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Chapter 1Introduction

Travel Medicine Data Collection: GeoSentinel & Global TravEpiNet

Regina C. LaRocque, David O. Freedman, Mark J. Sotir

During the past 2 decades, the knowledge base of travel medicine has been enhanced by medical provider networks designed to systematically collect data about travelers. This chapter discusses 2 of these networks, GeoSentinel Surveillance Network and Global TravEpiNet, both of which involve active participation of travel and tropical medicine clinics. Whereas GeoSentinel collects data from ill patients seen at clinics primarily during and after travel, Global TravEpiNet focuses on optimizing medical advice and care before travel.

Diagnosis of leptospirosis is usually based on clinical recognition and serology; microscopic agglutination test is the gold standard. Culture is relatively insensitive, but detection of the organism using real-time PCR can provide a more timely diagnosis.

GLOBAL TRAVEPINET

Global TravEpiNet was formed in 2009 to advance the pre-travel health care of US international travelers, particularly those at higher risk of travel-associated illness because of itinerary, purpose of travel, or existing medical conditions. Global TravEpiNet performs this work by systematically evaluating the health characteristics and pre-travel health care of travelers, developing evidence-based web tools for travelers and practitioners, and assessing the effect of pre-travel health interventions. As of September 2012, the Global TravEpiNet Consortium was composed of a network of 25 clinical sites across the United States, including primary care clinics, academic travel medicine practices, pharmacy-based practices, public health clinics, and occupational health clinics; many are registered to administer yellow fever vaccine.

Clinicians at Global TravEpiNet sites use a web tool to systematically collect data about the pre-travel health consultation. Data collected from the pre-travel consultation include demographics, travel itinerary, travel purpose, immunization history, vaccines administered, medication provided, and reasons for not administering a recommended vaccine. Data on >33,000 pre-travel consultations have been collected as of June 2012. More than 80% of travelers seen at Global TravEpiNet sites are visiting resource-poor destination countries. Africa is the most commonly visited region, and nearly a third of travelers visit multiple countries. Leisure (49%) is the most commonly reported purpose of travel, but business (15%), service work (15%), and VFR travelers (11%) are also common. Fifty-nine percent of travelers report an existing health condition before departure; 3% have an immune-suppressing condition of some type.

Patients declining recommended vaccines during the pre-travel consultation, particularly the influenza and rabies vaccines, have been identified as an area of concern within Global TravEpiNet. In particular, being a VFR traveler is an independent predictor of declining any recommended vaccine (OR, 1.45; 95% CI, 1.31–1.60). Global TravEpiNet is exploring the reasons that lead travelers to decline vaccines. Other areas of active research include determining the cost-effectiveness of the pre-travel consultation, evaluating specific traveling populations (such as VFR, pediatric, and immunocompromised travelers), and assessing the use of specific pre-travel interventions (such as yellow fever, Japanese encephalitis, and rabies vaccines).

Global TravEpiNet has identified that VFR travelers are less likely to seek timely pre-travel medical care and are more likely to decline recommended vaccines, even when they have sought medical advice. Because the Internet and primary care providers are common sources of health information for international travelers, especially VFR travelers, Global TravEpiNet has developed a number of web-based tools to optimize pre-travel health care for high-risk international travelers (Box 1-02). These publicly available web tools link directly to up-to-date recommendations from CDC. The Global TravEpiNet Consortium is also actively recruiting primary care and public health clinical sites that provide care to VFR and other high-risk travelers. More information on Global TravEpiNet, its web tools, and its membership can be found at www.healthful.travel.

Box 1-02. Publicly available travel resources from Global TravEpiNet

  • All resources are free, do not require registration, and can be accessed at www.healthful.travel.
  • The Travelers’ Health Tool encourages international travelers to seek pre-travel health advice and provides quick, itinerary-specific recommendations based on CDC guidelines.
  • The Healthcare Providers’ Tool guides clinicians through preparing a person for international travel and is up-to-date with CDC recommendations.

BIBLIOGRAPHY

  1. CDC. Notes from the field: acute muscular sarcocystosis among returning travelers—Tioman Island, Malaysia, 2011. MMWR Morb Mortal Wkly Rep. 2012 Jan 20;61(2):37–8.
  2. CDC. Update: outbreak of acute febrile respiratory illness among college students—Acapulco, Mexico, March 2001. MMWR Morb Mortal Wkly Rep. 2001 May 11;50(18):359–60.
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  6. LaRocque RC, Rao SR, Lee J, Ansdell V, Yates JA, Schwartz BS, et al. Global TravEpiNet: a national consortium of clinics providing care to international travelers—analysis of demographic characteristics, travel destinations, and pretravel healthcare of high-risk US international travelers, 2009–2011. Clin Infect Dis. 2012 Feb 15;54(4):455–62.
  7. LaRocque RC, Rao SR, Tsibris A, Lawton T, Barry MA, Marano N, et al. Pre-travel health advice-seeking behavior among US international travelers departing from Boston Logan International Airport. J Travel Med. 2010 Nov–Dec;17(6):387–91.
  8. Leder K, Black J, O’Brien D, Greenwood Z, Kain KC, Schwartz E, et al. Malaria in travelers: a review of the GeoSentinel surveillance network. Clin Infect Dis. 2004 Oct 15;39(8):1104–12.
  9. Leder K, Tong S, Weld L, Kain KC, Wilder-Smith A, von Sonnenburg F, et al. Illness in travelers visiting friends and relatives: a review of the GeoSentinel Surveillance Network. Clin Infect Dis. 2006 Nov 1;43(9):1185–93.
  10. Mendelson M, Davis XM, Jensenius M, Keystone JS, von Sonnenburg F, Hale DC, et al. Health risks in travelers to South Africa: the GeoSentinel experience and implications for the 2010 FIFA World Cup. Am J Trop Med Hyg. 2010 Jun;82(6):991–5.
  11. Schwartz E, Weld LH, Wilder-Smith A, von Sonnenburg F, Keystone JS, Kain KC, et al. Seasonality, annual trends, and characteristics of dengue among ill returned travelers, 1997–2006. Emerg Infect Dis. 2008 Jul;14(7):1081–8.
 
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