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Travel-associated illness trends and clusters, 2000-2010.

Leder K, Torresi J, Brownstein JS, Wilson ME, Keystone JS, Barnett E, Schwartz E, Schlagenhauf P, Wilder-Smith A, Castelli F, von Sonnenburg F, Freedman DO, Cheng AC, GeoSentinel Surveillance Netwo - Emerging Infect. Dis. (2013)

Bottom Line: The most common destinations from which ill travelers returned were sub-Saharan Africa (26%), Southeast Asia (17%), south-central Asia (15%), and South America (10%).The proportion who traveled for tourism decreased significantly, and the proportion who traveled to visit friends and relatives increased.This multisite longitudinal analysis highlights the utility of sentinel surveillance of travelers for contributing information on disease activity trends and an evidence base for travel medicine recommendations.

View Article: PubMed Central - PubMed

Affiliation: Royal Melbourne Hospital, Parkville, Victoria,Australia. karin.leder@monash.edu

ABSTRACT
Longitudinal data examining travel-associated illness patterns are lacking. To address this need and determine trends and clusters in travel-related illness, we examined data for 2000-2010, prospectively collected for 42,223 ill travelers by 18 GeoSentinel sites. The most common destinations from which ill travelers returned were sub-Saharan Africa (26%), Southeast Asia (17%), south-central Asia (15%), and South America (10%). The proportion who traveled for tourism decreased significantly, and the proportion who traveled to visit friends and relatives increased. Among travelers returning from malaria-endemic regions, the proportionate morbidity (PM) for malaria decreased; in contrast, the PM trends for enteric fever and dengue (excluding a 2002 peak) increased. Case clustering was detected for malaria (Africa 2000, 2007), dengue (Thailand 2002, India 2003), and enteric fever (Nepal 2009). This multisite longitudinal analysis highlights the utility of sentinel surveillance of travelers for contributing information on disease activity trends and an evidence base for travel medicine recommendations.

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Regional results for malaria, enteric fever, and dengue. For malaria, the top region for acquisition was sub-Saharan Africa (77%), and the region with the top average proportionate morbidity (248/1,000 ill travelers) and the greatest trend (–39/1,000, p = 0.01) Oceania. For enteric fever, the top region for acquisition was south-central Asia (67%); regional trends were not assessed. For dengue, the top region for acquisition (50%) and the highest average proportionate morbidity and trend (+70.5/1,000, p = 0.004) was Southeast Asia.
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Figure 7: Regional results for malaria, enteric fever, and dengue. For malaria, the top region for acquisition was sub-Saharan Africa (77%), and the region with the top average proportionate morbidity (248/1,000 ill travelers) and the greatest trend (–39/1,000, p = 0.01) Oceania. For enteric fever, the top region for acquisition was south-central Asia (67%); regional trends were not assessed. For dengue, the top region for acquisition (50%) and the highest average proportionate morbidity and trend (+70.5/1,000, p = 0.004) was Southeast Asia.

Mentions: Trends in morbidity rates for individual illnesses among travelers are influenced by many factors, including changes in disease incidence in regions visited, variations in uptake of preventive measures, and diagnostic factors. We report PM for specific illnesses, which is additionally influenced by changes in the number of travelers seen at GeoSentinel sites for other illnesses; therefore, interpretation of the longitudinal trends in PM requires caution. However, the proportion of the most common other illnesses seen was consistent (±3%) over the study years. Moreover, the lack of significant trends over time for some diseases examined, the decreasing trends for some illnesses, and the increasing trends for others suggest that these trends reflect real (albeit small) changes in the patterns and relative frequency of returned-traveler visits to specialist centers for these illnesses. In particular, the significant increase in proportion of ill travelers returning with enteric fever or dengue or seeking rabies PEP suggests that these conditions might have rising relevance for clinicians caring for ill returned travelers. For malaria, the average PM decreased significantly over the study period. Consistent regional trends were also seen, such as the high PMs for malaria among ill travelers returning from Oceania and sub-Saharan Africa, for enteric fever among those returning from south-central Asia, and for dengue among those returning from Southeast Asia (Figure 7). We also found significant clusters for malaria, enteric fever, and dengue.


