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  Subjects -> RECREATION, TRAVEL AND TOURISM (Total: 121 journals)
    - HOTELS AND RESTAURANTS (1 journals)
    - LEISURE AND RECREATION (20 journals)


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: 9)
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: 4)
Annals of Tourism Research     Hybrid Journal   (Followers: 24)
Asia Pacific Journal of Tourism Research     Hybrid Journal   (Followers: 15)
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: 14)
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: 2)
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: 3)
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: 8)
International Journal of Culture Tourism and Hospitality Research     Hybrid Journal   (Followers: 13)
International Journal of Digital Culture and Electronic Tourism     Hybrid Journal   (Followers: 7)
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: 11)
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: 1)
Journal of Hospitality & Tourism Research     Hybrid Journal   (Followers: 10)
Journal of Hospitality and Tourism Management     Full-text available via subscription   (Followers: 9)
Journal of Hospitality and Tourism Technology     Hybrid Journal   (Followers: 1)
Journal of Hospitality Financial Management     Open Access   (Followers: 3)
Journal of Hospitality Marketing & Management     Hybrid Journal   (Followers: 9)
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: 10)
Journal of Tourism and Cultural Change     Hybrid Journal   (Followers: 7)
Journal of Tourism and Recreation     Open Access   (Followers: 2)
Journal of Tourism Insights     Open Access  
Journal of Tourism Research & Hospitality     Partially Free  
Journal of Travel & Tourism Marketing     Hybrid Journal   (Followers: 9)
Journal of Travel Medicine     Hybrid Journal   (Followers: 1)
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: 4)
Multiciencias     Open Access  
PASOS Revista de Turismo y Patrimonio Cultural     Open Access  
Podium Sport, Leisure and Tourism Review     Open Access   (Followers: 2)
Polish Journal of Sport and Tourism     Open Access   (Followers: 2)
Provincia     Open Access  
Recreational Sport Journal     Hybrid Journal   (Followers: 5)
Research in Hospitality Management     Full-text available via subscription  
Revista de Gestão Ambiental e Sustentabilidade - GeAS     Open Access  
Revista de turism - studii si cercetari in turism     Open Access  
Revista 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: 2)
Tourism & Management Studies     Open Access  
Tourism Analysis     Full-text available via subscription   (Followers: 8)
Tourism and Hospitality Research     Hybrid Journal   (Followers: 6)
Tourism Culture & Communication     Full-text available via subscription   (Followers: 3)
Tourism Economics     Full-text available via subscription   (Followers: 5)
Tourism Geographies: An International Journal of Tourism Space, Place and Environment     Hybrid Journal   (Followers: 12)
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: 9)
Tourism Review     Hybrid Journal  
Tourism Review International     Full-text available via subscription   (Followers: 3)
Tourism, Leisure and Global Change     Open Access  
Tourist Studies     Hybrid Journal   (Followers: 4)
TRANSIT     Open Access  
Translation Studies     Hybrid Journal   (Followers: 13)
Worldwide Hospitality and Tourism Themes     Hybrid Journal   (Followers: 1)
Journal Cover Journal of Travel Medicine
   [3 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  [1603 journals]   [SJR: 0.85]   [H-I: 36]
  • Immunogenicity and Safety of Concomitant Administration of a Combined
           Hepatitis A/B Vaccine and a Quadrivalent Meningococcal Conjugate Vaccine
           in Healthy Adults
    • Authors: Martin Alberer; Gerd Burchard, Tomas Jelinek, Emil C. Reisinger, Seetha Meyer, Eduardo Forleo‐Neto, Alemnew F. Dagnew, Ashwani Kumar Arora
      Pages: n/a - n/a
      Abstract: Background This phase 3b randomized, open‐label study evaluated the immunogenicity and safety of coadministration of a hepatitis A and/or B vaccine with a quadrivalent oligosaccharide meningococcal CRM197‐conjugate vaccine (MenACWY‐CRM), in the context of an accelerated hepatitis A and/or B immunization schedule. Methods A total of 252 healthy adult subjects were randomized to three groups to receive hepatitis A/B only (HepA/B), hepatitis A/B coadministered with MenACWY‐CRM (HepA/B+MenACWY‐CRM), or MenACWY‐CRM only (MenACWY‐CRM). Hepatitis A and/or B vaccination was administered in the form of a single booster dose or a primary three‐dose series, depending on the hepatitis A and/or B vaccination history of subjects. Antibody responses to hepatitis A/B vaccination were assessed 1 month following the last hepatitis A and/or B dose. Serum bactericidal activity with human complement (hSBA) against meningococcal serogroups A, C, W‐135, and Y was assessed 1 month post‐MenACWY‐CRM vaccination. Safety was monitored throughout the study. Results At 1 month following the final hepatitis A and/or B vaccination, concomitant administration of hepatitis A/B and MenACWY‐CRM was non‐inferior to administration of hepatitis A/B alone in terms of geometric mean concentrations of antibodies against the hepatitis A and B antigens. One month post‐MenACWY‐CRM vaccination, the percentages of subjects achieving hSBA titers ≥8 for serogroups A, C, W‐135, and Y in the HepA/B+MenACWY‐CRM group (76, 87, 99, and 94%, respectively) were comparable to those in the MenACWY‐CRM group (67, 82, 96, and 88%, respectively). The percentages of subjects reporting adverse events (AEs) were similar across study groups and a majority of the reported AEs were mild to moderate in nature. There were no study vaccine‐related serious AEs. Conclusions MenACWY‐CRM can be administered concomitantly with a hepatitis A and/or B vaccine in the context of an accelerated hepatitis A and/or B immunization schedule without increasing safety concerns or compromising the immune responses to any of the vaccine antigens. [NCT01453348]
      PubDate: 2014-12-07T21:46:09.203647-05:
      DOI: 10.1111/jtm.12180
  • 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,
      Pages: n/a - n/a
      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
  • Effectiveness of the Typhoid Vi Vaccine in Overseas Travelers from England
    • Authors: Karen S. Wagner; Joanne L. Freedman, Nick J. Andrews, Jane A. Jones
      Pages: n/a - n/a
      Abstract: Background Approximately 500 cases of enteric fever, caused by Salmonella enterica serovar Typhi and Paratyphi, are reported in the UK each year. The majority are associated with travel to the Indian subcontinent. The typhoid Vi vaccine protects against S. Typhi and is available to travelers from their general practice or private clinics. The effectiveness of this vaccine has been assessed previously in endemic regions of the world but not in travelers. Methods Data from the enhanced surveillance scheme concerning persons in England aged ≥2 years who traveled from the UK and contracted culture‐confirmed enteric fever were used to calculate the effectiveness of the vaccine in travelers. A “case‐case” case–control design was used, in which patients with typhoid comprised the “cases” and those with paratyphoid acted as “controls.” Results The overall effectiveness of the vaccine, adjusted for age group, sex, ethnicity, birth in a typhoid‐endemic country, and year (of receipt of specimen), was 65% (95% confidence interval 53%–73%). Effectiveness did not vary across subgroups of any of the factors in the model, but there was some evidence of waning effectiveness of the vaccine with increasing time since receipt (trend p = 0.05). Conclusions The vaccine has been demonstrated to have a similar effectiveness in travelers as that found in endemic populations. It appears to be protective in all ages, including in young children (aged 2–5 years), a finding not consistently replicated in other studies. However, good hygiene practices are necessary in addition to vaccination to prevent infection. The “case‐case” case–control design provides a valuable method of calculating the effectiveness of this vaccine in travelers, given the availability of paratyphoid controls, a population with similar demographics and risk exposures.
