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Karin Leder,
Joseph Torresi,
Michael D Libman,
Jakob P Cramer,
Francesco Castelli,
Patricia Schlagenhauf,
Annelies Wilder-Smith,
Mary E Wilson, Jay S Keystone,
Eli Schwartz,
Elizabeth D Barnett,
Frank von Sonnenburg,
John S Brownstein,
Allen C Cheng,
Mark J Sotir,
Douglas H Esposito,
David O Freedman
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ABSTRACT: Chinese translation
International travel continues to increase, particularly to Asia and Africa. Clinicians are increasingly likely to be consulted for advice before travel or by ill returned travelers.
To describe typical diseases in returned travelers according to region, travel reason, and patient demographic characteristics; describe the pattern of low-frequency travel-associated diseases; and refine key messages for care before and after travel.
Descriptive, using GeoSentinel records.
53 tropical or travel disease units in 24 countries.
42 173 ill returned travelers seen between 2007 and 2011.
Frequencies of demographic characteristics, regions visited, and illnesses reported.
Asia (32.6%) and sub-Saharan Africa (26.7%) were the most common regions where illnesses were acquired. Three quarters of travel-related illness was due to gastrointestinal (34.0%), febrile (23.3%), and dermatologic (19.5%) diseases. Only 40.5% of all ill travelers reported pretravel medical visits. The relative frequency of many diseases varied with both travel destination and reason for travel, with travelers visiting friends and relatives in their country of origin having both a disproportionately high burden of serious febrile illness and very low rates of advice before travel (18.3%). Life-threatening diseases, such as Plasmodium falciparum malaria, melioidosis, and African trypanosomiasis, were reported.
Sentinel surveillance data collected by specialist clinics do not reflect healthy returning travelers or those with mild or self-limited illness. Data cannot be used to infer quantitative risk for illness.
Many illnesses may have been preventable with appropriate advice, chemoprophylaxis, or vaccination. Clinicians can use these 5-year GeoSentinel data to help tailor more efficient pretravel preparation strategies and evaluate possible differential diagnoses of ill returned travelers according to destination and reason for travel.
Centers for Disease Control and Prevention.
Annals of internal medicine 03/2013; 158(6):456-68. · 16.73 Impact Factor
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Karin Leder,
Joseph Torresi,
Michael D Libman,
Jakob P Cramer,
Francesco Castelli,
Patricia Schlagenhauf,
Annelies Wilder-Smith,
Mary E Wilson, Jay S Keystone,
Eli Schwartz,
Elizabeth D Barnett,
Frank Von Sonnenburg,
John S Brownstein,
Allen C Cheng,
Mark J Sotir,
Douglas H Esposito,
David O Freedman
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ABSTRACT: Amoebic liver abscess (ALA) is an uncommon but potentially life-threatening complication of infection with the protozoan parasite Entamoeba histolytica. E histolytica is widely distributed throughout the tropics and subtropics, causing up to 40 million infections annually. The parasite is transmitted via the fecal-oral route, and once it establishes itself in the colon, it has the propensity to invade the mucosa, leading to ulceration and colitis, and to disseminate to distant extraintestinal sites, the most common of which is the liver. The authors provide a topical review of ALA and summarize clinical data from a series of 29 patients with ALA presenting to seven hospitals in Toronto, Ontario, a nonendemic setting, over 30 years.
Canadian journal of gastroenterology = Journal canadien de gastroenterologie 10/2012; 26(10):729-33. · 1.21 Impact Factor
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ABSTRACT: International travel to exotic destinations continues to increase, as does the risk for illness during travel. Health problems
during travel are common. Although many medical problems that travelers incur are noninfectious in origin (eg, injuries, environment-associated illness), travelers often are at risk for acquiring a variety of infections. Many travelrelated
infections also occur commonly in the developed world, whereas other infections of travelers may be geographically restricted
to specific world regions and/or are infrequently encountered in developed nations. Antibiotics play an important role in
the treatment and prevention of a variety of bacterial and parasitic infections in travelers. This article reviews antibiotics
of particularly high utility to travelers, with emphasis on selected agents that, with appropriate advice from a travel medicine
specialist, can be used safely for prophylaxis and self-treatment during travel. The role of antibiotics in selected high-risk
travelers also is discussed.
Current Infectious Disease Reports 04/2012; 6(1):13-21.
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Jose Flores-Figueroa,
Pablo C Okhuysen,
Frank von Sonnenburg,
Herbert L DuPont,
Michael D Libman, Jay S Keystone,
Devon C Hale,
Gerd Burchard,
Pauline V Han,
Annelies Wilder-Smith,
David O Freedman
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ABSTRACT: Mexico and Central America are important travel destinations for North American and European travelers. There is limited information on regional differences in travel related morbidity.
