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Satarvandi D, van der Werff SD, Nauclér P, Hildenwall H, Sondén K. Scoring systems for prediction of malaria and dengue fever in non-endemic areas among travellers arriving from tropical and subtropical areas. Emerg Med J 2024; 41:242-248. [PMID: 38355290 PMCID: PMC10982626 DOI: 10.1136/emermed-2023-213296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Fever is a common symptom among travellers returning from tropical/subtropical areas to Europe, and promptly distinguishing severe illnesses from self-limiting febrile syndromes is important but can be challenging due to non-specific clinical presentation. METHODS A cross-sectional study enrolled adults and children who sought care during 2015-2020 at Karolinska University Hospital, Stockholm, Sweden with fever within 2 months after returning from travel to a tropical/subtropical area. Data on symptoms and laboratory parameters were prospectively and retrospectively collected. Two separate scoring systems for malaria and dengue were developed based on backward elimination regressions. RESULTS In total, 2113 adults (18-94 years) and 202 children (1-17 years) were included, with 112 (4.8%) confirmed malaria by blood thick smear and 90 (3.9%) PCR/serology dengue-positive cases. Malaria was more likely in a patient who had visited sub-Saharan Africa and presented with combination of thrombocytopenia, anaemia and fever ≥39.5°C. Leucopenia, muscle pain and rash after travelling to Asia or South/Latin America indicated high probability of dengue. Two scoring systems with points between 0 and 7 for prediction of malaria or dengue were created based on the above predictors. Scores ≥3 indicated >80% sensitivity and specificity for malaria and >90% specificity for dengue in children and adults (area under the curve (AUC) for dengue: 0.92 in adults (95% CI 0.90 to 0.95) and 0.95 in children (95% CI 0.88 to 1.0); AUC for malaria: 0.93 in adults (95% CI 0.91 to 0.96) and 0.88 in children (95% CI 0.78 to 0.99)). Internal validation of optimism and overfitting was managed with bootstrap. CONCLUSION The presented scoring systems provide novel tools for structured assessment of patients with tropical fever in a non-endemic area and highlight clinical signs associated with a potential severe aetiology to direct the need for microbial investigation.
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Affiliation(s)
- Donya Satarvandi
- Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Suzanne Desirée van der Werff
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Nauclér
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Hildenwall
- Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Karolinska Institute, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Klara Sondén
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
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Selimaj Kontoni V, Goetghebuer T, Hainaut M, Vanderfaeillie A, Nguyen VTP, Jourdain S, Pace D. Imported Malaria in Children: A Study Over an 11-Year Period in Brussels. Pediatr Infect Dis J 2023; 42:733-738. [PMID: 37406181 DOI: 10.1097/inf.0000000000003986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Malaria is a major global public health concern in endemic countries and imported childhood malaria is increasing in malaria non-endemic countries. METHODS This was a retrospective case review of all laboratory-confirmed malaria cases in children 0-16 years admitted between 2009 and 2019 in 2 large university teaching Hospitals in Brussels. RESULTS A total of 160 children with a median age of 6.8 years (range 5-191 months) were included. We identified 109 (68%) children living in Belgium who had acquired malaria during their visit to malaria-endemic countries to visiting friends and relatives (VFRs), 49 children (31%) visitors or newly installed migrants, and 2 Belgian tourists. Peak seasonal incidence occurred between August and September. Plasmodium falciparum was responsible for 89% of all malaria cases. Almost 80% of children living in Belgium visited a travel clinic for advice, but only one-third reported having taken the prophylaxis schedule according to the recommendations. Based on WHO criteria, 31 children (19.3%) developed severe malaria; most of the patients with severe malaria were VFR travelers and were significantly younger, had higher leukocytosis, had more thrombocytopenia, higher CRP, and lower natremia compared with patients with an uncomplicated course. All children recovered fully. CONCLUSIONS Malaria is a significant cause of morbidity among returning travelers and newly arrived immigrants to Belgium. Most of the children had an uncomplicated disease course. Physicians should educate families about traveling to malaria-endemic areas to correct malaria preventive measures and prophylaxis.