      PubDate: 2014-11-30T20:41:19.381399-05:
      DOI: 10.1111/jtm.12178
  • Point‐of‐Care Screening, Prevalence, and Risk Factors for
           Hepatitis B Infection Among 3,728 Mainly Undocumented Migrants From
           Non‐EU Countries in Northern Italy
    • Authors: Issa El‐Hamad; Maria Chiara Pezzoli, Erika Chiari, Carmelo Scarcella, Francesco Vassallo, Massimo Puoti, Anna Ciccaglione, Massimo Ciccozzi, Alfredo Scalzini, Francesco Castelli,
      Pages: n/a - n/a
      Abstract: Background Screening migrants from areas where hepatitis B virus (HBV) infection is endemic is important to implement preventive measures in Europe. The aim of our study was to assess (1) the feasibility of point‐of‐care screening in a primary care clinic and (2) hepatitis B surface antigen (HBsAg) prevalence, associated risk factors, and its clinical and epidemiological implications in undocumented migrants in Brescia, northern Italy. Methods A longitudinal prospective study was conducted from January 2006 to April 2010 to assess HBsAg reactivity and associated risk factors among consenting undocumented migrants who accessed the Service of International Medicine of Brescia's Local Health Authority. Genotyping assay was also performed in HBV DNA‐positive patients. Results Screening was accepted by 3,728/4,078 (91.4%) subjects consecutively observed during the study period, 224 (6%) of whom were found to be HBsAg‐positive. HBsAg reactivity was independently associated with the prevalence of HBsAg carriers in the geographical area of provenance (p 
      PubDate: 2014-11-26T00:13:21.984885-05:
      DOI: 10.1111/jtm.12176
  • Are Pharmacists Ready for a Greater Role in Travel Health? An
           Evaluation of the Knowledge and Confidence in Providing Travel Health
           Advice of Pharmacists Practicing in a Community Pharmacy Chain in Alberta,
    • Authors: Christina S. Bascom; Meagen M. Rosenthal, Sherilyn K.D. Houle
      Pages: n/a - n/a
      Abstract: Background Patients often consult community pharmacists for medication needs related to travel, but little is known of pharmacists' knowledge and readiness to provide this care. The aim of this study was to evaluate pharmacists' knowledge in travel health, and to assess their confidence in providing travel‐related advice to patients. Methods A web‐based survey was developed and distributed to 84 pharmacists practicing in a mid‐size pharmacy chain in Alberta, Canada. The survey included knowledge and confidence assessment components. To assess knowledge, pharmacists were provided two cases, along with multiple‐choice questions examining pre‐travel risk assessment, and advice on travel at altitude, vaccines, malaria, travelers' diarrhea, and other potential travel health risks. Confidence was assessed by asking respondents to report their level of confidence in answering each knowledge assessment question and providing travel advice overall, using a 5‐point Likert scale. Respondents were also asked to indicate preferred means for receiving additional training in travel health. Results A total of 53 pharmacists responded to the survey, with a response rate of 63%. Most (61%) indicated that they had some level of training in travel health and 69% counseled on travel health more than once a month. Only one respondent correctly answered all six questions in the knowledge assessment section. The mean knowledge score (proportion of correct answers, unaided) for the group was 27%. However, the majority (66%) felt confident that they would know where to seek the information required to answer the questions. Overall confidence in this group of pharmacists was determined to be low, with only 21% of respondents reporting that they felt highly confident in providing travel health advice. Conclusions Travel health is becoming an increasingly common topic of discussion between patients and pharmacists. This study suggests that pharmacists' baseline knowledge of travel health may be incomplete, affecting their confidence in providing this advice. Undergraduate and continuing education training programs must expand travel health curricula to meet this growing need.
      PubDate: 2014-11-20T00:13:13.064748-05:
      DOI: 10.1111/jtm.12172
  • Airport Surveys at Travel Destinations—Underutilized Opportunities
           in Travel Medicine Research?
    • Authors: Irmgard L. Bauer
      Pages: n/a - n/a
      Abstract: Background Research in destination airports, especially in resource‐poor areas, allows unique immediate access to travelers at the conclusion of their trip. Response rates are high and the recall gap small. Trip‐related health matters can be elicited relatively easily. An insight into travelers' decision‐making processes on location would fill large gaps in our knowledge regarding travel health advice provision; yet, this approach is still much underutilized. Methods Using PubMed, ScienceDirect, Google Scholar, and ProQuest, a review of the literature on airport surveys was conducted to determine where they were used, their response rates and purpose, and location‐relevant methodological information. Results The lack of methodological guidelines in the reviewed literature resulted in recommendations for planning and conducting an airport survey at a destination airport. Conclusions Millions of travelers in airports around the world represent an underutilized sample of potential study participants for topics that cannot be studied adequately in other settings. Benefiting from close cooperation between travel health professionals and airport authorities, researchers can expect not only large‐scale convenience samples for surveys, but also opportunities to explore exciting and creative research topics to broaden our understanding of travel medicine and health.
      PubDate: 2014-11-13T03:37:08.720699-05:
      DOI: 10.1111/jtm.12175
  • Increasing Risks of Human Dirofilariasis in Travelers
    • Authors: James H. Diaz
      Pages: n/a - n/a
      Abstract: Background Dirofilariasis is a zoonotic nematode infection of domestic and wild carnivores that can be transmitted to man by infected mosquitoes. Methods Internet search engines were queried with the key words to examine case reports, series, and descriptive analyses of animal and human dirofilariasis to meet the objectives of this review to describe the increasing prevalence of animal and human dirofilariasis worldwide; to resolve misconceptions regarding the pathophysiology and outcomes of animal versus human dirofilariasis; and to recommend new strategies for the diagnosis, management, and prevention of human dirofilariasis in travelers. Results Descriptive epidemiological studies in the United States and Europe have now established dirofilariasis as an emergent parasitic disease of dogs and man. Global warming has extended the mosquito‐vector‐borne transmission cycles, enzootic distributions, and canine microfilarial prevalences of the disease to non‐endemic regions. Conclusions Travel medicine clinicians must remain vigilant regarding the possibilities of human pulmonary dirofilariasis when solitary “coin lesions” appear on screening chest X‐rays or abdominal neuroimaging studies in asymptomatic patients without peripheral hypereosinophilia. The least invasive diagnostic methods are recommended. Future investigations should focus on conducting active epidemiological surveillance for dirofilariasis in humans and animals; on improving canine dirofilarial chemoprophylaxis; and on developing new, rapid molecular methods for diagnosing and differentiating human dirofilarial infections.
