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  Subjects -> RECREATION, TRAVEL AND TOURISM (Total: 160 journals)
    - LEISURE AND RECREATION (19 journals)

RECREATION, TRAVEL AND TOURISM (141 journals)                     

Showing 1 - 36 of 36 Journals sorted alphabetically
40 [degrees] South     Full-text available via subscription   (Followers: 2)
Acta Economica Et Turistica     Open Access  
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 6)
Almatourism - Journal of Tourism, Culture and Territorial Development     Open Access   (Followers: 11)
American Journal of Tourism Management     Open Access   (Followers: 8)
American Journal of Tourism Research     Open Access   (Followers: 13)
Anatolia : An International Journal of Tourism and Hospitality Research     Hybrid Journal   (Followers: 8)
Annals of Tourism Research     Hybrid Journal   (Followers: 32)
Applied Tourism     Open Access   (Followers: 1)
Asia Pacific Journal of Tourism Research     Hybrid Journal   (Followers: 20)
Australian Antarctic Magazine     Free   (Followers: 4)
Caderno Virtual de Turismo     Open Access   (Followers: 1)
Cornell Hospitality Quarterly     Hybrid Journal   (Followers: 8)
Craft Research     Hybrid Journal   (Followers: 3)
Cuadernos de Turismo     Open Access   (Followers: 2)
Current Issues in Tourism     Hybrid Journal   (Followers: 21)
Czech Journal of Tourism     Open Access   (Followers: 3)
Desafio Online     Open Access  
E-Journal of Tourism     Open Access   (Followers: 5)
EchoGéo     Open Access   (Followers: 1)
Educación física y deporte     Open Access   (Followers: 1)
El Periplo Sustentable     Open Access  
Enlightening Tourism. A Pathmaking Journal     Open Access   (Followers: 5)
Espiga     Open Access  
European Journal of Tourism, Hospitality and Recreation     Open Access   (Followers: 5)
Event Management     Full-text available via subscription   (Followers: 6)
Geofronter     Open Access  
Geotourism/Geoturystyka     Open Access   (Followers: 1)
Gestion Turistica     Open Access   (Followers: 1)
Globe, The     Full-text available via subscription   (Followers: 4)
Hospitality & Society     Hybrid Journal   (Followers: 4)
Hospitality Review     Full-text available via subscription   (Followers: 2)
Information Technology & Tourism     Full-text available via subscription   (Followers: 12)
Interaction     Full-text available via subscription   (Followers: 3)
International Journal of Applied Sciences in Tourism and Events     Open Access   (Followers: 1)
International Journal of Contemporary Hospitality Management     Hybrid Journal   (Followers: 12)
International Journal of Culture Tourism and Hospitality Research     Hybrid Journal   (Followers: 17)
International Journal of Digital Culture and Electronic Tourism     Hybrid Journal   (Followers: 7)
International Journal of Event and Festival Management     Hybrid Journal   (Followers: 6)
International Journal of Hospitality & Tourism Administration     Hybrid Journal   (Followers: 14)
International Journal of Hospitality and Event Management     Hybrid Journal   (Followers: 4)
International Journal of Hospitality Management     Hybrid Journal   (Followers: 19)
International Journal of Knowledge Management in Tourism and Hospitality     Hybrid Journal   (Followers: 2)
International Journal of Religious Tourism and Pilgrimage     Open Access   (Followers: 5)
International Journal of Tourism Anthropology     Hybrid Journal   (Followers: 10)
International Journal of Tourism Cities     Hybrid Journal   (Followers: 2)
International Journal of Tourism Policy     Hybrid Journal   (Followers: 8)
International Journal of Tourism Research     Hybrid Journal   (Followers: 15)
International Journal of Tourism Sciences     Hybrid Journal   (Followers: 5)
International Journal of Travel Medicine and Global Health     Open Access  
Journal of Business & Hotel Management     Partially Free   (Followers: 3)
Journal of China Tourism Research     Hybrid Journal   (Followers: 5)
Journal of Ecotourism     Hybrid Journal   (Followers: 2)
Journal of Environmental Management and Tourism     Open Access   (Followers: 11)
Journal of Franco-Irish Studies     Open Access   (Followers: 1)
Journal of Gastronomy and Tourism     Hybrid Journal   (Followers: 2)
Journal of Heritage Tourism     Hybrid Journal   (Followers: 13)
Journal of Hospitality & Tourism Education     Hybrid Journal   (Followers: 8)
Journal of Hospitality & Tourism Research     Hybrid Journal   (Followers: 14)
Journal of Hospitality and Tourism Technology     Hybrid Journal   (Followers: 4)
Journal of Hospitality Financial Management     Open Access   (Followers: 1)
Journal of Hospitality Management and Tourism     Open Access   (Followers: 4)
Journal of Hospitality Marketing & Management     Hybrid Journal   (Followers: 10)
Journal of Hospitality, Leisure, Sport & Tourism Education     Full-text available via subscription   (Followers: 1)
Journal of Indonesian Tourism and Development Studies     Open Access   (Followers: 1)
Journal of Outdoor Recreation and Tourism     Hybrid Journal   (Followers: 5)
Journal of Park and Recreation Administration     Full-text available via subscription   (Followers: 3)
Journal of Place Management and Development     Hybrid Journal   (Followers: 2)
Journal of Policy Research in Tourism, Leisure and Events     Hybrid Journal   (Followers: 9)
Journal of Quality Assurance in Hospitality & Tourism     Hybrid Journal   (Followers: 7)
Journal of Sport & Tourism     Hybrid Journal   (Followers: 7)
Journal of Sustainable Tourism     Hybrid Journal   (Followers: 16)
Journal of Tourism & Hospitality     Open Access   (Followers: 6)
Journal of Tourism and Cultural Change     Hybrid Journal   (Followers: 9)
Journal of Tourism and Recreation     Open Access   (Followers: 6)
Journal of Tourism Futures     Open Access   (Followers: 2)
Journal of Tourism Insights     Open Access   (Followers: 6)
Journal of Tourism Research & Hospitality     Hybrid Journal   (Followers: 6)
Journal of Tourism, Hospitality and Sports     Open Access   (Followers: 2)
Journal of Travel & Tourism Marketing     Hybrid Journal   (Followers: 17)
Journal of Travel Medicine     Hybrid Journal   (Followers: 3)
Journal of Travel Research     Hybrid Journal   (Followers: 15)
Journal of Vacation Marketing     Hybrid Journal   (Followers: 4)
Journeys     Full-text available via subscription  
Jurnal Manajemen, Strategi Bisnis dan Kewirausahaan     Open Access   (Followers: 4)
Jurnal Master Pariwisata (Journal Master in Tourism Studies)     Open Access   (Followers: 1)
Jurnal Pariwisata Pesona     Open Access  
Marketing & Tourism Review     Open Access  
Mobilities     Hybrid Journal   (Followers: 5)
Mondes du Tourisme     Open Access  
Multiciencias     Open Access  
PASOS Revista de Turismo y Patrimonio Cultural     Open Access   (Followers: 2)
Podium Sport, Leisure and Tourism Review     Open Access   (Followers: 2)
