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Infectious diseases acquired by international travellers visiting the USA.
J Travel Med. 2018 08 01; 25(1)JT

Abstract

Background

Estimates of travel-related illness have focused predominantly on populations from highly developed countries visiting low- or middle-income countries, yet travel to and within high-income countries is very frequent. Despite being a top international tourist destination, few sources describe the spectrum of infectious diseases acquired among travellers to the USA.

Methods

We performed a descriptive analysis summarizing demographic and travel characteristics, and clinical diagnoses among non-US-resident international travellers seen during or after travel to the USA at a GeoSentinel clinic from 1 January 1997 through 31 December 2016.

Results

There were 1222 ill non-US-resident travellers with 1393 diagnoses recorded during the 20-year analysis period. Median age was 40 (range 0-86 years); 52% were female. Patients visited from 63 countries and territories, most commonly Canada (31%), Germany (14%), France (9%) and Japan (7%). Travellers presented with a range of illnesses; skin and soft tissue infections of unspecified aetiology were the most frequently reported during travel (29 diagnoses, 14% of during-travel diagnoses); arthropod bite/sting was the most frequently reported after travel (173 diagnoses, 15% after-travel diagnoses). Lyme disease was the most frequently reported arthropod-borne disease after travel (42, 4%). Nonspecific respiratory, gastrointestinal and systemic infections were also among the most frequently reported diagnoses overall. Low-frequency illnesses (<2% of cases) made up over half of diagnoses during travel and 41% of diagnoses after travel, including 13 cases of coccidioidomycosis and mosquito-borne infections like West Nile, dengue and Zika virus diseases.

Conclusions

International travellers to the USA acquired a diverse array of mostly cosmopolitan infectious diseases, including nonspecific respiratory, gastrointestinal, dermatologic and systemic infections comparable to what has been reported among travellers to low- and middle-income countries. Clinicians should consider the specific health risks when preparing visitors to the USA and when evaluating and treating those who become ill.

Authors+Show Affiliations

Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), 1825 Century Blvd NE, MS E-28, Atlanta, GA, USA.Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), 1825 Century Blvd NE, MS E-28, Atlanta, GA, USA.Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), 1825 Century Blvd NE, MS E-28, Atlanta, GA, USA. Department of Medicine, Emory University, Atlanta, GA, USA.Department of Global Health, Boston University School of Public Health, Boston, MA, USA. Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA.Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.Division of Infectious Diseases, Cambridge University Hospitals, Cambridge, UK.J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada.Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. Victorian Infectious Disease Service, Royal Melbourne Hospital at the Doherty Institute, Melbourne, Australia.Institute of Geographic Medicine and Tropical Diseases, Sheba Medical Center, Tel Hashomer, Israel. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), 1825 Century Blvd NE, MS E-28, Atlanta, GA, USA.Orlando Health Infectious Disease, University of Central Florida College of Medicine, Orlando, FL, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