      PubDate: 2014-11-11T02:18:09.233863-05:
      DOI: 10.1111/jtm.12174
  • No Booster Dose for Yellow Fever Vaccination: What Are the Consequences
           for the Activity of Vaccination in Travel Clinics?
    • Authors: Benjamin Wyplosz; Jean‐Philippe Leroy, Ouda Derradji, Paul‐Henri Consigny
      Pages: n/a - n/a
      Abstract: In April 2013, the Strategic Advisory Group of Experts (SAGE) on immunization stated that a single dose of yellow fever (YF) vaccine is sufficient in the general population to confer a lifelong protection against YF. When the period of validity of the International Certificate of Vaccination (ICV) will be extended to a lifetime in June 2016, no booster dose will be needed. The objective of this prospective study was to determine the potential impact of the SAGE recommendations on the vaccination activity of our travel clinics. We showed that among 1,037 subjects seen in our three travel clinics for a YF vaccination in 2013, about 32.3% went for a booster dose that is no longer useful according to the SAGE. A drop in vaccination activity has to be expected by travel clinics in the next years, and changes in daily exercise have to be anticipated, as YF vaccination is a large part of the regular work of many healthcare providers specialized in travel medicine.
      PubDate: 2014-11-11T02:17:25.656681-05:
      DOI: 10.1111/jtm.12173
  • Vaccine‐Preventable Travel Health Risks: What
           Is the Evidence—What Are the Gaps?
    • Authors: Robert Steffen; Ron H. Behrens, David R. Hill, Christina Greenaway, Karin Leder
      Pages: n/a - n/a
      Abstract: Background Existing travel health guidelines are based on a variety of data with underpinning evidence ranging from high‐quality randomized controlled trials to best estimates from expert opinion. For strategic guidance and to set overall priorities, data about average risk are useful. The World Health Organization (WHO) plans to base future editions of “International Travel and Health” on its new “Handbook for Guideline Development.” Methods Based on a systematic search in PubMed, the existing evidence and quality of data on vaccine‐preventable disease (VPD) risks in travelers was examined and essentials of vaccine efficacy were briefly reviewed. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to evaluate the quality of the data. Results Moderate‐quality data to determine the risk of VPD exist on those that are frequently imported, whereas in most others the level of confidence with existing data is low or very low. Conclusions In order for the WHO to produce graded risk statements in the updated version of “International Travel and Health,” major investment of time plus additional high‐quality, generalizable risk data are needed.
      PubDate: 2014-11-06T01:32:09.753914-05:
      DOI: 10.1111/jtm.12171
  • Risk Assessment in Travel Medicine: How to Obtain, Interpret, and Use Risk
           Data for Informing Pre‐Travel Advice
    • Authors: Karin Leder; Robert Steffen, Jakob P. Cramer, Christina Greenaway
      Pages: n/a - n/a
      Abstract: Background It has been recommended that numerical risk data should be provided during the pre‐travel consultation in order for travelers to make informed decisions regarding uptake of preventive interventions. Methods In this article, we review the definitions of the various risk measures, particularly as they relate to travel health, and discuss the study designs and methodological details required to obtain each measure. Results Risk measures can be broadly divided into absolute risk measures (including incidence rate, attack rate, and incidence density) and risk factor measures (including relative risk, risk ratio, and odds ratio). Although there are limitations inherent to each measure, absolute risk measures estimate the baseline risk for an “average” traveler, and risk factor measures help determine whether the risks for an individual traveler are likely to be higher or lower than this average, which is determined by specific traveler and itinerary characteristics. Incremental risk considerations add additional complexity, and risk communication plus risk perception/risk tolerance have additional impact on the individual traveler's interpretation of risk measures. Conclusions Travel health practitioners should be aware of the complexities, limitations, and difficulties in understanding numerical risk data, as these factors are important in travelers' acceptance or rejection of interventions offered.
      PubDate: 2014-11-06T01:31:43.237405-05:
      DOI: 10.1111/jtm.12170
  • International Travel Patterns and Travel Risks for Stem Cell Transplant
    • Authors: Tarek Mikati; Kenneth Griffin, Dakotah Lane, Matthew Matasar, Monika K. Shah
      Pages: n/a - n/a
      Abstract: Background Stem cell transplantation (SCT) is being increasingly utilized for multiple medical illnesses. However, there is limited knowledge about international travel patterns and travel‐related illnesses of stem cell transplant recipients (SCTRs). Methods An observational cross‐sectional study was conducted among 979 SCTRs at Memorial Sloan Kettering Cancer Center using a previously standardized and validated questionnaire. International travel post SCT, pre‐travel health advice, exposure risks, and travel‐related illnesses were queried. Results A total of 516 SCTRs completed the survey (55% response rate); of these, 40% were allogeneic SCTRs. A total of 229 (44.3%) respondents reported international travel outside the United States and Canada post SCT. The international travel incidence was 32% [95% confidence interval CI 28–36] within 2 years after SCT. Using multivariable Cox regression analysis, variables significantly associated with international travel within first 2 years after SCT were history of international travel prior to SCT [hazard ratio (HR) = 5.3, 95% CI 2.3–12.0], autologous SCT (HR = 2.6, 95% CI 1.6–2.8), foreign birth (HR = 2.3, 95% CI 1.5–3.3), and high income (HR = 2.0, 95% CI 1.8–3.7). During their first trip, 64 travelers (28%) had traveled to destinations that may have required vaccination or malaria chemoprophylaxis. Only 56% reported seeking pre‐travel health advice. Of those who traveled, 16 travelers (7%) became ill enough to require medical attention during their first trip after SCT. Ill travelers were more likely to have visited high‐risk areas (60 vs 26%, p = 0.005), to have had a longer mean trip duration (24 vs 12 days, p = 0.0002), and to have visited friends and relatives (69 vs 21%, p 
      PubDate: 2014-10-17T04:42:37.64864-05:0
      DOI: 10.1111/jtm.12166
  • Leptospirosis After a Stay in Madagascar
    • Authors: Frédéric Pagès; Barbara Kuli, Marie‐Pierre Moiton, Cyrille Goarant, Marie‐Christine Jaffar‐Bandjee
      Pages: n/a - n/a
      Abstract: We report a case of polymerase chain reaction (PCR)‐confirmed leptospirosis in a patient who recently traveled to Madagascar, a country where only two cases have been reported since 1955. Although laboratory and clinical presentations were atypical and despite leptospirosis not being a documented disease in Madagascar, blood and urine tests for leptospirosis enabled retrospective confirmation of the diagnosis.
