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  Subjects -> RECREATION, TRAVEL AND TOURISM (Total: 128 journals)
    - HOTELS AND RESTAURANTS (1 journals)
    - LEISURE AND RECREATION (20 journals)

RECREATION, TRAVEL AND TOURISM (107 journals)                  1 2     

40 [degrees] South     Full-text available via subscription   (Followers: 3)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 5)
Almatourism - Journal of Tourism, Culture and Territorial Development     Open Access   (Followers: 10)
American Journal of Tourism Management     Open Access   (Followers: 2)
American Journal of Tourism Research     Open Access   (Followers: 9)
Anatolia : An International Journal of Tourism and Hospitality Research     Hybrid Journal   (Followers: 4)
Annals of Tourism Research     Hybrid Journal   (Followers: 26)
Asia Pacific Journal of Tourism Research     Hybrid Journal   (Followers: 17)
Australian Antarctic Magazine     Free   (Followers: 4)
Caderno Virtual de Turismo     Open Access  
Cornell Hospitality Quarterly     Hybrid Journal   (Followers: 6)
Craft Research     Hybrid Journal   (Followers: 1)
Cuadernos de Turismo     Open Access  
Current Issues in Tourism     Hybrid Journal   (Followers: 15)
Czech Journal of Tourism     Open Access   (Followers: 2)
EchoGéo     Open Access   (Followers: 1)
Educación física y deporte     Open Access  
El Periplo Sustentable     Open Access  
Enlightening Tourism. A Pathmaking Journal     Open Access   (Followers: 3)
Estudios y Perspectivas en Turismo     Open Access  
Event Management     Full-text available via subscription   (Followers: 7)
Gestion Turistica     Open Access  
Globe, The     Full-text available via subscription   (Followers: 4)
Hospitality & Society     Hybrid Journal   (Followers: 2)
Hospitality Review     Full-text available via subscription   (Followers: 2)
Information Technology & Tourism     Full-text available via subscription   (Followers: 16)
Interaction     Full-text available via subscription   (Followers: 2)
International Journal of Contemporary Hospitality Management     Hybrid Journal   (Followers: 11)
International Journal of Culture Tourism and Hospitality Research     Hybrid Journal   (Followers: 14)
International Journal of Digital Culture and Electronic Tourism     Hybrid Journal   (Followers: 8)
International Journal of Event and Festival Management     Hybrid Journal   (Followers: 7)
International Journal of Hospitality & Tourism Administration     Hybrid Journal   (Followers: 6)
International Journal of Hospitality Management     Hybrid Journal   (Followers: 13)
International Journal of Religious Tourism and Pilgrimage     Open Access   (Followers: 1)
International Journal of Tourism Anthropology     Hybrid Journal   (Followers: 6)
International Journal of Tourism Policy     Hybrid Journal   (Followers: 6)
International Journal of Tourism Research     Hybrid Journal   (Followers: 13)
Journal of Business & Hotel Management     Partially Free  
Journal of China Tourism Research     Hybrid Journal   (Followers: 6)
Journal of Ecotourism     Hybrid Journal   (Followers: 3)
Journal of Environmental Management and Tourism     Open Access   (Followers: 2)
Journal of Franco-Irish Studies     Open Access  
Journal of Heritage Tourism     Hybrid Journal   (Followers: 7)
Journal of Hospitality & Tourism Education     Hybrid Journal   (Followers: 2)
Journal of Hospitality & Tourism Research     Hybrid Journal   (Followers: 11)
Journal of Hospitality and Tourism Management     Full-text available via subscription   (Followers: 10)
Journal of Hospitality and Tourism Technology     Hybrid Journal   (Followers: 3)
Journal of Hospitality Financial Management     Open Access   (Followers: 2)
Journal of Hospitality Marketing & Management     Hybrid Journal   (Followers: 11)
Journal of Indonesian Tourism and Development Studies     Open Access  
Journal of Outdoor Recreation and Tourism     Hybrid Journal   (Followers: 1)
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: 5)
Journal of Sport & Tourism     Hybrid Journal   (Followers: 8)
Journal of Sustainable Tourism     Hybrid Journal   (Followers: 11)
Journal of Tourism & Hospitality     Open Access   (Followers: 1)
Journal of Tourism and Cultural Change     Hybrid Journal   (Followers: 8)
Journal of Tourism and Recreation     Open Access   (Followers: 2)
Journal of Tourism Insights     Open Access   (Followers: 1)
Journal of Tourism Research & Hospitality     Hybrid Journal   (Followers: 2)
Journal of Travel & Tourism Marketing     Hybrid Journal   (Followers: 11)
Journal of Travel Medicine     Hybrid Journal  
Journal of Travel Research     Hybrid Journal   (Followers: 14)
