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Baldovin T, Amoruso I, Zangrando D, Cocchio S, Maharjan M, Lazzari R, Buja A, Baldo V, Bertoncello C. Soil-transmitted helminthiases in Nepal: Transmission boundaries and implications for local communities and international travelers. Acta Trop 2019; 196:155-164. [PMID: 30991017 DOI: 10.1016/j.actatropica.2019.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/02/2019] [Accepted: 04/12/2019] [Indexed: 12/28/2022]
Abstract
Soil transmitted helminthiasis (STHs) are endemic in Nepal but since the country territory is extremely heterogeneous, a multidisciplinary assessment is required to evaluate the risk of infection in different areas. Prevalence data were retrieved with systematic literature search and geographical coordinates were assigned to each survey site. Spatial stratification was then implemented considering land use and ecological parameters. STH transmission boundaries were tested after reference criteria and elevation was evaluated as additional predictor: the elevation threshold of 3057 m above sea level is demarking the STH transmission limit. Areas above this threshold are safe, but since lodging in at-risk sites is a compulsory stopover for international travelers, STH risk exposure should be considered for every travel to the country.
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Lindsay L, DuPont HL, Moe CL, Alberer M, Hatz C, Kirby AE, Wu HM, Verstraeten T, Steffen R. Estimating the incidence of norovirus acute gastroenteritis among US and European international travelers to areas of moderate to high risk of traveler's diarrhea: a prospective cohort study protocol. BMC Infect Dis 2018; 18:605. [PMID: 30509202 PMCID: PMC6276235 DOI: 10.1186/s12879-018-3461-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 10/31/2018] [Indexed: 12/31/2022] Open
Abstract
Background Acute gastroenteritis (AGE) is the leading cause of illness among returning travelers seeking medical care. Multiple types of enteric pathogens can cause travel-acquired AGE and, while bacterial pathogens have a predominant role, the importance of viruses, such as norovirus, is increasingly recognized. There is a lack of information on travel-acquired norovirus incidence among symptomatic and asymptomatic individuals irrespective of healthcare-seeking behavior. Our aim is to estimate the incidence of travel-acquired AGE due to norovirus and to characterize the burden of disease among international travelers from the United States and Europe. Methods We describe a prospective cohort study implemented in five US and European sites to estimate the role of AGE due to norovirus among adult international travelers. We enrolled individuals aged 18 years and older who are traveling to regions of moderate-high risk of AGE, or via cruise ship with an international port stop, with a trip duration of 3–15 days. The study will generate a wide range of health and travel-related data for pre-, during, and up to 6-months post-travel. We will identify laboratory-confirmed travel-acquired norovirus infections among both symptomatic and asymptomatic individuals from self-collected whole stool samples tested via quantitative RT-PCR. Coinfections will be identified in a subset of travelers with AGE using a multiplex molecular-based assay. Discussion This study is unique in design and breadth of data collected. The prospective collection of health and behavioral data, as well as biologic samples from travelers irrespective of symptoms, will provide useful data to better understand the importance of norovirus AGE among international travelers. This study will provide data to estimate the incidence of norovirus infections and AGE and the risk of post-infectious sequelae in the 6-month post-travel period serving as a baseline for future norovirus AGE vaccination studies. This study will contribute valuable information to better understand the role of norovirus in travel-acquired AGE risk and the impact of these infections on a broad set of outcomes.
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Affiliation(s)
- Lisa Lindsay
- P95 Pharmacovigilance and Epidemiology Services, Koning Leopold III Laan 1, 3001, Leuven, Belgium.
