Travel-related Infectious Diseases Research Articles

Investigating Awareness Regarding Travel-Related Infectious Disease Prevention in a Metropolitan Area.

The rise in international travel has led to an increase in travel-related infectious diseases. It is predicted that by 2030, the number of international travelers will reach 1.8 billion, with over 250 million people affected globally. This issue also has an economic impact, as the eradication of travel-related infectious diseases leads to a loss of USD 12 billion in tourism. To understand the association between demographic variables and knowledge, attitude, and behaviors related to travel-related infectious diseases, a cross-sectional survey-based study was conducted among 1191 individuals in the metropolitan city of Naples, Italy. Multiple linear regression was performed over three models. The results revealed that knowledge about travel-related infectious diseases was positively associated with age, female gender, non-smoking habits, being single, and higher education attainment. The attitude towards travel-related infectious diseases was positively associated with being female, non-smoking habits, being single, higher education attainment, and a higher level of knowledge. A statistically significant association was observed between behaviors and non-smoking habits and between higher levels of knowledge and attitudes. To address this issue, public health programs could be implemented to improve behaviors in the general population. Overall, this study provides valuable information about the determinants of knowledge, attitude, and behaviors related to travel-related infectious diseases in the general population.

COVID-19 impact on EuroTravNet infectious diseases sentinel surveillance in Europe

BackgroundThe COVID-19 pandemic resulted in a sharp decline of post-travel patient encounters at the European sentinel surveillance network (EuroTravNet) of travellers’ health. We report on the impact of COVID-19 on travel-related infectious diseases as recorded by EuroTravNet clinics. MethodsTravelers who presented between January 1, 2019 and September 30, 2021 were included. Comparisons were made between the pre-pandemic period (14 months from January 1, 2019 to February 29, 2020); and the pandemic period (19 months from March 1, 2020 to September 30, 2021). ResultsOf the 15,124 visits to the network during the 33-month observation period, 10,941 (72%) were during the pre-pandemic period, and 4183 (28%) during the pandemic period. Average monthly visits declined from 782/month (pre-COVID-19 era) to 220/month (COVID-19 pandemic era). Among non-migrants, the top-10 countries of exposure changed after onset of the COVID-19 pandemic; destinations such as Italy and Austria, where COVID-19 exposure peaked in the first months, replaced typical travel destinations in Asia (Thailand, Indonesia, India). There was a small decline in migrant patients reported, with little change in the top countries of exposure (Bolivia, Mali).The three top diagnoses with the largest overall decreases in relative frequency were acute gastroenteritis (−5.3%), rabies post-exposure prophylaxis (−2.8%), and dengue (−2.6%). Apart from COVID-19 (which rose from 0.1% to 12.7%), the three top diagnoses with the largest overall relative frequency increase were schistosomiasis (+4.9%), strongyloidiasis (+2.7%), and latent tuberculosis (+2.4%). ConclusionsA marked COVID-19 pandemic-induced decline in global travel activities is reflected in reduced travel-related infectious diseases sentinel surveillance reporting.

Vaccine Passport Use and Travel Health Status Among Turkish Travelers at an International Airport

Introduction: Even though Istanbul is one of the centers of the world’s fastest-growing tourism and travel sector, there are limited statistics on the knowledge, attitudes, and practices (KAP) of travelers from this region regarding travel-related infectious diseases. This study aimed to determine the passengers’ KAP about contagious diseases and contribute to developing new solutions for the problems people face while traveling abroad. Methods: A questionnaire was administered to 182 Turkish travelers planning on traveling abroad and applied to the Istanbul Travel Health Center and the Istanbul Airport Health Control Center between January and March 2019. Results: The proportion of carrying a vaccination certificate was statistically higher in those who received healthcare services at international terminals (P=0.002), especially those who had yellow fever (P<0.001) and meningococcal vaccine (P=0.011). More than half of the vaccinated passengers did not carry their vaccination certificates, while around half (53.8%) were traveling to Africa. When compared to travelers flying to Europe, vaccination checks were 6.7 times (95% CI: 2.5-17.9) higher in passengers traveling to Africa, 6.1 times (95% CI: 1.5-24.3) higher in passengers traveling to Asia, and 14.8 times (95% CI: 1.3-164.3) higher in passengers traveling to South America. In addition, the vaccination certificate carrying proportion was significantly higher in those with a travel duration of 15 days or more (P=0.028), those who received health services at international terminals (P=0.002), and those vaccinated (P<0.001). Conclusion: Improved knowledge of travel-related infectious diseases and increased adoption of pre-travel health advice and vaccines are urgently needed among Turkish travelers.