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Affiliation(s)
| | - Tessa Goetghebuer
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Hainaut
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Anna Vanderfaeillie
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Vo Thanh Phuong Nguyen
- Department of Pediatrics, Laboratoire d'Hematologie, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Sarah Jourdain
- Department of Pediatrics, Hopital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - David Pace
- Department of Pediatrics, Mater Dei Hospital, Msida, Malta
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Gaps in knowledge and practices of malaria prevention in Francophone African immigrants in Metropolitan Edmonton. Malar J 2022; 21:197. [PMID: 35729617 PMCID: PMC9215031 DOI: 10.1186/s12936-022-04210-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/20/2022] [Indexed: 11/20/2022] Open
Abstract
Background Important knowledge gaps exist in the understanding of the management of the risks of imported malaria in Canada among Francophone immigrants from sub-Saharan Africa (FISSA). The aim of this cross-sectional study was to investigate the malaria related-knowledge, attitude and practices (KAP) of FISSA in Edmonton, where these immigrants are in an official minority language situation and the impact of language barriers on these factors. Methods A structured survey was used to examine the KAP of 382 FISSA in the Edmonton area from 2018 to 2019. Fisher’s Exact Test was applied to determine if there were associations between knowledge of malaria and different risk factors. Results Almost all FISSA (97%) had an accurate knowledge of fever as the key symptom of malaria. Interestingly, 60% of participants identified bed nets as a preventive method and only 19% of participants had accurate knowledge of malaria transmission. An accurate knowledge of symptoms was significantly associated with a high perceived risk of contracting malaria [odds ratio (OR) 4.33, 95% confidence interval (CI) 1.07–20.62]. Furthermore, even though 70% of FISSA had a high perceived risk of contracting malaria in endemic regions, only 52% of travellers had a pre-travel medical encounter. Importantly, language was not the predominant reason for not seeking pre-travel medical advice, although 84% of respondents chose French as their official language of preference when seeking medical advice. Having a French-speaking physician was correlated with satisfactory prevention knowledge (OR 1.96, 95% CI 1.16–3.35). With respect to health-seeking behaviour, 88% of respondents with a child < 5 years of age would seek medical care for fever in the child after travel to sub-Saharan Africa (SSA). Conclusion This study highlights that factors other than knowledge, risk assessment, and language might determine the lack of compliance with pre-travel medical encounters. It underscores the need for effective strategies to improve this adherence in minority settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04210-w.
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Underestimation of travel-associated risks by adult and paediatric travellers compared to expert assessment: A cross-sectional study at a hospital-based family pre-travel clinic. Travel Med Infect Dis 2022; 47:102315. [PMID: 35331951 DOI: 10.1016/j.tmaid.2022.102315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/20/2022] [Accepted: 03/17/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Travellers' perception of their risk for acquiring travel-related conditions is an important contributor to decisions and behaviors during travel. In this study, we aimed to assess the differences between traveller-perceived and expert-assessed risk of travel-related conditions in children and adults travelling internationally and describe factors that influence travellers' perception of risk. METHODS Children and adults were recruited at the Hospital for Sick Children's Family Travel Clinic between October 2014 and July 2015. A questionnaire was administered to participants to assess their perceived risk of acquiring 32 travel-related conditions using a 7-point Likert scale. Conditions were categorized as vector-borne diseases, vaccine-preventable diseases, food and water borne diseases, sexually transmitted infections and other conditions. Two certified travel medicine experts reviewed each patient's chart and assigned a risk score based on the same 7-point Likert scale. Traveller and expert risk scores were compared using paired t-tests. RESULTS In total, 207 participants were enrolled to participate in this study, 97 children (self-reported, n = 8; parent-reported, n = 89), and 110 adults. Travel-related risk for adults and parents answering for their children were significantly underestimated when compared to expert-assessed risk for 26 of the 32 assessed conditions. The underestimated conditions were the same for both adults and parents answering for children. Travel-related risk was not over-estimated for any condition. CONCLUSIONS Adults underestimated their children's and their own risk for most travel-related conditions. Strategies to improve the accuracy of risk perception of travel-related conditions by travellers are needed to optimize healthy travel for children and their families.
