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Volume 15, Number 11—November 2009


Illness in Long-Term Travelers Visiting GeoSentinel Clinics

Lin H. ChenComments to Author , Mary E. Wilson, Xiaohong Davis, Louis Loutan, Eli Schwartz, Jay Keystone, Devon Hale, Poh Lian Lim, Anne McCarthy, Effrossyni Gkrania-Klotsas, Patricia Schlagenhauf, and for the GeoSentinel Surveillance Network1
Author affiliations: Harvard University, Boston, Massachusetts, USA (L.H. Chen, M.E. Wilson); Mount Auburn Hospital, Cambridge, Massachusetts, USA (L.H. Chen, M.E. Wilson); Centers for Disease Prevention and Control, Atlanta, Georgia, USA (X. Davis); University of Geneva, Geneva, Switzerland (L. Loutan); Chaim Sheba Medical Centre, Tel Hashomer, Israel (E. Schwartz); Toronto General Hospital, Toronto, Ontario, Canada (J. Keystone); University of Utah, Salt Lake City, Utah, USA (D. Hale); Tan Tock Seng Hospital, Singapore (P.L. Lim); University of Ottawa, Ottawa, Ontario, Canada (A. McCarthy); University of Cambridge, Cambridge, UK (E. Gkrania-Klotsas); University of Zürich, Zürich, Switzerland (P. Schlagenhauf)

Main Article

Table 2

Comparison of rates for diagnoses among long-term and short-term travelers seen after travel by causal routes and preventive measures, GeoSentinel Surveillance Network, June 1996–December 2008*†

Grouped diagnoses Rate/1,000 travelers
Odds ratio (95% CI)
Short-term travelers Long-term travelers
Vector-borne infections 76 109 1.47 (1.33–1.63)
Dengue 24 17 0.69 (0.551–0.88)
Chikungunya 2 2 1.16 (0.59–2.29)
Leishmaniasis 3 14 4.89 (3.55–6.73)
Malaria, all species 39 68 1.83 (1.61–2.08)
Rickettsiosis 8 2 0.22 (0.11–0.45)
3.22 (1.981–5.24)
Ingestion 257 219 0.81 (0.75–0.87)
Enteric fever 5 9 1.70 (1.20–2.41)
Hepatitis A 2 3 1.21 (0.67–2.19)
Diarrhea, acute 123 41 0.31 (0.27–0.36)
Diarrhea, chronic 45 54 1.20 (1.04–1.38)
GI bacteria 34 15 0.42 (0.33–0.53)
Giardiasis 24 36 1.57 (1.32–1.86)
GI parasites
2.08 (1.88–2.312)
Contact‡ 33 38 1.15 (0.70–1.90)
Influenza 8 5 0.60 (0.39–0.92)
Latent TB (positive PPD or IGRAs) 4 11 3.26 (2.33–4.56)
Acute mononucleosis syndrome (CMV, EBV, other) 7 11 1.60 (1.18–2.18)
Hepatitis B 2 2 0.67 (0.31–1.47)
Hepatitis C 1 2 1.73 (0.85–3.49)
Other sexually transmitted infections 7 4 0.67 (0.43–1.05)
HIV (acute infection)
0.39 (0.12–1.27)
Environment 119 87 0.71 (0.63–0.79)
Schistosomiasis 6 24 4.26 (3.35–5.42)
Strongyloides 4 7 1.85 (1.24–2.75)
Hookworm 2 2 1.26 (0.62–2.60)
Animal bite 44 13 0.28 (0.22–0.37)
Other skin contact, noninfectious 60 18 0.29 (0.23–0.36)
Fungal infection (superficial/cutaneous mycosis) 4 10 2.33 (1.66–3.28)
0.98 (0.78–1.23)
Psychological 15 40 2.80 (2.35–3.33)
Anxiety 3 4 1.60 (0.96–2.65)
Depression 2 6 3.03 (1.89–4.86)
Psychosis, nonmefloquine 1 2 3.89 (1.68–8.99)
Stress 2 9 5.70 (3.77–8.61)
Fatigue >1 mo
3.09 (2.86–4.01)
Adverse events from medication or vaccine 7 3 0.44 (0.26–0.74)
Mefloquine intolerance 4 1 0.19 (0.07–0.52)
Medication intolerance, nonmefloquine 3 2 0.83 (0.44–1.56)

*Long-term travel defined as >6 mo, short-term as <1 mo. CI, confidence interval; GI, gastrointestinal; TB, tuberculosis; PPD, purified protein derivative; IGRA, interferon-gamma release assay; CMV, cytomegalovirus; EBV, Epstein-Barr virus.
†Diagnoses with proportionate illness <1/1,000 are omitted from table listing, such as hepatitis E, hepatitis delta, meningococcal meningitis, Haemophilus influenzae type b, pneumonia, pneumococcal pneumonia, varicella, chronic hepatitis, leptospirosis, altitude sickness, posttraumatic stress disorder, substance abuse, insomnia, delusional parasitosis, trauma, and violence exposure. Some patients may have >1 diagnosis.
‡Includes respiratory illnesses, blood/body fluid exchange, and sexually transmitted infections.

