatory system” (n = 5) or “mental disorders” (n = 3). Conclusion German business travelers to China are seeking primarily administrative support from a medical assistance provider and are mostly affected by non-infectious diseases. Pre-travel preparation of such travelers need to place more emphasis on non-communicable health risks and prevention.
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Affiliation(s)
- Linda Sanftenberg
- Institut für Allgemeinmedizin, Klinikum der Universität München, Germany
| | - Michaela Kramer
- Institut für Allgemeinmedizin, Klinikum der Universität München, Germany
| | | | - Jörg Schelling
- Institut für Allgemeinmedizin, Klinikum der Universität München, Germany
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13
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Boggild AK, Geduld J, Libman M, Yansouni CP, McCarthy AE, Hajek J, Ghesquiere W, Mirzanejad Y, Vincelette J, Kuhn S, Plourde PJ, Chakrabarti S, Greenaway C, Hamer DH, Kain KC. Spectrum of illness in migrants to Canada: sentinel surveillance through CanTravNet. J Travel Med 2019; 26:5159662. [PMID: 30395252 DOI: 10.1093/jtm/tay117] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Due to ongoing political instability and conflict in many parts of the world, migrants are increasingly seeking asylum and refuge in Canada. METHODS We examined demographic and travel correlates of illnesses among migrants to Canada to establish a detailed epidemiologic framework of this population for Canadian practitioners. Data on ill-returned Canadian travellers presenting to a CanTravNet site between 1 January 2015 and 31 December 2015 were analyzed. RESULTS During the study period, 2415 ill travellers and migrants presented to a CanTravNet site, and of those, 519 (21.5%) travelled for the purpose of migration. Sub-Saharan Africa (n = 160, 30.8%), southeast Asia (n = 84, 16.2%) and south central Asia (n = 75, 14.5%) were the most common source regions for migrants, while the top specific source countries, of 98 represented, were the Philippines (n = 45, 8.7%), China (n = 36, 6.9%) and Vietnam (n = 31, 6.0%). Compared with non-migrant travellers, migrants were more likely to have a pre-existing immunocompromising medical condition, such as HIV or diabetes mellitus (P < 0.0001), and to require inpatient management of their illness (P < 0.0001). Diagnoses such as tuberculosis (n = 263, 50.7%), hepatitis B and C (n = 78, 15%) and HIV (n = 11, 2.1%) were over-represented in the migrant population compared with non-migrant travellers (P < 0.0001). Most cases of tuberculosis in the migrant population (n = 263) were latent (82% [n = 216]); only 18% (n = 47) were active. CONCLUSIONS Compared with non-migrant travellers, migrants were more likely to present with a communicable infectious disease, such as tuberculosis, potentially complicated by an underlying immunosuppressing condition such as HIV. These differences highlight the divergent healthcare needs in the migrant population, and underscore the importance of surveillance programmes to understand their burden of illness. Intake programming should be adequately resourced to accommodate the medical needs of this vulnerable population of new Canadians.
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Affiliation(s)
- Andrea K Boggild
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University Health Network and the University of Toronto, Toronto ON, Canada.,Public Health Ontario Laboratories, Public Health Ontario, Toronto, ON, Canada
| | - Jennifer Geduld
- Office of Border and Travel Health, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Michael Libman
- The J.D. MacLean Centre for Tropical Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Cedric P Yansouni
- The J.D. MacLean Centre for Tropical Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Anne E McCarthy
- Tropical Medicine and International Health Clinic, Division of Infectious Diseases, Ottawa Hospital and the University of Ottawa, Ottawa ON, Canada
| | - Jan Hajek
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver British Columbia, Canada
| | - Wayne Ghesquiere
- Infectious Diseases, Vancouver Island Health Authority, Department of Medicine, University of British Columbia, Victoria, British Columbia, Canada
| | - Yazdan Mirzanejad
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver British Columbia, Canada.,Fraser Health, Surrey, British Columbia, Canada
| | - Jean Vincelette
- Hôpital Saint-Luc du CHUM, Université de Montréal, Montréal, Quebec, Canada
| | - Susan Kuhn
- Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine, Alberta Children's Hospital and the University of Calgary, Calgary, Alberta, Canada
| | - Pierre J Plourde
- Travel Health and Tropical Medicine Services, Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Sumontra Chakrabarti
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University Health Network and the University of Toronto, Toronto ON, Canada.,Trillium Health Partners, Mississauga, ON, Canada
| | - Christina Greenaway
- The J.D. MacLean Centre for Tropical Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
| | - Kevin C Kain
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University Health Network and the University of Toronto, Toronto ON, Canada.,SAR Laboratories, Sandra Rotman Centre for Global Health, Toronto, ON Canada
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14
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Blumentrath CG, Müller G, Teichmann D, Tiesmeier J, Petridou J. Relapse of typhoid fever following delayed response to meropenem: A case report and review of previously published cases indicating limited clinical efficacy of meropenem for the treatment of typhoid fever. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2019; 17:Doc01. [PMID: 30837820 PMCID: PMC6388674 DOI: 10.3205/000267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 12/21/2018] [Indexed: 11/30/2022]
Abstract
In times of emerging multi-drug resistance among Gram-negative bacteria (including Salmonella enterica, Serovar Typhi), we observed relapse of typhoid fever following delayed response to treatment with meropenem, suggestive for limited clinical efficacy of the drug. Three previously published cases supported our suspicion. Within this context, we discuss the case details with a focus on potential explanations for insufficient clinical response to meropenem (e.g. limited intracellular penetration, phenomena of tolerance and persistence). Meropenem is a last-resort antimicrobial agent for the treatment of multi-drug resistant Gram-negative infections. Reliable clinical data evaluating the efficacy of meropenem for the treatment of typhoid fever are urgently needed. Future clinical studies evaluating typhoid fever outcome should also investigate the impact of (i) intracellular penetration of antibiotics, and (ii) tolerance and persistence on outcome.