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Helfrich AM, Fraser JA, Hickey PW. Destination based errors in chloroquine malaria chemoprophylaxis vary based on provider specialty and credentials. Travel Med Infect Dis 2022; 47:102310. [DOI: 10.1016/j.tmaid.2022.102310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 11/28/2022]
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Comelli A, Guarner ME, Tomasoni LR, Fanetti Zamboni A, Moreno Pavón B, Zanotti P, Caligaris S, Matteelli A, Soriano-Arandes A, Castelli F. Severe imported Plasmodium falciparum malaria in children: characteristics and useful factors in the risk stratification. Travel Med Infect Dis 2021; 44:102196. [PMID: 34748988 DOI: 10.1016/j.tmaid.2021.102196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 08/09/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Severe imported pediatric malaria is of concern in non-endemic settings. We aimed to determine the features of pediatric severe cases in order to design a model able to stratify patients at presentation. METHODS We conducted a retrospective cross-sectional study including all imported P. falciparum malaria infection in patients ≤14 years of age, treated from January 2008 to February 2019 in two tertiary hospitals: Brescia, Italy and Barcelona, Spain. Severe malaria was defined according to World Health Organization criteria. Mortality rate, pediatric intensive care unit (PICU) stay and blood transfusion were analysed as adverse outcomes. RESULTS Out of 139 children included, 30.9% were severe malaria. Twenty-seven (19.4%) were admitted to PICU, and transfusion was required in 14 cases (10.1%). Predictors for severe malaria were: young age, low hemoglobin, high white blood cells (WBC) and high C-reactive protein. Platelet <130,000/μl correlated with severe malaria (without statistical significance). A model that includes age, WBC and C-reactive protein shows a high specificity to classify patients without severe malaria (92.3%) with 70% PPV and 75% NPV. CONCLUSIONS A score based on patient's age, WBC and C-reactive protein easily available at emergency room can help to identify children with higher risk of adverse outcomes.
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Affiliation(s)
- Agnese Comelli
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy.
| | - María Espiau Guarner
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall D'Hebron. PROSICS Barcelona. Universitat Autònoma de Barcelona. Barcelona, Spain
| | - Lina Rachele Tomasoni
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Agnese Fanetti Zamboni
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Belén Moreno Pavón
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall D'Hebron. PROSICS Barcelona. Universitat Autònoma de Barcelona. Barcelona, Spain
| | - Paola Zanotti
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Silvio Caligaris
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Alberto Matteelli
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall D'Hebron. PROSICS Barcelona. Universitat Autònoma de Barcelona. Barcelona, Spain
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
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Chehab H, Fischer PR, Christenson JC. Preparing Children for International Travel. Pediatr Rev 2021; 42:189-202. [PMID: 33795465 DOI: 10.1542/pir.2018-0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Hiba Chehab
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.,Pediatrics Department, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - John C Christenson
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN
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Enane LA, Sullivan KV, Spyridakis E, Feemster KA. Clinical Impact of Malaria Rapid Diagnostic Testing at a US Children's Hospital. J Pediatric Infect Dis Soc 2020; 9:298-304. [PMID: 30989220 PMCID: PMC7358041 DOI: 10.1093/jpids/piz022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/12/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Children who develop malaria after returning to a setting in which the disease is not endemic are at high risk for critical delays in diagnosis and initiation of antimalarial therapy. We assessed the clinical impact of the implementation of malaria rapid diagnostic testing (RDT) on the management of children with malaria at an urban US children's hospital that serves a large immigrant population. METHODS This was a retrospective cohort study of all children diagnosed with laboratory-confirmed malaria at the Children's Hospital of Philadelphia (CHOP) between 2000 and 2014. RDT using a US Food and Drug Administration-approved immunochromatographic assay was introduced at CHOP on August 1, 2007. We compared clinical management and outcomes of patients with malaria diagnosed before and after RDT introduction. RESULTS We analyzed 82 pediatric malaria cases (32 before and 50 after RDT implementation). The majority of these patients had traveled to West Africa (91.5%) and were infected with Plasmodium falciparum (80.5%). The mean time to a positive result decreased from 10.4 to 0.9 hours (P < .001) after the introduction of RDT for patients with P falciparum. The mean time to antimalarial therapy decreased from 13.1 to 6.9 hours (P =; .023) in hospitalized patients. We found no significant reduction in the mean number of clinical signs of severe malaria between 0 and 48 hours of hospitalization and no difference in the need for exchange transfusion, time to resolution of parasitemia, or length of hospital stay. CONCLUSIONS Implementation of RDT for malaria was associated with shorter times to malaria diagnosis and initiation of antimalarial therapy. The results of this study support RDT in the optimal management of patients with malaria who present in settings in which the disease is not endemic.
