Tropical Destinations Research Articles

Portrayed and perceived online destination personality of select island destinations

This study intends to delineate the match or mismatch between portrayed and perceived online destination personality of select tropical island destinations such as Barbados, Fiji, Seychelles, Hawaii and Mauritius considering their destination marketing organization (DMO) websites as a stimuli. A computer-aided content analysis using WordStat software was employed to uncover the portrayed destination personality dimensions, while the perceived personality dimensions were measured with the help of an online survey using Aaker's [Aaker, J. L. (1997). Dimensions of brand personality. Journal of Marketing Research, 34, 347–356] brand personality scale. This study demonstrates an online approach to assess a destination's brand personality dimensions. It offers insights to DMOs on the transfer of destination personality online through their websites. It also offers the means and measures to assess the association between the portrayed and perceived destination personality.

Corynebacterium diphtheriae and the Returned Tropical Traveler

In Western countries, nontoxigenic Corynebacterium diphtheriae is known to cause skin and soft tissue infections (SSIs), upper respiratory tract infections, and occasionally invasive disease. Its role as a skin pathogen in returned travelers from tropical destinations where the organism is endemic is often forgotten. A retrospective analysis of a large Australian private pathology laboratory's experience with C. diphtheriae was performed to identify how frequently overseas travel was associated with C. diptheriae infection/colonization. All C. diphtheriae isolates cultured from 2002 to 2012 were reviewed. Recorded clinical information regarding recent travel, country, and cause of infection was assessed. Antibiotic susceptibility was verified on all isolates. In all there were 72 patients who had C. diphtheriae isolated on clinical specimens, and information about prior travel was available for 63. Seventy percent of these were healthy individuals with an SSI and history of recent travel to a tropical nation. Ninety-seven percent had associated copathogens. Two isolates were penicillin resistant. There was uniform susceptibility to cephalothin, clindamycin, erythromycin, and vancomycin, with 14% resistance to trimethoprim/sulfamethoxazole and 4% resistance to tetracycline. Only one isolate was a toxigenic strain. The majority of C. diphtheriae isolated were from SSIs in otherwise healthy travelers returning from tropical destinations, rather than classical risk groups. Clinicians and laboratories need to be aware of this potential source of C. diphtheriae infection due to rare toxigenic strains.

A young traveller presenting with typhoid fever after oral vaccination: a case report

IntroductionTyphoid fever is one of the most common vaccine-preventable diseases in travellers returning from tropical destinations. However, immunity and the immune response to infection are barely understood.Case presentationWe report a case of tyhoid fever in a 29-year-old Caucasian, previously healthy woman who did not develop protective immunity or seroconversion of H or O antibodies neither after vaccination with the oral Ty21 vaccine, nor after infection with Salmonella typhi.ConclusionsThis case highlights the insufficiencies of the current vaccination and the lack of a reliable, rapid serologic diagnostic tool for typhoid fever. With this case report, we aim to sensitize the reader that typhoid fever has to be taken into account as a differential diagnosis in patients even after vaccination and with negative serological test results.

Seroepidemiology of dengue in travellers: A paired sera analysis

Dengue is a frequent cause of fever in travellers. The true extent is unknown as many infections are asymptomatic or undiagnosed. We used paired sera, with pre- and post-travel specimens from Swiss travellers to tropical destinations, to evaluate the seroepidemiology of travel-related dengue. Post-travel specimens were tested for the presence of IgG and IgM antibodies to dengue antigen serotypes (1, 2, 3 and 4) using an indirect enzyme-linked immunosorbent assay (ELISA). All post-travel sera that screened as positive for dengue IgG or IgM antibodies were re-tested with the corresponding pre-travel sera as paired assays in order to detect seroconversion. There were 285 travellers with specimens available for analysis. Two hundred and fifty seven of the 285 individuals (90.2%) had negative dengue serology post-travel. Of the remaining 28 cases, 25 were dengue IgG positive and 3 had equivocal results. This corresponds to IgG seropositivity in 8.9%. Eighteen of these 25 individuals had a pre-travel specimen available for testing, of which 15 were positive for IgG consistent with possible past exposure. Three of the 18 had negative serology pre-travel, indicating possible recent infection. This corresponds to an attack rate of possible dengue of 1.1% and an incidence rate of 6.7 per 1000 person-months (95% CI 0-60.0). Two of these three individuals had received yellow fever vaccine for their trip, raising the potential of cross-reactivity. The confirmed dengue attack rate therefore was 0.23% with a corresponding incidence rate of 2.2 per 1000 person-months (95% CI-0-33.1). Seroepidemiology provides additional evidence of an appreciable risk of acute dengue infection among travellers to tropical destinations.