Travel-related infection in Guangzhou, China,2009–2019

BackgroundWe analyzed the epidemiological characteristics of travel-related infectious diseases in reported Guangzhou between 2009 and 2019 to provide a scientific basis for prevention and control strategies. MethodThe infectious diseases report information system of China was mined for case reports, combined with clinical diagnosis records, and analyzed. ResultsBetween 2009 and 2019, 1478 cases of imported infectious diseases were reported in Guangzhou. Dengue fever accounted for 46.14%of cases and malaria accounted for 45.47% of cases. The patients with imported travel-related infection cases were mainly male (75.88%), Chinese (75.57%), and aged 20–45 years (83.01%). Cases increased from May each year, peaked between August and September, and declined rapidly after October. The main source areas of import were Africa and other countries in Asia. ConclusionsDengue fever and malaria are the main travel-related infection in Guangzhou, and are generally brought in by male Chinese workers. Intervention and health education in this population should be strengthened to prevent and control travel-related infection.

GeoSentinel: past, present and future†.

Rationale for reviewIn response to increased concerns about emerging infectious diseases, GeoSentinel, the Global Surveillance Network of the International Society of Travel Medicine in partnership with the US Centers for Disease Control and Prevention (CDC), was established in 1995 in order to serve as a global provider-based emerging infections sentinel network, conduct surveillance for travel-related infections and communicate and assist global public health responses. This review summarizes the history, past achievements and future directions of the GeoSentinel Network.Key findingsFunded by the US CDC in 1996, GeoSentinel has grown from a group of eight US-based travel and tropical medicine centers to a global network, which currently consists of 68 sites in 28 countries. GeoSentinel has provided important contributions that have enhanced the ability to use destination-specific differences to guide diagnosis and treatment of returning travelers, migrants and refugees. During the last two decades, GeoSentinel has identified a number of sentinel infectious disease events including previously unrecognized outbreaks and occurrence of diseases in locations thought not to harbor certain infectious agents. GeoSentinel has also provided useful insight into illnesses affecting different traveling populations such as migrants, business travelers and students, while characterizing in greater detail the epidemiology of infectious diseases such as typhoid fever, leishmaniasis and Zika virus disease.ConclusionsSurveillance of travel- and migration-related infectious diseases has been the main focus of GeoSentinel for the last 25 years. However, GeoSentinel is now evolving into a network that will conduct both research and surveillance. The large number of participating sites and excellent geographic coverage for identification of both common and illnesses in individuals who have traversed international borders uniquely position GeoSentinel to make important contributions of travel-related infectious diseases in the years to come.

Infectious Disease Acquisition in Pediatric International Travelers: A 10-Year Review at a Canadian Tertiary Care Hospital

Introduction: Children are frequent international travelers and may acquire serious infectious diseases during travel. We undertook a retrospective 10-year review examining children admitted to hospital with infectious diseases associated with international travel at a Canadian tertiary care pediatric hospital. Methods: Retrospective chart review was performed on select travel-related infectious diseases in children ranging in age from birth to <18 years who were admitted at the Hospital for Sick Children in Toronto between January 1st, 2009 and December 31st, 2018. Cases were identified using ICD-10 discharge codes. Patient demographics, travel history, epidemiological data, disease, and prophylaxis history were documented. Results: A total of 154 children were hospitalized with a travel-related infection over a 10-year period. The most common diagnoses were typhoid or paratyphoid fever (n = 58, 38%), malaria (n = 57, 37%), and hepatitis A (n = 14, 8%). The median age of those infected was 8 years (IQR 3-12). There were 120 (78%) children who were Canadian born, 31 (20%) immigrants and 3 (2%) who were visiting Canada. Of those who lived in Canada, 112 (90%) travelled for the purpose of visiting friends and relatives (VFR), 6 (5%) for tourism and 2 (2%) for humanitarian work. India was typically known for the acquisition of infection for typhoid or paratyphoid fever, and Nigeria for malaria. Hepatitis A was most commonly acquired in Pakistan. Conclusion: Imported infectious diseases continue to be a significant issue in travelers returning from trips suggesting improved preventative pre-travel care. VFR children are a group that should, in particular, be targeted for appropriate pre-travel advice and care.

