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  Subjects -> RECREATION, TRAVEL AND TOURISM (Total: 118 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: 4)
Almatourism - Journal of Tourism, Culture and Territorial Development     Open Access   (Followers: 8)
American Journal of Tourism Management     Open Access   (Followers: 2)
American Journal of Tourism Research     Open Access   (Followers: 9)
Anatolia : An International Journal of Tourism and Hospitality Research     Hybrid Journal   (Followers: 3)
Annals of Tourism Research     Hybrid Journal   (Followers: 22)
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: 13)
Czech Journal of Tourism     Open Access  
EchoGéo     Open Access   (Followers: 1)
Educación física y deporte     Open Access  
El Periplo Sustentable     Open Access  
Enlightening Tourism. A Pathmaking Journal     Open Access   (Followers: 1)
Estudios y Perspectivas en Turismo     Open Access  
Event Management     Full-text available via subscription   (Followers: 5)
Gestion Turistica     Open Access  
Globe, The     Full-text available via subscription   (Followers: 2)
Hospitality & Society     Hybrid Journal   (Followers: 1)
Hospitality Review     Full-text available via subscription  
Information Technology & Tourism     Full-text available via subscription   (Followers: 14)
Interaction     Full-text available via subscription   (Followers: 2)
International Journal of Contemporary Hospitality Management     Hybrid Journal   (Followers: 7)
International Journal of Culture Tourism and Hospitality Research     Hybrid Journal   (Followers: 13)
International Journal of Digital Culture and Electronic Tourism     Hybrid Journal   (Followers: 6)
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: 10)
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 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: 2)
Journal of Hospitality Marketing & Management     Hybrid Journal   (Followers: 7)
Journal of Park and Recreation Administration     Full-text available via subscription   (Followers: 1)
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: 7)
Journal of Sustainable Tourism     Hybrid Journal   (Followers: 9)
Journal of Tourism and Cultural Change     Hybrid Journal   (Followers: 7)
Journal of Tourism Insights     Open Access  
Journal of Tourism Research & Hospitality     Partially Free  
Journal of Travel & Tourism Marketing     Hybrid Journal   (Followers: 10)
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: 2)
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: 4)
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: 4)
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: 8)
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)
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]
  • Travelers With Sickle Cell Disease
    • Authors: Shaina M. Willen; Courtney D. Thornburg, Paul M. Lantos
      Pages: n/a - n/a
      Abstract: Background Sickle cell disease (SCD) is the most common genetic disease among persons with African ancestry. This article provides a background to SCD and reviews many important aspects of travel preparation in this population. Methods The medical literature was searched for studies on travel-associated preparedness and complications in individuals with SCD. Topics researched included malaria, bacterial infections, vaccinations, dehydration, altitude, air travel, and travel preparedness. Results There is very little published literature that specifically addresses the risks faced by travelers with SCD. Rates of medical complications during travel appear to be high. There is a body of literature that describes complications of SCD in indigenous populations, particularly within Africa. The generalizability of these data to a traveler is uncertain. Combining these sources of data and the broader medical literature, we address major travel-related questions that may face a provider preparing an individual with SCD for safe travel. Conclusions Travelers with SCD face considerable medical risks when traveling to developing tropical countries, including malaria, bacterial infections, hypovolemia, and sickle cell-associated vaso-occlusive crises. For individuals with SCD, frank counseling about the risks, vigilant preventative measures, and contingency planning for illness while abroad are necessary aspects of the pre-travel visit.
      PubDate: 2014-06-19T22:48:01.128282-05:
      DOI: 10.1111/jtm.12142
  • A Profile of Travelers—An Analysis From a Large Swiss Travel Clinic
    • Authors: Silja Bühler; Rolanda Rüegg, Robert Steffen, Christoph Hatz, Veronika K. Jaeger
      Pages: n/a - n/a
      Abstract: Background Globally, the Swiss have one of the highest proportions of the population traveling to tropical and subtropical countries. Large travel clinics serve an increasing number of customers with specific pre-travel needs including uncommon destinations and preexisting medical conditions. This study aims to identify health characteristics and travel patterns of travelers seeking advice in the largest Swiss travel clinic so that tailored advice can be delivered. Methods A descriptive analysis was performed on pre-travel visits between July 2010 and August 2012 at the Travel Clinic of the Institute of Social and Preventive Medicine, University of Zurich, Switzerland. Results A total of 22,584 travelers sought pre-travel advice. Tourism was the main reason for travel (17,875, 81.5%), followed by visiting friends and relatives (VFRs; 1,715, 7.8%), traveling for business (1,223, 5.6%), and “other reasons” (ie, volunteer work, pilgrimage, study abroad, and emigration; 1,112, 5.1%). The main travel destination was Thailand. In the VFR group, the highest proportions of traveling children (258, 15.1%) and of pregnant or breastfeeding women (23, 3.9%) were observed. Mental disorders were more prominent in VFRs (93, 5.4%) and in travel for “other reasons” (63, 5.7%). The latter stayed for the longest periods abroad; 272 (24.9%) stayed longer than 6 months. VFR travelers received the highest percentage of yellow fever vaccinations (523, 30.5%); in contrast, rabies (269, 24.2%) and typhoid vaccinations (279, 25.1%) were given more often to the “other travel reasons” group. Conclusions New insights into the characteristics of a selected and large population of Swiss international travelers results in improved understanding of the special needs of an increasingly diverse population and, thus, in targeted preventive advice and interventions.