Polish Journal of Sport and Tourism     Open Access  
Provincia     Open Access  
RACE - Revista de Administração, Contabilidade e Economia     Open Access   (Followers: 1)
Rangeland Journal     Hybrid Journal   (Followers: 4)
Recreational Sport Journal     Hybrid Journal   (Followers: 5)
ReiseRecht aktuell : Zeitschrift für das Tourismusrecht     Hybrid Journal  
Research in Hospitality Management     Full-text available via subscription  
Revista de Gestão Ambiental e Sustentabilidade - GeAS     Open Access  
Revista de turism - studii si cercetari in turism     Open Access  
Revista de Turismo Contemporâneo     Open Access   (Followers: 1)
Revista Eletrônica Academicus     Open Access  
Revista Eletrônica de Administração e Turismo     Open Access  
Revista Interamericana de Ambiente y Turismo     Open Access   (Followers: 1)
Revista Organizações em Contexto     Open Access  
Revista Portuguesa e Brasileira de Gestão     Open Access  
Revista Rosa dos Ventos     Open Access   (Followers: 1)
ROTUR : Revista de Ocio y Turismo     Open Access  
Scandinavian Journal of Hospitality and Tourism     Hybrid Journal   (Followers: 4)
South African Journal of Wildlife Research     Open Access   (Followers: 2)
Space and Culture     Hybrid Journal   (Followers: 6)
Studies in Travel Writing     Hybrid Journal   (Followers: 7)
Téoros     Open Access  
Tourism     Open Access   (Followers: 9)
Tourism & Hospitality Essentials Journal     Open Access   (Followers: 1)
Tourism & Management Studies     Open Access   (Followers: 7)
Tourism Analysis     Full-text available via subscription   (Followers: 14)
Tourism and Cultural Heritage     Open Access   (Followers: 6)
Tourism and Hospitality Research     Hybrid Journal   (Followers: 8)
Tourism Culture & Communication     Full-text available via subscription   (Followers: 8)
Tourism Geographies: An International Journal of Tourism Space, Place and Environment     Hybrid Journal   (Followers: 19)
Tourism in Marine Environments     Full-text available via subscription   (Followers: 3)
Tourism Management     Hybrid Journal   (Followers: 21)
Tourism Management Perspectives     Hybrid Journal   (Followers: 7)
Tourism Planning & Development     Hybrid Journal   (Followers: 9)
Tourism Recreation Research     Hybrid Journal   (Followers: 4)
Tourism Review     Hybrid Journal   (Followers: 6)
Tourism Review International     Full-text available via subscription   (Followers: 6)
Tourism, Leisure and Global Change     Open Access   (Followers: 2)
Tourist Studies     Hybrid Journal   (Followers: 6)
TRANSIT     Open Access  
Translation Studies     Hybrid Journal   (Followers: 23)
Turismo y Sociedad     Open Access   (Followers: 1)
Turismo y Sociedad     Open Access   (Followers: 1)
Turystyka Kulturowa     Open Access  
Visitor Studies     Hybrid Journal   (Followers: 6)
Worldwide Hospitality and Tourism Themes     Hybrid Journal   (Followers: 2)
Zeitschrift für Tourismuswissenschaft     Full-text available via subscription  
Современные проблемы сервиса и туризма     Full-text available via subscription   (Followers: 2)


Journal Cover Journal of Travel Medicine
  [SJR: 0.946]   [H-I: 45]   [3 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1195-1982 - ISSN (Online) 1708-8305
   Published by Oxford University Press Homepage  [370 journals]
  • Global trends in center accreditation by the Joint Commission
           International: growing patient implications for international medical and
           surgical care
    • Authors: Mehta A; Goldstein SD, Makary MA.
      Abstract: Millions of patients travel internationally for medical and surgical care. We found that the annual number of centers accredited by the Joint Commission International increased from one center in 1999 to 132 centers in 2016; there are currently 939 accredited centers across 66 countries. Public health and medicolegal implications related to medical travel deserve attention.
      PubDate: 2017-08-21
      DOI: 10.1093/jtm/tax048
      Issue No: Vol. 24, No. 5 (2017)
  • Corrigendum for Medical Evacuations in the Oil and Gas Industry - A
           Retrospective Review with Implications for Future Evacuation and
           Preventive Strategies
    • Abstract: In the originally published version of the article ‘Medical Evacuations in the Oil and Gas Industry - A Retrospective Review with Implications for Future Evacuation and Preventive Strategies’ (
      DOI : 10.1093/jtm/taw095) published 5 March 2017 the author, Johannes Berg, MD FACP, was incorrectly listed as the third author when he should have appeared as the last author. This has now been corrected.
      PubDate: 2017-08-18
      Issue No: Vol. 24, No. 5 (2017)
  • Can a galacto-oligosaccharide reduce the risk of traveller’s
           diarrhoea' A placebo-controlled, randomized, double-blind study
    • Authors: Hasle G; Raastad R, Bjune G, et al.
      Abstract: Background: Diarrhoea is a common medical problem affecting travellers to Asia, Africa and Latin America. The use of prophylactic antimicrobial agents may increase the risk of contracting resistant bacteria. Findings indicate that oligosaccharides, i.e. carbohydrate chains of 3–10 monosaccharides, reduce the risk of diarrhoea.Methods: We performed a placebo-controlled, double-blind study of a galacto-oligosaccharide, B-GOS (Bimuno®, Clasado Ltd, Milton Keynes UK), vs placebo for participants travelling to countries with a high/intermediate risk of diarrhoea for 7–15 days. The participants ingested 2.7g of B-GOS daily from 5 days prior to departure throughout the travel period, and returned a questionnaire, with a diarrhoea log, after their return. The case definition of diarrhoea was three or more loose stools per day.Results: Of 523 enrolled subjects, 334 travellers managed to comply per protocol (PP), 349 followed the protocol at least until the onset of diarrhoea (conditionally evaluable, CE), and 408 followed the protocol with fewer than 5 days of deviance from the protocol (intention to treat, ITT). There was a significant reduction of diarrhoea incidence in the PP group (odds ratio = 0.56, P = 0.03), while the effect in the CE group was non-significant (OR = 0.65, P = 0.08). No significant effect was found during the first 7 days after starting with B-GOS, but from day 8 there was a significant effect in both the PP and CE groups (OR = 0.47, P = 0.02 and OR = 0.53, P = 0.03, respectively). The entire effect was seen in 1-day (i.e. self-limiting) diarrhoea (PP: OR = 0.25, P = 0.004). There was no effect on duration or the number of bowel movements during diarrhoea. The severity of diarrhoea was not affected.Conclusions: B-GOS reduces the risk of diarrhoea lasting 1 day. The protection seemed to start after a week of treatment with B-GOS. Strict compliance is crucial. The treatment is environmentally friendly and without adverse effects.