| | - Herbert L DuPont
- University of Texas McGovern Medical School and School of Public Health, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Christine L Moe
- Emory University, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Martin Alberer
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
| | - Christoph Hatz
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4056, Basel, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland.,University of Zurich; Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Centre for Travellers' Health, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Amy E Kirby
- Emory University, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Henry M Wu
- Emory University, Division of Infectious Diseases, Department of Medicine, 550 Peachtree Street NE MOT 7, Atlanta, GA, 30308, USA
| | - Thomas Verstraeten
- P95 Pharmacovigilance and Epidemiology Services, Koning Leopold III Laan 1, 3001, Leuven, Belgium
| | - Robert Steffen
- University of Texas McGovern Medical School and School of Public Health, 1200 Pressler Street, Houston, TX, 77030, USA.,University of Zurich; Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Centre for Travellers' Health, Hirschengraben 84, 8001, Zurich, Switzerland
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Traveler's Diarrhea Recommendations for Solid Organ Transplant Recipients and Donors. Transplantation 2018; 102:S35-S41. [PMID: 29381576 DOI: 10.1097/tp.0000000000002015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Nissan B, Lachish T, Schwartz E. The effectiveness of empirical anti-parasitic treatment in returning travellers with persistent abdominal symptoms. J Travel Med 2018; 25:4711104. [PMID: 29232458 DOI: 10.1093/jtm/tax083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/14/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persistent abdominal symptoms (PAS) are common among returning-travellers. In the absence of sensitive tests to identify intestinal parasites, gastrointestinal (GI) symptoms often remain a diagnostic challenge. In this study we examined the effectiveness of empirical anti-parasitic treatment in returning-travellers with PAS despite no positive stool-test. METHODS A retrospective study among returning travellers who approached the clinic between the years 2014 and 2016 with GI complaints without a positive stool-test. The empirical treatment included broad-spectrum anti-parasitic agents-oral Tinidazole and Albendazole. A follow-up questionnaire was performed at least 6 months post-treatment. RESULTS A total of 102 patients responded the questionnaire-50% women; average age 31.14 (±12.20) years. The average duration of complaints before treatment was 16.52 (±30.06) months. Common GI symptoms included abdominal pain (83.3%) and diarrhoea (78.4%); 67.6% of the patients complained of extreme fatigue. Overall, 69% of the patients reported an improvement in GI symptoms, 37% of them reported full recovery within a few weeks post-treatment. Furthermore, there was an improvement in the energy level and general well-being in 68% and 70% of the patients, respectively. Only 33% of the patients reported minor side effects related to the treatment. CONCLUSIONS The improvement in GI symptoms, energy level and general well-being shortly after anti-parasitic treatment justifies this empirical approach in returning-travellers with PAS despite negative stool-tests. The association between fatigue and PAS post-travel and the improvement in both as a response to treatment defines fatigue as part of a new syndrome-'Post-travel fatigue and abdominal symptoms'.
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Affiliation(s)
- Batel Nissan
- The Faculty of Medicine, the Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Tamar Lachish
- The Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Eli Schwartz
- The Center for Geographic Medicine, the Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Duplessis CA, Gutierrez RL, Porter CK. Review: chronic and persistent diarrhea with a focus in the returning traveler. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2017; 3:9. [PMID: 28883979 PMCID: PMC5531020 DOI: 10.1186/s40794-017-0052-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 04/18/2017] [Indexed: 02/08/2023]
Abstract
Background Travelers’ diarrhea is a common malady afflicting up to 50% of travelers after a 2-week travel period. An appreciable percentage of these cases will become persistent or chronic. We summarized the published literature reporting persistent/chronic diarrhea in travelers elucidating current understanding of disease incidence, etiology and regional variability. Methods We searched electronic databases (Medline, Embase, and Cochrane database of clinical trials) from 1990 to 2015 using the following terms: “chronic or persistent diarrh* and (returning) travel* or enteropathogen, GeoSentinel, and travel-associated infection. Included studies published in the English language on adult returning travelers (duration < 3-months) reporting denominator data. Point estimates and standard 95% confidence intervals were calculated for incidence using a random-effects model. Study incidence heterogeneity rates were assessed using x2 heterogeneity statistics, graphically represented with Forest plots. Results We identified 19 studies meeting the inclusion criteria (all published after 1999). 18 studies reported upon the incidence of persistent/chronic diarrhea as a syndromic diagnosis in returning travelers; one study reported adequate denominator data from which to assess pathogen specific etiology. Giardiasis comprise an appreicaible percentage of infectious mediated persistent/chronic diarrhea in returning travelers. The overall estimate of persistent/chronic diarrhea incidence was 6% (0.05–0.07) in 321,454, travelers; with significant heterogeniety observed across regions. The total number of regional travelers, and point estimates for incidence (95% CI) for Latin American, African, and Asian travelers were [15816 (0.09 [0.07–0.11]), 42290 (0.06 [0.05–0.07]), and 27433 (0.07 [0.06–0.09])] respectively. We identified lower published rates of chronic diarrhea from Sub-Saharan Africa relative to [North Africa, South Central Asia, and Central America]. Persistent/chronic diarrhea ranked fourth as a syndromic diagnosis in all regions. Conclusions Persistent/Chronic diarrhea is a leading syndromic diagnosis in returning travelers across all regions. The 6% incidence [proportionate morbidity (PM) of 60] observed in over >300,000 global travelers is comparable to prior estimates. We identified lower published rates of chronic diarrhea from Sub-Saharan Africa relative to [North Africa, South Central Asia, and Central America]. Giardiasis comprises an appreciabile percentatge of travel-associated infectious mediated persistent/chronic diarrhea. There’s a dearth of published data characterizing the incidence of specific enteropathogenic etiologies for persistent/chronic diarrhea in returning travelers.