      PubDate: 2014-06-16T23:25:09.357557-05:
      DOI: 10.1111/jtm.12139
  • The Burden of Imported Malaria in Portugal 2003 to 2012
    • Authors: Ana Glória Fonseca; Sara S. Dias, Joao Luis Baptista, Jorge Torgal
      Abstract: Increasing international travel and expatriation to sub-Saharan countries where malaria is endemic has raised public health concerns about the burden of imported malaria cases in Portugal. From 2009 to 2012, there was a 60% increase in malaria hospitalizations, contradicting the declining trend observed since 2003. Older age was associated with longer length of stay in hospital and higher lethality.
      PubDate: 2014-06-13T02:12:59.620759-05:
      DOI: 10.1111/jtm.12141
  • A Case Suspected for Yellow Fever Vaccine-Associated Viscerotropic Disease
           in the Netherlands
    • Authors: Eva M. van de Pol; Elizabeth H. Gisolf, Clemens Richter
      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
  • Chronic Schistosoma mekongi in a Traveler—A Case Report
           and Review of the Literature
    • Authors: Pauline Campa; Michel Develoux, Ghania Belkadi, Denis Magne, Charles Lame, Marie-Jeanne Carayon, Pierre-Marie Girard
      Abstract: Travel-related schistosomiasis can be detected in patients without symptoms of acute or chronic infection. A case of Schistosoma mekongi acquired in an endemic area of Laos and discovered unexpectedly from colon biopsies taken 5 years after infection is presented here. A literature review of previous cases of S. mekongi infection specifically associated with travelers is then presented.
      PubDate: 2014-06-09T20:36:11.549501-05:
      DOI: 10.1111/jtm.12137
  • Health Risks of Young Adult Travelers With Type 1 Diabetes
    • Authors: Yael Levy-Shraga; Uri Hamiel, Marianna Yaron, Orit Pinhas-Hamiel
      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
  • Emergency Medical Equipment On Board German Airliners
    • Authors: Jochen Hinkelbein; Christopher Neuhaus, Wolfgang A. Wetsch, Oliver Spelten, Susanne Picker, Bernd W. Böttiger, Birgit S. Gathof
      Abstract: Background Medical emergencies often occur on commercial airline flights, but valid data on their causes and consequences are rare. Therefore, it is unclear what emergency medical equipment is necessary. Although a minimum standard for medical equipment is defined in regulations, additional material is not standardized and may vary significantly between different airlines. Methods German airlines operating aircrafts with more than 30 seats were selected and interviewed with a 5-page written questionnaire between August 2011 and January 2012. Besides pre-packed and required emergency medical material, drugs, medical devices, and equipment lists were queried. If no reply was received, airlines were contacted another three times by e-mail and/or phone. Descriptive analysis was used for data presentation and interpretation. Result From a total of 73 German airlines, 58 were excluded from analysis (eg, those not providing passenger transport). Fifteen airlines were contacted and data of 13 airlines were available for analysis (two airlines did not participate). A first aid kit was available on all airlines. Seven airlines reported having a doctor's kit, and another four provided an “emergency medical kit.” Four airlines provided an automated external defibrillator (AED)/electrocardiogram (ECG). While six airlines reported providing anesthesia drugs, a laryngoscope, and endotracheal tubes, another four airlines did not provide even a resuscitator bag. One airline did not provide any material for cardiopulmonary resuscitation (CPR). Conclusions Although the minimal material required according to European aviation regulations is provided by all airlines for medical emergencies, there are significant differences in the provision of additional material. The equipment on most airlines is not sufficient for the treatment of specific emergencies according to published medical guidelines (eg, for CPR or acute myocardial infarction).