Main Article

1The following members of the GeoSentinel Surveillance Network also contributed data (in descending order): Frank von Sonnenburg, University of Munich, Munich, Germany; Stefanie S. Gelman, University of Utah, Salt Lake City, Utah, USA; François Chappuis, University of Geneva, Geneva, Switzerland; Kevin C. Kain, University of Toronto, Toronto, Canada; Vanessa Field, InterHealth, London, UK; Gerd-Dieter Burchard, Bernhard–Nocht Institute for Tropical Medicine, Hamburg, Germany; Michael D. Libman and J. Dick Maclean, McGill University, Montreal, Quebec, Canada; Karin Leder, Joseph Torresi, and Graham Brown, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Philippe Parola, Fabrice Simon, and Jean Delmont, Hôpital Nord, Marseille, France; Robert Kass, Travellers Medical and Vaccination Centres of Australia, Adelaide, South Australia, Australia (December 1997–March 2001 only); Giampiero Carosi and Francesco Castelli, University of Brescia, Brescia, Italy; Prativa Pandey, CIWEC Clinic Travel Medicine Center, Kathmandu, Nepal; Marc Shaw, Worldwise Travellers Health and Vaccination Centre, Auckland, New Zealand; Phyllis E. Kozarsky and Carlos Franco-Paredes, Emory University, Atlanta, Georgia, USA; Watcharapong Piyaphanee and Udomsak Silachamroon, Mahidol University, Bangkok, Thailand; Natsuo Tachikawa and Hiroko Sagara, Yokohama Municipal Citizen's Hospital, Yokohama, Japan; Bradley A. Connor, Cornell University, New York City, New York, USA; Shuzo Kanagawa and Yasuyuki Kato, International Medical Center of Japan, Tokyo, Japan; Mogens Jensenius, Ullevål University Hospital, Oslo, Norway; N. Jean Haulman, David Roesel, and Elaine C. Jong, University of Washington, Seattle, Washington, USA; Christina M. Coyle and Murray Wittner, Albert Einstein School of Medicine, Bronx, New York, USA; Rogelio López-Vélez and Jose Antonio Pérez-Molina, Hospital Ramon y Cajal, Madrid, Spain; Thomas B. Nutman and Amy D. Klion, National Institutes of Health, Bethesda, Maryland, USA; Stefan Hagmann and Andy Miller, Bronx–Lebanon Hospital Center, Bronx; Rainer Weber and Robert Steffen, University of Zürich, Zürich, Switzerland; William M. Stauffer and Patricia F. Walker, University of Minnesota, Minneapolis, Minnesota, USA; David O. Freedman, University of Alabama at Birmingham, Birmingham, Alabama, USA; Vernon Ansdell, Kaiser Permanente, Honolulu, Hawaii, USA (October 1997–January 2003 only); Annelies Wilder-Smith, Tan Tock Seng Hospital, Singapore; R. Bradley Sack and Robin McKenzie, Johns Hopkins University, Baltimore, Maryland, USA (December 1997–August 2007 only); Eric Caumes and Alice Pérignon, Hôpital Pitié-Salpêtrière, Paris, France; Carmelo Licitra and Antonio Crespo, Orlando Regional Health Center, Orlando, Florida, USA; Elizabeth D. Barnett, Boston University, Boston, Massachusetts, USA; Alejandra Gurtman, Mount Sinai Medical Center, New York City (October 2002– August 2005 only); Cecilia Perret and Francisca Valdivieso, Pontificia Universidad Católica de Chile, Santiago, Chile; Robert Muller, Travel Clinic Services, Johannesburg, South Africa (May 2004–June 2005 only); John D. Cahill and George McKinley, St Luke’s–Roosevelt Hospital Center, New York City; Susan McLellan, Tulane University, New Orleans, Louisiana, USA (December 1999–August 2005 only); Susan MacDonald, Beijing United Family Hospital and Clinics, Beijing, Peoples Republic of China; Michael W. Lynch, Fresno International Travel Medical Center, Fresno, California, USA; Sarah Borwein, TravelSafe Medical Centre, Hong Kong Special Administrative Region, China; and Anne Anglim, University of Southern California, Los Angeles, California, USA.

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