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  • Blood-borne chronic viral infections in a large cohort of immigrants in southern Italy: A seven-centre, prospective, screening study
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2020-01-13
    Nicola Coppola; Caterina Monari; Loredana Alessio; Lorenzo Onorato; Luciano Gualdieri; Caterina Sagnelli; Carmine Minichini; Evangelista Sagnelli; Giovanni Di Caprio; Lorenzo Surace; Gaetano Scotto; Margherita Macera; Gianfranco Griffo; Italo Francesco Angelillo; Mariantonietta Pisaturo

    Background Aim of this study was to evaluate the prevalence of blood-borne chronic viral infections in immigrants living in southern Italy and identify factors associated to viral infections. Methods A prospective screening program was performed in seven clinical centers operating in Campania, Apulia and Calabria regions in southern Italy, in order to identify immigrants with HBV, HCV or HIV infections. Results Of 4,125 immigrants observed in the study period, 3,839 (93.0%) agreed to be screened: 381 (9.9%) resulted HBsAg-positive, 136 (3.5%) anti-HCV, 62 (1.6%) anti-HIV and 1,448 (37.7%) HBsAg-negative and anti-HBc-positive. Ongoing or previous HBV infection was observed more frequently in males (p = 0.02 and p < 0.001, respectively), whereas HIV infection in females (p = 0.01). Immigrants from western Africa showed a higher rate of HBsAg positivity (p < 0.0001), HBsAg negativity/anti-HBc positivity (p < 0.0001) and anti-HIV positivity (p = 0.004) compared with those from other geographical areas. At multivariate analysis, ongoing HBV infection was associated with male sex (OR 1.49, 95% CI: 1.04–2.14) and origin from western Africa (OR 4.67, 95% CI: 1.70–12.80) and eastern Europe (OR 3.44, 95% CI: 1.17–10.08). HCV infection showed the tendency to be more frequent among males (OR 1.84, 95% CI: 0.99–3.42). HIV infection was associated with an older age (OR 1.04, 95% CI: 1.01–1.06), origin from western Africa (OR 4.09, 95% CI: 1.26–13.29) and female sex (OR 2.38, 95% CI: 1.29–4,39; p = 0.006). Conclusions The high prevalence of HBV, HCV and HIV infections in our large cohort of immigrants should definitively prompt Italian Healthcare Authorities to develop adequate cost-effective screening policies.

    更新日期:2020-01-13
  • Electronic consultations with Video Supported PowerPoint versus in-clinic face-to-face, pre-travel consultations: A single-centre, comparative analysis
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2020-01-11
    Abinash Virk; Mandrekar Jayawant; Donna J. Springer; M.J. Kasten

    Background Pretravel consultation involves a face-to-face visit with a Travel Medicine expert and includes time consuming educating/counseling. Efficacy of electronic consultations for pretravel is unknown. We compared pretravel education via face-to-face consult to an electronic consultations combined with education via Video Supported PowerPoint for select travelers. Methods We conducted a prospective trial comparing pre-travel education via electronic consultations versus face-to-face consult. Study was conducted from May 2014 through May 2015. Results Pretravel surveys were completed by 100 in electronic consult arm and 94 in face-to-face consult arm; 67/100 (67%) in the electronic consult and 51/94 (54.2%) in the face-to-face group completed post-travel surveys. Both groups had similar baseline demographics. 36.2% of the face-to-face group felt the trip preparation could have effectively been accomplished through electronic consult, while 33% felt that a face-to-face consult was needed; in contrast, a majority (63.3%) of electronic consult group preferred the electronic consult. Pre-travel education effectiveness was similar in both groups. No statistically significant differences in responses were noted in both groups to 5 of the 6 knowledge assessment questions. A higher proportion (76/100; 76%) in the electronic consult group compared to 55.4% (51/94) (p = 0.0018) in face-to-face group chose the correct response regarding management of febrile bloody diarrhea. 53% reported behavior change to prevent travel related illnesses, with no statistically significant differences between the groups. Conclusions electronic consultation with Video Supported PowerPoint pre-travel education is as effective as education via face-to-face consultations and provides a viable alternative to face-to-face consultations in select travelers.

    更新日期:2020-01-13
  • Instances of altered gut microbiomes among Irish cricketers over periods of travel in the lead up to the 2016 World Cup: A sequencing analysis
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2020-01-11
    Ciara M. O’ Donovan; Brendan Connor; Sharon M. Madigan; Paul D. Cotter; Orla O’ Sullivan

    Background Changes and stresses experienced during travel have the potential to impact the gut microbiome, with travel implicated in the spread of antibiotic resistance genes across continents. The possibility of gut microbiome-mediated negative impacts arising from travel, and consequences for peak performance, would be of particular concern for elite athletes. Methods Faecal samples were collected from male (N = 14) and female (N = 7) cricket players during the build-up to the 2016 Cricket World Cup. Baseline and post-travel samples were collected from all participants and subjected to 16S rRNA amplicon sequencing. Samples from a subset of participants (N = 4) were analysed by shotgun metagenomic sequencing. Results Analysis revealed a single travel time point as having the potential to have an impact on the gut microbiome. Reductions in alpha diversity following travel were observed, accompanied by shifts in the taxonomic profile of the gut microbiome. Antibiotic resistance and virulence genes were also identified as undergoing changes following travel. Conclusions This study reveals that periods of travel, in particular following gastrointestinal distress, may result in gut microbiome disruption. While this analysis was completed in athletes, the findings are applicable to all travelling individuals and considerations should be made surrounding travel in an attempt to reduce these changes.

    更新日期:2020-01-13
  • Factors influencing the immune response after a double-dose 2-visit pre-exposure rabies intradermal vaccination schedule: A retrospective study
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2020-01-10
    Benjamin Damanet; Diana Isabela Costescu Strachinaru; Patrick Soentjens

    Background Double-dose 2-visit intradermal rabies schedules (22ID) have recently been accepted by the World Health Organization (WHO) as Pre-Exposure Prophylaxis (PrEP). The aim of this study is to determine which factors influence the levels of rabies virus neutralizing antibodies (RVNA) after a 22ID rabies vaccination schedule. Methods This is a retrospective study based on electronic health record vaccination data of subjects from the Belgian Armed Forces who received the 22ID rabies PrEP. An antibody titer ≥0.5 IU/mL, measured by rapid fluorescent focus inhibition test, is defined by the WHO as an adequate immune response after PrEP. Logistic regression was performed in order to identify predictive factors of RVNA level ≥3.0 IU/ml and >10 IU/ml. Results 301 subjects were included. 297 (98,6%) seroconverted with a RVNA ≥ 0.5 IU/ml. Multivariate analysis shows a significant better immune response in the subjects where the second dose was administered later on than on day 7 (RVNA >10 IU/ml (OR: 3.01 [1.36–6.67])). Postponing the timing of the serology control also influenced significantly the rapid fluorescent focus inhibition test (RVNA ≥ 3.0 IU/ml (OR: 0.12 [0.06–0.24]) and RVNA > 10 IU/ml (OR: 0.14 [0.06–0.29])). Conclusion A 22ID rabies PrEP vaccination schedule is highly effective and provides an adequate immune response in most subjects in a real live setting. Timing of the second vaccine dose significantly influences the response to ID rabies vaccine. Timing of RVNA determination is important in order to correctly assess the response to vaccination.

    更新日期:2020-01-11
  • Infectious disease symptoms and microbial carriage among French medical students travelling abroad: A prospective study
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-12-21
    Thi Loi Dao; Van Thuan Hoang; Ly Tran Duc Anh; Amal Magmoun; Naomie Canard; Tassadit Drali; Florence Fenollar; Laetitia Ninove; Didier Raoult; Philippe Parola; Johan Courjon; Philippe Gautret

    Background In France, no previous studies have focused specifically on health problems among medical students during internships abroad including the clinical symptoms suggestive of infectious diseases and the acquisition of pathogen carriage. Methods Clinical follow up and qPCR based respiratory, gastrointestinal and vaginal pathogen carriage before and after travel were prospectively assessed in a cohort of medical students departing from Marseille, France. Results 134 students were included. 73.9%, 38.8% and 5.0% of students reported gastrointestinal, respiratory and vaginal symptoms, respectively. The acquisition rate of Enteroaggregative Escherichia coli (EAEC) and Enteropathogenic E. coli (EPEC) was 53% and 41%, respectively. The acquisition of respiratory viruses was low but associated with persisting symptoms, while bacterial acquisition ranged from 3.3% for Streptococcus pyogenes to 15.0% for Haemophilus influenzae. Gardnerella vaginalis and Atopobium vaginae acquisition rates were 7.7% and 14.3% respectively. Five students (5.1%) had molecular quantification criteria for bacterial vaginosis on return. Conclusion This preliminary study demonstrates that besides the known risk of gastrointestinal and respiratory infections and associated changes in intestinal and respiratory microbiota, medical students abroad may also experience changes in vaginal microbiota leading, in some cases, to clinical symptoms or the acquisition of bacterial vaginosis, which may be asymptomatic.