New Perspectives on Tropical Coastal and Island Tourism Development

This special issue is presented as a thematic issue devoted to tropical coastal and island tourism. Included in the issue are articles on (eco)tourism in Madagascar, collaboration theory and tourism partnership models on an Indonesian island, development pressure and resilience on a Malaysian island, a survey of cruise passengers in Colombia, perception and limits to development in Costa Rica, and perception and reality on Pitcairn Island. Placed within theoretical or conceptual frameworks, these case studies can be applied to development challenges of tropical coastal and island destinations worldwide.

The tropics and the crime they did not commit

Travellers to tropical destinations who seek medical attention after returning to their home country often present with fever, frequently as a result of an imported infectious disease. For this reason, clinicians initially focus on an infectious cause when a clear relationship in time exists between travel and disease onset. We present a case of a patient, who developed fever 2 weeks after his return from Ghana and who was finally diagnosed with an auto-immune disease: arteritis of the large arteries. This case illustrates that broad differential diagnostic thinking is paramount in the assessment of returned travellers.

Profile of Travel‐Associated Illness in Children, Zürich, Switzerland

The number of families traveling with their children to their country of origin and/or to tropical destinations has increased in Switzerland and includes a changing profile and multinational range of patients. Defining the profile of reported travel-associated illnesses will help to improve the prevention and treatment of such illnesses in children. This study includes children aged up to 16 years who sought medical advice for a presumed travel-related illness at the emergency room of the University of Zürich Children's Hospital during the period July 2007 to December 2008. We analyzed data on 328 children (58.8% male, mean age: 4.62 y) who presented with travel-associated illness. Our analysis included 155 traditional (mainly tourist) travelers, 162 children who were visiting friends and relatives (VFR), and 11 immigrants. Some 11% were hospitalized. No deaths occurred. The main conditions recorded were diarrheal illness (39%), respiratory (28.7%) and febrile/systemic illness (13.4%). With increasing age, the proportion of children with diarrheal disease increased, while the proportion with respiratory illness declined. There were significant associations between geographic area of exposure and the profile of travel-related disease (p < 0.001). Among 36 children with more serious diseases requiring hospitalization, 12 (3.7% overall) presented with potentially serious diseases: malaria (n = 2), Salmonella typhi (n = 3), Salmonella paratyphi (n = 2), meningococcal meningitis (n = 1), tuberculosis (n = 2), visceral leishmania (n = 1), and hepatitis A (n = 1). Eleven of the 12 children presenting with these potentially serious illnesses were VFR or immigrant children. The main diagnoses for ill-returned Zürich children who presented for emergency care were diarrhea, respiratory, and febrile/systemic illness. A broad spectrum of morbidity was seen including meningococcal meningitis, malaria, tuberculosis, typhoid fever, leishmania, and hepatitis A. Diagnoses varied between geographic regions visited, and VFR child travelers constituted a large proportion of sick-returned children presenting for emergency care.

A Student's Reflection on the Co-Op Experience

A Student's Reflection on the Co-Op Experience

Malaria in rural Lanarkshire

Introduction Malaria is preventable, yet infection still occurs in UK travellers to tropical destinations. Effective health education, chemoprophylaxis and early identification of malaria are essential in primary care. Case presentation A 20 year old man presented with a fever associated with extreme lethargy and general myalgia during the H1N1 ‘pandemic’ in 2009. He was one of party of four people returning from The Gambia. Malaria was diagnosed and, following admission, Plasmodium falciparum parasites were identified. He was treated with intravenous quinine and doxycycline and made a full recovery. Two other members of the wedding party had flu like symptoms, but did not have malaria. One was diabetic. Conclusion Malaria must be considered in the differential diagnosis of fever in all people returning from the tropics. Primary care teams need to be aware of and encourage prevention strategies for people traveling to malarious areas. Diabetic patients may require dosage adjustments to prevent hypoglycaemia associated with anti-malarials.

