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  Subjects -> RECREATION, TRAVEL AND TOURISM (Total: 129 journals)
    - HOTELS AND RESTAURANTS (1 journals)
    - LEISURE AND RECREATION (20 journals)

RECREATION, TRAVEL AND TOURISM (108 journals)                  1 2     

40 [degrees] South     Full-text available via subscription   (Followers: 2)
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: 3)
American Journal of Tourism Research     Open Access   (Followers: 10)
Anatolia : An International Journal of Tourism and Hospitality Research     Hybrid Journal   (Followers: 5)
Annals of Tourism Research     Hybrid Journal   (Followers: 26)
Asia Pacific Journal of Tourism Research     Hybrid Journal   (Followers: 17)
Australian Antarctic Magazine     Free   (Followers: 3)
Caderno Virtual de Turismo     Open Access  
Cornell Hospitality Quarterly     Hybrid Journal   (Followers: 5)
Craft Research     Hybrid Journal  
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: 6)
Gestion Turistica     Open Access  
Globe, The     Full-text available via subscription   (Followers: 4)
Hospitality & Society     Hybrid Journal   (Followers: 1)
Hospitality Review     Full-text available via subscription   (Followers: 1)
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: 9)
International Journal of Culture Tourism and Hospitality Research     Hybrid Journal   (Followers: 13)
International Journal of Digital Culture and Electronic Tourism     Hybrid Journal   (Followers: 8)
International Journal of Event and Festival Management     Hybrid Journal   (Followers: 9)
International Journal of Hospitality & Tourism Administration     Hybrid Journal   (Followers: 6)
International Journal of Hospitality Management     Hybrid Journal   (Followers: 12)
International Journal of Religious Tourism and Pilgrimage     Open Access  
International Journal of Tourism Anthropology     Hybrid Journal   (Followers: 5)
International Journal of Tourism Policy     Hybrid Journal   (Followers: 5)
International Journal of Tourism Research     Hybrid Journal   (Followers: 12)
Journal of Applied Economics and Business     Open Access   (Followers: 1)
Journal of Business & Hotel Management     Partially Free  
Journal of China Tourism Research     Hybrid Journal   (Followers: 5)
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: 9)
Journal of Hospitality and Tourism Technology     Hybrid Journal   (Followers: 3)
Journal of Hospitality Financial Management     Open Access   (Followers: 3)
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  
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: 8)
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: 10)
Journal of Travel Medicine     Hybrid Journal  
Journal of Travel Research     Hybrid Journal   (Followers: 15)
Journal of Unconventional Parks, Tourism & Recreation Research     Open Access  
Journal of Vacation Marketing     Hybrid Journal   (Followers: 3)
Mobilities     Hybrid Journal   (Followers: 4)
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: 6)
ReiseRecht aktuell : Zeitschrift für das Tourismusrecht     Hybrid Journal  
Research in Hospitality Management     Full-text available via subscription   (Followers: 1)
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: 3)
Tourism & Management Studies     Open Access   (Followers: 1)
Tourism Analysis     Full-text available via subscription   (Followers: 9)
Tourism and Hospitality Research     Hybrid Journal   (Followers: 6)
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: 9)
Tourism Management Perspectives     Hybrid Journal   (Followers: 1)
Tourism Planning & Development     Hybrid Journal   (Followers: 10)
Tourism Recreation Research     Hybrid Journal  

        1 2     

Journal Cover   Journal of Travel Medicine
  [SJR: 0.738]   [H-I: 40]   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  [1607 journals]
  • High Rate of Multidrug‐Resistant Gram‐Negative Bacilli
           Carriage and Infection in Hospitalized Returning Travelers: A
           Cross‐Sectional Cohort Study
    • Authors: Loïc Epelboin; Jérôme Robert, Ellina Tsyrina‐Kouyoumdjian, Sonia Laouira, Vanina Meyssonnier, Eric Caumes,
      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
    • Authors: Tomas Jelinek; Gerd D. Burchard, Sebastian Dieckmann, Silja Bühler, Maria Paulke‐Korinek, Hans D. Nothdurft, Emil Reisinger, Khaleel Ahmed, Dietrich Bosse, Seetha Meyer, Marco Costantini, Michele Pellegrini
      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
    • Authors: Francesca F. Norman; Begoña Monge‐Maillo, Jose‐Antonio Perez‐Molina, Fernando de Ory, Leticia Franco, María‐Paz Sánchez‐Seco, Rogelio López‐Vélez
      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
  • Dengue Vaccines for Travelers: Has the Time Come?
