A K Boggild1,2, J Geduld3, M Libman4, B J Ward4, A McCarthy5, J Hajek6, W Ghesquiere7, J Vincelette8, S Kuhn9, D O Freedman10, K C Kain1,11. 1. Tropical Disease Unit, Department of Medicine, University Health Network and the University of Toronto, Toronto, ON. 2. Public Health Ontario Laboratories, Public Health Ontario, Toronto, ON. 3. Travel and Migration Health Division, Public Health Agency of Canada, Ottawa, ON. 4. Division of Infectious Diseases, McGill University Health Centre, Montreal, QC. 5. Tropical Medicine and International Health Clinic, Ottawa Hospital and the University of Ottawa, Ottawa, ON. 6. Division of Infectious Diseases, Vancouver General Hospital and University of British Columbia, Vancouver, BC. 7. Infectious Diseases, Vancouver Island Health Authority and University of British Columbia, Victoria, BC. 8. Hôpital Saint-Luc du CHUM and Université de Montréal, Montréal, QC. 9. Division of Pediatric Infectious Diseases, Alberta Children's Hospital and the University of Calgary, Calgary, AB. 10. Gorgas Center for Geographic Medicine, University of Alabama Birmingham, Birmingham, AL. 11. SAR Laboratories, Sandra Rotman Centre for Global Health, Toronto, ON.
Abstract
BACKGROUND: Important gaps remain in our knowledge of the infectious diseases people acquire while travelling and the impact of pathogens imported by Canadian travellers. OBJECTIVE: To provide a surveillance update of illness in a cohort of returned Canadian travellers and new immigrants. METHODS: Data on returning Canadian travellers and new immigrants presenting to a CanTravNet site between September 2011 and September 2012 were extracted and analyzed by destination, presenting symptoms, common and emerging infectious diseases and disease severity. RESULTS: During the study period, 2283 travellers and immigrants presented to a CanTravNet site, 88% (N=2004) of whom were assigned a travel-related diagnosis. Top three destinations for non-immigrant travellers were India (N=132), Mexico (N=103) and Cuba (N=89). Fifty-one cases of malaria were imported by ill returned travellers during the study period, 60% (N=30) of which were Plasmodium falciparum infections. Individuals travelling to visit friends and relatives accounted for 83% of enteric fever cases (15/18) and 41% of malaria cases (21/51). The requirement for inpatient management was over-represented among those with malaria compared to those without malaria (25% versus 2.8%; p<0.0001) and those travelling to visit friends and relatives versus those travelling for other reasons (12.1% versus 2.4%; p<0.0001). Nine new cases of HIV were diagnosed among the cohort, as well as one case of acute hepatitis B. Emerging infections among travellers included hepatitis E virus (N=6), chikungunya fever (N=4) and cutaneous leishmaniasis (N=16). Common chief complaints included gastrointestinal (N=804), dermatologic (N=440) and fever (N=287). Common specific causes of chief complaint of fever in the cohort were malaria (N=47/51 total cases), dengue fever (14/18 total cases), enteric fever (14/17 total cases) and influenza and influenza-like illness (15/21 total cases). Animal bites were the tenth most common diagnosis among tourist travellers. INTERPRETATION: Our analysis of surveillance data on ill returned Canadian travellers provides a recent update to the spectrum of imported illness among travelling Canadians. Preventable travel-acquired illnesses and injuries in the cohort include malaria, enteric fever, HIV, hepatitis B, hepatitis A, influenza and animal bites. Strategies to improve uptake of preventive interventions such as malaria chemoprophylaxis, immunizations and arthropod/animal avoidance may be warranted.
BACKGROUND: Important gaps remain in our knowledge of the infectious diseases people acquire while travelling and the impact of pathogens imported by Canadian travellers. OBJECTIVE: To provide a surveillance update of illness in a cohort of returned Canadian travellers and new immigrants. METHODS: Data on returning Canadian travellers and new immigrants presenting to a CanTravNet site between September 2011 and September 2012 were extracted and analyzed by destination, presenting symptoms, common and emerging infectious diseases and disease severity. RESULTS: During the study period, 2283 travellers and immigrants presented to a CanTravNet site, 88% (N=2004) of whom were assigned a travel-related diagnosis. Top three destinations for non-immigrant travellers were India (N=132), Mexico (N=103) and Cuba (N=89). Fifty-one cases of malaria were imported by ill returned travellers during the study period, 60% (N=30) of which were Plasmodium falciparum infections. Individuals travelling to visit friends and relatives accounted for 83% of enteric fever cases (15/18) and 41% of malaria cases (21/51). The requirement for inpatient management was over-represented among those with malaria compared to those without malaria (25% versus 2.8%; p<0.0001) and those travelling to visit friends and relatives versus those travelling for other reasons (12.1% versus 2.4%; p<0.0001). Nine new cases of HIV were diagnosed among the cohort, as well as one case of acute hepatitis B. Emerging infections among travellers included hepatitis E virus (N=6), chikungunya fever (N=4) and cutaneous leishmaniasis (N=16). Common chief complaints included gastrointestinal (N=804), dermatologic (N=440) and fever (N=287). Common specific causes of chief complaint of fever in the cohort were malaria (N=47/51 total cases), dengue fever (14/18 total cases), enteric fever (14/17 total cases) and influenza and influenza-like illness (15/21 total cases). Animal bites were the tenth most common diagnosis among tourist travellers. INTERPRETATION: Our analysis of surveillance data on ill returned Canadian travellers provides a recent update to the spectrum of imported illness among travelling Canadians. Preventable travel-acquired illnesses and injuries in the cohort include malaria, enteric fever, HIV, hepatitis B, hepatitis A, influenza and animal bites. Strategies to improve uptake of preventive interventions such as malaria chemoprophylaxis, immunizations and arthropod/animal avoidance may be warranted.
Authors: J D Correia; R T Shafer; V Patel; K C Kain; D Tessier; D MacPherson; J S Keystone Journal: J Travel Med Date: 2001 Sep-Oct Impact factor: 8.490
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Authors: Andrea K Boggild; Jennifer Geduld; Michael Libman; Cedric P Yansouni; Anne E McCarthy; Jan Hajek; Wayne Ghesquiere; Yazdan Mirzanejad; Jean Vincelette; Susan Kuhn; Pierre J Plourde; Sumontra Chakrabarti; David O Freedman; Kevin C Kain Journal: CMAJ Date: 2017-03-06 Impact factor: 8.262
Authors: Pascal Djiadeu; Martez D R Smith; Sameer Kushwaha; Apondi J Odhiambo; David Absalom; Winston Husbands; Wangari Tharao; Rotrease Regan; Ting Sa; Nanhua Zhang; Rupert Kaul; LaRon E Nelson Journal: J Int Assoc Provid AIDS Care Date: 2020 Jan-Dec
Authors: A K Boggild; J Geduld; M Libman; C P Yansouni; A E McCarthy; J Hajek; W Ghesquiere; J Vincelette; S Kuhn; P J Plourde; D O Freedman; K C Kain Journal: Can Commun Dis Rep Date: 2016-08-04