Travel-related infections presenting in Europe: A 20-year analysis of EuroTravNet surveillance data.

Martin P Grobusch,Vanessa Field,Federico Gobbi,Abraham Goorhuis,Frank P Mockenhaupt,Mirjam Schunk,Leisa Weld,Patricia Schlagenhauf,Davidson H Hamer,Denis Malvy,Philippe Gautret,Sabine Jordan,Mogens Jensenius,François Chappuis,Emmanuel Bottieau,Israel Molina,Francesco Castelli,Perry J.J Van Genderen,Carsten Schade Larsen ,Marta Díaz Menéndez ,C Rapp ,Effrossyni Gkrania‐Klotsas ,Simin Aysel Florescu ,David G Lalloo ,Hilmir Ásgeirsson ,Rogelio López‐Vélez ,Éric Caumes

doi:10.1016/j.lanepe.2020.100001

Abstract

BackgroundDisease epidemiology of (re-)emerging infectious diseases is changing rapidly, rendering surveillance of travel-associated illness important.MethodsWe evaluated travel-related illness encountered at EuroTravNet clinics, the European surveillance sub-network of GeoSentinel, between March 1, 1998 and March 31, 2018.Findings103,739 ill travellers were evaluated, including 11,239 (10.8%) migrants, 89,620 (86.4%) patients seen post-travel, and 2,880 (2.8%) during and after travel. Despite increasing numbers of patient encounters over 20 years, the regions of exposure by year of clinic visits have remained stable. In 5-year increments, greater proportions of patients were migrants or visiting friends and relatives (VFR); business travel-associated illness remained stable; tourism-related illness decreased. Falciparum malaria was amongst the most-frequently diagnosed illnesses with 5,254 cases (5.1% of all patients) and the most-frequent cause of death (risk ratio versus all other illnesses 2.5:1). Animal exposures requiring rabies post-exposure prophylaxis increased from 0.7% (1998–2002) to 3.6% (2013–2018). The proportion of patients with seasonal influenza increased from zero in 1998–2002 to 0.9% in 2013–2018. There were 44 cases of viral haemorrhagic fever, most during the past five years. Arboviral infection numbers increased significantly as did the range of presenting arboviral diseases, dengue and chikungunya diagnoses increased by 2.6% and 1%, respectively.InterpretationTravel medicine must adapt to serve the changing profile of travellers, with an increase in migrants and persons visiting relatives and friends and the strong emergence of vector-borne diseases, with potential for further local transmission in Europe.FundingThis project was supported by a cooperative agreement (U50CK00189) between the Centers for Disease Control and Prevention to the International Society of Travel Medicine (ISTM) and funding from the ISTM and the Public Health Agency of Canada.

Highlights

The global population currently encompasses more than 7.6 billion people, growing at annual rates between 5 and 10% [1]
We evaluated travel-related illness encountered at EuroTravNet clinics, the European surveillance sub-network of GeoSentinel, between March 1, 1998 and March 31, 2018
We provide a 20-year analysis of travel-related illness presenting at EuroTravNet clinics and propose up-to-date priorities in travel medicine practice based on these trends

Summary

Introduction

The global population currently encompasses more than 7.6 billion people, growing at annual rates between 5 and 10% [1]. Never have more people been displaced: an estimated 68.5 million, with more than 25 million refugees worldwide; the majority of whom are under-age minors [4] This means that the prevention and treatment of illness associated with human mobility has become an increasingly important topic. The International Society of Travel Medicine’s (ISTM) [5] European Travel and Tropical Medicine Network (EuroTravNet) [6] is a sub-network of the global GeoSentinel Surveillance Network [7], and currently includes 25 core sites. These are large-volume pre- and posttravel academic or clinical settings in twelve predominantly Western European countries [6]. Disease epidemiology of (re-)emerging infectious diseases is changing rapidly, rendering surveillance of travel-associated illness important.

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