Travel-associated illness trends and clusters, 2000-2010.

Leder K, Torresi J, Brownstein JS, Wilson ME, Keystone JS, Barnett E, Schwartz E, Schlagenhauf P, Wilder-Smith A, Castelli F, von Sonnenburg F, Freedman DO, Cheng AC, GeoSentinel Surveillance Netwo - Emerging Infect. Dis. (2013)

Regional results for malaria, enteric fever, and dengue. For malaria, the top region for acquisition was sub-Saharan Africa (77%), and the region with the top average proportionate morbidity (248/1,000 ill travelers) and the greatest trend (–39/1,000, p = 0.01) Oceania. For enteric fever, the top region for acquisition was south-central Asia (67%); regional trends were not assessed. For dengue, the top region for acquisition (50%) and the highest average proportionate morbidity and trend (+70.5/1,000, p = 0.004) was Southeast Asia.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3713975&req=5

Figure 7: Regional results for malaria, enteric fever, and dengue. For malaria, the top region for acquisition was sub-Saharan Africa (77%), and the region with the top average proportionate morbidity (248/1,000 ill travelers) and the greatest trend (–39/1,000, p = 0.01) Oceania. For enteric fever, the top region for acquisition was south-central Asia (67%); regional trends were not assessed. For dengue, the top region for acquisition (50%) and the highest average proportionate morbidity and trend (+70.5/1,000, p = 0.004) was Southeast Asia.
Mentions: Trends in morbidity rates for individual illnesses among travelers are influenced by many factors, including changes in disease incidence in regions visited, variations in uptake of preventive measures, and diagnostic factors. We report PM for specific illnesses, which is additionally influenced by changes in the number of travelers seen at GeoSentinel sites for other illnesses; therefore, interpretation of the longitudinal trends in PM requires caution. However, the proportion of the most common other illnesses seen was consistent (±3%) over the study years. Moreover, the lack of significant trends over time for some diseases examined, the decreasing trends for some illnesses, and the increasing trends for others suggest that these trends reflect real (albeit small) changes in the patterns and relative frequency of returned-traveler visits to specialist centers for these illnesses. In particular, the significant increase in proportion of ill travelers returning with enteric fever or dengue or seeking rabies PEP suggests that these conditions might have rising relevance for clinicians caring for ill returned travelers. For malaria, the average PM decreased significantly over the study period. Consistent regional trends were also seen, such as the high PMs for malaria among ill travelers returning from Oceania and sub-Saharan Africa, for enteric fever among those returning from south-central Asia, and for dengue among those returning from Southeast Asia (Figure 7). We also found significant clusters for malaria, enteric fever, and dengue.

Bottom Line: The most common destinations from which ill travelers returned were sub-Saharan Africa (26%), Southeast Asia (17%), south-central Asia (15%), and South America (10%).The proportion who traveled for tourism decreased significantly, and the proportion who traveled to visit friends and relatives increased.This multisite longitudinal analysis highlights the utility of sentinel surveillance of travelers for contributing information on disease activity trends and an evidence base for travel medicine recommendations.

View Article: PubMed Central - PubMed

Affiliation: Royal Melbourne Hospital, Parkville, Victoria,Australia. karin.leder@monash.edu

ABSTRACT
Longitudinal data examining travel-associated illness patterns are lacking. To address this need and determine trends and clusters in travel-related illness, we examined data for 2000-2010, prospectively collected for 42,223 ill travelers by 18 GeoSentinel sites. The most common destinations from which ill travelers returned were sub-Saharan Africa (26%), Southeast Asia (17%), south-central Asia (15%), and South America (10%). The proportion who traveled for tourism decreased significantly, and the proportion who traveled to visit friends and relatives increased. Among travelers returning from malaria-endemic regions, the proportionate morbidity (PM) for malaria decreased; in contrast, the PM trends for enteric fever and dengue (excluding a 2002 peak) increased. Case clustering was detected for malaria (Africa 2000, 2007), dengue (Thailand 2002, India 2003), and enteric fever (Nepal 2009). This multisite longitudinal analysis highlights the utility of sentinel surveillance of travelers for contributing information on disease activity trends and an evidence base for travel medicine recommendations.

Show MeSH
Related in: MedlinePlus