Malaria and travellers visiting friends and relatives

Among all travel-acquired illnesses, malaria carries the greatest burden not only considering the number of imported cases but also the potential of a fatal outcome. The increased number of imported malaria cases in developed countries in the last decades has been attributed to the increasing number of travel to tropical destinations in combination with the enormous influx of immigrants. At present, immigrants visiting friends and relatives (VFRs) constitute the most significant group of travellers for malaria importation in developed countries, with sub-Saharan Africa destinations carrying the highest risk. VFRs typically demonstrate travel and behavioural patterns which render them at high risk for acquisition of this largely preventable infection. Pre-travel services are rarely sought by VFRs, whereas misconceptions that they possess life-long immunity against malaria make them less likely to receive or adhere to antimalarial chemoprophylaxis recommendations. There is an urgent need to increase awareness about malaria of this group of travellers.

European cloth and "tropical" skin: clothing material and British ideas of health and hygiene in tropical climates.

As Britain's imperial and colonial ambitions intensified toward the end of the nineteenth century, the preservation of white European health in tropical climates became an increasingly important concern. Since at least the seventeenth century, the "tropics" had been seen as spaces holding vast potential wealth but also death and disease. To combat these deadly but desirable landscapes, the British built a considerable commodity culture around the preservation of white European health, and for many, tropical clothing was one of the most important and essential items in their "kits." This article investigates the composition and use of such clothing in relation to British ideas of health and hygiene in tropical climates. First, it considers debates that ensued over the best material--wool, cotton, linen, silk, or a combination of these materials--and the role of "black" skin and local practice in the development of tropical clothing. Second, it demonstrates the importance of location in any discussion of tropical medicine and hygiene, and the tension and ambiguity that still surrounded British ideas of health and hygiene in the tropical colonies. Third, it argues that tropical clothing was important in the maintenance of climatic etiologies despite advances in parasitology and sanitary science. Finally, it considers the relationship of tropical clothing to the formation of a unique colonial identity. To British men and women embarking for any number of tropical destinations, proper clothing was not a banal and mundane component of their outfitting. For many, the clothing signified a departure from the safe and "civil" climes of Britain for adventure in the expanding tropical empire.

Projecting Paradise: The Surf Media and the Hermeneutic Circle in Surfing Tourism

Imagery of perfect uncrowded surf in paradisaical tropical destinations has been the dominant theme in the surf media since its inception. The hermeneutic circle of representation in tourism has been explored in the context of tourism industry advertising material with tourists reproducing iconic images of destinations through their own photographic choices (Butler &amp; Hall, 1998; Crawshaw &amp; Urry, 1997; Hall, 1997; Jenkins, 2003; Urry, 1990a, 1990b). This article extends such research by exploring the media's role in driving a hermeneutic circle in the absence of tourism industry marketing. The article employs grounded theory method in an instrumental case study investigating the role of the surf media in the social construction of an idealized surfing tourist space. As well as providing the first empirical evidence of the relationship between the surf media and tourism demand, the article explores the symbolic elements of surfing tourist space, imagery of which drives a multi-billion-dollar global surf industry. The article expands the notion of the hermeneutic circle by looking beyond impacts on marketing and tourist behavior and questioning the implications of a tourism industry that continues to develop in remote, less-developed regions as an ad hoc response to demand fueled by media imagery of commercially created symbols designed to sell fashion items and consumer goods.

Tourism Research and the Tropics: Further Horizons

The origins of tourism and the foundations of tourism scholarship are in the temperate zones of the globe. While tropical destinations and themes have not been ignored in tourism study, a closer focus on the commonalities of tropical tourism settings is warranted. The defining common physical and social features of tropical locations include climate, political history and often modest levels of development. The perceptions of the tropics by external powers have also shaped the development of the region. The tourism related consequences of these features are distinctive patterns in seasonality, challenges in managing highly similar destination images and an array of natural and social resources which pose common management problems. Building on this context, the core aim of this paper is to encourage better benchmarking information for understanding and managing tourism in the tropics. The paper seeks to fulfill this aim both by outlining research topics to assist the management of tropical tourism and by using the tropics as a rich canvas for new directions in tourism study. Additionally, the role of tourism research in addressing pressing issues for the tropics is noted. Throughout, it is argued that there is much to be gained by more comparative studies of tourism processes and systems within tropical settings.

