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Benabdelmoumen G, Van der Pluijm RW, Taieb F, Jidar K, Kuhmel L, Lucet C, Buffet P, Hochedez P, Itani O, Consigny PH. Health problems and exposure to infectious risks in returning humanitarian aid workers. J Travel Med 2024; 31:taae050. [PMID: 38552155 DOI: 10.1093/jtm/taae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Humanitarian aid workers are exposed to deployment-related health threats. Identifying subgroups at a higher risk of infection in this diverse population could help optimize prevention. METHODS We carried out a retrospective study based on anonymized data of humanitarian aid workers that visited our clinic for a post-deployment visit between 1 January 2018 and 31 December 2021. We conducted a descriptive analysis of basic demographic data, self-reported risk exposure and health problems encountered during deployment extracted from a standard questionnaire. RESULTS The questionnaire was administered to 1238 aid workers during 1529 post-deployment medical consultations. The median age was 37.2 years (IQR 31.7-44.3), and 718/1529 (47.0%) were female aid workers. The median duration of deployment was 6 months (IQR 3-12 months). Most deployments (1321/1529 (86.4%)) were for a medical organization and in Sub-Saharan Africa (73.2%). The most common risk exposures were contact with freshwater in schistosomiasis endemic regions (187/1308 (14.3%)), unprotected sexual contact with a person other than a regular partner (138/1529 (9.0%)), suspected rabies exposure (56/1529 (3.7%)) and accidental exposure to blood (44/1529 (2.9%)). Gastrointestinal problems (487/1529 (31.9%)), malaria (237/1529 (15.5%)) and respiratory tract infections (94/1529 (6,2%)) were the most encountered health problems. Fifteen volunteers (1%) were hospitalized during deployment and 19 (1.2%) repatriated due to health problems. Adherence to malaria chemoprophylaxis was poor, only taken according to the prescription in 355 out of 1225 (29.0%) of aid workers for whom prophylaxis was indicated. CONCLUSION Humanitarian aid workers deployed abroad encounter significant rates of health problems and report a high level of risk exposure during their deployment, with the risks being greatest among younger people, those deployed to rural areas, and those working for non-medical organizations. These findings help guide future pre-deployment consultations, to increase awareness and reduce risk behaviour during deployment, as well as focus on adherence to medical advice such as malaria chemoprophylaxis.
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Affiliation(s)
| | | | - Fabien Taieb
- Institut Pasteur, Centre Médical, 75015 Paris, France
| | - Kaoutar Jidar
- Institut Pasteur, Centre Médical, 75015 Paris, France
| | - Lucie Kuhmel
- Institut Pasteur, Centre Médical, 75015 Paris, France
| | - Cora Lucet
- Institut Pasteur, Centre Médical, 75015 Paris, France
| | - Pierre Buffet
- Institut Pasteur, Centre Médical, 75015 Paris, France
| | | | - Oula Itani
- Institut Pasteur, Centre Médical, 75015 Paris, France
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Camprubí-Ferrer D, Tomazatos A, Balerdi-Sarasola L, Cobuccio LG, Van Den Broucke S, Horváth B, Van Esbroeck M, Martinez MJ, Gandasegui J, Subirà C, Saloni M, Genton B, Bottieau E, Cadar D, Muñoz J. Assessing viral metagenomics for the diagnosis of acute undifferentiated fever in returned travellers: a multicenter cohort study. J Travel Med 2024; 31:taae029. [PMID: 38381609 DOI: 10.1093/jtm/taae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/09/2024] [Accepted: 02/17/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Up to 45% of febrile returning travellers remain undiagnosed after a thorough diagnostic work-up, even at referral centres. Although metagenomic next-generation sequencing (mNGS) has emerged as a promising tool, evidence of its usefulness in imported fever is very limited. METHODS Travellers returning with fever were prospectively recruited in three referral clinics from November 2017 to November 2019. Unbiased mNGS optimised for virus detection was performed on serum samples of participants with acute undifferentiated febrile illness (AUFI), and results were compared to those obtained by reference diagnostic methods (RDM). RESULTS Among 507 returned febrile travellers, 433(85.4%) presented with AUFI. Dengue virus (n = 86) and Plasmodium spp. (n = 83) were the most common causes of fever. 103/433(23.8%) AUFI remained undiagnosed at the end of the follow-up.Metagenomic next-generation sequencing unveiled potentially pathogenic microorganisms in 196/433(38.7%) AUFI. mNGS identifications were more common in patients with a shorter duration of fever (42.3% in ≤5 days vs 28.7% in >5 days, P = 0.005). Potential causes of fever were revealed in 25/103(24.2%) undiagnosed AUFI and 5/23(21.7%) travellers with severe undiagnosed AUFI. Missed severe aetiologies included eight bacterial identifications and one co-infection of B19 parvovirus and Aspergillus spp.Additional identifications indicating possible co-infections occurred in 29/316(9.2%) travellers with AUFI, and in 11/128(8.6%) travellers with severe AUFI, who had received a diagnosis through RDM. The most common co-infections detected in severe AUFI were caused by Gram-negative bacteria. Serum mNGS was unable to detect >50% of infectious diagnoses achieved by RDM and also yielded 607 non-pathogenic identifications. DISCUSSION mNGS of serum can be a valuable diagnostic tool for selected travellers with undiagnosed AUFI or severe disease in addition to reference diagnostic techniques, especially during the first days of symptoms. Nevertheless, mNGS results interpretation presents a great challenge. Further studies evaluating the performance of mNGS using different sample types and protocols tailored to non-viral agents are needed.
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Affiliation(s)
- Daniel Camprubí-Ferrer
- International Health Department ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | - Alexandru Tomazatos
- Bernhard Nocht Institute for Tropical Medicine, National Reference Centre for Tropical Infectious Diseases, Hamburg, Germany
| | - Leire Balerdi-Sarasola
- International Health Department ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | - Ludovico G Cobuccio
- Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | | | - Balázs Horváth
- Bernhard Nocht Institute for Tropical Medicine, National Reference Centre for Tropical Infectious Diseases, Hamburg, Germany
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Miguel J Martinez
- Microbiology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Javier Gandasegui
- International Health Department ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | - Carme Subirà
- International Health Department ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | - Meritxell Saloni
- International Health Department ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | - Blaise Genton
- Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dániel Cadar
- Bernhard Nocht Institute for Tropical Medicine, National Reference Centre for Tropical Infectious Diseases, Hamburg, Germany
| | - Jose Muñoz
- International Health Department ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
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Mehendale AM, Vaishnav L, Joshi SH, Joshi A. Public Health Importance of Emporiatrics: A Review. Cureus 2023; 15:e36343. [PMID: 37082503 PMCID: PMC10110409 DOI: 10.7759/cureus.36343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/18/2023] [Indexed: 03/21/2023] Open
Abstract
People travel all around the world to explore, trade, sojourn, etc. Millions of individuals cross national and international borders. Travel medicine services are offered by general practitioners, specialized travel clinics, or immunization centers. Epidemiology, illness prevention, and travel-related self-treatment are all included in the interdisciplinary field of travel medicine. The main objective is to keep travelers alive and in good health, by reducing the effects of illness and accidents through preventative measures and self-care. The danger to a traveler's health and well-being must be understood, and the travel medicine practitioner's job is to help their patient or client recognize and manage those risks. The absence of any disease or symptom does not always indicate good health. Chronic illness sufferers, including those with cancer, diabetes, and hypertension, can maintain a reasonable level of health and mobility. Travel medicine is a rapidly developing, extremely dynamic, multidisciplinary field that calls for knowledge of a range of travel-related illnesses as well as current information on the global epidemiology of infectious and non-infectious health risks, immunization laws and requirements around the world, and the shifting trends in drug-resistant infections. Pre-travel consultation aims to reduce the traveler's risk of disease and harm while on the road through preventive counseling, education, recommended drugs, and essential vaccines. Specialized medical guidance can help reduce the potential health risks of travel. Emporiatrics is not only used for traveling advice or things to be done during the period of the journey but it also creates room in implementing the interdisciplinary subject with new methods or development of new policies, technologies, and various programs to reduce unnecessary problems of the travelers, which will boost tourism.
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Desmet S, Henckaerts L, Ombelet S, Damanet B, Vanbrabant P. Imported diseases in travellers presenting to the emergency department after a stay in a malaria-endemic country: a retrospective observational study. Trop Dis Travel Med Vaccines 2023; 9:3. [PMID: 36803441 PMCID: PMC9939251 DOI: 10.1186/s40794-023-00190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 02/06/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND We aimed to investigate the aetiology and outcomes of illnesses in patients presenting to an emergency department after travelling to a malaria-endemic country, in order to raise awareness of both tropical and cosmopolitan diseases. METHODS A retrospective chart review was performed for all patients who underwent blood smear testing for malaria at the Emergency Department of the University Hospitals Leuven from 2017 to 2020. Patient characteristics, results of laboratory and radiological examinations, diagnoses, disease course and outcome were collected and analysed. RESULTS A total of 253 patients were included in the study. The majority of ill travellers returned from Sub-Saharan Africa (68.4%) and Southeast Asia (19.4%). Their diagnoses fell into three major syndrome categories: systemic febrile illness (30.8%), inflammatory syndrome of unknown origin (23.3%) and acute diarrhoea (18.2%). Malaria (15.8%) was the most common specific diagnosis in patients with systemic febrile illness, followed by influenza (5.1%), rickettsiosis (3.2%), dengue (1.6%), enteric fever (0.8%), chikungunya (0.8%) and leptospirosis (0.8%). The presence of hyperbilirubinemia and thrombocytopenia increased the probability of malaria, with a likelihood ratio of 4.01 and 6.03, respectively. Seven patients (2.8%) were treated in the intensive care unit, and none died. CONCLUSION Systemic febrile illness, inflammatory syndrome of unknown origin and acute diarrhoea were the three major syndromic categories in returning travellers presenting to our emergency department after a stay in a malaria-endemic country. Malaria was the most common specific diagnosis in patients with systemic febrile illness. None of the patients died.
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Affiliation(s)
- Sofie Desmet
- grid.410569.f0000 0004 0626 3338Department of General Internal Medicine, KU Leuven, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Liesbet Henckaerts
- grid.410569.f0000 0004 0626 3338Department of General Internal Medicine, KU Leuven, University Hospitals Leuven, Herestraat 49, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Department of Microbiology, Immunology and Transplantation, KU Leuven, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Sien Ombelet
- grid.410569.f0000 0004 0626 3338Department of Laboratory Medicine, KU Leuven, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Benjamin Damanet
- grid.8767.e0000 0001 2290 8069School of Public Health, Free University of Brussels, Brussels, Belgium ,grid.489075.70000 0001 2287 089XNational Institute for Health and Disability Insurance (NIHDI), Brussels, Belgium
| | - Peter Vanbrabant
- Department of General Internal Medicine, KU Leuven, University Hospitals Leuven, Herestraat 49, Leuven, Belgium.
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Camprubí-Ferrer D, Oteo JA, Bottieau E, Genton B, Balerdi-Sarasola L, Portillo A, Cobuccio L, Van Den Broucke S, Santibáñez S, Cadar D, Rodriguez-Valero N, Almuedo-Riera A, Subirà C, d'Acremont V, Martinez MJ, Roldán M, Navero-Castillejos J, Van Esbroeck M, Muñoz J. Doxycycline responding illnesses in returning travellers with undifferentiated non-malaria fever: a European multicentre prospective cohort study. J Travel Med 2023; 30:6657742. [PMID: 35932455 DOI: 10.1093/jtm/taac094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/11/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diagnosis of undifferentiated non-malaria fevers (NMF) in returning travellers is a great challenge. Currently, there is no consensus about the use of empirical antibiotics in returning travellers with undifferentiated NMF. Although studies in endemic areas showed that a wide range of pathogens implicated in undifferentiated NMF are treatable with doxycycline, the role of doxycycline in returning travellers with fever still has to be explored. METHODS Prospective European multicentre cohort study of febrile international travellers (November 2017-November 2019). Immunological and molecular diagnostic techniques for doxycycline responding illnesses (DRI) agents such as Anaplasma phagocytophilum, spotted fever group Rickettsia spp., typhus group Rickettsia spp., Coxiella burnetii, Bartonella spp., Orientia tsutsugamushi, Borrelia miyamotoi, Borrelia recurrentis and Leptospira spp. were systematically performed in all patients with undifferentiated NMF. We estimated the prevalence and predictive factors of DRI in returning travellers with undifferentiated NMF. RESULTS Among 347 travellers with undifferentiated NMF, 106 (30·5%) were finally diagnosed with DRI. Only 57 (53·8%) of the 106 DRI infections were diagnosed by the standard of care. The main causes of DRI were: 55 (51·9%) Rickettsia spp., 16 (15·1%) C. burnetii; 15 (14·2%) Bartonella spp.; 13 (12·3%) Leptospira spp. and 10 (9·5%) A. phagocytophilum. The only predictive factor associated with DRI was presenting an eschar (aOR 39·52, 95%CI 4·85-322·18). Features of dengue such as retro-orbital pain (aOR 0·40, 95%CI 0·21-0·76) and neutropenia (aOR 0·41, 95%CI 0·21-0·79) were negatively associated with DRI. CONCLUSIONS Although DRI are responsible for 30% of undifferentiated NMF cases in travellers, those are seldom recognized during the first clinical encounter. Empirical treatment with doxycycline should be considered in returning travellers with undifferentiated fever and negative tests for malaria and dengue, particularly when presenting severe illness, predictive factors for rickettsiosis or no features of dengue.
