Travelers Returning Research Articles

Iquitos Virus in Traveler Returning to the United States from Ecuador.

We describe the case of a returned traveler to the United States from Ecuador who had an acute febrile illness, initially diagnosed as Oropouche fever. This illness was later confirmed to be a rare infection with Iquitos virus, a related bunyavirus that shares 2 of 3 genome segments with Oropouche virus.

Replication-Competent Oropouche Virus in Semen of Traveler Returning to Italy from Cuba, 2024.

A febrile man in Italy who had traveled to Cuba in July 2024 was diagnosed with Oropouche fever. Reverse transcription PCR detected prolonged shedding of Oropouche virus RNA in whole blood, serum, urine, and semen. Sixteen days after symptom onset, replication-competent virus was detected in semen, suggesting risk for sexual transmission.

Assessment of a Commercial Real-Time PCR Assay (Vitassay qPCR Malaria 5 Test) to Detect Human Malaria Infection in Travelers Returning to France.

Malaria is the most common human parasitic disease in the world with the highest morbidity and mortality. Due to the severity of malaria caused by Plasmodium falciparum and the urgency of therapeutic management, quick and reliable diagnosis is required for early detection. Blood smear microscopy remains the gold standard for malaria diagnosis. Molecular diagnosis techniques are the most sensitive and specific in cases of low parasitaemia and in the detection of mixed infections. The purpose of this study was to evaluate a new commercial test involving the molecular diagnostic technique to detect the five human Plasmodium species. The Vitassay qPCR Malaria 5 test is based on the multiplex real-time PCR of a conserved target region of the 18S rRNA gene for the five human Plasmodium species. A total of 190 samples collected from imported cases of malaria were diagnosed using this test and compared against a homemade reference real-time PCR. The sensitivities of the Vitassay qPCR Malaria 5 test for all Plasmodium species ranged from 93.8% to 100% and specificity ranged from 97.7% to 100%. Based on these criteria, this test is recommended for the diagnosis of the human Plasmodium species.

Photo Quiz: Fever in a Traveler Returning from West Malaysia.

Photo Quiz: Fever in a Traveler Returning from West Malaysia.

Fourteen mcr-1-Positive Salmonella enterica Isolates Recovered from Travelers Returning to the United States from the Dominican Republic.

ABSTRACTIn the United States, reports of Salmonella enterica carrying mcr-1 remain rare in humans, but when observed, the infection is often associated with travel. Here, we report 14 mcr-1-positive Salmonella enterica isolates from patients in the United States that reported travel to the Dominican Republic within the 12 months before illness.

Monkeypox in a Traveler Returning from Nigeria - Dallas, Texas, July 2021.

Monkeypox is a rare, sometimes life-threatening zoonotic infection that occurs in west and central Africa. It is caused by Monkeypox virus, an orthopoxvirus similar to Variola virus (the causative agent of smallpox) and Vaccinia virus (the live virus component of orthopoxvirus vaccines) and can spread to humans. After 39 years without detection of human disease in Nigeria, an outbreak involving 118 confirmed cases was identified during 2017-2018 (1); sporadic cases continue to occur. During September 2018-May 2021, six unrelated persons traveling from Nigeria received diagnoses of monkeypox in non-African countries: four in the United Kingdom and one each in Israel and Singapore. In July 2021, a man who traveled from Lagos, Nigeria, to Dallas, Texas, became the seventh traveler to a non-African country with diagnosed monkeypox. Among 194 monitored contacts, 144 (74%) were flight contacts. The patient received tecovirimat, an antiviral for treatment of orthopoxvirus infections, and his home required large-scale decontamination. Whole genome sequencing showed that the virus was consistent with a strain of Monkeypox virus known to circulate in Nigeria, but the specific source of the patient's infection was not identified. No epidemiologically linked cases were reported in Nigeria; no contact received postexposure prophylaxis (PEP) with the orthopoxvirus vaccine ACAM2000.