    更新日期:2019-12-21
  • Prevalence and risk factors for carriage of ESBL-producing Enterobacteriaceae in a population of Dutch travellers: A cross-sectional study
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-12-17
    Maris S. Arcilla; Jarne M. Van Hattem; Martin C.J. Bootsma; Perry J.J. Van Genderen; Abraham Goorhuis; Martin P. Grobusch; Corne Klaassen; Astrid M. Oude Lashof; Constance Schultsz; Ellen E. Stobberingh; Menno D. de Jong; John Penders; Henri A. Verbrugh; Damian C. Melles

    Background We investigated prevalence and predictive factors for ESBL-E carriage in a population of mostly travellers prior to their travel (n = 2216). In addition, we examined ESBL genotype before travel and compared these to returning travellers. Method A questionnaire and faecal sample were collected before travel, and a second faecal sample was collected immediately after travel. Faecal samples were analysed for ESBL-E, with genotypic characterization by PCR and sequencing. Risk factors for ESBL-E carriage prior to travel were identified by logistic regression analyses. Results Before travel, 136 participants (6.1%) were colonized with ESBL-E. Antibiotic use in the past three months (ORadjusted 2.57; 95% CI 1.59–4.16) and travel outside of Europe in the past year (1.92, 1.28–2.87) were risk factors for ESBL-E colonisation prior to travel. Travel outside of and Europe carried the largest attributable risk (39.8%). Prior to travel 31.3% (40/128) of participants carried blaCTX-M 15 and 21.9% (28/128) blaCTX-M 14/18. In returning travellers 633 acquired ESBL-E of who 53.4% (338/633) acquired blaCTX-M 15 and 17.7% (112/633) blaCTX-M 14/18. Conclusion In our population of Dutch travellers we found a pre-travel ESBL-E prevalence of 6.1%. Prior to travel, previous antibiotic use and travel outside of Europe were the strongest independent predictors for ESBL-E carriage, with travel outside of Europe carrying the largest attributable risk. Our molecular results suggest ESBL genes found in our study population prior to travel were in large part travel related.

    更新日期:2019-12-18
  • 更新日期:2019-12-13
  • Arbaeen public health concerns: A pilot cross-sectional survey
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-12-12
    Farah Al-Ansari; Mustafa Al Ansari; Grant A. Hill-Cawthorne; Mohammed Saeed Abdulzahra; Mohammad Basim Al-Ansari; Basma Al-Ansari; Harunor Rashid; Joel Negin; Katherine M. Conigrave

    Background Arbaeen is an annual religious procession in Iraq with an estimated 17–20 million participants. Public health risks associated with such a mass gathering can be serious at both local and global levels. This is the first quantitative examination of risk factors for, and symptoms of, infectious disease among Arbaeen participants. Methods A cross-sectional survey was conducted of a convenience sample of 191 Arbaeen participants in 2017. Interviewers administered a structured questionnaire. Questions included food sources, preventive measures used and symptoms of infectious diseases during the procession.in. Results Data were collected for 191 participants (143 males, 58 females). The most prevalent symptoms were respiratory (runny nose: 22.6%, cough: 22.5%). Diarrhoea was reported by 12.6% of participants, with a strong association with high-income country origin and eating street food (odds ratios 6.1 and 4.1, respectively, p < 0.05). All symptoms investigated, except breathlessness, were more prevalent in high-income country participants (p < 0.05). Conclusion Street food and high-income country origin were independent risk factors for respiratory or gastrointestinal infection symptoms in this sample of Arbaeen participants. However, these results cannot be generalised due to possible selection bias. Further studies are required to inform policy development and health system preparedness to reduce Arbaeen-associated health risks.

    更新日期:2019-12-13
  • Characteristics of Zika virus infection among international travelers: A prospective study from a Spanish referral unit
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-12-02
    Clara Crespillo-Andújar, Marta Díaz-Menéndez, Trigo Elena, Arsuaga Marta, De la Calle Fernando, Lago Mar, Ladrón de Guevara María Concepción, Barreiro Pablo, Montero Dolores, Garcia-Bujalance Silvia, Alvarado Eugenia Antolín, María de la Calle, María Paz Sánchez-Seco, Fernando de Ory, Vazquez Ana, Arribas Jose

    Background From the first Zika virus (ZIKV) description, it has progressively widespread worldwide. We analyzed demographic, clinical, microbiologic and travel-related characteristic from returned patients from a ZIKV endemic country in a referral Tropical Medicine Unit. Method A prospective cohort study performed in a Spanish referral center with the aim of determining the significant factors associated with confirmed Zika virus (ZIKV) infection. Results 817 patients, (56% women, median age 36 [IQR, Interquartile Range: 32–42]) were enrolled. Most had returned from Latin America (n = 486; 59.4%), travelled for tourism (n = 404; 49.4%) and stayed a median of 18 days (IQR: 10–30). 602 (73.6%) presented symptoms, but only 25 (4%) were finally diagnosed with confirmed ZIKV infection (including two pregnant women, without adverse fetal outcomes), 88% (n:22) presented with fever and 92% (n:23) with rash. 56% (n:14) arthralgia and/or myalgia and 28% (n:7) conjunctivitis. The presence of conjunctivitis, fever and rash were associated with an 8.9 (95% CI: 2.2–34.9), 6.4 (95% CI: 1.2–33.3) and 72.3 (95% CI: 9.2–563.5) times greater probability of confirmed ZIKV infection, respectively. Conclusion Travel characteristics and clinical presentation may help clinicians to optimize requests for microbiological testing. Diagnosis of arboviriasis in travellers arriving form endemic areas remains a challenge for clinicians, but must be detected for the possible transmission outside endemic areas, where the vector is present.

    更新日期:2019-12-02
  • Two measles clusters in connection with short inner-European air travels indicating impediments to effective measles control: A cluster analysis
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-28
    Julia Bitzegeio, Britta Bukowski, Marius Hausner, Dagmar Sissolak, Lasse D. Rasmussen, Peter H. Andersen, Katharina Katz, Hélène Englund, Per Hagstam, Daniel Sagebiel, Dirk Werber

    Importation and transmission of measles via air travel is a public health concern to countries, which are close to or have achieved elimination, i.e., to the majority of countries in Europe. In 2018, two measles cases occurred in Berlin residents, who flew within Europe while being infectious. In addition to contact tracing through passenger manifests, we contacted national authorities in flight destination countries or embarking countries and inquired about epidemiologically linked measles cases to the two Berlin index cases. We identified eight epidemiologically linked cases (six males, median age: 32 years) from three countries associated with three air-travels. Consequently measles was imported to Germany (Bavaria), Denmark and possibly Sweden. Our investigations revealed impediments to an effective public health response indicating the need to revisit current guidelines and methods to better control transmission of measles related to air travel.

    更新日期:2019-11-29
  • Intestinal colonization with extended-spectrum beta-lactamase producing enterobacterales (ESBL-PE) during long distance travel: A cohort study in a German travel clinic (2016–2017)
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-23
    Lynn Meurs, Felix S. Lempp, Norman Lippmann, Henning Trawinski, Arne C. Rodloff, Matthias Eckardt, Anja Klingeberg, Tim Eckmanns, Jan Walter, Christoph Lübbert

    Background Intercontinental travel contributes to the spread of extended-spectrum beta-lactamase producing Enterobacterales (ESBL-PE). We assessed risk factors for intestinal ESBL-PE colonization in people travelling to low and middle income countries in the tropics and subtropics to better understand how travel affects ESBL-PE spread. Method This prospective cohort study in travellers attending a travel clinic in Leipzig, Germany was conducted in 2016–2017. Information on risk factors related to travel, symptoms, antibiotic use, health care usage, accommodation, destination, diet and hygiene was collected by questionnaire after travel. Stools were phenotypically tested for ESBL-PE before and after travel. Risk factors for ESBL-PE colonization were identified using logistic regression. Results Of the 230 travellers that were ESBL-PE negative before travelling, 23% (n = 53) travellers returned positive. Multivariable analyses showed that age, type of accommodation and travelling to Asia were associated with ESBL-PE colonization. Conclusions Given that a considerable amount of travellers returned with ESBL-PE, we recommend raising awareness in returning high-risk travellers, e.g. those returning from high-risk areas. They should be aware that they may carry antimicrobial-resistant bacteria after travel, and how they can prevent its spread. The role of the type of accommodation as a factor favouring intestinal colonization with ESBL-PE requires further investigation.