Journal of Unconventional Parks, Tourism & Recreation Research     Open Access  
Journal of Vacation Marketing     Hybrid Journal   (Followers: 3)
Mobilities     Hybrid Journal   (Followers: 5)
Multiciencias     Open Access  
PASOS Revista de Turismo y Patrimonio Cultural     Open Access   (Followers: 1)
Podium Sport, Leisure and Tourism Review     Open Access   (Followers: 2)
Polish Journal of Sport and Tourism     Open Access   (Followers: 2)
Provincia     Open Access  
RACE - Revista de Administração, Contabilidade e Economia     Open Access  
Recreational Sport Journal     Hybrid Journal   (Followers: 5)
ReiseRecht aktuell : Zeitschrift für das Tourismusrecht     Hybrid Journal  
Research in Hospitality Management     Full-text available via subscription   (Followers: 2)
Revista de Gestão Ambiental e Sustentabilidade - GeAS     Open Access  
Revista de turism - studii si cercetari in turism     Open Access  
Revista Interamericana de Ambiente y Turismo     Open Access  
Revista Portuguesa e Brasileira de Gestão     Open Access  
Revista Rosa dos Ventos     Open Access   (Followers: 2)
Scandinavian Journal of Hospitality and Tourism     Hybrid Journal   (Followers: 4)
Space and Culture     Hybrid Journal   (Followers: 4)
Studies in Travel Writing     Hybrid Journal   (Followers: 5)
Téoros     Open Access  
The Rangeland Journal     Hybrid Journal   (Followers: 2)
Tourism     Open Access   (Followers: 4)
Tourism & Management Studies     Open Access   (Followers: 2)
Tourism Analysis     Full-text available via subscription   (Followers: 9)
Tourism and Hospitality Research     Hybrid Journal   (Followers: 7)
Tourism Culture & Communication     Full-text available via subscription   (Followers: 4)
Tourism Economics     Full-text available via subscription   (Followers: 5)
Tourism Geographies: An International Journal of Tourism Space, Place and Environment     Hybrid Journal   (Followers: 13)
Tourism in Marine Environments     Full-text available via subscription   (Followers: 2)
Tourism Management     Hybrid Journal   (Followers: 10)
Tourism Management Perspectives     Hybrid Journal   (Followers: 1)
Tourism Planning & Development     Hybrid Journal   (Followers: 9)
Tourism Recreation Research     Hybrid Journal  
Tourism Review     Hybrid Journal   (Followers: 2)

        1 2     

Journal Cover   Journal of Travel Medicine
  [SJR: 0.738]   [H-I: 40]   [0 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1195-1982 - ISSN (Online) 1708-8305
   Published by John Wiley and Sons Homepage  [1598 journals]
  • Legionnaires' Disease in Hotels and Passenger Ships: A Systematic Review
           of Evidence, Sources, and Contributing Factors
    • Authors: Varvara A. Mouchtouri; James W. Rudge
      Abstract: Background Travel‐associated Legionnaires' disease (LD) is a serious problem, and hundreds of cases are reported every year among travelers who stayed at hotels, despite the efforts of international and governmental authorities and hotel operators to prevent additional cases. Methods A systematic review of travel‐associated LD events (cases, clusters, outbreaks) and of environmental studies of Legionella contamination in accommodation sites was conducted. Two databases were searched (PubMed and EMBASE). Data were extracted from 50 peer‐reviewed articles that provided microbiological and epidemiological evidence for linking the accommodation sites with LD. The strength of evidence was classified as strong, possible, and probable. Results Three of the 21 hotel‐associated events identified and four of nine ship‐associated events occurred repeatedly on the same site. Of 197 hotel‐associated cases, 158 (80.2%) were linked to hotel cooling towers and/or potable water systems. Ship‐associated cases were most commonly linked to hot tubs (59/83, 71.1%). Common contributing factors included inadequate disinfection, maintenance, and monitoring; water stagnation; poor temperature control; and poor ventilation. Across all 30 events, Legionella concentrations in suspected water sources were >10,000 cfu/L,
      PubDate: 2015-07-29T05:26:07.93165-05:0
      DOI: 10.1111/jtm.12225
  • Concurrent Infection With Dengue Type 4 and Plasmodium falciparum Acquired
           in Haiti
    • Abstract: We report one laboratory‐confirmed coinfection by dengue type 4 and Plasmodium falciparum imported to Spain from Haiti. Diagnosis was made by real‐time polymerase chain reaction (RT‐PCR), serology, quantitative buffy coat, and thick blood smear. In areas where both infections are present, diagnosis of both diseases should be considered because a delay in the treatment of malaria could be fatal.