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Affiliation(s)
| | - José Antonio Oteo
- Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital Universitario San Pedro-CIBIR, Logroño 26006, Spain
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp 2000, Belgium
| | - Blaise Genton
- Swiss Tropical and Public Health Institute, Basel 4051, Switzerland
- Center for Primary Care and Public Health, University of Lausanne, 1011, Switzerland
| | | | - Aránzazu Portillo
- Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital Universitario San Pedro-CIBIR, Logroño 26006, Spain
| | - Ludovico Cobuccio
- Swiss Tropical and Public Health Institute, Basel 4051, Switzerland
- Center for Primary Care and Public Health, University of Lausanne, 1011, Switzerland
| | | | - Sonia Santibáñez
- Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital Universitario San Pedro-CIBIR, Logroño 26006, Spain
| | - Dániel Cadar
- Bernhard Nocht Institute for Tropical Medicine, National Reference Centre for Tropical Pathogens, Hamburg 20359, Germany
| | | | - Alex Almuedo-Riera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain
| | - Carme Subirà
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain
| | - Valérie d'Acremont
- Swiss Tropical and Public Health Institute, Basel 4051, Switzerland
- Center for Primary Care and Public Health, University of Lausanne, 1011, Switzerland
| | | | - Montserrat Roldán
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain
| | | | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp 2000, Belgium
| | - Jose Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain
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Harish V, Buajitti E, Burrows H, Posen J, Bogoch II, Corbeil A, Gubbay JB, Rosella LC, Morris SK. Geographic clustering of travel-acquired infections in Ontario, Canada, 2008-2020. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001608. [PMID: 36963058 PMCID: PMC10022755 DOI: 10.1371/journal.pgph.0001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/20/2023] [Indexed: 03/19/2023]
Abstract
As the frequency of international travel increases, more individuals are at risk of travel-acquired infections (TAIs). In this ecological study of over 170,000 unique tests from Public Health Ontario's laboratory, we reviewed all laboratory-reported cases of malaria, dengue, chikungunya, and enteric fever in Ontario, Canada between 2008-2020 to identify high-resolution geographical clusters for potential targeted pre-travel prevention. Smoothed standardized incidence ratios (SIRs) and 95% posterior credible intervals (CIs) were estimated using a spatial Bayesian hierarchical model. High- and low-incidence areas were described using data from the 2016 Census based on the home forward sortation area of patients testing positive. A second model was used to estimate the association between drivetime to the nearest travel clinic and incidence of TAI within high-incidence areas. There were 6,114 microbiologically confirmed TAIs across Ontario over the study period. There was spatial clustering of TAIs (Moran's I = 0.59, p<0.0001). Compared to low-incidence areas, high-incidence areas had higher proportions of immigrants (p<0.0001), were lower income (p = 0.0027), had higher levels of university education (p<0.0001), and less knowledge of English/French languages (p<0.0001). In the high-incidence Greater Toronto Area (GTA), each minute increase in drive time to the closest travel clinic was associated with a 3% reduction in TAI incidence (95% CI 1-6%). While urban neighbourhoods in the GTA had the highest burden of TAIs, geographic proximity to a travel clinic in the GTA was not associated with an area-level incidence reduction in TAI. This suggests other barriers to seeking and adhering to pre-travel advice.
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Affiliation(s)
- Vinyas Harish
- MD/PhD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Emmalin Buajitti
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Holly Burrows
- Yale School of Public Health, Yale University, New Haven, CT, United States of America
| | - Joshua Posen
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
| | - Isaac I. Bogoch
- Division of Infectious Diseases, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Jonathan B. Gubbay
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura C. Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Shaun K. Morris
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- * E-mail:
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Fernandez V, Ahmed SM, Graves MC, Pender MA, Shoemaker H, Birich H, Pupaibool J, Benson LS, Leung DT. Incidence Rate and Risk Factors Associated with Travelers' Diarrhea in International Travelers Departing from Utah, USA. Am J Trop Med Hyg 2022; 107:898-903. [PMID: 35970286 PMCID: PMC9651512 DOI: 10.4269/ajtmh.21-1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 06/01/2022] [Indexed: 11/07/2022] Open
Abstract
Despite knowledge on the causes and prevention strategies for travelers' diarrhea (TD), it continues to be one of the most common illnesses experienced by U.S. international travelers. However, studies of risk factors associated with TD among U.S. travelers are limited. In this study, we aimed to determine the incidence rate of TD, the proportion of travelers who experience TD, and to identify risk factors associated with TD. In this cross-sectional study, we collected and analyzed data from anonymous posttravel questionnaires submitted by international travelers recruited during their pretravel visit at two travel clinics in Salt Lake City, Utah, from October 2016 to March 2020. Of 571 travelers who completed posttravel surveys, 484 (85%) answered the TD question, of which 111 (23%) reported TD, for an incidence rate of 1.1 episodes per 100 travel-days (95% confidence interval [CI]: 0.9-1.4). In a multivariable model, visiting Southeast Asian (odds ratio [OR]: 2.60; 95% CI: 1.45-4.72) and African (OR: 2.06; 95% CI: 1.09-3.93]) WHO regions, having 10 or more individuals in the group (OR: 3.91; 95% CI: 1.50-11.32]), longer trip duration (OR: 1.01; 95% CI: 1.00-1.02), visiting both urban and rural destinations (OR: 1.94; 95% CI: 1.01-3.90), and taking medications/supplements to prevent TD (OR: 2.74; 95% CI: 1.69-4.47) were statistically significantly associated with increased odds of reporting TD. TD continues to be common in international travelers from the United States. Our findings provide insights regarding travelers' behaviors regarding TD in international travelers from high-income countries and shows the need for additional research into prevention strategies for travelers' diarrhea.
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Affiliation(s)
- Valerie Fernandez
- Division of Infectious Disease, University of Utah School of Medicine, Salt Lake City, Utah
| | - Sharia M. Ahmed
- Division of Infectious Disease, University of Utah School of Medicine, Salt Lake City, Utah
| | - Michael C. Graves
- Division of Infectious Disease, University of Utah School of Medicine, Salt Lake City, Utah
| | - Melissa A. Pender
- Division of Infectious Disease, University of Utah School of Medicine, Salt Lake City, Utah
| | - Holly Shoemaker
- Division of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah
| | - Holly Birich
- Salt Lake County Health Department, Salt Lake City, Utah
| | - Jakrapun Pupaibool
- Division of Infectious Disease, University of Utah School of Medicine, Salt Lake City, Utah
| | - L. Scott Benson
- Division of Public Health, University of Utah School of Medicine, Salt Lake City, Utah
| | - Daniel T. Leung
- Division of Infectious Disease, University of Utah School of Medicine, Salt Lake City, Utah
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Sørensen HT. Patients with Chronic Diseases Who Travel: Need for Global Access to Timely Health Care Data. Clin Epidemiol 2022; 14:513-519. [PMID: 35505690 PMCID: PMC9057227 DOI: 10.2147/clep.s360699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/18/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, DK-8200, Denmark
- Clinical Excellence Research Center, Stanford University, Palo Alto, CA, USA
- Correspondence: Henrik Toft Sørensen, Department of Clinical Epidemiology, Aarhus University, Olof Palmes Allé 43-45, Aarhus N, DK-8200, Denmark, Email
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Wang JL, Chen T, Deng LL, Han YJ, Wang DY, Wang LP, He GX. Epidemiological characteristics of imported respiratory infectious diseases in China, 2014‒2018. Infect Dis Poverty 2022; 11:22. [PMID: 35246236 PMCID: PMC8895356 DOI: 10.1186/s40249-022-00944-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background With the progress of globalization, international mobility increases, greatly facilitating cross-border transmission of respiratory infectious diseases (RIDs). This study aimed to analyze the epidemiological characteristics and factors influencing imported RIDs, with the goal of providing evidence to support adoption of high-tech, intelligent methods to early find imported RIDs and prevent their spread in China. Methods We obtained data of imported RIDs cases from 2014 to 2018 from the Inbound Sentinel Network of Customs and the National Notifiable Diseases Reporting System in China. We analyzed spatial, temporal, and population distribution characteristics of the imported RIDs. We developed an index to describe seasonality. Pearson correlation coefficients were used to examine associations between independent variables and imported cases. Data analyses and visualizations were conducted with R software. Results From a total of 1 409 265 253 inbound travelers, 31 732 (2.25/100 000) imported RIDs cases were reported. RIDs cases were imported from 142 countries and five continents. The incidence of imported RIDs was nearly 5 times higher in 2018 (2.81/100 000) than in 2014 (0.58/100 000). Among foreigners, incidence rates were higher among males (5.32/100 000), 0–14-year-olds (15.15/100 000), and cases originating in Oceania (11.10/100 000). The vast majority (90.3%) of imported RIDs were influenza, with seasonality consistent with annual seasonality of influenza. The spatial distribution of imported RIDs was different between Chinese citizens and foreigners. Increases in inbound travel volume and the number of influenza cases in source countries were associated with the number of imported RIDs. Conclusions Our study documented importation of RIDs into China from 142 countries. Inbound travel poses a significant risks bringing important RIDs to China. It is urgent to strengthen surveillance at customs of inbound travelers and establish an intelligent surveillance and early warning system to prevent importation of RIDs to China for preventing further spread within China. Graphical Abstract ![]()
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Affiliation(s)
- Jin-Long Wang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tao Chen
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Le-Le Deng
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ya-Jun Han
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Da-Yan Wang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li-Ping Wang
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Guang-Xue He
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Ginten C, Eberhard-Kuhn N, Braun D, Kälin M. [CME: Fever in Travelers Returning from the Tropics]. PRAXIS 2022; 110:63-74. [PMID: 35105209 DOI: 10.1024/1661-8157/a003819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CME: Fever in Travelers Returning from the Tropics Abstract. With rising numbers of travelers to tropic countries consultations for suspected tropical infections are on the rise in primary care and emergency units. The aim is to identify potentially life-threatening and highly contagious infectious diseases. In addition, counseling on the prevention of tropical diseases is taking on an important role. This article intends to provide an overview of the most important infections acquired in the tropics and support for clinical practice.
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Affiliation(s)
- Christina Ginten
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Zürich, Zürich
| | - Nadia Eberhard-Kuhn
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Zürich, Zürich
| | - Dominique Braun
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Zürich, Zürich
| | - Marisa Kälin
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Zürich, Zürich
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11
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Garcia-Ruiz de Morales A, Morcate C, Isaba-Ares E, Perez-Tanoira R, Perez-Molina JA. High prevalence of malaria in a non-endemic setting among febrile episodes in travellers and migrants coming from endemic areas: a retrospective analysis of a 2013-2018 cohort. Malar J 2021; 20:449. [PMID: 34838010 PMCID: PMC8627073 DOI: 10.1186/s12936-021-03984-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background The study aimed to analyse the likelihood of imported malaria in people with a suggestive clinical picture and its distinctive characteristics in a hospital in the south of Madrid, Spain. Methods Observational retrospective study that consisted of a review of all medical files of patients with any malaria test registered at Móstoles University Hospital between April 2013 and April 2018. All suspected malaria cases were confirmed by Plasmodium spp. polymerase chain reaction (PCR). Results Of the 328 patients with suspected malaria (53.7% migrant-travellers; 38.7% visitors; 7.6% travellers), 108 cases were confirmed (101 by Plasmodium falciparum), accounting for a 33% positive sample rate. Sixteen cases were diagnosed only by PCR. Patients with malaria, compared to those without, presented predominantly with fever (84% vs. 65%), were older (34 vs. 24 years), sought medical attention earlier (17d vs. 32d), had a greater number of previous malaria episodes (74% vs. 60%), lower levels of platelets (110,500µL vs. 250,000µL), and higher of bilirubin (0.6 mg/dL vs. 0.5 mg/dL). Severe malaria was present in 13 cases; no deaths were recorded. Malaria diagnosis showed a bimodal distribution with two peaks: June to September and November to January. Conclusions Malaria is still a common diagnosis among febrile patients coming from the tropics specially among migrant travellers. Fever, thrombocytopenia, and/or high bilirubin levels should raise suspicion for this parasitic infection. Prompt diagnosis is crucial to avoid severe cases and deaths. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03984-9.
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Affiliation(s)
- Alejandro Garcia-Ruiz de Morales
- Infectious Diseases Department, National Referral Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBER de Enfermedades Infecciosas, 28034, Madrid, Spain.,Internal Medicine Department, Móstoles University Hospital, Móstoles, Spain
| | - Covadonga Morcate
- Internal Medicine Department, Móstoles University Hospital, Móstoles, Spain
| | - Elena Isaba-Ares
- Internal Medicine Department, Móstoles University Hospital, Móstoles, Spain
| | - Ramon Perez-Tanoira
- Clinical Microbiology Department, Príncipe de Asturias University Hospital, Madrid, Spain.,Biomedicine and Biotechnology Department, Faculty of Medicine, Alcalá de Henares University, Alcalá de Henares, Spain
| | - Jose A Perez-Molina
- Infectious Diseases Department, National Referral Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBER de Enfermedades Infecciosas, 28034, Madrid, Spain.