    • Authors: Annelies Wilder‐Smith
      PubDate: 2015-04-01T01:35:56.793063-05:
      DOI: 10.1111/jtm.12198
  • Looking Over the Fence—How Travel Medicine Can Benefit From Tourism
    • Authors: Irmgard L. Bauer
      PubDate: 2015-03-19T01:21:16.474243-05:
      DOI: 10.1111/jtm.12197
  • Frequency and Characteristics of Infectious Diseases in Internationally
           Adopted Children: A Retrospective Study in Nantes From 2010 to 2012
    • Authors: Fanny Hénaff; Isabelle Hazart, Georges Picherot, Françoise Baqué, Christèle Gras‐Le Guen, Elise Launay
      Abstract: Background and Aims Internationally adopted children are more susceptible to developing and carrying acute or chronic infectious diseases. Specialized consultations exist in the main French cities; however, specialized consultation with a pediatrician is not mandatory. The main objective of this study was to determine the frequency and characteristics of infections (bacterial, viral, and parasitic) among a group of international adoptees in Nantes over a 3‐year period. Methods A retrospective chart review was conducted of internationally adopted children who went through the Medical Guidance for Adopted Children Consultation between 2010 and 2012. Results A total of 133 children were included in the study. Of these, 55% had an infectious disease; 8% were severe infections. We found a frequency of 38% [confidence interval (CI) 95% 30–46] for parasitic intestinal and 35% (CI 95% 27–43) for dermatologic infections. African children were more likely to have infections that required hospitalization [odds ratio (OR) = 12, p = 0.004, CI 95% 1.3–113.7] and more likely to carry extended‐spectrum β‐lactamase‐producing bacteria. Conclusion The frequency of infectious diseases, and sometimes severe diseases, found among our cohort of internationally adopted children highlights the need for systematic, specialized medical care.
      PubDate: 2015-03-17T01:28:57.109231-05:
      DOI: 10.1111/jtm.12196
  • Estimating Air Travel–Associated Importations of Dengue Virus Into
    • Authors: Mikkel B. Quam; Kamran Khan, Jennifer Sears, Wei Hu, Joacim Rocklöv, Annelies Wilder‐Smith
      Abstract: Background Southern Europe is increasingly at risk for dengue emergence, given the seasonal presence of relevant mosquito vectors and suitable climatic conditions. For example, Aedes mosquitoes, the main vector for both dengue and chikungunya, are abundant in Italy, and Italy experienced the first ever outbreak of chikungunya in Europe in 2007. We set out to estimate the extent of dengue virus importations into Italy via air travelers. Methods We attempted to quantify the number of dengue virus importations based on modeling of published estimates on dengue incidence in the countries of disembarkation and analysis of data on comprehensive air travel from these countries into Italy's largest international airport in Rome. Results From 2005 to 2012, more than 7.3 million air passengers departing from 100 dengue‐endemic countries arrived in Rome. Our Importation Model, which included air traveler volume, estimated the incidence of dengue infections in the countries of disembarkation, and the probability of infection coinciding with travel accounted for an average of 2,320 (1,621–3,255) imported dengue virus infections per year, of which 572 (381–858) were “apparent” dengue infections and 1,747 (1,240–2,397) “inapparent.” Conclusions Between 2005 and 2012, we found an increasing trend of dengue virus infections imported into Rome via air travel, which may pose a potential threat for future emergence of dengue in Italy, given that the reoccurring pattern of peak importations corresponds seasonally with periods of relevant mosquito vector activity. The observed increasing annual trends of dengue importation and the consistent peaks in late summer underpin the urgency in determining the threshold levels for the vector and infected human populations that could facilitate novel autochthonous transmission of dengue in Europe.