      PubDate: 2015-07-25T05:46:56.295842-05:
      DOI: 10.1111/jtm.12222
  • Inflight Emergencies During Eurasian Flights
    • Authors: Mustafa Kesapli; Can Akyol, Faruk Gungor, Angelika Janitzky Akyol, Dilek Soydam Guven, Gokhan Kaya
      Abstract: Background This study evaluated the incidence and status of urgent medical conditions, the attitudes of health professionals who encounter such conditions, the adequacy of medical kits and training of cabin crew in data‐received‐company aircrafts suggested by Aerospace Medical Association, and the demographic data of patients. Methods Data were collected from medical records of a major flight company from 2011 through 2013. All patients with complete records were included in the study. Numerical variables were defined as median and interquartiles (IQR) for median, while categorical variables were defined as numbers and percentage. Results During the study period, 10,100,000 passengers were carried by the company flights, with 1,312 (0.013%) demands for urgent medical support (UMS). The median age of the passengers who requested UMS was 45 years (IQR: 29–62). Females constituted 698 (53.2%) among the patients, and 721 (55%) patients were evaluated by medical professionals found among passengers. The most common nontraumatic complaints resulting in requests for UMS were flight anxiety (311 patients, 23.7%) and dyspnea (145 patients, 11%). The most common traumatic complaint was burns (221 patients, 16.8%) resulting from trauma during flight. A total of 22 (1.67%) emergency landings occurred for which the most frequent reasons were epilepsy (22.7%) and death (18.2%). Deaths during flights were recorded in 13 patients, whose median age was 77 years (IQR: 69–82), which was significantly higher compared to the age of patients requiring UMS (p 
      PubDate: 2015-07-23T02:24:15.085337-05:
      DOI: 10.1111/jtm.12230
  • General Practitioners' Perception of Risk for Travelers Visiting Friends
           and Relatives
    • Authors: Anita E. Heywood; Bradley L. Forssman, Holly Seale, C. Raina MacIntyre, Nicholas Zwar
      Abstract: Background General practitioners (GPs) are an important source of pre‐travel health advice for travelers; however, only a few studies have investigated primary healthcare provider–related barriers to the provision of pre‐travel health advice, particularly to travelers visiting friends and relatives (VFR). We aimed to investigate Australian GPs' knowledge, attitudes, and practices with regard to VFR travelers. Methods A postal survey was sent to randomly sampled GPs in Sydney, Australia, in 2012. The questionnaire investigated GPs' perception of risk and barriers to the provision of advice to VFR travelers. Results Of 563 GPs, 431 (76.6%) spoke a language other than English (LOTE) with 361 (64.1%) consulting in a LOTE. Overall, 222 (39.4%) GPs considered VFR travelers to be at higher risk than holiday travelers, with GPs consulting in English only [adjusted odds ratio (aOR) 1.65, 95% confidence interval (CI) 1.11–2.44, p = 0.01] and GPs considering long‐term migrants as VFR travelers (aOR 1.86 95% CI 1.07–3.23, p = 0.03) remaining significant on multivariate analysis. Conclusions Multilingual GPs are a valuable resource to reducing language and cultural barriers to healthcare. Targeted education of this subgroup of GPs may assist in promoting pre‐travel health assessments for VFR travelers. Awareness of the need for opportunistic targeting of migrants for pre‐travel consultation through routine identification of future travel is needed.
      PubDate: 2015-07-15T07:03:16.282346-05:
      DOI: 10.1111/jtm.12229
  • Rabies Vaccine and Rabies Immunoglobulin in Cambodia: Use and Obstacles to
    • Authors: Arnaud Tarantola; Sowath Ly, Sotheary In, Sivuth Ong, Yiksing Peng, Nayyim Heng, Philippe Buchy
      Abstract: Background Authorities have pledged to eliminate canine rabies by 2020 in Cambodia, a country with a very high rabies burden. Logistic and financial access to timely and adequate postexposure prophylaxis (PEP) is essential for preventing rabies in humans. Methods We undertook a survey of the few identified sites where PEP rabies vaccination and rabies immunoglobulin (RIG) are available in Cambodia. We examined the Rabies Prevention Center at Institut Pasteur du Cambodge (rpc@ipc) database and rpc@ipc order forms for 2012 to assess vaccine and RIG use. We conducted a rapid internet survey of centers that provide rabies vaccine and RIG in Cambodia, other than rpc@ipc. Results The cost of a full course of intramuscular or intradermal PEP in Cambodia, with and without RIG, was also estimated. Rabies vaccination is free of charge in one foundation hospital and is accessible for a fee at Institut Pasteur du Cambodge (IPC), some institutions, and some Cambodian private clinics. In 2012, 27,500 rabies vaccine doses (0.5 mL) and 591 equine RIG doses were used to provide intradermal PEP to 20,610 persons at rpc@ipc following animal bites. Outside of rpc@ipc, an estimated total of 53,400 vaccine doses and 200 RIG doses were used in Cambodia in 2012. The wholesale cost of full rabies PEP was estimated at 50% to 100% of a Cambodian farmer's monthly wage. Conclusions Local populations and travelers cannot be sure to locally access adequate and timely PEP due to high costs and low access to RIG. Travelers to high‐endemic areas such as Cambodia are strongly encouraged to undergo pre‐exposure vaccination or seek expert advice, as per World Health Organization (WHO) recommendations. State‐subsidized, pre‐positioned stocks of human vaccine and RIG in bite management centers would extend the rabies prevention centers network. Support from Institut Pasteur du Cambodge for staff training, cold chain, and quality control would contribute to reducing the risk of rabies deaths in Cambodia.
      PubDate: 2015-07-15T06:56:00.664976-05:
      DOI: 10.1111/jtm.12228
  • Round Pneumonia With Murine Typhus After Travel to Indonesia
    • Authors: Yukihiro Yoshimura; Yohei Sakamoto, Lee Kwangyeol, Yuichiro Amano, Natsuo Tachikawa
      PubDate: 2015-07-14T08:00:37.78943-05:0
      DOI: 10.1111/jtm.12226
  • Profile of Travelers With Preexisting Medical Conditions Attending a
           Specialist Travel Medicine Clinic in Ireland
    • Authors: Calvin Teo Jia Han; Gerard Flaherty
      Abstract: Background Patients with complex medical comorbidities travel for protracted periods to remote destinations, often with limited access to medical care. Few descriptions are available of their preexisting health burden. This study aimed to characterize preexisting medical conditions and medications of travelers seeking pre‐travel health advice at a specialized travel medicine clinic. Methods Records of travelers attending the Galway Tropical Medical Bureau clinic between 2008 and 2014 were examined and information relating to past medical history was entered into a database. Data were recorded only where the traveler had a documented medical history and/or was taking medications. Results Of the 4,817 records available, 56% had a documented medical history and 24% listed medications. The majority of travelers with preexisting conditions were female. The mean age of the cohort was 31.68 years. The mean period remaining before the planned trip was 40 days. Southeast Asia was the most popular single destination, and 17% of travelers with medical conditions were traveling alone. The most frequently reported conditions were allergies (20%), insect bite sensitivity (15%), asthma (11%), psychiatric conditions (4%), and hypertension (3%). Of the 30 diabetic travelers, 14 required insulin; 4.5% of travelers were taking immunosuppressant drugs, including corticosteroids. Half of the female travelers were taking the oral contraceptive pill while 11 travelers were pregnant at the time of their pre‐travel consultation. Conclusions This study provides an insight into the medical profile of travelers attending a travel health clinic. The diverse range of diseases reported highlights the importance of educating physicians and nurses about the specific travel health risks associated with particular conditions. Knowledge of the effects of travel on underlying medical conditions will inform the pre‐travel health consultation.