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12
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Kaplan S, Khoury S, Zaidenstein R, Cohen E, Tischler-Aurkin D, Sheffer R, Lewis M, Mor Z. Morbidity among Israeli backpack travelers to tropical areas. Travel Med Infect Dis 2021; 45:102178. [PMID: 34687872 DOI: 10.1016/j.tmaid.2021.102178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 09/21/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Travelers to tropical areas may be susceptible to illness or injuries. This study aims to assess morbidity among travelers during their travel and compare those who became ill or were injured with those who did not. METHODS This prospective study included 400 travelers who were counselled by a physician in pre-travel clinics in central Israel between 2017 and 2018. Participants were interviewed within a month after their return regarding morbidity during travel, including health problems that started one week following their return. RESULTS Most travelers (N = 320, 80%) reported at least one illness or injury. Illnesses/injuries were more common among females than males (84.9% vs. 75.1%, p = 0.01), travel periods longer than 30 days (87.7% vs. 77.2%, p = 0.03), and travelers accompanied by their friends or solo travelers compared with those who traveled with their family/partner (83.8% and 70.0%, respectively, p = 0.002). The most common complaint was diarrhea (N = 159, 49.6%), followed by high-altitude sickness (N = 118, 36.9%) and fever (N = 100, 31.2%). Altitude sickness symptoms were more common in females than in males (58.9% vs. 41.0%, p = 0.006) and in those who ascended rapidly in comparison to those who ascended gradually (58.7% vs. 44.6%, p = 0.04). Animal injury was reported by 30 (7.5%) participants yet only eight (27.0%) received medical care, seven of whom (23.3%) were vaccinated against rabies. CONCLUSIONS Being a female, traveling with friends or alone and longer travel periods were associated with illness/injury. Practitioners at pre-travel clinics should inform travelers of the possible risks including the potential severe consequences of rabies and altitude sickness.
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Affiliation(s)
- Shiran Kaplan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Sobhi Khoury
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Zaidenstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine Department A, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Mor Travel Clinics, Israel
| | - Erica Cohen
- Mor Travel Clinics, Israel; Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Rivka Sheffer
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Matthew Lewis
- Mor Travel Clinics, Israel; Israel District Health Office, Ministry of Health, Israel
| | - Zohar Mor
- Mor Travel Clinics, Israel; Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel; School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
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13
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Graumans W, Stone WJR, Bousema T. No time to die: An in-depth analysis of James Bond's exposure to infectious agents. Travel Med Infect Dis 2021; 44:102175. [PMID: 34662727 DOI: 10.1016/j.tmaid.2021.102175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 01/29/2023]
Abstract
Global travelers, whether tourists or secret agents, are exposed to a smörgåsbord of infectious agents. We hypothesized that agents pre-occupied with espionage and counterterrorism may, at their peril, fail to correctly prioritize travel medicine. To examine our hypothesis, we examined adherence to international travel advice during the 86 international journeys that James Bond was observed to undertake in feature films spanning 1962-2021. Scrutinizing these missions involved ∼3113 min of evening hours per author that could easily have been spent on more pressing societal issues. We uncovered above-average sexual activity, often without sufficient time for an exchange of sexual history, with a remarkably high mortality among Bond's sexual partners (27.1; 95% confidence interval 16.4-40.3). Given how inopportune a bout of diarrhea would be in the midst of world-saving action, it is striking that Bond is seen washing his hands on only two occasions, despite numerous exposures to foodborne pathogens. We hypothesize that his foolhardy courage, sometimes purposefully eliciting life-threatening situations, might even be a consequence of Toxoplasmosis. Bond's approach to vector-borne diseases and neglected tropical diseases is erratic, sometimes following travel advice to the letter, but more often dwelling on the side of complete ignorance. Given the limited time Bond receives to prepare for missions, we urgently ask his employer MI6 to take its responsibility seriously. We only live once.
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Affiliation(s)
- Wouter Graumans
- Department of Medical Microbiology & Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - William J R Stone
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Teun Bousema
- Department of Medical Microbiology & Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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14
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Drinking and Night-Time Driving May Increase the Risk of Severe Health Outcomes: A 5-Year Retrospective Study of Traffic Injuries among International Travelers at a University Hospital Emergency Center in Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189823. [PMID: 34574746 PMCID: PMC8466615 DOI: 10.3390/ijerph18189823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 11/28/2022]
Abstract
Road traffic injury (RTI) is a leading cause of death in developing countries. This burden affects not only locals, but also international travelers. Data on international travelers with RTIs in Thailand, especially from a medical perspective, are limited. This study aimed to analyze the factors associated with severe health outcomes following RTIs among international travelers at a university hospital emergency center in Thailand from January 2015 to December 2019. The retrieved data consisted of demographics, risks, preventive factors, and health outcomes. The severity of outcome was classified as fatality, hospitalization, or non-severe. A multinomial logistic regression model was used to identify the possible determinants of severity of health outcome among international travelers with RTI. A total of 720 travelers with RTIs (69% males; 82.5% were Southeast Asian) were included, with a mean age of 28.5 years. Of these, 144 (20%) had severe health outcomes: 64 (9%) fatalities and 80 (11%) hospitalizations. The level of severity of outcome was not associated with travelers’ demographics, but was associated with conventional risk factors, i.e., motorcycle use, alcohol/drug use, night-time driving, and less use of seatbelt/helmet. In a multinomial logistic regression analysis, alcohol drinking (adjusted odds ratio (AOR) 2.53, 95% confidence interval (CI) 1.41–4.55) and night-time driving (AOR 2.54, 95% CI 1.36–4.75) were associated with hospitalization. Patients who had a history of tetanus vaccination were less likely to die (AOR 0.37, 95% CI 0.17–0.81). In conclusion, one-fifth of RTIs resulted in severe health outcomes, and 9% were fatal. Road safety campaigns in Thailand should target travelers of all nationalities. Interventions that enhance travelers’ safety practices and proper preparation for road accidents should be explored further.
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15
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Costello VH, Tribble D, Eickhoff C, Tilley DH, Utz G, Telu K, Ganesan A, Fraser J, Lalani T. Travel-Related Risk Behaviors and Antibiotic Use Among Older Travelers. Open Forum Infect Dis 2021; 8:ofab395. [PMID: 34430673 PMCID: PMC8378587 DOI: 10.1093/ofid/ofab395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background Antibiotic stewardship in the pretravel care of older adults is important to effectively treat infections while minimizing harm from side effects and unnecessary antibiotic use. The objective of this study was to compare the characteristics, risk behaviors, infectious diseases, and antibiotic use between older (≥60 years) and younger (18-59 years) travelers. Methods TravMil is a prospective, observational cohort of United States (US) Department of Defense beneficiaries traveling outside the continental US for ≤6.5 months. For this analysis, we included adults enrolled pretravel between January 2010 and August 2018 and excluded active duty personnel on deployment. Pre and post-travel surveys captured trip characteristics, exposures, illnesses, and antibiotic use. Results A total of 1742 travelers were analyzed: 747 (42.9%) were aged ≥60 years and 995 (57.1%) were aged 18-59 years. Older travelers were less likely to engage in high-risk dietary behaviors and experience travelers' diarrhea than younger travelers (18.2% vs 22.9%; P < .05). Influenza-like illness (12.5%) and febrile illness (3.4%) occurred less frequently in the older cohort. Antibiotic use for self-treatment was common in both age groups (25.7% vs 26.7%) and often inappropriate, for example, for treatment of occasional loose stool or mild travelers' diarrhea (67.0% [67/100] in older adults vs 57.6% [83/144] in younger adults; P < .05), and influenza-like illness (63.4% [64/101] vs 58.6% [68/116], respectively; P < .05). Conclusions Older travelers were less likely to engage in high-risk behaviors and experience travelers' diarrhea, and both age groups experienced mild, self-limited infections. Inappropriate use of antibiotics was common, suggesting that antimicrobial stewardship should be emphasized at pretravel counseling with international travelers.
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Affiliation(s)
| | - David Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | | | - Gregory Utz
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Naval Medical Center San Diego, San Diego, California, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Kalyani Telu
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA.,Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jamie Fraser
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Tahaniyat Lalani
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA.,Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
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16
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Brockhus L, Eich AS, Exadaktylos A, Jachmann A, Klukowska-Rötzler J. Repatriations of Ill and Injured Travelers and Emigrants to Switzerland: A Retrospective Analysis at a Tertiary Emergency Department from 2013-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052777. [PMID: 33803358 PMCID: PMC7967485 DOI: 10.3390/ijerph18052777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 11/16/2022]
Abstract
Background: As more and more people are travelling abroad, there are also increasing numbers who fall ill or have accidents in foreign countries. Some patients must be repatriated. While it has been reported that the number of repatriations is rising steadily, little is known about patients' characteristics, calling for in depth investigations of this patient group. Methods: We have conducted a retrospective study including 447 patients repatriated to the Emergency Department at the University Hospital (Inselspital) in Bern, Switzerland from 2013-2018. Results: Between 2013 and 2018, the number of repatriated patients increased by 42.6%, from 54 to 77 cases. In total, 59% of these patients were male and the median age was 60 years. Overall, 79% of patients were repatriated from European countries, with the top five countries being Italy, France, Spain, Germany and Austria. About half the cases (51.9%) were caused by illness, the other half by accidents. In total, 127 patients had to undergo surgical intervention abroad; another 194 patients underwent surgery after repatriation. The hospitalization rate was 81.4%, with a median length of in-hospital stay of 9 days (IQR 5-14) at the Inselspital. The mortality rate of at the Inselspital hospitalized patients was 4.4%, with 16 patients dying within the first 30 days after repatriation. The median cost per case was 12,005.79 CHF (IQR 4717.66-24,462.79). A multiple regression analysis showed a significant association of total costs with hospitalization (p = 0.001), surgical intervention (p = 0.001), as well as treatment in the intensive care unit (p = 0.001). Conclusions: The number of repatriations has been continuously increasing in recent years and reached a mean value of more than one case per week at the Inselspital (77 cases per year in 2018). The 30 day-mortality rate of 4.4% and the median cost per case are relatively high, demonstrating a neglected Public Health concern. These findings may provide impetus-not only for further research into repatriations but also for Public Health Promotion strategies.
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17
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Vlot JA, Vive MGD, Brockhoff HJ, van Genderen PJJ, Trompenaars MCE, van Steenbergen JE, Visser LG. Predicting morbidity in older travellers during a short-term stay in the tropics: the ELDEST study. J Travel Med 2021; 28:taaa216. [PMID: 33225347 PMCID: PMC7788562 DOI: 10.1093/jtm/taaa216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/19/2020] [Accepted: 11/06/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Older persons may suffer more from travel-related health problems because of ageing and underlying chronic disorders. Knowledge on who is more likely to have these health problems helps to tailor travel health advice more specifically. This study aimed to determine predictors of travel-related morbidity in older travellers by assessing their pre-travel characteristics and performance using physical and cognitive functioning tests. METHODS Multicentre prospective cohort study among older travellers (≥60 years) who consulted one of the participating Dutch travel clinics. Handgrip strength and cognitive performance were measured pre-travel. Participants completed questionnaires before departure and 1 and 4 weeks after return. A diary recorded health complaints during travel until 2-week post-travel. RESULTS In total, 477 travellers completed the study (follow-up rate of 97%). Participants' median age was 66 years. The most visited regions were South-East Asia (34%) and South Asia (14%). Median travel duration was 19 days. Polypharmacy (≥5 medications per day) was not uncommon (16%). The median Charlson Comorbidity Index (CCI) score was 0. Self-reported travel-related infectious diseases concerned primarily respiratory tract infections (21%) and gastroenteritis (10%) whereas non-infectious complaints were injuries (13%), peripheral edema (12%) and dehydration (3%). Medical assistance was sought by 18%, mostly post-travel from their general practitioner (87%). Self-reported physical and mental health-related quality of life significantly improved during and after travel. Predictors for an increased risk of travel-related morbidity were higher CCI score, more travel experience, longer travel duration, higher number of daily medications, visiting northern Africa or South-East and East Asia, and phone and social media use. CONCLUSION Older Dutch travellers are generally fit, well-prepared and suffer not only from common infectious health problems, but also from injuries. Travel improved their self-perceived health. The predictors could be used to identify the more at-risk older traveller and to decrease travel-related morbidity by optimizing pre-travel advice.
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Affiliation(s)
- Jessica A Vlot
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Marissa G D Vive
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Henricus J Brockhoff
- Department of Infectious Diseases, Municipal Health Service, Westeinde 128, 2512 HE The Hague, The Netherlands
| | - Pieter J J van Genderen
- Harbour Hospital and Institute for Tropical Diseases, currently working on Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | | | - James E van Steenbergen
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Centre for Infectious Disease Control, Netherlands Institute for Public Health and Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Leonardus G Visser
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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18
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Boddington NL, Steinberger S, Pebody RG. Screening at ports of entry for Ebola Virus Disease in England-a descriptive analysis of screening assessment data, 2014-2015. J Public Health (Oxf) 2020; 44:370-377. [PMID: 33348353 DOI: 10.1093/pubmed/fdaa216] [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: 05/31/2020] [Revised: 10/21/2020] [Accepted: 10/30/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In response to the outbreak of Ebola Virus Disease (EVD) in West Africa in 2014 and evidence of spread to other countries, pre-entry screening was introduced by PHE at five major ports of entry in the England. METHODS All passengers that entered the England via the five ports returning from Liberia, Guinea and Sierra Leonne were required to complete a Health Assessment Form and have their temperature taken. The numbers, characteristics and outcomes of these passengers were analysed. RESULTS Between 14 October 2014 and 13 October 2015, a total of 12 648 passengers from affected countries had been screened. The majority of passengers were assessed as having no direct contact with EVD cases or high-risk events (12 069, 95.4%), although 535 (4.2%) passengers were assessed as requiring public health follow-up. In total, 39 passengers were referred directly to secondary care, although none were diagnosed with EVD. One high-risk passenger was later referred to secondary care and diagnosed with EVD. CONCLUSIONS Collection of these screening data enabled timely monitoring of the numbers and characteristics of passengers screened for EVD, facilitated resourcing decisions and acted as a mechanism to inform passengers of the necessary public health actions.