      PubDate: 2014-10-15T20:44:15.782856-05:
      DOI: 10.1111/jtm.12163
  • Rabies Postexposure Consultations in New Zealand from 1998 to 2012
    • Authors: Marc T.M. Shaw; Jenny Visser, Ciaran Edwards
      Pages: n/a - n/a
      Abstract: Background Rabies is an invariably fatal zoonotic viral disease. New Zealanders going abroad are largely unaware of the risk of contracting the disease. Prevention is the key to controlling the spread of this disease. Methods Data from 363 individuals presenting to New Zealand travel health clinics between 1998 and 2012 for post‐travel consultations on potential rabies exposure were collated retrospectively. The data focused on traveler demographics, the country and nature of exposure, the purpose of travel, and pre‐travel rabies awareness. Results The female‐to‐male ratio of subject travelers presenting was almost equal (1.1 : 1 ratio, respectively); the subjects were typically between 16 and 30 years (44.6%), tourists (64.5%), traveling less than 1 month (55.3%), and likely to have been exposed to animal contact in either Thailand (31.1%), China (13.2%), or Indonesia (12.3%). The animals to which they were exposed were usually dogs (59.5%) or monkeys (28.7%). Most potential exposures were penetrating (69.9%). Injury caused by the animal was more common in the lower limbs (50%) than in the upper limbs (43.4%); 89.4% of exposures were of World Health Organization (WHO) category III. Travelers were more likely to have received pre‐travel rabies advice if they had been seen by a travel medicine specialist (96.1%) compared to a general practitioner (GP) (53.3%). Sixteen percent of travelers received rabies preexposure prophylaxis. Of the subjects who were managed following exposure, 79.7% did not receive immunoglobulin when indicated, and 21.5% did not receive any vaccine. Of the travelers that did receive a vaccine, 62.5% did so on the day of exposure. Of the travelers assessed, 16.7% had traveled without insurance. Conclusions New Zealanders require better guidance in understanding the need for travel‐related rabies vaccination, as they are not managed abroad according to WHO guidelines. Few travelers had had pre‐travel immunization, and only 20.3% of them had received WHO‐advised postexposure management. Thus, 79.7% of the cohort theoretically remained at risk for contracting rabies because of inappropriate management following possible exposure to the disease.
      PubDate: 2014-10-15T01:36:09.396278-05:
      DOI: 10.1111/jtm.12167
  • Safety and Immunogenicity of Typhoid Fever and Yellow Fever Vaccines When
           Administered Concomitantly With Quadrivalent Meningococcal ACWY
           Glycoconjugate Vaccine in Healthy Adults
    • Authors: Martin Alberer; Gerd Burchard, Tomas Jelinek, Emil Reisinger, Jiri Beran, Lucie Cerna Hlavata, Eduardo Forleo‐Neto, Alemnew F. Dagnew, Ashwani K. Arora
      Pages: n/a - n/a
      Abstract: Background Compact and short pre‐travel immunization schedules, which include several vaccinations in a single visit, are desirable for many travelers. However, concomitant vaccination could potentially compromise immunogenicity and/or safety of the individual vaccines and, therefore, possible vaccine interferences should be carefully assessed. This article discusses the immunogenicity and safety of travel vaccines for typhoid fever (TF) and yellow fever (YF), when administered with or without a quadrivalent meningococcal glycoconjugate ACWY‐CRM vaccine (MenACWY‐CRM). Methods Healthy adults (18–≤60 years) were randomized to one of three vaccine regimens: TF + YF + MenACWY‐CRM (group I; n = 100), TF + YF (group II; n = 101), or MenACWY‐CRM (group III; n = 100). Immunogenicity at baseline and 4 weeks post‐vaccination (day 29) was assessed by serum bactericidal assay using human complement (hSBA), enzyme‐linked immunosorbent assay (ELISA), or a neutralization test. Adverse events (AEs) and serious adverse events (SAEs) were collected throughout the study period. Results Non‐inferiority of post‐vaccination geometric mean concentrations (GMCs) and geometric mean titers (GMTs) was established for TF and YF vaccines, respectively, when given concomitantly with MenACWY‐CRM vaccine versus when given alone. The percentages of subjects with seroprotective neutralizing titers against YF on day 29 were similar in groups I and II. The antibody responses to meningococcal serogroups A, C, W‐135, and Y were within the same range when MenACWY‐CRM was given separately or together with TF and YF vaccines. The percentage of subjects reporting AEs was the same for TF and YF vaccines with or without MenACWY‐CRM vaccine. There were no reports of SAEs or AEs leading to study withdrawals. Conclusions These data provide evidence that MenACWY‐CRM can be administered with typhoid Vi polysaccharide vaccine and live attenuated YF vaccine without compromising antibody responses stimulated by the individual vaccines. MenACWY‐CRM can, therefore, be incorporated into travelers' vaccination programs without necessitating an additional clinic visit (NCT01466387).
      PubDate: 2014-10-13T03:48:26.202878-05:
      DOI: 10.1111/jtm.12164
  • Schistosomiasis in Pregnant Travelers: A Case Series
    • Authors: Eli Ben‐Chetrit; Tamar Lachish, Kristine Mørch, Drorit Atias, Conor Maguire, Eli Schwartz
      Pages: n/a - n/a
      Abstract: Background Travel‐related acquisition of schistosomiasis in Africa is well established. Data concerning Schistosoma infection in pregnant travelers are lacking and treatment derives from studies in endemic regions. Methods This study was a retrospective case‐series of pregnant patients who were infected with Schistosoma species. Data regarding exposure history, clinical presentation, diagnosis, treatment, and fetal outcomes were collected and analyzed. Diagnosis of schistosomiasis was based on serology tests and/or ova recovery. Results Travel‐related schistosomiasis during pregnancy was diagnosed in 10 travelers (with 20 pregnancies). Of the 10 women, 4 pregnant travelers with recent exposure were treated during their pregnancy with praziquantel (PZQ). The course and outcome of pregnancy in these patients was uneventful, and treatment had no apparent adverse effects on either the mothers or their babies. Six asymptomatic women were diagnosed years after exposure. During this period, they gave birth to 13 babies. They were never treated with PZQ. Birth weights of their infants were significantly smaller as compared with those of the infants of the women who were treated during their pregnancy (median 2.8 vs 3.5 kg). One baby was born preterm. One patient had three miscarriages. Conclusion This is the first case‐series of pregnant travelers with schistosomiasis. Although a small case‐series with possible confounders, it suggests that schistosomiasis in pregnant travelers can be treated. A trend of lower birth weights was observed in the infants of the pregnant travelers who were not treated. PZQ therapy during pregnancy was not associated with adverse pregnancy or fetal outcomes in those four cases. Our results emphasize the importance of screening female travelers of childbearing age with a relevant history of freshwater exposure. Further studies are needed to reinforce these recommendations.