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Affiliation(s)
- Leslie A Enane
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Pennsylvania
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Kaede V Sullivan
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Pennsylvania
| | - Evangelos Spyridakis
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis
| | - Kristen A Feemster
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Pennsylvania
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Division of Disease Control, Philadelphia Department of Public Health, Pennsylvania
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Fong EKK, Pell LG, Faress A, Nguyen JH, Ma XW, Lam RE, Louch D, Science ME, Morris SK. Adherence to recommendations at a Canadian tertiary care Family Travel Clinic - A single centre analysis. Travel Med Infect Dis 2020; 34:101579. [PMID: 32074482 DOI: 10.1016/j.tmaid.2020.101579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 01/27/2020] [Accepted: 02/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Infectious and non-infectious risks associated with international travel can be reduced with adherence to pre-travel advice from practitioners trained in travel medicine. METHODS A prospective cohort study was conducted in a tertiary care children's hospital to assess adherence to malaria chemoprophylaxis, safe water and food consumption, mosquito bite protection, motor vehicle safety and travel vaccines using structured questionnaires. High risk groups assessed included child travelers and those visiting friends and relatives (VFRs). RESULTS In total, 290 participants (133 children and 157 adults) were enrolled and completed at least one study questionnaire. In general, with the exception of vaccines, adherence to recommendations was sub-optimal. Among children and adults, adherence to malaria prophylaxis recommendations was lower in VFRs than in non-VFRs. The proportion of children VFRs (cVFRs) and adult VFRs (aVFRs) who adhered to the following recommendations were malaria chemoprophylaxis (47%, 33%), safe water (71%, 74%) and food recommendations (18%, 6%), insect bite avoidance (21%, 12%), and motor vehicle safety (13%, 11%) respectively. Adherence to recommended vaccines uptake was greater than 90% in all groups. CONCLUSION With the exception of vaccine uptake, sub-optimal adherence levels to travel recommendations was identified in all groups, and in particular VFRs, highlighting the need for proactive discussions around barriers to adherence.
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Affiliation(s)
- Emily K K Fong
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - Lisa G Pell
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Ahmed Faress
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; School of Public Health, University of Montreal, Montreal, Canada
| | - Jenny Hoang Nguyen
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Xiao Wei Ma
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Ray E Lam
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada
| | - Debra Louch
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada
| | - Michelle E Science
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Shaun K Morris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada.
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10
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Christenson JC, Chehab H. Pediatric Travelers and Immigrant Children. Pediatr Ann 2019; 48:e360-e369. [PMID: 31505010 DOI: 10.3928/19382359-20190812-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Children comprise a special group of international travelers. Immigrant and refugee children, along with children traveling to visit friends and relatives abroad or on leisure trips, require special attention by clinicians to prevent and treat travel-related conditions. [Pediatr Ann. 2019;48(9):e360-e369.].