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Affiliation(s)
- Christian G Blumentrath
- Clinic for Cardiology, Angiology and Intensive Care Medicine, Klinikum Lippe Detmold, Germany
| | - Gernot Müller
- Department of Infectious Diseases and Tropical Medicine, Städtisches Klinikum Dresden, Germany
| | - Dieter Teichmann
- Department of Infectious Diseases and Tropical Medicine, Städtisches Klinikum Dresden, Germany
| | - Jens Tiesmeier
- Institute of Anaesthesiology, Intensive Care and Emergency Medicine, General Hospital Lübbecke-Rahden, Germany
| | - Jasmina Petridou
- Institute of Medical Microbiology, University Hospital Minden, Germany
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15
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16
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Huits R, Van Den Bossche D, Eggermont K, Lotgering E, Feyens AM, Potters I, Jacobs J, Van Esbroeck M, Cnops L, Bottieau E. Incidence of Zika virus infection in a prospective cohort of Belgian travellers to the Americas in 2016. Int J Infect Dis 2018; 78:39-43. [PMID: 30368020 DOI: 10.1016/j.ijid.2018.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/15/2018] [Accepted: 10/19/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The incidence rate of Zika virus (ZIKV) infection in travellers from non-endemic areas to the Americas during the ZIKV outbreak in 2016 is unknown. METHODS Belgian adults who planned to travel to South America, Central America, and the Caribbean were recruited prospectively to study the incidence and characteristics of ZIKV. Demographic data and sera were collected at baseline. Participants were trained to collect capillary blood on filter paper (BFP). When ill during travel, the participants completed a questionnaire and they sampled BFP for post-hoc analysis. All symptomatic participants were screened for ZIKV using ZIKV-specific RT-PCR on serum or urine, or BFP, and antibody detection assays (ELISA). Follow-up sera of asymptomatic travellers, obtained at least 20 days post travel, were tested by ZIKV ELISA only. All positive ELISA results were subject to confirmation by virus neutralization testing (VNT). RESULTS Forty-nine participants completed follow-up: 38 women and 11 men, with a median age of 32 years (range 19-64 years). Travel destinations were countries in South America (n=20), Central America (n=24), and the Caribbean (n=5). The total travel duration was 67.8 person-months. Illness was reported by 24 participants (49.0%). ZIKV infection was confirmed in nine cases, by RT-PCR (n=5) and by VNT (n=4). Only one of nine ZIKV cases (11.1%) was asymptomatic. The ZIKV incidence rate was 17.0% (95% confidence interval 7.8-32.2%) per month of travel. CONCLUSIONS The ZIKV incidence rate in adult travellers from non-endemic countries to the epidemic territories during the 2016 outbreak was high. Asymptomatic ZIKV infection was rare in this population.
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Affiliation(s)
- Ralph Huits
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
| | | | - Kaat Eggermont
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Erica Lotgering
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Anne-Marie Feyens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Idzi Potters
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Microbiology and Immunology, University of Leuven, Leuven, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lieselotte Cnops
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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17
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Learoyd TP. Asian travel: from the rare to the difficult. J Travel Med 2018; 25:S1-S2. [PMID: 29718438 DOI: 10.1093/jtm/tay015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 02/08/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Tristan P Learoyd
- Valneva UK, Centaur House, Ancells Business Park, Ancells Road, Hampshire, Fleet GU51 2UJ, UK
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18
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Heywood AE, Zwar N. Improving access and provision of pre-travel healthcare for travellers visiting friends and relatives: a review of the evidence. J Travel Med 2018; 25:4934909. [PMID: 29608738 DOI: 10.1093/jtm/tay010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/02/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Travellers visiting friends and relatives (VFR travellers) in their country of origin are at increased risk of a range of preventable infections. Risks are broadly related to circumstances of travel, risk misconceptions and access to health services. Despite nearly two decades of literature highlighting these increased risks little impact has been made on their risk disparity. METHODS This review draws on evidence from travel medicine literature, supplemented by evidence from the broader field of immigrant health, and is structured to include strategies that aim to reduce barriers at the patient, provider and health system level. RESULTS For the travel medicine provider, tailored risk communication that is cognisant of the unique health beliefs and barriers to travel health for VFR travellers is needed, including enhanced communication through the use of interpreters and supplementary written communication. Primary care providers are uniquely placed to identify future travel plans among immigrant patients, however, greater awareness of VFR traveller risks and training in travel medicine are required. Community health promotion interventions that are culturally appropriate, translated into multiple languages and takes into account the cumulative risk of multiple return visits are key to normalizing travel healthcare seeking behaviours and improving awareness of VFR travel risks. Currently, there are few examples of novel strategies to engage migrant communities in travel health with no formal evaluations of their effectiveness. Best practice includes the use of community-consulted approaches in collaboration with government, primary care and travel medicine. CONCLUSIONS Multifactorial barriers related to health beliefs and access to health services require a range of strategies and interventions in both reaching and providing advice to VFR travellers. To improve the evidence base, future research should focus on the evaluation of novel strategies that address these barriers and improve access and provision of pre-travel healthcare to VFR travellers.
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Affiliation(s)
- Anita E Heywood
- School of Public Health and Community Medicine, UNSW Sydney, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, UNSW Sydney, Australia.,School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Australia
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19
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Andreeva IV, Stetsiouk O.U. OU. Current approaches to prophylaxis and treatment of travelers’ diarrhea. CLINICAL MICROBIOLOGY AND ANTIMICROBIAL CHEMOTHERAPY 2018. [DOI: 10.36488/cmac.2018.3.172-180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Travelers’ diarrhea is the most common infectious disease in this subpopulation and usually develops within the first week of travel. This review presents summarized data on epidemiology and etiology of travelers’ diarrhea. Nonspecific precautions and medical treatments (antimicrobials, probiotics) to prevent this infection are described in detail. Current approaches to the treatment of travelers’ diarrhea (oral rehydration, probiotics, antidiarrheals, antimicrobials) in adults and children depending on disease severity are also considered.
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Affiliation(s)
- Irina V. Andreeva
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University
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20
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Flaherty GT, Chen B, Avalos G. Individual traveller health priorities and the pre-travel health consultation. J Travel Med 2017; 24:4108123. [PMID: 28922821 DOI: 10.1093/jtm/tax059] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The purpose of this study was to examine the principal travel health priorities of travellers. The most frequently selected travel health concerns were accessing medical care abroad, dying abroad, insect bites, malaria, personal safety and travel security threats. The travel health risks of least concern were culture shock, fear of flying, jet lag and sexually transmitted infections. This study is the first to develop a hierarchy of self-declared travel health risk priorities among travellers.
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Affiliation(s)
- Gerard T Flaherty
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Bingling Chen
- School of Biomedical Science, National University of Ireland Galway, Galway, Ireland
| | - Gloria Avalos
- School of Medicine, National University of Ireland Galway, Galway, Ireland
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21
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Torresi J, Steffen R. Redefining priorities towards graded travel-related infectious disease research. J Travel Med 2017; 24:4359791. [PMID: 29088486 DOI: 10.1093/jtm/tax064] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Indexed: 01/01/2023]
Abstract
Our knowledge of the health problems and infections encountered by international travellers has evolved considerably in the past decades. The growth of global networks such as the GeoSentinel Surveillance network, TropNet Europe, EuroTravNet and networks based in North America have provided valuable information on the frequency of a wide array of travel-related diseases and accidents, including details on the destination of travel and trends over time. The information gained from these network studies has provided important data for the practice of travel medicine and in some instances for the development of practice guidelines. However, network data due to a lack of denominators usually cannot serve as a basis for a GRADE approach to guideline development. Although epidemiological network studies will continue to serve an important role in travel medicine we encourage an additional strong focus towards translational scientific research questions and towards the broader use of novel techniques to obtain more accurate epidemiological analyses to address the many unanswered questions in our field.