      PubDate: 2015-03-10T03:59:32.747507-05:
      DOI: 10.1111/jtm.12192
  • Delayed Diagnosis of High Drug‐Resistant Microorganisms Carriage in
           Repatriated Patients: Three Cases in a French Intensive Care Unit
    • Authors: Jérôme Allyn; Marion Angue, Olivier Belmonte, Nathalie Lugagne, Nicolas Traversier, David Vandroux, Yannick Lefort, Nicolas Allou
      Abstract: We report three cases of high drug‐resistant microorganisms (HDRMO) carriage by patients repatriated from a foreign country. National recommendations suggest systematic screening and contact isolation pending results of admission screening of all patients recently hospitalized abroad. HDRMO carriage (carbapenem‐resistant Acinetobacter baumanii and carbapenemase‐producing Enterobacteriaceae) was not isolated on admission screening swabs, but later between 3 and 8 days after admission. In absence of cross‐transmission, two hypotheses seem possible: a false‐negative test on admission, or a late onset favored by antibiotic pressure. Prolonged isolation may be discussed even in case of negative screening on admission from high‐risk patients.
      PubDate: 2015-02-28T03:46:15.381153-05:
      DOI: 10.1111/jtm.12194
  • The Estimation of Imported Dengue Virus From Thailand
    • Authors: Sittisede Polwiang
      Abstract: Background Dengue fever is one of the important causes of illness among travelers returning from Thailand. The risk of infection depends on the length of stay, activities, and arrival time. Due to globalization, there is a concern that infected travelers may carry dengue virus (DENV) to their country of residence and cause an outbreak. Methods To estimate the infective person‐days of travelers returning from Thailand, we developed a model with the following parameters: the probability of travelers being infected, number of arrivals, length of stay of travelers, incubation period, and duration of the infective period. The data used in this study were the dengue incidences in Thailand during 2004–2013 and foreign traveler arrivals in 2013. Results We estimated the highest infective person‐days for each country group. The highest value was from June to August during the rainy season in Thailand for all groups. Infective person‐days ranged from 87 to 112 per 100,000 travelers each year. Conclusion Our results provided a fundamental step toward estimation of the risk of the secondary transmission of DENV in non‐epidemic countries via travelers, which can serve as an early warning of a dengue outbreak. The highest infective person‐day is associated with the rainy season in Thailand. The increasing number of overseas travelers may increase the risk of global transmission of the DENV. Better understanding of the virus transmission dynamics will enable further quantitative predictions of epidemic risk.
      PubDate: 2015-02-28T02:02:51.188032-05:
      DOI: 10.1111/jtm.12193
  • The Raised Potential for Vector‐Borne Diseases in European Travelers
           Following the EU's Biocide Directive on DEET Dosing
    • Authors: Ron H. Behrens
      PubDate: 2015-02-28T01:52:13.628549-05:
      DOI: 10.1111/jtm.12191
  • Massive Intra‐Alveolar Hemorrhage Caused by Leptospira Serovar
           Djasiman in a Traveler Returning From Laos
    • Authors: Guillaume Héry; Julien Letheulle, Erwan Flécher, Charlotte Quentin, Caroline Piau, Yves Le Tulzo, Pierre Tattevin
      Abstract: Leptospirosis is one of the most common pathogens responsible for life‐threatening tropical disease in travelers. We report a case of massive intra‐alveolar hemorrhage caused by Leptospira serovar Djasiman in a 38‐year‐old man returning from Laos, who was cured with antibiotics and salvage treatment with extra‐corporeal membrane oxygenation.