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Panin F, Orlandini E, Galli L, De Martino M, Chiappini E. Increasing imported malaria in children and adults in Tuscany, Italy, (2000 to 2017): A retrospective analysis. Travel Med Infect Dis 2019; 29:34-39. [DOI: 10.1016/j.tmaid.2019.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 03/17/2019] [Accepted: 03/28/2019] [Indexed: 11/15/2022]
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Beiter KJ, Wentlent ZJ, Hamouda AR, Thomas BN. Nonconventional opponents: a review of malaria and leishmaniasis among United States Armed Forces. PeerJ 2019; 7:e6313. [PMID: 30701136 PMCID: PMC6348955 DOI: 10.7717/peerj.6313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/19/2018] [Indexed: 01/10/2023] Open
Abstract
As the United States military engage with different countries and cultures throughout the world, personnel become exposed to new biospheres as well. There are many infectious pathogens that are not endemic to the US, but two of particular importance are Plasmodium and Leishmania, which respectively cause malaria and leishmaniasis. These parasites are both known to cause significant disease burden in their endemic locales, and thus pose a threat to military travelers. This review introduces readers to basic life cycle and disease mechanisms for each. Local and military epidemiology are described, as are the specific actions taken by the US military for prevention and treatment purposes. Complications of such measures with regard to human health are also discussed, including possible chemical toxicities. Additionally, poor recognition of these diseases upon an individual's return leading to complications and treatment delays in the United States are examined. Information about canine leishmaniasis, poorly studied relative to its human manifestation, but of importance due to the utilization of dogs in military endeavors is presented. Future implications for the American healthcare system regarding malaria and leishmaniasis are also presented.
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Affiliation(s)
- Kaylin J Beiter
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, United States of America
| | - Zachariah J Wentlent
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, United States of America
| | - Adrian R Hamouda
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, United States of America
| | - Bolaji N Thomas
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, United States of America
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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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Lanneaux J, Dauger S, Pham LL, Naudin J, Faye A, Gillet Y, Bosdure E, Carbajal R, Dubos F, Vialet R, Chéron G, Angoulvant F. Retrospective study of imported falciparum malaria in French paediatric intensive care units. Arch Dis Child 2016; 101:1004-1009. [PMID: 27281455 DOI: 10.1136/archdischild-2015-309665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 05/04/2016] [Accepted: 05/10/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The World Health Organization (WHO) severity criteria for paediatric Plasmodium falciparum (Pf) malaria are based on studies in countries of endemic malaria. The relevance of these criteria for other countries remains unclear. We assessed the relevance of these criteria in an industrialised country. DESIGN Retrospective case-control study. SETTING Eight French university hospitals, from 2006 to 2012. PATIENTS Children with Pf malaria admitted to paediatric intensive care units (cases: n=55) or paediatric emergency departments (controls: n=110). MAIN OUTCOME MEASURES Descriptive analysis of WHO severity criteria and major interventions (mechanical ventilation, blood transfusion, fluid challenge, treatment of cerebral oedema, renal replacement therapy). Thresholds were set by receiver operating characteristics curve analysis. RESULTS Altered consciousness (71% vs 5%), shock (24% vs 1%), renal failure (20% vs 1%), anaemia <50 g/L (7% vs 2%), acidosis (38% vs 0%), bilirubin level >50 µmol/L (25% vs 8%) and parasitaemia >10% (30% vs 8%) were more frequent in cases (p<0.01). All these criteria were associated with major interventions (p<0.001). Respiratory distress (six cases), and hypoglycaemia (two cases) were infrequent. Thrombocytopenia <50 000/mm3 (46% vs 7%) and anaemia (haemoglobin concentration <70 g/L (41% vs 13%)) were more frequent in cases (p<0.0001). CONCLUSIONS The WHO severity criteria for paediatric Pf malaria are relevant for countries without endemic malaria. The infrequent but severe complications also provide a timely reminder of the morbidity and mortality associated with this condition worldwide. In non-endemic countries haemoglobin <70 g/L and platelet count <50 000/mm3 could be used as additional criteria to identify children needing high level of care.