      PubDate: 2015-06-22T02:02:55.90801-05:0
      DOI: 10.1111/jtm.12221
  • Risk Factors for Colonization With Multidrug‐Resistant Bacteria
           Among Patients Admitted to the Intensive Care Unit After Returning From
    • Abstract: Background Few national recommendations exist on management of patients returning from abroad and all focus on hospitalized patients. Our purpose was to compare, in an intensive care unit (ICU), the admission prevalence and acquisition of multidrug‐resistant (MDR) bacteria carriage in patients with (“Abroad”) or without (“Local”) a recent stay abroad, and then identify the risk factors in “Abroad” patients. Methods In this retrospective study, we reviewed charts of all the patients hospitalized in the ICU unit from January 2011 through July 2013 with hygiene samplings performed. We identified all patients who had stayed abroad (“Abroad”) within 6 months prior to ICU admission. Results Of 1,842 ICU patients, 129 (7%) “Abroad” patients were reported. In the “Abroad” group, the rate of MDR strain carriage was higher at admission (33% vs 6.7%, p 
      PubDate: 2015-06-17T03:47:14.591385-05:
      DOI: 10.1111/jtm.12220
  • Travelers With Chikungunya Virus Infection Returning to Northwest Italy
           From the Caribbean and Central America During June–November 2014
    • Authors: Elisa Burdino; Tina Ruggiero, Maria Grazia Milia, Alex Proietti, Giuseppina Sergi, Ilaria Torta, Guido Calleri, Pietro Caramello, Donatella Tiberti, Valeria Ghisetti
      Abstract: Chikungunya virus (CHIKV) has recently emerged in the Caribbean. In Italy, CHIKV vector is documented in the Po river valley; therefore, a risk for autochthonous outbreaks is present. We report a case series of seven imported CHIKV infections in travelers returning from the Caribbean and Latin America occurring between June and November 2014, in the area of Turin, Northwest Italy, 3 years after the last imported cases were reported. These cases are a reminder of the need to always consider CHIKV infection in travelers from these epidemic areas as well as the importance of a prompt diagnosis.
      PubDate: 2015-06-17T03:04:16.186376-05:
      DOI: 10.1111/jtm.12219
  • Immunological Biomarkers in Postinfectious Irritable Bowel Syndrome
    • Authors: Brian L. Pike; Katie Ann Paden, Ashley N. Alcala, Kayla M. Jaep, Robert P. Gormley, Alexander C. Maue, Benjamin S. Christmann, Charles O. Elson, Mark S. Riddle, Chad K. Porter
      Abstract: Background There is a recognized need for biological markers to facilitate diagnoses of irritable bowel syndrome (IBS) and to distinguish it from other functional and organic disorders. As postinfectious IBS (PI‐IBS) is believed to account for as many as one third of all IBS cases, here we sought to identify differences in specific cytokines and serologic responses across patients with idiopathic IBS and PI‐IBS and healthy controls. Methods At total of 120 US military personnel were identified from the Defense Medical Surveillance System‐based International Classification of Diseases, 9th Revision, Clinical Modification (ICD9‐CM) codes recorded during medical encounters and were grouped based on infectious gastroenteritis (IGE) episode (Shigella, Campylobacter, Salmonella, or an unspecified pathogen) followed by IBS, IBS without antecedent IGE, or IGE without subsequent IBS within 2 years of the IGE exposure. Sera from subjects were assayed for cytokine levels and antibodies against a panel of microbiome antigens. Results In total, 10 of 118 markers considered were shown to differ between IBS patients and healthy controls, including cytokines interleukin‐6 (IL‐6), IL‐8, IL‐1β, and macrophage inflammatory protein‐1β (MIP‐1β), as well as antibody responses to microbial antigens. Antimicrobial antibody response profiles also differed between PI‐IBS cases compared with IBS cases without an antecedent episode of acute IGE. Comparisons also suggest that immunoglobulin A (IgA) and IgG profiles may point to pathogen‐specific origins among PI‐IBS cases. Conclusion Taken together, these results provide further evidence as to the molecular distinctness of classes of IBS cases and that serum biomarkers may prove useful in elucidating their pathobiological pathways.
      PubDate: 2015-06-08T07:15:02.970164-05:
      DOI: 10.1111/jtm.12218
  • Severe Sunburn After a Hot Air Balloon Ride: A Case Report and Literature
    • Authors: Sinan Ozturk; Huseyin Karagoz
      Abstract: Hot air balloon tours are very popular among travelers worldwide. Preventable burn injuries associated with hot air balloon rides have been reported during crashes into power lines, in propane burner explosions, and following contact with the propane burner tanks. We present a case of severe repeated sunburn, which poses another risk of preventable injury during hot air balloon rides, and briefly discuss the injury epidemiology of hot air balloon rides.
