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Journal of Travel Medicine

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ISSN (Print) 1195-1982 - ISSN (Online) 1708-8305
Published by John Wiley and Sons

[1587 journals]

Response to Letter
- Authors: Rosalie Zimmermann; Christoph Hatz, Reto Nüesch
  Pages: n/a - n/a
  PubDate: 2013-05-16T04:50:28.062155-05:
  DOI: 10.1111/jtm.12044_2
What Is the PRISM Visual Tool Measuring? Risk Affiliation?
- Authors: Rudy Zimmer
  Pages: n/a - n/a
  PubDate: 2013-05-16T04:50:12.48566-05:0
  DOI: 10.1111/jtm.12044_1
Travel‐Related Leptospirosis: A Series of 15 Imported Cases
- Authors: Charlotte van de Werve; Alice Perignon, Stéphane Jauréguiberry, François Bricaire, Pascal Bourhy, Eric Caumes
  Pages: n/a - n/a
  Abstract: Background Leptospirosis belongs to the spectrum of travel‐related infections. Methods We retrospectively studied all the consecutive cases of travel‐related leptospirosis seen in our department between January 2008 and September 2011. Patients were included with a clinical picture compatible with the disease within 21 days after return, the presence of a thermoresistant antigen or IgM antibodies, Elisa ≥ 1 /400, and a positive microagglutination test (MAT) ≥ 1/100. Results Fifteen leptospirosis cases were evaluated. Exposure occurred in Asia (47%), Africa (20%), the Caribbean (20%), and Indian Ocean (13%). Fourteen patients were infected during water‐related activities. On admission the most frequent symptoms were fever (100%), headache (80%), and digestive disorders (67%). Relevant laboratory findings included impaired liver function tests (100%), lymphocytopenia (80%), thrombocytopenia (67%), and elevated C‐reactive protein (CRP) (67%). Our cases were confirmed by MAT that found antibodies against nine different serovars. Seven patients were cured with amoxicillin, four with doxycycline, two with ceftriaxone, one with ceftriaxone, doxycycline, and spiramycin, whereas one recovered spontaneously (retrospective diagnosis). Eight patients were hospitalized. All patients recovered. Conclusion Our cases involved nine different serovars. They were related to travel in Asia, Africa, and the Caribbean. Bathing or other fresh‐water leisure activities (canoeing, kayaking, rafting) are the most likely at‐risk exposure. Any traveler with fever and at‐risk exposure should be investigated for leptospirosis.
  PubDate: 2013-05-15T02:38:51.175852-05:
  DOI: 10.1111/jtm.12035
Acute Hepatitis in Israeli Travelers
- Authors: Tamar Lachish; Moshik Tandlich, Eli Schwartz
  Pages: n/a - n/a
  Abstract: Background Acute hepatitis is a well‐described cause of morbidity and sporadic mortality in travelers. Data regarding the epidemiology of hepatitis in travelers are lacking. The aim of this study is to describe the epidemiology of acute viral hepatitis among travelers returning from tropical countries, with particular attention to enterically transmitted hepatitis. Methods This study is a prospective observational study of ill‐returned travelers who presented at two travel medicine clinics in Israel between the years 1997 and 2012. Data of patients with acute hepatitis were summarized. Only travelers were included, immigrants and foreign workers were excluded. Results Among 4,970 Israeli travelers who were seen during this period, 49 (1%) were diagnosed with acute hepatitis. Among them, hepatitis E virus (HEV) was the etiology in 19 (39%) cases and hepatitis A virus (HAV) was the etiology in 13 (27%) cases, demonstrating that 65% of all cases were due to enterically transmitted hepatitis. Acquiring acute hepatitis B (two cases) or acute hepatitis C (one case) was uncommon (6.1%). In 27% of the cases, no diagnosis was determined. Fifty‐five percent of cases were imported from the Indian subcontinent, with a predominance of HEV infection (84%). A significant male predominance was seen in all groups regardless of etiology. Pre‐travel consultation was documented in only 7% of those with vaccine preventable hepatitis (hepatitis A & B) compared to 89% in those with hepatitis E. Conclusions Enterically transmitted hepatitis is the main causes of viral hepatitis among travelers. HEV is an emerging disease and has become the most common hepatitis among Israeli travelers. Although an efficacious vaccine has been developed, no licensed HEV vaccine is yet available. Although hepatitis A vaccine is highly efficacious, safe, and easily available, there is a stable number of HAV cases.