      PubDate: 2014-06-05T23:57:09.504683-05:
      DOI: 10.1111/jtm.12138
  • Imported Plasmodium vivax Malaria ex Pakistan
    • Authors: Silvia Odolini; Philippe Gautret, Kevin C. Kain, Kitty Smith, Karin Leder, Mogens Jensenius, Christina M. Coyle, Francesco Castelli, Alberto Matteelli
      Abstract: Background According to WHO, 1.5 million cases of malaria are reported annually in Pakistan. Malaria distribution in Pakistan is heterogeneous, and some areas, including Punjab, are considered at low risk for malaria. The aim of this study is to describe the trend of imported malaria cases from Pakistan reported to the international surveillance systems from 2005 to 2012. Methods Clinics reporting malaria cases acquired after a stay in Pakistan between January 1, 2005, and December 31, 2012, were identified from the GeoSentinel ( and EuroTravNet ( networks. Demographic and travel-related information was retrieved from the database and further information such as areas of destination within Pakistan was obtained directly from the reporting sites. Standard linear regression models were used to assess the statistical significance of the time trend. Results From January 2005 to December 2012, a total of 63 cases of malaria acquired in Pakistan were retrieved in six countries over three continents. A statistically significant increasing trend in imported Plasmodium vivax malaria cases acquired in Pakistan, particularly for those exposed in Punjab, was observed over time (p = 0.006). Conclusions Our observation may herald a variation in malaria incidence in the Punjab province of Pakistan. This is in contrast with the previously described decreasing incidence of malaria in travelers to the Indian subcontinent, and with reports that describe Punjab as a low risk area for malaria. Nevertheless, this event is considered plausible by international organizations. This has potential implications for changes in chemoprophylaxis options and reinforces the need for increased surveillance, also considering the risk of introduction of autochthonous P. vivax malaria in areas where competent vectors are present, such as Europe.
      PubDate: 2014-06-03T04:44:45.605752-05:
      DOI: 10.1111/jtm.12134
  • Influenza B Outbreak on a Cruise Ship off the São Paulo Coast, Brazil
    • Authors: Eder G. Fernandes; Priscila B. de Souza, Maria Emília B. de Oliveira, Gisele D.F. Lima, Alessandra Cristina G. Pellini, Manoel Carlos S.A. Ribeiro, Helena K. Sato, Ana F. Ribeiro, Ana Lucia F. Yu
      Abstract: Background In February 2012, crew and passengers of a cruise ship sailing off the coast of São Paulo, Brazil, were hospitalized for acute respiratory illness (ARI). A field investigation was performed to identify the disease involved and factors associated. Methods Information on passengers and crew with ARI was obtained from the medical records of hospitalized individuals. Active case finding was performed onboard the ship. ARI was defined as the presence of one nonspecific symptom (fever, chills, myalgia, arthralgia, headache, or malaise) and one respiratory symptom (cough, nasal congestion, sore throat, or dyspnea). A case–control study was conducted among the crew. The cases were crew members with symptoms of influenza-like illness (ILI) (fever and one of the following symptoms: cough, sore throat, and dyspnea) in February 2012. The controls were asymptomatic crew members. Results The study identified 104 ARI cases: 54 (51.9%) crew members and 50 (49.1%) passengers. Among 11 ARI hospitalized cases, 6 had influenza B virus isolated in nasopharyngeal swab. One mortality among these patients was caused by postinfluenza Staphylococcus aureus pneumonia. The crew members housed in the two lower decks and those belonging to the 18- to 32-year-old age group were more likely to develop ILI [odds ratio (OR) = 2.39, 95% confidence interval (CI) 1.09–5.25 and OR = 3.72, CI 1.25–11.16, respectively]. Conclusions In February 2012, an influenza B outbreak occurred onboard a cruise ship. Among crew members, ILI was associated with lower cabin location and younger age group. This was the first influenza outbreak detected by Brazilian public health authorities in a vessel cruising in South American waters.
