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Patjas A, Martelius A, Ollgren J, Kantele A. International travel increases risk of urinary tract infection caused by extended-spectrum beta-lactamase-producing Enterobacterales-three-arm case-control study. J Travel Med 2024; 31:taad155. [PMID: 38123504 DOI: 10.1093/jtm/taad155] [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: 10/11/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) have worldwide become increasingly prevalent as pathogens causing urinary tract infections (UTIs), posing challenges in their treatment. Of particular concern are travellers to low- and middle-income countries (LMICs), a substantial proportion of whom become colonized by ESBL-PE, with UTIs as the most common clinical manifestation. Seeking tools for preventing ESBL-PE UTI, we explored factors associated with (i) any UTI (versus control), (ii) ESBL-PE UTI (versus control) and (iii) ESBL-PE versus non-ESBL-PE UTI. METHODS During 2015-20, we recruited patients with recent ESBL-PE or non-ESBL-PE UTIs, and controls with no UTI to fill in questionnaires covering potential (ESBL-PE-)UTI risk factors. RESULTS Of our 430 participants, 130 had ESBL-PE UTI and 187 non-ESBL-PE UTI; 113 were controls. Our three comparisons showed several risk factors as exemplified for any UTI versus controls by female sex, lower education, age, diabetes, antibiotic use, diarrhoea; for ESBL-PE UTI versus controls by travel to LMICs, antibiotic use, swimming; and ESBL-PE versus non-ESBL-PE UTI by male sex, higher education, LMIC travel (participant/household member), pets and antibiotic use. Weekly fish meals appeared protective against both UTI and ESBL-PE UTI. CONCLUSIONS Of the numerous factors predisposing to UTI and/or ESBL-PE UTI, our study highlights antibiotic use and LMIC travel. Household members' LMIC travel appears to pose a risk of ESBL-PE UTI, pointing to household transmission of travel-acquired uropathogens. As predisposing factors to multidrug-resistant UTI, international travel and antibiotic use constitute practical targets for prevention efforts.
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Affiliation(s)
- Anu Patjas
- Meilahti Vaccine Research Centre, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Unit, University of Helsinki, Helsinki, Finland
- Centre of Excellence in Antimicrobial Resistance Research, FIMAR, Helsinki, Finland
| | - Antti Martelius
- Meilahti Vaccine Research Centre, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Unit, University of Helsinki, Helsinki, Finland
| | - Jukka Ollgren
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anu Kantele
- Meilahti Vaccine Research Centre, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Unit, University of Helsinki, Helsinki, Finland
- Centre of Excellence in Antimicrobial Resistance Research, FIMAR, Helsinki, Finland
- Travel Clinic, Aava Medical Centre, Helsinki, Finland
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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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Tan R, Elmers J, Genton B. Malaria standby emergency treatment (SBET) for travellers visiting malaria endemic areas: a systematic review and meta-analysis. J Travel Med 2019; 26:5475009. [PMID: 30995308 DOI: 10.1093/jtm/taz027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Malaria prevention methods for travellers to low or moderate malaria risk areas vary and remain controversial. Standby emergency treatment (SBET) for malaria is one possible strategy increasingly recommended since 1988 with little evidence on its effectiveness or how it is truly being used. METHODS A systematic review and meta-analysis were performed based on a structured search in Embase, Medline, PubMed, Cochrane and Web of Science on 7 September 2018. The primary outcome was the overall prevalence of SBET use in travellers, and secondary outcomes were the proportion carrying SBET, the response to fever [use of SBET, health facility attendance and use of malaria rapid diagnostic test (mRDT)], adverse events to SBET and the proportion using SBET incorrectly (incorrect dosage/duration). The pooled SBET use prevalence was analysed using a random effects model. A descriptive summary was done to present secondary outcomes. The study protocol was registered with PROSPERO CRD42018103703. RESULTS A total of 11 studies were eligible for inclusion among the 1027 titles identified by our search. The studies included 7/11 prospective cohort studies that recruited pre-travel clinic attendees in Europe and 4/11 cross-sectional studies, of which 3 recruited travellers at airports before their return home from Southeast Asia and Africa and 1 from an employee registry including long-term travellers. The overall pooled prevalence of SBET use among the 26 403 travellers was 2.5% (95% confidence interval, 1.1-4.3%; range, 0.4-10.8%). There was significant variation in the proportion of travellers carrying SBET medication (40-100%), the proportion of travellers with appropriate response to fever (23-100%), adverse events (0-33%) and incorrect dosage/duration of SBET (0-100%). CONCLUSION Adherence to the proposed recommendations for SBET use, notably the response to fever, was poor. If the use of SBET is to be pursued, modifications to the current SBET strategy should be considered, such as better selection of travellers at higher risk for malaria and the potential addition of mRDTs.
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Affiliation(s)
- Rainer Tan
- Travel Clinic, Department of Research, Innovation and Training, Unisanté, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Jolanda Elmers
- Medical Library, Research and Education Department, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - Blaise Genton
- Travel Clinic, Department of Research, Innovation and Training, Unisanté, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
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Self-reported infections during international travel and notifiable infections among returning international travellers, Sweden, 2009-2013. PLoS One 2017; 12:e0181625. [PMID: 28753671 PMCID: PMC5533450 DOI: 10.1371/journal.pone.0181625] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 07/05/2017] [Indexed: 11/19/2022] Open
Abstract
We studied food and water-borne diseases (FWDs), sexually transmitted diseases (STDs), vector-borne diseases (VBDs) and diseases vaccinated against in the Swedish childhood vaccination programme among Swedish international travellers, in order to identify countries associated with a high number of infections. We used the national database for notifiable infections to estimate the number of FWDs (campylobacteriosis, salmonellosis, giardiasis, shigellosis, EHEC, Entamoeba histolytica, yersinosis, hepatitis A, paratyphoid fever, typhoid fever, hepatitis E, listeriosis, cholera), STIs (chlamydia, gonorrhoea and acute hepatitis B), VBDs (dengue fever, malaria, West Nile fever, Japanese encephalitis and yellow fever) and diseases vaccinated against in the Swedish childhood vaccination programme (pertussis, measles, mumps, rubella, diphtheria) acquired abroad 2009–2013. We obtained number and duration of trips to each country from a database that monthly collects travel data from a randomly selected proportion of the Swedish population. We calculated number of infections per country 2009–2013 and incidence/million travel days for the five countries with the highest number of infections. Thailand had the highest number of FWDs (7,697, incidence 191/million travel days), STIs (1,388, incidence 34/million travel days) and VBDs (358, incidence 9/million travel days). France had the highest number of cases of diseases vaccinated against in the Swedish childhood vaccination programme (8, 0.4/million travel days). Swedish travellers contracted most infections in Thailand. Special focus should be placed on giving advice to travellers to this destination.