      PubDate: 2015-06-08T07:14:05.641046-05:
      DOI: 10.1111/jtm.12213
  • Travel Medicine Encounters of Australian General Practice Trainees—A
           Cross‐Sectional Study
    • Authors: Simon Morgan; Kim M. Henderson, Amanda Tapley, John Scott, Mieke L. van Driel, Neil A. Spike, Lawrie A. McArthur, Andrew R. Davey, Nigel F. Catzikiris, Parker J. Magin
      Abstract: Background Travel medicine is a common and challenging area of clinical practice and practitioners need up‐to‐date knowledge and experience in a range of areas. Australian general practitioners (GPs) play a significant role in the delivery of travel medicine advice. We aimed to describe the rate and nature of travel medicine consultations, including both the clinical and educational aspects of the consultations. Methods A cross‐sectional analysis from an ongoing cohort study of GP trainees' clinical consultations was performed. Trainees contemporaneously recorded demographic, clinical, and educational details of consecutive patient consultations. Proportions of all problems/diagnoses managed in these consultations that were coded “travel‐related” and “travel advice” were both calculated with 95% confidence intervals (CIs). Associations of a problem/diagnosis being “travel‐related” or “travel advice” were tested using simple logistic regression within the generalized estimating equations (GEE) framework. Results A total of 856 trainees contributed data on 169,307 problems from 108,759 consultations (2010–2014). Travel‐related and travel advice problems were managed at a rate of 1.1 and 0.5 problems per 100 encounters, respectively. Significant positive associations of travel‐related problems were younger trainee and patient age; new patient to the trainee and practice; privately billing, larger, urban, and higher socioeconomic status practices; and involvement of the practice nurse. Trainees sought in‐consultation information and generated learning goals in 34.7 and 20.8% of travel advice problems, respectively, significantly more than in non‐travel advice problems. Significant positive associations of travel advice problems were seeking in‐consultation information, generation of learning goals, longer consultation duration, and more problems managed. Conclusions Our findings reinforce the importance of focused training in travel medicine for GP trainees and adequate exposure to patients in the practice setting. In addition, our findings have implications more broadly for the delivery of travel medicine in general practice.
      PubDate: 2015-06-02T02:07:34.937118-05:
      DOI: 10.1111/jtm.12216
  • Tungiasis Outbreak in Travelers From Madagascar
    • Abstract: Seven patients from a group of 16 travelers were diagnosed at our institution with one or more sand fleas on their toes, 1 day to 3 weeks after returning from Madagascar. A questionnaire was sent to the whole group to collect clinical and epidemiological information, which showed that 9 of 13 (69%) had received pre‐travel medical advice, but none were aware of sand flea; thus prevention measures were rarely applied. Five of seven (71%) patients wore open sandals throughout the trip. Overall, 10 sand fleas were extracted.
      PubDate: 2015-06-02T02:06:11.136902-05:
      DOI: 10.1111/jtm.12217
  • Influenza Outbreaks Among Passengers and Crew on Two Cruise Ships: A
           Recent Account of Preparedness and Response to an Ever‐Present
    • Authors: Alexander J. Millman; Krista Kornylo Duong, Kathryn Lafond, Nicole M. Green, Susan A. Lippold, Michael A. Jhung
      Abstract: Background During spring 2014, two large influenza outbreaks occurred among cruise ship passengers and crew on trans‐hemispheric itineraries. Methods Passenger and crew information for both ships was obtained from components of the ship medical records. Data included demographics, diagnosis of influenza‐like illness (ILI) or acute respiratory illness (ARI), illness onset date, passenger cabin number, crew occupation, influenza vaccination history, and rapid influenza diagnostic test (RIDT) result, if performed. Results In total, 3.7% of passengers and 3.1% of crew on Ship A had medically attended acute respiratory illness (MAARI). On Ship B, 6.2% of passengers and 4.7% of crew had MAARI. In both outbreaks, passengers reported illness prior to the ship's departure. Influenza activity was low in the places of origin of the majority of passengers and both ships' ports of call. The median age of affected passengers on both ships was 70 years. Diagnostic testing revealed three different co‐circulating influenza viruses [influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B] on Ship A and one circulating influenza virus (influenza B) on Ship B. Both ships voluntarily reported the outbreaks to the Centers for Disease Control and Prevention (CDC) and implemented outbreak response plans including isolation of sick individuals and antiviral treatment and prophylaxis. Conclusions Influenza activity can become widespread during cruise ship outbreaks and can occur outside of traditional influenza seasons. Comprehensive outbreak prevention and control plans, including prompt antiviral treatment and prophylaxis, may mitigate the impact of influenza outbreaks on cruise ships.
