Volume 15, Number 11—November 2009
Research
Illness in Long-Term Travelers Visiting GeoSentinel Clinics
, Mary E. Wilson, Xiaohong Davis, Louis Loutan, Eli Schwartz, Jay S. Keystone, Devon Hale, Poh Lian Lim, Anne McCarthy, Effrossyni Gkrania-Klotsas, Patricia Schlagenhauf, and for the GeoSentinel Surveillance Network1
Table 1
Most common diagnoses for long-term travelers (n = 4,742) seen after travel and proportionate illness compared with short-term travelers (n = 28,618), GeoSentinel Surveillance Network, June 1996–December 2008*
| Rank† | Diagnosis | Rate/1,000 travelers | Odds ratio (95% confidence interval) |
||||
|---|---|---|---|---|---|---|---|
| Overall | South America | Southeast Asia | Sub-Saharan Africa | All other regions | |||
| 1 | Diarrhea, chronic unknown | 50 | 1.20‡ (1.04–1.38) | 1.19 (0.81–1.75) | 1.59§ (1.05–2.39) | 0.92 (0.64–1.31) | 1.19 (0.99–1.44) |
| 2 | Giardia spp. | 36 | 1.57‡ (1.32–1.86) | 0.85 (0.49–1.47) | 1.48 (0.80–2.73) | 1.93‡ (1.39–2.67) | 1.59‡ (1.26–2.01) |
| 3 | Irritable bowel syndrome, postinfectious | 36 | 1.69‡ (1.41–2.01) | 2.13§ (1.42–3.18) | 2.76§ (1.52–5.02) | 1.59¶ (1.03–2.45) | 1.42§ (1.11–1.80) |
| 4 | Malaria, Plasmodium falciparum | 36 | 1.50‡ (1.26–1.78) | NA | 5.05‡ (2.58–9.88) | 1.05 (0.86–1.27) | 2.77§ (1.58–4.87) |
| 6 | Malaria, P. vivax | 19 | 2.46‡ (1.92–3.17) | 0.83 (0.33–2.07) | 4.79‡ (2.86–8.01) | 1.14 (0.67–1.94) | 3.66‡ (2.57–5.22) |
| 8 | Fatigue >1 month (not febrile) | 18 | 3.09‡ (2.86–4.01) | 3.45§ (1.59–7.50) | 1.94 (0.86–4.37) | 1.79 (0.98–3.25) | 4.27‡ (3.01–6.05) |
| 9 | Eosinophilia | 17 | 3.34‡ (2.53–4.42) | 3.49§ (1.56–7.83) | 3.11§ (1.46–6.60) | 4.11‡ (2.46–6.84) | 2.89‡ (1.91–4.37) |
| 11 | Leishmaniasis, cutaneous | 14 | 4.89‡ (3.55–6.73) | 9.14‡ (5.15–16.24) | NA | 0.77 (0.09–6.40) | 2.30§ (1.35–3.92) |
| 12 | Schistosomiasis, human species unknown# | 13 | 4.45‡ (3.16–6.25) | 2.92 (0.18–46.68) | 3.30 (0.34–31.80) | 3.10‡ (2.09–4.59) | 7.44‡ (3.83–14.47) |
| 17 | TB, positive PPD or IGRA | 11 | 3.26‡ (2.33–4.56) | 2.92 (0.73–11.72) | 24.27‡ (8.52–69.17) | 2.44¶ (1.13–5.26) | 2.68‡ (1.71–4.18) |
| 18 | Entamoeba histolytica, diarrhea | 11 | 3.33‡ (2.34–4.73) | 2.57 (0.93–7.10) | 1.52 (0.34–6.77) | 3.88‡ (1.95–7.72) | 3.52‡ (2.23–5.56) |
| 21 | Stress | 9 | 5.70‡ (3.77–8.61) | NA | 1.65 (0.20–13.73) | 7.57‡ (3.13–18.30) | 5.55‡ (3.32–9.30) |
| 22 | Epstein-Barr virus | 8 | 2.60‡ (1.72–3.91) | 12.86‡ (3.65–45.27) | 2.99¶ (1.20–7.48) | 0.38 (0.05–2.96) | 2.29§ (1.30–4.03) |
| 25 | Strongyloidiasis, simple intestinal | 7 | 1.85§ (1.24–2.75) | 0.83 (0.17–4.01) | 3.11¶ (1.14–8.53) | 1.62 (0.88–2.99) | 1.89 (0.94–3.81) |
*Long-term travel is defined as >6 mo, short-term travel as <1 mo. NA, not applicable; TB, tuberculosis; PPD, purified protein derivative test; IGRA, interferon-gamma release assay.
†Among 25 most common illnesses for all travelers.
‡p<0.0001.
§p<0.01.
¶p<0.05.
#Aggregated schistosomiasis diagnoses (mansoni, haematobium, japonicum, mekongi, and unknown) are grouped together and shown in Appendix Table 3,.
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.