Abstract
BackgroundExpatriates are a distinct population at unique risk for health problems related to their travel exposure.MethodsWe analyzed GeoSentinel data comparing ill returned expatriates with other travelers for demographics, travel characteristics, and proportionate morbidity (PM) for travel-related illness.ResultsOur study included 2,883 expatriates and 11,910 non-expatriates who visited GeoSentinel clinics ill after travel. Expatriates were more likely to be male, do volunteer work, be long-stay travelers (>6 months), and have sought pre-travel advice. Compared to non-expatriates, expatriates returning from Africa had higher proportionate morbidity (PM) for malaria, filariasis, schistosomiasis, and hepatitis E; expatriates from the Asia-Pacific region had higher PM for strongyloidiasis, depression, and anxiety; expatriates returning from Latin America had higher PM for mononucleosis and ingestion-related infections (giardiasis, brucellosis). Expatriates returning from all three regions had higher PM for latent TB, amebiasis, and gastrointestinal infections (other than acute diarrhea) compared to non-expatriates. When the data were stratified by travel reason, business expatriates had higher PM for febrile systemic illness (malaria and dengue) and vaccine-preventable infections (hepatitis A), and volunteer expatriates had higher PM for parasitic infections. Expatriates overall had higher adjusted odds ratios for latent TB and lower odds ratios for acute diarrhea and dermatologic illness.ConclusionsIll returned expatriates differ from other travelers in travel characteristics and proportionate morbidity for specific diseases, based on the region of exposure and travel reason. They are more likely to present with more serious illness.
Highlights
Expatriates are a distinct population at unique risk for health problems related to their travel exposure
Expatriates are considered distinct from tourists, who use commercial lodgings such as hotels or hostels, or travelers visiting friends and relatives (VFRs), who stay in local homes as guests
Definitions Site clinicians marked a traveler as “expatriate”, according to the GeoSentinel data entry definition as those living in a destination country with an independent residence, using mostly the infrastructure used by local residents of the same economic class, independent of duration of residence
Summary
Expatriates are a distinct population at unique risk for health problems related to their travel exposure. Expatriates are a diverse group who must adapt to their host culture, who have a longer duration of exposure to country-related hazards, and who have the opportunity to modify risks in their immediate environment [1]. Expatriate travel has grown substantially, along with an increasing need to understand the health issues for these travelers. Using local infrastructure and longer-term residence abroad expose expatriates to health risks. Expatriates are considered distinct from tourists, who use commercial lodgings such as hotels or hostels, or travelers visiting friends and relatives (VFRs), who stay in local homes as guests. Expatriates are distinct from immigrants in their nonpermanent residence in their destination country, many expatriates reside abroad for long periods, from months to years
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