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Affiliation(s)
- Justine Lanneaux
- Department of Paediatric Intensive care, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Stéphane Dauger
- Department of Paediatric Intensive care, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Luu-Ly Pham
- Paediatric Emergency Department, AP-HP, Hôpital Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Jérôme Naudin
- Department of Paediatric Intensive care, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Albert Faye
- Department of General Paediatrics, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Yves Gillet
- Paediatric Emergency Department, HCL, HFME Lyon, Université de Lyon 1, Lyon, France
| | | | - Ricardo Carbajal
- Paediatric Emergency Department, AP-HP, Hôpital Armand Trousseau, Université Pierre et Marie Curie Paris 6, Paris, France
| | - François Dubos
- Paediatric Emergency and Infectious Diseases Departments, Université de Lille, Hôpital R. Salengro, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Renaud Vialet
- Paediatric Intensive Care Department, APHM, CHU Nord, Marseille, France
| | - Gérard Chéron
- Paediatric Emergency Department, AP-HP, Hôpital Necker-Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - François Angoulvant
- Paediatric Emergency Department, AP-HP, Hôpital Necker-Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Clinical Epidemiology Unit ECEVE, INSERM UMR 1123, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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15
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Ma XW, Pell LG, Akseer N, Khan S, Lam RE, Louch D, Science M, Morris SK. Characteristics and pre-travel preparation of travelers at a Canadian pediatric tertiary care travel clinic: A retrospective analysis. Travel Med Infect Dis 2015; 14:148-54. [PMID: 26705839 DOI: 10.1016/j.tmaid.2015.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/05/2015] [Accepted: 11/24/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND International travelers are susceptible to a wide spectrum of travel related morbidities. Despite rising number of international travelers in Canada, the demographics, risk profiles, and preventative strategies of high-risk traveler groups, including pediatric travelers visiting friends and relatives (VFRs) are not well described. METHODS A descriptive analysis was conducted on pre-travel consultations completed between January 2013 and August 2014 at a large pediatric tertiary care center in Toronto, Canada. Data on demographics, travel characteristics, and pre-travel interventions were extracted from 370 pre-travel consultations. Results were compared between all VFR and non-VFR travelers, as well as between children traveling to visit friends and relatives, for vacation, and for education and/or volunteer purposes. RESULTS Forty-eight percent of consultations were for children <18 years of age (n = 177), of which 31% were for young children (<5 years of age). Young children were more likely to travel to visit friends and/or relatives than for other purposes (29% vs 9%, p < 0.0001). Children VFRs (cVFRs) were more likely to travel for >28 days than children traveling for vacation (43% vs 1%, p < 0.0001), and children traveling for education/volunteer purposes (43% vs 21%, p = 0.03). Around half of cVFRs traveled to destinations in Asia (51%). The majority stayed with locals, friends and/or relatives (85%), and nearly all traveled to urban destinations (98%). The most prescribed interventions for children were azithromycin (84%), Dukoral (66%), and the hepatitis A vaccine (60%). Atovaquone/proguanil was the most commonly prescribed antimalarial for children. CONCLUSION Children that travel to visit friends and relatives represent a unique travel group and may require specific considerations during pre-travel preparations. Our findings can help develop targeted pre-travel strategies for children VFRs.
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Affiliation(s)
- Xiao Wei Ma
- Centre for Global Child Health, The Hospital for Sick Children, Canada
| | - Lisa G Pell
- Centre for Global Child Health, The Hospital for Sick Children, Canada
| | - Nadia Akseer
- Centre for Global Child Health, The Hospital for Sick Children, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Sarah Khan
- Division of Infectious Diseases, The Hospital for Sick Children, Canada; Department of Paediatrics, University of Toronto, Canada
| | - Ray E Lam
- Division of Infectious Diseases, The Hospital for Sick Children, Canada; Department of Paediatrics, University of Toronto, Canada
| | - Debra Louch
- Division of Infectious Diseases, The Hospital for Sick Children, Canada
| | - Michelle Science
- Division of Infectious Diseases, The Hospital for Sick Children, Canada; Department of Paediatrics, University of Toronto, Canada
| | - Shaun K Morris
- Centre for Global Child Health, The Hospital for Sick Children, Canada; Dalla Lana School of Public Health, University of Toronto, Canada; Division of Infectious Diseases, The Hospital for Sick Children, Canada; Department of Paediatrics, University of Toronto, Canada.