      PubDate: 2015-06-02T01:56:56.141959-05:
      DOI: 10.1111/jtm.12215
  • Expert Review of Evidence Bases for Managing Monkey Bites in Travelers
    • Authors: Nicholas J. Riesland; Henry Wilde
      PubDate: 2015-06-02T01:56:26.009192-05:
      DOI: 10.1111/jtm.12214
  • High Rate of Multidrug‐Resistant Gram‐Negative Bacilli
           Carriage and Infection in Hospitalized Returning Travelers: A
           Cross‐Sectional Cohort Study
    • Abstract: Background Carriage of and infection with multidrug‐resistant Gram‐negative bacilli (MDR‐GNB) are a potential cause of concern in travelers with no history of hospitalization abroad. Methods All consecutive returning travelers hospitalized in our department between February 2012 and January 2013 were prospectively screened for MDR‐GNB gastrointestinal tract carriage or infection. We compared the prevalence of MDR‐GNB in travelers to a non‐travelers nonexposed group. Then among the travelers, MDR‐GNB carriers were compared to noncarriers to determine risk factors of acquisition of MDR‐GNB. Results Overall, 359 patients (191 travelers, 168 non‐travelers) were included, and 25 (6.4%), including 23 travelers, harbored MDR‐GNB. Five travelers had an MDR‐GNB infection while 18 were asymptomatic enteric carriers. MDR‐GNB carriage or infection was significantly more frequent in travelers (11.0% vs 1.2% for non‐travelers, odds ratio (OR) = 11.3, p 
      PubDate: 2015-05-22T02:06:14.84014-05:0
      DOI: 10.1111/jtm.12211
  • Gnathostomiasis: An Emerging Infection of Raw Fish Consumers in
           Gnathostoma Nematode‐Endemic and Nonendemic Countries
    • Authors: James H. Diaz
      Abstract: Background Gnathostomiasis, a helminthic infection commonly reported in Southeast Asia and Latin America, may follow consumption of raw seafood infected with muscle‐encysted larvae of Gnathostoma species nematodes. As a result of increasingly exotic tastes for local ethnic dishes, including raw seafood, some regions outside of gnathostome‐endemic areas import live species for raw consumption. This may facilitate imported human gnathostomiasis or potentially the establishment of this zoonosis in formerly nonendemic regions. Traveling to a gnathostome‐endemic area is no longer a criterion for diagnosis. The objectives of this review are to enhance clinician awareness of this infection by describing the behavioral risk factors for its acquisition, life‐cycle, clinical manifestations, diagnosis, management, and prevention. Methods Internet search engines were queried with the key medical subject heading words. Case reports, case series, epidemiological investigations, and laboratory studies were reviewed; high risk behaviors for gnathostomiasis were identified; and human cases were stratified as cutaneous gnathostomiasis, visceral gnathostomiasis, neurognathostomiasis, and ocular gnathostomiasis. Results The greatest risk factors for gnathostomiasis included the consumption of raw freshwater seafood dishes in endemic regions and the consumption of raw imported or domestic seafood dishes in households and ethnic restaurants in many nonendemic regions. Conclusions Gnathostomiasis is no longer a disease of returning travelers, and autochthonous cases may be anticipated to increase as a result of the importation of live Gnathostoma‐infected species and the potential establishment of regional zoonoses of Gnathostoma‐infected wild species. Since the eradication of gnathostomiasis is unlikely given the global distribution of Gnathostoma nematodes, the only effective preventive strategy is to educate persons in endemic and nonendemic areas that fish, eels, frogs, snakes, and birds must be cooked thoroughly first before eating and not eaten raw or marinated. The onset of migratory subcutaneous swellings with hyper‐eosinophilia weeks to months after consuming raw seafood should provoke suspicion of gnathostomiasis.
      PubDate: 2015-05-22T02:05:59.403378-05:
      DOI: 10.1111/jtm.12212
  • Short‐Term Immunogenicity and Safety of an Accelerated
           Pre‐Exposure Prophylaxis Regimen With Japanese Encephalitis Vaccine
           in Combination With a Rabies Vaccine: A Phase III, Multicenter,
           Observer‐Blind Study
    • Abstract: Background The current Japanese encephalitis (JE) vaccination regimen requires two doses and 4 weeks to complete, which may not always be feasible for travelers on short notice. One of the primary endpoints of this phase III study was to demonstrate noninferiority of immune responses to a JE vaccine following an accelerated 1‐week JE vaccination regimen administered concomitantly with a rabies vaccine as compared to a standard 4‐week JE regimen alone. In addition, the immunogenicity of concomitant administration of JE and rabies vaccines following standard regimens was evaluated, as well as the tolerability and safety profile of each regimen under study. Methods Healthy adults aged 18 to ≤65 years were randomized to regimens with an accelerated or standard schedule: JE+rabies‐standard (n = 167), JE+rabies‐accelerated (n = 217) or JE‐standard (n = 56). Immunogenicity against JE antigen was assessed by a 50% plaque reduction neutralization test (PRNT50) titer of ≥1 : 10, measured 28 days after last active vaccine (LAV) administration. Solicited reactions were collected 7 days after each vaccination; spontaneously reported adverse events (AEs) and serious AEs were monitored up to day 57. This paper reports results until day 57. Results Noninferiority of immune responses was established for JE+rabies‐accelerated compared to the JE‐standard regimen 28 days after LAV administration. Overall, 99% and 100% of subjects in the JE+rabies‐accelerated and JE‐standard groups, respectively, achieved PRNT50 titers of ≥1 : 10 at 28 days after LAV administration. No impact of concomitant rabies vaccination was observed either on immune responses or on the safety profile of the JE vaccine. Conclusions This was the first randomized, controlled trial that demonstrated the strong short‐term immunogenicity of a new, accelerated, 1‐week JE‐regimen, which was noninferior to that of the standard regimen, with a satisfactory tolerability and safety profile and no impact of concomitant rabies vaccination. This accelerated regimen, if licensed, could potentially be a valid alternative for individuals requiring a primary series of JE vaccination and rabies pre‐exposure prophylaxis on short notice.