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Affiliation(s)
- Joseph Torresi
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, Division of Communicable Diseases, WHO Collaborating Centre for Travellers' Health, University of Zurich, Zurich, Switzerland.,Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, TX, USA
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22
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Flaherty GT. Getting personal: signalling the genomic era of travel medicine research. J Travel Med 2017; 24:4339136. [PMID: 29088484 DOI: 10.1093/jtm/tax067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 08/23/2017] [Indexed: 11/13/2022]
Affiliation(s)
- G T Flaherty
- School of Medicine, National University of Ireland Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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23
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Abstract
BACKGROUND Travellers' diarrhea (TD) continues to be the most frequent health problem in travellers with destinations in lower income parts of the world as compared with where they reside, even if that risk has slightly decreased. METHODS A systematic review was published 18 months ago; now PubMed was searched for more recent publications relating to travel, diarrhea, epidemiology, incidence, risk. RESULTS A trend to decreasing incidence rates have been noted in this as compared with the last century, but TD remains frequent. The clinical picture varies from a trivial ailment to severe with subsequent hospitalization. Of great concern are long-term sequelae, particularly post-infectious irritable bowel syndrome. The most important risk factors are the destination and duration of exposure among the environmental factors, whereas the age is the most relevant host factor. CONCLUSIONS Even if improved hygienic conditions in low-income countries often visited by travellers have resulted in slightly diminished incidence rates of TD, this remains a frequent health problem. Visitors to such destinations must be informed about that health risk and it is beneficial to equip them with instructions and a travel kit to enable them to some extent self-manage TD occurring abroad.
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Affiliation(s)
- Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, World Health Organization Collaborating Centre for Traveller's Health, University of Zurich, Zurich, Switzerland.,Division of Epidemiology Human Genetics & Environmental Sciences, The University of Texas School of Public Health, Houston, TX, USA
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24
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Boggild AK, Geduld J, Libman M, Yansouni CP, McCarthy AE, Hajek J, Ghesquiere W, Mirzanejad Y, Vincelette J, Kuhn S, Plourde PJ, Chakrabarti S, Freedman DO, Kain KC. Surveillance report of Zika virus among Canadian travellers returning from the Americas. CMAJ 2017; 189:E334-E340. [PMID: 28280063 PMCID: PMC5334005 DOI: 10.1503/cmaj.161241] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Widespread transmission of Zika virus in the Americas has occurred since late 2015. We examined demographic and travel-related characteristics of returned Canadian travellers with Zika infection acquired in the Americas to illuminate risk factors for acquisition and the clinical spectrum. METHODS We analyzed demographic and travel-related data for returned Canadian travellers who presented to a CanTravNet site between October 2015 and September 2016 for care of Zika virus acquired in the Americas. Data were collected with use of the GeoSentinel Surveillance Network data platform. RESULTS During the study period, 1118 travellers presented to a CanTravNet site after returning from the Americas, 41 (3.7%) of whom had Zika infection. Zika infection from the Americas was diagnosed at CanTravNet sites as often as dengue (n = 41) over the study period. In the first half of the study period, Zika virus burden was borne by people visiting friends and relatives in South America. In the latter half, coincident with the increased spread of Zika throughout the Caribbean and Central America, Zika virus occurred more often in tourists in the Caribbean. Forty (98%) of the travellers with Zika infection acquired it through probable mosquito exposure, and 1 had confirmed sexual acquisition. Congenital transmission occurred in 2 of 3 pregnancies. Two (5%) of those with Zika had symptoms resembling those of Guillain-Barré syndrome, 1 of whom also had Zika viral meningitis. INTERPRETATION Even in this small cohort, we observed the full clinical spectrum of acute Zika virus, including adverse fetal and neurologic outcomes. Our observations suggest that complications from Zika infection are underestimated by data arising exclusively from populations where Zika is endemic. Travellers should adhere to mosquito-avoidance measures and barrier protection during sexual activity.
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Affiliation(s)
- Andrea K Boggild
- Department of Medicine (Boggild, Chakrabarti, Kain), Tropical Disease Unit, Division of Infectious Diseases, University Health Network and University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; The J.D. MacLean Centre for Tropical Diseases (Libman, Yansouni), McGill University, Montréal, Que.; Tropical Medicine and International Health Clinic (McCarthy), Division of Infectious Diseases, Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek, Mirzanejad), University of British Columbia, Vancouver, BC; Infectious Diseases (Ghesquiere), Vancouver Island Health Authority, Victoria, BC; Department of Medicine (Ghesquiere), University of British Columbia, Vancouver, BC; Fraser Health (Mirzanejad), Surrey, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Departments of Pediatrics and Medicine (Kuhn), Section of Pediatric Infectious Diseases, Alberta Children's Hospital and University of Calgary, Calgary, Alta.; Travel Health and Tropical Medicine Services (Plourde), Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Man.; Trillium Health Partners (Chakrabarti), Mississauga, Ont.; Department of Medicine (Freedman), Center for Geographic Medicine, University of Alabama Birmingham, Birmingham, Ala.; SAR Laboratories (Kain), Sandra Rotman Centre, Toronto, Ont.