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16
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Jaeger VK, Tschudi N, Rüegg R, Hatz C, Bühler S. The elderly, the young and the pregnant traveler -- A retrospective data analysis from a large Swiss Travel Center with a special focus on malaria prophylaxis and yellow fever vaccination. Travel Med Infect Dis 2015; 13:475-84. [PMID: 26526774 DOI: 10.1016/j.tmaid.2015.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/12/2015] [Accepted: 10/05/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Vulnerable individuals such as elderly, children/adolescents and pregnant/breastfeeding women increasingly travel overseas. We describe the travel and vaccination patterns of these groups at the largest Travel Clinic in Switzerland especially focusing on travel to yellow fever and malaria-endemic countries, and yellow fever vaccination (YFV) and malaria medications. METHOD An analysis of pre-travel visits between 2010 and 2012 at the Travel Clinic of the University of Zurich, was performed assessing differences between the elderly, young and middle-aged travelers as well as between pregnant/breastfeeding and other female travelers. RESULTS Overall, the vulnerable groups did not differ from other travelers regarding their travel patterns. YFV was the most often administered vaccine to elderly travelers; half of them received it for the first time. More than 30% of children/adolescents received YFV, but no child below six months was vaccinated. 80% of young travelers and a similar percentage of pregnant women went to malaria-endemic regions. Twenty-five pregnant/breastfeeding women traveled to YF endemic areas. CONCLUSIONS Travel patterns of vulnerable travelers are comparable to those of other travelers. In view of the limited data on malaria medications and precautions against YFV during pregnancy and at the extreme ages of life, giving travel advice to these groups is challenging.
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Affiliation(s)
- Veronika K Jaeger
- Department of Rheumatology, Basel University Hospital, Petersgraben 4, 4031 Basel, Switzerland; Swiss Tropical and Public Health Institute, Department of Medicine and Diagnostics, Socinstrasse 57, 4051 Basel, Switzerland.
| | - Nadine Tschudi
- Department of Public Health, Division of Infectious Diseases/Travel Clinic, Epidemiology, Biostatistics and Prevention Institute, Hirschengraben 84, 8001 Zurich, Switzerland.
| | - Rolanda Rüegg
- Department of Public Health, Division of Infectious Diseases/Travel Clinic, Epidemiology, Biostatistics and Prevention Institute, Hirschengraben 84, 8001 Zurich, Switzerland.
| | - Christoph Hatz
- Swiss Tropical and Public Health Institute, Department of Medicine and Diagnostics, Socinstrasse 57, 4051 Basel, Switzerland; Department of Public Health, Division of Infectious Diseases/Travel Clinic, Epidemiology, Biostatistics and Prevention Institute, Hirschengraben 84, 8001 Zurich, Switzerland.
| | - Silja Bühler
- Department of Public Health, Division of Infectious Diseases/Travel Clinic, Epidemiology, Biostatistics and Prevention Institute, Hirschengraben 84, 8001 Zurich, Switzerland.
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17
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Flores MS, Hickey PW, Fields JH, Ottolini MG. A "Syndromic" Approach for Diagnosing and Managing Travel-Related Infectious Diseases in Children. Curr Probl Pediatr Adolesc Health Care 2015; 45:231-43. [PMID: 26253891 PMCID: PMC7106018 DOI: 10.1016/j.cppeds.2015.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michelle S Flores
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Patrick W Hickey
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Joshua H Fields
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Martin G Ottolini
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814; Office of Curriculum, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
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