      PubDate: 2014-06-03T04:37:35.933437-05:
      DOI: 10.1111/jtm.12132
  • Travel-Related Shigellosis in Quebec, Canada: An Analysis of Risk Factors
    • Authors: Stéphane Trépanier; Yen-Giang Bui, Manon Blackburn, François Milord, Éric Levac, Suzanne Gagnon
      Abstract: Background Travel-related shigellosis is not well documented in Canada although it is frequently acquired abroad and can cause severe disease. Objectives To describe the epidemiology of travel-related cases of shigellosis for Quebec (Canada) and to identify high-risk groups of travelers. Method and Data Sources We performed a random sampling of 335 shigellosis cases (from a total of 760 cases) reported in the provincial database of reportable diseases from January 1, 2004, to December 31, 2007. Each case was analyzed according to information available in the epidemiology questionnaire. Total number of trips by region from Statistics Canada was used as denominator to estimate the risk according to region of travel. Results Annually, between 43 and 54% of the shigellosis cases were reported in travelers, 45% of whom were aged between 20 and 44 years. Children under 11 years accounted for nearly 16% of cases, but represent only 4% of travelers. Most cases in travelers were serogroups Shigella sonnei (50%) or Shigella flexneri (45%). Almost 31% of cases were reported between January and March. The majority (64%) were acquired in Central America, Mexico, or the Caribbean. However, the Indian subcontinent, Africa, and South America had the highest ratio of number of cases per number of trips. Tourists represented 76% of the cases; 62% of them had traveled for
      PubDate: 2014-06-03T02:51:35.419123-05:
      DOI: 10.1111/jtm.12130
  • The Visiting Internet Fiancé/ée (VIF): An Emerging Group of
           International Travelers
    • Authors: Theresa A. Sofarelli; Holly K. Birich, DeVon C. Hale
      Abstract: Here we describe an emerging category of travelers called the Visiting Internet Fiancé/ée (VIF), characterized by their travel to pursue a romantic relationship with an individual they have only encountered online. The VIF is not well identified in travel medicine literature despite having a higher risk for several travel-related issues including sexually transmitted infections, monetary fraud, and international scams. We also propose specific counseling interventions designed to minimize the adverse outcomes faced by the VIF traveler.
      PubDate: 2014-05-28T21:16:23.371738-05:
      DOI: 10.1111/jtm.12128
  • A Case Series of Three US Adults With Japanese Encephalitis,
    • Authors: Susan L. Hills; Juliet Stoltey, Diana Martínez, Paul Y. Kim, Heather Sheriff, Ana Zangeneh, Sally R. Eilerman, Marc Fischer
      Abstract: Background Japanese encephalitis (JE) virus is the leading cause of vaccine-preventable encephalitis in Asia. Although the risk for acquiring JE for most travelers to Asia is low, it varies based on the destination, season, trip duration, and activities. Methods We present case reports of three US adults who were infected with JE virus while traveling or residing in Asia. Results Among the three JE patients, the first made a 10-day trip to mainland China and participated in outdoor activities in a rural area, the second had been resident in Taiwan for 4 months, and the third, fatal case was an expatriate living in South Korea. Conclusions JE should be considered in the differential diagnosis for any patient with an acute neurologic infection, who has recently been in a JE-endemic country. Health-care providers should assess the itineraries of travelers to JE-endemic countries, provide guidance on personal protective measures to prevent vector-borne diseases, and consider recommending JE vaccine for travelers at increased risk for JE virus infection.
      PubDate: 2014-05-26T03:30:32.38278-05:0
      DOI: 10.1111/jtm.12127
  • Plasmodium knowlesi: Clinical Presentation and Laboratory Diagnosis of the
           First Human Case in a Scottish Traveler
    • Authors: Claire J. Cordina; Richard Culleton, Brian L. Jones, Catherine C. Smith, Alisdair A. MacConnachie, Michael J. Coyne, Claire L. Alexander
      Abstract: The first imported case of Plasmodium knowlesi in Scotland is described in a 33-year-old female with a travel history to Borneo. The patient ceased to take antimalarial prophylaxis after 4 days of her 10-day visit and presented with a history of fever, rigor, vomiting, and diarrhea after 13 days on her return to the UK. Malaria antigen detection using the Optimal-IT and Binax-NOW kits was negative. Unusual trophozoite-like structures were observed under microscopic examination and the identification of P. knowlesi performed by a nested polymerase chain reaction (PCR) gel-based approach was confirmed by using a PCR-sequencing assay.
      PubDate: 2014-05-26T02:00:14.626499-05:
      DOI: 10.1111/jtm.12131
  • Hepatitis B Surface Antigen Positivity After Twinrix Vaccination:
           A Case Report
    • Authors: Yirang Lee; Jae-Seok Kim, Ji-Young Park, Soo Young Kim, In Hong Hwang, Hyoun Chan Cho
      Abstract: Travelers might have an increased risk of hepatitis B virus (HBV) infection. We report a case of prolonged transient hepatitis B surface antigenemia in a healthy Canadian female 8 days after administration of a combined hepatitis A and hepatitis B vaccine. Travel health providers providing hepatitis B vaccines need to be aware of this phenomenon and educate their patients accordingly.
      PubDate: 2014-05-26T01:58:28.961443-05:
      DOI: 10.1111/jtm.12129
  • Three Cases of Imported Dengue Virus Infection From Madeira to Belgium,
    • Authors: Lieselotte Cnops; Leticia Franco, Britt Van Meensel, Jef Van den Ende, Maria Paz Sanchez‐Seco, Marjan Van Esbroeck
      Pages: n/a - n/a
      Abstract: We report three laboratory‐confirmed dengue virus (DENV) infections imported to Belgium by travelers returning from Madeira (Portugal). Despite the use of a mosquito‐repellent spray as reported by two patients, the infection could not be prevented. Diagnosis was made by antigen detection and real‐time reverse transcriptase polymerase chain reaction (RT‐PCR) in two cases and by serology 1 month after onset of symptoms in a third one. The responsible virus was identified as DENV serotype 1, American/African genotype (genotype V). The close relationship to isolates from Colombia supports the previous findings that a South American strain originated the outbreak in Madeira in 2012.