| | - Jennifer Geduld
- Department of Medicine (Boggild, Chakrabarti, Kain), Tropical Disease Unit, Division of Infectious Diseases, University Health Network and University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; The J.D. MacLean Centre for Tropical Diseases (Libman, Yansouni), McGill University, Montréal, Que.; Tropical Medicine and International Health Clinic (McCarthy), Division of Infectious Diseases, Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek, Mirzanejad), University of British Columbia, Vancouver, BC; Infectious Diseases (Ghesquiere), Vancouver Island Health Authority, Victoria, BC; Department of Medicine (Ghesquiere), University of British Columbia, Vancouver, BC; Fraser Health (Mirzanejad), Surrey, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Departments of Pediatrics and Medicine (Kuhn), Section of Pediatric Infectious Diseases, Alberta Children's Hospital and University of Calgary, Calgary, Alta.; Travel Health and Tropical Medicine Services (Plourde), Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Man.; Trillium Health Partners (Chakrabarti), Mississauga, Ont.; Department of Medicine (Freedman), Center for Geographic Medicine, University of Alabama Birmingham, Birmingham, Ala.; SAR Laboratories (Kain), Sandra Rotman Centre, Toronto, Ont
| | - Michael Libman
- Department of Medicine (Boggild, Chakrabarti, Kain), Tropical Disease Unit, Division of Infectious Diseases, University Health Network and University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; The J.D. MacLean Centre for Tropical Diseases (Libman, Yansouni), McGill University, Montréal, Que.; Tropical Medicine and International Health Clinic (McCarthy), Division of Infectious Diseases, Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek, Mirzanejad), University of British Columbia, Vancouver, BC; Infectious Diseases (Ghesquiere), Vancouver Island Health Authority, Victoria, BC; Department of Medicine (Ghesquiere), University of British Columbia, Vancouver, BC; Fraser Health (Mirzanejad), Surrey, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Departments of Pediatrics and Medicine (Kuhn), Section of Pediatric Infectious Diseases, Alberta Children's Hospital and University of Calgary, Calgary, Alta.; Travel Health and Tropical Medicine Services (Plourde), Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Man.; Trillium Health Partners (Chakrabarti), Mississauga, Ont.; Department of Medicine (Freedman), Center for Geographic Medicine, University of Alabama Birmingham, Birmingham, Ala.; SAR Laboratories (Kain), Sandra Rotman Centre, Toronto, Ont
| | - Cedric P Yansouni
- Department of Medicine (Boggild, Chakrabarti, Kain), Tropical Disease Unit, Division of Infectious Diseases, University Health Network and University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; The J.D. MacLean Centre for Tropical Diseases (Libman, Yansouni), McGill University, Montréal, Que.; Tropical Medicine and International Health Clinic (McCarthy), Division of Infectious Diseases, Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek, Mirzanejad), University of British Columbia, Vancouver, BC; Infectious Diseases (Ghesquiere), Vancouver Island Health Authority, Victoria, BC; Department of Medicine (Ghesquiere), University of British Columbia, Vancouver, BC; Fraser Health (Mirzanejad), Surrey, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Departments of Pediatrics and Medicine (Kuhn), Section of Pediatric Infectious Diseases, Alberta Children's Hospital and University of Calgary, Calgary, Alta.; Travel Health and Tropical Medicine Services (Plourde), Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Man.; Trillium Health Partners (Chakrabarti), Mississauga, Ont.; Department of Medicine (Freedman), Center for Geographic Medicine, University of Alabama Birmingham, Birmingham, Ala.; SAR Laboratories (Kain), Sandra Rotman Centre, Toronto, Ont
| | - Anne E McCarthy
- Department of Medicine (Boggild, Chakrabarti, Kain), Tropical Disease Unit, Division of Infectious Diseases, University Health Network and University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; The J.D. MacLean Centre for Tropical Diseases (Libman, Yansouni), McGill University, Montréal, Que.; Tropical Medicine and International Health Clinic (McCarthy), Division of Infectious Diseases, Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek, Mirzanejad), University of British Columbia, Vancouver, BC; Infectious Diseases (Ghesquiere), Vancouver Island Health Authority, Victoria, BC; Department of Medicine (Ghesquiere), University of British Columbia, Vancouver, BC; Fraser Health (Mirzanejad), Surrey, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Departments of Pediatrics and Medicine (Kuhn), Section of Pediatric Infectious Diseases, Alberta Children's Hospital and University of Calgary, Calgary, Alta.; Travel Health and Tropical Medicine Services (Plourde), Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Man.; Trillium Health Partners (Chakrabarti), Mississauga, Ont.; Department of Medicine (Freedman), Center for Geographic Medicine, University of Alabama Birmingham, Birmingham, Ala.; SAR Laboratories (Kain), Sandra Rotman Centre, Toronto, Ont
| | - Jan Hajek
- Department of Medicine (Boggild, Chakrabarti, Kain), Tropical Disease Unit, Division of Infectious Diseases, University Health Network and University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; The J.D. MacLean Centre for Tropical Diseases (Libman, Yansouni), McGill University, Montréal, Que.; Tropical Medicine and International Health Clinic (McCarthy), Division of Infectious Diseases, Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek, Mirzanejad), University of British Columbia, Vancouver, BC; Infectious Diseases (Ghesquiere), Vancouver Island Health Authority, Victoria, BC; Department of Medicine (Ghesquiere), University of British Columbia, Vancouver, BC; Fraser Health (Mirzanejad), Surrey, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Departments of Pediatrics and Medicine (Kuhn), Section of Pediatric Infectious Diseases, Alberta Children's Hospital and University of Calgary, Calgary, Alta.; Travel Health and Tropical Medicine Services (Plourde), Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Man.; Trillium Health Partners (Chakrabarti), Mississauga, Ont.; Department of Medicine (Freedman), Center for Geographic Medicine, University of Alabama Birmingham, Birmingham, Ala.; SAR Laboratories (Kain), Sandra Rotman Centre, Toronto, Ont
| | - Wayne Ghesquiere
- Department of Medicine (Boggild, Chakrabarti, Kain), Tropical Disease Unit, Division of Infectious Diseases, University Health Network and University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; The J.D. MacLean Centre for Tropical Diseases (Libman, Yansouni), McGill University, Montréal, Que.; Tropical Medicine and International Health Clinic (McCarthy), Division of Infectious Diseases, Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek, Mirzanejad), University of British Columbia, Vancouver, BC; Infectious Diseases (Ghesquiere), Vancouver Island Health Authority, Victoria, BC; Department of Medicine (Ghesquiere), University of British Columbia, Vancouver, BC; Fraser Health (Mirzanejad), Surrey, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Departments of Pediatrics and Medicine (Kuhn), Section of Pediatric Infectious Diseases, Alberta Children's Hospital and University of Calgary, Calgary, Alta.; Travel Health and Tropical Medicine Services (Plourde), Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Man.; Trillium Health Partners (Chakrabarti), Mississauga, Ont.; Department of Medicine (Freedman), Center for Geographic Medicine, University of Alabama Birmingham, Birmingham, Ala.; SAR Laboratories (Kain), Sandra Rotman Centre, Toronto, Ont
| | - Yazdan Mirzanejad
- Department of Medicine (Boggild, Chakrabarti, Kain), Tropical Disease Unit, Division of Infectious Diseases, University Health Network and University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; The J.D. MacLean Centre for Tropical Diseases (Libman, Yansouni), McGill University, Montréal, Que.; Tropical Medicine and International Health Clinic (McCarthy), Division of Infectious Diseases, Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek, Mirzanejad), University of British Columbia, Vancouver, BC; Infectious Diseases (Ghesquiere), Vancouver Island Health Authority, Victoria, BC; Department of Medicine (Ghesquiere), University of British Columbia, Vancouver, BC; Fraser Health (Mirzanejad), Surrey, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Departments of Pediatrics and Medicine (Kuhn), Section of Pediatric Infectious Diseases, Alberta Children's Hospital and University of Calgary, Calgary, Alta.; Travel Health and Tropical Medicine Services (Plourde), Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Man.; Trillium Health Partners (Chakrabarti), Mississauga, Ont.; Department of Medicine (Freedman), Center for Geographic Medicine, University of Alabama Birmingham, Birmingham, Ala.; SAR Laboratories (Kain), Sandra Rotman Centre, Toronto, Ont
| | - Jean Vincelette