      PubDate: 2015-05-22T01:55:31.774843-05:
      DOI: 10.1111/jtm.12210
  • Zika Virus in an American Recreational Traveler
    • Authors: Dyan J. Summers; Rebecca Wolfe Acosta, Alberto M. Acosta
      Abstract: We report the case of a 48‐year‐old American traveler who presented to our clinic with diffuse rash, malaise, fatigue, fever, arthralgia, low back pain, and bilateral exudative conjunctivitis. The patient had an extensive vaccination and travel history: most notable for prior receipt of yellow fever vaccine; extensive travel or residence in areas endemic for dengue, chikungunya, and West Nile virus; and recent travel to French Polynesia. Clinical and laboratory findings were consistent with Zika virus (ZIKV) infection. Our report highlights the need to include ZIKV in the differential diagnosis, especially in febrile patients with a rash returning from endemic areas.
      PubDate: 2015-05-21T07:02:51.572295-05:
      DOI: 10.1111/jtm.12208
  • Yellow Fever Vaccination of a Primary Vaccinee During Adalimumab Therapy
    • Authors: Esther R. Nash; Myron Brand, Spyridon Chalkias
      Abstract: In this case report, we describe a 63‐year‐old female with Crohn's disease since age 16 years, and on adalimumab therapy, who inadvertently received a yellow fever vaccine (YFV) 4 days before her next dose of adalimumab. She had never received YFV. Her next dose of tumor necrosis factor (TNF) antagonist was held. She did not report any adverse effects referable to the vaccine. Reverse transcriptase‐polymerase chain reaction (RT‐PCR) for yellow fever (YF) viral RNA on days 12 and 18 postvaccination was negative. Neutralizing antibody to YF virus vaccine was immunoprotective on day 18 following vaccination, which further increased by day 26. A neutralizing antibody obtained 2 years following vaccination also remained immunoprotective.
      PubDate: 2015-04-29T02:01:15.672925-05:
      DOI: 10.1111/jtm.12209
  • A Case of Rickettsia felis Infection Imported From Nepal
    • Authors: Giorgia Sulis; Paola Rodari, Silvio Caligaris, Lina R. Tomasoni, Francesco Castelli, Maurizio Gulletta
      Abstract: Rickettsia felis is an emerging spotted fever group pathogen that may be responsible for potentially life‐threatening infections. A cosmopolitan distribution has been postulated though most human cases were observed in Africa and the Americas. We report an imported case from Nepal that occurred in an Italian tourist who presented with a 1‐week history of fever, headache, nausea, vomiting, and a mild maculopapular rash 14 days after return.
      PubDate: 2015-04-17T06:05:27.400816-05:
      DOI: 10.1111/jtm.12207
  • Marine Scorpaenidae Envenomation in Travelers: Epidemiology, Management,
           and Prevention
    • Authors: James H. Diaz
      Abstract: Background The Scorpaenidae are a large family of venomous marine fish that include scorpionfish, lionfish, and stonefish. Although most stonefish are confined to the Indo‐Pacific, scorpionfish are distributed in the tropics worldwide, and two species of Indo‐Pacific lionfish were inadvertently introduced into the Eastern Atlantic in the 1990s. Since then, lionfish have invaded shallow reef systems in the Eastern Atlantic, Gulf of Mexico, and Caribbean Sea. All of these regions are popular travel destinations for beachcombing, fishing, swimming, and scuba diving—recreational activities that increase risks of Scorpaenidae envenomation. Methods To meet the objectives of describing species‐specific presenting clinical manifestations, diagnostic and treatment strategies, and outcomes of Scorpaenidae envenomation in travelers, Internet search engines were queried with the key words. Results Well‐conducted, retrospective epidemiological investigations of Scorpaenidae envenomation case series concluded: (1) most cases occurred in young adult male vacationers visiting endemic regions; (2) victims sought medical attention for pain control within 2 hours of injury and presented with intense pain, edema, and erythema in affected extremities; (3) systemic manifestations and surgical interventions were relatively uncommon following initial management with hot water soaks and parenteral analgesics; (4) all cases required tetanus prophylaxis; deeply penetrating, lacerated, and necrotic wounds required antibiotic prophylaxis; and (5) equine Fab stonefish antivenom does have antigen‐neutralizing cross‐reactivities with both Indo‐Pacific and Atlantic Scorpaenidae species and is indicated in severe scorpionfish and stonefish envenomation worldwide. Conclusions Travel medicine practitioners should counsel their patients about Scorpaenidae envenomation risks in endemic regions and maintain a high index of suspicion regarding Scorpaenidae envenomation in all travelers returning from tropical beach and ocean holidays and reporting painful fish sting injuries.
      PubDate: 2015-04-17T05:55:59.386949-05:
      DOI: 10.1111/jtm.12206
  • A Bubble Turtle: Bullous Contact Dermatitis After a Black Henna Tattoo in
           a Backpacker in Thailand
    • Authors: Vorada Choovichian; Lapakorn Chatapat, Watcharapong Piyaphanee
      PubDate: 2015-04-09T07:17:22.824958-05:
      DOI: 10.1111/jtm.12202
  • Fasciola hepatica in a German Traveler Returning From Thailand
    • Authors: Helmut J.F. Salzer; Stefan Schmiedel
      PubDate: 2015-04-09T07:17:10.48929-05:0
      DOI: 10.1111/jtm.12205
  • Lymphadenopathy in Patients With Chikungunya Virus Infection Imported From
           Hispaniola: Case Reports
    • Abstract: Chikungunya virus (CHIKV) is currently spreading in the Caribbean and America. Lymphadenopathy, described in infections with other alphaviruses, is not commonly reported in CHIKV infections. Painful lymphadenopathy was found in three of the first six CHIKV infections from the current outbreak diagnosed at a reference center in Madrid, Spain.