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Olanwijitwong J, Piyaphanee W, Poovorawan K, Lawpoolsri S, Chanthavanich P, Wichainprasast P, Tantawichien T. Health problems among Thai tourists returning from India. J Travel Med 2017; 24:3095985. [PMID: 28426113 DOI: 10.1093/jtm/tax013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND The number of Thai tourists visiting India is increasing each year. Most studies investigating health problems among international travellers to India have focused on travellers from Europe or North America, and the applicability of these studies to Asian travellers is unknown. METHODS This cross-sectional study used data collected from Thai tourists who had recently completed a trip to India. A questionnaire on demographic data, travel characteristics, pre-travel health preparation, and health problems during the trip to India was administered. All participants were also invited to answer a follow-up questionnaire 15 days after their arrival. RESULTS The study included 1,304 Thai tourists returning from India between October 2014 and March 2015. Sixty-two percent were female. Overall median age was 49 years, and the median length of stay was 10.6 days. Most were package tourists, and 52% (675) reported health problems during their trip. Common health problems were cough, runny nose, and sore throat (31.1%), followed by musculoskeletal problems (21.7%), fever (12.7%), diarrhea (9.8%) and skin problems (6.6%). Other reported problems were related to the eyes/ears (2.1%), animal exposure (1.9%) and accidents (0.8%). We found that several factors may be associated with the incidence of health problems among these tourists, including travelling style and travel health preparation. In the follow-up questionnaire, 16.8% of the participants reported new or additional symptoms that developed after their return to Thailand. Respiratory symptoms were still the most common health problems during this 15-day period. CONCLUSIONS Over half (52%) of Thai tourists experienced health problems during their trip to India. The most common health problem was not travellers' diarrhoea, as would be expected from published studies. Rather, respiratory and musculoskeletal problems were common symptoms. This information will be useful in pre-travel assessment and care. Our findings may indicate that health risks among travellers vary by nationality.
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Affiliation(s)
- Jutarmas Olanwijitwong
- Faculty of Tropical Medicine, Hospital for Tropical Diseases, Mahidol University, Bangkok, Thailand
| | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kittiyod Poovorawan
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pornthep Chanthavanich
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pongdej Wichainprasast
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Terapong Tantawichien
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Rogers HL, Reilly SM. A Survey of the Health Experiences of International Business Travelers. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/216507990205001006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Occupational health professionals need to know more about the health, worklife, and family life of international business travelers (IBTs). This descriptive correlational study, in two parts, examines the physiological and psychosocial experiences associated with business travel for a sample of 140 employees from western Canada's oil and gas industry. Results for Part One show that 76% of IBTs report travel related health problems, 74% have jet lag, 45% have travelers' diarrhea and gastrointestinal complaints, 12% to 16% have climate adaptation problems, and 2% report accidents and minor injuries. High risk behaviors include not carrying a first aid travel kit (54%); drinking more alcohol than ordinarily (21%); and neglecting food, water, and antimalarial precautions (6% to 14%). Other risk factors include age, length of stay, destination, pre-travel medical examinations, pre-travel advice, and eating and accommodation facilities. Findings show that IBTs are at risk for travel related physiological health problems. Implications for practitioners call for increased occupational health expertise in pre-travel preparation, follow up post-travel and regular health surveillance for employees who travel on international business.
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Vilkman K, Pakkanen SH, Lääveri T, Siikamäki H, Kantele A. Travelers' health problems and behavior: prospective study with post-travel follow-up. BMC Infect Dis 2016; 16:328. [PMID: 27412525 PMCID: PMC4944265 DOI: 10.1186/s12879-016-1682-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 06/20/2016] [Indexed: 11/17/2022] Open
Abstract
Background The annual number of international tourist arrivals has recently exceeded one billion, yet surprisingly few studies have characterized travelers’ behavior, illness, and risk factors in a prospective setting. Particularly scarce are surveys of data spanning travel, return, and follow-up of the same cohort. This study examines behavior and illness among travelers while abroad, after return home, and at follow-up. Patterns of behavior connected to type of travel and illness are characterized so as to identify risk factors and provide background data for pre-travel advice. Methods Volunteers to this prospective cohort study were recruited at visits to a travel clinic prior to departure. Data on the subjects’ health and behavior were collected by questionnaires before and after journeys and over a three-week follow-up. In addition, the subjects were asked to fill in health diaries while traveling. Results The final study population consisted of 460 subjects, 79 % of whom reported illness during travel or on arrival: 69 % had travelers’ diarrhea (TD), 17 % skin problems, 17 % fever, 12 % vomiting, 8 % respiratory tract infection, 4 % urinary tract infection, 2 % ear infection, 4 % gastrointestinal complaints other than TD or vomiting, and 4 % other symptoms. Of all subjects, 10 % consulted a doctor and 0.7 % were hospitalized; 18 % took antimicrobials, with TD as the most common indication (64 %). Ongoing symptoms were reported by 25 % of all travelers upon return home. During the three-week follow-up (return rate 51 %), 32 % of respondents developed new-onset symptoms, 20 % visited a doctor and 1.7 % were hospitalized. Factors predisposing to health problems were identified by multivariable analysis: certain regions (Southern Asia, South-Eastern Asia, and Eastern Africa), female gender, young age, and long travel duration. Conclusions Despite proper preventive measures like vaccinations, malaria prophylaxis, and travel advice, the majority of our subjects fell ill during or after travel. As the symptoms mostly remained mild, health care services were seldom needed. Typical traveler profiles were identified, thereby providing a tool for pre-travel advice. The finding that one third reported new-onset illness during follow-up attests to the importance of advising clients on potential post-travel health problems already during pre-travel visits. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1682-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katri Vilkman
- Department of Bacteriology and Immunology, University of Helsinki, Haartmaninkatu 3, (P.O. Box 21), 00014, Helsinki, Finland.,Inflammation Center, Clinic of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Aurora Hospital, Nordenskiöldinkatu 20, (P.O. Box 348), Helsinki, Finland
| | - Sari H Pakkanen
- Department of Bacteriology and Immunology, University of Helsinki, Haartmaninkatu 3, (P.O. Box 21), 00014, Helsinki, Finland
| | - Tinja Lääveri
- Inflammation Center, Clinic of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Aurora Hospital, Nordenskiöldinkatu 20, (P.O. Box 348), Helsinki, Finland
| | - Heli Siikamäki
- Inflammation Center, Clinic of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Aurora Hospital, Nordenskiöldinkatu 20, (P.O. Box 348), Helsinki, Finland
| | - Anu Kantele
- Inflammation Center, Clinic of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Aurora Hospital, Nordenskiöldinkatu 20, (P.O. Box 348), Helsinki, Finland. .,Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland. .,Aava Travel Clinic, Medical Centre Aava, Annankatu 32, 00100, Helsinki, Finland. .,Unit of Infectious Diseases, Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
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Stoney RJ, Kozarsky P, Bostick RM, Sotir MJ. International travellers from New Jersey: piloting a travel health module in the 2011 Behavioral Risk Factor Surveillance System survey. J Travel Med 2016; 23:tav015. [PMID: 26782130 PMCID: PMC4843503 DOI: 10.1093/jtm/tav015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND In 2011, the Centers for Disease Control and Prevention and the New Jersey Department of Health used the New Jersey Behavioral Risk Factor Survey (NJBRFS), a state component of the national Behavioral Risk Factor Surveillance System (BRFSS) to pilot a travel health module designed to collect population-based data on New Jersey residents travelling internationally. Our objective was to use this population-based travel health information to serve as a baseline to evaluate trends in US international travellers. METHODS A representative sample of New Jersey residents was identified through a random-digit-dialing method and administered the travel health module, which asked five questions: travel outside of USA during the previous year; destination; purpose; if a healthcare provider was visited before travel and any travel-related illness. Additional health variables from the larger NJBRFS were considered and included in bivariate analyses and multiple logistic regression; weights were assigned to variables to account for survey design complexity. RESULTS Of 4029 participants, 841 (21%) travelled internationally. Top destinations included Mexico (10%), Canada (9%), Dominican Republic (6%), Bahamas (5%) and Italy (5%). Variables positively associated with travel included foreign birth, ≥$75 000 annual household income, college education and no children living in the household. One hundred fifty (18%) of 821 travellers with known destinations went to high-risk countries; 40% were visiting friends and relatives and only 30% sought pre-travel healthcare. Forty-eight (6%) of 837 responding travellers reported travel-related illness; 44% visited high-risk countries. CONCLUSIONS Approximately one in five NJBRFS respondents travelled internationally during the previous year, a sizeable proportion to high-risk destinations. Few reported becoming ill as a result of travel but almost one-half of those ill had travelled to high-risk destinations. Population-based surveillance data on travellers can help document trends in destinations, traveller type and disease prevalence and evaluate the effectiveness of disease prevention programmmes.