  PubDate: 2013-05-15T02:34:00.318704-05:
  DOI: 10.1111/jtm.12039
Hepatitis B and C Infection in International Travelers
- Authors: Douglas F. Johnson; Karin Leder, Joseph Torresi
  Pages: n/a - n/a
  Abstract: Background Hepatitis B and C virus (HBV and HCV) cause significant morbidity and mortality worldwide. With the rise in international travel over the last three decades, many travelers are at risk of HBV and HCV infection. Methods This review focuses on the epidemiology of HBV and HCV in international travelers, the modes of transmission, and the prevention of infection in travelers. Results The risk of HBV and HCV infection varies widely and depends on the prevalence of the destination country, the duration of travel, and the activities undertaken while abroad. Travelers commonly undertake high‐risk activities that place them at risk of both HBV and HCV infection. Poor uptake of preventative health measures and poor adherence to health recommendations are also common. The monthly incidence of HBV infection for long‐term travelers to endemic countries ranges from 25 to 420 per 100,000 travelers. HBV infection can be prevented through timely vaccination of travelers. HBV vaccination is safe and efficacious with protective levels of antibodies achieved in >90% of recipients. Information regarding the risk of HCV acquisition is scarce and until recently was limited to case reports following medical interventions. Conclusions This review demonstrates international travelers are at risk of HBV and HCV infection and provides evidence‐based information enabling health practitioners to provide more appropriate pre‐travel advice. HBV vaccination should be considered in all travelers to countries with a moderate to high HBV prevalence (HBsAg ≥ 2%) and the risk and benefits discussed with the individuals in consultation with the health practitioner. There is no duration of travel without risk of HBV infection. However, it is apparent that those travelers with a longer duration of travel are at greatest risk of HBV infection (ie, expatriates). Travelers should also receive advice regarding the modes of transmission and the activities that place them at risk of both HBV and HCV infection.
  PubDate: 2013-04-03T23:33:22.152332-05:
  DOI: 10.1111/jtm.12026
International Travelers as Sentinels for Sustained Influenza Transmission During the 2009 Influenza A(H1N1)pdm09 Pandemic
- Authors: Xiaohong M. Davis; Kelly A. Hay, D. Adam Plier, Sandra S. Chaves, Poh Lian Lim, Eric Caumes, Francesco Castelli, Phyllis E. Kozarsky, Martin S. Cetron, David O. Freedman,
  Pages: n/a - n/a
  Abstract: Background International travelers were at risk of acquiring influenza A(H1N1)pdm09 (H1N1pdm09) virus infection during travel and importing the virus to their home or other countries. Methods Characteristics of travelers reported to the GeoSentinel Surveillance Network who carried H1N1pdm09 influenza virus across international borders into a receiving country from April 1, 2009, through October 24, 2009, are described. The relationship between the detection of H1N1pdm09 in travelers and the level of H1N1pdm09 transmission in the exposure country as defined by pandemic intervals was examined using analysis of variance (anova). Results Among the 203 (189 confirmed; 14 probable) H1N1pdm09 case‐travelers identified, 56% were male; a majority, 60%, traveled for tourism; and 20% traveled for business. Paralleling age profiles in population‐based studies only 13% of H1N1pdm09 case‐travelers were older than 45 years. H1N1pdm09 case‐travelers sought pre‐travel medical advice less often (8%) than travelers with non‐H1N1pdm09 unspecified respiratory illnesses (24%), and less often than travelers with nonrespiratory illnesses (43%; p
  PubDate: 2013-03-14T01:55:45.818719-05:
  DOI: 10.1111/jtm.12025
The Global Availability of Rabies Immune Globulin and Rabies Vaccine in Clinics Providing Direct Care to Travelers
- Authors: Emily S. Jentes; Jesse D. Blanton, Katherine J. Johnson, Brett W. Petersen, Mark J. Lamias, Kis Robertson, Richard Franka, Deborah Briggs, Peter Costa, Irene Lai, Doug Quarry, Charles E. Rupprecht, Nina Marano, Gary W. Brunette
  Pages: n/a - n/a
  Abstract: Background Rabies, which is globally endemic, poses a risk to international travelers. To improve recommendations for travelers, we assessed the global availability of rabies vaccine (RV) and rabies immune globulin (RIG). Methods We conducted a 20‐question online survey, in English, Spanish, and French, distributed via e‐mail to travel medicine providers and other clinicians worldwide from February 1 to March 30, 2011. Results were compiled according to the region. Results Among total respondents, only 190 indicated that they provided traveler postexposure care. Most responses came from North America (38%), Western Europe (19%), Australia and South and West Pacific Islands (11%), East and Southeast Asia (8%), and Southern Africa (6%). Approximately one third of 187 respondents stated that patients presented with wounds from an animal exposure that were seldom or never adequately cleansed. RIG was often or always accessible for 100% (n = 5) of respondents in the Middle East and North Africa; 94% (n = 17) in Australia and South and West Pacific Islands; 20% (n = 1) in Tropical South America; and 56% (n = 5) in Eastern Europe and Northern Asia. Ninety‐one percent (n = 158) of all respondents reported that RV was often or always accessible. For all regions, 35% (n = 58) and 26% (n = 43) of respondents felt that the cost was too high for RIG and RV, respectively. Conclusion The availability of RV and RIG varied by geographic region. All travelers should be informed that RIG and RV might not be readily available at their destination and that travel health and medical evacuation insurance should be considered prior to departure. Travelers should be educated to avoid animal exposures; to clean all animal bites, licks, and scratches thoroughly with soap and water; and to seek medical care immediately, even if overseas.