      PubDate: 2014-03-13T03:01:56.88213-05:0
      DOI: 10.1111/jtm.12113
  • Medical Cruise Challenges in Antarctica
    • Authors: Eilif Dahl
      Pages: 223 - 224
      PubDate: 2014-07-01T02:11:53.187508-05:
      DOI: 10.1111/jtm.12118
  • Methicillin‐Resistant Staphylococcus aureus and Intercontinental
           Travel—“Bad Bugs on the Move!”
    • Authors: Philipp Zanger
      Pages: 225 - 227
      PubDate: 2014-07-01T02:11:51.647385-05:
      DOI: 10.1111/jtm.12140
  • Pattern of Passenger Injury and Illness on Expedition Cruise Ships to
    • Authors: Lusana Schutz; Dan Zak, James F. Holmes
      First page: 228
      Abstract: Background Expedition ships to Antarctica travel to remote areas with limited medical support. Objectives This study determines the rate and patterns of passenger illness and injuries among those traveling on expedition ships to Antarctica. We hypothesize that severe medical conditions are encountered that require physicians serving on these ships to be skilled enough to care for critically ill or injured patients. Methods We performed a retrospective analysis of the medical records of all passengers who were provided medical care on 26 Antarctica voyages from October 2010 to March 2011 (four different expedition ships). A structured system was used to categorize the diagnoses from each patient encounter. The pattern of traumatic injuries was noted, including location of occurrence. Treatments rendered including patient evacuations were documented. The population is described with incidence rates. Results A total of 2,366 passengers traveled on 26 trips, for a total of 34,501 person-days. In all, 680 physician visits were done, including 150 consultations for motion sickness preventive care, leaving 530 visits (15.4 visits per 1,000 person-days) for active medical care. Median age was 50 (range 10–90) years and 51% were females. Incidence rates per 1,000 person-days for the most common processes include motion sickness (4.2), infections (3.5), and injury (2.0). Injuries were more likely to occur on the ship (66%, 95% CI: 54–77%) compared to off the ship (34%, 95% CI: 23–46%). Four subjects (0.12/1,000 person-days) were evacuated (three due to traumatic conditions and one due to medical complications) and one person died (medical complication). Conclusion Passengers on expedition ships to Antarctica may experience significant illness and injury. Ship physicians should be aware of the patterns of injuries and illnesses that occur on expedition ships and should have appropriate training to treat various medical and traumatic conditions including life-threatening illnesses.
      PubDate: 2014-05-15T22:17:38.601865-05:
      DOI: 10.1111/jtm.12126
  • Laboratory Features of Common Causes of Fever in Returned Travelers
    • Authors: Eden C. Cooper; Irani Ratnam, Mohammadreza Mohebbi, Karin Leder
      First page: 235
      Abstract: Background There can be considerable overlap in the clinical presentation and laboratory features of dengue, malaria, and enteric fever, three important causes of fever in returned travelers. Routine laboratory tests including full blood examination (FBE), liver function tests (LFTs), and C-reactive protein (CRP) are frequently ordered on febrile patients, and may help differentiate between these possible diagnoses. Methods Adult travelers returning to Australia who presented to the Royal Melbourne Hospital with confirmed diagnosis of dengue, malaria, or enteric fever between January 1, 2000 and March 1, 2013 were included in this retrospective study. Laboratory results for routine initial investigations performed within the first 2 days were extracted and analyzed. Results There were 304 presentations including 58 with dengue fever, 187 with malaria, and 59 with enteric fever, comprising 56% of all returned travelers with a febrile systemic illness during the study period. Significant findings included 9-fold and 21-fold odds of a normal CRP in dengue compared with malaria and enteric fever, respectively. The odds of an abnormally low white cell count (WCC) were also significantly greater in dengue versus malaria or enteric fever. Approximately one third of dengue presentations and almost half of the malaria presentations had platelet counts
      PubDate: 2014-04-22T20:55:12.591363-05:
      DOI: 10.1111/jtm.12122
  • Incidence of Potential Rabies Exposure Among Japanese Expatriates and
           Travelers in Thailand
    • Authors: Wataru Kashino; Watcharapong Piyaphanee, Chatporn Kittitrakul, Noppadon Tangpukdee, Suda Sibunruang, Saranath Lawpoolsri, Hiroaki Yamashita, Sant Muangnoicharoen, Udomsak Silachamroon, Terapong Tantawichien
      First page: 240