      PubDate: 2017-08-18
      DOI: 10.1093/jtm/tax057
      Issue No: Vol. 24, No. 5 (2017)
  • Previous exposure in a high-risk area for travellers’ diarrhoea within
           the past year is associated with a significant protective effect for
           travellers’ diarrhoea: a prospective observational cohort study in
           travellers to South Asia
    • Authors: Kuenzli E; Juergensen D, Kling K, et al.
      Abstract: Background: Travellers’ diarrhoea is the most common health problem in travellers. Depending on the region visited, up to 40% of travellers develop diarrhoea during a 2-week trip. The aim of this study was to assess risk factors for TD among travellers to the Indian subcontinent.Methods: An observational prospective multicentre cohort study investigated travellers to the Indian subcontinent. Participants completed questionnaires assessing the incidence of travellers’ diarrhoea and identifying potential risk factors. Covariates were assessed univariately, followed by a multivariate regression.Results: Two-hundred and twenty-six travellers were enrolled into the study, 178 filled in both pre- and post-travel questionnaires. Overall, the attack rate of travellers’ diarrhoea was 38.2%. Travel destination is a key risk factor for the occurrence of TD. Travelling to India or Nepal vs Bhutan is associated with an increased risk for TD (OR 6.68 and 6.62, respectively). A length of stay of more than 3 weeks compared to less than 2 weeks is also associated with a significantly increased risk (OR 5.45). Having stayed in a high-risk area for travellers’ diarrhoea within the past year before the current trip is associated with a significantly decreased risk (OR 0.19). No association was found between consumption of high risk food (i.e. tap water, ice cream, raw meat and hamburgers) and travellers’ diarrhoea.Conclusion: Travellers’ diarrhoea is a frequent problem in travellers to the Indian subcontinent. Previous exposure in a high-risk area for travellers’ diarrhoea within the past year appears to have a significant protective effect. Furthermore, an association between the occurrence of travellers’ diarrhoea and travel destination and length of stay, respectively, was observed. Consumption of risk food did not confer a TD risk in our study.
      PubDate: 2017-08-18
      DOI: 10.1093/jtm/tax056
      Issue No: Vol. 24, No. 5 (2017)
  • The quantified self during travel: mapping health in a prospective cohort
           of travellers
    • Authors: Farnham A; Furrer R, Blanke U, et al.
      Abstract: Background: Travel medicine research has remained relatively unchanged in the face of rapid expansion of international travel and is unlikely to meet health challenges beyond infectious diseases. Our aim was to identify the range of health outcomes during travel using real-time monitoring and daily reporting of health behaviours and outcomes and identify traveller subgroups who may benefit from more targeted advice before and during travel.Methods: We recruited a prospective cohort of travellers ≥ 18 years and planning travel to Thailand for <5 weeks from the travel clinics in Zurich and Basel (Switzerland). Participants answered demographic, clinical and risk behaviour questionnaires pre-travel and a daily health questionnaire each day during travel using a smartphone application. Environmental and location data were collected passively by GPS. Classification trees were used to identify predictors of health behaviour and outcomes during travel.Results: Non-infectious disease events were relatively common, with 22.7% (17 out of 75 travellers) experiencing an accident, 40.0% (n = 30) a wound or cut and 14.7% (n = 11) a bite or lick from an animal. Mental health associated events were widely reported, with 80.0% (n = 60) reporting lethargy, 34.7% (n = 26) anxiety and 34.7% (n = 26) feeling tense or irritable. Classification trees identified age, trip length, previous travel experience and having experienced a sports injury in the past year as the most important discriminatory variables for health threats.Conclusions: Our study offers a revolutionary look at an almost real-time timeline of health events and behaviours during travel using mHealth technology. Non-infectious disease related health issues were common in this cohort, despite being largely unaddressed in traditional travel medicine research and suggest a substantial potential for improving evidence-based travel medicine advice.
      PubDate: 2017-08-18
      DOI: 10.1093/jtm/tax050
      Issue No: Vol. 24, No. 5 (2017)
  • A rare case of subcutaneous abscess with intercostal muscles involvement
           by pleural tuberculosis in a Malagasy young traveller
    • Authors: Spoto S; Ciccozzi M, Angeletti S.
      Abstract: A 20-year-old Malagasy woman presented with two-month history of dorsal painful swelling in absence of other clinical symptoms, while she was in Rome, Italy, as student. Her medical history was negative for trauma, intramuscular injection at the local site, travelling abroad, contact with people affected by tuberculosis and family medical history of tuberculosis. On physical examination, two firm and tender soft-tissue masses with central floating, slightly painful, without other signs of flogosis, of 7 and 5 cm in size, localized on dorsal and paramedian right side were evident (Figure 1a and b). The overlying skin appeared normal, with no wounds, scars, rash, or sinuses. Computerized tomography (CT) and magnetic resonance imaging (MRI) of the chest showed different fluid collections: at the level of the intercostal muscles of the fifth and sixth right ribs (23 × 49 and 21 × 47 mm) and subpleural (18 × 11 and 49 × 9 mm) (Figure 1c). Larger collections were documented in the rear side of the right hemithorax (76 × 25 and 35 × 11 mm) (Figure 1d). HBsAg antigen, anti-HCV, anti-HIV, anti-Treponema antibodies and VDRL assay were negative. Quantiferon-TB Gold test was positive; C-reactive protein was 5.8mg/l (normal value, <3), Erythrocyte sedimentation rate was 106mm/h (normal value, <43), White Blood Cells number was 8240/mm3 (67.6% Neutrophils, 20.9% Lymphocytes), Haemoglobin was 12g/dl (normal value, 12–16), Autoimmunity screening was negative. From the subcutaneous collections, 150ml of caseous fluid sample positive for Mycobacterium tubercolosis nucleic acid amplification, rifampicin sensitive (Cepheid, Xpert MTB/RIF), was drained (Figure 1e). Mycobacterium tubercolosis nucleic acid amplification in bronchoalveolar lavage was negative. A diagnosis of pleural tuberculosis with subcutaneous dorsal paravertebral and axillary right fistulization from the pleura to the intercostal muscles, rarely described, was posed. Patient began treatment with isoniazid, rifampicin, pyrazinamide and ethambutol.
      PubDate: 2017-07-27
      DOI: 10.1093/jtm/tax053
      Issue No: Vol. 24, No. 5 (2017)
  • The incidence of breast cancer among female flight attendants: an updated
    • Authors: Rafnsson V.