Predicting morbidity in older travellers during a short-term stay in the tropics: the ELDEST study.

BackgroundOlder persons may suffer more from travel-related health problems because of ageing and underlying chronic disorders. Knowledge on who is more likely to have these health problems helps to tailor travel health advice more specifically. This study aimed to determine predictors of travel-related morbidity in older travellers by assessing their pre-travel characteristics and performance using physical and cognitive functioning tests.MethodsMulticentre prospective cohort study among older travellers (≥60 years) who consulted one of the participating Dutch travel clinics. Handgrip strength and cognitive performance were measured pre-travel. Participants completed questionnaires before departure and 1 and 4 weeks after return. A diary recorded health complaints during travel until 2-week post-travel.ResultsIn total, 477 travellers completed the study (follow-up rate of 97%). Participants’ median age was 66 years. The most visited regions were South-East Asia (34%) and South Asia (14%). Median travel duration was 19 days. Polypharmacy (≥5 medications per day) was not uncommon (16%). The median Charlson Comorbidity Index (CCI) score was 0. Self-reported travel-related infectious diseases concerned primarily respiratory tract infections (21%) and gastroenteritis (10%) whereas non-infectious complaints were injuries (13%), peripheral edema (12%) and dehydration (3%). Medical assistance was sought by 18%, mostly post-travel from their general practitioner (87%). Self-reported physical and mental health-related quality of life significantly improved during and after travel. Predictors for an increased risk of travel-related morbidity were higher CCI score, more travel experience, longer travel duration, higher number of daily medications, visiting northern Africa or South-East and East Asia, and phone and social media use.ConclusionOlder Dutch travellers are generally fit, well-prepared and suffer not only from common infectious health problems, but also from injuries. Travel improved their self-perceived health. The predictors could be used to identify the more at-risk older traveller and to decrease travel-related morbidity by optimizing pre-travel advice.

Management of Travel-Related Infectious Diseases in the Emergency Department.

Purpose of ReviewEmergency physicians generally have limited exposure to internationally acquired illnesses. However, travelers can present quite ill, and delays in recognition and treatment can lead to increased morbidity and mortality. This paper aims to summarize typical presentations of common international diseases and provide the emergency physician with a practical approach based on current guidelines.Recent FindingsIn the treatment of traveler’s diarrhea, azithromycin has become the treatment of choice due to the growing antibiotic resistance. Intravenous artesunate was approved in 2019 under investigational new drug protocol for the treatment of severe malaria, and artemisinin-based combination therapies (ACTs) have become the first-line treatment for most cases of uncomplicated malaria. Since the 2015 outbreak, Zika has become a concern to many travelers, but the current treatment is supportive.SummaryClinicians should be aware of a few noteworthy updates in the treatment of internationally acquired illnesses, but more importantly, they must recognize warning signs of severe illness and treat promptly. Future research on workup and disposition could help emergency physicians identify which patients need admission in well-appearing febrile travelers.

Direct Medical Costs of 3 Reportable Travel-Related Infections in Ontario, Canada, 2012-2014.

Immigrants traveling to their birth countries to visit friends or relatives are disproportionately affected by travel-related infections, in part because most preventive travel health services are not publicly funded. To help identify cost-effective policies to reduce this disparity, we measured the medical costs (in 2015 Canadian dollars) of 3 reportable travel-related infectious diseases (hepatitis A, malaria, and enteric fever) that accrued during a 3-year period (2012–2014) in an ethnoculturally diverse region of Canada (Peel, Ontario) by linking reportable disease surveillance and health administrative data. In total, 318 case-patients were included, each matched with 2 controls. Most spending accrued in inpatient settings. Direct healthcare spending totaled $2,058,196; the mean attributable cost per case was $6,098 (95% CI $5,328–$6,868) but varied by disease (range $4,558–$7,852). Costs were greatest for enteric fever. Policies that address financial barriers to preventive health services for high-risk groups should be evaluated.