- Department of Medicine (Boggild, Chakrabarti, Kain), Tropical Disease Unit, Division of Infectious Diseases, University Health Network and University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; The J.D. MacLean Centre for Tropical Diseases (Libman, Yansouni), McGill University, Montréal, Que.; Tropical Medicine and International Health Clinic (McCarthy), Division of Infectious Diseases, Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek, Mirzanejad), University of British Columbia, Vancouver, BC; Infectious Diseases (Ghesquiere), Vancouver Island Health Authority, Victoria, BC; Department of Medicine (Ghesquiere), University of British Columbia, Vancouver, BC; Fraser Health (Mirzanejad), Surrey, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Departments of Pediatrics and Medicine (Kuhn), Section of Pediatric Infectious Diseases, Alberta Children's Hospital and University of Calgary, Calgary, Alta.; Travel Health and Tropical Medicine Services (Plourde), Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Man.; Trillium Health Partners (Chakrabarti), Mississauga, Ont.; Department of Medicine (Freedman), Center for Geographic Medicine, University of Alabama Birmingham, Birmingham, Ala.; SAR Laboratories (Kain), Sandra Rotman Centre, Toronto, Ont
| | - Susan Kuhn
- Department of Medicine (Boggild, Chakrabarti, Kain), Tropical Disease Unit, Division of Infectious Diseases, University Health Network and University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; The J.D. MacLean Centre for Tropical Diseases (Libman, Yansouni), McGill University, Montréal, Que.; Tropical Medicine and International Health Clinic (McCarthy), Division of Infectious Diseases, Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek, Mirzanejad), University of British Columbia, Vancouver, BC; Infectious Diseases (Ghesquiere), Vancouver Island Health Authority, Victoria, BC; Department of Medicine (Ghesquiere), University of British Columbia, Vancouver, BC; Fraser Health (Mirzanejad), Surrey, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Departments of Pediatrics and Medicine (Kuhn), Section of Pediatric Infectious Diseases, Alberta Children's Hospital and University of Calgary, Calgary, Alta.; Travel Health and Tropical Medicine Services (Plourde), Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Man.; Trillium Health Partners (Chakrabarti), Mississauga, Ont.; Department of Medicine (Freedman), Center for Geographic Medicine, University of Alabama Birmingham, Birmingham, Ala.; SAR Laboratories (Kain), Sandra Rotman Centre, Toronto, Ont
| | - Pierre J Plourde
- Department of Medicine (Boggild, Chakrabarti, Kain), Tropical Disease Unit, Division of Infectious Diseases, University Health Network and University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; The J.D. MacLean Centre for Tropical Diseases (Libman, Yansouni), McGill University, Montréal, Que.; Tropical Medicine and International Health Clinic (McCarthy), Division of Infectious Diseases, Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek, Mirzanejad), University of British Columbia, Vancouver, BC; Infectious Diseases (Ghesquiere), Vancouver Island Health Authority, Victoria, BC; Department of Medicine (Ghesquiere), University of British Columbia, Vancouver, BC; Fraser Health (Mirzanejad), Surrey, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Departments of Pediatrics and Medicine (Kuhn), Section of Pediatric Infectious Diseases, Alberta Children's Hospital and University of Calgary, Calgary, Alta.; Travel Health and Tropical Medicine Services (Plourde), Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Man.; Trillium Health Partners (Chakrabarti), Mississauga, Ont.; Department of Medicine (Freedman), Center for Geographic Medicine, University of Alabama Birmingham, Birmingham, Ala.; SAR Laboratories (Kain), Sandra Rotman Centre, Toronto, Ont
| | - Sumontra Chakrabarti
- Department of Medicine (Boggild, Chakrabarti, Kain), Tropical Disease Unit, Division of Infectious Diseases, University Health Network and University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; The J.D. MacLean Centre for Tropical Diseases (Libman, Yansouni), McGill University, Montréal, Que.; Tropical Medicine and International Health Clinic (McCarthy), Division of Infectious Diseases, Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek, Mirzanejad), University of British Columbia, Vancouver, BC; Infectious Diseases (Ghesquiere), Vancouver Island Health Authority, Victoria, BC; Department of Medicine (Ghesquiere), University of British Columbia, Vancouver, BC; Fraser Health (Mirzanejad), Surrey, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Departments of Pediatrics and Medicine (Kuhn), Section of Pediatric Infectious Diseases, Alberta Children's Hospital and University of Calgary, Calgary, Alta.; Travel Health and Tropical Medicine Services (Plourde), Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Man.; Trillium Health Partners (Chakrabarti), Mississauga, Ont.; Department of Medicine (Freedman), Center for Geographic Medicine, University of Alabama Birmingham, Birmingham, Ala.; SAR Laboratories (Kain), Sandra Rotman Centre, Toronto, Ont
| | - David O Freedman
- Department of Medicine (Boggild, Chakrabarti, Kain), Tropical Disease Unit, Division of Infectious Diseases, University Health Network and University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; The J.D. MacLean Centre for Tropical Diseases (Libman, Yansouni), McGill University, Montréal, Que.; Tropical Medicine and International Health Clinic (McCarthy), Division of Infectious Diseases, Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek, Mirzanejad), University of British Columbia, Vancouver, BC; Infectious Diseases (Ghesquiere), Vancouver Island Health Authority, Victoria, BC; Department of Medicine (Ghesquiere), University of British Columbia, Vancouver, BC; Fraser Health (Mirzanejad), Surrey, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Departments of Pediatrics and Medicine (Kuhn), Section of Pediatric Infectious Diseases, Alberta Children's Hospital and University of Calgary, Calgary, Alta.; Travel Health and Tropical Medicine Services (Plourde), Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Man.; Trillium Health Partners (Chakrabarti), Mississauga, Ont.; Department of Medicine (Freedman), Center for Geographic Medicine, University of Alabama Birmingham, Birmingham, Ala.; SAR Laboratories (Kain), Sandra Rotman Centre, Toronto, Ont
| | - Kevin C Kain
- Department of Medicine (Boggild, Chakrabarti, Kain), Tropical Disease Unit, Division of Infectious Diseases, University Health Network and University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; The J.D. MacLean Centre for Tropical Diseases (Libman, Yansouni), McGill University, Montréal, Que.; Tropical Medicine and International Health Clinic (McCarthy), Division of Infectious Diseases, Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek, Mirzanejad), University of British Columbia, Vancouver, BC; Infectious Diseases (Ghesquiere), Vancouver Island Health Authority, Victoria, BC; Department of Medicine (Ghesquiere), University of British Columbia, Vancouver, BC; Fraser Health (Mirzanejad), Surrey, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Departments of Pediatrics and Medicine (Kuhn), Section of Pediatric Infectious Diseases, Alberta Children's Hospital and University of Calgary, Calgary, Alta.; Travel Health and Tropical Medicine Services (Plourde), Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Man.; Trillium Health Partners (Chakrabarti), Mississauga, Ont.; Department of Medicine (Freedman), Center for Geographic Medicine, University of Alabama Birmingham, Birmingham, Ala.; SAR Laboratories (Kain), Sandra Rotman Centre, Toronto, Ont
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Wiklund S, Fagerberg I, Örtqvist Å, Broliden K, Tammelin A. Acquisition of extended spectrum β-lactamases during travel abroad-A qualitative study among Swedish travellers examining their knowledge, risk assessment, and behaviour. Int J Qual Stud Health Well-being 2016; 11:32378. [PMID: 27806830 PMCID: PMC5093322 DOI: 10.3402/qhw.v11.32378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Travel to foreign countries involves the risk of becoming a carrier of antibiotic-resistant bacteria, especially when the destination is a country with a high prevalence of this type of bacteria. AIM AND METHODS The aim of this study was to learn about the knowledge of antibiotic resistance, and the behaviour and risk-taking among travellers, who had become carriers of extended spectrum beta-lactamases (ESBL)-producing bacteria during travel to a high-prevalence country. A modified version of grounded theory was used to analyse 15 open interviews. RESULTS The analysis resulted in a core category: A need for knowledge to avoid risk-taking. Before the journey, the participants did not perceive there to be any risk of becoming a carrier of antibiotic- resistant bacteria. The low level of knowledge of antibiotic-resistant bacteria and transmission routes influenced their behaviour and risk-taking during their journey, resulting in them exposing themselves to risk situations. After their trip, the majority did not believe that their personal risk behaviour could have caused them to become carriers of ESBL. CONCLUSION The participants' lack of knowledge of antibiotic-resistant bacteria resulted in unconscious risk-taking during their journey, which may have resulted in becoming carriers of ESBL-producing bacteria.
