Abstract
BackgroundDespite the considerable burden of helminth infections in developing countries and increasing international travel, little is known about the risks of infection for travelers.ObjectiveWe studied the attack and incidence rate of serology confirmed strongyloidiasis, filariasis, and toxocariasis among long-term travelers and associated factors. A second objective was to evaluate eosinophilia as a positive/negative predictive value (PPV/NPV) for a recent helminth infection.MethodsFrom 2008 to 2011, clients of the Public Health Service travel clinic planning travel to (sub)tropical countries for 12–52 weeks were invited to participate in a prospective study. Participants kept a weekly diary, recording itinerary, symptoms, and physician visits during travel and completed a post-travel questionnaire. Pre- and post-travel blood samples were serologically tested for the presence of IgG antibodies against Schistosoma species, Strongyloides stercoralis, filarial species, and Toxacara species and were used for a blood cell count. Factors associated with recent infection were analyzed using Poisson regression. Differences among groups of travelers were studied using chi square tests.ResultsFor the 604 participants, median age was 25 years (interquartile range [IQR]: 23–29), 36% were male, median travel duration was 20 weeks (IQR: 15–25), and travel purpose was predominantly tourism (62%). Destinations were Asia (45%), Africa (18%), and the Americas (37%).Evidence of previous infection was found in 13/604 participants: antibodies against Schistosoma spp. in 5 (0.8%), against S.stercoralis in 3 (0.5%), against filarial species in 4 (0.7%), and against Toxocara spp. in 1 (0.2%). Ten recent infections were found in 9 participants (3, 1, 6, 0 cases, in the above order), making the attack rates 0.61, 0.17, 1.1 and 0, and the incidence rates per 1000 person-months 1.5, 0.34, 2.6 and 0. The overall PPV and NPV of eosinophila for recent infection were 0 and 98%, respectively.ConclusionsThe risk of the helminth infections under study in this cohort of long-term travelers was low. Routine screening for eosinophilia appeared not to be of diagnostic value.
Highlights
Being among the most widespread infectious agents in human populations, helminths are an enormous burden for many low-income countries [1, 2]
From 2008 to 2011, clients of the Public Health Service travel clinic planning travel to tropical countries for 12–52 weeks were invited to participate in a prospective study
mass drug administration (MDA) proved to be an effective global public health control measure that could by-pass the cost of screening diagnostics and use drugs donated by pharmaceutical companies [1, 10]
Summary
Being among the most widespread infectious agents in human populations, helminths (i.e., roundworm and flatworm parasites) are an enormous burden for many low-income countries [1, 2]. Several programs regarding helminths have been launched, like the Onchocerciasis Elimination Program for the Americas (OEPA, 1993), African Programme for Onchocerciasis Control (APOC, 1995), Global Programme to Eliminate Lymphatic Filariasis (GPELF, 2000), and Schistosomiasis Control Initiative (SCI, 2002) [4,5,6,7,8]. Several such programs include mass drug administration (MDA) which often can prevent and alleviate symptoms of disease and reduce infection prevalence to levels that mitigate transmission and new infections [9]. Despite the considerable burden of helminth infections in developing countries and increasing international travel, little is known about the risks of infection for travelers
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