      PubDate: 2014-10-13T02:47:54.272229-05:
      DOI: 10.1111/jtm.12165
  • Serious Altitude Illness in Travelers Who Visited a Pre‐Travel
    • Authors: Mieke Croughs; Alfons Van Gompel, Sarah Rameckers, Jef Van den Ende
      Pages: n/a - n/a
      Abstract: Background Few data are available on the incidence and predictors of serious altitude illness in travelers who visit pre‐travel clinics. Travel health consultants advise on measures to be taken in case of serious altitude illness but it is not clear if travelers adhere to these recommendations. Methods Visitors to six travel clinics who planned to travel to an altitude of ≥3,000 m were asked to complete a diary from the first day at 2,000 m until 3 days after reaching the maximum sleeping altitude. Serious altitude illness was defined as having symptoms of serious acute mountain sickness (AMS score ≥ 6) and/or cerebral edema and/or pulmonary edema. Results The incidence of serious altitude illness in the 401 included participants of whom 90% reached ≥4,000 m, was 35%; 23% had symptoms of serious AMS, 25% symptoms of cerebral edema, and 13% symptoms of pulmonary edema. Independent predictors were young age, the occurrence of dark urine, travel in South America or Africa, and lack of acclimatization between 1,000 and 2,500 m. Acetazolamide was brought along by 77% of the responders of whom 41% took at least one dose. Of those with serious altitude illness, 57% had taken at least one dose of acetazolamide, 20% descended below 2,500 m on the same day or the next, and 11% consulted a physician. Conclusions Serious altitude illness was a very frequent problem in travelers who visited pre‐travel clinics. Young age, dark urine, travel in South America or Africa, and lack of acclimatization nights at moderate altitude were independent predictors. Furthermore, we found that seriously ill travelers seldom followed the advice to descend and to visit a physician.
      PubDate: 2014-09-19T04:45:20.152231-05:
      DOI: 10.1111/jtm.12160
  • A Case of Melioidosis Probably Acquired by Inhalation of Dusts During a
           Helicopter Flight in a Healthy Traveler Returning From Singapore
    • Authors: Silvia Amadasi; Sarah Dal Zoppo, Annalisa Bonomini, Anna Bussi, Palmino Pedroni, Gianpaolo Balestrieri, Liana Signorini, Francesco Castelli
      Pages: n/a - n/a
      Abstract: We present a case of melioidosis in an Italian male returning from Singapore after a short travel. He probably acquired the disease by inhalation, which is not the typical mode of transmission, in the absence of evident risk factors. The diagnosis was confirmed by real‐time polymerase chain reaction of the culture while serology was useful to assess professional exposure among laboratory workers. Treatment consisted of an initial intensive phase with meropenem and trimethoprim–sulfamethaxazole (TMP–SMX), followed by 6 months of eradication therapy with TMP–SMX.
      PubDate: 2014-09-02T21:59:02.630486-05:
      DOI: 10.1111/jtm.12150
  • Optic Neuritis in a Traveler Returning From Dominican Republic to Spain
           With Dengue Virus Infection
    • Authors: José M. Ramos; Antonio Tello, Antonio Alzamora, María Luisa Ramón
      Pages: n/a - n/a
      Abstract: A search of medical literature will show that dengue infection is rarely linked to optic neuritis. Here we report the development of loss of vision in a female traveler who returned to Spain from the Caribbean after acquiring a dengue infection.
      PubDate: 2014-08-29T04:21:37.619896-05:
      DOI: 10.1111/jtm.12157
  • Chikungunya: Acute Fever, Rash and Debilitating Arthralgias in a Returning
           Traveler From Haiti
    • Authors: Kathryn B. Anderson; Vincent Pureza, Patricia F. Walker
      Pages: n/a - n/a
      Abstract: The following case report details a case of chikungunya fever in a returning traveler from Haiti. The report highlights the clinical presentation and natural history of the disease, and emphasizes that chikungunya has become established in the western hemisphere, with a resultant need for heightened provider awareness.
      PubDate: 2014-08-28T20:52:33.561442-05:
      DOI: 10.1111/jtm.12159
  • Red Herring in Returned Traveler: Drug Reaction With Eosinophilia and
           Systemic Symptom (DRESS) Syndrome Mimicking Sepsis
    • Authors: Hui Yin Lim; Gene Khai Lin Huang, Joseph Torresi, Douglas Johnson
      Pages: n/a - n/a
      Abstract: We report a case of a 51‐year‐old Han Chinese recently returned traveler, who was admitted with a generalized maculopapular rash, fevers, shock, and multi‐organ failure. Extensive investigations failed to reveal an infective cause. Skin biopsy findings together with the recent commencement of allopurinol raised a diagnosis of drug reaction with eosinophilia and systemic symptom syndrome. High‐dose prednisolone was commenced and the patient made a rapid recovery. This case highlights that not all sepsis‐like presentations in returned travelers are due to infective causes and that severe drug reactions need to be considered in the differential diagnosis.
      PubDate: 2014-08-28T20:48:36.537102-05:
      DOI: 10.1111/jtm.12152
  • Carybdea marsupialis (Cubozoa) in the Mediterranean Sea: The First Case of
           a Sting Causing Cutaneous and Systemic Manifestations
    • Authors: Cesar Bordehore; Santiago Nogué, Josep‐Maria Gili, Melissa J. Acevedo, Verónica L. Fuentes
      Pages: n/a - n/a
      Abstract: A woman stung by the box jellyfish Carybdea marsupialis (Cnidaria, Cubozoa) at a Spanish Mediterranean beach showed systemic manifestations over several months [pain far from the inoculation point, arthralgia, paresthesia, hyperesthesia, increase in eosinophils and immunoglobulin E (IgE)] in addition to the skin condition.