We describe the morbidity among 4779 ill travelers returned from Mexico and Central America who were evaluated at GeoSentinel network clinics during December 1996 to February 2010.
The most frequent presenting syndromes included acute and chronic diarrhea, dermatologic diseases, febrile systemic illness, and respiratory disease. A higher proportion of ill travelers from the United States had acute diarrhea, compared with their Canadian and European counterparts (odds ratio, 1.9; P < .0001). During the 2009 H1N1 influenza outbreak from March 2009 through February 2010, the proportionate morbidity (PM) associated with respiratory illnesses in ill travelers increased among those returned from Mexico, compared with prior years (196.0 cases per 1000 ill returned travelers vs 53.7 cases per 1000 ill returned travelers; P < .0001); the PM remained constant in the rest of Central America (57.3 cases per 1000 ill returned travelers). We identified 50 travelers returned from Mexico and Central America who developed influenza, including infection due to 2009 H1N1 strains and influenza-like illness. The overall risk of malaria was low; only 4 cases of malaria were acquired in Mexico (PM, 2.2 cases per 1000 ill returned travelers) in 13 years, compared with 18 from Honduras (PM, 79.6 cases per 1000 ill returned travelers) and 14 from Guatemala (PM, 34.4 cases per 1000 ill returned travelers) during the same period. Plasmodium vivax malaria was the most frequent malaria diagnosis.
Travel medicine practitioners advising and treating travelers visiting these regions should dedicate special attention to vaccine-preventable illnesses and should consider the uncommon occurrence of acute hepatitis A, leptospirosis, neurocysticercosis, acute Chagas disease, onchocerciasis, mucocutaneous leishmaniasis, neurocysticercosis, HIV, malaria, and brucellosis.
Clinical Infectious Diseases 09/2011; 53(6):523-31. · 9.15 Impact Factor
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International journal of dermatology 08/2011; 50(8):1024-6. · 1.18 Impact Factor
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Journal of Travel Medicine 03/2011; 18(2):71-2. · 1.75 Impact Factor
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ABSTRACT: Using the GeoSentinel database, an analysis of ill patients returning from throughout sub-Saharan Africa over a 13-year period was performed. Systemic febrile illness, dermatologic, and acute diarrheal illness were the most common syndromic groupings, whereas spotted fever group rickettsiosis was the most common individual diagnosis for travelers to South Africa. In contrast to the rest of sub-Saharan Africa, only six cases of malaria were documented in South Africa travelers. Vaccine-preventable diseases, typhoid, hepatitis A, and potential rabies exposures were uncommon in South Africa travelers. Pre-travel advice for the travelers to the 2010 World Cup should be individualized according to these findings.
The American journal of tropical medicine and hygiene 06/2010; 82(6):991-5. · 2.59 Impact Factor
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Mogens Jensenius,
Xiaohong Davis,
Frank von Sonnenburg,
Eli Schwartz, Jay S Keystone,
Karin Leder,
Rogelio Lopéz-Véléz,
Eric Caumes,
Jakob P Cramer,
Lin Chen,
Philippe Parola
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ABSTRACT: We investigated epidemiologic and clinical aspects of rickettsial diseases in 280 international travelers reported to the GeoSentinel surveillance Network during 1996-2008. Of these 280 travelers, 231 (82.5%) had spotted fever (SFG) rickettsiosis, 16 (5.7%) scrub typhus, 11 (3.9%) Q fever, 10 (3.6%) typhus group (TG) rickettsiosis, 7 (2.5%) bartonellosis, 4 (1.4%) indeterminable SFG/TG rickettsiosis, and 1 (0.4%) human granulocytic anaplasmosis. One hundred ninety-seven (87.6%) SFG rickettsiosis cases were acquired in sub-Saharan Africa and were associated with higher age, male gender, travel to southern Africa, late summer season travel, and travel for tourism. More than 90% of patients with rickettsial disease were treated with doxycycline, 43 (15.4%) were hospitalized, and 4 had a complicated course, including 1 fatal case of scrub typhus encephalitis acquired in Thailand.
Emerging Infectious Diseases 11/2009; 15(11):1791-8. · 6.79 Impact Factor
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Clinical Infectious Diseases 11/2009; 49(9):1461. · 9.15 Impact Factor
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Canadian Medical Association Journal 06/2009; 180(11):1129-31. · 8.22 Impact Factor
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ABSTRACT: Selected data collected for travelers to China from 1998 through November 2007 by the GeoSentinel Surveillance Network were used to provide an evidence base for prioritizing recommendations for Olympic and other future travelers to China. Respiratory illness and injuries were common among patients seen during their travel; acute diarrhea and dog bites were common among those seen after travel. Tropical and parasitic diseases were rare. Pre-travel consultation for China travelers should be individualized according to these findings.