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Affiliation(s)
- Rhett J Stoney
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA and
| | - Phyllis Kozarsky
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA and
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mark J Sotir
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA and
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Johnning A, Kristiansson E, Angelin M, Marathe N, Shouche YS, Johansson A, Larsson DGJ. Quinolone resistance mutations in the faecal microbiota of Swedish travellers to India. BMC Microbiol 2015; 15:235. [PMID: 26498929 PMCID: PMC4619388 DOI: 10.1186/s12866-015-0574-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/16/2015] [Indexed: 01/03/2023] Open
Abstract
Background International travel contributes to the spread of antibiotic resistant bacteria over the world. Most studies addressing travel-related changes in the faecal flora have focused on specific mobile resistance genes, or depended on culturing of individual bacterial isolates. Antibiotic resistance can, however, also spread via travellers colonized by bacteria carrying chromosomal antibiotic resistance mutations, but this has received little attention so far. Here we aimed at exploring the abundance of chromosomal quinolone resistance mutations in Escherichia communities residing in the gut of Swedish travellers, and to determine potential changes after visiting India. Sweden is a country with a comparably low degree of quinolone use and quinolone resistance, whereas the opposite is true for India. Methods Massively parallel amplicon sequencing targeting the quinolone-resistance determining region of gyrA and parC was applied to total DNA extracted from faecal samples. Paired samples were collected from 12 Swedish medical students before and after a 4–15 week visit to India. Twelve Indian residents were included for additional comparisons. Methods known resistance mutations were common in Swedes before travel as well as in Indians, with a trend for all mutations to be more common in the Indian sub group. There was a significant increase in the abundance of the most common amino acid substitution in GyrA (S83L, from 44 to 72 %, p = 0.036) in the samples collected after return to Sweden. No other substitution, including others commonly associated with quinolone resistance (D87N in GyrA, S80I in ParC) changed significantly. The number of distinct genotypes encoded in each traveller was significantly reduced after their visit to India for both GyrA (p = 0.0020) and ParC (p = 0.0051), indicating a reduced genetic diversity, similar to that found in the Indians. Conclusions International travel can alter the composition of the Escherichia communities in the faecal flora, favouring bacteria carrying certain resistance mutations, and, thereby, contributes to the global spread of antibiotic resistance. A high abundance of specific mutations in Swedish travellers before visiting India is consistent with the hypothesis that these mutation have no fitness cost even in the absence of an antibiotic selection pressure. Electronic supplementary material The online version of this article (doi:10.1186/s12866-015-0574-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Johnning
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Guldhedsgatan 10, SE-413 46, Gothenburg, Sweden. .,Department of Mathematical Sciences, Chalmers University of Technology, SE-412 96, Gothenburg, Sweden.
| | - Erik Kristiansson
- Department of Mathematical Sciences, Chalmers University of Technology, SE-412 96, Gothenburg, Sweden.
| | - Martin Angelin
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, SE-901 85, Umeå, Sweden.
| | - Nachiket Marathe
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Guldhedsgatan 10, SE-413 46, Gothenburg, Sweden. .,Microbial Culture Collection, National Centre for Cell Science, Ganeshkhind, Pune, 411 007, India.
| | - Yogesh S Shouche
- Microbial Culture Collection, National Centre for Cell Science, Ganeshkhind, Pune, 411 007, India.
| | - Anders Johansson
- Laboratory for Molecular Infection Medicine Sweden, Department of Clinical Microbiology, Bacteriology, Umeå University, SE- 901 87, Umeå, Sweden.
| | - D G Joakim Larsson
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Guldhedsgatan 10, SE-413 46, Gothenburg, Sweden.
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Siikamäki H, Kivelä P, Fotopoulos M, Ollgren J, Kantele A. Illness and injury of travellers abroad: Finnish nationwide data from 2010 to 2012, with incidences in various regions of the world. Euro Surveill 2015. [DOI: 10.2807/1560-7917.es2015.20.19.21128] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- H Siikamäki
- Inflammation Center, Clinic for Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- SOS International, Frederiksberg, Denmark
| | - P Kivelä
- Inflammation Center, Clinic for Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - J Ollgren
- National Institute for Health and Welfare, Helsinki, Finland
| | - A Kantele
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, University of Helsinki, Helsinki, Finland
- Inflammation Center, Clinic for Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Angelin M, Evengård B, Palmgren H. Travel health advice: Benefits, compliance, and outcome. ACTA ACUST UNITED AC 2014; 46:447-53. [DOI: 10.3109/00365548.2014.896030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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13
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Kariminia S, Ahmad SS, Hashim R, Ismail Z. Environmental Consequences of Antarctic Tourism from a Global Perspective. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.sbspro.2013.11.081] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mackaness CA, Osborne A, Verma D, Templer S, Weiss MJ, Knouse MC. A quality improvement initiative using a novel travel survey to promote patient-centered counseling. J Travel Med 2013; 20:237-42. [PMID: 23809074 DOI: 10.1111/jtm.12034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 01/29/2013] [Accepted: 02/04/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND We sought to evaluate and provide better itinerary-specific care to precounseled travelers and to assess diseases occurring while traveling abroad by surveying a community population. An additional quality improvement initiative was to expand our post-travel survey to be a more valuable tool in gathering high-quality quantitative data. METHODS From de-identified data collected via post-travel surveys, we identified a cohort of 525 patients for a retrospective observational analysis. We analyzed illness encountered while abroad, medication use, and whether a physician was consulted. We also examined itinerary variables, including continents and countries visited. RESULTS The 525 post-travel surveys collected showed that the majority of respondents traveled to Asia (31%) or Africa (30%). The mean number of travel days was 21.3 (median, 14). Univariate analysis demonstrated a statistically significant increase of risk for general illness when comparing travel duration of less than 14 days to greater than 14 days (11.3% vs 27.7%, p < 0.001). Duration of travel was also significant with regard to development of traveler's diarrhea (TD) (p = 0.0015). Destination of travel and development of traveler's diarrhea trended toward significance. Serious illness requiring a physician visit was infrequent, as were vaccine-related complications. CONCLUSIONS Despite pre-travel counseling, traveler's diarrhea was the most common illness in our cohort; expanded prevention strategies will be necessary to lower the impact that diarrheal illness has on generally healthy travelers. Overall rates of illness did not vary by destination; however, there was a strong association between duration of travel and likelihood of illness. To further identify specific variables contributing to travel-related disease, including patient co-morbidities, reason for travel, and accommodations, the post-travel survey has been modified and expanded. A limitation of this study was the low survey response rate (18%); to improve the return rate, we plan to implement supplemental modalities including email and a web-based database.