      PubDate: 2015-04-01T01:44:17.40182-05:0
      DOI: 10.1111/jtm.12204
  • Establishment of Health Utility Indices for Post‐Infectious
           Functional Gastrointestinal Disorders in Active Duty US Military
    • Authors: Chad K. Porter; Nadia Thura, Carey D. Schlett, John W. Sanders, David R. Tribble, Marshall R. Monteville, Mark S. Riddle
      Abstract: Introduction Knowledge of disease burden attributable to functional gastrointestinal disorders (FGD) in travelers is lacking, despite the high incidence of travelers' diarrhea (TD) associated with increased FGD risk. One tool for assessing the impact of disease on health‐related quality of life is the health utility index (HUI), which values health states based on preferential health outcomes. Health utilities can be used as preference weights in the estimation of quality‐adjusted life‐years (QALYs). Methods Six months following travel to Egypt or Turkey, 120 US military personnel completed a survey on TD during deployment, health‐related quality of life (SF‐36), and the onset of functional bowel disorders (Rome II). Elements from the SF‐36 were used to develop SF‐6D values, which were combined with health state valuations to enable calculation of HUI scores for each subject. Mean index scores were compared across functional outcomes, specific symptoms, and demographic profiles. Results The presence of FGD significantly reduced index scores, with irritable bowel syndrome (IBS) and dyspepsia showing the greatest impact (−0.17 and −0.19, respectively) compared with those with no FGD (p 
      PubDate: 2015-04-01T01:42:53.443363-05:
      DOI: 10.1111/jtm.12200
  • Myiasis in Travelers
    • Authors: Tamar Lachish; Enbal Marhoom, Kosta Y. Mumcuoglu, Moshik Tandlich, Eli Schwartz
      Abstract: Background Cutaneous myiasis is a well‐established diagnosis in returning travelers from tropical countries. The most common form of myiasis seen in this population is localized furuncular myiasis caused by Dermatobia hominis and Cordylobia anthropophaga. There are limited data on the disease course and outcome in travelers to tropical countries. Methods A retrospective observational study of patients who presented with myiasis was conducted between 1999 and July 2014 in the post‐travel clinics in Israel. Data regarding exposure history, travel duration, clinical presentation, treatment, and parasitological identification were collected and analyzed. Results Among 6,867 ill returning Israeli travelers, 1,419 (21%) had a dermatologic complaint, 90 (6.3%) of them were diagnosed with myiasis. Myiasis was acquired in Latin America by 72 (80%) patients, mainly (54%) in the Madidi National Park, Amazonas Basin, Bolivia; 18 cases (20%) were acquired in Africa. In 76% of cases, manual extraction was sufficient to remove the larva; 24% required surgical intervention. Despite the fact that most patients did not receive antibiotic treatment, only one developed secondary infection, upon partial removal of the larva. Conclusions This is the largest myiasis case series in ill returning travelers. Myiasis is not a rare dermatologic complaint with most Israeli cases imported from Latin America and specifically the Madidi National Park in Bolivia. Treatment is based on full extraction of the larva after which no antibiotic treatment is needed. Myiasis is a preventable disease and travelers should be informed of the different preventive measures according to their travel destination.
      PubDate: 2015-04-01T01:42:51.051098-05:
      DOI: 10.1111/jtm.12203
  • The Risk of Sexual Assault and Rape During International Travel:
           Implications for the Practice of Travel Medicine
    • Authors: Kieran M. Kennedy; Gerard T. Flaherty
      PubDate: 2015-04-01T01:42:32.217967-05:
      DOI: 10.1111/jtm.12201
  • Imminent Departures: Rapid Vaccination Strategies Designed to Induce
           Short‐Term Immunogenicity for the Trip at Hand
    • Authors: David O. Freedman
      Pages: 219 - 220
      PubDate: 2015-07-05T22:53:55.064084-05:
      DOI: 10.1111/jtm.12199
  • What's New in Travel‐Associated Dermatology?
    • Authors: Gentiane Monsel; Eric Caumes
      Pages: 221 - 224
      PubDate: 2015-07-05T22:53:58.103569-05:
      DOI: 10.1111/jtm.12224
  • Severe Toxic Skin Reaction Caused by a Common Anemone and Identification
           of the Culprit Organism
    • Pages: 269 - 271
      Abstract: In a marine envenomation, identification of the culprit organism can be difficult. In this case report, we present our method to identify snakelocks anemone (Anemonia viridis or formerly Anemonia sulcata) as the culprit of a severe toxic skin reaction. A. viridis is one of the most common anemones of the Mediterranean Sea and the North Atlantic Ocean. It lives at a depth of up to 10 m. It is a member of the phylum Cnidaria, which includes jellyfish, anemones, hydroids, and corals. They have toxic organelles called cnidocysts that have the capacity to inject venom with microscopic harpoon‐like structures. The cnidocysts of A. viridis may cause toxic and allergic reactions, and although its venom is one of the most studied cnidarian venoms, detailed case reports are rare.
      PubDate: 2015-07-05T22:53:55.930842-05:
      DOI: 10.1111/jtm.12223
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