      Abstract: To the Editor-in-Chief:
      PubDate: 2017-07-27
      DOI: 10.1093/jtm/tax051
      Issue No: Vol. 24, No. 5 (2017)
  • Medical and psychological problems faced by young Australian gap year
           travellers ‡
    • Authors: Furuya-Kanamori L; Mills D, Sheridan S, et al.
      Abstract: Background: Gap year travellers can potentially be exposed to many infectious diseases and other travel-related health problems including injuries and psychological problems. Currently, there is little information on health and wellbeing of this particular group of travellers.Methods: Participants were recruited from an organization that specialized in organising international gap year placements. Gap year travellers were asked to complete a pre-departure survey on demographics, placement destination and duration, previous travel experience, hobbies, risk taking behaviour, anticipated problems during the placement, and pre-travel preparations. After the placement, participants were asked to complete a post-trip survey on their experiences, problems, health issues, and medical treatment required.Results: The 88 and 34 gap year travellers aged 17–23 years completed pre- and post-placement surveys respectively. The duration of placements ranged from 3 to 12 months. Psychological stressors were frequently reported [n = 26 (76.5%) felt home sick; n = 18 (52.9%) experienced culture shock; n = 17 (50.0%) had difficulty communicating with the locals]. The majority of participants (91.2%) tried to work out a solution for the stressor on their own. Twenty-eight (82.4%) participants reported medical problems during their placement; the most common problems were sunburn (n = 19; 55.9%), respiratory infections (n = 15; 44.1%), weight change (n = 14; 41.2%), and diarrhoea/food poisoning (n = 13; 38.2%). Three participants (3.4%) were admitted to hospital; for a muscle injury, head injury and skin infection after getting a tribal tattoo.Conclusions: Psychological stressors were common, but most did not seek help. Some medical problems encountered during their placement may have been preventable with improved pre-departure preparation.Key words: Gap year, pre-departure, preparation
      PubDate: 2017-07-27
      DOI: 10.1093/jtm/tax052
      Issue No: Vol. 24, No. 5 (2017)
  • Lyme disease vs Baggio–Yoshinari syndrome in a returned traveller
           from Brazil
    • Authors: Vien VP; Bassi R, Maxim T, et al.
      Abstract: BrazilLymeBorrelia burgdorferiborreliosisBaggio–Yoshinari syndromeerythema migranstick
      PubDate: 2017-07-19
      DOI: 10.1093/jtm/tax055
      Issue No: Vol. 24, No. 5 (2017)
  • Malaria prevention strategies and recommendations, from chemoprophylaxis
           to stand-by emergency treatment: a 10-year prospective study in a Swiss
           Travel Clinic
    • Authors: Boubaker R; Hérard Fossati A, Meige P, et al.
      Abstract: Background: There are several possible malaria prevention strategies for travellers. In Switzerland, chemoprophylaxis (CP) is recommended for persons visiting areas highly endemic for malaria and stand-by emergency treatment (SBET) for areas with moderate to low risk.Objective: To describe the type of malaria prevention prescribed to travel clinic attendees with a specific focus on changes over time following adaptation of recommendations.Methods: All pre-travel first consultation data recorded between November 2002 and December 2012 were included. Country-specific malaria preventive recommendations provided and medicines prescribed over time were analysed.Results: In total, 64 858 client-trips were recorded. 91% of travellers planned to visit a malaria endemic country. Among those clients, 42% were prescribed an antimalarial medicine as CP only, 36% as SBET only, and 3% both. Between 2002 and 2012, there was a 16% drop of CP prescription (P < 0.001) and a 21% increase of SBET prescription (P < 0.001). Among travellers receiving CP, the proportion of those prescribed mefloquine dropped from 82% in 2002 to 46% in 2012 while those prescribed atovaquone-proguanil (AP) increased from 7% to 39%. For those prescribed SBET, the proportion dropped from 46% to 30% for AP and increased from 2% to 61% for artemether-lumefantrine. CP prescription for travellers to India fell from 62% to 5% and SBET prescription increased from 40% to 88% after the change of recommendation from CP to SBET in 2005 for this country. Comparatively, CP prescription for travellers to Senegal, for which no change of recommendation occurred, remained relatively stable between 88% in 2002 and 89% in 2012.Conclusion: This study shows the considerable decline of antimalarial prescription for chemoprophylaxis that occurred over the 10-year period in favour of SBET.
      PubDate: 2017-07-19
      DOI: 10.1093/jtm/tax043
      Issue No: Vol. 24, No. 5 (2017)
  • Standby emergency treatment of malaria in travellers (SBET): So Be Eager
           to Test …
    • Authors: Genton B; D’Acremont V.
      Abstract: The strategy of ‘standby emergency treatment’ (SBET) for malaria in travellers consists of providing the travellers with emergency malaria treatment for self-administration in case of fever when no medical attention is available, or eventually for use under medical supervision after a confirmed malaria diagnosis.1 This malaria preventive option has been used in Switzerland for almost 30 years (at least for Thailand), and is now recommended by several European countries, as well as Japan. It is based on a risk–benefit analysis (risk of serious adverse events versus avoidance of infection) in relation to malaria chemoprophylaxis. The risk threshold to decide on SBET instead of chemoprophylaxis has been established at around <1/10 000 (i.e. when incidence of SAEs among chemoprophylaxis users outweighs the attack rate of malaria among travellers without chemoprophylaxis). This strategy has not been accompanied by an increase of imported malaria from the destination countries where it has been recommended since years, such as Thailand, Vietnam and more India (Gysin & Hatz, Swiss Federal Office of Health 2016).
      PubDate: 2017-07-18
      DOI: 10.1093/jtm/tax032
      Issue No: Vol. 24, No. 5 (2017)
  • Infection with Echinostoma sp. in a group of travellers to Lake
           Tanganyika, Tanzania, in January 2017
    • Authors: Chunge RN; Chunge CN.
      Abstract: A small group of travellers became infected with Echinostoma sp. after ingesting raw fish which they caught in Lake Tanganyika, Tanzania, in January 2017. The infection was diagnosed by finding the characteristic eggs in stool samples collected over a 2-week period following their return to Kenya. Echinostoma is a genus of parasitic flukes normally known to infect humans in southeast Asia and the Far East. This appears to be the first report of echinostomiasis in East Africa which can be attributed clearly to ingestion of locally caught raw fish.
      PubDate: 2017-07-18
      DOI: 10.1093/jtm/tax036
      Issue No: Vol. 24, No. 5 (2017)
  • Skin lesions caused by Tabanus bovinus bites
    • Authors: Veraldi S; Esposito L.