Do national cultures matter for tourism development? Some international evidence

This research examines whether a destination’s national culture has a substantial effect on tourism development. It focuses on six national culture proportions of Hofstede (2010). To account for probable asymmetric and non-linear associations among factors, the study tests a quantile regression by utilizing panel data from 101 nations and finds that most national cultures are non-linearly and statistically significant in explaining diverse quantiles of international traveler arrivals and international tourism receipts, whereas they do not do so for travel and leisure industry returns. We show that masculinity and indulgence negatively affect traveler arrivals, while power distance positively affects traveler arrivals.

The Clinical and Economic Impact of Measles-Mumps-Rubella Vaccinations to Prevent Measles Importations From US Pediatric Travelers Returning From Abroad.

BackgroundPediatric international travelers account for nearly half of measles importations in the United States. Over one third of pediatric international travelers depart the United States without the recommended measles-mumps-rubella (MMR) vaccinations: 2 doses for travelers ≥12 months and 1 dose for travelers 6 to <12 months.MethodsWe developed a model to compare 2 strategies among a simulated cohort of international travelers (6 months to <6 years): (1) No pretravel health encounter (PHE): travelers depart with baseline MMR vaccination status; (2) PHE: MMR-eligible travelers are offered vaccination. All pediatric travelers experience a destination-specific risk of measles exposure (mean, 30 exposures/million travelers). If exposed to measles, travelers’ age and MMR vaccination status determine the risk of infection (range, 3%-90%). We included costs of medical care, contact tracing, and lost wages from the societal perspective. We varied inputs in sensitivity analyses. Model outcomes included projected measles cases, costs, and incremental cost-effectiveness ratios ($/quality-adjusted life year [QALY], cost-effectiveness threshold ≤$100 000/QALY).ResultsCompared with no PHE, PHE would avert 57 measles cases at $9.2 million/QALY among infant travelers and 7 measles cases at $15.0 million/QALY among preschool-aged travelers. Clinical benefits of PHE would be greatest for infants but cost-effective only for travelers to destinations with higher risk for measles exposure (ie, ≥160 exposures/million travelers) or if more US-acquired cases resulted from an infected traveler, such as in communities with limited MMR coverage.ConclusionsPretravel MMR vaccination provides the greatest clinical benefit for infant travelers and can be cost-effective before travel to destinations with high risk for measles exposure or from communities with low MMR vaccination coverage.

The impact of matches and travel on rugby players' sleep, wellness and training.

Matches and travel, which are common in professional team sports, may have a negative impact on players. The aim of this study was to quantify the impact on sleep, wellness and training of Super Rugby players. Sleep of 122 players from four teams was monitored using activity monitors for up to three nights before and after matches played at home and overseas. Wellness and internal training load (questionnaires) and external training load (GPS/accelerometer) were also recorded. Separate analyses were performed for each team using a general linear mixed model to estimate the mean effects of travel (translocation overseas and return to the home country) on sleep, wellness and training. The mean effects of matches on sleep and wellness on the nights before, of and after matches. were also estimated. Teams generally experienced small to large reductions in sleep and wellness when overseas; on return, sleep and wellness recovered somewhat. The impact of matches on sleep and wellness differed in magnitude and direction (large reductions to small increases) between teams. External load overseas and upon return was reduced for three of the four teams, whilst internal load was reduced for the three teams that measured it. The changes in sleep, wellness and training can be explained by a combination of travel- and match-related stressors that differed between teams. Teams should consider remediation strategies to mitigate the effects of travel.

The impacts of ICTs on tourism development: International evidence based on a panel quantile approach

Information and communication technologies (ICTs) have transformed the travel and leisure sector worldwide, yet until now there are no studies presenting international evidence of the different impacts of ICTs (i.e., Internet usage, secure Internet servers, mobile cellular subscriptions, high-technology export, communications as well as computer, and fixed broadband subscriptions) on tourism development (i.e., international traveler arrivals, increased international tourism receipts, and travel and leisure sector returns) by considering countries with different tourism development processes (e.g., high or low tourism development quantile). It is possible that ICTs have diverse or non-linear impacts on countries undergoing varying tourism development processes. Using international data based on a new panel quantile approach, this research thus aims to explore whether ICTs affect tourism development and looks into the possible asymmetric and non-linear relationships among the many variables. Results show that increasing mobile cellular subscriptions, secure Internet servers, and fixed broadband subscriptions have greater positive effects on traveler arrivals. ICTs also asymmetrically and non-linearly influence tourism across different quantiles. Non-global financial sub-periods and developing nations gain benefits from ICTs’ establishment. Lastly, there are geographic differences in the ICTs-tourism nexus.