    更新日期:2019-11-26
  • Global commercial passenger airlines and travel health information regarding infection control and the prevention of infectious disease: What's in a website?
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-21
    Ramon Z. Shaban, Cristina F. Sotomayor-Castillo, Jeremy Malik, Cecilia Li

    Background Air travel has never been easier, cheaper or faster, with large volumes of people travelling around the world. These factors increase the risk of the spread of infectious diseases by air travel. Little is known, however, about the extent to which airlines provide information to passengers on infection control and measures to prevent the spread of infectious diseases. This study examined the websites of the global commercial passenger airlines to see if they contained information about infection control and prevention of infectious diseases and appraised the clinical usefulness of that information. Method A cross-sectional text-based analysis of the 73 airline websites from the six global commercial passenger airline conglomerates was performed to identify information about infection control and prevention of infectious between July and August 2019. Results Of the 73 airline websites, less than half (n = 35, 28.6%) contained information deemed useful for passengers. While there was a range of general health advice within the websites, there was limited information about infection control and preventing infectious diseases. A minority of websites contained information about vaccination status prior to travel, and to a lesser extent handwashing and hand hygiene, with very few including disease-specific advice or preventive measures. Conclusions Airline websites are an underutilised source of information for infection control and the prevention of infectious diseases. Providing passengers with information on basic infection control and prevention measures may support the global efforts against the spread of infectious diseases.

    更新日期:2019-11-21
  • Plasmid-mediated colistin resistance in Latin America and Caribbean: A systematic review
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-07-20
    Victor Rocha Mendes Oliveira, Magna Cristina Paiva, William Gustavo Lima

    A systematic review was performed in order to integrate and synthesize available information on mcr genes dissemination in Latin America. Four databases were searched for articles reporting plasmid-mediated colistin resistance between bacteria isolated from countries of Latin America and the Caribbean. Abstract books of scientific events realized in each region were also examined. After search and selection, 48 studies that included 18,705 isolates recovered between 2000 and 2018 were evaluated. The overall frequency of mcr genes in Latin America was 2.9% (550/18,705), with IncX4 plasmids shown to be the key vectors responsible for the dissemination of genes within the continent. Brazil, Bolivia and Argentina were the countries with the highest number of mcr-positive isolates, and only Colombia (mcr-5) and Brazil (mcr-3) presented mcr genes other than type 1. Escherichia coli, Klebsiella pneumoniae, and Salmonella enterica serovar Typhimurium were mainly found to carry the gene within the continent and these microorganisms showed high susceptibility to ertapenem, meropenem, piperacillin/tazobactam, fosfomycin and tigecycline. This review showed that the mcr gene is circulating in several countries of Latin America. Thus, it is important to encourage microbiological and molecular surveillance programs to avoid the spread of these genes within and outside the continent.

    更新日期:2019-11-18
  • The use of air travel data for predicting dengue importation to China: A modelling study
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-07-05
    Aidan Findlater, Rahim Moineddin, Dylan Kain, Juan Yang, Xiling Wang, Shengjie Lai, Kamran Khan, Isaac I. Bogoch

    Background Dengue virus importation from abroad is still the main driver of dengue incidence in China. Using global flight data to model importation may improve our understanding and prediction of dengue virus importation and onward transmission. Methods A retrospective analysis was performed of surveillance cases of dengue infections imported to China and volume of air traffic to China for the years 2005 through 2014, inclusive. The data were aggregated by year, destination province, and source country. Descriptive statistics were calculated, and a random effects negative binomial model was created to predict the number of imported cases based on the volume of travelers from dengue-endemic countries. Results There were 1,822 cases of imported dengue infections over the study period. Most imported cases are from a small number of high-incidence countries with a large volume of travel to China, most notably Myanmar (22% of cases). The number of imported cases of dengue infections increased by 5.9% for every 10% increase in travel volume from dengue-endemic countries. Conclusion Patterns of air travel have a measurable impact on the importation of dengue to China. Modelling dengue importation risk may be a useful strategy to direct public health surveillance and interventions.

    更新日期:2019-11-18
  • Gastrointestinal basidiobolomycosis: An emerging mycosis difficult to diagnose but curable. Case report and review of the literature
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-01-17
    Maria Diletta Pezzani, Valentina Di Cristo, Carlo Parravicini, Angelica Sonzogni, Cristina Tonello, Marco Franzetti, Salvatore Sollima, Mario Corbellino, Massimo Galli, Laura Milazzo, Spinello Antinori

    Background Gastrointestinal basidiobolomycosis (GIB) is a rare mycosis affecting almost exclusively immunocompetent subjects. Methods We describe a case of GIB caused by Basidiobolus ranarum in a 25-year-old Italian immunocompetent man resident in Ireland who presented a 2-month history of epigastric pain. Suspecting colon cancer he underwent a right hemicolectomy subsequently leading to a diagnosis of GIB by means of molecular biology. After surgery a 9-month therapy with itraconazole was employed with a good outcome. A review of medical literature regarding GIB cases published in the period 1964–2017 is presented. Results One-hundred and two cases of GIB were included in this analysis. The disease was observed predominantly in male gender (74.5%) and children (41.2%). Abdominal pain was the single most common complaint (86.3%) followed by fever (40.2%) and evidence of an abdominal mass (30.4%). Peripheral blood eosinophilia was detected in 85.7% of cases. Most of the patients were diagnosed in Saudi Arabia (37.2%) followed by USA (21.6%) and Iran (20.6%). Surgery plus antifungal therapy was employed in the majority of patients (77.5%). An unfavourable outcome was documented globally in 18.6% of patients. Conclusions GIB seems to be an emerging intestinal mycosis among immunocompetent patients living in the Middle East and Arizona.

    更新日期:2019-11-18
  • Risk of acquisition of human diarrhoeagenic Escherichia coli virulence genes in intercontinental travellers: A prospective, multi-centre study
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-01-01
    Jarne M. van Hattem, Adriana Cabal, Maris S. Arcilla, Julio Alvarez, Menno D. de Jong, Damian C. Melles, John Penders, Christian Gortázar Schmidt, Constance Schultsz

    Background We studied geographic distribution of diarrhoeagenic Escherichia coli virulence genes (DEC VGs) acquisition in travellers and investigated if they acquired highly virulent EAEC/STEC hybrid strains. Methods From the prospective, multicentre COMBAT study among 2001 Dutch travellers, 491 travellers were selected based on travel destination to 7 subregions. Faecal samples taken directly before and after travel were screened for nine DEC VGs with real-time PCR. Incidence proportions and rates were calculated for each gene and subregion. Results 479 travellers were analysed. 21.8% acquired aggR (EAEC), with highest acquisition rates in Northern and Western Africa and 15.3% acquired eae (STEC/EPEC) with highest rates in travellers to Western and Eastern Africa. ETEC (elt or est gene) was acquired by 4.2% of travellers and acquisition of est was associated with traveller's diarrhoea. Overall, the risk of acquiring DEC VGs was low in Southern Africa and South America. Although the combination of aggR (EAEC) and stx1/2 (STEC) was acquired by 3 travellers, these genes could not be detected together in a single E. coli strain. Conclusions The risk of acquisition of DEC VGs strongly depends on the travel destination, with those travelling to Africa - except Southern Africa - having a higher risk.

    更新日期:2019-11-18
  • Inpatient treatment of trekkers and Nepalese workers in the high-altitude environment of Mt. Everest Region 1996–2011: A retrospective analysis
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2018-11-28
    Christian Kühn, Christian Apel, Daniela Bertsch, Maren Grass, Carina Gschwandtl, Nina Hundt, Miriam Müller-Ost, Julia Risse, Sonja Schmitz, Kami Sherpa, Lisa Timmermann, Michsel van der Giet, Simone van der Giet, Knut Wernitz, Audry Morrison, Thomas Küpper

    Background The study investigates the diagnoses of inpatients (tourists and Nepali workers) of Kunde Hospital (Mt.Everest region) over 15 years. Methods Records from January 1996 to September 2011 were analyzed concerning date, gender, age group, nationality, purpose of visit, diagnosis, length of treatment, and condition at discharge. Diagnoses were coded according to ICD-10-WHO 2010. Data were analyzed using descriptive statistics and non-parametric tests. P < 0.05 was defined as significant. Results 479 inpatients were included: 363 (75.8%) males (202 trekkers (42.2%), 277 Nepalese workers (57.8%)). Most suffered from altitude sickness (45.5%), acute gastroenteritis (10.4%) or acute respiratory infection (8.4%). Severe cases of altitude sickness amongst trekkers decreased but increased amongst workers. Severe cases of acute gastroenteritis amongst trekkers increased. Mean length of inpatient treatment was 4.6 days ±2.7 days. 573/2030 days of treatment were caused by altitude sickness. 70 patients were evacuated, 9 died. Conclusion Altitude illness caused the majority of inpatient treatment and acute gastroenteritis may be an underestimated risk for both groups. Other severe problems were mostly illnesses, not trauma. Improved prevention strategies are needed for both groups. For tourists who often show pre-existing diseases this includes an individual pre-travel expert advice. Nepali workers should be instructed concerning acclimatization.