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Affiliation(s)
- Craig A Mackaness
- Department of General Internal Medicine, Lehigh Valley Health Network, Allentown, PA, USA
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Severs D, Moolenaar C, van Genderen PJ. Value of routine chest radiography in the diagnostic work-up of ill returned travelers. Int J Gen Med 2012; 5:1003-8. [PMID: 23271918 PMCID: PMC3526872 DOI: 10.2147/ijgm.s36424] [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] [Indexed: 11/24/2022] Open
Abstract
Background Respiratory tract infections frequently occur in ill returned travelers, a minority of whom present with pneumonia. The most accurate and cost-effective diagnostic work-up remains an area of uncertainty. In this retrospective cohort study, the utility of routine chest radiography was evaluated. Methods This study was performed at the Institute for Tropical Diseases in Rotterdam and included all returned travelers in the period between 2007 and 2009 that were ill with symptoms lasting less than 1 month and had chest radiography on admission. Travelers’ demographic (including travel history), clinical, and laboratory data were collected on admission and evaluated for their diagnostic power to predict radiographic evidence of a pulmonary infiltrate. Results Fifty-three (7%) of 750 ill returned travelers had radiographic evidence of a pulmonary infiltrate. Presentation with cough (odds ratio [OR] 2.80, 95% confidence interval [CI] 1.46–5.38), or elevated C-reactive protein values (OR 1.13, 95% CI 1.09–1.17), and white blood cell count (OR 1.08, 95% CI 1.05–1.17) strongly correlated with the presence of a pulmonary infiltrate. Recursive partitioning analysis identified a subset of 384 patients presenting with both cough and fever, or C-reactive protein values in excess of 23 mg/L that would optimally benefit from chest radiography. Conclusion The results of this study indicate that a more judicious use of chest radiography in the routine work-up of ill returned travelers is warranted.
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Affiliation(s)
- David Severs
- Institute for Tropical Diseases, Rotterdam, The Netherlands
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Heywood AE, Zhang M, MacIntyre CR, Seale H. Travel risk behaviours and uptake of pre-travel health preventions by university students in Australia. BMC Infect Dis 2012; 12:43. [PMID: 22339735 PMCID: PMC3305552 DOI: 10.1186/1471-2334-12-43] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 02/17/2012] [Indexed: 11/24/2022] Open
Abstract
Background Forward planning and preventative measures before travelling can significantly reduce the risk of many vaccine preventable travel-related infectious diseases. Higher education students may be at an increased risk of importing infectious disease as many undertake multiple visits to regions with higher infectious disease endemicity. Little is known about the health behaviours of domestic or international university students, particularly students from low resource countries who travel to high-resource countries for education. This study aimed to assess travel-associated health risks and preventative behaviours in a sample of both domestic and international university students in Australia. Methods In 2010, a 28 item self-administered online survey was distributed to students enrolled at the University of New South Wales, Sydney, Australia. Multiple methods of distributing links to the online survey were utilised. The survey examined the international travel history, travel intentions, infection control behaviours and self-reported vaccination history. Results A total of 1663 respondents completed the online survey, 22.1% were international students and 83.9% were enrolled at an undergraduate level. Half had travelled internationally in the previous 12 months, with 69% of those travelling only once during that time with no difference in travel from Australia between domestic and international students (p = 0.8). Uptake of pre-travel health advice was low overall with 68% of respondents reporting they had not sought any advice from a health professional prior to their last international trip. Domestic students were more likely to report uptake of a range of preventative travel health measures compared to international students, including diarrhoeal medication, insect repellent, food avoidance and condoms (P < 0.0001). Overall, students reported low risk perception of travel threats and a low corresponding concern for these threats. Conclusions Our study highlights the need to educate students about the risk associated with travel and improve preventative health-seeking and uptake of precautionary health measures in this highly mobile young adult population. Although immunisation is not an entry requirement to study at Universities in Australia, large tertiary institutions provide an opportunity to engage with young adults on the importance of travel health and provision of vaccines required for travel, including missed childhood vaccines.
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Affiliation(s)
- Anita E Heywood
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
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Broglia A, Kapel C. Changing dietary habits in a changing world: Emerging drivers for the transmission of foodborne parasitic zoonoses. Vet Parasitol 2011; 182:2-13. [DOI: 10.1016/j.vetpar.2011.07.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Angelin M, Evengård B, Palmgren H. Travel and vaccination patterns: A report from a travel medicine clinic in northern Sweden. ACTA ACUST UNITED AC 2011; 43:714-20. [DOI: 10.3109/00365548.2011.581306] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Alon D, Shitrit P, Chowers M. Risk behaviors and spectrum of diseases among elderly travelers: a comparison of younger and older adults. J Travel Med 2010; 17:250-5. [PMID: 20636598 DOI: 10.1111/j.1708-8305.2010.00425.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Elderly travel to the developing world is increasing. Little information is available regarding risk behaviors and health during and after travel in this population. METHODS We compared the risk factors and occurrence of travel-related diseases in two populations of Israelis, travelers aged 60 years and older and travelers in the age group of 20 to 30 years. Only people traveling for less than a month were included. Pre-travel, each person received routine counseling regarding travel-associated health risks, was immunized, and given anti-malarial prescriptions as needed. Travelers were surveyed by telephone 6 to 12 months following travel about underlying medical conditions, current medications, and travel history. Risk and preventive behaviors, compliance with anti-malarial prophylaxis, and history of illness during and after travel were assessed. RESULTS Of patients who visited the clinic from January to June 2008, 191/208 (91%) travelers aged 60 and older and 203/291 (69%) travelers aged 20 to 30 years were contacted by phone and recruited. Fewer elderly travelers drank open drinks, compared to young travelers (8% vs 35%, p < 0.01), and fewer purchased street food compared to young travelers (16.2% vs 37.9%, p < 0.01). More elderly travelers were fully compliant with their anti-malarial chemoprophylaxis regimen (60.7% vs 33.8%, p < 0.01). More elderly travelers took organized tours (61% vs 2%, p < 0.001). Young travelers more often backpacked (50.7% vs 10.4%, p < 0.001). Illness, most commonly diarrhea, was reported by 18.8% of elderly travelers compared to 34.0% of the young travelers (p = 0.001). In a logistic regression model only travel to East Asia (OR 4.66) (95%CI 1.93-11.22) and traveling under basic conditions (OR 1.94) (95% CI 1.42-3.29) remained significantly associated with illness, irrespective of age. CONCLUSIONS Because elderly travelers tend to comply with health-related recommendations better and use less risky travel modes, their risk for illness during travel was lower. Traveling to East Asia and travel mode are associated with illness during travel, irrespective of age.
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Affiliation(s)
- Danny Alon
- Traveler's Clinic and Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel.
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Heywood AE, Watkins RE, Pattanasin S, Iamsirithaworn S, Nilvarangkul K, Macintyre CR. Self-reported symptoms of infection among travelers departing from Sydney and Bangkok airports. J Travel Med 2010; 17:243-9. [PMID: 20636597 DOI: 10.1111/j.1708-8305.2010.00422.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data on the burden of illness in travelers departing from both developing and developed countries within the Asia-Pacific region is scarce. We conducted a survey to assess symptoms of infection among travelers within the region. METHODS A self-administered questionnaire was distributed to travelers departing Sydney airport, Australia, for destinations in Asia and departing Bangkok Airport, Thailand, for Australian destinations during the respective winter months of 2007. A two-stage cluster sampling technique was developed to ensure representativeness and a weighting was applied to the Sydney sample. Travelers were assessed for symptoms of infection (fever, sore throat, diarrhea, rash, and myalgia), travel activities, and social contact in the 2 weeks prior to departure. RESULTS A total of 843 surveys was included in the final sample (Sydney 729, response rate 56%; Bangkok 114, response rate 60%). Overall, 45.6% of respondents were Australian residents and 26.7% were residents of countries in Asia. At least one symptom of infection was reported by 23.8% of respondents and 5.4% reported two or more symptoms of infection in the 2 weeks prior to departure. The proportion reporting symptoms was higher in those departing Bangkok compared to Sydney. Significant risk factors for the reporting of symptoms differed between residents and visitors departing each study site. Activities resulting in high rates of social contact prior to travel, particularly contact with febrile persons, were found to be independent predictors of reported symptoms. CONCLUSIONS Self-reported symptoms of infection were common in our sample of travelers. Infectious diseases in travelers can result in spread across international borders and may be associated with the frequency of social contacts and reported illness among travelers.