      Abstract: We report seven Caucasian adult patients who were bitten by horseflies (Tabanus bovinus Linnaeus, 1758) during a trip to Bolivia. Clinical picture was superimposable in all patients: it was characterized by multiple, erythematous, roundish, flattened, large plaques, often with a central point corresponding to horsefly bite, surrounded by satellite, similar, although smaller, lesions. All lesions were located on the neck and/or the upper chest and/or the shoulders; one patient had lesions also on the face. All patients complained of pain at the site of the bite. No systemic symptoms and/or signs were recorded. Rapid recovery was achieved with topical corticosteroids. It is possible that this clinical presentation is pathognomonic of horsefly bites.
      PubDate: 2017-07-18
      DOI: 10.1093/jtm/tax049
      Issue No: Vol. 24, No. 5 (2017)
  • Standby emergency treatment of malaria for travellers to low transmission
           destinations. Does it make sense or save lives'
    • Authors: Behrens R.
      Abstract: The recommendation for carriage standby emergency treatment (SBET) for malaria is now becoming more widespread across Europe. This follows as a replacement to the withdrawal of recommendations for use of malaria chemoprophylaxis, predominantly therefore to falling transmission of Plasmodium falciparum malaria on the successful malaria control programmes across South East Asia and South America.1 Travellers are prescribed SBET antimalarial medication to carry during their journey. The policy is aimed at travel to areas of low falciparum malaria transmission in the above continents, not at travellers to Sub Saharan Africa. They are advised to use the medication when malaria is suspected and prompt medical attention is unavailable, but ideally, to attend a medical centre within 24 h of onset of symptoms for a diagnosis, and if malaria is confirmed, use the medication secure in the knowledge that it is not counterfeit.
      PubDate: 2017-07-18
      DOI: 10.1093/jtm/tax034
      Issue No: Vol. 24, No. 5 (2017)
  • Challenges to providing pre-travel care for travellers visiting friends
           and relatives: an audit of a specialist travel medicine clinic
    • Authors: Rowe K; Chaves N, Leder K.
      Abstract: Travellers visiting friends and relatives (VFRs) often have complex pre-travel needs. We identified the characteristics, destinations, vaccinations and pre-travel advice provided to VFRs and compared these with non-VFR travellers. The significant differences we found suggest that future research should focus on improving the uptake of recommended interventions in VFR travellers.
      PubDate: 2017-07-12
      DOI: 10.1093/jtm/tax038
      Issue No: Vol. 24, No. 5 (2017)
  • An uncommon triad †
    • Authors: Aoun O; Rapp C, Bialé L, et al.
      Abstract: Reactive arthritistraveler’s diarrhoeaGiardia intestinalismilitary
      PubDate: 2017-07-12
      DOI: 10.1093/jtm/tax047
      Issue No: Vol. 24, No. 5 (2017)
  • Psychiatric issues in travel medicine: what is needed now
    • Authors: Valk TH.
      Abstract: In this issue, Felkai et al.1 present a worthy review of the many psychiatric and psychological issues effecting international travellers. The authors focus upon the hazards that confront a traveller who succumbs to a mental illness while travelling: profound difficulty in gaining culturally compatible treatment in a foreign country; travel insurance policies that do not cover psychiatric disorders; and the difficulties inherent in stabilizing such patients prior to repatriation. In short, psychiatric illness in the overseas environment represents an expensive and non-trivial risk to travellers.
      PubDate: 2017-07-12
      DOI: 10.1093/jtm/tax037
      Issue No: Vol. 24, No. 5 (2017)
  • Travel health education
    • Authors: Cegolon L; Heymann WC, Lange JH, et al.
      Abstract: The paper by Marchand et al. outlines some critical aspects related to travel health consultations.1 A survey of French travel health specialists with a response rate of 79% drew the following important conclusions: All travelers should have a pre-trip medical consultation to be adequately instructed and informed about health risks and prophylactic measures in relation with their journey. The pre-travel consultation is in fact the main opportunity to advice travelers about strategies to reduce the health risk associated with traveling;The travel health consultation should entail:‐ a technical component that takes into account practical aspects such as the travel destination, the disease risk and the preventative measures in general and‐ an individualized component that considers the traveler’s profile in terms of knowledge, personal history, risk perception, personality, skills;An element of pedagogy is an essential element of the travel health consultation to properly communicate the key messages and interact effectively with travelers. For this reason the term ‘Travel Health Consultation’ should be better off changed into ‘Travel Health Education’.
      PubDate: 2017-07-12
      DOI: 10.1093/jtm/tax039
      Issue No: Vol. 24, No. 5 (2017)
  • 6-year review of +Redivi: a prospective registry of imported infectious
           diseases in Spain
    • Authors: Pérez-Molina JA; López-Polín A, Treviño B, et al.
      Abstract: Background: Understanding and detecting imported diseases is a priority in the prevention and management of prevalent and emergent infectious diseases acquired abroad. The +Redivi network measures the burden of imported infections in Spain and is essential for closing the gap in travel medicine. Methods: Demographic characteristics, travel information, syndromes and confirmed travel-related diagnoses were registered in a standardised online database. Results: A total of 10 767 cases of imported infectious diseases were registered between October 2009 and December 2015. Of these, 60.8% of cases were immigrants seen for the first time after arrival, 20.6% were travellers, and 18.4% were individuals visiting friends and relatives (VFR [immigrants and travellers]). The median time between arrival and medical consultation was 5.5 years for immigrants, 2.0 weeks for travellers, 3.1 weeks for VFR-travellers and 11.4 for VFR-immigrants. The most prevalent diagnoses were Chagas disease in immigrants and nonspecific acute diarrhoea in travellers. Malaria by P. falciparum was one of the most prevalent diagnoses among VFR. More than half the travellers saw a physician before travelling, although one-third of those for whom antimalarial medication was indicated did not take their medication correctly. As for VFR, only 10.4% of VFR-immigrants and 32.5% of VFR-travellers sought pre-travel advice. Only 23 and 21%, respectively, of those for whom antimalarial prophylaxis was indicated took the medication properly. Conclusions: +Redivi provides a clear picture of the prevalence of imported infectious diseases among travellers and immigrants in Spain. The data collected could be used to improve everyday health care provided to travellers and immigrants after travel, to guide pre-travel consultations and to monitor the potential occurrence of tropical or exotic infectious diseases.
      PubDate: 2017-07-12
      DOI: 10.1093/jtm/tax035
      Issue No: Vol. 24, No. 5 (2017)
  • A descriptive study of advising practices during travel health
           consultations in France
    • Authors: Marchand CC; Merrina FF, Gagnayre RR, et al.