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Affiliation(s)
- Nicki L Boddington
- Immunisation and Countermeasures Department, Public Health England, London NW9 5EQ, UK
| | - Sophia Steinberger
- Immunisation and Countermeasures Department, Public Health England, London NW9 5EQ, UK
| | - Richard G Pebody
- Immunisation and Countermeasures Department, Public Health England, London NW9 5EQ, UK
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Perez-Molina JA, Crespillo-Andújar C, Moreno S, Serrano-Villar S, López-Vélez R. Travelling with HIV in the XXI century: Case report and narrative review. Travel Med Infect Dis 2020; 38:101921. [PMID: 33220457 DOI: 10.1016/j.tmaid.2020.101921] [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: 06/27/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/26/2022]
Abstract
The number of migrants and travellers has grown in recent decades. This phenomenon is also true of people living with HIV, given their much-improved life expectancy and quality of life. A significant number of travellers with HIV are migrants returning to their home countries to visit friends and relatives (VFRs). This population constitutes a high-risk group because they travel for longer and often to rural and remote areas and have closer contact with the local population. In this review we discuss the sociodemographic characteristics of travellers with HIV, the differences between conventional travellers and VFRs, and the risks of HIV acquisition and transmission during travel. We also present the most relevant travel-associated illnesses and highlight the particularities of pre-travel advice given to this population, including immunosuppression, responses to vaccines, high incidence of comorbidities, drug interactions, legal and language barriers. The need to integrate these factors based on far less evidence than that available for the general population makes pre-travel advice for travellers with HIV genuinely challenging.
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Affiliation(s)
- Jose A Perez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar, Km 9.1, 28034, Madrid, Spain.
| | - Clara Crespillo-Andújar
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar, Km 9.1, 28034, Madrid, Spain
| | - Santiago Moreno
- HIV Unit, Infectious Diseases Department, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar, Km 9.1, 28034, Madrid, Spain
| | - Sergio Serrano-Villar
- HIV Unit, Infectious Diseases Department, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar, Km 9.1, 28034, Madrid, Spain
| | - Rogelio López-Vélez
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar, Km 9.1, 28034, Madrid, Spain
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20
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Lago K, Telu K, Tribble D, Ganesan A, Kunz A, Geist C, Fraser J, Mitra I, Lalani T, Yun HC. Doxycycline Malaria Prophylaxis Impact on Risk of Travelers' Diarrhea among International Travelers. Am J Trop Med Hyg 2020; 103:1864-1870. [PMID: 32815505 PMCID: PMC7646764 DOI: 10.4269/ajtmh.20-0241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/11/2020] [Indexed: 12/21/2022] Open
Abstract
International travelers are frequently at risk for travelers' diarrhea (TD) and malaria. Doxycycline was one of the earliest antibiotics shown to have efficacy in TD prevention. With increasing resistance and recommendations against antibiotic chemoprophylaxis, doxycycline fell out of use. We evaluated TD incidence and risk factors in a prospective cohort of travelers, specifically in regard to malaria prophylaxis. Travelers' diarrhea was defined as ≥ 3 loose stools in 24 hours or two loose stools in 24 hours associated with other gastrointestinal symptoms. The Poisson regression model with robust error variance was used to estimate the RR of TD. Three thousand two hundred twenty-seven trips were enrolled: 62.1% of participants were male, with a median age of 39 years (interquartile range [IQR] 27,59) and a median travel duration of 19 days (IQR 12,49); 17.4% developed TD; 32% traveled to Africa, 40% to Asia, and 27% to the Caribbean and Latin America; and 20% took doxycycline for malaria chemoprophylaxis, 50% took other antimalarials, and 30% took none. Decreased RR of TD was associated with doxycycline (RR 0.62 [0.47-0.82], P < 0.01) and military travel (RR 0.57 [0.47-0.70], P < 0.01). Increased risk of TD was associated with female gender (RR 1.28 [1.09-1.50], P < 0.01), hotel accommodations (RR 1.30 [1.10-1.53], P < 0.01), travel to tropical South America (RR 1.34 [1.09-1.64], P < 0.01), and duration of travel (RR 1.00 [1.00-1.01], P < 0.01). The use of doxycycline for malaria prophylaxis is associated with lower TD risk, suggesting increasing bacterial enteropathogen susceptibility similar to previous observations. Doxycycline selection for antimalarial chemoprophylaxis may provide additional traveler benefit in infection prevention.
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Affiliation(s)
- Kathryn Lago
- Brooke Army Medical Center, Fort Sam Houston, Texas
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kalyani Telu
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - David Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Anjali Kunz
- Madigan Army Medical Center, Tacoma, Washington
| | - Charla Geist
- Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Jamie Fraser
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Indrani Mitra
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
- Naval Medical Center, Portsmouth, Virginia
| | - Heather C. Yun
- Brooke Army Medical Center, Fort Sam Houston, Texas
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - for the Infectious Disease Clinical Research Program TravMil Study Group
- Brooke Army Medical Center, Fort Sam Houston, Texas
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
- Walter Reed National Military Medical Center, Bethesda, Maryland
- Madigan Army Medical Center, Tacoma, Washington
- Landstuhl Regional Medical Center, Landstuhl, Germany
- Naval Medical Center, Portsmouth, Virginia
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21
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Stefanati A, Pierobon A, Baccello V, DeStefani E, Gamberoni D, Furlan P, Sandri F, Stano A, Coin P, Baldo V, Gabutti G. Travellers' risk behaviors and health problems: Post-travel follow up in two travel medicine centers in Italy. Infect Dis Now 2020; 51:279-284. [PMID: 33069841 DOI: 10.1016/j.medmal.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/15/2020] [Accepted: 10/08/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We examined the association between travellers' characteristics, compliance with pre-travel recommendations and health problems. METHODS Volunteer travellers were enrolled and data collected using a questionnaire between 30-60 days after returning home. We analyzed the associations through bivariate and multivariate models. RESULTS Of the 468 enrolled travelers, 68% consumed raw food and 81% food containing milk and/or eggs. 32% consumed street vendor food and 30% drinks containing ice. 24% used the recommended mechanical prophylaxis measures. 46% got sick during and/or after travel (gastrointestinal symptoms most frequently). Factors predisposing to health problems were female gender, youth/middle age, intermediate travel duration and profession. The American continent and staying in hostels and tents were significantly associated with febrile illness. Street vendor food was significantly associated with skin reactions. CONCLUSIONS Adherence to behavioral recommendations remains low. Travellers must be informed of health risks during and after travel.
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Affiliation(s)
- A Stefanati
- University of Ferrara, Department of Medical Sciences, Ferrara, Italy.
| | - A Pierobon
- Local Health Unit 7 Pedemontana, Veneto Regione, Departiment of Prevention, Bassano del Grappa, Italy
| | - V Baccello
- University of Ferrara, Department of Medical Sciences, Ferrara, Italy
| | - E DeStefani
- Local Health Unit 7 Pedemontana, Veneto Regione, Departiment of Prevention, Bassano del Grappa, Italy
| | - D Gamberoni
- University of Ferrara, Department of Medical Sciences, Ferrara, Italy
| | - P Furlan
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - F Sandri
- University of Ferrara, Department of Medical Sciences, Ferrara, Italy
| | - A Stano
- Local Health Unit 7 Pedemontana, Veneto Regione, Departiment of Prevention, Bassano del Grappa, Italy
| | - P Coin
- Local Health Unit 7 Pedemontana, Veneto Regione, Departiment of Prevention, Bassano del Grappa, Italy
| | - V Baldo
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - G Gabutti
- University of Ferrara, Department of Medical Sciences, Ferrara, Italy
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22
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Szabados F, Kragh J, Rasmussen C, Leutscher PDC. Biological therapy and international travel: A questionnaire survey among Danish patients with rheumatic disease. Eur J Rheumatol 2020; 7:eurjrheum.2020.19190. [PMID: 32910755 PMCID: PMC7574764 DOI: 10.5152/eurjrheum.2020.19190] [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: 11/07/2019] [Accepted: 04/11/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe travel activities, preparations, and health problems encountered by patients with arthritis receiving biological therapy. METHODS A travel survey was conducted in a Danish rheumatology outpatient clinic by distribution of a semistructured questionnaire to 300 consecutive patients with arthritis. RESULTS Among the 273 (91%) patients returning the questionnaire, a history of traveling outside Denmark was reported by 203 (74%) respondents and outside Europe by 92 (34%). In 81% of the patients, travel activities had not decreased after the initiation of biological treatment. However, 24% reported that they had become more cautious regarding the choice of travel destination. Pre-travel advice was sought by less than one-third of the patients, whereas travel insurance was taken out by 86%, but only half of them had disclosed information about the biological treatment. Treatment was discontinued temporarily while traveling in 26% of patients on subcutaneous biologics. The main reason for discontinuation was concern about transport and storage of medicine. Only 6% of the travelers had experienced health problems, which were of only minor importance. CONCLUSION Treatment with biologics seems not to have any major influence on international travel activity among Danish patients with arthritis. Health problems when traveling were of minor importance. However, pre-travel advice issues, including treatment compliance, transport of medicine, and insurance coverage, need to be addressed proactively by the outpatient clinic staff as part of patient consultation.
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Affiliation(s)
- Fruzsina Szabados
- Department of Reumatology, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Jette Kragh
- Department of Reumatology, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Claus Rasmussen
- Department of Reumatology, North Denmark Regional Hospital, Hjoerring, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Peter Derek Christian Leutscher
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
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23
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Fever in the Returned Traveler. HUNTER'S TROPICAL MEDICINE AND EMERGING INFECTIOUS DISEASES 2020. [PMCID: PMC7152027 DOI: 10.1016/b978-0-323-55512-8.00150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
International travel is associated with a risk of infections not typically seen in high-income settings. Malaria is the most important tropical infection in travelers, but epidemics of dengue, chikungunya, and Zika emphasize that clinicians need to be aware of the rapidly changing distribution of many arboviruses. A detailed travel history and a syndromic approach to the investigation and management of patients is key. Consultation with a specialist is often recommended to ensure that appropriate management and investigations are undertaken in febrile returned travelers. Travel, especially to low-income regions, is associated with an increased risk of infections not typically seen in high-income countries (e.g., malaria, enteric fever, dengue, chikungunya, Zika, and schistosomiasis). Although gastroenteritis, respiratory tract infections, and self-limiting viral infections are common, a minority of patients will have a potentially life-threatening tropical infection. The evaluation of an ill returned traveler requires a detailed travel history with an understanding of the geographic distribution of infections, risk factors for acquisition, incubation periods, clinical presentations, and appropriate laboratory investigations. A syndromic approach to specific investigations, and to presumptive therapy pending laboratory confirmation of the diagnosis, is appropriate. Travel is also a risk factor for acquisition of antimicrobial-resistant bacteria, such as those containing extended spectrum β-lactamases, that become part of the traveler's colonizing flora. As a rule, malaria should be excluded in all travelers presenting with a fever who have visited the tropics.
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24
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Gauthier P, Bellanger AP, Bozon F, Lepiller Q, Chirouze C, Marguet P. A survey investigating the current practice of French health professionals regarding infection risk after monkey bites. Zoonoses Public Health 2019; 67:193-197. [PMID: 31828958 DOI: 10.1111/zph.12665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/16/2019] [Accepted: 11/06/2019] [Indexed: 12/01/2022]
Abstract
International tourism is steadily increasing, with 15% of travellers reporting health problems when they come back. Animal bites represent 2% of consulting causes, of which 20% are due to monkey bites. The Monkey B virus (Macacine alphaherpesvirus 1) is an alphaherpesvirus (Herpesviridae, genus Simplexvirus) enzootic in macaques (Genus Macaca). Zoonotic infections with the Monkey B virus following exposure to macaques are exceptionally rare, but can cause fatal encephalomyelitis in humans. An observational survey was undertaken in 2018 to assess the practice of French health professionals regarding infection risk after monkey bites. French health professionals practicing in vaccination and rabies centres were specifically targeted for this study. Standardized questionnaires were sent by email to a sample of French health professionals. They were asked to participate on a voluntary and anonymous basis. The questionnaires requested epidemiological details and included multiple-choice questions about the infection management of monkey bites. The response rate was 33.5%. The frequency of monkey bites in 2017 was variable with a minority of centres managing more than 6 per year (12%), 46% managing 1-5 monkey bites and 42% none. Most of the monkey bites were described as occurring in South Asia at tourist sites, on naked upper limbs, shortly after the travellers arrived at their destination. Tetanus status verification, rabies post-exposure prophylaxis and antibiotic therapy were said to be prescribed in most cases. Knowledge about the Monkey B virus was reported as scarce for 38% of the participants. The number of monkey bites managed per year per centre varied greatly but practices regarding infectious risk after monkey bites were generally homogeneous. The risk of Monkey B virus transmission did not readily come to mind in the differential diagnosis of infection risk for many French health professionals.