Evaluation of the Sick Child Following Travel to the Tropics

&lt;P&gt;According to the U.S. Department of Transportation, 31 million Americans traveled overseas in 2007, excluding Mexico and Canada. Children are accompanying their parents to overseas destinations more often for both business- and pleasure-related travel, with an estimated 1.9 million children traveling overseas each year. Children who travel to tropical destinations are at risk for infections not typically encountered in the United States. In addition, the epidemiology of health issues may vary in this subpopulation due to age-specific variations in immunity and behavior. Data on the etiology of infectious diseases in pediatric travelers are limited. However, several small studies have demonstrated that after common respiratory viral infections, diarrheal illnesses, malaria, dengue fever, and typhoid fever are most commonly reported. More recently, research involving the GeoSentinel Surveillance Network, a global infectious disease reporting system that includes information on more than 50,000 ill travelers, has provided additional information on travel-related illnesses. One study using this database assessed how commonly fever is reported as a chief reason for seeking medical care. Of the 24,920 patients that met inclusion criteria, 5% to 6% of whom were younger than 20 years of age, 6,957 travelers or 28% included fever as the chief complaint. Of those with fever, 35% had a febrile systemic illness, 15% had diarrheal disease, and 13% had fever in conjunction with a respiratory illness. Malaria was diagnosed in 21% of those with fever, making it the most common specific diagnosis. Therefore, it is essential that healthcare providers who may encounter children who have visited a tropical destination have a basic understanding of initial evaluation and treatment of travel-related disorders.&lt;/P&gt; &lt;H4&gt;ABOUT THE AUTHORS&lt;/H4&gt; &lt;P&gt;Andrea Summer, MD, MSCR, is with the Department of Pediatrics, Medical University of South Carolina, Charleston. William M Stauffer MD, MSPH, is with the Department of Medicine, Infectious Diseases and International Medicine; and the Department of Pediatrics, Infectious Diseases, University of Minnesota, Minneapolis.&lt;/P&gt; &lt;P&gt;Address correspondence to: Andrea Summer, MD, MSCR, Medical University of South Carolina, Department of Pediatrics, 135 Rutledge Avenue, PO Box 250561, Charleston, SC 29425; fax 843-876-8709; or e-mail &lt;a href="mailto:summera@musc.edu"&gt;summera@musc.edu&lt;/a&gt;.&lt;/P&gt; &lt;P&gt;Dr. Summer and Dr. Staufer have disclosed no relevant financial relationships.&lt;/P&gt; &lt;H4&gt;EDUCATIONAL OBJECTIVES&lt;/H4&gt; &lt;OL&gt; &lt;LI&gt;Recognize the diverse infectious pathogens that must be considered in an ill child who recently returned from international travel.&lt;/LI&gt; &lt;LI&gt;Discuss the importance of rapidly evaluating fever in returned travelers from tropical areas.&lt;/LI&gt; &lt;LI&gt;Describe the general approach for efficiently identifying infections in ill returning travelers.&lt;/LI&gt; &lt;/OL&gt;

Determinants of Malaria Prophylaxis Among German Travelers to Kenya, Senegal, and Thailand

Malaria chemoprophylaxis is a mainstay of malaria prevention in travelers. Adequate pretravel advice forms the basis for efficient malaria prophylaxis. This study assessed the determinants for seeking pretravel advice and evaluated the quality of advice from each source and its influence on the patterns and outcome of malaria prophylaxis intake. In March and April 2004, a self-administered questionnaire was distributed by cabin crews to passengers flying back to Germany from three popular tourist destinations: Kenya, Senegal, and Thailand. To evaluate the quality of advice and actual intake, figures were assessed against the official recommendations of the German Society of Travel Medicine and International Health (DTG). A total of 1,001 passengers were included in the study (Kenya, 492; Senegal, 131; and Thailand, 378), of which 81% had sought any kind of pretravel health advice. Travelers' age and time of pretravel consultation were associated with the source of information consulted. Seventy-five percent of travelers from Senegal and Kenya received DTG compliant advice compared to only 17% of travelers from areas with low malaria risk in Thailand. Travelers returning from Kenya and Senegal had used correct chemoprophylaxis in only 65 and 47% of trips, respectively. In multivariate analysis, the factors determining correct intake among Senegal and Kenya travelers were receiving pretravel advice (from nonmedical professionals: OR 4.4, 95% CI 1.9-10.0 and from medical professionals: OR 15.4, 95% CI 7.3-32.4), a correct risk perception (OR 2.9, 95% CI 1.9-4.5), 2 to 3 weeks of travel abroad (vs a duration >3 wk: OR 2.2, 95% CI 1.3-3.8), and travel to Kenya (OR 1.9, 95% CI 1.1-3.1). Malaria prevention among a large proportion of German travelers to tropical destinations is inadequate. Public health efforts should be made to raise awareness among travelers, travel agencies, and medical institutions in Germany.

