Epidemiology of Travel-Related Hospitalization

Abstract

Background: Limited information exists on causes of hospitalization in patients returning from the tropics, and most is focused on febrile diseases. We evaluated all causes of post-travel hospitalization in a tertiary care hospital in Israel.Methods: Demographics, diagnoses, and destinations of patients admitted between January 1999 and December 2003 with a history of recent travel were recorded. Demographics and destination of healthy travelers presenting to our pretravel clinic at the same period were recorded.Results: Of 211 patients admitted, 71% were males, 8% were immigrants/foreign workers, and febrile diseases accounted for 77% of admissions. The most common diagnoses were malaria in 54 (26%), unidentified febrile disease in 34 (16%), and dengue fever in 27 (13%). New World cutaneous leishmaniasis was the most common cause of admission among nonfebrile patients (18 [9%]). Diarrheal diseases accounted for only 11% of admissions. Regarding destination, 101 (48%) patients had been to Asia, 71 (34%) to Africa, and 43 (20%) to the Americas. Of our healthy traveler population, 59% traveled to Asia, 20% to Africa, and 20% to the Americas. Travel to Africa carried the highest risk of being hospitalized (OR 1.85, 95% CI 1.16-2.97; p = .01). Most (59%) patients returning from Africa had malaria. The principal health problem originating in Asia was dengue fever (27%), and from Latin America, cutaneous leishmaniasis (48%). Males comprised 71% of the patients, and 59% of the healthy traveler population (p < .0001). Males were more likely to acquire malaria (OR 2.15, 95% CI 1.13-4.09; p = .02) and leishmaniasis (OR 3.41,; p = .05).Conclusions: Febrile diseases were the most common cause for hospitalization, with malaria, unidentified febrile diseases, and dengue fever being the most common. Diseases were destination related; travel to Africa was associated with a higher rate of hospitalization. Malaria and cutaneous leishmaniasis had a substantially male predominance, probably due to risk-taking behavior.

Acute and Potentially Life-Threatening Tropical Diseases in Western Travelers—A GeoSentinel Multicenter Study, 1996–2011

“…24,25 In our study, males represented 67% of the falciparum malaria cases. This finding is consistent with an Israeli study on post-travel-related hospitalization, where 75% of malaria cases were seen in males, 26 and it probably reflects different risk-taking behaviors between the sexes.…”

Travel-Related Leptospirosis in Israel: A Nationwide Study

“…23 In a series of hospitalized returned Israeli travelers, 2 (1.2%) of 163 patients had leptospirosis. 24 The rate of unspecified febrile illness was 16-24% in the three series. It is possible that underdiagnosis of leptospirosis contributed to this large proportion of unspecified febrile travelers in these series.…”

Malaria in travellers returning or migrating to Canada: surveillance report from CanTravNet surveillance data, 2004-2014

“…About two-thirds of malaria cases in this analysis occurred in men, a phenomenon noted previously. 11,12 Higher rates of malaria and deaths due to malaria among male travellers may reflect both biological (e.g., attractiveness to vectors) and behavioural (e.g., adherence to chemoprophylaxis) risk factors, 11,[13][14][15][16][17] although their continued over representation in epidemiologic analyses speaks to the need for better, targeted prevention initiatives.…”