      PubDate: 2015-02-28T01:31:35.309969-05:
      DOI: 10.1111/jtm.12189
  • Patient Awareness of Need for Hepatitis A Vaccination (Prophylaxis) Before
           International Travel
    • Authors: Stephen J. Liu; Umid Sharapov, Monina Klevens
      Abstract: Introduction Although hepatitis A virus (HAV) infection is preventable through vaccination, cases associated with international travel continue to occur. The purpose of this study was to examine the frequency of international travel and countries visited among persons infected with HAV and assess reasons why travelers had not received hepatitis A vaccine before traveling. Methods Using data from sentinel surveillance for HAV infection in seven US counties during 1996 to 2006, we examined the role of international travel in hepatitis A incidence and the reasons for patients not being vaccinated. Results Of 2,002 hepatitis A patients for whom travel history was available, 300 (15%) reported traveling outside of the United States. Compared to non‐travelers, travelers were more likely to be female [odds ratio (OR) = 1.74 (95% confidence interval [95% CI], 1.35, 2.24)], aged 0 to 17 years [OR = 3.30 (1.83, 5.94)], Hispanic [OR = 3.69 (2.81, 4.86)], Asian [OR = 2.00 (1.06, 3.77)], and were less likely to be black non‐Hispanic [OR = 0.30 (0.11, 0.82)]. The majority, 189 (61.6%), had traveled to Mexico. The most common reason for not getting pre‐travel vaccination was “Didn't know I could [or should] get shots” [100/154 (65%)]. Conclusion Low awareness of HAV vaccination was the predominant reason for not being protected before travel. Different modes of traveler education could improve prevention of hepatitis A. To highlight the risk of infection before traveling to endemic countries including Mexico, travel and consulate websites could list reminders of vaccine recommendations.
      PubDate: 2015-01-24T09:36:03.9437-05:00
      DOI: 10.1111/jtm.12186
  • Acute Schistosomiasis: A Risk Underestimated by Travelers and a Diagnosis
           Frequently Missed by General Practitioners—A Cluster Analysis of 42
    • Authors: Laurence Rochat; Alain Bizzini, Nicolas Senn, Pierre‐Yves Bochud, Blaise Genton, Serge de Vallière
      Abstract: Background In 2011, a patient was admitted to our hospital with acute schistosomiasis after having returned from Madagascar and having bathed at the Lily waterfalls. On the basis of this patient's indication, infection was suspected in 41 other subjects. This study investigated (1) the knowledge of the travelers about the risks of schistosomiasis and their related behavior to evaluate the appropriateness of prevention messages and (2) the diagnostic workup of symptomatic travelers by general practitioners to evaluate medical care of travelers with a history of freshwater exposure in tropical areas. Methods A questionnaire was sent to the 42 travelers with potential exposure to schistosomiasis. It focused on pre‐travel knowledge of the disease, bathing conditions, clinical presentation, first suspected diagnosis, and treatment. Results Of the 42 questionnaires, 40 (95%) were returned, among which 37 travelers (92%) reported an exposure to freshwater, and 18 (45%) were aware of the risk of schistosomiasis. Among these latter subjects, 16 (89%) still reported an exposure to freshwater. Serology was positive in 28 (78%) of 36 exposed subjects at least 3 months after exposure. Of the 28 infected travelers, 23 (82%) exhibited symptoms and 16 (70%) consulted their general practitioner before the information about the outbreak had spread, but none of these patients had a serology for schistosomiasis done during the first consultation. Conclusions The usual prevention message of avoiding freshwater contact when traveling in tropical regions had no impact on the behavior of these travelers, who still went swimming at the Lily waterfalls. This prevention message should, therefore, be either modified or abandoned. The clinical presentation of acute schistosomiasis is often misleading. General practitioners should at least request an eosinophil count, when confronted with a returning traveler with fever. If eosinophilia is detected, it should prompt the search for a parasitic disease.
