Illness in French Travelers to Senegal: Prospective Cohort Follow‐up and Sentinel Surveillance Data

Dia, Aïssata; Adheossi, Eric; Bienaimé, Albane; Gaillard, Catherine; Simon, Fabrice; Parola, Philippe; Brouqui, Philippe

doi:10.1111/j.1708-8305.2010.00439.x

Cited by 20 publications

(19 citation statements)

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“…Compliance with these measures and, therefore, the effectiveness of the recommendations has been found to be poor [6,20]. The high risk of TD found in our study is comparable with earlier prospective studies, which have found attack rates to vary between 25% and 57% [4,9,11,21,22]. …”

Section: Discussionsupporting

confidence: 71%

Incidence, risk factors and treatment of diarrhoea among Dutch travellers: reasons not to routinely prescribe antibiotics

et al. 2011

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BackgroundTravellers' diarrhoea (TD) is the most common infectious disease among travellers. In the Netherlands, stand-by or prophylactic antibiotics are not routinely prescribed to travellers. This study prospectively assessed the incidence rate, risk factors, and treatment of TD among immunocompetent travellers.MethodsPersons who attended the travel clinic of the Public Health Service Amsterdam in 2006-2007 before short-term travel to tropical and subtropical countries were invited to answer a questionnaire regarding sociodemographics and travel purpose; they were also asked to keep a daily structured travel diary, recording their itinerary, symptoms, and self-medication or consultation with a doctor. Diarrhoea episodes containing blood or mucous were considered severe.ResultsOf 1202 travellers, the median age was 38 years, and the median travel duration 3 weeks. Of all episodes, 96% were mild. The median duration of TD was 2 days and significantly shorter in subsequent episodes compared to first episodes (p < 0.0005). Of first episodes 38% started in the first travel week. The incidence rate (IR) for first episodes was 2.49 (95% confidence interval [CI], 2.30-2.70) per 100 travel days, with the highest IR among travellers to South-Central and West Asia. The IR for first and subsequent episodes was comparable. Risk factors for first episodes included female sex, a Western country of birth, and tourism as the purpose of travel. The lowest risk was in travellers to South America. An independent risk factor for subsequent episodes was female sex. In total, 5% of travellers used antibiotics; of those, 92% had mild diarrhoea, and 53% received antibiotics over the counter.ConclusionsTD is common among travellers, but the overall course is mild, not requiring treatment. The incidence rates for first and second episodes are comparable. Female sex is a risk factor for the first episode, as well as subsequent ones. Prescription antibiotics are not needed in short-term healthy travellers.

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Section: Discussionsupporting

confidence: 71%

Incidence, risk factors and treatment of diarrhoea among Dutch travellers: reasons not to routinely prescribe antibiotics

et al. 2011

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“…tourists or conference attendees) and nationality of travellers included. During the past 40 years, seven additional studies, 9–15 six of which were published since 2006, have provided information that may lead to a more generalizable and accurate estimate of the proportion of international travellers that acquire a travel-related illness.…”

Section: Discussionmentioning

confidence: 99%

“…7,9,10,12,13,15 Travellers who attend a pre-travel consultation receive education on mitigation of health risks during travel and prevention of infectious diseases, including personal protective measures, chemoprophylaxis, and vaccination. 16 Attendance at a pre-travel consultation may result in decreased illness if clinicians provide travellers with prevention information 17 and the travellers adhere to these preventive measures.…”

Section: Discussionmentioning

confidence: 99%

“…On the contrary, short follow-up periods may not capture illness from diseases with long incubation periods, such as Plasmodium ovale or Plasmodium vivax malaria. Exclusion of travellers from the study for travel lasting longer than 2 or 3 months 12,14,15 may create similar issues.…”

Section: Discussionmentioning

confidence: 99%

“…For example, in Dia et al , 87% of travellers, the most of any study, experienced health a travel-related complaint. 15 The post-travel questionnaire in this study included specific questions about arthropod bites and sunburns, which likely contributed to the high prevalence of dermatological complaints in this cohort. In five other studies, 7,8,10,12,14 travellers were asked about ‘skin problems’, ‘dermatosis’ or ‘dermatological problems’, while only Vilkman et al further specified the exclusion of dry skin, atopy, acne and insect stings, while including sunburn, sun rash and infected skin due to insect stings as travel-related illnesses.…”

Section: Discussionmentioning

confidence: 99%

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What proportion of international travellers acquire a travel-related illness? A review of the literature