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Affiliation(s)
- Susanne Wiklund
- Department of Infection Control and Hospital Hygiene, Stockholm County Council, Stockholm, Sweden
- Unit of Infectious Diseases, Department of Medicine, Solna (MedS), Karolinska, Institutet, Stockholm, Sweden
| | - Ingegerd Fagerberg
- Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden
| | - Åke Örtqvist
- Unit of Infectious Diseases, Department of Medicine, Solna (MedS), Karolinska, Institutet, Stockholm, Sweden
- Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden
| | - Kristina Broliden
- Unit of Infectious Diseases, Department of Medicine, Solna (MedS), Karolinska, Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ann Tammelin
- Department of Infection Control and Hospital Hygiene, Stockholm County Council, Stockholm, Sweden
- Unit of Infectious Diseases, Department of Medicine, Solna (MedS), Karolinska, Institutet, Stockholm, Sweden
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Illness in Canadian travellers and migrants from Brazil: CanTravNet surveillance data, 2013-2016. ACTA ACUST UNITED AC 2016; 42:153-157. [PMID: 29770022 DOI: 10.14745/ccdr.v42i08a01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background In light of the 2016 summer Olympic games it is anticipated that Canadian practitioners will require information about common illnesses that may affect travellers returning from Brazil. Objective To identify the demographic and travel correlates of illness among recent Canadian travellers and migrants from Brazil attending a network of travel health clinics across Canada. Methods Data was analyzed on returned Canadian travellers and migrants presenting to a CanTravNet site for care of an illness between June 2013 and June 2016. Results During the study period, 7,707 ill travellers and migrants presented to a CanTravNet site and 89 (0.01%) acquired their illness in Brazil. Tourists were most well represented (n=45, 50.6%), followed by those travelling to "visit friends and relatives" (n=14, 15.7%). The median age was 37 years (range <1-78 years), 49 travellers were men (55.1%) and 40 were women (44.9%). Of the 40 women, 26 (65%) were of childbearing age. Nine percent (n=8) of travellers were diagnosed with arboviruses including dengue (n=6), chikungunya (n=1) and Zika virus (n=1), while another 14.6% (n=13) presented for care of non-specific viral syndrome (n=7), non-specific febrile illness (n=1), peripheral neuropathy (n=1) and non-specific rash (n=4), which are four syndromes that may be indicative of Zika virus infection. Ill returned travellers to Brazil were more likely to present for care of arboviral or Zika-like illness than other ill returned travellers to South America (23.6 per 100 travellers versus 10.5 per 100 travellers, respectively [p=0.0024]). Interpretation An epidemiologic approach to illness among returned Canadian travellers to Brazil can inform Canadian practitioners encountering both prospective and returned travellers to the Olympic games. Analysis showed that vector-borne illnesses such as dengue are common and even in this small group of travellers, both chikungunya and Zika virus were represented. It is extremely important to educate travellers about mosquito-avoidance measures in advance of travel to Brazil.
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Sridhar S, Régner I, Brouqui P, Gautret P. Methodologies for measuring travelers' risk perception of infectious diseases: A systematic review. Travel Med Infect Dis 2016; 14:360-72. [PMID: 27238906 PMCID: PMC7110652 DOI: 10.1016/j.tmaid.2016.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 12/14/2022]
Abstract
Numerous studies in the past have stressed the importance of travelers' psychology and perception in the implementation of preventive measures. The aim of this systematic review was to identify the methodologies used in studies reporting on travelers' risk perception of infectious diseases. A systematic search for relevant literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. There were 39 studies identified. In 35 of 39 studies, the methodology used was that of a knowledge, attitude and practice (KAP) survey based on questionnaires. One study used a combination of questionnaires and a visual psychometric measuring instrument called the 'pictorial representation of illness and self-measurement" or PRISM. One study used a self-representation model (SRM) method. Two studies measured psychosocial factors. Valuable information was obtained from KAP surveys showing an overall lack of knowledge among travelers about the most frequent travel-associated infections and associated preventive measures. This methodological approach however, is mainly descriptive, addressing knowledge, attitudes, and practices separately and lacking an examination of the interrelationships between these three components. Another limitation of the KAP method is underestimating psychosocial variables that have proved influential in health related behaviors, including perceived benefits and costs of preventive measures, perceived social pressure, perceived personal control, unrealistic optimism and risk propensity. Future risk perception studies in travel medicine should consider psychosocial variables with inferential and multivariate statistical analyses. The use of implicit measurements of attitudes could also provide new insights in the field of travelers' risk perception of travel-associated infectious diseases.
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Affiliation(s)
- Shruti Sridhar
- Aix Marseille Université, Emerging Tropical and Infectious Disease Unit (URMITE), Faculty of Medicine, 27 Bd Jean Moulin, 13005 Marseille, France
| | - Isabelle Régner
- Aix Marseille Université, CNRS, LPC UMR 7290, 13331, Marseille, France
| | - Philippe Brouqui
- Aix Marseille Université, Emerging Tropical and Infectious Disease Unit (URMITE), Faculty of Medicine, 27 Bd Jean Moulin, 13005 Marseille, France; Assistance Publique Hôpitaux de Marseille, Institut Méditerranée Infection, Infectious Diseases and Tropical Medicine Unit, North Hospital, Chemin des Bourrelys, 13915, Marseille, France
| | - Philippe Gautret
- Aix Marseille Université, Emerging Tropical and Infectious Disease Unit (URMITE), Faculty of Medicine, 27 Bd Jean Moulin, 13005 Marseille, France; Assistance Publique Hôpitaux de Marseille, Institut Méditerranée Infection, Infectious Diseases and Tropical Medicine Unit, North Hospital, Chemin des Bourrelys, 13915, Marseille, France.