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Affiliation(s)
- Christopher A Duplessis
- Enteric Disease Department, Infectious Disease Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910 USA
| | - Ramiro L Gutierrez
- Enteric Disease Department, Infectious Disease Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910 USA
| | - Chad K Porter
- Enteric Disease Department, Infectious Disease Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910 USA
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Abstract
Familiarity with the distribution, mode of transmission, and risk factors for acquisition of illnesses commonly transmitted to travelers to low-income nations can help guide clinicians in their work-up of an ill returned traveler. The 3 most common categories of illness in returned international travelers are gastrointestinal illness, fever, and dermatoses. Diarrhea is the most common illness reported in returned international travelers. Fever is a marker of a potentially significant illness; work-up of the ill febrile returned traveler should be conducted promptly.
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Affiliation(s)
- Christopher A Sanford
- Family Medicine, Global Health, University of Washington, Box 358732, Seattle, WA 98125, USA.
| | - Claire Fung
- Family Medicine, The Everett Clinic at Snohomish, 401 2nd Street, Snohomish, WA 98290, USA; Department of Family Medicine, University of Washington Family Medicine Residency, 331 Northeast Thornton Place, Seattle, WA 98125, USA
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Ricotta EE, Palmer A, Wymore K, Clogher P, Oosmanally N, Robinson T, Lathrop S, Karr J, Hatch J, Dunn J, Ryan P, Blythe D. Epidemiology and antimicrobial resistance of international travel-associated Campylobacter infections in the United States, 2005-2011. Am J Public Health 2014; 104:e108-14. [PMID: 24832415 DOI: 10.2105/ajph.2013.301867] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The objective of this study was to determine the role international travel plays in US Campylobacter epidemiology and antimicrobial resistance. METHODS In this study, epidemiological and antimicrobial resistance data, encompassing the years 2005 to 2011, from 10 sites participating in the Foodborne Diseases Active Surveillance Network were linked. The 10 sites are represented by 7 states that conducted surveillance on a statewide level, and 3 states which conducted county-level surveillance. Cases of Campylobacter among persons with history of international travel in the week prior to illness were compared with cases among individuals with no international travel. RESULTS Approximately 18% of Campylobacter infections were estimated to be associated with international travel, and 60% of international travel-associated infections had a quinolone-resistant Campylobacter isolate. CONCLUSIONS We confirm that international travel plays a significant role in campylobacteriosis diagnosed in the United States. Recognizing this is important to both medical management decisions and understanding burden and attribution estimates of US campylobacteriosis and antibiotic-resistant campylobacteriosis.