      PubDate: 2014-08-28T03:18:25.17583-05:0
      DOI: 10.1111/jtm.12153
  • Dengue‐Associated Hemophagocytic Syndrome in a Japanese Traveler: A
           Case Report
    • Authors: Ken‐ichiro Kobayashi; Mayu Hikone, Naoya Sakamoto, Sentaro Iwabuchi, Masahiro Kashiura, Tomohiko Takasaki, Hiroshi Fujita, Kenji Ohnishi
      Pages: n/a - n/a
      Abstract: Hemophagocytic syndrome (HPS) can develop as a complication of dengue in rare cases, but its relationship with dengue is not well known. We report a case of dengue‐associated HPS with liver involvement and coagulopathy. The patient, a Japanese female traveler who had recently returned from Thailand, had severe complications of dengue infection, but she recovered fully with symptomatic treatment.
      PubDate: 2014-08-27T03:14:08.628431-05:
      DOI: 10.1111/jtm.12158
  • Intent‐to‐Adhere and Adherence to Malaria Prevention
           Recommendations in Two Travel Clinics
    • Authors: Irit Goldstein; Rami Grefat, Moshe Ephros, Shmuel Rishpon
      Pages: n/a - n/a
      Abstract: Malaria infects 30,000 travelers annually worldwide. At greatest risk are those who travel for long duration. Prevention of malaria includes chemoprophylaxis. This prospective study on 121 travelers who visited two travel clinics shows that adherence to prophylactic treatment was low, especially in long duration trips, and that adherence rate could be predicted by the much more available intent‐to‐adhere rate.
      PubDate: 2014-08-27T03:13:00.277193-05:
      DOI: 10.1111/jtm.12156
  • Preparing Children for International Travel: Need for Training and
           Pediatric‐Focused Research
    • Authors: Stefan H.F. Hagmann; Eyal Leshem, Philip R. Fischer, William M. Stauffer, Elizabeth D. Barnett, John C. Christenson
      Pages: n/a - n/a
      Abstract: Background The International Society of Travel Medicine (ISTM) Pediatric Interest Group (PedIG) was created in 2010. We studied the group's professional characteristics and practice patterns to identify clinical areas requiring further training and research related to pediatric international travel. Methods PedIG members were emailed a two‐part online questionnaire in September 2011, which comprised questions about professional and practice details, followed by a survey regarding decisions on nine patient scenarios that represent common pediatric pre‐travel health challenges. Results Ninety‐three (34%) of 273 members completed the survey. Most were physicians (80%) having a primary specialization in pediatrics (55%) and family medicine (19%). About a third (37%) had acquired the ISTM Certificate in Travel Health® (CTH®); 14 and 11% chose not to provide malaria chemoprophylaxis for a 2‐month‐old infant and a 13‐year‐old child traveling to West Africa, respectively. Azithromycin for empiric treatment of travelers' diarrhea in a 2‐year‐old traveler to Thailand and Mexico was suggested by 74 and 58%, respectively, while the use of acetazolamide for a 2‐month old infant traveling to a high‐altitude destination was rarely (13%) chosen. In vaccine‐focused scenarios, 71, 69, 21, and 10% would prescribe the meningococcal vaccine for a 6‐month‐old traveler to Burkina Faso, Japanese encephalitis vaccine to a 10‐year‐old traveler to Cambodia, hepatitis A vaccine to a 6‐month‐old traveler to El Salvador, and the typhoid vaccine to a 1‐year‐old traveler to India, respectively. Conclusions Members of the PedIG have diverse professional and practice backgrounds. Lack of awareness of established guidelines may place international pediatric travelers at risk for travel‐associated morbidity. Strategies are needed to facilitate education and support research in pediatric travel medicine to formulate evidence‐based guidelines wherever they are currently missing.
      PubDate: 2014-08-27T03:10:38.541584-05:
      DOI: 10.1111/jtm.12155
  • Noneruptive Fever Revealing Murine Typhus in a Traveler Returning From
    • Authors: Laura Gastellier; Fanny Lanternier, Aurélie Renvoisé, Sébastien Rivière, Didier Raoult, Olivier Lortholary, Marc Lecuit
      Pages: n/a - n/a
      Abstract: Rickettsia species are increasingly being recognized as a cause of infection among returning travelers. Murine typhus (MT) was mistakenly thought to have disappeared in the 1970s in Tunisia, yet recent serological data show that Rickettsia typhi, the causative agent of MT, still circulates in the Tunisian population. We report here a case of MT in a woman returning from Tunisia and hospitalized in France. Her presentation was nonspecific, with acute noneruptive fever. Diagnosis was confirmed by cross‐adsorption and immunoblotting. Clinicians taking care of returning travelers with fever should be aware of MT, and know how to diagnose and treat it.
      PubDate: 2014-08-27T02:44:38.738714-05:
      DOI: 10.1111/jtm.12154
  • Recurrent Furunculosis in Returning Travelers: Newly Defined Entity
    • Authors: Ofir Artzi; Maya Sinai, Michal Solomon, Eli Schwartz
      Pages: n/a - n/a
      Abstract: Background Bacterial skin infection is a common dermatologic problem in travelers, which usually resolves without sequela. In contrast, post‐travel recurrent furunculosis (PTRF) is a new unique entity of a sequential occurrence of many furuncles seen after returning home from a trip to the Tropics. Objective The objective of this study was to characterize the disease course and possible causes of PTRF. Methods A retrospective study was conducted on a group of young, healthy individuals (16 males and 5 females), who presented with PTRF after returning from tropical countries. Results In all patients, the first furuncle appeared toward the end of the trip and continued for several months after returning home. The average duration of disease was 8.4 months with an average of 4.2 recurrences. Along the disease course, subsequent recurrences became shorter and milder with longer inter‐recurrence intervals. Bacterial cultures most commonly grew methicillin‐sensitive Staphylococcus aureus (MSSA, 76.5%). Nasal colonization was demonstrated in 47% of patients. There were neither companion travelers nor family members experiencing furuncles. Conclusions PTRF should be defined as a clinical entity with prolonged travel to the Tropics being its major risk factor. In the author's opinion, a transient immune change in a subpopulation of travelers ignites a series of recurrent furuncles, resolving upon restoration of normal immunity.