      Abstract: Background Rabies has become a forgotten and neglected disease in Japan. In 2006, there was a slight increase in social awareness of rabies when Japan had two reported cases of human rabies, originating in the Philippines. Although the number of Japanese either traveling or living in other Asian countries has been increasing, the exact risk of this population contracting rabies is unknown. Thus, this study utilized a questionnaire to investigate the incidence of rabies exposure, as well as the knowledge, attitude, and practice toward rabies prevention among Japanese expatriates and travelers in Thailand. Methods Japanese travelers and expatriates were asked questions related to knowledge, attitude, practice toward rabies risk, and experiences of potential rabies exposure such as animal bites, licks, and scratches. Questionnaires were either completed at the Bangkok Suvarnabhumi International Airport and other tourist areas or distributed within Japanese associations in Thailand. Results A total of 1,208 questionnaires from Japanese expatriates and 590 from Japanese travelers were collected and analyzed. We found high incidence rates of potential exposure events among these populations. In particular, Japanese travelers had the highest incidence rate compared to previous studies of international travelers in Thailand. While expatriates' incidence rates of animal bites, licks, and scratches were 1.7, 6.9, and 1.8/1,000 person-months, travelers have much higher incidence rates of 43.1, 136.1, and 33.0/1,000 person-months. Generally, travelers, compared to expatriates, tended to have less accurate knowledge and less often had the pre-exposure prophylaxis vaccination. Moreover, survey answers indicated that 55.0% of expatriates and 88.9% of travelers who were bitten would not seek proper treatment. Conclusions Since rabies is a preventable disease as long as one has the appropriate knowledge, attitude, and practice, it is essential to promote prevention activities for the Japanese population in Thailand to avert serious consequences of this disease.
      PubDate: 2014-05-20T21:31:15.676168-05:
      DOI: 10.1111/jtm.12124
  • Travel‐Related Infection in European Travelers, EuroTravNet 2011
    • Authors: Ben Warne; Leisa H. Weld, Jakob P. Cramer, Vanessa K. Field, Martin P. Grobusch, Eric Caumes, Mogens Jensenius, Philippe Gautret, Patricia Schlagenhauf, Francesco Castelli, David G. Lalloo, Johan Ursing, François Chappuis, Frank von Sonnenburg, Rogelio López‐Vélez, Christophe Rapp, Kitty C. Smith, Philippe Parola, Effrossyni Gkrania‐Klotsas,
      Pages: 248 - 254
      Abstract: Background Limited data exist on infectious diseases imported to various locations in Europe, particularly after travel within the continent. Methods To investigate travel‐related disease relevant to Europe that is potentially preventable through pre‐travel intervention, we analyzed the EuroTravNet database of 5,965 ill travelers reported by 16 centers in “Western” Europe in 2011. Results There were 54 cases of vaccine‐preventable disease, mostly hepatitis A (n = 16), typhoid fever (n = 11), and measles (n = 8); 6 cases (including 3 measles cases) were associated with travel within “Western” Europe. Malaria was the most commonly diagnosed infection (n = 482, 8.1% of all travel‐related morbidity). Among patients with malaria, the military most commonly received pre‐travel advice (95%), followed by travelers for missionary, volunteer, research, or aid work (81%) but travelers visiting friends and relatives (VFRs) were least likely to receive pre‐travel advice (21%). The vast majority (96%) of malaria patients were resident in “Western” Europe, but over half (56%) were born elsewhere. Other significant causes of morbidity, which could be reduced through advice and behavioral change, include Giardia (n = 221, 3.7%), dengue (n = 146, 2.4%), and schistosomiasis (n = 131, 2.2%). Of 206 (3.5%) travelers with exposure in “Western” Europe, 75% were tourists; the highest burden of disease was acute gastrointestinal infection (35% cases). Travel from “Eastern” Europe (n = 132, 2.2%) was largely associated with migration‐related travel (53%); among chronic infectious diseases, tuberculosis was frequently diagnosed (n = 20). Travelers VFRs contributed the largest group of malaria patients (46%), but also had the lowest documented rate of pre‐travel health advice in this subset (20%). Overall, 44% of nonimmigrant ill travelers did not receive pre‐travel advice. Conclusion There is a burden of infectious diseases in travelers attending European health centers that is potentially preventable through comprehensive pre‐travel advice, chemoprophylaxis, and vaccination. Targeted interventions for high‐risk groups such as travelers VFRs and migration‐associated travelers are of particular importance.