Oil prices, policy uncertainty and travel and leisure stocks in China

By utilizing the time-varying parameter vector autoregressive (TVP-VAR) model, we investigate the time-varying effects of oil price shocks and policy uncertainty on travel and leisure stocks from January 2000 to December 2018 in China. The results suggest that the impacts of oil price shocks on travel and leisure stock returns are mainly positive, which support the market inertia theory. However, the effects of policy uncertainty on travel and leisure stock returns fluctuate between positive and negative. Furthermore, the impacts of oil price shocks and policy uncertainty vary significantly across different sub-industries. For classified travel and leisure stocks, oil price shocks and policy uncertainty both have the greatest influences on scenic spot stock returns. Among classified policy uncertainty, the influences of trade policy uncertainty on travel and leisure stocks are the most significant. • • The impacts of oil price shocks on travel and leisure stock returns are mainly positive. • • The effects of policy uncertainty on travel and leisure stock returns vary between positive and negative. • • The impacts of oil price shocks and policy uncertainty vary significantly across different sub-industries. • • Oil price shocks and policy uncertainty both have the greatest influences on scenic spot stock returns. • • The influences of trade policy uncertainty on travel and leisure stocks are the most significant.

Supersonic Travel Returns: Boom's XB-1 test aircraft may usher in faster-than-sound commercial flight

The Concorde, the world's first supersonic airliner, landed for the last time 17 years ago. It was a beautiful feat of engineering, but it never turned a profit. So why should we believe that Boom Supersonic can do better now?

Outbreak of Cyclosporiasis in Korean Travelers Returning from Nepal.

Cyclospora cayetanensis is an apicomplexan protozoan and is one of the most common pathogens causing chronic diarrhea worldwide. Eight stool samples with diarrheal symptom out of 18 Korean residents who traveled to Nepal were obtained, and examined for 25 enteropathogens including 16 bacterial species, 5 viral species, and 4 protozoans in stool samples as causative agents of water-borne and food-borne disease. Only C. cayetanensis was detected by nested PCR, and 3 PCR-positive samples were sequenced to confirm species identification. However, the oocysts of C. cayetanensis in fecal samples could not be detected by direct microscopy of the stained sample. As far as we know, this is the first report of a group infection with C. cayetanensis from a traveler visiting Nepal, and the second report of a traveler’s diarrhea by C. cayetanensis imported in Korea.

Do Country Risks Matter for Tourism Development? International Evidence

This research fills the gap in the tourism literature on the impacts of country stability—including political, financial, and economic—on tourism development (i.e., international tourist arrivals, international tourism revenues, and travel and leisure sector returns). To account for possible asymmetric and nonlinear relationships among variables, we apply a new method of moment quantile regression, by using panel data from 106 countries spanning the period 2006–2017. From a global perspective, the empirical results indicate that higher country stability generally leads to higher tourism development, while there is no salient influence of financial stability on travel and leisure sector returns. This suggests that the effects of country risk ratings are mostly nonlinear across different tourism development quantiles. Additionally, different components of risk rating scores have diverse impacts on tourism development. The findings mean that policy makers should consider their tourism condition when setting country stability strategies.

