Open Access Highly Accessed Research article

Expatriates ill after travel: Results from the Geosentinel Surveillance Network

Poh-Lian Lim1*, Pauline Han2, Lin H Chen34, Susan MacDonald5, Prativa Pandey6, DeVon Hale7, Patricia Schlagenhauf8, Louis Loutan9, Annelies Wilder-Smith10, Xiaohong M Davis2, David O Freedman11 and GeoSentinel Surveillance Network

Author affiliations

1 Department of Infectious Diseases, Institute of Infectious Disease & Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore

2 Centers for Disease Control and Prevention, Atlanta, Georgia, USA

3 Mount Auburn Hospital, Cambridge, Massachusetts, USA

4 Harvard Medical School, Boston, Massachusetts, USA

5 University Hospital of Northern British Columbia, Prince George, Canada

6 CIWEC Clinic Travel Medicine Center, Katmandu, Nepal

7 Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA

8 University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travellers’ Health, University of Zurich, Zurich, Switzerland

9 University of Geneva, Geneva, Switzerland

10 Institute of Public Health, University of Heidelberg, Heidelberg, Germany

11 Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA

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Citation and License

BMC Infectious Diseases 2012, 12:386  doi:10.1186/1471-2334-12-386

Published: 31 December 2012



Expatriates are a distinct population at unique risk for health problems related to their travel exposure.


We analyzed GeoSentinel data comparing ill returned expatriates with other travelers for demographics, travel characteristics, and proportionate morbidity (PM) for travel-related illness.


Our study included 2,883 expatriates and 11,910 non-expatriates who visited GeoSentinel clinics ill after travel. Expatriates were more likely to be male, do volunteer work, be long-stay travelers (>6 months), and have sought pre-travel advice. Compared to non-expatriates, expatriates returning from Africa had higher proportionate morbidity (PM) for malaria, filariasis, schistosomiasis, and hepatitis E; expatriates from the Asia-Pacific region had higher PM for strongyloidiasis, depression, and anxiety; expatriates returning from Latin America had higher PM for mononucleosis and ingestion-related infections (giardiasis, brucellosis). Expatriates returning from all three regions had higher PM for latent TB, amebiasis, and gastrointestinal infections (other than acute diarrhea) compared to non-expatriates. When the data were stratified by travel reason, business expatriates had higher PM for febrile systemic illness (malaria and dengue) and vaccine-preventable infections (hepatitis A), and volunteer expatriates had higher PM for parasitic infections. Expatriates overall had higher adjusted odds ratios for latent TB and lower odds ratios for acute diarrhea and dermatologic illness.


Ill returned expatriates differ from other travelers in travel characteristics and proportionate morbidity for specific diseases, based on the region of exposure and travel reason. They are more likely to present with more serious illness.

Expatriate; Travelers; GeoSentinel; Malaria