      Abstract: Background: Recommendations for improving traveler adherence address both the content of the advice given and the structure of the consultation. The objective of this article is to describe how travel health consultations are structured in France.Methods: A questionnaire based on both theoretical foundations and recommendations in the literature was sent to health professionals who practice in travel clinics, all of them members of France’s Société de Médecine des Voyages.Results: The response rate was 78.5% (176/224). One hundred thirty nine respondents (78.9%) reported that treatment (vaccinations, in particular) and advising were done at separate times in the consultation. The majority of respondents questioned the traveler on his wishes, difficulties, expectations, experiences, and previous knowledge. A third explored the traveler’s perceptions regarding the seriousness of diseases, the effectiveness of prevention measures and the latter’s adverse effects with a difference when health professionals were practicing >5 years and/or had received specific training (P < 0.05). At the end of the consultation, 92% of the respondents asked the traveler whether he understood the advice given. One hundred thirty seven respondents (77.8%) gave travelers a booklet with additional advice, and 66.5% gave them a website where they could find health advice on their destination. Travelers were almost never offered group consultations or the opportunity to work on real-life situations. When there were language barriers, the respondents were more likely to seek help from a French-speaking member of the traveler’s entourage (48.9%) than from an interpreter (22.7%).Conclusions: While the majority of practitioners follow most of the recommendations regarding the structure of travel health consultations, some of the factors that enhance traveler learning are underutilized, reducing the likelihood that travelers will apply the advice given. The study illustrates the need to develop more educational intervention methods and to evaluate their impact on travelers.
      PubDate: 2017-07-12
      DOI: 10.1093/jtm/tax042
      Issue No: Vol. 24, No. 5 (2017)
  • Cutaneous Mycobacterium gordonae infection in an elderly diabetic returned
    • Authors: Al-Busaidi I; Wong D, Boggild AK.
      Abstract: Mycobacterium gordonae, a low pathogenicity organism, is rarely implicated in skin and soft tissue infections. We present a 77-year-old returned diabetic traveler from rural Sudan with cutaneous M. gordonae infection. Several months of ciprofloxacin, rifampin and ethambutol led to resolution of his plaque, without signs of recurrence at 6-month follow-up.
      PubDate: 2017-07-12
      DOI: 10.1093/jtm/tax019
      Issue No: Vol. 24, No. 5 (2017)
  • Oxygen saturation increases over the course of the night in mountaineers
           at high altitude (3050–6354 m)
    • Authors: Tannheimer M; van der Spek R, Brenner F, et al.
      Abstract: Background: Blood oxygen saturation (SpO2) is frequently measured to determine acclimatization status in high-altitude travellers. However, little is known about nocturnal time course of SpO2 (SpO2N), but alterations in SpO2N might be practically relevant as well. To this end, we describe the time-course of SpO2N in mountaineers at high altitude.Methods: SpO2N was continuously measured in ten male mountaineers during a three-week expedition in Peru (3,050-6,354m). Average SpO2N of the first (SpO2N1) and second half (SpO2N2) of an individual's sleep duration was calculated from 2h intervals of uninterrupted sleep. Heart rate oscillations and sleep dairies were used to exclude periods of wakefulness. SpO2 was also measured at rest in the morning.Results: SpO2N significantly increased from SpO2N1 to SpO2N2. The magnitude of this increase (ΔSpO2) was reduced with time spent at altitude. On night 1 (3,050m) SpO2 increased from 83.4% (N1) to 86.3% (N2). At the same location on night 21, SpO2 increased from 88.3% to 90.1%, which is a relative change of 4.7% and 2.0%, respectively. This pattern of increase in SpO2N was perturbed when individual acclimatization was poor or altitude was extreme (5630m). SpO2N was significantly lower than SpO2 at rest in the morning.Conclusions:  This study is the first to demonstrate an increase of SpO2 during the night in mountaineers at high altitude (3,050-6,354m) with high consistency between and within subjects. The magnitude of ΔSpO2N decreased as acclimatization improved, suggesting that these changes in ΔSpO2 between nights might be a valuable indicator of individual acclimatization. In addition, the failure of any increase in SpO2N during the night might indicate insufficient acclimatization. Even though underlying mechanisms for the nocturnal increase remain unclear, the timing of SpO2N measurement is obviously of utmost importance for its interpretation. Finally our study illustrates the detailed effects of ventilatory acclimatization over several weeks.
      PubDate: 2017-07-12
      DOI: 10.1093/jtm/tax041
      Issue No: Vol. 24, No. 5 (2017)
  • Rescuing Israeli travellers: effects of substance abuse, mental health,
           geographic region of rescue, gender and age of rescuees
    • Authors: Bonny-Noach H; Sagiv-Alayoff M.
      Abstract: Background: Research conducted on young Israeli travellers has pointed to high substance usage rates. For some drug-using backpackers, actual extraction and rescue from their trip abroad is necessary. This study represents a first attempt to explore the influence of geographic region in which rescue occurs, cause for rescue and gender and age differences among Israeli rescuees.Methods: Sub-analysis of all logs of individual rescuees during a 5-year period from 2011 to 2016 (N = 86) included 66 men and 20 women, with an average age of 27.83 (SD = 7.86).Results: The findings demonstrate that Israelis are most frequently rescued from South and Southeast Asia (57%) followed by Europe (22%), South America (17%), North America (2.3%) and Africa (1.2%). India was the country with the highest rate of rescue incidents (N = 36) followed by Thailand (N = 8) and the Netherlands (N = 5). The most common cause for rescue was substance abuse (87%). However, significant regional differences were found based on the variable of age (F = 3.21, df = 3,50, P < 0.05). The youngest rescuees were evacuated from South America (M = 24.20 years, SD = 3.8), while the oldest were from Europe (M = 32.86 years, SD = 10.9). The most frequent mental diagnosis for rescuees was acute psychosis due to substance use disorder (81%) and bipolar disorder, manic subtype due to substance abuse (7%). Significant gender differences were found among rescuees diagnosed with bipolar disorder, manic type: 25% were female, while men only accounted for 1.5% (χ2 = 61.70, df = 24, P < 0.0001).Conclusions: Region, age and gender of young travellers should be taken into consideration when thinking about induced acute psychosis caused by substance use. Policymakers need to consider prevention and harm reduction interventions relevant to this risk group.
      PubDate: 2017-07-12
      DOI: 10.1093/jtm/tax045
      Issue No: Vol. 24, No. 5 (2017)
  • Risk activities and pre-travel health seeking practices of notified cases
           of imported infectious diseases in Australia
    • Authors: Paudel P; Raina CC, Zwar N, et al.
