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Infectious Risks of Traveling Abroad

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  • Authors: Lin H. Chen1, Barbra M. Blair3
  • Editor: David Schlossberg5
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Mount Auburn Hospital, Cambridge, MA 02138; 2: Harvard Medical School, Boston, MA 02115; 3: Mount Auburn Hospital, Cambridge, MA 02138; 4: Harvard Medical School, Boston, MA 02115; 5: Philadelphia Health Department, Philadelphia, PA
  • Source: microbiolspec August 2015 vol. 3 no. 4 doi:10.1128/microbiolspec.IOL5-0005-2015
  • Received 18 February 2015 Accepted 20 April 2015 Published 07 August 2015
  • Lin H. Chen, lchen@hms.harvard.edu
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  • Abstract:

    A popular leisure activity, international travel can be associated with some infections. The most common travel-related illnesses appear to be gastrointestinal, dermatologic, respiratory, and systemic febrile syndromes. The pretravel medical consultation includes immunizations, malaria chemoprophylaxis, self-treatment for traveler’s diarrhea, and advice on the prevention of a myriad of other infectious causes including dengue, chikungunya, rickettsiosis, leptospirosis, schistosomiasis, and strongyloidiasis. Travel to locations experiencing outbreaks such as Ebola virus disease, Middle East respiratory syndrome, avian influenza, and chikungunya call for specific alerts on preventive strategies. After travel, evaluation of an ill traveler must explore details of exposure, including destinations visited; activities; ingestion of contaminated food or drinks; contact with vectors, animals, fresh water, or blood and body fluids; and other potential exposures. Knowledge of the geographic distribution of infectious diseases is important in generating the differential diagnoses and testing accordingly. Empiric treatment is sometimes necessary when suspicion of a certain diagnosis is strong and confirmatory tests are delayed or lacking, particularly for infections that are rapidly progressive (for example, malaria) or for which timing of testing is prolonged (such as leptospirosis).

  • Citation: Chen L, Blair B. 2015. Infectious Risks of Traveling Abroad. Microbiol Spectrum 3(4):IOL5-0005-2015. doi:10.1128/microbiolspec.IOL5-0005-2015.

Key Concept Ranking

Infectious Diseases
0.85699856
Vector-Borne Diseases
0.773406
Zoonotic Diseases
0.77129865
Gastrointestinal Diseases
0.69976
Bacterial Vaccines
0.6289019
Traveler's Diarrhea
0.51125723
0.85699856

References

1. Centers for Disease Control and Prevention. 2014. CDC Health Information for International Travel 2014. Oxford University Press, New York.
2. Hill DR. 2000. Health problems in a large cohort of Americans travelling to developing countries. J Travel Med 7:259–266. [PubMed][CrossRef]
3. Hill DR, Ericsson CD, Pearson RD, Keystone JS, Freedman DO, Kozarsky PE, DuPont HL, Bia FJ, Fischer PR, Ryan ET, Infectious Diseases Society of America. 2006. The practice of travel medicine: guidelines by the Infectious Diseases Society of America. Clin Infect Dis 43:1499–1539. [PubMed][CrossRef]
4. Leder K, Torresi J, Libman MD, Cramer JP, Castelli F, Schlagenhauf P, Wilder-Smith A, Wilson ME, Keystone JS, Schwartz E, Barnett ED, von Sonnenburg F, Brownstein JS, Cheng AC, Sotir MJ, Esposito DH, Freedman DO, GeoSentinel Surveillance Network. 2013. GeoSentinel surveillance of illness in returned travelers, 2007-2011. Ann Intern Med 158:456–468. [PubMed][CrossRef]
5. Lederman ER, Weld LH, Elyazer IRF, von Sonnenberg F, Loutan L, Schwartz E, Keystone JS. 2008. Dermatologic conditions of the ill returned traveler: an analysis from the GeoSentinel Surveillance Network. Int J Infect Dis 12:593–601. [PubMed][CrossRef]
6. National Center for Immunization and Respiratory Diseases. 2011. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 60:1–64. [PubMed]
7. Petersen EK, Chen LH, Schlagenhauf P (ed). 2011. Infectious Diseases: A Geographic Guide. Wiley-Blackwell, Chichester, UK. [CrossRef]
8. Ross AGP, Olds GR, Cripps AW, Farrar JJ, McManus DP. 2013. Enteropathogens and chronic illness in returning travelers. N Engl J Med 368:1817–1825. [PubMed][CrossRef]
9. Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, Bousvaros A, Dhanireddy S, Sung L, Keyserling H, Kang I, Infectious Diseases Society of America. 2014. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 58:309–318. [PubMed][CrossRef]
10. Ryan ET, Wilson ME, Kain KC. 2002. Illness after international travel. N Engl J Med 347:505–516. [PubMed][CrossRef]
11. Steffen R, Hill DR, DuPont HL. 2015. Traveler’s diarrhea. JAMA 313:71–80. [PubMed][CrossRef]
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2015-08-07
2017-10-23

Abstract:

A popular leisure activity, international travel can be associated with some infections. The most common travel-related illnesses appear to be gastrointestinal, dermatologic, respiratory, and systemic febrile syndromes. The pretravel medical consultation includes immunizations, malaria chemoprophylaxis, self-treatment for traveler’s diarrhea, and advice on the prevention of a myriad of other infectious causes including dengue, chikungunya, rickettsiosis, leptospirosis, schistosomiasis, and strongyloidiasis. Travel to locations experiencing outbreaks such as Ebola virus disease, Middle East respiratory syndrome, avian influenza, and chikungunya call for specific alerts on preventive strategies. After travel, evaluation of an ill traveler must explore details of exposure, including destinations visited; activities; ingestion of contaminated food or drinks; contact with vectors, animals, fresh water, or blood and body fluids; and other potential exposures. Knowledge of the geographic distribution of infectious diseases is important in generating the differential diagnoses and testing accordingly. Empiric treatment is sometimes necessary when suspicion of a certain diagnosis is strong and confirmatory tests are delayed or lacking, particularly for infections that are rapidly progressive (for example, malaria) or for which timing of testing is prolonged (such as leptospirosis).

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FIGURE 1

Map with geographic illustration of most common diagnoses. (Data from Leder et al. 2013.) doi:10.1128/microbiolspec.IOL5-0005-2015.f1

Source: microbiolspec August 2015 vol. 3 no. 4 doi:10.1128/microbiolspec.IOL5-0005-2015
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Tables

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TABLE 1

Resources for the practice of travel medicine, including some international and national authorities, online links, and reference books

Source: microbiolspec August 2015 vol. 3 no. 4 doi:10.1128/microbiolspec.IOL5-0005-2015
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TABLE 2

Immunizations commonly considered in pretravel consultation (for a comprehensive list of routine vaccines, see routine immunization schedules published by the Advisory Committee on Immunization Practices and updated annually)

Source: microbiolspec August 2015 vol. 3 no. 4 doi:10.1128/microbiolspec.IOL5-0005-2015
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TABLE 3

Malaria chemoprophylaxis drugs

Source: microbiolspec August 2015 vol. 3 no. 4 doi:10.1128/microbiolspec.IOL5-0005-2015
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TABLE 4

Key exposures to ask about when evaluating ill returned travelers

Source: microbiolspec August 2015 vol. 3 no. 4 doi:10.1128/microbiolspec.IOL5-0005-2015

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