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Affiliation(s)
- Pauline Gauthier
- Emergency Department, Regional Hospital of Pontarlier, Pontarlier, France
| | | | - Fabienne Bozon
- Infectious and Tropical Disease Department, University Hospital of Besançon, Besancon, France
| | - Quentin Lepiller
- Virology Department, University Hospital of Besançon, Besancon, France.,EA3181, University Bourgogne Franche-Comté, Besancon, France
| | - Catherine Chirouze
- Infectious and Tropical Disease Department, University Hospital of Besançon, Besancon, France
| | - Philippe Marguet
- Emergency Department, Regional Hospital of Pontarlier, Pontarlier, France
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25
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Pisutsan P, Soonthornworasiri N, Matsee W, Phumratanaprapin W, Punrin S, Leowattana W, Mansanguan C, Leshem E, Piyaphanee W. Incidence of health problems in travelers to Southeast Asia: a prospective cohort study. J Travel Med 2019; 26:5520737. [PMID: 31218345 DOI: 10.1093/jtm/taz045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/14/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND There are few studies of the incidence of health problems among travelers to Southeast Asia. The current study sought to determine the incidence of self-reported health problems among travelers visiting the region. METHODS A prospective questionnaire-based study was conducted among travelers from high-income countries who visited Southeast Asia. Participants were enrolled at time of their pre-travel visit at Mahidol University, Bangkok, Thailand. Travelers were prospectively followed by self-administered questionnaires 2 weeks after arrival, upon return to their home country and 2 weeks after return. RESULTS During January 2018-February 2019, 359 travelers were enrolled in Bangkok, Thailand, and the first questionnaire was administered. Follow-up questionnaires were returned by 191, 96 and 64 participants 2 weeks later, at the end of the trip and 2 weeks after return, respectively. A total of 6094 travel days were included in the final analysis. The incidence of acute diarrhea per month per 1000 travelers was 217 [95% confidence interval (CI), 189-248] episodes; skin problems, 197 (95% CI, 170-227); respiratory symptoms, 133 (95% CI, 111-158); fever, 49 (95% CI, 36-65); and potential rabies exposure, 34 (95% CI, 24-48). The incidence of acute diarrhea episodes per month per 1000 travelers was significantly higher during the first 2 weeks of travel compared with subsequent weeks of travel: 325 (95% CI, 291-362) vs 132 (95% CI, 110-1157) (P < 0.05). The incidence of outpatient visits and hospitalizations per month per 1000 travelers was 49 (95% CI, 36-65) and 5 (95% CI, 2-10), respectively. CONCLUSIONS In this prospective cohort study we observed substantial burden of acute diarrhea and skin and respiratory symptoms among travelers to Southeast Asia. The higher incidence of diarrhea in the first 2 weeks of travel should be further investigated.
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Affiliation(s)
- Phimphan Pisutsan
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Wasin Matsee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Weerapong Phumratanaprapin
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Suda Punrin
- Queen Saovabha Memorial Institute, The Thai Red Cross Society, Bangkok, Thailand
| | - Wattana Leowattana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Chayasin Mansanguan
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Eyal Leshem
- Sackler School of Medicine, Tel Aviv University, Sheba Medical Center, Ramat Gan, Israel
| | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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26
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Darrat M, Flaherty GT. Retrospective analysis of older travellers attending a specialist travel health clinic. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2019; 5:17. [PMID: 31548898 PMCID: PMC6751636 DOI: 10.1186/s40794-019-0094-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/09/2019] [Indexed: 12/12/2022]
Abstract
Background Older people represent a significant proportion of overseas travellers. The epidemiology of older international travellers is not well described in the literature. This study aims to identify demographics, travel characteristics and the medical profile of older travellers seeking pre-travel health advice in a specialist travel medicine clinic. Methods Records of travellers aged 60 years and older attending the Tropical Medical Bureau clinic in Galway, Ireland between 2014 and 2018 were examined. Descriptive and inferential.analysis of data was performed. Results A total of 337 older travellers sought pre-travel health advice during the study period. The mean age of the cohort was 65.42 (±10) years. Most of the travellers (n = 267, 80%) had at least one travelling companion. Nearly half of older travellers (n = 155, 46.8%) were travelling with a single companion. Tourism was the main reason for travel for the majority (n = 260, 77.6%), followed by visiting friends and relatives (VFR) (n = 23, 6.9%) travellers. The mean interval remaining before the planned trip was 4.36 (±2) weeks, and the mean duration of travel was 3.16 (±1) weeks. The most popular single country of destination was India with 33 (9.8%) visitors, and South East Asia was the most popular region with 132 (39.2%) older travellers. The majority of travellers (n = 267, 79.2%) had a documented pre-existing medical condition. The most commonly reported medical conditions were hypertension (n = 26, 7.7%), dyslipidaemia (n = 18, 5.3%), diabetes mellitus (n = 12, 3.5%), insect bite sensitivity (n = 11, 3.3%), and hypothyroidism (n = 9, 2.6%). Antihypertensive agents (n = 32, 9.4%) and statins (n = 24, 7.1%) were the most frequently used medications. Typhoid (n = 112, 33.2%) and hepatitis A (n = 84, 24.9%) were the most common vaccinations administered to older travellers at the clinic. Conclusions This study provides an insight into the demographics, travel characteristics, and medical profile of elderly travellers seeking advice at a large travel clinic in Ireland. A wide range of travel destinations, diseases and medication use was reported among this group of travellers, which may enable travel medicine physicians to provide more tailored advice and to more appropriately counsel older travellers.
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Affiliation(s)
- Milad Darrat
- 1School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Gerard T Flaherty
- 1School of Medicine, National University of Ireland Galway, Galway, Ireland.,2School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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27
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Kain D, Findlater A, Lightfoot D, Maxim T, Kraemer MUG, Brady OJ, Watts A, Khan K, Bogoch II. Factors Affecting Pre-Travel Health Seeking Behaviour and Adherence to Pre-Travel Health Advice: A Systematic Review. J Travel Med 2019; 26:5549355. [PMID: 31407776 DOI: 10.1093/jtm/taz059] [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: 06/16/2019] [Revised: 07/25/2019] [Accepted: 07/25/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Recent years have seen unprecedented growth in international travel. Travellers are at high risk for acquiring infections while abroad and potentially bringing these infections back to their home country. There are many ways to mitigate this risk by seeking pre-travel advice (PTA), including receiving recommended vaccinations and chemoprophylaxis, however many travellers do not seek or adhere to PTA. We conducted a systematic review to further understand PTA-seeking behaviour with an ultimate aim to implement interventions that improve adherence to PTA and reduce morbidity and mortality in travellers. METHODS We conducted a systematic review of published medical literature selecting studies that examined reasons for not seeking PTA and non-adherence to PTA over the last ten years. 4484 articles were screened of which 56 studies met our search criteria after full text review. RESULTS The major reason for not seeking or non-adherence to PTA was perceived low risk of infection while travelling. Side effects played a significant role for lack of adherence specific to malaria prophylaxis. CONCLUSIONS These data may help clinicians and public health providers to better understand reasons for non-adherence to PTA and target interventions to improve travellers understanding of potential and modifiable risks. Additionally, we discuss specific recommendations to increase public health education that may enable travellers to seek PTA.
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Affiliation(s)
- Dylan Kain
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Aidan Findlater
- Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Timea Maxim
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | | | - Oliver J Brady
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Alexander Watts
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Kamran Khan
- Department of Medicine, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, Canada.,Divisions of General Internal Medicine and Infectious Diseases, University Health Network, Toronto, Canada
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28
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Penberthy K, Mendoza J, Mendoza M, Harrison G, Lancaster L, Belyea B, Zeichner SL. Abdominal Pain and Intermittent Fevers in a 16-Year-Old Girl. Pediatrics 2019; 144:e20190093. [PMID: 31375532 PMCID: PMC6855813 DOI: 10.1542/peds.2019-0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 01/19/2023] Open
Abstract
A 16-year-old girl presented to the emergency department with intermittent fevers and worsening abdominal pain of 5 weeks duration. She had a history of travel to a less developed country and exposure to possible infectious diseases. Abdominal imaging and blood tests revealed diffuse mesenteric lymphadenopathy, elevated transaminases, and elevation of inflammatory markers. Gastroesophageal and colon endoscopies revealed gastric ulcers, and the patient was discharged with a presumptive diagnosis of systemic juvenile idiopathic arthritis given the lymphadenopathy seen on imaging, serositis, sacroiliac joint stiffness noted on physical examination, and pain relief with celecoxib. She presented again 4 days later with worsening abdominal tenderness, elevated transaminases, and new-onset abdominal distention. Tissue biopsy yielded the diagnosis and directed appropriate treatment.
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MESH Headings
- Abdominal Pain/etiology
- Adolescent
- Animals
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Arthritis, Juvenile/diagnosis
- Biomarkers/blood
- Biopsy
- Diagnosis, Differential
- Emergency Service, Hospital
- Endoscopy, Gastrointestinal
- Enterobiasis/diagnosis
- Female
- Fever/etiology
- Humans
- Inflammation/diagnosis
- Lymphadenopathy/diagnosis
- Lymphoma, Large-Cell, Anaplastic/diagnosis
- Lymphoma, Large-Cell, Anaplastic/diagnostic imaging
- Lymphoma, Large-Cell, Anaplastic/drug therapy
- Lymphoma, Large-Cell, Anaplastic/pathology
- Positron Emission Tomography Computed Tomography
- Stomach Ulcer/chemically induced
- Stomach Ulcer/diagnosis
- Tomography, X-Ray Computed
- Transaminases/blood
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Affiliation(s)
- Kristen Penberthy
- Microbiology, Immunology, and Cancer Biology, School of Medicine, University of Virginia, Charlottesville, Virginia
| | | | | | | | | | | | - Steven L Zeichner
- Pediatric Infectious Diseases, Department of Pediatrics and Departments of
- Microbiology, Immunology, and Cancer Biology, School of Medicine, University of Virginia, Charlottesville, Virginia
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29
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Adou AA, Napolitano F, Vastola A, Angelillo IF. Travelers' knowledge, attitudes, and behavior related to infectious diseases in Italy. PLoS One 2019; 14:e0215252. [PMID: 30978211 PMCID: PMC6461267 DOI: 10.1371/journal.pone.0215252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/29/2019] [Indexed: 01/04/2023] Open
Abstract
The objectives of this investigation were to examine the travelers’ knowledge, attitudes, and behavior about travel-related diseases and to evaluate the factors that influence their knowledge, attitudes, and behavior. A cross-sectional study was performed between May and September 2018 among a random sample of individuals attending randomly selected travel agencies in the geographical areas of Caserta and Naples, Italy. One fourth of participants (25.6%) had a poor level of knowledge, 50.2% a moderate, and only 24.2% a good level about the most common infectious diseases in the destination country. Those who had received information from physicians about the most common infectious diseases in the destination country and who do not need additional information were significantly more likely to have a good level of knowledge. A large majority (91%) showed no concern about the risk of getting an infectious disease during the travel. Almost half of the respondents had received information concerning the most common infectious diseases in the destination country and the related prevention measures. This information was more likely acquired by those graduated, those who know the foods that can cause the infectious diseases, and those who self-perceived a well health status, and less likely by those who had a poor level of knowledge about the most common infectious diseases in the destination country and who were going to Asia and South America. Education and communication activities regarding all aspects of travel-related diseases are needed to increase the knowledge and the access to preventive measures.
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Affiliation(s)
- Abdoulkader Ali Adou
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni, Naples, Italy
| | - Francesco Napolitano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni, Naples, Italy
| | - Alessandra Vastola
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni, Naples, Italy
| | - Italo Francesco Angelillo
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni, Naples, Italy
- * E-mail:
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30
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Pistone T, Ouattara E, Gabillard D, Lele N, Duvignaud A, Cordel H, Malvy D, Bouchaud O, Abgrall S. Travel-related health events and their risk factors in HIV-infected sub-Saharan migrants living in France and visiting their native country: The ANRS VIHVO cohort study. Travel Med Infect Dis 2019; 29:40-47. [PMID: 30951905 DOI: 10.1016/j.tmaid.2019.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/20/2019] [Accepted: 03/28/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Literature on health events in HIV-infected travellers is scarce, particularly in sub-Saharan African (SSA) migrants. METHODS We investigated health events in HIV-infected SSA migrants living in France during and after travel to their native country. All had a pre-travel plasma viral load (pVL) below 200 copies/mL and were on stable combined antiretroviral therapy (cART). Logistic regression models were used to assess the risk factors for at least one adverse health event or febrile event. RESULTS Among 264 HIV migrants, pre-travel median CD4 count was 439/mm3 and 27 migrants (6%) experienced a low-level viremia between 50 and 200 copies/mL. One hundred (38%) experienced at least one event (13 experienced two events). The most common events were gastrointestinal, including diarrhoea (n = 29, 26%), respiratory events (n = 20, 18%), and malaria (n = 17, 15%; 1 death). In multivariable analysis, a pre-travel low-level viremia and a lack of pre-travel medical advice significantly increased the risk for any event (OR 4.31, 95% CI, 1.41-13.1; and OR 3.62, 95% CI, 1.38-9.47; respectively). A lack of pre-travel advice significantly increased the risk for febrile event. CONCLUSIONS Early and tailored counselling on pre-travel medical advice regarding diarrhoea and vector-borne diseases prophylactic measures in HIV-infected SSA migrants should be emphasised before travel to Africa.