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Boggild AK, Geduld J, Libman M, Yansouni CP, McCarthy AE, Hajek J, Ghesquiere W, Vincelette J, Kuhn S, Freedman DO, Kain KC. Malaria in travellers returning or migrating to Canada: surveillance report from CanTravNet surveillance data, 2004-2014. CMAJ Open 2016; 4:E352-E358. [PMID: 27730099 PMCID: PMC5047843 DOI: 10.9778/cmajo.20150115] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Malaria remains the most common specific cause of fever in returned travellers and can be life-threatening. We examined demographic and travel correlates of malaria among Canadian travellers and immigrants to identify groups for targeted pretravel intervention. METHODS Descriptive data on ill returned Canadian travellers and immigrants presenting to a CanTravNet site between 2004 and 2014 with a diagnosis of malaria were analyzed. Data were collected using the GeoSentinel data platform. This network comprises 63 specialized travel and tropical medicine clinics, including 7 Canadian sites (Vancouver, Calgary, Toronto, Ottawa, Winnipeg and Montréal), that contribute anonymous, delinked, clinician- and questionnaire-based travel surveillance data on all ill travellers examined to a centralized Structure Query Language database. RESULTS During the study period, 20 345 travellers and immigrants were evaluated, and 93% had a travel-related diagnosis. Of these, 437 (2.1%) patients received 456 malaria diagnoses, the most common species being Plasmodium falciparum (n = 282, 61.8%). People travelling to visit friends and relatives were most well-represented (n = 169, 38.7%), followed by business travellers (n = 71, 16.2%). Sub-Saharan Africa was the most common source region, accounting for 341 (74.8%) malaria diagnoses, followed by South Central Asia (n = 55, 12%). Nigeria was the most well-represented source country, accounting for 41 cases (9.0%). India, a high-volume destination for Canadians, accounted for 40 cases (8.8%), 36 of which were caused by Plasmodium vivax. Of 456 malaria diagnoses, 26 (5.7%) were severe. Of 377 nonimmigrant travellers with malaria, 19.9% (n = 75) travelled for less than 2 weeks, and 7.2% (n = 27) travelled for less than 1 week. INTERPRETATION This analysis provides an epidemiologic framework for Canadian practitioners encountering prospective and returned travellers. It confirms the importance of preventive measures and surveillance associated with travel to sub-Saharan Africa and India, particularly by travellers visiting friends or relatives. Short-duration travel confers important malaria risk.
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Affiliation(s)
- Andrea K Boggild
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont
| | - Jennifer Geduld
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont
| | - Michael Libman
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont
| | - Cedric P Yansouni
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont
| | - Anne E McCarthy
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont
| | - Jan Hajek
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont
| | - Wayne Ghesquiere
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont
| | - Jean Vincelette
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont
| | - Susan Kuhn
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont
| | - David O Freedman
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont
| | - Kevin C Kain
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont
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29
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Travel Risks and Preventive Strategies: An Overview. INTERNATIONAL JOURNAL OF TRAVEL MEDICINE AND GLOBAL HEALTH 2016. [DOI: 10.20286/ijtmgh-04021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Drewett G, Leder K. Infectious disease following travel to developed regions: a snapshot of presentations to an Australian travel medicine clinic. J Travel Med 2016; 23:taw053. [PMID: 27496541 DOI: 10.1093/jtm/taw053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/11/2016] [Indexed: 12/30/2022]
Abstract
Much of the travel medicine literature focuses on travel to 'developing' regions by travellers from 'developed' regions; however literature about travel to developed regions is scarce. This article examines presentations to a travel medicine clinic over a 17-year period with illnesses resulting from travel to developed regions. From a cohort of general presentations to the clinic of 1077 patients, 85 patients acquired infections due to travel to developed regions, with a total of 99 infectious diagnoses made. This serves to highlight the risk of infectious disease even among travel to only developed regions, and the importance of travel advice in these situations.
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Affiliation(s)
- George Drewett
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Karin Leder
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Australia Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
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Eberhardt KA, Vinnemeier CD, Dehnerdt J, Rolling T, Steffen R, Cramer JP. Travelers to the FIFA world cup 2014 in Brazil: Health risks related to mass gatherings/sports events and implications for the Summer Olympic Games in Rio de Janeiro in 2016. Travel Med Infect Dis 2016; 14:212-20. [PMID: 27238909 DOI: 10.1016/j.tmaid.2016.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health threats during mass gatherings, such as the FIFA world cup 2014 differ from traditional health risks. The influence of event type, demographics of attendees and environmental conditions are still not fully understood. METHODS An observational, prospective case-control survey conducted at the Frankfurt international airport in Germany on 544 travelers to the FIFA world cup 2014 and 432 regular travelers to Brazil departing after the end of the world cup. RESULTS Travelers to the FIFA world cup 2014 were predominantly male whereas the gender distribution in the control group was more balanced. The majority in both groups obtained insect bites and sunburns as environmental risk factors. Every third traveler suffered from diarrheal complaints in both groups, whereas the proportion of travelers with flu-like symptoms was higher in the case group. Travelers to the FIFA world cup 2014 indicated alcohol intake and sexual contacts outside of a relationship more frequently than travelers in the control group. CONCLUSIONS The additional health risks of travelers to sporting events as the FIFA world cup 2014 should be addressed in addition to traditional health threats in pre-travel counseling for the Summer Olympic Games 2016 in Brazil.
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Affiliation(s)
| | - Christof David Vinnemeier
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Section Tropical Medicine, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Dehnerdt
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Thierry Rolling
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Section Tropical Medicine, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Steffen
- University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travelers' Health, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
| | - Jakob Peter Cramer
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
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Flaherty G, Md Nor MN. Travel itinerary uncertainty and the pre-travel consultation--a pilot study. J Travel Med 2016; 23:tav010. [PMID: 26782127 DOI: 10.1093/jtm/tav010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 11/13/2022]
Abstract
Risk assessment relies on the accuracy of the information provided by the traveller. A questionnaire was administered to 83 consecutive travellers attending a travel medicine clinic. The majority of travellers was uncertain about destinations within countries, transportation or type of accommodation. Most travellers were uncertain if they would be visiting malaria regions. The degree of uncertainty about itinerary potentially impacts on the ability of the travel medicine specialist to perform an adequate risk assessment, select appropriate vaccinations and prescribe malaria prophylaxis. This study reveals high levels of traveller uncertainty about their itinerary which may potentially reduce the effectiveness of their pre-travel consultation.