What is needed to improve tropical conservation? Appropriate education, training, and encouragement

Currently, there is a need for a better multidisciplinary education system for tropical conservation, as well as a need for more people from developing countries to receive such improved education and training. If this combination is achieved, universities in both developed and developing nations will likely produce graduates who are better prepared for jobs involving non-academic tropical conservation initiatives and, simultaneously produce graduates who may be better accepted as conservationists in tropical destinations.

Incidence and Types of Illness When Traveling to the Tropics: A Prospective Controlled Study of Children and Their Parents

Increasingly, families travel to tropical destinations exposing them to infectious agents and tropical diseases not encountered at home. We studied 157 children (0-16 years) and their adult relatives traveling to the tropics, who attended a pretravel clinic and were generally adherent to prescribed advice. Incidence rates of common illness in children and adults were respectively 16.9 (14.3-19.7) and 15.1 (12.7-17.8) episodes/100 person-weeks. Diarrhea, abdominal pain, and fever were the most frequent complaints. There was no significant difference in the incidence of morbid episodes between children and adults, except for fever (more frequent in children). Most episodes occurred in the first 10 days of travel. The similar incidence of morbidity in children and adults and the episodes' mildness challenge the view that it is unwise to travel with small children.

Malaria in UK travellers: assessment, prevention and treatment

Malaria is the most serious tropical disease. Increasing numbers of people are travelling to tropical destinations where they are at risk of malaria. Nurses need to be aware of the disease risk, prevention of mosquito bites and appropriate chemoprophylaxis to protect the health of travellers. This article describes the malaria lifecycle, bite prevention, chemoprophylaxis, diagnosis and prevention strategies for people travelling to malarious areas. Additional resources are supplied for nurses who want further information.

Malaria in UK travellers: assessment, prevention and treatment

Malaria is the most serious tropical disease. Increasing numbers of people are travelling to tropical destinations where they are at risk of malaria. Nurses need to be aware of the disease risk, prevention of mosquito bites and appropriate chemoprophylaxis to protect the health of travellers. This article describes the malaria lifecycle, bite prevention, chemoprophylaxis, diagnosis and prevention strategies for people travelling to malarious areas. Additional resources are supplied for nurses who want further information.

Nationwide Survey of the Role of Travel Medicine in Primary Care in Germany

With more persons traveling to (sub)tropical destinations, travel medicine is an increasing challenge for the health care system in many countries. This study investigated the role and scope of travel medicine provided by general practitioners (GPs) in primary health care, assessed the determinants of specific prophylactic recommendations, and identified the needs of GPs regarding training and cooperation in travel medicine. A national survey was conducted among randomly selected GPs in Germany. Information on the type and extent of activities in travel medicine, the number and characteristics of patients, the use of specific information systems, and training and cooperation, was obtained with a standardized postal questionnaire. Representativeness was assessed by a computer-assisted telephone survey among nonrespondents. Univariate and multivariate statistical analysis was performed. Of all GPs (n=1,320), 95% provided medical pretravel advice or post-travel counseling (13.2 patients/month). The most common topics in pretravel consultation were immunizations (95%), malaria chemoprophylaxis (94%), advice on exposure prophylaxis (41%), and advice on protection from sexually transmitted infections (STIs) (43%). GPs frequently advised certain patient groups (e.g., cardiovascular patients 68%, pregnant women 20%). Travelers' diarrhea was the most common topic in post-travel consultation (89%), followed by fever (38%). Of the GPs, 25% cooperated regularly with institutions with special expertise in travel medicine or tropical diseases. Sixty-four percent had received some training in travel medicine, and 86% stated a need for additional training. In the multivariate analysis, independent determinants for advice on exposure prophylaxis and STI risks included special training in travel medicine, use of country-specific information sources, and location of the practice in the former West Germany and urban areas. Travel medicine is of importance in primary health care in Germany. There is a need for improved counseling on exposure and STI prophylaxis. GPs' training in travel medicine and cooperation with institutions such as institutes, clinics and laboratories for tropical medicine should be improved.