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Affiliation(s)
- Thierry Pistone
- CHU Bordeaux, Department for Infectious and Tropical Diseases, 33000, Bordeaux, France; Inserm U1219, Infectious Diseases in Lower Income Countries (IDLIC), Université de Bordeaux, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France.
| | - Eric Ouattara
- CHU Bordeaux, Department for Infectious and Tropical Diseases, 33000, Bordeaux, France; Inserm U1219, Infectious Diseases in Lower Income Countries (IDLIC), Université de Bordeaux, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France.
| | - Delphine Gabillard
- Inserm U1219, Infectious Diseases in Lower Income Countries (IDLIC), Université de Bordeaux, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France.
| | - Nathalie Lele
- AP-HP, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, 93000, Bobigny, France; Université Paris 13, Bobigny, France.
| | - Alexandre Duvignaud
- CHU Bordeaux, Department for Infectious and Tropical Diseases, 33000, Bordeaux, France; Inserm U1219, Infectious Diseases in Lower Income Countries (IDLIC), Université de Bordeaux, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France.
| | - Hugues Cordel
- AP-HP, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, 93000, Bobigny, France; Université Paris 13, Bobigny, France.
| | - Denis Malvy
- CHU Bordeaux, Department for Infectious and Tropical Diseases, 33000, Bordeaux, France; Inserm U1219, Infectious Diseases in Lower Income Countries (IDLIC), Université de Bordeaux, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France.
| | - Olivier Bouchaud
- AP-HP, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, 93000, Bobigny, France; Université Paris 13, Bobigny, France.
| | - Sophie Abgrall
- AP-HP, Hôpital Antoine Béclère, Clamart, France; Inserm U1018, Centre de recherche en Epidémiologie et Santé des Populations (CESP), Le Kremlin-Bicêtre Cedex, Université Paris Sud University, Paris Saclay University, France.
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An assessment of household water quality among Peace Corps volunteers in Guatemala. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2019; 5:2. [PMID: 30923625 PMCID: PMC6419464 DOI: 10.1186/s40794-019-0078-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/21/2019] [Indexed: 11/10/2022]
Abstract
Background Gastrointestinal (GI) illness is the most commonly reported health concern among Peace Corps Volunteers (PCVs) serving in Guatemala. This project identified water types and treatment and storage practices used by PCVs and measured select water quality parameters in their household water. Methods A survey about water types and practices was conducted of PCVs in Guatemala. The water type most frequently consumed in the household ("primary drinking water") and other water types present in the household ("secondary water") were tested for free chlorine residual (FCR) and for the presence of Escherichia coli and total coliforms. A negative binomial regression model was used to analyze data on incidence of self-reported GI illness. Results Tambo (commercially purified water in a 5-gal bottle) was the water type most frequently (64%) reported as primary drinking water in 39 PCV households. Most (74%) PCVs reported drinking water other than primary drinking water ≥1 day per week; the incidence rate of GI illness per PCV per month was significantly lower among PCVs who reported never consuming water other than primary drinking water compared to those who did (0.4 and 1.6 GI illnesses per PCV per month, respectively) (p < 0.05). E. coli was not detected in any primary drinking water sample, but was detected in 35% of secondary water samples. Total coliforms were detected in more than two-thirds of primary drinking water and secondary water samples. Nearly all water samples had an FCR of < 0.2 mg/L. Conclusions Consuming primary drinking water exclusively likely contributes to reducing the rate of GI illness among PCVs. However, most PCVs reported drinking multiple water types, which may include contaminated secondary water types in the household. All water intended for consumption, including secondary sources within and outside the household, should be properly treated and safely stored.
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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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Health Issues in Returned Travellers. MANUAL OF TRAVEL MEDICINE 2019. [PMCID: PMC7120798 DOI: 10.1007/978-981-13-7252-0_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Travellers are more than ever choosing to visit adventurous destinations, sometimes in remote places. In addition, the ease of international travel makes it possible for travellers with underlying medical conditions, such as immunosuppression, the elderly, pregnant women and children to travel to destinations that may place them at risk of a range of exotic infections. It is therefore important for the travel medicine practitioner to have a firm understanding of the spectrum of infections that travellers may acquire according to their travel destination. This chapter provides an overview of the spectrum of infections travellers may encounter and provides an approach to the diagnosis and management of ill returned travellers.
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Hoffman L, Crooks VA, Snyder J. A challenging entanglement: health care providers' perspectives on caring for ill and injured tourists on Cozumel Island, Mexico. Int J Qual Stud Health Well-being 2018; 13:1479583. [PMID: 29869593 PMCID: PMC5990945 DOI: 10.1080/17482631.2018.1479583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose: Despite established knowledge that tourists often fall ill or are injured abroad, little is known about their treatment. The intent of this study was to explore health care professionals’ treatment provision experiences on Cozumel Island, Mexico. Methods: 13 semi-structured interviews were undertaken with professionals across a number of health care vocations on Cozumel Island. Interviews were transcribed and thematically analysed to determine common challenges faced in the provision of treatment for transnational tourists. Results: Three thematic challenges emerged from the data: human and physical resource deficiencies, medical (mis)perceptions held by patients and complexities surrounding remuneration of care. Health care providers employ unique strategies to mitigate these challenges. Conclusion: Although many of these challenges exist within other touristic and peripheral spaces, we suggest that the challenges experienced by Cozumel Island’s health care professionals, and their mitigation strategies, exist as part of a complex entanglement between the island’s health care sector and its dominant tourism landscape. We call on tangential tourism services to take a larger role in ensuring the ease of access to, and provision of quality health care services for tourists on Cozumel Island.
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Affiliation(s)
- Leon Hoffman
- a Department of Geography , Simon Fraser University , Burnaby , Canada
| | - Valorie A Crooks
- a Department of Geography , Simon Fraser University , Burnaby , Canada
| | - Jeremy Snyder
- b Faculty of Health Sciences , Simon Fraser University , Burnaby , Canada
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Stoney RJ, Esposito DH, Kozarsky P, Hamer DH, Grobusch MP, Gkrania-Klotsas E, Libman M, Gautret P, Lian Lim P, Leder K, Schwartz E, Sotir MJ, Licitra C. Infectious diseases acquired by international travellers visiting the USA. J Travel Med 2018; 25:5075537. [PMID: 30124885 PMCID: PMC6638561 DOI: 10.1093/jtm/tay053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/26/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND Estimates of travel-related illness have focused predominantly on populations from highly developed countries visiting low- or middle-income countries, yet travel to and within high-income countries is very frequent. Despite being a top international tourist destination, few sources describe the spectrum of infectious diseases acquired among travellers to the USA. METHODS We performed a descriptive analysis summarizing demographic and travel characteristics, and clinical diagnoses among non-US-resident international travellers seen during or after travel to the USA at a GeoSentinel clinic from 1 January 1997 through 31 December 2016. RESULTS There were 1222 ill non-US-resident travellers with 1393 diagnoses recorded during the 20-year analysis period. Median age was 40 (range 0-86 years); 52% were female. Patients visited from 63 countries and territories, most commonly Canada (31%), Germany (14%), France (9%) and Japan (7%). Travellers presented with a range of illnesses; skin and soft tissue infections of unspecified aetiology were the most frequently reported during travel (29 diagnoses, 14% of during-travel diagnoses); arthropod bite/sting was the most frequently reported after travel (173 diagnoses, 15% after-travel diagnoses). Lyme disease was the most frequently reported arthropod-borne disease after travel (42, 4%). Nonspecific respiratory, gastrointestinal and systemic infections were also among the most frequently reported diagnoses overall. Low-frequency illnesses (<2% of cases) made up over half of diagnoses during travel and 41% of diagnoses after travel, including 13 cases of coccidioidomycosis and mosquito-borne infections like West Nile, dengue and Zika virus diseases. CONCLUSIONS International travellers to the USA acquired a diverse array of mostly cosmopolitan infectious diseases, including nonspecific respiratory, gastrointestinal, dermatologic and systemic infections comparable to what has been reported among travellers to low- and middle-income countries. Clinicians should consider the specific health risks when preparing visitors to the USA and when evaluating and treating those who become ill.
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Affiliation(s)
- Rhett J. Stoney
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Douglas H. Esposito
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Phyllis Kozarsky
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | | | - Michael Libman
- Centre for Tropical Diseases, McGill University Health Centre, Montreal, Canada
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Poh Lian Lim
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Infectious Disease Service, Royal Melbourne Hospital at the Doherty Institute, Melbourne, Australia
| | - Eli Schwartz
- Institute of Geographic Medicine and Tropical Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark J. Sotir
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Carmelo Licitra
- Orlando Health Infectious Disease, University of Central Florida College of Medicine, Orlando, FL, USA
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Leischker AH, Heppner HJ. [Fit for travel in older adults]. MMW Fortschr Med 2018; 160:38-42. [PMID: 29754342 DOI: 10.1007/s15006-018-0531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Andreas H Leischker
- Lehrbeauftragter für das Fach "Geriatrie" an der Heinrich-Heine-Universität Düsseldorf, Klinik für Geriatrie und Gelbfieberimpfstelle, Alexianer Krefeld GmbH, Dießemer Bruch 81, D-47805, Krefeld, Deutschland.
| | - Hans Jürgen Heppner
- Lehrstuhl für Geriatrie, Private Universität Witten/Herdecke gGmbH und Klinik für Geriatrie mit Tagesklinik, Helios Kliniken Schwelm, Schwelm, Deutschland
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Hitch G, Fleming N. Antibiotic resistance in travellers' diarrhoeal disease, an external perspective. J Travel Med 2018; 25:S27-S37. [PMID: 29718437 DOI: 10.1093/jtm/tay014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/08/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are many recommendations on the use of antibiotics for prophylaxis and treatment of travellers' diarrhoea (TD). As pharmacists with a special interest in antimicrobial stewardship, we examine and offer our perspective on advice that is recommended to travellers in terms of prevention, treatment and management of TD with a focus on antibiotic use and resistance. METHODS Publications on TD were identified through PubMed, Google Scholar and Cochrane Library databases searches using search terms 'travellers diarrhoea', 'travellers diarrhoea', 'travellers' diarrhoea' 'guidelines', 'expert opinion', 'expert reviews', 'South Asia' and 'South East Asia' (S and SE Asia), 'antibiotics', 'resistance genes', 'travel advice', 'pharmacists', 'guidelines', 'prevention' and 'treatment'. References of articles were also screened for additional relevant studies. RESULTS Whilst most guidelines and expert reviews were in agreement with the restricted use of antibiotics unless there was a clinical need, the literature review identified gaps in research into behaviours of travellers regarding non-compliance with the pre-travel advice provided and the need for in depth training and education for all healthcare professionals in providing 'tailored' advice for travellers going to high-risk destinations. CONCLUSIONS Travellers should be made aware of the problems of antimicrobial resistance in their destination and home countries and offered alternative forms of prophylaxis for TD. Strategies for prevention of TD, other than the use of antibiotics, also need to be emphasized. All healthcare professionals involved in giving advice about TD should be familiar with the epidemiology of the condition as this will inform responsible behaviours, risk assessment and management strategies in different geographical areas.
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Affiliation(s)
- Geeta Hitch
- Department of Life Sciences/Pharmacy, JMS Building, University of Sussex, Falmer, Brighton BN1 9RH, UK
| | - Naomi Fleming
- Department of Pharmacy, Kettering General Hospital, Rothwell Road, Kettering, Northamptonshire NN16 8UZ, UK
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Heggie TW, Küpper T. Pediatric and adolescent injury in wilderness and extreme environments. Res Sports Med 2018; 26:186-198. [DOI: 10.1080/15438627.2018.1438280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Travis W. Heggie
- School of Human Movement, Sport and Leisure Studies, Bowling Green State University, Bowling Green, OH, USA
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, QLD, Australia
| | - Thomas Küpper
- Institute of Occupational and Social Medicine, RWTH Aachen Technical University, Aachen, Germany
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Houle SKD. Pharmacy travel health services: current perspectives and future prospects. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2018; 7:13-20. [PMID: 29721445 PMCID: PMC5919161 DOI: 10.2147/iprp.s142982] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Rates of international travel are increasing annually, with particular growth observed in travel to Southeast Asia and to emerging economies. While all patients traveling across geographic regions are recommended to receive a pre-travel consultation to consider their individual risks, many do not, or receive care and recommendations that are not consistent with current evidence-based guidelines. As experts in drug therapy, and given the largely preventive nature of most travel health recommendations, pharmacists are well suited to help address this need. Pharmacists generally possess a high degree of knowledge and confidence with more commonly observed travel health topics in community practice such as travelers' diarrhea; however, training in more specialized travel health topics such as travel vaccinations and traveling at altitude has generally been lacking from pharmacy curricula. Pharmacists with an interest in providing pre-travel consultations are encouraged to pursue additional training in this specialty and to consider Certificate in Travel Health designation from the International Society of Travel Medicine. Future roles for pharmacists to include the prescribing of medications and vaccines for travel and the in-pharmacy administration of travel vaccinations may improve patient access to pre-travel consultations and recommended preventive measures, improving the health of travelers and potentially reducing the burden of communicable disease worldwide. Pharmacists providing travel care to patients are also reminded to consider noninfectious risks of illness and injury abroad and to counsel patients on strategies to minimize these risks in addition to providing drug and vaccine recommendations.
