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  Subjects -> RECREATION, TRAVEL AND TOURISM (Total: 125 journals)
    - HOTELS AND RESTAURANTS (1 journals)
    - LEISURE AND RECREATION (20 journals)
    - RECREATION, TRAVEL AND TOURISM (104 journals)

RECREATION, TRAVEL AND TOURISM (104 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: 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: 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: 11)
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: 2)
Journal of Hospitality Financial Management     Open Access   (Followers: 3)
Journal of Hospitality Marketing & Management     Hybrid Journal   (Followers: 10)
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: 9)
Journal of Tourism & Hospitality     Open Access  
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     Hybrid Journal   (Followers: 1)
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  
RACE - Revista de Administração, Contabilidade e Economia     Open Access  
Recreational Sport Journal     Hybrid Journal   (Followers: 6)
ReiseRecht aktuell : Zeitschrift für das Tourismusrecht     Full-text available via subscription  
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: 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   (Followers: 1)
Tourism Review International     Full-text available via subscription   (Followers: 3)
Tourism, Leisure and Global Change     Open Access  

        1 2     

Journal Cover   Journal of Travel Medicine
  [SJR: 0.738]   [H-I: 40]   [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  [1611 journals]
  • Looking Over the Fence—How Travel Medicine Can Benefit From Tourism
           Research
    • Authors: Irmgard L. Bauer
      Pages: n/a - n/a
      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
      Pages: n/a - n/a
      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
           Italy
    • Authors: Mikkel B. Quam; Kamran Khan, Jennifer Sears, Wei Hu, Joacim Rocklöv, Annelies Wilder‐Smith
      Pages: n/a - n/a
      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
      Pages: n/a - n/a
      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
      Pages: n/a - n/a
      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
      Pages: n/a - n/a
      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
      Pages: n/a - n/a
      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
      Pages: n/a - n/a
      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
           Travelers
    • Authors: Laurence Rochat; Alain Bizzini, Nicolas Senn, Pierre‐Yves Bochud, Blaise Genton, Serge de Vallière
      Pages: n/a - n/a
      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
           Consultation
    • Authors: Sarah L. McGuinness; Tim Spelman, Douglas F. Johnson, Karin Leder
      Pages: n/a - n/a
      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
       
  • Should We Offer Screening for Hepatitis B and Other Infections to
           Immigrants—Legal or Illegal?
    • Authors: Eskild Petersen
      Pages: 73 - 75
      PubDate: 2015-03-06T08:21:27.887486-05:
      DOI: 10.1111/jtm.12188
       
  • Evaluating Typhoid Vaccine Effectiveness in Travelers' Vaccination
    • Authors: Conall H. Watson
      Pages: 76 - 77
      PubDate: 2015-03-06T08:21:27.722271-05:
      DOI: 10.1111/jtm.12185
       
  • Peer Reviewers, Journal of Travel Medicine 2014
    • Pages: 115 - 115
      PubDate: 2015-03-06T08:21:31.561272-05:
      DOI: 10.1111/jtm.12195
       
  • Travelers With Immune‐Mediated Inflammatory Diseases: Are They
           Different?
    • Authors: Veronika K. Jaeger; Rolanda Rüegg, Robert Steffen, Christoph Hatz, Silja Bühler
      Pages: n/a - n/a
      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
      Pages: n/a - n/a
      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
       
  • 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,
           Canada
    • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
 
 
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