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Affiliation(s)
- Anita E Heywood
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
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Runel-Belliard C, Lesprit E, Quinet B, Grimprel E. Sickle cell children traveling abroad: primary risk is infection. J Travel Med 2009; 16:253-7. [PMID: 19674265 DOI: 10.1111/j.1708-8305.2009.00303.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Pediatricians taking care of sickle cell children in France are concerned about giving travel advice. Very few articles are published and no study has been done about it. A lot of pediatricians are using their own experience to decide if sickle cell children can travel abroad. Studying the consequences of such travel for sickle cell children is important to discuss common recommendations. METHODS We conducted a prospective study from June 2006 to December 2007 on desires to travel expressed during our consultations with sickle cell children. We studied notable events that occurred during travel and at least 2 months after return. RESULTS Of 52 desires to travel, 10 were cancelled. All of the 42 trips were to Africa. Median duration of travel was 1.29 months (0.5-3). Median age at travel was 7.6 years (0.2-17.7). Events during travel were two hospitalizations (4.8%), a transfusion (2.4%), and four paramedical or medical examinations (9.6%). After return, four events occurred: two SS children had Plasmodium falciparum malaria (4.8%) and two had digestive bacteremia (4.8%) in SC and Sbeta+ children. No event occurred during plane travel. None of our patients died. CONCLUSIONS The primary risk for sickle cell children traveling to Africa is infection: malaria first and digestive septicemia second. These risks are increased by long travel and poor sanitary conditions. Each travel should be prepared a long time before departure, and each pediatrician should insist on malaria prophylaxis and sanitary conditions, especially for young children. Trips should be shorter than 1 month when possible. A longer prospective study will be done to confirm these results.
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Affiliation(s)
- Camille Runel-Belliard
- Sickle Cell and Travel Consultation Unit, Department of Pediatrics, Armand Trousseau Hospital, Paris, France.
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24
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Greenwood Z, Black J, Weld L, O'Brien D, Leder K, Von Sonnenburg F, Pandey P, Schwartz E, Connor BA, Brown G, Freedman DO, Torresi J. Gastrointestinal infection among international travelers globally. J Travel Med 2008; 15:221-8. [PMID: 18666921 DOI: 10.1111/j.1708-8305.2008.00203.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Data on relative rates of acquisition of gastrointestinal infections by travelers are incomplete. The objective of this study was to analyze infections associated with oral ingestion of pathogens in international travelers in relation to place of exposure. METHODS We performed a multicenter, retrospective observational analysis of 6,086 travelers ill enough with any gastrointestinal infection to seek medical care at a GeoSentinel clinic after completion of travel during 2000 to 2005. We determined regional and country-specific reporting rate ratios (RRRs) in comparison to risk in northern and western Europe. RESULTS Travel to sub-Saharan Africa (RRR = 282), South America (RRR = 203), and South Asia (RRR = 890) was associated with the greatest rate of gastrointestinal infections. RRRs were moderate (25-142) for travel to Oceania, the Middle East, North Africa, Central America, the Caribbean, and Southeast Asia. RRRs were least (<28) following travel to southern, central, and eastern Europe; North America; Northeast Asia; and Australasia. Income level of the country visited was inversely proportional to the RRR for gastrointestinal infection. For bacterial and parasitic infections examined separately, the regions group in the same way. RRRs could be estimated for 28 individual countries and together with regional data were used to derive a global RRR map for travel-related gastrointestinal infection. CONCLUSIONS This analysis of morbidity associated with oral ingestion of pathogens abroad determines which parts of the world currently are high-risk destinations.
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Affiliation(s)
- Zoe Greenwood
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Victoria, Australia
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Pai HH, Lai JL. Health problems among international travellers: from a subtropical region to tropical and non-tropical regions. Travel Med Infect Dis 2008; 6:201-4. [PMID: 18571109 DOI: 10.1016/j.tmaid.2008.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Accepted: 03/03/2008] [Indexed: 11/19/2022]
Abstract
International travel may be associated with the risk of a wide range of infectious diseases. This study was designed to obtain information on the health problems among international travellers from a subtropical region to the neighbouring tropical, subtropical, and temperate regions. Health problems among international travellers from Taiwan to the Philippines, Malaysia, Indonesia, Singapore, Vietnam, Thailand (tropical group), Hong Kong, Macao, China and Japan (non-tropical group) were surveyed through the telephone. Of 649 travellers surveyed, 8.2% had one or more health problems and insect bite (3.4%) and coughing or sore throats (3.2%) were the most important symptoms. The rate of coughing or sore throats was significantly higher among those returned from the non-tropical regions. However, no associations were found between health problems and the demographic factors, travel style or travelling duration of travel.
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Affiliation(s)
- Hsiu-Hua Pai
- Department of Kinesiology, Health, and Leisure Studies, National University of Kaohsiung, No. 700, Kaohsiung University Road, Nan Tzu District, Kaohsiung 811, Taiwan, ROC.
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26
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[The HIV-infected traveler: infectious risks and prevention]. Presse Med 2007; 37:490-9. [PMID: 18036772 DOI: 10.1016/j.lpm.2007.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 06/19/2007] [Accepted: 06/20/2007] [Indexed: 10/22/2022] Open
Abstract
Patients with human immunodeficient virus (HIV) must make special preparations before traveling. They have a higher risk of infection than the general population. They are more likely to develop malaria and the clinical episodes will be more severe, particularly in pregnant women. Prescriptions for malaria prophylaxis and treatment must take into account their interactions with antiretroviral drugs. Vaccination decisions require consideration of the risk and severity of the vaccine preventable diseases in the destination area, the nature of the vaccine, the patient's immune status, and the risk of virological rebound as a consequence of vaccination. Some countries have entry restriction for travelers with HIV. Special precautions may be necessary for transporting and storing antiretroviral medications.
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Lau JTF, Yang X, Tsui HY. Health services-seeking behaviors of people traveling from developed areas--a case of Hong Kong residents visiting mainland China. J Travel Med 2007; 14:215-25. [PMID: 17617843 DOI: 10.1111/j.1708-8305.2007.00121.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The study investigated risk perceptions and inclination to defer seeking of medical services among Hong Kong residents if they become sick in mainland China, and prevalence and factors associated with purchase of travel medical insurance. METHOD A random, population-based telephone survey was conducted on 406 Hong Kong Chinese aged 18 to 60. RESULT Of all respondents, 70.9, 62.9, and 57.2%, respectively, would defer seeking medical consultation until back to Hong Kong for mild conditions of influenza, injury, and acute disease; 55.6, 36.7, and 37.3%, respectively, would do so even for the three severe medical conditions. Concern for inferior medical standards in mainland China is the main reason for inclination to defer seeking medical services when traveling in mainland China. Multivariately, fear for nosocomial infection, lack of family/social support, and lack of knowledge about medical services in mainland China were significant factors associated with the inclination. Travel medical insurance was purchased by 20.0% of the respondents. Other difficulties for using medical services in mainland China and demands for relevant services were reported. CONCLUSIONS A dilemma exists between deferring seeking medical services and exposure to risk due to suboptimal medical services when people are traveling from developed areas to developing areas.