30124885

Citation

Stoney, Rhett J., et al. "Infectious Diseases Acquired By International Travellers Visiting the USA." Journal of Travel Medicine, vol. 25, no. 1, 2018.
Stoney RJ, Esposito DH, Kozarsky P, et al. Infectious diseases acquired by international travellers visiting the USA. J Travel Med. 2018;25(1).
Stoney, R. J., Esposito, D. H., Kozarsky, P., Hamer, D. H., Grobusch, M. P., Gkrania-Klotsas, E., Libman, M., Gautret, P., Lim, P. L., Leder, K., Schwartz, E., Sotir, M. J., Licitra, C., Yansouni, C., Thomas, A., Sonnenburg, F. V., Rothe, C., Kain, K., Boggild, A., ... Anderson, S. (2018). Infectious diseases acquired by international travellers visiting the USA. Journal of Travel Medicine, 25(1). https://doi.org/10.1093/jtm/tay053
Stoney RJ, et al. Infectious Diseases Acquired By International Travellers Visiting the USA. J Travel Med. 2018 08 1;25(1) PubMed PMID: 30124885.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Infectious diseases acquired by international travellers visiting the USA. AU - Stoney,Rhett J, AU - Esposito,Douglas H, AU - Kozarsky,Phyllis, AU - Hamer,Davidson H, AU - Grobusch,Martin P, AU - Gkrania-Klotsas,Effrossyni, AU - Libman,Michael, AU - Gautret,Philippe, AU - Lim,Poh Lian, AU - Leder,Karin, AU - Schwartz,Eli, AU - Sotir,Mark J, AU - Licitra,Carmelo, AU - ,, AU - Yansouni,Cedric, AU - Thomas,Ashley, AU - Sonnenburg,Frank V, AU - Rothe,Camilla, AU - Kain,Kevin, AU - Boggild,Andrea, AU - Cahill,John, AU - McKinley,George, AU - Yoshimura,Yokihiro, AU - Tachikawa,Natsuo, AU - Javelle,Emilie, AU - Borwein,Sarah, AU - Caumes,Eric, AU - Perignon,Alice, AU - Mockenhaupt,Frank, AU - Harms-Zwigenberger,Gundel, AU - Kanagawa,Shuzo, AU - Kato,Yasuyuki, AU - Schlagenhauf,Pat, AU - Weber,Rainer, AU - Plewes,Katherine, AU - Ghesquire,Wayne, AU - Mirzanejad,Yazdan, AU - Jordan,Sabine, AU - Vinnemeier,Christof, AU - Mendelson,Marc, AU - Parker,Salim, AU - McCarthy,Anne, AU - Vincelette,Jean, AU - Barkati,Sapha, AU - Asgeirsson,Hilmir, AU - Glans,Hedvig, AU - Castelli,Francesco, AU - Matteelli,Alberto, AU - Kuhn,Susan, AU - Warne,Ben, AU - Torresi,Joseph, AU - Connor,Brad, AU - Jensenius,Mogens, AU - Genderen,Perry V, AU - Kelly,Paul, AU - Rapp,Christophe, AU - Ficko,Cecile, AU - Perret-Perez,Cecilia, AU - Siu,Hugo, AU - Valdez,Luis M, AU - Goorhuis,Abraham, AU - Chappuis,Francois, AU - Hoang Phu,Phi T, AU - Pandey,Prativa, AU - Murphy,Holly, AU - Shaw,Marc, AU - Lopez-Velez,Rogelio, AU - Norman,Francesca, AU - Piyaphanee,Watcharapong, AU - Silachamroon,Udomsak, AU - Haulman,Jean, AU - Terry,Anne, AU - Larsen,Carsten S, AU - Wejse,Christian, AU - Bottieau,Emmanuel, AU - Clerinx,Joannes, AU - Flores-Figueroa,Jose, AU - Lalloo,David, AU - Beeching,Nicholas, AU - Anderson,Susan, PY - 2018/03/15/received PY - 2018/07/26/accepted PY - 2018/8/21/entrez PY - 2018/8/21/pubmed PY - 2019/7/16/medline JF - Journal of travel medicine JO - J Travel Med VL - 25 IS - 1 N2 - Background: Estimates of travel-related illness have focused predominantly on populations from highly developed countries visiting low- or middle-income countries, yet travel to and within high-income countries is very frequent. Despite being a top international tourist destination, few sources describe the spectrum of infectious diseases acquired among travellers to the USA. Methods: We performed a descriptive analysis summarizing demographic and travel characteristics, and clinical diagnoses among non-US-resident international travellers seen during or after travel to the USA at a GeoSentinel clinic from 1 January 1997 through 31 December 2016. Results: There were 1222 ill non-US-resident travellers with 1393 diagnoses recorded during the 20-year analysis period. Median age was 40 (range 0-86 years); 52% were female. Patients visited from 63 countries and territories, most commonly Canada (31%), Germany (14%), France (9%) and Japan (7%). Travellers presented with a range of illnesses; skin and soft tissue infections of unspecified aetiology were the most frequently reported during travel (29 diagnoses, 14% of during-travel diagnoses); arthropod bite/sting was the most frequently reported after travel (173 diagnoses, 15% after-travel diagnoses). Lyme disease was the most frequently reported arthropod-borne disease after travel (42, 4%). Nonspecific respiratory, gastrointestinal and systemic infections were also among the most frequently reported diagnoses overall. Low-frequency illnesses (<2% of cases) made up over half of diagnoses during travel and 41% of diagnoses after travel, including 13 cases of coccidioidomycosis and mosquito-borne infections like West Nile, dengue and Zika virus diseases. Conclusions: International travellers to the USA acquired a diverse array of mostly cosmopolitan infectious diseases, including nonspecific respiratory, gastrointestinal, dermatologic and systemic infections comparable to what has been reported among travellers to low- and middle-income countries. Clinicians should consider the specific health risks when preparing visitors to the USA and when evaluating and treating those who become ill. SN - 1708-8305 UR - https://www.unboundmedicine.com/medline/citation/30124885/Infectious_diseases_acquired_by_international_travellers_visiting_the_USA_ L2 - https://academic.oup.com/jtm/article-lookup/doi/10.1093/jtm/tay053 DB - PRIME DP - Unbound Medicine ER -