  PubDate: 2013-03-14T01:25:49.958324-05:
  DOI: 10.1111/jtm.12024
Hypoxia‐Related Altitude Illnesses
- Authors: Nikolaus Netzer; Kingman Strohl, Martin Faulhaber, Hannes Gatterer, Martin Burtscher
  Pages: n/a - n/a
  Abstract: Background Millions of tourists and climbers visit high altitudes annually. Many unsuspecting and otherwise healthy individuals may get sick when sojourning to these high regions. Acute mountain sickness represents the most common illness, which is usually benign but can rapidly progress to the more severe and potentially fatal forms of high‐altitude cerebral edema and high‐altitude pulmonary edema. Methods Data were identified by searches of Medline (1965 to May 2012) and references from relevant articles and books. Studies, reviews, and books specifically pertaining to the epidemiology, prevention, and treatment of high‐altitude illnesses in travelers were selected. Results This review provides information on geographical aspects, physiology/pathophysiology, clinical features, risk factors, and the prevalence of high‐altitude illnesses and also state‐of‐the art recommendations for prevention and treatment of such illnesses. Conclusion Given an increasing number of recreational activities at high and extreme altitudes, the general practitioner and specialist are in higher demand for medical recommendations regarding the prevention and treatment of altitude illness. Despite an ongoing scientific discussion and controversies about the pathophysiological causes of altitude illness, treatment and prevention recommendations are clearer with increased experience over the last two decades.
  PubDate: 2013-03-10T23:35:38.441282-05:
  DOI: 10.1111/jtm.12017
Detection of Dengue Virus Nonstructural Protein 1 (NS1) by Using ELISA as a Useful Laboratory Diagnostic Method for Dengue Virus Infection of International Travelers
- Authors: Meng Ling Moi; Tsutomu Omatsu, Shigeru Tajima, Chang‐Kweng Lim, Akira Kotaki, Makiko Ikeda, Fumiue Harada, Mikako Ito, Masayuki Saijo, Ichiro Kurane, Tomohiko Takasaki
  Pages: n/a - n/a
  Abstract: Background Dengue virus ( DENV) nonstructural protein 1 ( NS1) has been used as a novel diagnostic marker during the early phase of DENV infection. Methods Presence of NS1 antigen was examined using 336 serum samples obtained from 276 travelers returning to Japan from Asia, Central and South America, Pacific Islands, and Africa with dengue. Assay specificity was evaluated using 148 non‐dengue samples. Results Positive rates among four DENV serotypes were 68%–89%. NS1 antigen positive rates were at similar levels between primary infection and secondary infection. NS1 antigen positive rates were 88%–96% on days 1–5, 75%–100% on days 6–10, and 36–60% on ≥day 11. Positive rates using real‐time polymerase chain reaction (RT‐PCR) were over 70% on days 1–5, but decreased thereafter. Conclusions The results indicate that NS1 antigen positive rates were higher than those of RT‐PCR during longer period of early phase in DENV infection. Thus, NS1 antigen ELISA is a useful tool for confirming DENV infection in international travelers, when it is used in combination with anti‐DENV IgM ELISA.