    更新日期:2019-11-18
  • Risk factors for acute childhood diarrhea: A cross-sectional study comparing refugee camps and host communities in Gambella Region, Ethiopia
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-02-14
    Getachew Kabew Mekonnen, Bezatu Mengistie Alemu, Worku Mulat, Geremew Sahilu, Helmut Kloos

    Background Diarrhea is one of the most common causes of child morbidity and mortality in refugee camps, aggravated by inadequate water, sanitation and hygiene services, and malnutrition, particularly in developing countries. Methodology A comparative cross-sectional study was conducted to assess acute diarrhea and associated risk factors among under-five children in refugee and host communities in Gambella Region, Ethiopia. Descriptive statistics were used, and bivariate and multivariate logistic regressions were performed to identify variables associated with diarrhea. Results A total of 1667 under-five children was included in this study, and prevalence of diarrhea differed between the refugee (38%) and host (33%) communities [OR = 1.37, 95% CI 1.04, 1.8]. Refugee camp households using uncovered water containers, consuming low quantities of water, and lacking hand washing setups were more likely to report children with diarrhea. Within host communities, households were more likely to report acute childhood diarrhea if they consumed surface water or did not have a latrine. Conclusion The two-week prevalence of diarrhea was significantly higher among children in the refugee camps than those in the host communities. Therefore, further collaboration between government and non-government organizations is required to identify persisting factors of diarrhea transmission in various communities in the region.

    更新日期:2019-11-18
  • Bacterial respiratory carriage in French Hajj pilgrims and the effect of pneumococcal vaccine and other individual preventive measures: A prospective cohort survey
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2018-11-08
    Van-Thuan Hoang, Mohammed Meftah, Tran Duc Anh Ly, Tassadit Drali, Saber Yezli, Badriah Alotaibi, Didier Raoult, Philippe Parola, Vincent Pommier de Santi, Philippe Gautret

    Background Viral respiratory tract infections are known to be common in Hajj pilgrims while the role of bacteria is less studied. Methods Clinical follow-up, adherence to preventive measures and PCR-based pharyngeal bacterial carriage pre- and post-Hajj, were assessed in a cohort of 119 French Hajj pilgrims. Results 55% had an indication for pneumococcal vaccination. Occurrence of respiratory symptoms was 76.5%, with cough (70.6%) and sore throat (44.5%) being the most frequent; fever was reported by 38.7% pilgrims and 42.0% took antibiotics. Respiratory symptoms, fever and antibiotic intake were significantly more frequent in pilgrims with indication for vaccination against pneumococcal infection. The prevalence of S. pneumoniae carriage (1.8% pre-, 9.8% post-Hajj), H. influenzae carriage (0.9%, 45.4%) and K. pneumoniae (2.8%, 9.8%) significantly increased post-Hajj. Pilgrims vaccinated with conjugate pneumococcal vaccine were seven time less likely to present S. pneumoniae carriage post-Hajj compared to those not vaccinated (3.2% vs. 18.0%, OR = 0.15; 95% CI [0.03–0.74], p = 0.02). Conclusions Pilgrims at risk for pneumococcal disease are more likely to suffer from febrile respiratory symptoms at the Hajj despite being immunized against pneumococcal disease and despite lowered S. pneumoniae carriage and should be targeted for reinforced prevention against respiratory infections.

    更新日期:2019-11-18
  • Evaluation of the multiplex real-time PCR assays RealStar malaria S&T PCR kit 1.0 and FTD malaria differentiation for the differentiation of Plasmodium species in clinical samples
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-06-27
    Hagen Frickmann, Christine Wegner, Stefanie Ruben, Christoph Behrens, Hans Kollenda, Rebecca Hinz, Sandra Rojak, Norbert G. Schwarz, Ralf Matthias Hagen, Egbert Tannich

    Background Two commercial PCR assays were assessed in a retrospective study to determine their reliability as tools for the differentiation of Plasmodium species in human blood. Methods A total of 1022 blood samples from 817 patients with suspected or confirmed malaria submitted to the German National Reference Centre for Tropical Pathogens were subjected to malaria microscopy using thick and thin blood films as well as to a genus-specific malaria real-time PCR. Parasite-positive samples were analysed by RealStar Malaria S&T PCR Kit 1.0 (altona Diagnostics) and FTD Malaria Differentiation (Fast Track Diagnostics) multiplex real-time PCR assays targeting species-specific Plasmodium DNA. Results Out of the 1022 blood samples, 247 (24.2%) tested positive for Plasmodium spp. The two multiplex assays showed rather similar performance characteristics and provided concordant species information in 98.9% of samples positive by malaria microscopy and in 95.1% (RealStar) and 96.8% (FTD) of samples positive by genus-specific PCR. Compared to FTD, RealStar revealed slightly reduced sensitivity for submicroscopic, low-level P. falciparum infections, while FTD was unable to detect P. knowlesi. Conclusions The two commercial malaria PCR assays assessed are suitable for discriminating Plasmodium species in clinical samples, and can provide additional information in cases of microscopically uncertain findings.

    更新日期:2019-11-18
  • Spatial distribution of Zika in Honduras during 2016–2017 using geographic information systems (GIS) – Implications for public health and travel medicine
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-02-02
    Lysien I. Zambrano, Walter O. Vasquez-Bonilla, Itzel Carolina Fuentes-Barahona, José Cláudio da Silva, Jorge Alberto Valle-Reconco, Marco Tulio Medina, John D. England, Jorge A. Sánchez-Duque, Alfonso J. Rodríguez-Morales

    Background Zika virus (ZIKV) infection has significantly affected Latin America in 2015–2017. Most studies have been reported from Brazil and Colombia, and only a few from Central America. For these reasons, we analyzed the incidence, incidence rates and evolution of cases in Honduras from 2016 to 2017. Methods Using epidemiological weeks (EW) surveillance data on the ZIKV epidemics in Honduras, we estimated incidence rates (cases/100,000 population), and developed maps at national, departmental and municipal levels. Results From 1 January 2016 to 31 December 2017, a total of 32,607 cases of ZIKV were reported (98.5% in 2016 for an incidence rate of 36.85 cases/100,000 pop; 1% confirmed by RT-PCR). The highest peak was reached on the EW 6°, 2016 (2559 cases; 29.34 cases/100,000 pop). The department with the highest number of cases and incidence rate was Cortés (13,128 cases, 791.08 cases/100,000 pop in 2016). Discussion The pattern and evolution of ZIKV infection in Honduras have been similar to that which occurred for chikungunya in 2015. As previously reported, infection with chikungunya involved predominantly the central and capital area of the country, reaching incidences there >750 cases/100,000 pop. Studies using geographical information systems linked with clinical disease characteristics are necessary to attain accurate epidemiological data for public health systems. Such information is also useful for assessment of risk for travelers who visit specific areas in a destination country.

    更新日期:2019-11-18
  • Pediatric travelers presenting to an Australian emergency department (2014–2015): A retrospective, cross-sectional analysis
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2018-11-03
    Connie H. Chong, Mary E. McCaskill, Philip N. Britton

    Background Epidemiological data on pediatric travelers are lacking, especially from Oceania. We aimed to evaluate travelers presenting to a pediatric emergency department in Sydney during a time of heightened travel surveillance. Method Cases between December 2014 and February 2015 were ascertained by screening medical records for key terms and visa status, as well as laboratory data for malaria testing. Cases were restricted to communicable diseases and evidence of travel within 21 days. Results 104 children were identified. 82 children were Australian-resident travelers returning from abroad, 11 were visitors to Australia, 8 were recent migrants/refugees and 3 were medical transfers. Travel and behavioral patterns were characterized by exposures to low-income countries in the Asia-Pacific, visiting families and relatives, prolonged exposure periods and limited uptake of prophylaxis. Intrinsic vulnerabilities included extremes of age (median: 3.3 years) and pre-existing co-morbidities (6.7%). Common syndromes were respiratory (38.5%), systemic febrile illness (19.2%), acute diarrhea (17.3%) and dermatological conditions (9.6%). A minority were diagnosed with tropical infections: four typhoid or paratyphoid fever, two dengue and one tropical ulcer. Conclusions Young travelers are a heterogeneous group who present with a broad spectrum of diseases, from the benign to the life-threatening. Our data may be used to inform diagnostic approaches, empiric therapies and contribute towards public health strategies.