      Abstract: Background: Travellers are at risk of acquiring infectious diseases during travel, with risks differing by destination, travel and traveller characteristics. A pre-travel health consultation may minimize this risk. However, uptake of pre-travel health advice remains low. We investigated pre-travel health preparations and disease-specific risk behaviours among notified cases of selected travel-associated infectious diseases imported into Australia.Methods: Prospective enhanced surveillance of notified cases of typhoid, paratyphoid, measles, hepatitis A, hepatitis E, malaria and chikungunya was conducted in two Australian states between February 2013 and January 2014. Details of pre-travel health preparation and disease-specific risk behaviours were collected.Results: Among 180 cases associated with international travel, 28% were <18 years, 65% were VFR travellers and 22% were frequent travellers, having travelled ≥5 times in the past 5 years. 25% had sought pre-travel advice from a healthcare provider, and 16% reported a pre-travel vaccine. Seeking pre-travel health advice did not differ by immigrant status (P = 0.22) or by reason for travel (P = 0.13) but was more commonly sought by first time travellers (P = 0.03). Travellers visiting friends and relatives were more likely to report at-risk activities of brushing teeth with tap water (P < 0.001) and eating uncooked food (P = 0.03) during travel compared to other travellers.Conclusions: Pre-travel health advice seeking practices and vaccine uptake was suboptimal among cases of notified disease. The results of this study highlight the need for a better understanding of barriers to pre-travel health seeking, particularly among high risk travellers, to reduce the importation of infectious diseases into Australia.
      PubDate: 2017-07-12
      DOI: 10.1093/jtm/tax044
      Issue No: Vol. 24, No. 5 (2017)
  • Patients with mental problems - the most defenseless travellers
    • Authors: Felkai P; Kurimay T.
      Abstract: Background. Severe mental illness occurring abroad is a difficult situation for patients, their families, and for the local medical community. Patients with mental problem are doublely stigmatized due to their mental illness and because they are foreigners in an unfamiliar country. The appropriate treatment is often delayed, while patients are often dealt with in a manner that violates their human rights. Moreover, repatriation – which is vital in this case – is often delayed due to the lack of international protocols for the transportation and treatment of mentally ill travelers.Methods.
      Authors analyzed several factors related to acute mental health problems during travel: the etiology of symptoms, the appropriate treatment possibilities abroad, and medical evacuation and repatriation of the psychotic patient. The article presents a brief review of travel-related mental disorders, the epidemiology of mental health issues faced by travelers, and the significance of pre-travel advice for these patients. The first problem is to recognize (and redress) the particular challenges faced by a psychotic patient in a strange country. The second challenge is to prepare the patients, often in a poor psychiatric state, for medical evacuation by commercial aircraft. Another important question is the best way to take the patient through customs and security control. All of these, as yet unresolved, issues can make the mental patient virtually defenseless.Conclusions. Although timely repatriation of a mentally ill patient is vital and urgent, most travel insurance policies exclude treatment and repatriation costs incurred due to acute mental illness. The high cost of treatment and repatriation must be paid by the patient or their family, which could lead to severe financial strain or insolvency. Changing the approaches taken by the local mental health care community, police, airport security, and insurance companies remain a challenge for psychiatrists.
      PubDate: 2017-07-12
      DOI: 10.1093/jtm/tax005
      Issue No: Vol. 24, No. 5 (2017)
  • Single visit rabies pre-exposure priming induces a robust anamnestic
           antibody response after simulated post-exposure vaccination: results of a
           dose-finding study
    • Authors: Jonker EF; Visser LG.
      Abstract: Background: The current standard 3-dose intramuscular rabies PrEP schedule suffers from a number of disadvantages that severely limit accessibility and availability. The cost of is often prohibitive, it requires 3 visits to the clinic, and there are regular vaccine shortages.There is accumulating evidence that PrEP can be shortened to 2 visits without affecting seroconversion rates or memory formation. The primary objective of this dose finding study is to determine the optimal pre-exposure priming regimen that would require only a single visit to the clinic in order to produce an adequate memory response in all subjects 1 year later.Methods: Volunteers (N = 30) were randomly assigned to 4 study arms: 1 standard dose intramuscular (IM) dose of PVRV (purified Vero cell rabies vaccine, Verorab), and 1/5th, 2/5th or 3/5th- fractional intradermal (ID) dose of PVRV in a single visit. All subjects received a simulated rabies post-exposure prophylaxis (D0, D3) 1 year later. Rabies virus neutralizing antibodies (RVNA) were determined by virus neutralization microtest (FAVN) on D0, D7, D28, Y1 and Y1 + D7.Results: 28 out of 30 subjects (93%) seroconverted 1 month after primary vaccination; 1 subject in the 1-dose IM arm and 1 in the 1/5th-fractional dose ID arm did not. After 1 year, 22 out of 30 subjects (73%) no longer had RVNA above 0.5 IU/ml, with no discernible difference between study groups. After 1 year, all 30 subjects mounted a booster response within 7 days after simulated PEP, with the highest titers found in the single dose IM group (P < 0.03).Conclusions: This dose finding study demonstrates that priming with a single dose of rabies vaccine was sufficient to induce an adequate anamnestic antibody response to rabies PEP in all subjects 1 year later, even in those in whom the RVNA threshold of 0.5 IU/ml was not reached after priming.
      PubDate: 2017-07-12
      DOI: 10.1093/jtm/tax033
      Issue No: Vol. 24, No. 5 (2017)
  • What proportion of international travellers acquire a travel-related
           illness' A review of the literature
    • Authors: Angelo KM; Kozarsky PE, Ryan ET, et al.
      Abstract: 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.KeywordsInternational travel, travel, illness
      PubDate: 2017-07-12
      DOI: 10.1093/jtm/tax046
      Issue No: Vol. 24, No. 5 (2017)
  • A case report of anaphylaxis to Typhoid Vaccine Live Oral Ty21a (Vivotif)
    • Authors: Haas NL; Haas MC, Gregory C.
      Abstract: Typhoid Vaccine Live Oral Ty21a (Vivotif) is typically well tolerated, and adverse events are infrequent and mild. To the best of the authors’ knowledge, only one prior anaphylactic reaction has previously been reported. We present a case of anaphylaxis related to Vivotif, in which a 66-year-old male with no medical comorbidities developed anaphylaxis following the third of a four-dose course (in the absence of concomitant vaccination administration), which consisted of tongue swelling, difficulty breathing, abdominal discomfort and rash. He was managed with epinephrine, corticosteroids and antihistamines.
      PubDate: 2017-05-12
      DOI: 10.1093/jtm/tax022
  • Acute eosinophilic pneumonia following artenimol–piperaquine
    • Authors: Fourmont L; Revest M, Polard E, et al.
      Abstract: Acute eosinophilic pneumonia (AEP) has been reported following chloroquine or mefloquine exposure, both structurally related to piperaquine. We report a case of AEP with typical CT scan patterns, hypereosinophilia in blood (9.8 109/l), and bronchoalveolar lavage (78% of 600 000 cells/ml), 10 days after artenimol–piperaquine exposure in a 26-year-old man.
      PubDate: 2017-05-12
      DOI: 10.1093/jtm/tax023
  • Bibliometric analysis and curriculum mapping of travel medicine research
    • Authors: Flaherty GT; Lim Yap K.