Impact of economic sentiment and economic policy uncertainty on travel and leisure stock return

PurposeThis paper considers the role of economic sentiment and economic policy uncertainty (both domestic and European) in explaining the changes in the contemporaneous and future travel and leisure stock index returns in top European Union (EU) tourism destinations, namely, in France, Germany, Spain and the UK.Design/methodology/approachThe authors conducted the ordinary least square (OLS) regression estimations to investigate the impact of changes in economic sentiment and economic policy uncertainty on travel and leisure stock returns. Furthermore, the authors used predictive regressions to determine whether economic sentiment and economic policy uncertainty are useful predictors over the short- or medium-term for travel and leisure stock returns.FindingsEmpirical results revealed that, in France and Spain, the changes in regional economic sentiments predominantly and positively affected travel and leisure stock index returns. Also, results indicated that changes in European economic sentiment have a strong positive effect on the future travel and leisure stock returns in Spain and the UK over the short run, while in France, changes in European economic policy uncertainty have a weak negative effect on the future travel and leisure stock returns over the medium-term.Research limitations/implicationsThis paper provides valuable practical implications for investors who trade travel and leisure stocks. Traders can use economic sentiment and economic policy uncertainty to establish arbitrageur strategies.Originality/valueThis study is the first to examine the effects of economic sentiment and economic policy uncertainty (both domestic and European) on contemporaneous and future travel and leisure stock returns in a top European tourism destination.

Tourism development and happiness: International evidence

The existing tourism- and happiness-related literature commonly investigates whether a happy destination does in fact render tourists happy and how tourist arrivals affect residents’ happiness. This research thus first explores whether the host country and Twitter happiness indices influence tourism development in an international framework (i.e. tourist arrivals, tourism revenues, and travel and leisure sector returns). To account for intricate correlations among variables, the study employs a quantile regression approach on panel data from 119 countries spanning 2006–2017. Evidences find that most host country happiness indices and macroeconomic factors show salient, nonlinear, and asymmetric impacts across both tourist arrival and tourism revenue quantiles in concurrent and subsequent periods, except for European country results. Moreover, Twitter happiness index strongly affects travel and leisure sector returns, but has no impact on tourist arrivals as well as tourism revenues, implying the importance of social media happiness on said returns.

2769. The Clinical and Economic Impact of MMR Vaccinations to Prevent Measles Importations from US Pediatric Travelers Returning from Abroad

BackgroundAlthough pediatric travelers comprise < 10% of US international travelers, they account for almost half of all measles importations among returning travelers. For travelers 1–18 years with no other evidence of measles immunity, the Advisory Committee on Immunization Practices (ACIP) recommends 2 MMR vaccine doses before departure; 1 dose is recommended for infant travelers (6 to <12 months) and does not count toward their primary immunization series. All US travelers (6 months to < 6 years) are at risk for being undervaccinated for measles because MMR is routinely given at 1 years and 4–6 years.MethodsWe developed a decision tree model to evaluate the clinical impact and cost per case averted of pretravel health encounters (PHE) that vaccinate MMR-eligible pediatric international travelers. We compared 2 strategies for infant (6 to < 12 months) and preschool-aged (1 to <6 years) travelers: (1) no PHE: travelers departed with baseline MMR vaccination status vs. (2) PHE: MMR-eligible travelers were offered vaccination. All simulated travelers experienced a destination-specific risk of measles exposure during travel (mean, 237exposures/10M travelers; range, 19–6,750 exposures/10M travelers); if exposed to measles, travelers were at risk of illness stratified by age and MMR vaccination status (range, 0.03–0.90). Costs include direct medical costs and lost work wages for guardians. Model outcomes included measles cases, costs, and cost per case averted. We varied inputs in sensitivity analyses.ResultsCompared with no PHE, PHE averted 451 measles cases at $985,000/case averted for infant travelers and 54 measles cases at $1.5 million/case averted for preschool-aged travelers (table, bottom). PHE can be cost-saving for travelers to regions with higher risk of measles exposure and if more MMR-eligible travelers are vaccinated at PHE (Figure 1). At a risk of exposure associated with European travel, PHE had better value when a measles importation led to a higher number of contacts or more US-acquired cases per importation (Figure 2).Conclusion PHE for pediatric travelers (6 months to <6 years) decreased the number of imported measles cases and saved costs, especially if targeted to travelers with higher-risk destinations, if more MMR-eligible travelers are vaccinated at PHE, or if outbreaks are larger. Disclosures All authors: No reported disclosures.

Alterations of Functional Brain Connectivity After Long-Duration Spaceflight as Revealed by fMRI.

