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Volume 15, Number 11—November 2009
CME ACTIVITY - Research

Multicenter GeoSentinel Analysis of Rickettsial Diseases in International Travelers, 1996–2008

Mogens JenseniusComments to Author , Xiaohong Davis, Frank von Sonnenburg, Eli Schwartz, Jay S. Keystone, Karin Leder, Rogelio Lopéz-Véléz, Eric Caumes, Jakob P. Cramer, Lin Chen, Philippe Parola, and for the GeoSentinel Surveillance Network
Author affiliations: Oslo University Hospital, Oslo, Norway (M. Jensenius); University of Oslo, Oslo (M. Jensenius); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (X. Davis); University of Munich, Munich, Germany (F. von Sonnenburg); Chaim Sheba Medical Centre, Tel Hashomer, Israel (E. Schwartz); Toronto General Hospital, Toronto, Ontario, Canada (J.S. Keystone); Royal Melbourne Hospital, Parkville, Victoria, Australia (K. Leder); Ramón y Cajal Hospital, Madrid, Spain (R. Lopéz-Véléz); Hôpital Pitié-Salpêtrière, Paris, France (E. Caumes); Bernhard-Nocht-Clinic for Tropical Medicine, Hamburg, Germany (J.P. Cramer); Harvard Medical School, Boston, Massachusetts, USA (L. Chen); WHO Collaborative Center for Rickettsioses and Other Arthropod Borne Bacterial Diseases, Marseille, France (P. Parola); Hôpital Nord, Marseille (P. Parola); 1Additional members of the GeoSentinal Surveillance Network who contributed data are listed at the end of this article.

Main Article

Table 2

Univariate and multivariate analyses of risk factors associated with SFG rickettsiosis in travelers to sub-Saharan Africa, 1996–2008*

Variable Travelers with SFG rickettsiosis, N = 197† Travelers without SFG rickettsiosis, N = 11,690† Univariate association
 Multivariate model‡
OR (95% CI) p value OR (95% CI) p value
Mean age, y 43.9, n = 196 36.5, n = 11,608 – <0.0001 1.02 
(1.01–1.03)§ <0.0001
Male gender, no. (%) 115 (58.4), n = 197 6,105 (52.6), n = 11,599 1.26 
(0.95–1.68) 0.11 1.40 
(1.02–1.92) 0.035
Travel to southern Africa,¶ no. (%) 139 (70.6), n = 197 759 (6.5), n = 11,686 34.5 
(25.18–47.28) <0.0001 23.61 
(16.86–33.07) <0.0001
Travel in late summer,# no. (%) 89 (47.1), n = 189 4,220 (40.6), n = 10,402 1.30
(0.98–1.74) 0.07 1.57 
(1.15–2.15) 0.005
Travel duration >7 d, no. (%) 173 (91.5), n = 189 9,661 (92.9), n = 10,402 0.83
(0.49–1.39) 0.48 0.67 
(0.38–1.18) 0.164
No pretravel clinic visit, no. (%) 40 (21.7), n = 184 2,823 (26.5), n = 10,665 0.77 
(0.54–1.10) 0.15 0.98 
(0.66–1.44) 0.903
Independent travel,** no. (%) 34 (44.2), n = 77 4,100 (58.6), n = 6,993 0.56 
(0.35–0.87) 0.01 0.83 
(0.56–1.25) 0.373
Tourism as reason for travel, no. (%) 163 (82.7), n = 197 5,027 (43.0), n = 11,686 6.35 
(4.38–9.21) <0.0001 2.96 
(1.97–4.45) <0.0001

*SFG, spotted fever group; OR, odds ratio; CI, confidence interval.
†n = number of travelers for whom this information was available.
‡This model included all variables considered at univariate level because of their clinical relevance. The Hosmer and Lemeshow goodness-of-fit test for this model is p = 0.575.
§Odds ratio is for 1-y increase in age.
¶United Nations subregion comprising Botswana, Lesotho, Namibia, South Africa, and Swaziland.
#March–May.
**Independent travel was not formally collected by GeoSentinel until after May 2007.

Main Article

In addition to the authors, the following members of the GeoSentinel Surveillance Network contributed data: Kevin C. Kain, University of Toronto, Toronto, Ontario, Canada; Phyllis E. Kozarsky and Carlos Franco-Paredes, Emory University, Atlanta, Georgia, USA; Louis Loutan and François Chappuis, University of Geneva, Geneva, Switzerland; Joseph Torresi and Graham Brown, Royal Melbourne Hospital, Melbourne, Victoria, Australia; DeVon C. Hale and Stefanie S. Gelman, University of Utah, Salt Lake City, Utah, USA; Alice Pérignon, Hôpital Pitié-Salpêtrière, Paris, France; Gerd-Dieter Burchard, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany; Mary E. Wilson, Harvard University, Cambridge, Massachusetts, USA; Fabrice Simon and Jean Delmont, Hôpital Nord, Marseille, France; William M. Stauffer and Patricia F. Walker, University of Minnesota, Minneapolis, Minnesota, USA; Poh Lian Lim and Annelies Wilder-Smith, Tan Tock Seng Hospital, Singapore; Jose Antonio Perez Molina, Hospital Ramon y Cajal, Madrid, Spain; Bradley A. Connor, Cornell University, Ithaca, New York, USA; Carmelo Licitra and Antonio Crespo, Orlando Regional Health Center, Orlando, Florida, USA; David O. Freedman, University of Alabama at Birmingham, Birmingham, Alabama, USA; Effrossyni Gkrania-Klotsas, Addenbrooke's Hospital, Cambridge, UK; Giampiero Carosi and Francesco Castelli, University of Brescia, Brescia, Italy; Marc Shaw, Worldwise Travelers Health and Vaccination Centre, Auckland, New Zealand; Prativa Pandey, CIWEC Clinic Travel Medicine Center, Kathmandu, Nepal; R. Bradley Sack and Robin McKenzie, Johns Hopkins University, Baltimore, Maryland, USA (Dec 1997–Aug 2007); Elizabeth D. Barnett, Boston University, Boston, Massachusetts, USA; Christina M. Coyle and Murray Wittner, Albert Einstein School of Medicine, Bronx, New York, USA; Stefan Hagmann and Andy Miller, Bronx-Lebanon Hospital Center, Bronx; Michael W. Lynch, Fresno International Travel Medical Center, Fresno, California, USA; Vanessa Field, InterHealth, London, UK; Michael D. Libman and J. Dick Maclean, McGill University, Montreal, Quebec, Canada; Alejandra Gurtman, Mount Sinai Medical Center, New York, New York, USA (Oct 2002–Aug 2005); Shuzo Kanagawa and Yasuyuki Kato, International Medical Center of Japan, Tokyo, Japan; and Patricia Schlagenhauf, Rainer Weber, and Robert Steffen, University of Zürich, Zürich, Switzerland.

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