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Affiliation(s)
- Joseph T F Lau
- Centre for Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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28
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Affiliation(s)
- David R Boulware
- Department of Medicine, Division of Infectious Disease and International Medicine, Minneapolis, Minnesota, USA
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Redman CA, Maclennan A, Wilson E, Walker E. Diarrhea and respiratory symptoms among travelers to Asia, Africa, and South and Central America from Scotland. J Travel Med 2006; 13:203-11. [PMID: 16884402 DOI: 10.1111/j.1708-8305.2006.00046.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Surveillance using admissions to hospital, while being useful, is a poor indicator of the real incidence of disease encountered by travelers. An alternative is self-reported illness among those who attended at a pretravel clinic prior to their travels. Estimates of incidence and risk factors were determined for attendees at a travel clinic in Scotland using a questionnaire. Analysis for risk factors was carried out for those travelers visiting countries in Africa, Asia, or South and Central America, who had traveled for 1 week or more and had returned between 1997 and 2001 (N= 4,856). Multivariate logistic regression was used to test the hypotheses that time abroad and age-group would be significant for both respiratory and diarrheal symptoms regardless of which of the three geographical areas are visited. From 2006 returned questionnaires (response rate = 41.3%), diarrhea and respiratory symptoms were reported by 44.2 and 16.8% of respondents, respectively; the incidence was significantly greater among travelers to Asia for both diarrheal (55.5%) and respiratory (23.7%) symptoms than among travelers to Africa (36.6 and 12.2%, respectively) or South and Central America (39.5 and 16.2%, respectively). For diarrhea, age was a highly significant risk factor for travelers to Asia, South and Central America, and Africa. Being a self-organized tourist/backpacker, traveling to Asia was associated with increased risk, while for Africa and South and Central America visiting family or friends was associated with a lower risk. For travelers to Asia, traveling to the Indian subcontinent was significantly associated with increased risk. The majority of travelers had an adverse event while traveling abroad, with diarrhea and respiratory conditions being especially common despite attending a travel clinic for advice prior to departure. However, the limitations of this surveillance-based strategy have highlighted the requirement for more research to understand more fully the issues of risk and incidence among travelers to high-risk destinations from Scotland.
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Patel D, Easmon C, Seed P, Dow C, Snashall D. Morbidity in expatriates--a prospective cohort study. Occup Med (Lond) 2006; 56:345-52. [PMID: 16717049 DOI: 10.1093/occmed/kql026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Expatriates comprise an important, but rarely studied subset of international travellers. This study was performed to assess the incidence of health events in an expatriate group and to evaluate factors affecting this incidence. METHODS A cohort of 2020 Foreign and Commonwealth Office (FCO) staff and partners living abroad were followed-up over 1 year. The main outcome measure was incidence of illness or injury serious enough to require consultation with a doctor. Data collection was by means of a self-administered questionnaire. Poisson regression was used to estimate the rates of health events and to test for association between health events and a number of independent variables. RESULTS The incidence of health events was 21%. Trauma (incidence 5%), musculoskeletal disorders (incidence 4%) and infectious disease (incidence 3%) were the principal causes of morbidity. The incidence of psychological disorders was low (1%). Of significance, employees were at increased risk of morbidity when compared to partners, with a higher incidence of health events [incidence rate ratio (IRR) 1.4, 95% CI 1.1-1.9] and psychological disorders (IRR 5.9, 95% CI 1.0-34.1). Moreover, unaccompanied employees were at increased risk of health events (IRR 1.3, 95% CI 1.0-1.7), and of traumatic injury (IRR 2.3, 95% CI 1.3-4.3) when compared to accompanied employees. CONCLUSION While the morbidity in FCO personnel is low in comparison to other expatriate groups, the higher risk of morbidity in employees and unaccompanied individuals merits further research, particularly to ascertain whether work demands, isolation or risk-taking behaviour are contributory factors.
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Affiliation(s)
- Dipti Patel
- Guy's, King's and St Thomas' School of Medicine and Dentistry, London, UK.
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Evans MR, Sarvotham T, Thomas DR, Howard AJ. Domestic and travel-related foodborne gastrointestinal illness in a population health survey. Epidemiol Infect 2006; 134:686-93. [PMID: 16436220 PMCID: PMC2870465 DOI: 10.1017/s0950268805005790] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2005] [Indexed: 11/06/2022] Open
Abstract
Routine surveillance data underestimate incidence of foodborne gastrointestinal (FGI) illness and provide little information on illness related to travel. We analysed data from the Welsh Health Survey to estimate population incidence, and to examine risk factors for FGI and factors associated with consulting a doctor. Reported frequency of any FGI in the 3 months before interview was 20.0% [95% confidence interval (CI) 19.5-20.4; equivalent to 0.8 episodes per person-year], and for travel-related FGI was 1.6% (95% CI 1.5-1.8). In the final model, sex, age group, marital status, self-reported health, long-term illness, smoking and alcohol consumption were all independent predictors of FGI. People who consulted a doctor were likely to be older, in poorer health, taking regular medication, or to report mental illness. FGI is common but risk factors for illness and consultation differ and impressions of the epidemiology of the disease based on surveillance data are therefore distorted.
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Affiliation(s)
- M R Evans
- Department of Epidemiology, Statistics and Public Health, College of Medicine, Cardiff University, UK.
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Rack J, Wichmann O, Kamara B, Günther M, Cramer J, Schönfeld C, Henning T, Schwarz U, Mühlen M, Weitzel T, Friedrich-Jänicke B, Foroutan B, Jelinek T. Risk and spectrum of diseases in travelers to popular tourist destinations. J Travel Med 2005; 12:248-53. [PMID: 16256047 DOI: 10.2310/7060.2005.12502] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Traveling to tropical regions is related to increased health risks. Travelers' diarrhea is the most frequent health problem, but the range of travel-related diseases also includes potential life-threatening diseases such as malaria. The actual risk of European travelers acquiring specific infectious diseases and other hazards in the tropics is to a large extent unknown and is therefore often adopted from that of the indigenous population. The objective of this study was to elucidate the risk for travel-related diseases, symptoms, and accidents in a population of Europeans who travel to popular tourist destinations. METHODS From July 2003 to June 2004, 794 travelers consulting the travel clinic of the Berlin Institute of Tropical Medicine were recruited for a questionnaire-based observational study before traveling to Kenya, Tanzania, Senegal, the Gambia, India, Nepal, Thailand, or Brazil. RESULTS Overall, illness was reported by 42.9% of travelers, with 10.2% reporting more than one adverse health event. Most frequently gastrointestinal symptoms were noted (34.6%), followed by respiratory symptoms (13.7%). More than 5% experienced an accident. Travel to the Indian subcontinent nearly doubled the risk of becoming ill; travel to Thailand significantly decreased the risk. Additional risk factors were a long duration of staying abroad, young age, and traveling under basic conditions. Of all travelers, 80% did not follow the traditionally recommended dietary restrictions. Among travelers visiting malaria-endemic areas, 20% did not carry any antimalarial drugs with them, not continuous chemoprophylaxis or standby medication. CONCLUSIONS Because of the rising travel activity, especially to tropical countries, the importance of qualified pretravel advice consultation is increasing. To improve the travelers' health, attention needs to be paid to individual risk factors, the prevention and therapy of travelers' diarrhea, malaria prophylaxis, management of respiratory illness, and personal safety.