      PubDate: 2014-08-25T03:46:05.969691-05:
      DOI: 10.1111/jtm.12151
  • Advice on Malaria and Yellow Fever Prevention Provided at Travel Agencies
           in Cuzco, Peru
    • Authors: Pablo G. Villanueva‐Meyer; Carlos A. Garcia‐Jasso, Chelsea A. Springer, Jenna K. Lane, Bonny S. Su, Idania S. Hidalgo, Mary R. Goodrich, Emily L. Deichsel, A. C. White, Miguel M. Cabada
      Pages: n/a - n/a
      Abstract: Background Travelers receive medical advice from a variety of sources, including travel agencies. The aim of this study is to describe the quality of pre‐travel advice provided by travel agencies in Cuzco to travelers interested in visiting malaria and yellow fever endemic areas. Methods Trained medical students posed as tourists and visited travel agencies in Cuzco requesting travel advice for a trip to the southern Amazon of Peru, recording advice regarding risk and prevention of malaria and yellow fever. Results A total of 163 registered travel agencies were included in the study. The mean proposed tour duration was 6.8 days (±1.4 days) with a median time to departure of 3 days and a median tour cost of 805 US dollars (USD) [interquartile range (IQR) 580–1,095]. Overall, 45% employees failed to mention the risk for any illness. Eighteen percent of the employees acknowledged risk of malaria and 53% risk of yellow fever. However, 36% denied malaria risk and 2% denied risk of yellow fever in the region. The price of tours from travel agencies that did not mention any health risk was significantly lower [1,009.6 ± 500.5 vs 783.9 ± 402 USD, t (152) = 3, p 
      PubDate: 2014-08-25T03:24:18.708232-05:
      DOI: 10.1111/jtm.12149
  • What Do We Know About Medical Tourism? A Review of the Literature With
           Discussion of Its Implications for the UK National Health Service as an
           Example of a Public Health Care System
    • Authors: Johanna Hanefeld; Richard Smith, Daniel Horsfall, Neil Lunt
      Pages: n/a - n/a
      Abstract: Background Medical tourism is a growing phenomenon. This review of the literature maps current knowledge and discusses findings with reference to the UK National Health Service (NHS). Methods Databases were systematically searched between September 2011 and March 2012 and 100 papers were selected for review. Results The literature shows specific types of tourism depending on treatment, eg, dentistry, cosmetic, or fertility. Patient motivation is complex and while further research is needed, factors beyond cost, including availability and distance, are clearly important. The provision of medical tourism varies. Volume of patient travel, economic cost and benefit were established for 13 countries. It highlights contributions not only to recipient countries' economies but also to a possible growth in health systems' inequities. Evidence suggests that UK patients travel abroad to receive treatment, complications arise and are treated by the NHS, indicating costs from medical travel for originating health systems. Conclusion It demonstrates the importance of quality standards and holds lessons as the UK and other EU countries implement the EU Directive on cross‐border care. Lifting the private‐patient‐cap for NHS hospitals increases potential for growth in inbound medical tourism; yet no research exists on this. Research is required on volume, cost, patient motivation, industry, and on long‐term health outcomes in medical tourists.
      PubDate: 2014-08-25T02:41:15.607673-05:
      DOI: 10.1111/jtm.12147
  • Influenza Vaccination Among Australian Hajj Pilgrims: Uptake, Attitudes,
           and Barriers
    • Authors: Osamah Barasheed; Harunor Rashid, Leon Heron, Iman Ridda, Elizabeth Haworth, Jonathan Nguyen‐Van‐Tam, Dominic E. Dwyer, Robert Booy,
      Pages: n/a - n/a
      Abstract: Background Hajj is the largest annual mass gathering where the risk of respiratory infection is high. Although the Saudi Arabian authority recommends influenza vaccination for Hajj pilgrims, the uptake is variable. Influenza vaccine uptake data among Australian Hajj pilgrims is not readily available. Therefore, we aimed to estimate the influenza vaccination uptake rate and identify both attitudes and barriers to vaccine uptake from two consecutives surveys at Hajj in 2011 and 2012. Methods Using an anonymous self‐administered questionnaire, surveys were conducted in Mecca, Saudi Arabia, among Hajj pilgrims from Australia in 2011 and 2012. Pilgrims staying in “Australian” tents were recruited serially. Results In 2011, 431 Australian pilgrims completed the survey—median age was 42 (range 7–86) years, 55% were male; 65% reported receiving influenza vaccine. In 2012, 535 pilgrims of median age 43 (range 12–83) years completed the survey, 62% were male; 89% reported receiving the vaccine. Both in 2011 and 2012, common reasons for not receiving the vaccine were the pilgrims' reliance on their “natural immunity” (33 and 26%, respectively, p = 0.4) and believing that they would rarely catch influenza or come in contact with influenza patients (18 and 29%, respectively, p = 0.1). In 2012, when asked why they had received the vaccine, 65% pilgrims responded that it was because of the tour group leaders' recommendation. Conclusion Influenza vaccine uptake among Australian Hajj pilgrims seems satisfactory and increasing but could be better because many pilgrims have misconceptions about vaccines. Tour operators may play a greater role in promoting vaccination.
      PubDate: 2014-08-21T22:21:37.679339-05:
      DOI: 10.1111/jtm.12146
  • Visceral Leishmaniasis‐Associated Hemophagocytic Lymphohistiocytosis
           in a Traveler Returning From a Pilgrimage to the Camino de Santiago
    • Authors: Emily R. Watkins; Sriram Shamasunder, Thomas Cascino, Kristie L. White, Shereen Katrak, Caryn Bern, Brian S. Schwartz
      Pages: n/a - n/a
      Abstract: We report the case of a 73‐year‐old American traveler who presented with 3 weeks of fatigue, fevers, chills, and pancytopenia. Clinical and laboratory findings were consistent with hemophagocytic lymphohystiocytosis (HLH) and bone marrow biopsy revealed amastigotes consistent with visceral leishmaniasis. The range of endemic visceral leishmaniasis transmission now extends into northern Spain and travelers to this region should use personal protective measures against sand fly exposure.