The American journal of tropical medicine and hygiene 08/2008; 79(1):4-8. · 2.59 Impact Factor
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ABSTRACT: Skin disorders are common in travelers. Knowledge of the relative frequency of post-travel-related skin disorders, including their geographic and demographic risk factors, will allow for effective pre-travel counseling, as well as improved post-travel diagnosis and therapeutic intervention.
We performed a retrospective study using anonymous patient demographic, clinical, and travel-related data from the GeoSentinel Surveillance Network clinics from January 1997 through February 2006. The characteristics of these travelers and their itineraries were analyzed using SAS 9.0 statistical software.
A skin-related diagnosis was reported for 4594 patients (18% of all patients seen in a GeoSentinel clinic after travel). The most common skin-related diagnoses were cutaneous larva migrans (CLM), insect bites including superinfected bites, skin abscess, and allergic reaction (38% of all diagnoses). Arthropod-related skin diseases accounted for 31% of all skin diagnoses. Ill travelers who visited countries in the Caribbean experienced the highest proportionate morbidity due to dermatologic conditions. Pediatric travelers had significantly more dog bites and CLM and fewer insect bites compared with their adult counterparts; geriatric travelers had proportionately more spotted fever and cellulitis.
Clinicians seeing patients post-travel should be alert to classic travel-related skin diseases such as CLM as well as more mundane entities such as pyodermas and allergic reactions. To prevent and manage skin-related morbidity during travel, international travelers should avoid direct contact with sand, soil, and animals and carry a travel kit including insect repellent, topical antifungals, and corticosteroids and, in the case of extended and/or remote travel, an oral antibiotic with ample coverage for pyogenic organisms.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 04/2008; 12(6):593-602. · 2.17 Impact Factor
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ABSTRACT: Hepatitis A virus (HAV) and hepatitis B virus (HBV) are vaccine-preventable. Current recommendations advocate vaccination of non-immune adults at risk of exposure, including travelers to HAV or HBV endemic areas, individuals with high risk of contracting a sexually transmitted infection, and some correctional facility inmates. We review the use of an accelerated schedule to administer the combination hepatitis A and hepatitis B vaccine (Twinrix). Administering three doses over three weeks and a fourth at 12 months provides rapid initial protection of most individuals for whom the standard 6-month vaccination schedule would not be suitable, including last-minute travelers and short-term correctional facility inmates. Furthermore, we consider the role of a universal vaccination strategy in preventing the spread of HAV and HBV.
International Journal of Infectious Diseases 02/2008; 12(1):3-11. · 1.94 Impact Factor
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ABSTRACT: Although efficacious forms of malaria chemoprophylaxis currently exist, many travelers to malaria-endemic areas fail to use them effectively. We suggest that taking antimalarial medications prior to travel may prevent more malaria by improving compliance. Treatment regimens of antimalarial drugs taken prior to travel could protect persons for up to one month of exposure. We urge additional testing of pre-travel malaria chemoprophylaxis regimens.
The American journal of tropical medicine and hygiene 08/2007; 77(1):1-2. · 2.59 Impact Factor
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ABSTRACT: Fever is a marker of potentially serious illness in returned travelers. Information about causes of fever, organized by geographic area and traveler characteristics, can facilitate timely, appropriate treatment and preventive measures.
Using a large, multicenter database, we assessed how frequently fever is cited as a chief reason for seeking medical care among ill returned travelers. We defined the causes of fever by place of exposure and traveler characteristics.
Of 24,920 returned travelers seen at a GeoSentinel clinic from March 1997 through March 2006, 6957 (28%) cited fever as a chief reason for seeking care. Of patients with fever, 26% were hospitalized (compared with 3% who did not have fever); 35% had a febrile systemic illness, 15% had a febrile diarrheal disease, and 14% had fever and a respiratory illness. Malaria was the most common specific etiologic diagnosis, found in 21% of ill returned travelers with fever. Causes of fever varied by region visited and by time of presentation after travel. Ill travelers who returned from sub-Saharan Africa, south-central Asia, and Latin America whose reason for travel was visiting friends and relatives were more likely to experience fever than any other group. More than 17% of travelers with fever had a vaccine-preventable infection or falciparum malaria, which is preventable with chemoprophylaxis. Malaria accounted for 33% of the 12 deaths among febrile travelers.
Fever is common in ill returned travelers and often results in hospitalization. The time of presentation after travel provides important clues toward establishing a diagnosis. Preventing and promptly treating malaria, providing appropriate vaccines, and identifying ways to reach travelers whose purpose for travel is visiting friends and relatives in advance of travel can reduce the burden of travel-related illness.