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Affiliation(s)
- Julia Rack
- Berlin Institute of Tropical Medicine, Berlin, Germany
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Abstract
BACKGROUND To date there is little sound knowledge on the relationship between travel and health status as perceived by the traveller. Our aim was to investigate the frequency and risk factors of travel-associated illnesses and injuries and identify potential protective factors. METHODS All adults enrolled in a health insurance scheme who planned to travel in 2002 were eligible for participation in a baseline survey. Pre-travel written questionnaires and post-travel telephone interviews were conducted with responders. We analysed travel-associated health problems using descriptive methods and multivariate logistic regression. RESULTS From 8316 persons who returned a pre-travel questionnaire, a sample of 2384 were chosen, of whom 1471 completed post-travel interviews. 10.1% of all travellers reported travel-associated illnesses, and 1.8% suffered from injuries during travel. Among travellers to European destinations, 6.0% reported an illness as opposed to 16.2% of travellers to overseas destinations. Predictors for travel-associated illness were age <30 years (OR 1.48), duration of travel >4 weeks (OR 3.35) and travel destination. Perceived health status as scored by the travellers improved after travel. The frequency of medical consultations and personal health-related expenses decreased significantly shortly after travel. CONCLUSIONS In this study, travel had a positive effect on the perceived health status of the traveller. The positive effects of travel seemed to outweigh the impact of health problems. Travel did not lead to increased health-related costs, neither in individual health expenses nor indirectly through increased medical consultation rates.
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Affiliation(s)
- Susanna Fleck
- Bernhard-Nocht Institute for Tropical Medicine, Center for Travel Medicine, Hamburg, Germany
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Leutscher PDC, Bagley SW. Health-related challenges in United States Peace Corps Volunteers serving for two years in Madagascar. J Travel Med 2003; 10:263-7. [PMID: 14531978 DOI: 10.2310/7060.2003.2690] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The United States Peace Corps has nearly 8000 Volunteers (PCVs) working in more than 70 countries, predominantly in the developing part of the world. The volunteers are challenged by many new and unfamiliar health problems, as a result of change in living conditions during their service. The goal of this study was to assess the health problems of PCVs in Madagascar, and to use this information to evaluate the effectiveness of the current PCV health support program. METHODS PCVs, finalizing their 2 years of service, were enrolled in the study. Data were retrieved from individual Peace Corps service medical records, the close of service (COS) physical evaluation, and a PCV questionnaire, which elicited additional self-reported health problems and concerns. RESULTS Sixty-nine PCVs took part in the study. Median age at COS was 24 years (95% CI 23-26 years), and the male/female ratio was 1 : 3.6 (15 males and 54 females). Skin, gastrointestinal and respiratory infections constituted the three most common reported health problems. Among the registered parasitic infections were ova and parasites in the stool (42.0%), confirmed and presumptive malaria (15.9%) and schistosomiasis (11.6%). Female PCVs more frequently reported dermatologic manifestations than male PCVs: postadolescent acne (48.2% vs. 13.3%) and telogen hair loss (33.3% vs. 6.7%). Amenorrhea, as the most commonly reported menstrual alteration during service, was reported by 15 (27.7%) female PCVs. CONCLUSIONS The PCVs in Madagascar encounter a broad range of health-related problems, most of which are preventable infectious diseases. Reinforcement of the preservice personal health-training curriculum later during service is needed. Reported dermatologic and menstrual disturbances in female subjects may be associated with stress-related estrogen imbalance. More studies are warranted to assess the stress impact of long-term travel on the female physiology.
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Affiliation(s)
- Peter D C Leutscher
- The United States Peace Corps, Medical Unit, BP 620, Antananarivo, Madagascar
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Leder K, Sundararajan V, Weld L, Pandey P, Brown G, Torresi J. Respiratory tract infections in travelers: a review of the GeoSentinel surveillance network. Clin Infect Dis 2003; 36:399-406. [PMID: 12567296 DOI: 10.1086/346155] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2002] [Accepted: 10/20/2002] [Indexed: 11/03/2022] Open
Abstract
Respiratory tract infections are common in travelers, and improving our knowledge of risk factors associated with specific types of respiratory infections should enable implementation of better preventive strategies. Data collected by the GeoSentinel surveillance network were analyzed, and the most significant predictors for developing specific categories of respiratory infections while abroad were age, sex, season of travel, trip duration, and reason for travel. In particular, influenza was associated with travel to the Northern Hemisphere during the period of December through February, travel involving visits to friends or relatives, and trip duration of >30 days. Lower respiratory tract infections were associated with male sex and increasing age. Knowledge of the respiratory tract infections that occur in specific groups of travelers allows for the development of targeted pretravel preventive strategies to high-risk groups.
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Affiliation(s)
- Karin Leder
- Victorian Infectious Disease Service, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
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Abstract
BACKGROUND During recent years international travel, including visits to the developing world, has become increasingly popular. Many of these travelers suffer from some sort of health problem during their trip or after their return. Travelers clinics that give pretravel immunization and counseling have emerged. This study analyzes the incidence and risk factors for health problems among Israelis traveling abroad. METHODS The study surveyed by telephone 200 people who visited the traveler's clinic at Soroka Medical Center in Beer-Sheva during the years 1998 to 1999. The travelers were questioned after returning from their journey about the type and duration of the trip, compliance with medical advice given in the travel clinic, and health problems during the trip. RESULTS The mean age was 26.4 +/- 9.4 years, 7% went on an organized tour, 23% traveled alone, and 77% traveled with a friend. The mean duration of the trip was 14.7 +/- 13.4 weeks. Of the travelers, 70% reported some health impairment. Problems reported most frequently were gastrointestinal tract diseases (43%), respiratory tract diseases (25%), and injuries (10%). Only 4% were admitted to a hospital during their trip. After their return, 19.5% consulted a physician. Comparing the group of travelers who were sick with the rest, a correlation between noncompliance with the keeping of food hygiene and illness was found (p =.008). Additional risk factors for illness were long duration (p <.001), solitary trip (p =.04), and young age (p <.001). Of the people who were advised to take antimalaria chemoprophylaxis, 55% reported regular use of these drugs. Compliance with treatment correlated with older age (p <.001), short duration of stay (p =.01), previous experience, and travel to Africa (p <.001). CONCLUSIONS Most of the travelers to developing countries are young, travel for long periods, and live in basic conditions during their stay abroad. For these reasons travelers are at increased risk for morbidity. High risk travelers should be identified and counseled in order to increase their compliance with the medical advice and immunizations. A screening program for returning travelers should be considered.
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Affiliation(s)
- Lihi Winer
- Traveler's clinic, Soroka Medical Center and Department of Epidemiology, Ben Gurion University of the Negev, Beersheva, Israel
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Payment P. Transmission of gastrointestinal diseases: hygiene as the final barrier. Am J Infect Control 2001; 29:218-21. [PMID: 11486257 PMCID: PMC7132730 DOI: 10.1067/mic.2001.115683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Am J Infect Control 2001;29:218-21
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Affiliation(s)
- P Payment
- INRS-Institut Armand-Frappier, Centre de Microbiologie et Biotechnologie, Universite du Quebec, Laval, Canada
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Evans MR, Shickle D, Morgan MZ. Travel illness in British package holiday tourists: prospective cohort study. J Infect 2001; 43:140-7. [PMID: 11676522 DOI: 10.1053/jinf.2001.0876] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To examine the relationship between knowledge of travel health matters, health preparation for travel and risk of travel related illness. METHODS Travellers on holiday charter flights from Cardiff-Wales Airport provided information on holiday preparation before departure and were surveyed 2 weeks after return for details of holiday lifestyle and travel illness. RESULTS Travellers' diarrhoea was reported by 25.7% of 1469 travellers; 24.4% had sunburn and 7.6% had respiratory infection. Attack rates for travellers' diarrhoea were highest in people aged 15-34 years (34.1%). Rates were higher the shorter the interval between holiday booking and departure (chi(2)for linear trend 13.5, 1df, P <0.001) and lower in travellers who sought advice from their general practitioner before departure (adjusted odds ratio 0.6, 95% confidence interval 0.4-0.9). The most important predictors for travellers' diarrhoea were travel with friends, country of destination, stay in room only or bed and breakfast accommodation, and type of meals most frequently eaten. CONCLUSIONS Better holiday preparation seems to reduce risk of travel illness, even after adjusting for variables that may reflect the more cautious personality of the traveller. Encouragement to book early, take medical advice and travel well prepared could have a positive health benefit, but intervention studies are required.