      PubDate: 2015-01-21T04:18:59.920383-05:
      DOI: 10.1111/jtm.12187
  • Immediate Recall of Health Issues Discussed During a Pre‐Travel
    • Authors: Sarah L. McGuinness; Tim Spelman, Douglas F. Johnson, Karin Leder
      Abstract: Background An important role of pre‐travel consultations is to improve travelers' understanding of travel‐related diseases, but the efficacy of education provided is unknown. This study sought to assess recall and knowledge immediately following a pre‐travel consultation. Methods The study was conducted at a hospital‐based pre‐travel clinic in Melbourne, Australia. Travelers aged ≥16 years seen between September 2010 and March 2012 were invited to complete an anonymous self‐administered questionnaire immediately following their consultation to assess knowledge of appropriate preventive measures and presumptive self‐treatment strategies for common travel risks. The doctor of each participating traveler also completed a survey regarding issues discussed. Results A total of 300 participants were recruited (34% male, median age 31 years). Most were traveling for vacation (77%) and reported previous travel (95%). Main travel destinations were Asia (43%), Americas (21%), and Africa (17%). Doctors' and travelers' surveys showed variable levels of concordance: 94% of patients recalled discussion of malaria, 84% rabies, and 76% dengue. For malaria, 95% remembered discussions regarding insect repellents, and 92% recalled that medical advice should be sought if fever developed. For travelers with whom rabies was discussed, 94% recalled that medical advice must be urgently sought following a bite/scratch. For travelers' diarrhea (TD), 99% knew to drink only boiled/bottled water, but 13% did not recall avoiding unpeeled fruit/vegetables as a prevention strategy. There was 20% discordance between doctors and travelers regarding antibiotics for TD self‐treatment, but only 4% discordance regarding prescription of malaria prophylaxis. Factors associated with improved recall were doctor discussion, previous travel, and a university education. Conclusions Key travel health messages are well assimilated after pre‐travel consultation. However, large amounts of information are discussed and immediate recollection of all information is not possible. This study reinforces the importance of providing supplementary information (eg, written and/or electronic resources) to accompany pre‐travel consultations.
      PubDate: 2015-01-16T01:10:56.08216-05:0
      DOI: 10.1111/jtm.12183
  • The Pre‐Travel Health Consultation
    • Authors: Iain B. McIntosh
      Pages: 143 - 144
      PubDate: 2015-04-23T02:18:05.891783-05:
      DOI: 10.1111/jtm.12182
  • Medical Tourism
    • Authors: Lin H. Chen; Mary E. Wilson
      Pages: 218 - 218
      PubDate: 2015-04-23T02:18:02.608282-05:
      DOI: 10.1111/jtm.12190
  • Travelers With Immune‐Mediated Inflammatory Diseases: Are They
    • Authors: Veronika K. Jaeger; Rolanda Rüegg, Robert Steffen, Christoph Hatz, Silja Bühler
      Abstract: Background Patients with immune‐mediated inflammatory diseases (IMIDs) increasingly benefit from improved health due to new therapeutic regimens allowing increasing numbers of such patients to travel overseas. This study aims to assess the proportion of IMID travelers seeking advice at the Travel Clinic of the University of Zurich, Switzerland, and to determine whether demographics, travel, and vaccination patterns differ between IMID‐ and non‐IMID travelers. Methods Pre‐travel visits and differences between IMID‐ and non‐IMID travelers were assessed; logistic regression was used to adjust for confounders. Results Among 22,584 travelers who visited the Zurich Travel Clinic in a 25‐month period, 1.8% suffered from an IMID, with gastroenterological and rheumatic conditions being the most common; 34.2% were using immunosuppressive or immunomodulatory medication. The reasons for travel and the destinations did not differ between IMID‐ and non‐IMID travelers, Thailand and India being the most common destinations. IMID travelers stayed less often for longer than 1 month abroad and traveled less frequently on a low budget. Inactivated vaccines were similarly administered to both groups, while live vaccines were given half as often to IMID travelers. Conclusions The increasing numbers of IMID patients, many using immunosuppressive or immunomodulatory therapy, show similar travel patterns as non‐IMID travelers. Thus, they are exposed to the same travel health risks, vaccine‐preventable infections being one among them. Particularly, in view of the fact that live attenuated vaccines are less often administered to IMID patients more data are needed on the safety and immunogenicity of vaccines and on travel‐specific risks to be able to offer evidence‐based pre‐travel health advice.