The present study reports alterations of task-based functional brain connectivity in a group of 11 cosmonauts after a long-duration spaceflight, compared to a healthy control group not involved in the space program. To elicit the postural and locomotor sensorimotor mechanisms that are usually most significantly impaired when space travelers return to Earth, a plantar stimulation paradigm was used in a block design fMRI study. The motor control system activated by the plantar stimulation involved the pre-central and post-central gyri, SMA, SII/operculum, and, to a lesser degree, the insular cortex and cerebellum. While no post-flight alterations were observed in terms of activation, the network-based statistics approach revealed task-specific functional connectivity modifications within a broader set of regions involving the activation sites along with other parts of the sensorimotor neural network and the visual, proprioceptive, and vestibular systems. The most notable findings included a post-flight increase in the stimulation-specific connectivity of the right posterior supramarginal gyrus with the rest of the brain; a strengthening of connections between the left and right insulae; decreased connectivity of the vestibular nuclei, right inferior parietal cortex (BA40) and cerebellum with areas associated with motor, visual, vestibular, and proprioception functions; and decreased coupling of the cerebellum with the visual cortex and the right inferior parietal cortex. The severity of space motion sickness symptoms was found to correlate with a post- to pre-flight difference in connectivity between the right supramarginal gyrus and the left anterior insula. Due to the complex nature and rapid dynamics of adaptation to gravity alterations, the post-flight findings might be attributed to both the long-term microgravity exposure and to the readaptation to Earth’s gravity that took place between the landing and post-flight MRI session. Nevertheless, the results have implications for the multisensory reweighting and gravitational motor system theories, generating hypotheses to be tested in future research.

Dengue Virus in Traveler Returning to Japan from the Democratic Republic of the Congo, 2015.

Dengue fever (DF) is a mosquito-borne disease and a significant global public health problem. Although a few serological surveys in the literature suggest endemic DF in many parts of Africa, DF cases in these countries are generally underreported because of the lack of diagnostic testing and systematic surveillance; thus, little is known about the phylogenetic profile of circulating strains. In April 2015, DF was diagnosed in a Japanese national returning from the Democratic Republic of the Congo (DRC). Dengue virus 1 (DENV-1) RNA was detected in the patient's serum sample using real-time reverse transcription PCR. Phylogenetic analysis of the E gene revealed that the detected DENV-1 strain was classified as genotype V and was closely related, with 100% nucleotide identity, to the strain causing the 2013 DF epidemic in Angola, which is located directly south of the DRC. This is the first report to characterize the circulating DENV strain in the DRC, and the findings indicate that the DENV-1 strain causing the 2013 DF epidemic in Angola was also circulating in the DRC in 2015.

Clinical Features and Laboratory Findings of Travelers Returning to South Australia with Dengue Virus Infection.

Reported cases of dengue are rising in South Australia (SA) in travellers returning from dengue-endemic regions. We have undertaken a retrospective analysis to identify the clinical and laboratory characteristics of patients returning to SA with suspected dengue virus (DENV) infection. From 488 requests, 49 (10%) were defined by serology as acute dengue, with the majority of patients (75%) testing as non-structural protein 1 (NS1) and/or IgM positive. Dengue was most commonly acquired in Indonesia (42.9%) with clinical features of fever (95%), headache (41%) and myalgia/arthralgia (56%). The presence of rash (36%) and laboratory findings of neutropenia, leukopenia, thrombocytopenia, but not elevated C-reactive protein, were distinct from findings in DENV-seronegative patients. Available dengue seropositive samples were analysed by RT-PCR, with 14/32 (43.8%) positive by a serotype non-specific DENV assay, but 28/32 positive (87.5%) when also assessed by serotype-specific RT-PCR. Serotype analysis revealed the predominance of DENV-1 and DENV-2 and the presence of DENV-3, but not DENV-4 or Zika virus (ZIKV). Thus, dengue in returned travellers in SA presents in a manner consistent with World Health Organization (WHO) definitions, with symptoms, travel history and laboratory results useful in prioritising the likelihood of dengue. This definition will assist the future management in DENV-non-endemic regions, such as SA.