  PubDate: 2013-03-08T04:55:37.637372-05:
  DOI: 10.1111/jtm.12018
A Survey of US Travelers to Asia to Assess Compliance With Recommendations for the Use of Japanese Encephalitis Vaccine
- Authors: Mark R. Duffy; Christie Reed, Paul J. Edelson, Sena Blumensaadt, Kimberly Crocker, Anne Griggs, Brad J. Biggerstaff, Mark J. Delorey, Edward B. Hayes, Marc Fischer
  Pages: n/a - n/a
  Abstract: Background Japanese encephalitis (JE) vaccine is recommended for travelers to Asia whose itineraries increase their risk of exposure to JE virus. The numbers of travelers with such itineraries and the proportion of those who receive JE vaccine are unknown. We performed a survey to estimate the proportion of US travelers to Asia who receive JE vaccine according to the Advisory Committee on Immunization Practices (ACIP) recommendations. Methods We surveyed US residents ≥18 years old departing on 38 flights to Asia selected through a stratified random sample of all direct flights to JE‐endemic countries from three US airports. We asked participants about planned itineraries and activities, sources of travel health information, JE vaccination status, and potential barriers to vaccination. Participants planning to spend ≥30 days in Asia or at least half of their time in rural areas were defined as “higher JE risk” travelers for whom vaccination should have been considered. Results Of 2,341 eligible travelers contacted, 1,691(72%) completed the survey. Among these 1,691 participants, 415 (25%) described itineraries for which JE vaccination should have been considered. Of these 415 higher JE risk travelers, only 47 (11%) reported receiving ≥1 dose of JE vaccine. Of the 164 unvaccinated higher JE risk travelers who visited a health care provider before their trip, 113 (69%) indicated that they had never heard of JE vaccine or their health care provider had not offered or recommended JE vaccine. Conclusions A quarter of surveyed US travelers to Asia reported planned itineraries for which JE vaccination should have been considered. However, few of these at‐risk travelers received JE vaccine.
  PubDate: 2013-03-08T04:55:25.564555-05:
  DOI: 10.1111/jtm.12020
Rabies Immunization of Travelers in a Canine Rabies Endemic Area
- Authors: Suda Sibunruang; Saowaluck Tepsumethanon, Natthasri Raksakhet, Terapong Tantawichien
  Pages: n/a - n/a
  Abstract: Background Travelers to countries where rabies is endemic may be at risk of rabies exposure. We assessed rabies immunization of travelers attending a travel clinic in Thailand. Methods The medical charts of international travelers who came for preexposure (PrEP) or postexposure (PEP) rabies prophylaxis at the Queen Saovabha Memorial Institute (QSMI), Bangkok, Thailand between 2001 and 2011 were retrospectively reviewed. Results A total of 782 travelers, including 188 patients who presented with mammal‐associated injuries and possible rabies exposures and 594 persons who came requesting PrEP, were studied. Of the travelers who received PEP, only 27 (14.3%) had been previously immunized against rabies and 141 (75.0%) cases experienced high‐risk WHO category III exposure. Most of the incidents were unprovoked. Although promptly seeking medical services after the injuries, 114 (60.7%) travelers did not undertake any first‐aid care for their wounds. Of these travelers, 19 (10.3%) received intradermal rabies vaccination as they could complete the series here. Rabies immunoglobulin was given to 118 of 121 (97.5%) patients. About one fourth of recipients could accomplish the full schedule at QSMI. Among visitors who requested PrEP, 454 (76.4%) persons had just started their first dose. Among all visitors, 263 (44.3%) were Japanese. The number of Japanese asking for PrEP was higher in 2006, the year when cases of imported human rabies to Japan were reported. This trend has sustained since then. Two (0.3%) travelers were bitten by suspected rabid dogs before they completed their PrEP program. Conclusion Rabies prophylaxis is an important decision for each traveler. It should be made before visiting endemic areas.
  PubDate: 2013-03-08T04:09:19.5147-05:00
  DOI: 10.1111/jtm.12023
Low Risk of Japanese Encephalitis in Short‐Term Australian Travelers to Asia
- Authors: Irani Ratnam; Karin Leder, Jim Black, Beverley‐Ann Biggs, Elizabeth Matchett, Alex Padiglione, Ian Woolley, Theo Panagiotidis, Tony Gherardin, Christine Luxemburger, Joseph Torresi
  Pages: n/a - n/a
  Abstract: The risk of Japanese encephalitis (JE) in travelers is unknown. In this prospective study, we investigated the incidence of JE in 387 short‐term Australian travelers visiting Asia over a 32‐month period from August 2007 to February 2010 by performing pre‐ and post‐travel antibody testing. No travelers were infected with JE virus during travel, indicating a low risk of infection for short‐term travelers.