Clinical Infectious Diseases 07/2007; 44(12):1560-8. · 9.15 Impact Factor
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ABSTRACT: As international travel increases, there is rising exposure to many pathogens not traditionally encountered in the resource-rich countries of the world. Filarial infections, a great problem throughout the tropics and subtropics, are relatively rare among travelers even to filaria-endemic regions of the world. The GeoSentinel Surveillance Network, a global network of medicine/travel clinics, was established in 1995 to detect morbidity trends among travelers.
We examined data from the GeoSentinel database to determine demographic and travel characteristics associated with filaria acquisition and to understand the differences in clinical presentation between nonendemic visitors and those born in filaria-endemic regions of the world. Filarial infections comprised 0.62% (n = 271) of all medical conditions reported to the GeoSentinel Network from travelers; 37% of patients were diagnosed with Onchocerca volvulus, 25% were infected with Loa loa, and another 25% were diagnosed with Wuchereria bancrofti. Most infections were reported from immigrants and from those immigrants returning to their county of origin (those visiting friends and relatives); the majority of filarial infections were acquired in sub-Saharan Africa. Among the patients who were natives of filaria-nonendemic regions, 70.6% acquired their filarial infection with exposure greater than 1 month. Moreover, nonendemic visitors to filaria-endemic regions were more likely to present to GeoSentinel sites with clinically symptomatic conditions compared with those who had lifelong exposure.
Codifying the filarial infections presenting to the GeoSentinel Surveillance Network has provided insights into the clinical differences seen among filaria-infected expatriates and those from endemic regions and demonstrated that O. volvulus infection can be acquired with short-term travel.
PLoS Neglected Tropical Diseases 02/2007; 1(3):e88. · 4.69 Impact Factor
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Clinical Infectious Diseases 01/2007; 43(12):1499-539. · 9.15 Impact Factor
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ABSTRACT: Approximately 8 percent of travelers to the developing world require medical care during or after travel. Current understanding of morbidity profiles among ill returned travelers is based on limited data from the 1980s.
Thirty GeoSentinel sites, which are specialized travel or tropical-medicine clinics on six continents, contributed clinician-based sentinel surveillance data for 17,353 ill returned travelers. We compared the frequency of occurrence of each diagnosis among travelers returning from six developing regions of the world.
Significant regional differences in proportionate morbidity were detected in 16 of 21 broad syndromic categories. Among travelers presenting to GeoSentinel sites, systemic febrile illness without localizing findings occurred disproportionately among those returning from sub-Saharan Africa or Southeast Asia, acute diarrhea among those returning from south central Asia, and dermatologic problems among those returning from the Caribbean or Central or South America. With respect to specific diagnoses, malaria was one of the three most frequent causes of systemic febrile illness among travelers from every region, although travelers from every region except sub-Saharan Africa and Central America had confirmed or probable dengue more frequently than malaria. Among travelers returning from sub-Saharan Africa, rickettsial infection, primarily tick-borne spotted fever, occurred more frequently than typhoid or dengue. Travelers from all regions except Southeast Asia presented with parasite-induced diarrhea more often than with bacterial diarrhea.
When patients present to specialized clinics after travel to the developing world, travel destinations are associated with the probability of the diagnosis of certain diseases. Diagnostic approaches and empiric therapies can be guided by these destination-specific differences.
New England Journal of Medicine 02/2006; 354(2):119-30. · 53.30 Impact Factor
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Jay S Keystone
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ABSTRACT: Rates of global travel and tourism are increasing dramatically, especially to regions with medium or high endemicity for hepatitis A and B, such as Asia, Africa, Latin America, and the Middle East. International travelers to these areas should be protected against both hepatitis A and B, regardless of their anticipated length of stay. However, many travelers depart within weeks of planning their trip (too late to complete the accelerated 0-, 1-, 2-month regimen for hepatitis B), and a majority of those traveling depart without being vaccinated. Although extended-stay travelers are at high risk for hepatitis B, short-stay travelers also are at risk. The most commonly encountered risk factors for travel-related hepatitis B are casual sexual activity with a new partner, medical and dental care abroad, and in the expatriate community, adoption of children who are hepatitis B carriers. Although efficacy studies of accelerated schedules for hepatitis B immunization have not been conducted, the results of immunogenicity studies in healthy volunteers who received an accelerated, 3-dose regimen on a 0-,7-, and 21-day schedule suggest that excellent, rapid, and long-term protection will be conferred. More data are needed to assess the efficacy of accelerated schedules in persons aged >40 years and to determine whether a fourth dose of hepatitis B vaccine is needed in all age groups.
The American Journal of Medicine 10/2005; 118 Suppl 10A:63S-68S. · 5.43 Impact Factor
