Travel-associated enteric infections diagnosed after return to the United States, Foodborne Diseases Active Surveillance Network (FoodNet), 2004-2009.
ABSTRACT Approximately 40% of US travelers to less developed countries experience diarrheal illness. Using data from the Foodborne Diseases Active Surveillance Network (FoodNet), we describe travel-associated enteric infections during 2004-2009, characterizing the patients, pathogens, and destinations involved.
FoodNet conducts active surveillance at 10 US sites for laboratory-confirmed infections with 9 pathogens transmitted commonly through food. Travel-associated infections are infections diagnosed in the United States but likely acquired abroad based on a pathogen-specific time window between return from international travel to diagnosis. We compare the demographic, clinical, and exposure-related characteristics of travelers with those of nontravelers and estimate the risk of travel-associated infections by destination, using US Department of Commerce data.
Of 64,039 enteric infections reported to FoodNet with information about travel, 8270 (13%) were travel associated. The pathogens identified most commonly in travelers were Campylobacter (42%), nontyphoidal Salmonella (32%), and Shigella (13%). The most common travel destinations were Mexico, India, Peru, Dominican Republic, and Jamaica. Most travel-associated infections occurred in travelers returning from Latin America and the Caribbean (LAC). Risk was greatest after travel to Africa (75.9 cases per 100,000 population), followed by Asia (22.7 cases per 100,000), and LAC (20.0 cases per 100,000).
The Latin America and Caribbean region accounts for most travel-associated enteric infections diagnosed in the United States, although travel to Africa carries the greatest risk. Although FoodNet surveillance does not cover enterotoxigenic Escherichia coli, a common travel-associated infection, this information about other key enteric pathogens can be used by travelers and clinicians in pre- and posttravel consultations.
Enfermedades Infecciosas y Microbiología Clínica 12/2014; DOI:10.1016/j.eimc.2014.11.001 · 1.88 Impact Factor
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ABSTRACT: Background. Travel-related shigellosis is not well documented in Canada although it is frequently acquired abroad and can cause severe disease. Objectives. To describe the epidemiology of travel-related cases of shigellosis for Quebec (Canada) and to identify high-risk groups of travelers. Method and Data Sources. We performed a random sampling of 335 shigellosis cases (from a total of 760 cases) reported in the provincial database of reportable diseases from January 1, 2004, to December 31, 2007. Each case was analyzed according to information available in the epidemiology questionnaire. Total number of trips by region from Statistics Canada was used as denominator to estimate the risk according to region of travel. Results. Annually, between 43 and 54% of the shigellosis cases were reported in travelers, 45% of whom were aged between 20 and 44 years. Children under 11 years accounted for nearly 16% of cases, but represent only 4% of travelers. Most cases in travelers were serogroups Shigella sonnei (50%) or Shigella flexneri (45%). Almost 31% of cases were reported between January and March. The majority (64%) were acquired in Central America, Mexico, or the Caribbean. However, the Indian subcontinent, Africa, and South America had the highest ratio of number of cases per number of trips. Tourists represented 76% of the cases; 62% of them had traveled for <2weeks. At least 15% of cases among travelers were hospitalized. Conclusions. In Quebec, travel-related cases of shigellosis represent a large burden of total cases. Short-term travelers are at risk, as well as young children. The majority of cases occur in the winter months, corresponding to the peak of travel to "sunshine destinations." Continuous efforts should be made to encourage all travelers to seek pre-travel care, and to inform primary care practitioners of health risks faced by their patients abroad, even for those going to resorts.Journal of Travel Medicine 06/2014; 21(5). DOI:10.1111/jtm.12130 · 1.53 Impact Factor
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ABSTRACT: We found a strong association between nalidixic acid (NA)-resistant Salmonella serotype Enteritidis (SE) infections in the United States and recent international travel.Clinical Infectious Diseases 06/2014; 59(9). DOI:10.1093/cid/ciu505 · 9.42 Impact Factor