      PubDate: 2014-12-22T02:53:49.098708-05:
      DOI: 10.1111/jtm.12184
  • Risk of Hepatitis A Decreased Among Dutch Travelers to Endemic Regions in
           2003 to 2011
    • Authors: Jussi Sane; Rita de Sousa, Wilfrid van Pelt, Mariska Petrignani, Linda Verhoef, Marion Koopmans
      Abstract: We divided the number of travel‐related hepatitis A cases notified in Dutch surveillance (2003–2011) by travel data obtained from an annual holiday survey to estimate the risk of hepatitis A among Dutch travelers. Of the 2,094 cases notified, 931 (44%) were imported. Morocco (n = 272, 29%), Turkey (n = 98, 11%), and Egypt (n = 87, 9%) accounted for the largest proportion of cases. Attack rates in returnees from high or intermediate endemic regions declined from 7.5 per 100,000 travelers (95% CI 6.7–8.4) in 2003–2005 to 3.5 (95% CI 3.0–4.0) in 2009–2011 (p 
      PubDate: 2014-12-22T02:53:14.066365-05:
      DOI: 10.1111/jtm.12181
  • Epidemiology and Self‐Treatment of Travelers' Diarrhea in a Large,
           Prospective Cohort of Department of Defense Beneficiaries
    • Authors: Tahaniyat Lalani; Jason D. Maguire, Edward M. Grant, Jamie Fraser, Anuradha Ganesan, Mark D. Johnson, Robert G. Deiss, Mark S. Riddle, Timothy Burgess, David R. Tribble,
      Abstract: Background Infectious diarrhea is a common problem among travelers. Expert guidelines recommend the prompt use of antibiotics for self‐treatment of moderate or severe travelers' diarrhea (TD). There is limited data on whether travelers follow these self‐treatment guidelines. We evaluated the risk factors associated with TD, the use of TD self‐treatment, and the risk of irritable bowel syndrome (IBS) during travel. Methods Department of Defense beneficiaries traveling outside the United States for ≤6.5 months were enrolled in a prospective cohort study. Participants received pre‐ and post‐travel surveys, and could opt into a travel illness diary and follow‐up surveys for symptoms of IBS. Standard definitions were used to assess for TD and IBS. Suboptimal self‐treatment was defined as the use of antibiotics (with or without antidiarrheal agents) for mild TD, or the use of antidiarrheals alone or no self‐treatment in cases of moderate or severe TD. Results Twenty‐four percent of participants (270/1,120) met the criteria for TD. The highest incidence was recorded in Africa [8.6 cases/100 person‐weeks, 95% confidence interval (CI): 6.7–10.5]. Two hundred and twelve participants with TD provided information regarding severity and self‐treatment: 89 (42%) had mild TD and 123 (58%) had moderate or severe TD. Moderate or severe TD was independently associated with suboptimal self‐treatment [OR 10.4 (95% CI: 4.92–22.0)]. Time to last unformed stool did not differ between optimal and suboptimal self‐treatment. IBS occurred in 4.5% (7/154) of TD cases and in 3.1% (16/516) of cases without TD (p = 0.39). Among TD cases, a lower incidence of IBS was noted in participants who took antibiotics [4.8% (5/105) vs 2.2% (1/46)] in those who did not, but the difference did not reach statistical significance (p = 0.60). Conclusions Our results suggest the underutilization of antibiotics in travelers with moderate or severe TD. Further studies are needed to systematically evaluate pre‐travel instruction and traveler adherence to self‐treatment guidelines, and the impact of suboptimal self‐treatment on outcomes.
      PubDate: 2014-12-07T21:36:49.087225-05:
      DOI: 10.1111/jtm.12179
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