  PubDate: 2013-03-08T02:25:25.177557-05:
  DOI: 10.1111/jtm.12019
Family Compliance With Counseling for Children Traveling to the Tropics
- Authors: Stéphanie Caillet‐Gossot; Rémi Laporte, Guilhem Noël, Philippe Gautret, Georges Soula, Jean Delmont, Benoit Faucher, Philippe Parola, Lindsay Osei, Philippe Minodier
  Pages: n/a - n/a
  Abstract: Background The number of people, both adults and children, traveling abroad, is on the rise. Some seek counseling at travel medicine centers before departure. Methods A prospective study was conducted among children
  PubDate: 2013-03-08T02:23:05.521817-05:
  DOI: 10.1111/jtm.12016
Human Rabies Prevention (Comment From a Canine‐Rabies‐Endemic Region)
- Authors: Henry Wilde; Supaporn Wacharapluesadee, Abhinbhen Saraya, Boonlert Lumlertdacha, Thiravat Hemachudha
  Pages: 139 - 142
  PubDate: 2013-04-12T01:51:37.467286-05:
  DOI: 10.1111/jtm.12022
Pre‐travel Consultation and Hepatitis B: A Double Opportunity for Preventing Infection in At‐Risk Patients and Life‐Threatening Complications in HBV Carriers
- Authors: Patricia F. Walker
  Pages: 143 - 145
  PubDate: 2013-04-12T01:51:37.467286-05:
  DOI: 10.1111/jtm.12027
Probing Guideline Fundamentals: An Alternate Perspective on Adherence
- Authors: Peter Teitelbaum
  Pages: 146 - 147
  PubDate: 2013-04-12T01:51:37.467286-05:
  DOI: 10.1111/jtm.12021
The Incidence of HBV and HCV Infection in Australian Travelers to Asia
- Authors: Douglas F. Johnson; Irani Ratnam, Elizabeth Matchett, Linda Earnest‐Silveria, Dale Christiansen, Karin Leder, Michael L. Grayson, Joseph Torresi
  Pages: 203 - 205
  Abstract: We analyzed paired pre‐ and post‐travel sera in a cohort of Australian travelers to Asia and demonstrated the acquisition of hepatitis C virus (HCV) and hepatitis B virus (HBV) infection. The incidence density in nonimmune travelers for HCV infection was calculated as 1.8 infections per 10,000 traveler‐days and for HBV infection 2.19 per 10,000 traveler‐days.
  PubDate: 2013-04-12T01:51:37.467286-05:
  DOI: 10.1111/jtm.12029
What to Do With Travelers Who Have Isolated Antibody to Hepatitis B Core Antigen?
- Authors: Stefan Hagmann; Syed A. Shah, Murli Purswani
  Pages: 209 - 209
  PubDate: 2013-04-12T01:51:37.467286-05:
  DOI: 10.1111/jtm.12028_1
Response to Letter
- Authors: Lin H. Chen; Elizabeth D. Barnett, Mary E. Wilson, William MacLeod, Emad A. Yanni, Winnie Ooi, Adolf W. Karchmer, Laura Kogelman, Nina Marano, Davidson H. Hamer
  Pages: 210 - 210
  PubDate: 2013-04-12T01:51:37.467286-05:
  DOI: 10.1111/jtm.12028_2
Dengue Surveillance in the French Armed Forces: A Dengue Sentinel Surveillance System in Countries Without Efficient Local Epidemiological Surveillance
- Authors: Franck de Laval; Aissata Dia, Sébastien Plumet, Christophe Decam, Isabelle Leparc Goffart, Xavier Deparis
  Pages: n/a - n/a
  Abstract: Surveillance of travel‐acquired dengue could improve dengue risk estimation in countries without ability. Surveillance in the French army in 2010 to 2011 highlighted 330 dengue cases, mainly in French West Indies and Guiana: DENV‐1 circulated in Guadeloupe, Martinique, French Guiana, New Caledonia, Djibouti; DENV‐3 in Mayotte and Djibouti; and DENV‐4 in French Guiana.
  PubDate: 2012-12-12T04:12:03.348719-05:
  DOI: 10.1111/j.1708-8305.2012.00674.x