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Affiliation(s)
- Gerard Flaherty
- School of Medicine, National University of Ireland, Galway, Ireland and School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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Heywood AE, Forssman BL, Seale H, MacIntyre CR, Zwar N. General Practitioners' Perception of Risk for Travelers Visiting Friends and Relatives. J Travel Med 2015; 22:368-74. [PMID: 26173496 DOI: 10.1111/jtm.12229] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/12/2015] [Accepted: 06/08/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND General practitioners (GPs) are an important source of pre-travel health advice for travelers; however, only a few studies have investigated primary healthcare provider-related barriers to the provision of pre-travel health advice, particularly to travelers visiting friends and relatives (VFR). We aimed to investigate Australian GPs' knowledge, attitudes, and practices with regard to VFR travelers. METHODS A postal survey was sent to randomly sampled GPs in Sydney, Australia, in 2012. The questionnaire investigated GPs' perception of risk and barriers to the provision of advice to VFR travelers. RESULTS Of 563 GPs, 431 (76.6%) spoke a language other than English (LOTE) with 361 (64.1%) consulting in a LOTE. Overall, 222 (39.4%) GPs considered VFR travelers to be at higher risk than holiday travelers, with GPs consulting in English only [adjusted odds ratio (aOR) 1.65, 95% confidence interval (CI) 1.11-2.44, p = 0.01] and GPs considering long-term migrants as VFR travelers (aOR 1.86 95% CI 1.07-3.23, p = 0.03) remaining significant on multivariate analysis. CONCLUSIONS Multilingual GPs are a valuable resource to reducing language and cultural barriers to healthcare. Targeted education of this subgroup of GPs may assist in promoting pre-travel health assessments for VFR travelers. Awareness of the need for opportunistic targeting of migrants for pre-travel consultation through routine identification of future travel is needed.
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Affiliation(s)
- Anita E Heywood
- School of Public Health & Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | - Bradley L Forssman
- Public Health Unit, Nepean Blue Mountains Local Health District, Sydney, NSW, Australia
| | - Holly Seale
- School of Public Health & Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | - C Raina MacIntyre
- School of Public Health & Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | - Nicholas Zwar
- School of Public Health & Community Medicine, UNSW Australia, Sydney, NSW, Australia
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Boggild AK, Esposito DH, Kozarsky PE, Ansdell V, Beeching NJ, Campion D, Castelli F, Caumes E, Chappuis F, Cramer JP, Gkrania-Klotsas E, Grobusch MP, Hagmann SH, Hynes NA, Lim PL, López-Vélez R, Malvy DJ, Mendelson M, Parola P, Sotir MJ, Wu HM, Hamer DH. Differential diagnosis of illness in travelers arriving from Sierra Leone, Liberia, or Guinea: a cross-sectional study from the GeoSentinel Surveillance Network. Ann Intern Med 2015; 162:757-64. [PMID: 25961811 PMCID: PMC4629254 DOI: 10.7326/m15-0074] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The largest-ever outbreak of Ebola virus disease (EVD), ongoing in West Africa since late 2013, has led to export of cases to Europe and North America. Clinicians encountering ill travelers arriving from countries with widespread Ebola virus transmission must be aware of alternate diagnoses associated with fever and other nonspecific symptoms. OBJECTIVE To define the spectrum of illness observed in persons returning from areas of West Africa where EVD transmission has been widespread. DESIGN Descriptive, using GeoSentinel records. SETTING 57 travel or tropical medicine clinics in 25 countries. PATIENTS 805 ill returned travelers and new immigrants from Sierra Leone, Liberia, or Guinea seen between September 2009 and August 2014. MEASUREMENTS Frequencies of demographic and travel-related characteristics and illnesses reported. RESULTS The most common specific diagnosis among 770 nonimmigrant travelers was malaria (n = 310 [40.3%]), with Plasmodium falciparum or severe malaria in 267 (86%) and non-P. falciparum malaria in 43 (14%). Acute diarrhea was the second most common diagnosis among nonimmigrant travelers (n = 95 [12.3%]). Such common diagnoses as upper respiratory tract infection, urinary tract infection, and influenza-like illness occurred in only 26, 9, and 7 returning travelers, respectively. Few instances of typhoid fever (n = 8), acute HIV infection (n = 5), and dengue (n = 2) were encountered. LIMITATION Surveillance data collected by specialist clinics may not be representative of all ill returned travelers. CONCLUSION Although EVD may currently drive clinical evaluation of ill travelers arriving from Sierra Leone, Liberia, and Guinea, clinicians must be aware of other more common, potentially fatal diseases. Malaria remains a common diagnosis among travelers seen at GeoSentinel sites. Prompt exclusion of malaria and other life-threatening conditions is critical to limiting morbidity and mortality. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Andrea K. Boggild
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Douglas H. Esposito
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Phyllis E. Kozarsky
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Vernon Ansdell
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Nicholas J. Beeching
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Daniel Campion
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Francesco Castelli
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Eric Caumes
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Francois Chappuis
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Jakob P. Cramer
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Effrossyni Gkrania-Klotsas
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Martin P. Grobusch
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Stefan H.F. Hagmann
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Noreen A. Hynes
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Poh Lian Lim
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Rogelio López-Vélez
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Denis J.M. Malvy
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Marc Mendelson
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Philippe Parola
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Mark J. Sotir
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Henry M. Wu
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Davidson H. Hamer
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
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Steffen R, Behrens RH, Hill DR, Greenaway C, Leder K. Vaccine-preventable travel health risks: what is the evidence--what are the gaps? J Travel Med 2015; 22:1-12. [PMID: 25378212 DOI: 10.1111/jtm.12171] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 08/02/2014] [Accepted: 09/08/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Existing travel health guidelines are based on a variety of data with underpinning evidence ranging from high-quality randomized controlled trials to best estimates from expert opinion. For strategic guidance and to set overall priorities, data about average risk are useful. The World Health Organization (WHO) plans to base future editions of "International Travel and Health" on its new "Handbook for Guideline Development." METHODS Based on a systematic search in PubMed, the existing evidence and quality of data on vaccine-preventable disease (VPD) risks in travelers was examined and essentials of vaccine efficacy were briefly reviewed. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to evaluate the quality of the data. RESULTS Moderate-quality data to determine the risk of VPD exist on those that are frequently imported, whereas in most others the level of confidence with existing data is low or very low. CONCLUSIONS In order for the WHO to produce graded risk statements in the updated version of "International Travel and Health," major investment of time plus additional high-quality, generalizable risk data are needed.
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Affiliation(s)
- Robert Steffen
- Department of Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, WHO Collaborating Centre for Traveller's Health, Zurich, Switzerland
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