      PubDate: 2014-04-20T22:28:54.020055-05:
      DOI: 10.1111/jtm.12120
  • Problems Associated With Hemodialysis and Travel
    • Authors: Richard W. Corbett; Virginia Prout, Deborah Haynes, Claire Edwards, Andrew H. Frankel
      Pages: 255 - 259
      Abstract: Background While there is a recognized risk of hepatitis C acquisition associated with dialysis away from the “home” center, there is little documented data on the effect that dialysis while traveling has on the dialysis patient's health. This study was designed to examine the incidence of travel within a hemodialysis population and to ascertain whether travel was associated with morbidity for patients on hemodialysis. Methods Travel data were collected prospectively over a 6‐month period, from April 2009, for all patients receiving maintenance hemodialysis across our dialysis centers. Biochemical, microbiological, and hematological parameters as well as hepatitis serology and antibiotic starts were recorded for 12 weeks prior to and following dialysis away from center. Results A total of 172 individuals traveled on 200 occasions. The blood stream infection rate for travelers with a central venous catheter was 0.25 versus 0.83/1,000 access days (p = 0.038) in the 12 weeks pre‐travel versus post‐travel. Parenteral and oral antibiotic starts were both significantly elevated post‐travel and were mainly instituted for either chest or urinary sepsis. There was evidence of raised inflammatory markers and anemia on return to center but no evidence of hepatitis B or hepatitis C seroconversion. Conclusions Travel and dialysis away from a patient's usual hemodialysis unit is a common occurrence but is associated with an increased risk of bacterial infection, anemia, and inflammatory response. This study provides evidence for the concern that hemodialysis away from center is associated with increased morbidity.
      PubDate: 2014-04-20T22:28:55.791404-05:
      DOI: 10.1111/jtm.12121
  • A Double-Dose Hepatitis B Vaccination Schedule in Travelers Presenting for
           Late Consultation
    • Authors: Jason Wong; Michael Payne, Susan Hollenberg
      First page: 260
      Abstract: Background Vaccination against hepatitis B virus (HBV) is recommended for all travelers visiting HBV-endemic countries. However, travelers often present with insufficient time for the standard HBV vaccine schedule (SVS). We examined seroprotection against HBV following an alternative two-visit vaccination schedule (TVS) with currently available vaccine products, and completion rates with this TVS. Methods A retrospective cohort study was conducted in three travel clinics in British Columbia, Canada. Adults ≥20 years old traveling to an HBV-endemic country, and unable to complete the standard or rapid HBV vaccination schedule before departure, were offered a TVS that consisted of a double dose of HBV vaccine at day 0, followed by a single dose in 4 to 12 months. Immunity to HBV [anti-HBV surface antigen (HBs) ≥10 mIU/mL] was determined 1 to 6 months following the final dose of HBV vaccine. Logistic regression modeling was used to assess correlates of seroprotection. We also determined completion rate with this TVS at two clinics. Results In total, 117 participants (age range, 21–81 years, median age 57) met the inclusion criteria. Of these, 97 (82.9%) were immune after the TVS. Immunity was demonstrated in 93.1% of patients
      PubDate: 2014-05-05T03:00:26.02832-05:0
      DOI: 10.1111/jtm.12123
  • Preferences and Decision Needs of Boston‐Area Travelers to Countries
           With Risk of Yellow Fever Virus Transmission: Implications for Health Care
    • Authors: Beth A. Lown; Lin H. Chen, Pauline V. Han, Emily S. Jentes, Mary E. Wilson, Christine M. Benoit, Karen A. Avery, Winnie Ooi, Davidson H. Hamer, Elizabeth D. Barnett,
      Pages: 266 - 271
      Abstract: Background Yellow fever (YF), a potentially fatal mosquito‐borne infection, is preventable with a live‐attenuated vaccine, rarely associated with severe adverse events. We surveyed travelers to assess their reasons for pre‐travel medical consultation, information they considered important regarding YF disease and vaccination, whether they recalled receiving this information, and whether they were involved in vaccine decision‐making. Methods Travelers aged 18 years and older were surveyed at three Boston‐area travel clinics. Only those making YF vaccination decisions were included for analyses. Results Of 831 travelers surveyed, 589 (70%) indicated making a YF vaccination decision. Travel medicine providers recommended YF vaccination to 537 (91%) of 589 travelers; 92% of these 537 received vaccine. Among 101 travelers aged 60 years and older, 9% declined the vaccine; among those younger than 60 years, 4% declined the vaccine (p = 0.06). Of 589 travelers, most agreed they needed to understand destination‐specific YF risks (82%) and vaccine risks (88%), and were involved in YF vaccine decisions (87%). Less than half recalled discussing their concerns about YF vaccine with the provider (42%) or what risks and benefits mattered most to them (32%). Conclusion Most participants sought YF disease and vaccine risk information and wanted to be involved in decision‐making; however, fewer than half recalled discussing their opinions or concerns about YF vaccine. Providers need effective risk communication skills and the ability to elicit and respond to travelers' concerns to help them make informed, shared decisions.
