Travel-associated disease among US residents visiting US GeoSentinel clinics after return from international travel

Abstract

Background US residents make 60 million international trips annually. Family practice providers need to be aware of travel-associated diseases affecting this growing mobile population. Objective To describe demographics, travel characteristics and clinical diagnoses of US residents who present ill after international travel. Methods Descriptive analysis of travel-associated morbidity and mortality among US travellers seeking care at 1 of the 22 US practices and clinics participating in the GeoSentinel Global Surveillance Network from January 2000 to December 2012. Results Of the 9624 ill US travellers included in the analysis, 3656 (38%) were tourist travellers, 2379 (25%) missionary/volunteer/research/aid workers (MVRA), 1580 (16%) travellers visiting friends and relatives (VFRs), 1394 (15%) business travellers and 593 (6%) student travellers. Median (interquartile range) travel duration was 20 days (10–60 days). Pre-travel advice was sought by 45%. Hospitalization was required by 7%. Compared with other groups of travellers, ill MVRA travellers returned from longer trips (median duration 61 days), while VFR travellers disproportionately required higher rates of inpatient care (24%) and less frequently had received pre-travel medical advice (20%). Illnesses of the gastrointestinal tract were the most common (58%), followed by systemic febrile illnesses (18%) and dermatologic disorders (17%). Three deaths were reported. Diagnoses varied according to the purpose of travel and region of exposure. Conclusions Returning ill US international travellers present with a broad spectrum of travel-associated diseases. Destination and reason for travel may help primary health care providers to generate an accurate differential diagnosis for the most common disorders and for those that may be life-threatening.

Demographic and Travel Characteristics of Travel-Associated Zika Virus Infection Case-Patients in San Diego County, California (January 1, 2016–March 31, 2017)

“…In our analysis, a higher percentage of Hispanic and foreign-born patients were VFR travelers. VFR travelers have been reported to be less likely than tourists or business travelers to seek pre-travel health advice or to follow health prevention recommendations during travel [8]. They are also more likely to have longer stays [9], to stay in family settings (increasing their risk of mosquito exposure), and to have sexual encounters with the local population (increasing their risk of ZIKV sexual transmission) [10].…”

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“…5,9 Systemic/febrile illness occurs most often in children traveling to Sub-Saharan Africa, diarrhea is associated with travel to the Middle East/Southern Asia and North Africa, dermatological illness occurs frequently after exposure in Latin America and respiratory infections are associated with travel in Europe or North Africa. 5 In our study population, Southern Europe was the most popular travel destination (34.3%) often visited by VFRs and by tourists.…”

“…The same is true for the study of American pediatric travelers. 9 In adults, travelers' diarrhea is usually a mild albeit difficult to prevent, using the current strategies. 15 Young children have a higher risk of having severe illness and are more susceptible to the effects of gastrointestinal fluid losses.…”

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