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Affiliation(s)
- Emily E Ricotta
- Emily E. Ricotta, Amanda Palmer, Patricia Ryan, and David Blythe are with the Maryland Department of Health and Mental Hygiene, Baltimore. Katie Wymore is with Public Health Foundation Enterprises, Oakland, CA. Paula Clogher is with the Yale School of Public Health, New Haven, CT. Nadine Oosmanally is with the Georgia Department of Public Health, Atlanta. Trisha Robinson is with the Minnesota Department of Health, St. Paul. Sarah Lathrop is with the University of New Mexico, Alburquerque. Jillian Karr is with the New York State Department of Health, Rochester. Julie Hatch is with the Oregon Health Authority, Public Health Division, Portland. John Dunn is with the Tennessee Department of Health, Nashville
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The Diagnosis of Traveler’s Diarrhea Disguises an Unusual Cause of Ileus. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2013. [DOI: 10.1097/ipc.0b013e31827ddec9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marchou B. Diarrhées du voyageur : épidémiologie, prévention et conduite à tenir. Presse Med 2013; 42:76-81. [DOI: 10.1016/j.lpm.2012.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 10/04/2012] [Indexed: 01/10/2023] Open
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Tran HD, Alam M, Trung NV, Van Kinh N, Nguyen HH, Pham VC, Ansaruzzaman M, Rashed SM, Bhuiyan NA, Dao TT, Endtz HP, Wertheim HFL. Multi-drug resistant Vibrio cholerae O1 variant El Tor isolated in northern Vietnam between 2007 and 2010. J Med Microbiol 2011; 61:431-437. [PMID: 22016560 PMCID: PMC3347965 DOI: 10.1099/jmm.0.034744-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Since 2007, there has been a re-emergence of cholera outbreaks in northern Vietnam. To understand the molecular epidemiological relatedness and determine the antibiotic susceptibility profiles of responsible V. cholerae O1 outbreak strains, a representative collection of 100 V. cholerae O1 strains was characterized. V. cholerae O1 strains isolated from diarrhoeal patients in northern Vietnam between 2007 and 2010 were investigated for antibiotic susceptibility and characterized by using phenotypic and genotypic tests, including PFGE analysis. Ten clinical V. cholerae O1 isolates from Bangladesh and Zimbabwe were included for comparison. The results revealed that all isolates were resistant to co-trimoxazole and nalidixic acid, 29 % were resistant to tetracycline and 1 % were resistant to azithromycin. All strains were susceptible to ampicillin–sulbactam, doxycycline, chloramphenicol and ciprofloxacin and 95 % were susceptible to azithromycin. MIC values did show reduced susceptibility to fluoroquinolones and 63 % of the strains were intermediately resistant to tetracycline. The isolates expressed phenotypic traits of both serogroup O1 Ogawa and El Tor and harboured an rstR El Tor and ctxB classical biotype. Among the outbreak isolates, only a single PFGE pattern was observed throughout the study period. This study shows that multi-drug resistant V. cholerae altered El Tor producing classical CT strains are now predominant in northern Vietnam.
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Affiliation(s)
- Huu Dat Tran
- Department of Medical Microbiology, Hanoi Medical University, 1 Ton That Tung Street, Hanoi, Vietnam.,National Hospital of Tropical Diseases, 78 Giai Phong Street, Hanoi, Vietnam
| | - Munirul Alam
- Enteric & Food Microbiology Laboratory, ICDDR,B: International Centre for Diarrhoeal Disease Research, Bangladesh GPO Box 128, Dhaka 1000, Bangladesh
| | - Nguyen Vu Trung
- Department of Medical Microbiology, Hanoi Medical University, 1 Ton That Tung Street, Hanoi, Vietnam.,National Hospital of Tropical Diseases, 78 Giai Phong Street, Hanoi, Vietnam
| | - Nguyen Van Kinh
- Department of Infectious Diseases, Hanoi Medical University, 1 Ton That Tung Street, Hanoi, Vietnam.,National Hospital of Tropical Diseases, 78 Giai Phong Street, Hanoi, Vietnam
| | - Hong Ha Nguyen
- National Hospital of Tropical Diseases, 78 Giai Phong Street, Hanoi, Vietnam
| | - Van Ca Pham
- National Hospital of Tropical Diseases, 78 Giai Phong Street, Hanoi, Vietnam
| | - Mohammad Ansaruzzaman
- Enteric & Food Microbiology Laboratory, ICDDR,B: International Centre for Diarrhoeal Disease Research, Bangladesh GPO Box 128, Dhaka 1000, Bangladesh
| | - Shah Manzur Rashed
- Enteric & Food Microbiology Laboratory, ICDDR,B: International Centre for Diarrhoeal Disease Research, Bangladesh GPO Box 128, Dhaka 1000, Bangladesh
| | - Nurul A Bhuiyan
- Enteric & Food Microbiology Laboratory, ICDDR,B: International Centre for Diarrhoeal Disease Research, Bangladesh GPO Box 128, Dhaka 1000, Bangladesh
| | - Tuyet Trinh Dao
- National Hospital of Tropical Diseases, 78 Giai Phong Street, Hanoi, Vietnam
| | - Hubert P Endtz
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.,Enteric & Food Microbiology Laboratory, ICDDR,B: International Centre for Diarrhoeal Disease Research, Bangladesh GPO Box 128, Dhaka 1000, Bangladesh
| | - Heiman F L Wertheim
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Old Road, Oxford OX3 7LJ, UK.,Oxford University Clinical Research Unit Vietnam, Wellcome Trust Major Overseas Program, National Hospital of Tropical Diseases, 78 Giai Phong Road, Dong Da, Hanoi, Vietnam
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