      PubDate: 2014-04-16T02:11:19.091731-05:
      DOI: 10.1111/jtm.12119
  • The Role of International Travel in the Spread
           of Methicillin-Resistant Staphylococcus aureus
    • Authors: Yvonne P. Zhou; Annelies Wilder-Smith, Li-Yang Hsu
      First page: 272
      Abstract: Background Increasing international travel has facilitated the transmission of various multidrug-resistant bacteria—including methicillin-resistant Staphylococcus aureus (MRSA)—across continents. Individuals may acquire MRSA from the community, healthcare facilities, or even from animal exposure. Skin contact with colonized individuals, fomites, or animals during an overseas trip may result in either asymptomatic colonization or subsequent clinically significant MRSA disease. MRSA strains that harbor the Panton-Valentine leucocidin toxin are particularly associated with community transmission and may potentially have enhanced virulence resulting in serious skin and soft tissue infections or even necrotizing pneumonia. More importantly, secondary transmission events upon return from traveling have been documented, leading to potentially detrimental outbreaks within the community or the healthcare setting. We sought to review the existing literature relating to the role of various aspects of travel in the spread of MRSA. Risk factors for acquiring MRSA during travel together with the need for targeted screening of high-risk individuals will also be explored. Methods Data for this article were identified via PubMed searches using a combination of search terms: “methicillin resistance,” “MRSA,” “livestock-associated MRSA,” “community-associated MRSA,” “travel,” and “outbreak.” The relevant articles were extensively perused to determine secondary sources of data. Results and Conclusions Our review of the current literature suggests that international travel plays a significant role in the transmission of MRSA, potentially contributing to the replacement of existing endemic MRSA with fitter and more transmissible strains. Therefore, selective and targeted screening of travelers with risk factors for MRSA colonization may be beneficial. Healthcare professionals and patients should be considered for screening if they were to return from endemic areas, with the former group decolonized before returning to patient care work, in order to reduce the transmission of MRSA to vulnerable patient populations.
      PubDate: 2014-06-03T05:05:53.914475-05:
      DOI: 10.1111/jtm.12133
  • The Practice of Skin‐Bleaching for a Cosmetic Purpose in Immigrant
    • Authors: Antoine Mahé
      Pages: 282 - 287
      Abstract: Background Using skin‐lightening compounds for a cosmetic purpose that are normally restricted to medical use or forbidden has become a world‐wide practice. Complications are numerous. Immigrant communities often import their practice from their original country. Methods A review of the literature on the subject of complications of cosmetic skin‐bleaching, with special focus on data concerning immigrants originating from highly endemic countries, was conducted. Results Complications of cosmetic skin‐bleaching are common, involving mainly the skin although some general complications are also reported with a growing incidence. Conclusion The high frequency of this practice, added to the frequency of various complications, suggests it might be considered as a genuine public health problem currently.
      PubDate: 2014-03-11T01:30:14.797447-05:
      DOI: 10.1111/jtm.12106
  • Travel Health Risk Perceptions and Preparations Among Travelers at Hong
           Kong International Airport
    • Authors: Kevin K.C. Hung; Agatha K.Y. Lin, Calvin K.Y. Cheng, Emily Y.Y. Chan, Colin A. Graham
      Pages: 288 - 291
      Abstract: Four levels of pre‐travel health preparations were defined to allow the measurement of general travel health preparations by the traveling public. A cross‐sectional survey of 770 travelers using Hong Kong International Airport was conducted. Important gaps were found in the self‐preparation domain. Length of travel was the only factor associated with higher levels of health preparations after adjusting for potential confounders. Targeted health education should be considered to improve health risk perceptions among travelers in Hong Kong and other similar metropolitan cities that are critical hubs for commercial air transport.
      PubDate: 2014-03-13T03:01:44.543518-05:
      DOI: 10.1111/jtm.12112
  • Chronic Pulmonary Penicilliosis Due to Penicillium marneffei: Late
           Presentation in a French Traveler
    • Authors: Anne De Monte; Karine Risso, Anne-Cécile Normand, Guy Boyer, Coralie L'Ollivier, Pierre Marty, Martine Gari-Toussaint
      First page: 292
      Abstract: We report a case of pulmonary penicilliosis due to Penicillium marneffei in an immunocompetent French patient with chronic obstructive pulmonary disease, who had traveled in endemic countries several years before. The long interval between exposure and initial symptoms of infection, and relapse despite prolonged voriconazole treatment are unusual features.
      PubDate: 2014-05-11T22:01:03.764733-05:
      DOI: 10.1111/jtm.12125
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