    更新日期:2019-11-18
  • Atovaquone-proguanil exposure in pregnancy and risk for adverse fetal and infant outcomes: A retrospective analysis
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-17
    Julie R. Gutman, Clinton Hall, Zeina G. Khodr, Anna T. Bukowinski, Gia R. Gumbs, Ava Marie S. Conlin, Natalie Y. Wells, Kathrine R. Tan

    Background Malaria in pregnancy can cause severe maternal and fetal complications. Chloroquine (CQ) and mefloquine (MQ) are recommended for chemoprophylaxis in pregnancy, but are not always suitable. Atovaquone-proguanil (AP) might be a viable option for malaria prevention in pregnancy, but more safety data are needed. Methods Data for pregnancies and live births among active duty military women, 2003–2014, from the Department of Defense Birth and Infant Health Research program were linked with pharmacy data to determine antimalarial exposure. Multivariable Cox and logistic regression models were used to assess the relationship of antimalarial exposure with fetal and infant outcomes, respectively. Results Among 198,164 pregnancies, 50 were exposed to AP, 156 to MQ, and 131 to CQ. Overall, 17.6% of unexposed pregnancies and 28.0%, 16.0%, and 6.1% of pregnancies exposed to AP, MQ, and CQ, respectively, ended in fetal loss (spontaneous abortion or stillbirth) (adjusted hazard ratios [aHR] = 1.46, 95% confidence interval [CI] 0.87–2.46; aHR = 1.06, 95% CI 0.72–1.57, and aHR = 0.47, 95% CI 0.24–0.94, respectively). Conclusions The small number of AP exposed pregnancies highlights the difficulty in assessing safety. While definitive conclusions are not possible, these data suggest further research of AP exposure in pregnancy and fetal loss is warranted. Twitter line More research on fetal loss following atovaquone-proguanil exposure in pregnancy is warranted.

    更新日期:2019-11-18
  • Latent and active tuberculosis infections in migrants and travellers: A retrospective analysis from the Spanish +REDIVI collaborative network
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-07-29
    Philip Wikman-Jorgensen, Rogelio López-Velez, Jara Llenas-García, Begoña Treviño, Reyes Pascual, Israel Molina, Ángel Domínguez, Diego Torrús, José Manuel Ruiz Giardín, Begoña Monge-Maillo, Francesca F. Norman, Mónica Romero, José A. Perez-Molina

    Background Tuberculosis (TB) is the leading cause of infectious disease mortality worldwide. We analysed active and latent TB infections (LTBI) from the Spanish Network for the Study of Imported Infectious Diseases by Travellers and Immigrants (+REDIVI). Methods Observational, retrospective, multicentre study of TB and LTBI registered in the +REDIVI network from October 2009 to December 2016. Results Of 1008 cases of LTBI, 884 (87.7%) were immigrants; 93 (4.5%), immigrants visiting friends and relatives (VFR); 2 (0.9%), VFR-travellers; and 29 (1.1%), travellers. Absolute (N = 157 vs. N = 75) and relative (12.5% vs. 5.9%) frequency decreased over the study period (p = 0.003). Median time to diagnosis was 24.6 months (females 50.3 vs males 11.9; p < 0.001). Of 448 TB cases, 405 (90.4%) were in immigrants; 30 (6.7%), VFR-immigrants; 6 (1.3%), VFR-travellers; and 7 (1.6%), travellers. Median time to diagnosis was 62.5 months (females 86.6 vs males 70.1; p = 0.0075). There were 8 multidrug resistant TB cases and 1 extensively drug resistant case of TB, all in immigrants. Conclusion TB was frequently diagnosed more than 5 years after arrival in Spain. Screening programmes for TB and LTBI in immigrants should be considered beyond this time point. Women showed a higher diagnostic delay for both latent and active TB.

    更新日期:2019-11-18
  • Melioidosis in travelers: An analysis of Dutch melioidosis registry data 1985–2018
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-07-29
    Emma Birnie, Jelmer Savelkoel, Frans Reubsaet, Joris J.T.H. Roelofs, Robin Soetekouw, Saskia Kolkman, Anne Lia Cremers, Martin P. Grobusch, Daan W. Notermans, W. Joost Wiersinga

    Background Melioidosis, caused by the Gram-negative bacterium Burkholderia pseudomallei, is an opportunistic infection across the tropics. Here, we provide a systematic overview of imported human cases in a non-endemic country over a 25-year period. Methods All 55 Dutch microbiology laboratories were contacted in order to identify all B. pseudomallei positive cultures from 1990 to 2018. A response rate of 100% was achieved. Additionally, a systematic literature search was performed, medical-charts reviewed, and tissue/autopsy specimens were re-assessed. Results Thirty-three travelers with melioidosis were identified: 70% male with a median-age of 54 years. Risk factors were present in most patients (n = 23, 70%), most notably diabetes (n = 8, 24%) and cystic fibrosis (n = 3, 9%). Countries of acquisition included Thailand, Brazil, Indonesia, Panama, and The Gambia. Disease manifestations included pneumonia, intra-abdominal abscesses, otitis externa, genitourinary, skin-, CNS-, and thyroid gland infections. Twelve (36%) patients developed sepsis and/or septic shock. Repeat episodes of active infection were observed in five (15%) and mortality in four (12%) patients. Post-mortem analysis showed extensive metastatic (micro)abscesses amongst other sites in the adrenal gland and bone marrow. Conclusions The number of imported melioidosis is likely to increase, given rising numbers of (immunocompromised) travelers, and increased vigilance of the condition. This first systematic retrospective surveillance study in a non-endemic melioidosis country shows that imported cases can serve as sentinels to provide information about disease activity in areas visited and inform pre-travel advice and post-travel clinical management.

    更新日期:2019-11-18
  • Spatial and temporal variation of dengue incidence in the island of Bali, Indonesia: An ecological study
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-07-27
    Pandji Wibawa Dhewantara, Rina Marina, Tities Puspita, Yusniar Ariati, Edy Purwanto, Miko Hananto, Wenbiao Hu, Ricardo J. Soares Magalhaes

    Background Dengue fever control in the tropical island of Bali in Indonesia carries important significance both nationally and globally, as it is one of the most endemic islands in Indonesia and a worldwide popular travel destination. Despite its importance, the spatial and temporal heterogeneity in dengue risk and factors associated with its variation in risk across the island has not been not well explored. This study was aimed to analyze for the first time the geographical and temporal patterns of the incidence of dengue and to quantify the role of environmental and social factors on the spatial heterogeneity of dengue incidence in Bali. Methods We analyzed retrospective dengue notification data at the sub-district level (Kecamatan) from January 2012 to December 2017 which obtained from the Indonesian Ministry of Health. Seasonality in notified dengue incidence was assessed by seasonal trend decomposition analysis with Loess (STL) smoothing. Crude standardized morbidity rates (SMRs) of dengue were calculated. Moran's I and local indicators of spatial autocorrelation (LISA) analysis were employed to assess spatial clustering and high-risk areas over the period studied. Bayesian spatial and temporal conditional autoregressive (CAR) modeling was performed to quantify the effects of rainfall, temperature, elevation, and population density on the spatial distribution of risk of dengue in Bali. Results Strong seasonality of dengue incidence was observed with most cases notified during January to May. Dengue incidence was spatially clustered during the period studied with high-risk kecamatans concentrated in the south of the island, but since 2014, the high-risk areas expanded toward the eastern part of the island. The best-fitted CAR model showed increased dengue risk in kecamatans with high total annual rainfall (relative risk (RR): 1.16 for each 1-mm increase in rainfall; 95% Credible interval (CrI): 1.03–1.31) and high population density (RR: 7.90 per 1000 people/sq.km increase; 95% CrI: 3.01–20.40). The RR of dengue was decreased in kecamatans with higher elevation (RR: 0.73 for each 1-m increase in elevation; 95% CrI: 0.55–0.98). No significant association was observed between dengue RR and year except in 2014, where the dengue RR was significantly lower (RR: 0.53; 95% CrI: 0.30–0.92) relative to 2012. Conclusions Dengue incidence was strongly seasonal and spatially clustered in Bali. High-risk areas were spread from kecamatans in Badung and Denpasar toward Karangasem and Klungkung. The spatial heterogeneity of dengue risk across Bali was influenced by rainfall, elevation, and population density. Surveillance and targeted intervention strategies should be prioritized in the high-risk kecamatans identified in this study to better control dengue transmission in this most touristic island in Indonesia. Local health authorities should recommend travelers to use personal protective measures, especially during the peak epidemic period, before visiting Bali.