      PubDate: 2014-08-21T22:17:44.018886-05:
      DOI: 10.1111/jtm.12145
  • Targeted Therapy in Travelers' Diarrhea: What Is the Role for the
    • Authors: Mark S. Riddle; Bradley A. Connor, David R. Tribble
      Pages: 365 - 368
      PubDate: 2014-10-27T04:54:14.18243-05:0
      DOI: 10.1111/jtm.12162
  • Targeting of Rifamycin SV to the Colon for Treatment of Travelers'
           Diarrhea: A Randomized, Double‐Blind, Placebo‐Controlled Phase
           3 Study
    • Authors: Herbert L. DuPont; AnnKatrin Petersen, Jeff Zhao, Arley Mundt, Zhi‐Dong Jiang, Stephan Miller, Jose Flores, Reshma Shringarpure, Luigi Moro, Robert G. Bagin, E. David Ballard, Mark C. Totoritis
      Pages: 369 - 376
      Abstract: Background Rifamycin SV is under development for treatment of travelers' diarrhea (TD) in a new oral formulation, Rifamycin SV MMX® (RIF‐MMX; Santarus Inc., San Diego, CA, USA), which targets its delivery to the colon, making it a unique rifamycin drug. Methods This was a randomized, double‐blind, phase 3 study of adult travelers to Mexico or Guatemala experiencing acute diarrhea. A total of 264 patients received RIF‐MMX (2 × 200 mg twice daily for 3 days, n = 199) or placebo (n = 65) in a 3 : 1 ratio. The primary endpoint was the length of time between the administration of first dose of study drug and passage of the last unformed stool (TLUS; after which clinical cure was declared). Other endpoints included eradication of pathogens from the stools, pathogen minimum inhibitory concentration (MIC), and adverse events (AEs). Results TLUS was significantly shorter in the RIF‐MMX group (median: 46.0 hours) compared with placebo (median: 68.0 hours; p = 0.0008) and a larger percentage of RIF‐MMX treated patients (81.4%) achieved clinical cure compared with placebo patients (56.9%). TLUS was significantly shorter in the subgroups of patients with enteroaggregative, enterotoxigenic, or diffusely adherent Escherichia coli infections (p = 0.0035) with nonsignificant activity against invasive bacteria (p = 0.3804). Overall pathogen eradication rates were numerically higher in the RIF‐MMX group (67.0%) compared with placebo (54.8%) but the difference did not reach significance (p = 0.0836). In vitro resistance to rifamycin SV was observed in some bacteria remaining after treatment of patients with RIF‐MMX but was not associated with lower efficacy in them. AEs appeared to be more frequent with placebo (38.5%) than with RIF‐MMX (29.6%). Conclusions RIF‐MMX shortened the duration of TD in patients with a broad range of pathogens and was well tolerated. The unique pharmacokinetic properties of the drug offer evidence that TD pathogens work at the level of the colon.
      PubDate: 2014-10-27T04:54:16.497124-05:
      DOI: 10.1111/jtm.12168
  • Health Risks of Young Adult Travelers With Type 1 Diabetes
    • Authors: Yael Levy-Shraga; Uri Hamiel, Marianna Yaron, Orit Pinhas-Hamiel
      First page: 391
      Abstract: Aim International travel has become popular among young adults. This study evaluated the rate and characteristics of travel-associated health risks among young adults with type 1 diabetes mellitus (T1DM) compared with healthy same-aged individuals. Methods A retrospective study was conducted of 47 young adults with T1DM and 48 without (controls). Structured questionnaires accessed information regarding 154 international trips during the preceding 5 years and lasted 7 days and longer. Results Mean ± SD ages of the diabetic and control groups were 26.6 ± 5.0 and 26.9 ± 2.6 years, respectively. Mean trip durations were 80.0 (range 7.0–390.0) and 87.6 days (range 7.0–395.0), respectively. The number of trips per person was 1.5 ± 0.6 and 1.7 ± 0.8, and the proportion of trips to developing countries 64 and 61%, respectively. There were no differences between the groups in rates of travel-related diseases that required medical consultation (11% vs 15% for all trips). No patient sought medical attention for acute problems related to diabetes management. Prior to 71% of their trips to developing countries, respondents with diabetes consulted their diabetes physician; prior to 26% of their trips they switched from an insulin pump to injections; during 41% of the trips they increased glucose monitoring; and for the period of 11% of the trips they defined their metabolic control as poor. Self-reported mean hemoglobin A1c (HbA1c) levels before and after trips were 7.65 ± 1.45 and 7.81 ± 1.23%, respectively (p = 0.42, paired t-test). Conclusions Young adults with type 1 diabetes did not report more travel-related diseases than did healthy individuals. Most reported reasonable to good glycemic control during the trip without severe consequences.
      PubDate: 2014-06-09T05:01:01.732026-05:
      DOI: 10.1111/jtm.12136
  • Two Clusters of Ciguatera Fish Poisoning in Paris, France, Related to
           Tropical Fish Imported From the French Caribbean by Travelers
    • Authors: Loïc Epelboin; Alice Pérignon, Virginie Hossen, Renaud Vincent, Sophie Krys, Eric Caumes
      Pages: 397 - 402
      Abstract: Background Ciguatera fish poisoning (CFP) is a food‐borne illness due to the consumption of reef fish containing pathogenic toxins. CFP is endemic to tropical areas and may be described in travelers in non‐endemic areas. Methods We describe two clusters of autochthonous cases of CFP in Paris, France. They were related to two fish caught in Guadeloupe (French West Indies) and consumed in Paris after being air‐transported in a cooler. In both cases, fish flesh was analyzed and the presence of ciguatoxins by mouse bioassay (MBA) was confirmed. Results The first cluster involved eight individuals among whom five presented gastrointestinal symptoms and four presented neurological symptoms after consuming barracuda flesh (Sphyraena barracuda). The second cluster involved a couple who consumed a grey snapper (Lutjanus griseus). Most of them consulted at different emergency departments in the region of Paris. Conclusions CFP may be seen in non‐traveler patients outside endemic countries resulting from imported species of fish. Thus, CFP may be undiagnosed as physicians are not aware of this tropical disease outside endemic countries. The detection of ciguatoxins by MBA in the French National Reference Laboratory is useful in the confirmation of the diagnosis.
      PubDate: 2014-10-27T04:54:13.809152-05:
      DOI: 10.1111/jtm.12161
  • A Case Suspected for Yellow Fever Vaccine-Associated Viscerotropic Disease
           in the Netherlands
    • Authors: Eva M. van de Pol; Elizabeth H. Gisolf, Clemens Richter
      First page: 421
      Abstract: Yellow fever (YF) 17D vaccine is one of the most successful vaccines ever developed. Since 2001, 56 cases of yellow fever vaccine-associated viscerotropic disease (YEL-AVD) have been published in the peer-reviewed literature. Here, we report a new case suspected for YEL-AVD in the Netherlands. Further research is needed to determine the true incidence of YEL-AVD and to clarify host and vaccine-associated factors in the pathogenesis of YEL-AVD. Because of the potential adverse events, healthcare providers should carefully consider vaccination only in people who are truly at risk for YF infection, especially in primary vaccine recipients.
      PubDate: 2014-06-11T22:48:34.963426-05:
      DOI: 10.1111/jtm.12135
  • Follow‐Up of Treatment Response in Imported Acute Schistosomiasis
    • Authors: Patrick Soentjens; Muriel Ruyffelaert, Audrey Collée, Sandrine Haverals, Alfons Van Gompel, Emmanuel Bottieau
      Pages: 433 - 434
      PubDate: 2014-10-27T04:54:15.998377-05:
      DOI: 10.1111/jtm.12148
  • Response to Letter
    • Authors: Liliana Praticò; Bianca Mariani, Enrico Brunetti, Roberta Maserati, Antonella Bruno, Stefano Novati, Guido Chichino
      Pages: 434 - 435
      PubDate: 2014-10-27T04:54:13.692418-05:
      DOI: 10.1111/jtm.12148_1
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