Using dengue epidemics and local weather in Bali, Indonesia to predict imported dengue in Australia

BackgroundAlthough the association between dengue in Bali, Indonesia, and imported dengue in Australia has been widely asserted, no study has quantified this association so far. MethodsMonthly data on dengue and climatic factors over the past decade for Bali and Jakarta as well as monthly data on imported dengue in Australia underwent a three-stage analysis. Stage I: a quasi-Poisson regression with distributed lag non-linear model was used to assess the associations of climatic factors with dengue in Bali. Stage II: a generalized additive model was used to quantify the association of dengue in Bali with imported dengue in Australia with and without including the number of travelers in log scale as an offset. Stage III: the associations of mean temperature and rainfall (two climatic factors identified in stage I) in Bali with imported dengue in Australia were examined using stage I approach. ResultsThe number of dengue cases in Bali increased with increasing mean temperature, and, up to a certain level, it also increased with increasing rainfall but dropped off for high levels of rainfall. Above a monthly incidence of 1.05 cases per 100,000, dengue in Bali was almost linearly associated with imported dengue in Australia at a lag of one month. Mean temperature (relative risk (RR) per 0.5 °C increase: 2.95, 95% confidence interval (CI): 1.87, 4.66) and rainfall (RR per 7.5 mm increase: 3.42, 95% CI: 1.07, 10.92) in Bali were significantly associated with imported dengue in Australia at a lag of four months. ConclusionsThis study suggests that climatic factors (i.e., mean temperature and rainfall) known to be conducive of dengue transmission in Bali can provide an early warning with 4-month lead time for Australia in order to mitigate future outbreaks of local dengue in Australia. This study also provides a template and framework for future surveillance of travel-related infectious diseases globally.

Factor Analysis of a Novel Scoring-Based Instrument on Forecasting Malaysian Travelers’ Behavioral Preparedness for Travel-Related Infectious Diseases

Introduction: Preparedness for the prevention of travel-related infectious diseases among Malaysian international travelers has yet to be explored. With no such data, health programs to empower travelers on behavioral responses towards travel-related illnesses will be ineffective. The current study aimed to develop and validate a new scoring-based instrument measuring Malaysian international travelers’ preparedness in terms of their risk perception (RP), attitude, and practices (RisPAK-Q) towards travel-related infectious diseases using factor analysis. Methods: The newly developed instrument was tested among 200 Malaysian international travelers based on the systematic random sampling method. The number of domains, model-fit index, construct validity, and internal consistency for this instrument were determined using exploratory and confirmatory factor analysis (CFA). Results: Twenty-two out of 34 questions were retained, and the following 5 domains were extracted: RP, pre-travel attitude (PTA), during-travel attitude (DTA), general traveling practice, and food practice (FP). All 22 questions had factor loadings of above 0.6. All 5 domains achieved a stable model fit index with good convergent and discriminant construct validity of above 0.5 indicated by the average variance extracted (AVE) with all of the maximum shared variance (MSV) values below their corresponding AVEs. All domains also had high internal consistency with a composite reliability (CR) of above 0.7. Conclusion: The RisPAK-Q containing 22 questions in 5 domains is a valid and reliable instrument for measuring the preparedness of Malaysian travelers for travel-related infectious diseases and can be used in a subsequent larger study.

Tour leaders with detailed knowledge of travel-related diseases play a key role in disease prevention.

In Taiwan, group tours are a popular mode of international travel; hence, group tour leaders must ensure traveler safety and health. This study identified factors influencing tour leaders’ willingness to recommend pretravel medical consultation and vaccination.A cross-sectional questionnaire survey was administered to tour leaders from January 2011 to December 2012. Multivariate logistic regression analyses were performed to estimate the odds ratios of having a positive attitude and willingness based on different knowledge scores of the tour leaders after adjustments for age, sex, education level, and seniority.Tour leaders with a more detailed knowledge of both travel-related infectious and noninfectious diseases demonstrated a higher willingness to receive vaccination. They believed that consultation at travel clinics before travel can improve travelers’ health (P < .05).This study supports the importance and effectiveness on educating tour leaders’ knowledge about travel-related diseases to improve health care for travelers.

Importation of travel-related infectious diseases is increasing in South Korea: An analysis of salmonellosis, shigellosis, malaria, and dengue surveillance data.