    更新日期:2019-11-18
  • Management of hospitalized drug sensitive pulmonary tuberculosis patients during the Hajj mass gathering: A cross sectional study
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-07-13
    Badriah Alotaibi, Kingsley Bieh, Yara Yassin, Abdulaziz Mushi, Fuad Maashi, Amnah Awam, Gamal Mohamed, Amir Hassan, Saber Yezli

    Background To document the management of drug-sensitive TB patients during the Hajj and assess compliance with the Saudi TB management guidelines. Method The study was conducted in hospitals in Makkah during the 2016 and 2017 Hajj seasons. Structured questionnaire was used to collect data on relevant indices on TB management and a scoring system was developed to assess compliance with guidelines. Results Data was collected from 31 TB cases, 65.4% (17/26) were Saudi residents. Sputum culture was the only diagnostic test applied in 67.7% (21/31) of patients. Most (96.8%, 30/31) confirmed TB cases were isolated, but only 12.9% (4/28) were tested for HIV and merely 37% (10/27) received the recommended four 1st-line anti-TB drugs. Guideline compliance scores were highest for infection prevention and control and surveillance (9.6/10) and identifying TB suspects (7.2/10). The least scores were obtained for treating TB (5.0/10) and diagnosing TB (3.0/10). Conclusions Healthcare providers training and supervision are paramount to improve their knowledge and skill and ensure their compliance with existing TB management guidelines. However, there may be a need for the introduction of an international policy/guideline for TB control and management during mass gatherings such as the Hajj to guide providers’ choices and facilitate monitoring.

    更新日期:2019-11-18
  • Epidemiological and etiological features of travel-related febrile illnesses in hospitalized Russian children and adults: A single-centre, retrospective analysis in Moscow
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-07-05
    Nadezda Nikolaevna Zvereva, Mukhammad Abdulfaritovich Saifullin, Ruslan Faridovich Sayfullin, Alexander Anatolievich Erovichenkov, Marina Victorovna Bazarova, Natalia Yurievna Pshenichnaya

    Background A number of factors can lead to differences in infectious disease morbidity in children versus adults after a trip abroad. We aimed to investigate the epidemiological and etiological features of infectious diseases in children after international travel. Methods: we analyzed the medical records of 2135 patients (416 children) who were hospitalized during the period 2009–2017 after return from international travel. Results Hospitalized children were under the age of 1 year in 8.7% of cases, 1–3 years - 39.4%, 4–6 years – 17.3%, 7–11 years – 16.8%, 12–17 years – 17.8%. Children were hospitalized after visiting the following main destinations: Turkey (15%), Egypt (12%), Central Asia microregion [11%] and Thailand (9%). Hospitalizations among children occurred mainly in summer (38.0%; CI 33.3–42.4). In adults there were no significant seasonal differences. Children were more likely to have acute diarrhea (18.3 vs 11.1%), acute respiratory tract infections (51.2 vs 41.2%) and enterovirus infections (8.2 vs 3.1%). Among the non-endemic infections for Russia, 8 children were diagnosed with dengue fever, 1 with typhoid, 1 with malaria, and 1 with wild-poliovirus excretion. Conclusion children were mainly hospitalized during summer. Among hospitalized children, almost half was under 3 years old. In children acute respiratory infection and intestinal infections predominated, while in adults, vector-borne diseases were more frequently observed.

    更新日期:2019-11-18
  • The first report of atovaquone/proguanil-induced vanishing bile duct syndrome: Case report and mini-review
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-06-22
    Ashraf Abugroun, Ibett Colina Garcia, Fatima Ahmed, Steven Potts, Michael Flicker

    The combination of Atovaquone and Proguanil (Malarone™) has been widely used for treatment and prevention of Plasmodium falciparum malaria. Transient elevation of liver enzymes is a recognized side effect of the medication. The association of Vanishing bile duct syndrome (VBDS) with the use of Atovaqoune/Proguanil was not previously reported. We describe a case of a 62-year-old male with no history of liver disease who presented with painless jaundice after receiving malaria prophylaxis with Atovaquone-proguanil for 25 days. The patient developed severe hepatitis with Vanishing bile duct syndrome. This case highlights a serious side effect of a usually well-tolerated medication.

    更新日期:2019-11-18
  • What do we know about travel for children with special health care needs? A review of the literature
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-06-21
    Sarah E. Kohl, Elizabeth D. Barnett

    Background Children travel with their families, including children with chronic illness. We know that adults with chronic illness who travel are more likely than their healthy peers to become sick while traveling. A review of the literature was undertaken to identify what is known about traveling with children with special health care needs and to identify gaps in our knowledge. Methods An Online search of the PubMed, CINAHL and Google databases of English language literature was conducted June 2016, October 2017, June 2018 and April 2019 using the terms children and travel, air travel, travel health, disabled child, children with special healthcare needs, parents of disabled children, vacations, recreation, international, wheelchairs, planning techniques, asthma, diabetes, altitude, cystic fibrosis, inflammatory bowel disease, sickle cell disease, depression, food allergies, Attention Deficit Hyperactivity Disorder (ADHD), and seizures. The search was limited to years 2000-2019. A secondary search of relevant articles was conducted using the reference sections of articles identified in the primary search. Results 185 papers were examined for travel health related outcomes for children and adults with chronic diseases. Articles were excluded if they addressed the educational needs of students with disabilities traveling abroad, did not directly address travel health (e.g travel skills, travel itineraries), contained outdated policy statements, or were case reports of a single patient. The remaining 84 papers were organized and reviewed by organ systems. The articles were primarily descriptive and did not lend themselves to a systematic review. Conclusion Children traveling with chronic and complex health conditions are a heterogeneous group of vulnerable travelers. Closing the knowledge gap about how to best help these travelers requires a multipronged approach. Research is urgently needed to identify best practices for five of the most common chronic childhood diseases: asthma, depression, ADHD, food allergies and autism. For less common illnesses, ones typically cared for in specialty clinics, expert consensus opinion and multi-center studies are needed. Families and disease advocacy societies should be included in the research as they may have already identified the most pressing travel-related health concerns and solutions for these problems.

    更新日期:2019-11-18
  • Re-emergence of scrub typhus in Zhejiang Province, southern China: A 45-year population-based surveillance study
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-05-21
    Jiangping Ren, Jimin Sun, Zhengting Wang, Feng Ling, Xuguang Shi, Rong Zhang, Ying Liu, Zhiping Chen, Enfu Chen

    Background Scrub typhus is the leading cause of treatable unidentified febrile illnesses in Southeast Asia. This study was conducted to document the epidemiological characteristics of scrub typhus and its change in Zhejiang, one of traditional epidemic provinces in China. Methods Scrub typhus surveillance data in Zhejiang province during 1957–1989 and 2006–2012 were obtained. Descriptive analysis was conducted to characterize the epidemiology of scrub typhus. The spatial distributions over the periods were explored using spatial autocorrelation analysis and spatiotemporal cluster analysis. Results A total of 4104 cases and 7 deaths were reported from 1957 to 1989 and 2006 to 2017. The incidence declined since 1959, remained low from 1967 to 1989, and then exponentially increased after 2006. The seasonality changed from a summer pattern between 1957 and 1989 to a bimodal peak pattern in July to August and October to November from 2006 to 2017. One primary and three secondary high-risk clusters were affirmed in both periods from 1980 to 1989 and 2006 to 2017. The primary cluster expanded southwestward and the time span of the secondary clusters extended in the later period compared to the clusters in the previous time frame. Conclusion Zhejiang recently underwent a seasonality change, geographic extension, and incidence increase in scrub typhus. More attention should be paid to controlling scrub typhus.

    更新日期:2019-11-18
  • Fever of unknown origin caused by infectious diseases in the era of migrant and refugee crisis
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-05-14
    Nikolaos Spernovasilis, Constantinos Tsioutis, Lamprini Markaki, Maria Zafeiri, Stella Soundoulounaki, Achilleas Gikas

    Concern exists in Europe about the possibility of importation of infectious diseases due to the recent influx of migrants and refugees after 2011. In this retrospective 6-year study, we examined the epidemiology of fever of unknown origin (FUO) in Greece over the past years. Forty-eight patients with classical FUO were included. The proportion of infectious causes of FUO (29.2%) was similar to previous studies in Greece and all infections were endemic to the area. Disease-related mortality was 12.5% and no deaths due to infection were recorded. In conclusion, none of the diagnosed infectious causes of FUO raised concerns about the possibility of imported diseases or pathogens. These results re-inforce the perception that migrants and refugees are not carriers of communicable diseases that can cause public health problems to European countries.

