Travel and migration associated infectious diseases morbidity in Europe, 2008

Abstract

BackgroundEuropeans represent the majority of international travellers and clinicians encountering returned patients have an essential role in recognizing, and communicating travel-associated public health risks.MethodsTo investigate the morbidity of travel associated infectious diseases in European travellers, we analysed diagnoses with demographic, clinical and travel-related predictors of disease, in 6957 ill returned travellers who presented in 2008 to EuroTravNet centres with a presumed travel associated condition.ResultsGastro-intestinal (GI) diseases accounted for 33% of illnesses, followed by febrile systemic illnesses (20%), dermatological conditions (12%) and respiratory illnesses (8%). There were 3 deaths recorded; a sepsis caused by Escherichia coli pyelonephritis, a dengue shock syndrome and a Plasmodium falciparum malaria.GI conditions included bacterial acute diarrhea (6.9%), as well as giardiasis and amebasis (2.3%). Among febrile systemic illnesses with identified pathogens, malaria (5.4%) accounted for most cases followed by dengue (1.9%) and others including chikungunya, rickettsial diseases, leptospirosis, brucellosis, Epstein Barr virus infections, tick-borne encephalitis (TBE) and viral hepatitis. Dermatological conditions were dominated by bacterial infections, arthropod bites, cutaneous larva migrans and animal bites requiring rabies post-exposure prophylaxis and also leishmaniasis, myasis, tungiasis and one case of leprosy. Respiratory illness included 112 cases of tuberculosis including cases of multi-drug resistant or extensively drug resistant tuberculosis, 104 cases of influenza like illness, and 5 cases of Legionnaires disease. Sexually transmitted infections (STI) accounted for 0.6% of total diagnoses and included HIV infection and syphilis. A total of 165 cases of potentially vaccine preventable diseases were reported. Purpose of travel and destination specific risk factors was identified for several diagnoses such as Chagas disease in immigrant travellers from South America and P. falciparum malaria in immigrants from sub-Saharan Africa. Travel within Europe was also associated with health risks with distinctive profiles for Eastern and Western Europe.ConclusionsIn 2008, a broad spectrum of travel associated diseases were diagnosed at EuroTravNet core sites. Diagnoses varied according to regions visited by ill travellers. The spectrum of travel associated morbidity also shows that there is a need to dispel the misconception that travel, close to home, in Europe, is without significant health risk.

Illness and injury of travellers abroad: Finnish nationwide data from 2010 to 2012, with incidences in various regions of the world

“…Even though the proportionate morbidity data presented in this and previous [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] studies are very informative, the incidence figures are of special value, as they describe more accurately the risks for travellers and, as illustrated in Figure 3, allow comparisons between various regions. Our study sample represents the most severe cases, yet the actual incidence of health problems among travellers needing medical care abroad may in reality be sixfold higher than that presented here (Figure 1).…”

“…Assessment of travellers' health problems has largely been based on calculations of proportionate morbidity of returning travellers as reported by specialised centres for travel and tropical medicine [3][4][5][6]. Data on illness or injury while abroad have been collected chiefly after travel from questionnaires, telephone surveys [2,[7][8][9][10][11][12][13][14] and insurance claims [15,16], data recorded during actual travel are scarce.…”

Dengue: an update for clinicians working in non-endemic areas

“…10 Surveillance data indicate that dengue is now the most common cause for fever in travellers returning from all geographical regions except sub-Saharan Africa and Central America, where malaria remains the most common cause. 11,12 Travellers returning to Europe usually acquire dengue from South-East Asia, particularly Thailand, 13 while in the USA the highest rates followed travel to Dominican Republic and Mexico. 14 Autochthonous spread has been reported from the south of France and Croatia, and in 2012 the fi rst European dengue outbreak since the 1920's occurred in Madeira, resulting in over 2,000 cases and 120 hospitalisations.…”

Spectrum of Imported Infectious Diseases: A Comparative Prevalence Study of 16,817 German Travelers and 977 Immigrants from the Tropics and Subtropics

“…9,10 Several studies have shown that the most prevalent symptoms among travelers and immigrants were diarrhea, fever, and skin disorders. 6,11,[18][19][20] In some studies that compared travelers with immigrants whose purpose of travel was VFR, the risk of acute diarrhea was higher among travelers, whereas the risk for malaria and viral hepatitis was higher among VFRs. 21 The findings mentioned above were considered when patients consulted the Department of Infectious Diseases and Tropical Medicine (DITM) of the University of Munich, Germany.…”