BackgroundInternational travel has an important role in transmission of emerging infectious diseases. We described the imported infectious diseases in Korea from 2003 to 2012, and to analyze association of travels with the change in the incidences.MethodsWe used National Notifiable Disease Surveillance System to investigate the incidence of salmonellosis, shigellosis, malaria, and dengue. Data from Korea Tourism Organization was used to describe the inbound and outbound travelers by their age group, gender, and purpose of travel. We assessed association between international travel and the incidence of the infectious diseases, and seasonal variability.ResultsAmong 1849 imported cases, dengue comprised the largest number with 631 cases. The proportion of imported cases among total cases gradually increased from 4.1% in 2003 to 30.3% in 2012 (P < 0.001). There was a positive correlation between the number of travelers and the number of imported cases of shigellosis, dengue (P < 0.001), but not for malaria. Seasonal variability was observed for importation of salmonellosis, shigellosis and dengue fever (P = 0.005).ConclusionInternational travel was associated with the incidence of imported infectious diseases in Korea. Pre-travel consultation for international travelers planned to visit endemic area should be recommended strongly.

Practices and Attitudes to Prevention of Travel-related Infectious Diseases in United Arab Emirates

Introduction: Among the United Arab Emirates (UAE) population more and more people now consider travelling abroad. This is potentially problematic because travelling enhances exposure between hosts and pathogens and so people that travel are putting their health at risk. This concern makes it necessary that public education is provided to inform people of the risks of travelling abroad so that such risks can be minimized. Guidelines and advice on travelling abroad are available and easily accessible but several studies have shown that travellers do not always follow such advice. In this study, the aim was to look into the practices and attitudes of UAE residents in relation to prevention of travel-related infectious diseases. Methods: A cross-sectional study was conducted from February to April 2015, in different emirates of the UAE. A self-administered anonymous questionnaire was developed based on material acquired from similar studies. The methodology applied quota sampling whereby adults above the age of 18 who’d travelled abroad in the past year were chosen from the seven emirates. The number of participants selected from each emirate was proportionate to the population size of each state. Results: A total of 385 questionnaires were completed. A remarkable 70% of respondents indicated that they had not taken on any precautionary measures prior to travel. Of greater interest was that only 21% of participants had taken advice on health prior to travel, while the outstanding majority 79% reported that they had not taken advice. The most common source of advice had been taken from family and friends among those who had taken advice at 41%, while only 15.4% had acquired it from specialized travel medicine clinics. High risk perception, spending more preparation time and travelling for longer durations were important factors that encouraged pretrial health consultation and undertook preventive measures. Conclusion: This study revealed that UAE residents had not taken adequate measures to prevent travel related infectious diseases. Despite the limitations of this study, it still provides sufficient data to improve public health intervention directed at encouraging travellers to acquire pre travel health consultation.

A “Syndromic” Approach for Diagnosing and Managing Travel-Related Infectious Diseases in Children

ri P mary care physicians practicing in the United States are often less familiar with many of the common as well as more exotic diseases that children can acquire when traveling abroad. This review will focus mainly on infectious diseases specifically associated with travel-related exposures. While having access to reference material to help guide diagnostic resources and therapy is useful, it is most useful to have a consistent well-organized approach to help identify specific risk factors associated with both the most common and the most severe illnesses potentially occurring in a child who has recently traveled internationally. According to the National Travel and Tourism Office the number of Americans traveling abroad increased to more than 61.9 million in 2013. The main areas of travel included Europe at 34.6%, the Caribbean at 24.8%, Asia at 18.8%, South America at 7.3%, Central America at 6.9%, Africa at 3.1%, the Middle East at 5.9%, and Oceania at 1.9%. Nearly 27% of travel was to visit friends and families. This category accounts for a significant portion of the travel in the pediatric age groups. Although travel to Asia and Africa accounted for only 21.9% of US traveler the majority of travelrelated illnesses were acquired from Asia (32.6%) and sub-Saharan Africa (26.7%) according to a recent geosentinel-illness surveillance of returned international travelers presenting to the GeoSentinel Network. As

Tour Leaders’ Knowledge of and Attitudes toward Rabies Vaccination, Taiwan

Tour Leaders’ Knowledge of and Attitudes toward Rabies Vaccination, Taiwan

Travel to Tropical Countries: A Review of Travel-Related Infectious Diseases

Travel to Tropical Countries: A Review of Travel-Related Infectious Diseases

Travel risk behaviours and uptake of pre-travel health preventions by university students in Australia