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Affiliation(s)
- M R Evans
- Department of Public Health Medicine, South Glamorgan Health Authority, Temple of Peace and Health, Cardiff, UK.
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Abstract
BACKGROUND Millions of Americans visit developing countries each year, however, little is known about their health during travel. This study describes health problems in a large cohort of American travelers during and after their trip. METHODS A 2-year survey of 784 travelers (95% follow-up) was conducted for persons traveling for < or = 90 days. At the pretravel visit, travelers were given a postcard to record adverse health events. Following travel, standardized telephone interviews were performed for any positive responses, or if the card was not returned. All travelers were contacted 2 months after return to determine late occurring illness and compliance with antimalarials. RESULTS Travelers had a mean age of 44 years, a median duration of 19 days, and visited 123 countries. An illness was reported by 64% (1.6 illnesses per traveler). Ill travelers were more often female, and traveled longer than those who were not ill; depending upon destination, each day of travel increased by 3 to 4% the chance of becoming ill. Diarrhea was most common, occurring in 46%; 34% met a strict definition for traveler's diarrhea. Respiratory illness occurred in 26%, skin disorders in 8%, acute mountain sickness in 6%, motion sickness in 5%, accidents and injuries in 5%, and isolated febrile episodes in 3%. Medical care was sought by 8% of all travelers and 12% of those reporting illness. On return, 26% of travelers were ill, 56% of whom became ill after return. Diarrhea, respiratory illness, skin disorders, and febrile syndromes were most common, and 46% of those who were ill sought medical care. Complete compliance with antimalarials was 80%. Noncompliant individuals usually discontinued medications on return. Side effects were reported by 4% of those taking chloroquine, 11% of those taking chloroquine plus proguanil, and 14% of those taking mefloquine, with half of these neuropsychiatric. The incidence of documented malaria was 3.8 cases per 1,000 travelers. CONCLUSIONS Many travelers experience adverse health events during and after travel to the developing world. Attention to the prevention and therapy of traveler's diarrhea, prophylaxis of malaria, management of respiratory illness, personal safety, and access to medical care during travel, and, recognition of clinical syndromes after return, will help to improve the traveler's health.
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Affiliation(s)
- D R Hill
- The International Traveler's Medical Service, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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40
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Bath NE. Health and safety problems and lack of information among international visitors backpacking through North Queensland. J Travel Med 2000; 7:234-8. [PMID: 11231206 DOI: 10.2310/7060.2000.00071] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND International visitors to tropical Australia may be exposed to health and safety problems. Because they are younger, stay longer and participate in more activities, backpackers have a greater exposure to such problems than other visitors. METHOD The study's aim was to determine how many backpackers experience problems and lack health and safety information. Four hundred and thirty-one international visitors staying in a random sample of youth hostels and backpacker accommodation in Townsville were surveyed over the summer. RESULTS Sixty two percent experienced a health and safety problem, commonly, insect bites, sunburn, headaches, lacerations, coral cuts, ear infections and diarrhea. Seventeen percent resolved only with professional help. Only 54% of backpackers had been offered health and safety information prior to departure, mainly vaccination advice. CONCLUSION The proportion of backpackers offered health and safety information about tropical Australia, and the breadth of that information, needs to be increased.
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Abdullah AS AM, Hedley AJ, Fielding R. Prevalence of travel related illness amongst a group of Chinese undergraduate students in Hong Kong. J Travel Med 2000; 7:125-32. [PMID: 11179941 DOI: 10.2310/7060.2000.00043] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Regional and global travel by Asian residents is increasing. Young people seeking new experiences through travel may be particularly at risk of a wide spectrum of health problems. This study assesses travel-associated health risks and examines the prevalence and likely impact of pretravel health advice among Chinese undergraduate students in Hong Kong. METHODS Year 1 and year 3 undergraduate students of the University of Hong Kong were surveyed during September to December 1996, using a structured self-administered questionnaire. A total of 1,067 subjects were required to give a power of 95% (p =.50+/-3%). RESULTS Of 1,197 students (514 male and 680 female) surveyed, 52% had traveled outside Hong Kong at least once within the previous 12 months. Of these travelers (n = 578), 41% had developed one or more health problems, 7% had to consult a doctor and 2% needed hospitalization during travel, and 8% developed health problems within 2 weeks of returning for which they had to consult a doctor. Most (75%) took no pretravel health advice and 48% took no travel health precautions. About half (41%) of those who received advice received this from nonexpert sources. Those more likely to develop health problems were aged over 20 years (Odds Ratio, 1.49, 95% confidence interval, 1.06-2.10), in financial difficulties (1.60, 1.02-2.51), ever-smokers (1.69, 1.03-2.77), reporting poorer current health status (1.64, 1.04-2.57). Also, those who sought health advice from nonprofessional sources (2.13, 1.03-4.01) and took precautions (1.88, 1.33-2.63) were more likely to develop health problems. CONCLUSIONS This study demonstrated that young Chinese adults, with the benefits of higher education, are potentially at risk of a variety of avoidable travel-related health problems. Taking pretravel health advice from nonprofessional sources was common among respondents, but taking precautions did not reduce health problems. The comprehensibility and effectiveness of the advice and appropriateness of precautions taken need scrutiny in randomized trials. Specific topics for pretravel health education that will target higher risk travelers with preventive messages need to be identified and evaluated.
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Affiliation(s)
- A M Abdullah AS
- Department of Community Medicine, The University of Hong Kong, Hong Kong
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Abstract
Background: There is a perceived increased health risk in senior visitors to malaria endemic countries. Methods: The authors sought to compare effectiveness and tolerability of malaria chemoprophylaxis in senior travelers (>=60 years) with those in younger travelers (20-59 years). The "Malpro 2" database consists of more than 100,000 questionnaires completed by travelers on charter planes returning from East Africa to Europe during July 1988-December 1991. Among them, 9106 (9.1%) of the travelers were 60 years or older, and 84,562 (84.6%) of the travelers reported to be 20-59 years. Variables of demography, travel data, and the effectiveness and tolerability of chemoprophylaxis were compared in the two subgroups. Results: Malaria in Africa was reported by 8 (1/1000) elderly travelers and by 189 (2.2/1000) travelers aged 20-59 years. Adjusting for age, sex, prophylaxis, and duration of stay in Africa in a logistic regression model, malaria was significantly more frequent in younger than in senior travelers (p<.05). Any travel-associated illness was reported by 7.0% in the senior age group and by 13.6% in the younger age group (p<.05). The rates of travelers who indicated they had "side effects" attributable to malaria prophylaxis varied between 9.7% in the elderly and 15.5% in the younger travelers (p<.05). Conclusion: Senior travelers tolerate malaria chemoprophylaxis and visits to the tropics at least as well as younger travelers.
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Affiliation(s)
- ML Mittelholzer
- Pharmaceuticals Division, Business Development & Strategic Marketing, F. Hoffmann-La Roche Ltd., Basel, Switzerland
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