    更新日期:2019-11-18
  • Low adherence with national travel medicine recommendations in Belgian expatriate children: A retrospective analysis
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-05-11
    Ine Ilona Decuyper, Pierre Van Damme, Patrick Soentjens, Marek Wojciechowski

    Background Expatriates (expats) from European countries regularly migrate to low-income countries where infectious diseases are more prevalent. Little evidence exists however on pediatric expatriates’ compliance with preventive measures related to infectious diseases. This study aims to evaluate compliance in Belgian expat-children. Methods Data of 135 Belgian expat-children, visiting the Institute of Tropical Medicine (Antwerp, Belgium), were collected from clinical notes, laboratory results and from a web-based immunization-register. Information on routine vaccinations, yellow fever, hepatitis A, rabies, typhoid fever, meningococcal ACW135Y, Japanese encephalitis, BCG vaccine and anti-malaria chemoprophylaxis was collected. Results Overall, 87% of expat-children were up-to-date with their routine vaccinations. Although all children were eligible for hepatitis A, typhoid and rabies vaccination, only 8–21% were fully vaccinated. Only 29 and 61% of eligible children were vaccinated against meningococcal (ACW135Y) or yellow fever respectively. Finally, only 10% of children who lived in malaria-endemic-areas, reported chemoprophylaxis-use. Conclusion Although routine vaccination coverage in expat-children seems adequate, additional preventive measures are often needed. Whether this is due to lack of high-quality health care-access, fear of side-effects or insufficient knowledge about the risks/available preventive measures, remains elusive. Nevertheless, expats seem to constitute a separate risk-group for infectious diseases and destination-related health issues.

    更新日期:2019-11-18
  • Respiratory and gastrointestinal infections at the 2017 Grand Magal de Touba, Senegal: A prospective cohort survey
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-05-03
    Van-Thuan Hoang, Ndiaw Goumballa, Thi-Loi Dao, Tran Duc Anh Ly, Laetitia Ninove, Stéphane Ranque, Didier Raoult, Philippe Parola, Cheikh Sokhna, Vincent Pommier de Santi, Philippe Gautret

    Background The Grand Magal of Touba is the largest Muslim pilgrimage in Senegal with a potential for infectious disease transmission. Methods Clinical follow-up, adherence to preventive measures and qPCR-based respiratory and gastrointestinal pathogens carriage pre- and post-Magal, were assessed. Results 110 pilgrims from South Senegal were included. The duration of stay in Touba was 3 days. 41.8% and 14.5% pilgrims reported respiratory and gastrointestinal symptoms. Most individuals having the onset of symptoms during their stay in Touba, or soon after returning. The acquisition of rhinoviruses, coronaviruses and adenovirus was 13.0, 16.7 and 4.6% respectively and that of Streptococcus pneumoniae and Haemophilus influenzae was 3.7% and 26.9%. Acquisition of gastrointestinal viruses and parasites was low, while bacterial acquisition ranged from 2.2% for Campylobacter jejuni to 33.0% for enteropathogenic Escherichia coli. Conclusion This preliminary study confirms that Grand Magal pilgrims are likely to be exposed to communicable disease risk as observed in other pilgrimage settings. Further study including larger numbers of pilgrims are needed to investigate potential risk factors for respiratory and gastrointestinal infections at the Grand Magal.

    更新日期:2019-11-18
  • MERS-CoV as an emerging respiratory illness: A review of prevention methods
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-12
    Salim Baharoon, Ziad A. Memish

    Introduction Middle East Respiratory Coronavirus Virus (MERS-CoV) first emerged from Saudi Arabia in 2012 and has since been recognized as a significant human respiratory pathogen on a global level. Methods In this narrative review, we focus on the prevention of MERS-CoV. We searched PubMed, Embase, Cochrane, Scopus, and Google Scholar, using the following terms: ‘MERS’, ‘MERS-CoV’, ‘Middle East respiratory syndrome’ in combination with ‘prevention’ or ‘infection control’. We also reviewed the references of each article to further include other studies or reports not identified by the search. Results As of Nov 2019, a total of 2468 laboratory-confirmed cases of MERS-CoV were diagnosed mostly from Middle Eastern regions with a mortality rate of at least 35%. A major outbreak that occurred outside the Middle East (in South Korea) and infections reported from 27 countries. MERS-CoV has gained recognition as a pathogen of global significance. Prevention of MERS-CoV infection is a global public health priority. Healthcare facility transmission and by extension community transmission, the main amplifier of persistent outbreaks, can be prevented through early identification and isolation of infected humans. While MERS-CoV vaccine studies were initially hindered by multiple challenges, recent vaccine development for MERS-CoV is showing promise. Conclusions The main factors leading to sustainability of MERS-CoV infection in high risk courtiers is healthcare facility transmission. MERS-CoV transmission in healthcare facility mainly results from laps in infection control measures and late isolation of suspected cases. Preventive measures for MERS-CoV include disease control in camels, prevention of camel to human transmission.

    更新日期:2019-11-13
  • Severe toxoplasmosis imported from tropical Africa in immunocompetent patients: A case series
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-09
    Jordan Leroy, Sandrine Houzé, Marie-Laure Dardé, Hélène Yéra, Benjamin Rossi, Laurence Delhaes, Frédéric Gabriel, Paul Loubet, Anne-Sophie Deleplancque, Eric Senneville, Faïza Ajana, Boualem Sendid, Denis Malvy

    Background Toxoplasmosis is a zoonosis caused by the protozoan Toxoplasma gondii. In immunocompetent patients the infection is usually benign. However, cases of severe and even lethal primo-infections are regularly reported in South America. In contrast, data from tropical Africa are fragmentary. Methods Data for French cases of severe toxoplasmosis acquired between 2013 and 2018, in tropical Africa and among immunocompetent patients were collected retrospectively in 2018. Results Four male patients with a mean age of 34-years were identified. All infections originated in West or Central Africa. The clinical presentations were heterogeneous: two patients had severe disseminated toxoplasmosis, of which one presented with chorioretinitis associated with myositis and the other with febrile pneumopathy; one patient presented with post-infectious acute cerebellar ataxia and the final case had general symptoms and skin manifestations. The diagnosis of acute toxoplasmosis was confirmed by serology in four patients. Molecular diagnosis confirmed T. gondii infection in three patients with Africa 1 as the dominant genotype. The infection was cured with anti-infective treatment in all four patients. Ocular sequelae were reported in the two patients with chorioretinitis. Conclusions Imported cases of severe toxoplasmosis in immunocompetent patients are rare in France. However, this aetiology should be evoked rapidly in a patient with a severe infectious syndrome who has recently visited or originated from tropical Africa.

    更新日期:2019-11-11
  • International mass gatherings and travel-associated illness: A GeoSentinel cross-sectional, observational study
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-09
    Philippe Gautret, Kristina M. Angelo, Hilmir Asgeirsson, Alexandre Duvignaud, Perry J.J. van Genderen, Emmanuel Bottieau, Lin H. Chen, Salim Parker, Bradley A. Connor, Elizabeth D. Barnett, Michael Libman, Davidson H. Hamer

    Background Travelers to international mass gatherings may be exposed to conditions which increase their risk of acquiring infectious diseases. Most existing data come from single clinical sites seeing returning travelers, or relate to single events. Methods Investigators evaluated ill travelers returning from a mass gathering, and presenting to a GeoSentinel site between August 2015 and April 2019, and collected data on the nature of the event and the relation between final diagnoses and the mass gathering. Results Of 296 ill travelers, 51% were female and the median age was 54 years (range: 1–88). Over 82% returned from a religious mass gathering, most frequently Umrah or Hajj. Only 3% returned from the Olympics in Brazil or South Korea. Other mass gatherings included other sporting events, cultural or entertainment events, and conferences. Respiratory diseases accounted for almost 80% of all diagnoses, with vaccine preventable illnesses such as influenza and pneumonia accounting for 26% and 20% of all diagnoses respectively. This was followed by gastrointestinal illnesses, accounting for 4.5%. Sixty-three percent of travelers reported having a pre-travel encounter with a healthcare provider. Conclusions Despite this surveillance being limited to patients presenting to GeoSentinel sites, our findings highlight the importance of respiratory diseases at mass gatherings, the need for pre-travel consultations before mass gatherings, and consideration of vaccination against influenza and pneumococcal disease..

    更新日期:2019-11-11
  • Spatial distribution of dengue in Honduras during 2016–2019 using a geographic information systems (GIS)–Dengue epidemic implications for public health and travel medicine
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-09
    Lysien I. Zambrano, Edith Rodriguez, Iván Alfonso Espinoza-Salvado, Itzel Carolina Fuentes-Barahona, Tales Lyra de Oliveira, Glaucia Luciano da Veiga, José Cláudio da Silva, Jorge Alberto Valle-Reconco, Alfonso J. Rodríguez-Morales

    Background After serious epidemics of chikungunya (CHIKV) and Zika (ZIKV) in the Americas, dengue (DENV) have reemerged in most countries. We analyzed the incidence, incidence rates, and evolution of DENV cases in Honduras from 2015 to 2018 and the ongoing 2019 epidemic. Methods Using epidemiological weeks (EW) surveillance data on the DENV in Honduras, we estimated incidence rates (cases/100,000 population), and developed maps at national, departmental, and municipal levels. Results From January 1, 2016 to July 21, 2019, a total of 109,557 cases of DENV were reported, 28,603 in 2019, with an incidence rate of 312.32 cases/100,000 population this year; 0.13% laboratory-confirmed. The highest peak was reached on the EW 28°, 2019 (5,299 cases; 57.89 cases/100,000 population). The department with the highest number of cases and incidence rate was Cortes (8,404 cases, 479.68 cases/100,000 population in 2019). Discussion The pattern and evolution of DENV epidemic in 2019 in Honduras has been similar to that which occurred for in 2015. As previously reported, this epidemic involved the north and central areas of the country predominantly, reaching municipality incidences there >1,000 cases/100,000 population (or 1%). Studies using geographical information systems linked with clinical disease characteristics are necessary to obtain accurate epidemiological data for public health systems. Such information is also useful for assessment of risk for travelers who visit specific areas in a destination country.