BackgroundForward planning and preventative measures before travelling can significantly reduce the risk of many vaccine preventable travel-related infectious diseases. Higher education students may be at an increased risk of importing infectious disease as many undertake multiple visits to regions with higher infectious disease endemicity. Little is known about the health behaviours of domestic or international university students, particularly students from low resource countries who travel to high-resource countries for education. This study aimed to assess travel-associated health risks and preventative behaviours in a sample of both domestic and international university students in Australia.MethodsIn 2010, a 28 item self-administered online survey was distributed to students enrolled at the University of New South Wales, Sydney, Australia. Multiple methods of distributing links to the online survey were utilised. The survey examined the international travel history, travel intentions, infection control behaviours and self-reported vaccination history.ResultsA total of 1663 respondents completed the online survey, 22.1% were international students and 83.9% were enrolled at an undergraduate level. Half had travelled internationally in the previous 12 months, with 69% of those travelling only once during that time with no difference in travel from Australia between domestic and international students (p = 0.8). Uptake of pre-travel health advice was low overall with 68% of respondents reporting they had not sought any advice from a health professional prior to their last international trip. Domestic students were more likely to report uptake of a range of preventative travel health measures compared to international students, including diarrhoeal medication, insect repellent, food avoidance and condoms (P < 0.0001). Overall, students reported low risk perception of travel threats and a low corresponding concern for these threats.ConclusionsOur study highlights the need to educate students about the risk associated with travel and improve preventative health-seeking and uptake of precautionary health measures in this highly mobile young adult population. Although immunisation is not an entry requirement to study at Universities in Australia, large tertiary institutions provide an opportunity to engage with young adults on the importance of travel health and provision of vaccines required for travel, including missed childhood vaccines.

Mosquito‐Borne Illnesses in Travelers: A Review of Risk and Prevention

In 2008, residents of the United States made 12 million visits to developing countries in Asia, South America, Central America, Oceania, the Middle East, and Africa. Due to the presence of Anopheles, Aedes, and Culex mosquitoes, travel to these destinations poses a risk for diseases such as malaria, yellow fever, and Japanese encephalitis that cause significant morbidity and mortality. To gain a better understanding of the major emerging and established travel-related infectious diseases transmitted principally by mosquitoes and the measures for their prevention in U.S. residents who travel to these developing countries, we performed a literature search of the PubMed and MEDLINE databases (January 1950-February 2010). Information from the Centers for Disease Control and Prevention and the World Health Organization and relevant references from the publications identified were also reviewed. Vaccines for the prevention of Japanese encephalitis and yellow fever are commercially available to U.S. travelers and should be administered when indicated. However, the prevention of malaria, dengue fever, chikungunya, and West Nile virus relies on personal insect protection measures and chemoprophylaxis for malaria. As the rate of international travel continues to rise, individuals traveling overseas should be made aware of the risk of various infectious diseases and the importance of prevention. Physicians, pharmacists, nurses, and other practitioners can play a vital role in disease education and prevention, including the administration of vaccines and provision of chemoprophylactic drugs.

Multicenter EuroTravNet/GeoSentinel Study of Travel-related Infectious Diseases in Europe

We analyzed prospective data on 17,228 European patients who sought treatment at GeoSentinel sites from 1997 to 2007. Gastrointestinal illness (particularly in tourists), fever (those visiting friends and relatives [VFRs]), and skin disorders (in tourists) were the most common reasons for seeking medical care. Diagnoses varied by country of origin, region visited, or categories of travelers. VFRs who returned from sub-Saharan Africa and Indian Ocean islands were more likely to experience falciparum malaria than any other group. Multiple correspondence analysis identified Italian, French, and Swiss VFRs and expatriate travelers to sub-Saharan Africa and Indian Ocean Islands as most likely to exhibit febrile illnesses. German tourists to Southeast and south-central Asia were most likely to seek treatment for acute diarrhea. Non-European travelers (12,663 patients from other industrialized countries) were less likely to acquire certain travel-associated infectious diseases. These results should be considered in the practice of travel medicine and development of health recommendations for European travelers.