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Lääveri T, Pakkanen SH, Kirveskari J, Kantele A. Travellers' diarrhoea: Impact of TD definition and control group design on study results. Travel Med Infect Dis 2018; 24:37-43. [PMID: 29409749 DOI: 10.1016/j.tmaid.2018.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Travellers' diarrhoea (TD) is a common health problem among visitors to the (sub)tropics. Much research deals with aetiology, prevention, and post-infection sequalae, yet the data may not allow comparisons due to incompatible definitions of TD and No TD control groups. METHOD The impact of defining TD and No TD control groups was explored by revisiting our recent data. We set up two TD groups: classical TD i.e. ≥3 loose or liquid stools/day and WHO TD (diarrhoea as defined by the WHO) i.e. any diarrhoea, and four No TD groups by TD definition and timing (no classical/WHO TD during travel, no ongoing classical/WHO TD). RESULTS TD was recorded for 37% versus 65% of subjects when using classical versus WHO definitions, respectively; the proportions of the various pathogens proved similar. The strictest criterion for the No TD control group (no WHO TD during travel) yielded pathogens among 61% and the least strict (no ongoing classical TD) among 73% of the travellers; the differences were greatest for enteroaggregative Escherichia coli and Campylobacter. CONCLUSIONS Definition of TD and control group design substantially impact on TD study results. The WHO definition yields more cases, but the pathogen selection is similar by both definitions. Design of the No TD control group was found critical: only those remaining asymptomatic throughout the journey should be included.
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Affiliation(s)
- Tinja Lääveri
- Inflammation Center, Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, POB 348, FIN-00029 HUS, Helsinki, Finland
| | - Sari H Pakkanen
- Department of Bacteriology and Immunology, University of Helsinki, P.O. Box 21, FIN-00014 Helsinki, Finland
| | - Juha Kirveskari
- Helsinki University Hospital Laboratory (HUSLAB), Department of Bacteriology, POB 720, FIN-00029 HUS, Helsinki, Finland; Mobidiag Ltd, Keilaranta 16 A, FIN-02150 Espoo, Finland
| | - Anu Kantele
- Inflammation Center, Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, POB 348, FIN-00029 HUS, Helsinki, Finland; Clinicum, University of Helsinki, PO Box 63, FIN-00014, Helsinki, Finland; Aava Travel Clinic, Medical Centre Aava, Annankatu 32, FIN-00100 Helsinki, Finland; Unit of Infectious Diseases, Department of Medicine/Solna, Karolinska Institutet, SE-17176 Stockholm, Sweden.
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Affiliation(s)
- Doug Fink
- The Hospital for Tropical Diseases, Mortimer Market Centre, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | - Robert Serafino Wani
- Department of Infection, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Victoria Johnston
- The Hospital for Tropical Diseases, Mortimer Market Centre, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
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Olanwijitwong J, Lawpoolsri S, Ponam T, Puengpholpool P, Sharma C, Chatapat L, Pawan V, Kittitrakul C, Piyaphanee W. Incidence and spectrum of health problems among travellers to Myanmar. J Travel Med 2018; 25:4711110. [PMID: 29232462 DOI: 10.1093/jtm/tax077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/31/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND The number of international travellers visiting Myanmar increases each year. However, information about pre-travel preparation and incidence of health problems among these travellers is limited. METHODS This cross-sectional study was conducted at three international airports in Thailand. Travellers returning from Myanmar completed questionnaires querying demographic profile, pre-travel health preparations and health problems during their stay in Myanmar. RESULTS From March 2015 to May 2017, we collected and analysed questionnaires completed by 397 Thai and 467 non-Thai travellers (total: 50.1% men, median age 37 years). Non-Thai travellers were from Europe (59%), Northern America (21.4%), Asia (16.5%) and Australia or New Zealand (3.0%). Approximately 74% of non-Thais sought pre-travel health information; only 36% of Thais did so. Tourism was the main purpose for travel among both Thais (58.4%) and non-Thais (85.2%). Non-Thais were more likely than Thais to travel as backpackers and perform outdoor activities such as trekking, cycling or swimming. The average length of stay in Myanmar among non-Thais was significantly longer than that of Thais (26.58 days vs 7.08 days, P < 0.001). Health problems were reported by 22.9% of non-Thais; the most common was diarrhoea (21.0%) followed by upper respiratory tract symptoms (9.2%), fever (3.4%) and skin problems (3.0%). Only 12.6% of Thais reported health problems, the most common being upper respiratory tract symptoms (7.6%), followed by diarrhoea (3.1%), fever (2.8%) and skin problems (2.0%). Most health problems were mild and self-limited in both groups. Only one Thai and eight non-Thai travellers required a doctor's visit during their trip to Myanmar, and two non-Thais required hospitalization. CONCLUSIONS Health problems are not very common among travellers to Myanmar. Overall, health problems were reported among 18.2% of travellers in our study. Most problems were mild, with spontaneous recovery. Only two foreign travellers required hospitalization.
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Affiliation(s)
- Jutarmas Olanwijitwong
- Faculty of Tropical Medicine, Hospital for Tropical Diseases, Mahidol University, Bangkok, Thailand
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Thitiya Ponam
- Faculty of Tropical Medicine, Hospital for Tropical Diseases, Mahidol University, Bangkok, Thailand
| | | | | | - Lapakorn Chatapat
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Chatporn Kittitrakul
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Farnham A, Röösli M, Blanke U, Stone E, Hatz C, Puhan MA. Streaming data from a smartphone application: A new approach to mapping health during travel. Travel Med Infect Dis 2018; 21:36-42. [DOI: 10.1016/j.tmaid.2017.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/08/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
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Lääveri T, Vilkman K, Pakkanen SH, Kirveskari J, Kantele A. A prospective study of travellers' diarrhoea: analysis of pathogen findings by destination in various (sub)tropical regions. Clin Microbiol Infect 2017; 24:908.e9-908.e16. [PMID: 29133155 DOI: 10.1016/j.cmi.2017.10.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/12/2017] [Accepted: 10/24/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Eighty million travellers visiting (sub)tropical regions contract travellers' diarrhoea (TD) each year, yet prospective data comparing the prevalence of TD pathogens in various geographical regions are scarce. Our recent study using modern molecular methods found enteropathogenic (EPEC) and enteroaggregative (EAEC) Escherichia coli to be the most frequent pathogens, followed by enterotoxigenic E. coli (ETEC) and Campylobacter. We revisited our data to compare the findings by geographical region. METHODS A total of 459 prospectively recruited travellers provided stool samples and completed questionnaires before and after visiting destinations in various geographical regions. A multiplex quantitative real-time PCR assay was used to analyse Salmonella, Yersinia, Campylobacter jejuni/Campylobacter coli, Shigella, Vibrio cholerae, EPEC, EAEC, ETEC, enterohaemorrhagic E. coli and enteroinvasive E. coli. RESULTS TD was contracted by 69% (316/459) of the subjects; EPEC and EAEC outnumbered ETEC and Campylobacter in all regions. Multiple pathogens were detected in 42% (133/316) of the samples. The proportions of all pathogens varied by region. The greatest differences were seen for Campylobacter: while relatively frequent in South Asia (n = 11; 20% of the 55 with TD during travel) and Southeast Asia (15/84, 15%), it was less common in East and West Africa (5/71, 7% and 1/57, 2%) and absent in South America and the Caribbean (0/40). CONCLUSIONS EPEC and EAEC outnumbered ETEC and Campylobacter everywhere, yet the proportions of pathogen findings varied by region, with ETEC and Campylobacter rates showing the greatest differences. The high frequency of multibacterial findings in many regions indicates a need for further investigation of the clinical role of each pathogen.
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Affiliation(s)
- T Lääveri
- Inflammation Center, Division of Infectious Diseases, Helsinki University Hospital, Finland and University of Helsinki, Finland
| | - K Vilkman
- Inflammation Center, Division of Infectious Diseases, Helsinki University Hospital, Finland and University of Helsinki, Finland; Aava Travel Clinic, Medical Centre Aava, Helsinki, Finland
| | - S H Pakkanen
- Department of Bacteriology and Immunology, University of Helsinki, Finland
| | - J Kirveskari
- Department of Bacteriology, Helsinki University Hospital Laboratory (HUSLAB), Finland
| | - A Kantele
- Inflammation Center, Division of Infectious Diseases, Helsinki University Hospital, Finland and University of Helsinki, Finland; Aava Travel Clinic, Medical Centre Aava, Helsinki, Finland; Clinicum, University of Helsinki, Finland; Unit of Infectious Diseases, Department of Medicine/Solna, Karolinska Institutet, Stockholm, Sweden.
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Tickell‐Painter M, Maayan N, Saunders R, Pace C, Sinclair D. Mefloquine for preventing malaria during travel to endemic areas. Cochrane Database Syst Rev 2017; 10:CD006491. [PMID: 29083100 PMCID: PMC5686653 DOI: 10.1002/14651858.cd006491.pub4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Mefloquine is one of four antimalarial agents commonly recommended for preventing malaria in travellers to malaria-endemic areas. Despite its high efficacy, there is controversy about its psychological side effects. OBJECTIVES To summarize the efficacy and safety of mefloquine used as prophylaxis for malaria in travellers. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published on the Cochrane Library; MEDLINE; Embase (OVID); TOXLINE (https://toxnet.nlm.nih.gov/newtoxnet/toxline.htm); and LILACS. We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP; http://www.who.int/ictrp/en/) and ClinicalTrials.gov (https://clinicaltrials.gov/ct2/home) for trials in progress, using 'mefloquine', 'Lariam', and 'malaria' as search terms. The search date was 22 June 2017. SELECTION CRITERIA We included randomized controlled trials (for efficacy and safety) and non-randomized cohort studies (for safety). We compared prophylactic mefloquine with placebo, no treatment, or an alternative recommended antimalarial agent. Our study populations included all adults and children, including pregnant women. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility and risk of bias of trials, extracted and analysed data. We compared dichotomous outcomes using risk ratios (RR) with 95% confidence intervals (CI). Prespecified adverse outcomes are included in 'Summary of findings' tables, with the best available estimate of the absolute frequency of each outcome in short-term international travellers. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 20 RCTs (11,470 participants); 35 cohort studies (198,493 participants); and four large retrospective analyses of health records (800,652 participants). Nine RCTs explicitly excluded participants with a psychiatric history, and 25 cohort studies stated that the choice of antimalarial agent was based on medical history and personal preference. Most RCTs and cohort studies collected data on self-reported or clinician-assessed symptoms, rather than formal medical diagnoses. Mefloquine efficacyOf 12 trials comparing mefloquine and placebo, none were performed in short-term international travellers, and most populations had a degree of immunity to malaria. The percentage of people developing a malaria episode in the control arm varied from 1% to 82% (median 22%) and 0% to 13% in the mefloquine group (median 1%).In four RCTs that directly compared mefloquine, atovaquone-proguanil and doxycycline in non-immune, short-term international travellers, only one clinical case of malaria occurred (4 trials, 1822 participants). Mefloquine safety versus atovaquone-proguanil Participants receiving mefloquine were more likely to discontinue their medication due to adverse effects than atovaquone-proguanil users (RR 2.86, 95% CI 1.53 to 5.31; 3 RCTs, 1438 participants; high-certainty evidence). There were few serious adverse effects reported with mefloquine (15/2651 travellers) and none with atovaquone-proguanil (940 travellers).One RCT and six cohort studies reported on our prespecified adverse effects. In the RCT with short-term travellers, mefloquine users were more likely to report abnormal dreams (RR 2.04, 95% CI 1.37 to 3.04, moderate-certainty evidence), insomnia (RR 4.42, 95% CI 2.56 to 7.64, moderate-certainty evidence), anxiety (RR 6.12, 95% CI 1.82 to 20.66, moderate-certainty evidence), and depressed mood during travel (RR 5.78, 95% CI 1.71 to 19.61, moderate-certainty evidence). The cohort studies in longer-term travellers were consistent with this finding but most had larger effect sizes. Mefloquine users were also more likely to report nausea (high-certainty evidence) and dizziness (high-certainty evidence).Based on the available evidence, our best estimates of absolute effect sizes for mefloquine versus atovaquone-proguanil are 6% versus 2% for discontinuation of the drug, 13% versus 3% for insomnia, 14% versus 7% for abnormal dreams, 6% versus 1% for anxiety, and 6% versus 1% for depressed mood. Mefloquine safety versus doxycyclineNo difference was found in numbers of serious adverse effects with mefloquine and doxycycline (low-certainty evidence) or numbers of discontinuations due to adverse effects (RR 1.08, 95% CI 0.41 to 2.87; 4 RCTs, 763 participants; low-certainty evidence).Six cohort studies in longer-term occupational travellers reported our prespecified adverse effects; one RCT in military personnel and one cohort study in short-term travellers reported adverse events. Mefloquine users were more likely to report abnormal dreams (RR 10.49, 95% CI 3.79 to 29.10; 4 cohort studies, 2588 participants, very low-certainty evidence), insomnia (RR 4.14, 95% CI 1.19 to 14.44; 4 cohort studies, 3212 participants, very low-certainty evidence), anxiety (RR 18.04, 95% CI 9.32 to 34.93; 3 cohort studies, 2559 participants, very low-certainty evidence), and depressed mood (RR 11.43, 95% CI 5.21 to 25.07; 2 cohort studies, 2445 participants, very low-certainty evidence). The findings of the single cohort study reporting adverse events in short-term international travellers were consistent with this finding but the single RCT in military personnel did not demonstrate a difference between groups in frequencies of abnormal dreams or insomnia.Mefloquine users were less likely to report dyspepsia (RR 0.26, 95% CI 0.09 to 0.74; 5 cohort studies, 5104 participants, low certainty-evidence), photosensitivity (RR 0.08, 95% CI 0.05 to 0.11; 2 cohort studies, 1875 participants, very low-certainty evidence), vomiting (RR 0.18, 95% CI 0.12 to 0.27; 4 cohort studies, 5071 participants, very low-certainty evidence), and vaginal thrush (RR 0.10, 95% CI 0.06 to 0.16; 1 cohort study, 1761 participants, very low-certainty evidence).Based on the available evidence, our best estimates of absolute effect for mefloquine versus doxycyline were: 2% versus 2% for discontinuation, 12% versus 3% for insomnia, 31% versus 3% for abnormal dreams, 18% versus 1% for anxiety, 11% versus 1% for depressed mood, 4% versus 14% for dyspepsia, 2% versus 19% for photosensitivity, 1% versus 5% for vomiting, and 2% versus 16% for vaginal thrush.Additional analyses, including comparisons of mefloquine with chloroquine, added no new information. Subgroup analysis by study design, duration of travel, and military versus non-military participants, provided no conclusive findings. AUTHORS' CONCLUSIONS The absolute risk of malaria during short-term travel appears low with all three established antimalarial agents (mefloquine, doxycycline, and atovaquone-proguanil).The choice of antimalarial agent depends on how individual travellers assess the importance of specific adverse effects, pill burden, and cost. Some travellers will prefer mefloquine for its once-weekly regimen, but this should be balanced against the increased frequency of abnormal dreams, anxiety, insomnia, and depressed mood.
