Travel and migration associated infectious diseases morbidity in Europe, 2008
1 InterHealth and National Travel Health Network and Centre (NaTHNaC), London, UK
2 Service des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, Marseille, France
3 University of Zürich Centre for Travel Medicine, University of Zürich, Hirschengraben 84, Zürich, Switzerland
4 University Medical Centre Hamburg-Eppendorf, Dept. of Tropical Medicine and Bernhard-Nocht Outpatient Dept., Hamburg, Germany
5 Service des Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpétrière, Paris, France
6 Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway
7 Institute for Infectious and Tropical Disease, University of Brescia, Brescia, Italy
8 Addenbrooke's Hospital, Hills Road, Cambridge, UK
9 ISTM/Geosentinel Statistician Consultant, Victoria, B.C., Canada
10 Tropical Medicine & Clinical Parasitology. Infectious Diseases Dept., Ramón y Cajal Hospital, Madrid, Spain
11 Division of Infectious, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, the Netherlands
12 Department of Infectious Diseases and Tropical Medicine, LMU University of Munich, Munich, Germany
13 Division of International and Humanitarian Health, Geneva University Hospitals, Geneva, Switzerland
BMC Infectious Diseases 2010, 10:330 doi:10.1186/1471-2334-10-330Published: 17 November 2010
Europeans represent the majority of international travellers and clinicians encountering returned patients have an essential role in recognizing, and communicating travel-associated public health risks.
To 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.
Gastro-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.
In 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.