Angelo

Kozarsky

Ryan

et al. 2017

Journal of Travel Medicine

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Introduction As international travel increases, travellers may be at increased risk of acquiring infectious diseases not endemic in their home countries. Many journal articles and reference books related to travel medicine cite that between 22–64% of international travellers become ill during or after travel; however, this information is minimal, outdated and limited by poor generalizability. We aim to provide a current and more accurate estimate of the proportion of international travellers who acquire a travel-related illness. Methods We identified studies via PubMed or travel medicine experts, published between January 1, 1976–December 31, 2016 that included the number of international travellers acquiring a travel-related illness. We excluded studies that focused on a single disease or did not determine a rate based on the total number of travellers. We abstracted information on traveller demographics, trip specifics, study enrollment and follow-up and number of ill travellers and their illnesses. Results Of 743 studies, nine met the inclusion criteria. The data sources were from North America (four studies) and Europe (five studies). Most travellers were tourists, the most frequent destination regions were Asia and Africa, and the median trip duration ranged from 8–21 days. Six studies enrolled participants at the travellers’ pre-travel consultation. All studies collected data through either extraction from the medical record, weekly diaries, or pre- and post-travel questionnaires. Data collection timeframes varied by study. Between 6–87% of travellers became ill across all studies. Four studies provided the best estimate: between 43–79% of travellers who frequently visited developing nations (e.g. India, Tanzania, and Kenya) became ill; travellers most frequently reported diarrhoea. Conclusion This is the most comprehensive assessment available on the proportion of international travellers that develop a travel-related illness. Additional cohort studies would provide needed data to more precisely determine the rates of illness in international travellers.

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Mefloquine for preventing malaria during travel to endemic areas

Tickell-Painter

Maayan²,

Saunders

et al. 2017

Cochrane Database of Systematic Reviews

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BackgroundMefloquine is one of four antimalarial agents commonly recommended for preventing malaria in travellers to malaria-endemic areas. Despite its high efficacy, there is controversy about its psychological side effects.ObjectivesTo summarize the efficacy and safety of mefloquine used as prophylaxis for malaria in travellers.Search methodsWe searched the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published on the Cochrane Library; MEDLINE; Embase (OVID); TOXLINE (https://toxnet.nlm.nih.gov/newtoxnet/toxline.htm); and LILACS. We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP; http://www.who.int/ictrp/en/) and ClinicalTrials.gov (https://clinicaltrials.gov/ct2/home) for trials in progress, using 'mefloquine', 'Lariam', and 'malaria' as search terms. The search date was 22 June 2017.Selection criteriaWe included randomized controlled trials (for efficacy and safety) and non-randomized cohort studies (for safety). We compared prophylactic mefloquine with placebo, no treatment, or an alternative recommended antimalarial agent. Our study populations included all adults and children, including pregnant women.Data collection and analysisTwo review authors independently assessed the eligibility and risk of bias of trials, extracted and analysed data. We compared dichotomous outcomes using risk ratios (RR) with 95% confidence intervals (CI). Prespecified adverse outcomes are included in 'Summary of findings' tables, with the best available estimate of the absolute frequency of each outcome in short-term international travellers. We assessed the certainty of the evidence using the GRADE approach.Main resultsWe included 20 RCTs (11,470 participants); 35 cohort studies (198,493 participants); and four large retrospective analyses of health records (800,652 participants). Nine RCTs explicitly excluded participants with a psychiatric history, and 25 cohort studies stated that the choice of antimalarial agent was based on medical history and personal preference. Most RCTs and cohort studies collected data on self-reported or clinician-assessed symptoms, rather than formal medical diagnoses.Mefloquine efficacyOf 12 trials comparing mefloquine and placebo, none were performed in short-term international travellers, and most populations had a degree of immunity to malaria. The percentage of people developing a malaria episode in the control arm varied from 1% to 82% (median 22%) and 0% to 13% in the mefloquine group (median 1%).In four RCTs that directly compared mefloquine, atovaquone-proguanil and doxycycline in non-immune, short-term international travellers, only one clinical case of malaria occurred (4 trials, 1822 participants).Mefloquine safety versus atovaquone-proguanilParticipants receiving mefloquine were more likely to discontinue their medication due to adverse effects than atovaquone-proguanil users (RR 2.86, 95% CI 1.53 to 5.31; 3 RCTs, 1438 participants; high-certainty evidence)....

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Illness in French Travelers to Senegal: Prospective Cohort Follow‐up and Sentinel Surveillance Data

Cited by 20 publications

References 26 publications

Incidence, risk factors and treatment of diarrhoea among Dutch travellers: reasons not to routinely prescribe antibiotics

Incidence, risk factors and treatment of diarrhoea among Dutch travellers: reasons not to routinely prescribe antibiotics

What proportion of international travellers acquire a travel-related illness? A review of the literature

Mefloquine for preventing malaria during travel to endemic areas

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