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Affiliation(s)
| | - Nicola Maayan
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Rachel Saunders
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesLiverpoolUK
| | - Cheryl Pace
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesLiverpoolUK
| | - David Sinclair
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesLiverpoolUK
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Zöldi V, Sane J, Kantele A, Rimhanen-Finne R, Salmenlinna S, Lyytikäinen O. Destination specific risks of acquisition of notifiable food- and waterborne infections or sexually transmitted infections among Finnish international travellers, 1995-2015. Travel Med Infect Dis 2017; 25:35-41. [PMID: 29030321 DOI: 10.1016/j.tmaid.2017.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 09/22/2017] [Accepted: 10/09/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Overnight international travels made by Finns more than doubled during 1995-2015. To estimate risks and observe trends of travel-related notifiable sexually transmitted and food- and water-borne infections (STIs and FWIs) among travellers, we analysed national reports of gonorrhoea, syphilis, hepatitis A, shigellosis, campylobacteriosis and salmonellosis cases and related them to travel statistics. METHOD Cases notified as travel-related to the Finnish infectious diseases register were used as numerators and overnight stays of Statistics Finland surveys as denominator. We calculated overall risks (per 100,000 travellers) and assessed trends (using regression model) in various geographic regions. RESULTS Of all travel-related cases during 1995-2015, 2304 were STIs and 70,929 FWIs. During 2012-2015, Asia-Oceania showed highest risk estimates for gonorrhoea (11.0; 95%CI, 9.5-13), syphilis (1.4; 0.93-2.1), salmonellosis (157; 151-164), and campylobacteriosis (135; 129-141), and Africa for hepatitis A (4.5; 2.5-7.9), and shigellosis (35; 28-43). When evaluating at country level, the highest risks of infections was found in Thailand, except for hepatitis A ranking Hungary the first. During 2000-2011, significantly decreasing trends occurred for most FWIs particularly in the European regions and for STIs in Russia-Baltics. CONCLUSIONS Our findings can be used in targeting pre-travel advice, which should also cover those visiting Thailand or European hepatitis A risk areas.
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Affiliation(s)
- Viktor Zöldi
- Department of Health Security, National Institute for Health and Welfare (THL), Helsinki, Finland; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | - Jussi Sane
- Department of Health Security, National Institute for Health and Welfare (THL), Helsinki, Finland.
| | - Anu Kantele
- Infectious Diseases, University of Helsinki, Helsinki University Hospital, Helsinki, Finland; Unit of Infectious Diseases, Karolinska Institutet, Solna, Stockholm, Sweden.
| | - Ruska Rimhanen-Finne
- Department of Health Security, National Institute for Health and Welfare (THL), Helsinki, Finland.
| | - Saara Salmenlinna
- Department of Health Security, National Institute for Health and Welfare (THL), Helsinki, Finland.
| | - Outi Lyytikäinen
- Department of Health Security, National Institute for Health and Welfare (THL), Helsinki, Finland.
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Wyss K, Wångdahl A, Vesterlund M, Hammar U, Dashti S, Naucler P, Färnert A. Obesity and Diabetes as Risk Factors for Severe Plasmodium falciparum Malaria: Results From a Swedish Nationwide Study. Clin Infect Dis 2017; 65:949-958. [PMID: 28510633 PMCID: PMC5848256 DOI: 10.1093/cid/cix437] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 05/07/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Noncommunicable diseases and obesity are increasing in prevalence globally, also in populations at risk of malaria. We sought to investigate if comorbidity, in terms of chronic diseases and obesity, is associated with severe Plasmodium falciparum malaria. METHODS We performed a retrospective observational study in adults (≥18 years of age) diagnosed with malaria in Sweden between January 1995 and May 2015. We identified cases through the surveillance database at the Public Health Agency of Sweden and reviewed clinical data from 18 hospitals. Multivariable logistic regression was used to assess associations between comorbidities and severe malaria. RESULTS Among 937 adults (median age, 37 years; 66.5% were male), patients with severe malaria had higher prevalence of chronic diseases (28/92 [30.4%]) compared with nonsevere cases (151/845 [17.9%]) (P = .004). Charlson comorbidity score ≥1 was associated with severe malaria (adjusted odds ratio [aOR], 2.63 [95% confidence interval {CI}, 1.45-4.77), as was diabetes among individual diagnoses (aOR, 2.98 [95% CI, 1.25-7.09]). Median body mass index was higher among severe (29.3 kg/m2) than nonsevere cases (24.7 kg/m2) (P < .001). Obesity was strongly associated with severe malaria, both independently (aOR, 5.58 [95% CI, 2.03-15.36]) and in combination with an additional metabolic risk factor (hypertension, dyslipidemia, or diabetes) (aOR, 6.54 [95% CI, 1.87-22.88]). The associations were observed among nonimmune travelers as well as immigrants from endemic areas. CONCLUSIONS Comorbidities, specifically obesity and diabetes, are previously unidentified risk factors for severe malaria in adults diagnosed with P. falciparum. Noncommunicable diseases should be considered in the acute management and prevention of malaria.
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Affiliation(s)
- Katja Wyss
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
- Emergency Medicine and
- Infectious Diseases, Karolinska University Hospital, Stockholm
| | - Andreas Wångdahl
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
- Department of Infectious Diseases, Västerås Central Hospital, and
| | - Maria Vesterlund
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
| | - Ulf Hammar
- Unit of Biostatistics, Department of Epidemiology, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Saduddin Dashti
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
| | - Pontus Naucler
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
- Infectious Diseases, Karolinska University Hospital, Stockholm
| | - Anna Färnert
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
- Infectious Diseases, Karolinska University Hospital, Stockholm
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Angelo KM, Kozarsky PE, Ryan ET, Chen LH, Sotir MJ. What proportion of international travellers acquire a travel-related illness? A review of the literature. J Travel Med 2017; 24:3954792. [PMID: 28931136 PMCID: PMC5825178 DOI: 10.1093/jtm/tax046] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2017] [Indexed: 11/12/2022]
Abstract
INTRODUCTION As international travel increases, travellers may be at increased risk of acquiring infectious diseases not endemic in their home countries. Many journal articles and reference books related to travel medicine cite that between 22-64% of international travellers become ill during or after travel; however, this information is minimal, outdated and limited by poor generalizability. We aim to provide a current and more accurate estimate of the proportion of international travellers who acquire a travel-related illness. METHODS We identified studies via PubMed or travel medicine experts, published between January 1, 1976-December 31, 2016 that included the number of international travellers acquiring a travel-related illness. We excluded studies that focused on a single disease or did not determine a rate based on the total number of travellers. We abstracted information on traveller demographics, trip specifics, study enrollment and follow-up and number of ill travellers and their illnesses. RESULTS Of 743 studies, nine met the inclusion criteria. The data sources were from North America (four studies) and Europe (five studies). Most travellers were tourists, the most frequent destination regions were Asia and Africa, and the median trip duration ranged from 8-21 days. Six studies enrolled participants at the travellers' pre-travel consultation. All studies collected data through either extraction from the medical record, weekly diaries, or pre- and post-travel questionnaires. Data collection timeframes varied by study. Between 6-87% of travellers became ill across all studies. Four studies provided the best estimate: between 43-79% of travellers who frequently visited developing nations (e.g. India, Tanzania, and Kenya) became ill; travellers most frequently reported diarrhoea. CONCLUSION This is the most comprehensive assessment available on the proportion of international travellers that develop a travel-related illness. Additional cohort studies would provide needed data to more precisely determine the rates of illness in international travellers. KEYWORDS International travel, travel, illness.
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Affiliation(s)
- Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA
| | - Phyllis E Kozarsky
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA.,Department of Medicine, Emory University, 1364 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Edward T Ryan
- Massachusetts General Hospital Travelers' Advice and Immunization Center, 55 Fruit Street, Boston, MA 02114, USA.,Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Lin H Chen
- Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.,Mount Auburn Hospital, 330 Mt. Auburn St, Cambridge, MA, 02138, USA
| | - Mark J Sotir
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA
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Leischker AH, Heppner HJ. [Travel medicine - characteristics in the elderly]. MMW Fortschr Med 2017; 159:50-54. [PMID: 28608067 DOI: 10.1007/s15006-017-9792-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Andreas H Leischker
- Klinik für Geriatrie und Gelbfieberimpfstation, Alexianer Krefeld GmbH, Dießemer Bruch 81, D-47805, Krefeld, Deutschland.
| | - Hans Jürgen Heppner
- Geriatrische Klinik und Tagesklinik, Lehrstuhl für Geriatrie, Universität Witten/Herdecke, Schwelm, Deutschland
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Stoney RJ, Han PV, Barnett ED, Wilson ME, Jentes ES, Benoit CM, MacLeod WB, Hamer DH, Chen LH. Travelers' Diarrhea and Other Gastrointestinal Symptoms Among Boston-Area International Travelers. Am J Trop Med Hyg 2017; 96:1388-1393. [PMID: 28719282 PMCID: PMC5462577 DOI: 10.4269/ajtmh.16-0447] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 02/11/2017] [Indexed: 11/07/2022] Open
Abstract
AbstractThis prospective cohort study describes travelers' diarrhea (TD) and non-TD gastrointestinal (GI) symptoms among international travelers from the Boston area, the association of TD with traveler characteristics and dietary practices, use of prescribed antidiarrheal medications, and the impact of TD and non-TD GI symptoms on planned activities during and after travel. We included adults who received a pre-travel consultation at three Boston-area travel clinics and who completed a three-part survey: pre-travel, during travel, and post-travel (2-4 weeks after return). TD was defined as self-reported diarrhea with or without nausea/vomiting, abdominal pain, or fever. Demographic and travel characteristics were evaluated by χ2 test for categorical and Wilcoxon rank-sum test for continuous variables. Analysis of dietary practices used logistic generalized estimating equation models or logistic regression models. Of 628 travelers, 208 (33%) experienced TD and 45 (7%) experienced non-TD GI symptoms. Of 208 with TD, 128 (64%), 71 (36%), and 123 (62%) were prescribed ciprofloxacin, azithromycin, and/or loperamide before travel, respectively. Thirty-nine (36%) of 108 took ciprofloxacin, 20 (38%) of 55 took azithromycin, and 28 (28%) of 99 took loperamide during travel. Of 172 with TD during travel, 24% stopped planned activities, and 2% were hospitalized. Of 31 with non-TD GI symptoms during travel, six (13%) stopped planned activities. International travelers continue to experience diarrhea and other GI symptoms, resulting in disruption of planned activities and healthcare visits for some. Although these illnesses resulted in interruption of travel plans, a relatively small proportion took prescribed antibiotics.
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Affiliation(s)
- Rhett J. Stoney
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pauline V. Han
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth D. Barnett
- Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Mary E. Wilson
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Emily S. Jentes
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christine M. Benoit
- Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - William B. MacLeod
- Center for Global Health and Development, Boston University School of Public Health (BUSPH), Boston, Massachusetts
- Department of Global Health, BUSPH, Boston, Massachusetts
| | - Davidson H. Hamer
- Center for Global Health and Development, Boston University School of Public Health (BUSPH), Boston, Massachusetts
- Department of Global Health, BUSPH, Boston, Massachusetts
- Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - Lin H. Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
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