      Abstract: Evidence-based travel medicine requires that research priorities reflect the wide knowledge base of this discipline. Bibliometric analysis of articles published in Journal of Travel Medicine yielded the following results: epidemiology (6%, n = 105); immunology/vaccinology (8.5%, n = 148); pre-travel assessment/consultation (30.5%, n = 533); diseases contracted during travel (48.3%, n = 843); other clinical conditions associated with travel (6.8%, n = 119); post-travel assessment (5.2%, n = 91) and administrative and general travel medicine issues (6%, n = 105).
      PubDate: 2017-05-12
      DOI: 10.1093/jtm/tax024
  • Detection of Zika virus in a traveller from Vietnam to Japan
    • Authors: Katanami Y; Kutsuna S, Taniguchi S, et al.
      Abstract: We report an imported case of Zika fever in a traveller from Vietnam. Zika virus (ZIKV) is currently widespread in Vietnam. Ongoing transmission of ZIKV has been reported in Southeast Asia, and with frequent travel between neighbouring regions, careful surveillance for imported cases is needed.
      PubDate: 2017-05-12
      DOI: 10.1093/jtm/tax031
  • Fatal case of chikungunya and concomitant thrombotic thrombocytopenic
           purpura in French Guiana during air flight medical evacuation
    • Authors: Epelboin L; Bidaud B, Mosnier E, et al.
      Abstract: Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy associated to severe ADAMTS13 deficiency. It has been linked to various viral infections. Among arboviruses, only Crimean–Congo haemorrhagic fever and dengue fever have been linked to this severe disease. We report the first documented case of TTP concomitant to Chikungunya virus infection.
      PubDate: 2017-05-12
      DOI: 10.1093/jtm/tax028
  • Atypical hand, foot and mouth disease due to Coxsackievirus A6 in a
           traveler returning from Indonesia to Italy
    • Authors: Magnelli D; Zammarchi L, Antonelli A, et al.
      Abstract: We report a case of hand, foot and mouth disease (HFMD) in a previously healthy 44-year-old woman. She presented to the Infectious and Tropical Disease Unit, Careggi University Hospital, Florence, Italy with a 3 days history of fever and pharyngitis associated with appearance, since 2 days, of skin lesions bilaterally on hands, legs and feet. Physical examination, revealed the presence of large partially confluent vesicles on the dorsum of feet (Figure 1C and D), smaller vesicles, papules and petechiae on her knees and ankles (Figure 1B) and palmoplantar purpuric macules (Figure 1A). The oral cavity was normal. The patient was returned since 3 days from a 15 days travel in Bali, Indonesia. Her symptoms appeared 3 days before returning in Italy. During the travel she denied contacts with children, she spent most of time on beaches and referred having had several massages. Routine blood tests were normal. Serological tests for Coxsackie A and Coxsackie B were negatives. A swab for Real-time PCR (RT-PCR) for Herpes simplex virus (HSV)-1, HSV-2, Varicella Zoster virus and Enterovirus was taken from a vesicle in the left foot dorsum. Only Enterovirus RT-PCR resulted positive (Enterovirus Q-PCR Alert Kit, Elitech). Amplification and sequencing on both strands with Enterovirus universal primers,1 revealed the presence of Coxsackievirus A6 (CVA6) (99% identity with accession no. LC126164.1). The patient recovered in 2 weeks. Figure 1.Skin lesions of the patient with hand, foot and mouth disease on the day of presentation to the Infectious and Tropical Disease Unit, Careggi University Hospital, Florence, Italy. (A) Palmar purpuric lesions; (B) Vesicles, papules and petechiae on knees and ankles; (C–D) Large partially confluent vesicles on the dorsum of feet
      PubDate: 2017-05-12
      DOI: 10.1093/jtm/tax029
  • A meta-analysis of the use of rifaximin to prevent travellers’
    • Authors: Ng Q; Ho C, Shin D, et al.
      Abstract: Background: Travellers’ diarrhoea affects tens of millions of people travelling to less developed countries or regions annually. There are positive reports of the use of rifaximin, a non-absorbed, gut-selective antibiotic to prevent travellers’ diarrhoea. This study will critically review and analyse clinical trials on the subject.Methods: Using the keywords [diarrhoea OR diarrhoea OR travel*] AND [rifaximin OR xifaxan OR xifaxanta OR normix OR rifagut], a preliminary search on the PubMed and Ovid databases yielded 411 papers published in English between 1 January 1988 and 1 July 2016. Of these, there were only five relevant clinical trials.Results: The clinical trials were double-blind, placebo-controlled, randomized trials with a total of 879 subjects. The meta-analysis found significant reduction in risk of travellers’ diarrhoea with rifaximin use compared to placebo (pooled RR 0.478, 95% CI: 0.375–0.610, and P < 0.001). For the entire travel and follow-up period, the risk of developing travellers’ diarrhoea was significantly greater in individuals receiving the placebo than those receiving rifaximin (daily doses of 400–600 mg). Overall, rifaximin offered significant protection rates of 48–72%, with lower protection rates for Asian than Latin American countries. In terms of tolerability, similar rates of adverse events were reported for the rifaximin and placebo group (P > 0.05), with no clinically significant or serious adverse events related to rifaximin use.Conclusions: There is good evidence supporting the use of rifaximin as a chemoprophylactic agent against travellers’ diarrhoea, especially in individuals who are at high risk of severe complications from acute infectious diarrhoea. Rifaximin has an excellent tolerability/safety profile and demonstrated efficacy against diarrhoeagenic Escherichia coli and even enteroinvasive bacteria such Campylobacter species. Future studies should study the most effective dosing regimen for rifaximin chemoprophylaxis, as well as profile local antimicrobial resistance/susceptibility data in less developed regions to further guide rifaximin use.
      PubDate: 2017-05-12
      DOI: 10.1093/jtm/tax025
  • Preventive measures for “Pet Friendly” lodging facilities: association
           of Leishmaniasis expansion route in São Paulo and preventive measures for
           regional animals displacement
    • Authors: de Carvalho C; Fujita D, da Silva Nali L, et al.
      Abstract: Travel medicine has been facing new challenges in public health due to the increase in international travel (2015—n = 1.2 billion) and the inclusion of pets in this framework can intensify the transmission of many zoonotic diseases. Pet facilities are increasing significantly in many countries, e.g. the American Pet Products Association—APPA, estimated a revenue of $62.75 billion, an increase of 4% over 2015.1 Many pets are imported from other countries, as an example, in UK, 164 836 dogs were introduced following the international rules in recent years, with the importation of 65 080 dogs importation from 128 countries only in 2015.2
      PubDate: 2017-05-12
      DOI: 10.1093/jtm/tax030
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