    更新日期:2019-11-11
  • The surveillance of four mosquito-borne diseases in international travelers arriving at Guangzhou Baiyun International Airport, China, 2016–2017
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-08
    Xue Feng, Wei Sun, Guthrie S. Birkhead, Xuanzhuo Wang, Zhongmin Guo, Jiahai Lu

    Background Little comprehensive analysis combining epidemiological and clinical data has been done with mosquito-borne diseases imported into Guangzhou by air travelers. Methods We screened international travelers (body temperature >36.5 °C) arriving at Guangzhou Baiyun International Airport, and recorded their epidemiological and clinical information. Whole-blood samples were collected for laboratory diagnosis of dengue virus (DENV), chikungunya virus (CHIKV), zika virus (ZIKV) infections and malaria. Results Between March 1, 2016 and December 31, 2017, 155 (6.6%) cases (100 of DENV, 21 of CHIKV, 1 of ZIKV, 34 of malaria, including one co-infection of DENV and CHIKV) were identified among 2350 febrile travelers. DENV (90.0%) and CHIKV (100.0%) cases mainly came from Southern and Southeast Asia. Malaria cases (91.2%) mainly came from sub-Saharan Africa. Traveling abroad (28/74, 37.8%) and living/working abroad (11/22, 50.0%) were the most common causes of DENV infection and malaria for Chinese, respectively. Cases with these four mosquito-borne diseases were more likely to have nervous, musculoskeletal and skin symptoms and signs than other febrile diseases (P < 0.001). Conclusions It is important to strengthen the surveillance of mosquito-borne diseases among tourists and workers returning from Southeast Asia, Southern Asia and sub-Saharan Africa, especially those with nervous, musculoskeletal and skin symptoms and signs.

    更新日期:2019-11-08
  • Was Zika introduced to Brazil by participants at the 2013 Beach Soccer World Cup held in Tahiti: A phylogeographical analysis
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-05
    Quentin Le Hingrat, Marine Perrier, Charlotte Charpentier, Alaric Jacquot, Nadhira Houhou-Fidouh, Diane Descamps, Benoit Visseaux

    Background Zika virus (ZIKV) was initially responsible for a limited number of punctual epidemics throughout Africa and Asia. Recently, large epidemics occurred in French Polynesia, Brazil and Pan-America. These outbreaks were associated with severe outcomes such as Guillain-Barré Syndrome and microcephaly of in-utero infected newborns. Previous studies demonstrated that ZIKV was introduced in Brazil from French Polynesia but failed to identify a founding event. Method All publicly available ZIKV full-genome sequences (n = 182) were phylogenetically analyzed, using Bayesian method, to estimate the introduction date of ZIKV into Brazil. Results Introduction date into Brazil was estimated between 8th of July 2013 and 4th of November 2013, encompassing the Beach Soccer World Cup held in French Polynesia, in September 2013, which gathered Brazilian athletes and supporters. We also observed that ZIKV sequences from travelers infected in South-East Asia or in Pacific islands were closely related to viruses identified prior to the French Polynesian epidemic, underlining an endemic circulation of ZIKV in those countries since 2007, at least. Conclusion This work provides a narrower estimation of ZIKV introduction into Brazil and illustrates the need for a better exploration of ZIKV circulation and endemicity in South-East Asia, while epidemiological and prevention efforts have been mainly focused on the Pan-American epidemic.

    更新日期:2019-11-06
  • Adherence to hepatitis A travel health guidelines: A cross-sectional seroprevalence study in Dutch travelling families - The Dutch travel Vaccination Study (DiVeST)
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-05
    Laura Doornekamp, Corine GeurtsvanKessel, Lennert Slobbe, Merel R. te Marvelde, Sandra M.J. Scherbeijn, Perry J.J. van Genderen, Eric C.M. van Gorp, Marco Goeijenbier

    Background This Dutch travel Vaccination Study (DiVeST) aimed to study adherence or compliance to Dutch travel health guidelines in travelling families and to identify risk groups to provide better advice and protection for international travellers. Methods Between 2016 and 2018, family members who travelled to Eastern Europe or outside Europe during the preceding year were recruited via Dutch secondary schools. The vaccination status of the travellers was assessed using questionnaires and vaccination records and hepatitis A virus antibody concentrations in dried blood spot (DBS) eluates. Subgroups of travellers with lower adherence to guidelines were identified. Results Of the 246 travellers that participated in this study, 155 (63%) travelled to destinations for which the HAV vaccination was recommended. Of these 155 travellers, 56 (36%) said they visited a pre-travel clinic, and 64 of them (41%) showed a valid HAV vaccination in their vaccination records. Of the 145 travellers with available DBS eluates, anti-HAV antibodies were detected in 98 (68%) of them. Conclusions We found that adherence to travel health guidelines, in terms of HAV vaccination, was suboptimal. According to our results, specific attention should be paid to children, persons visiting friends and relatives and those who travel relatively short distances.

    更新日期:2019-11-06
  • Severe complications of imported schistosomiasis, Spain: A retrospective observational study
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-05
    Joaquín Salas-Coronas, José Vázquez-Villegas, Ana B. Lozano-Serrano, Manuel J. Soriano-Pérez, Isabel Cabeza-Barrera, M Teresa Cabezas-Fernández, Antonio Villarejo-Ordóñez, José Carlos Sánchez-Sánchez, José Ignacio Abad Vivas-Pérez, Salvador Vázquez Blanc, Matilde Palanca Jiménez, José A. Cuenca-Gómez

    Background Chronic schistosomiasis silently leads to severe organ-specific disorders, such as hydroureter, bladder cancer or portal hypertension in around 10% of infected people in endemic zones. However, in non-endemic areas, information on schistosomiasis' severe complications and their actual prevalence is scarce because diagnosis is usually reached when such complications are well established. Methods Retrospective observational study of data obtained from a screening protocol designed for sub-Saharan migrants including search for stool parasites and schistosoma serology. After screening 3090 sub-Saharans, 326 (10.5%) confirmed cases of schistosomiasis were found, based on detection of ova in feces, urine or in biopsy samples. Another 830 patients (26.9%) were diagnosed of probable schistosomiasis (positive serology and/or suggestive imaging findings). Results Only patients with confirmed schistosomiasis were included in the final analysis. Among them, 13 (4%) presented severe complications at the time of diagnosis. Depending on the location, they account for 5% of patients with hepatointestinal schistosomiasis and 3.5% of patients with urogenital infection. Conclusions Targeted systematic screening could reduce the prevalence of severe complications by enabling early diagnosis and treatment. Having indigenous transmission been demonstrated in southern Europe, prevention of future cases in non-endemic countries might be another sound reason supporting such screening.

    更新日期:2019-11-06
  • Imported malaria and artemisinin-based combination therapy failure in travellers returning to Belgium: A retrospective study
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-10-31
    Eduard Rovira-Vallbona, Emmanuel Bottieau, Pieter Guetens, Jacob Verschueren, Javiera Rebolledo, Eric Nulens, Jeroen Van der Hilst, Jan Clerinx, Marjan Van Esbroeck, Anna Rosanas-Urgell

    Background Malaria (Plasmodium spp) remains a top cause of travel-associated morbidity among European residents. Here, we describe recent trends of imported malaria to Belgium and characterize the first cases of P.falciparum failure to artemisinin combination therapy (ACT). Methods National surveillance data and registers from national reference laboratory were used to investigate malaria cases and ACT failures in the past 20 years. Recurrent infections were confirmed by pfmsp genotyping and polymorphisms in drug resistance-associated genes pfk13, pfcrt, pfmdr1, pfpm2, pfap2mu and pfubp1 were determined by sequencing and qPCR. Results Annual malaria cases steadily increased in the last decade, reaching 428 in 2017 (all species). An estimated 15% of P.falciparum cases were severe. Between 2014 and 2017, 727 P.falciparum cases were reported and six non-immune travellers presented late recurrence. Five had hyperparasitaemia and/or signs of severe malaria at initial consultation. No mutations in ACT drug resistance markers were detected, although pfcrt-pfmdr1 haplotypes associated with lumefantrine tolerance were common. Conclusions The upward trend in imported malaria, the substantial proportion of severe cases and the emergence of ACT failures are sources of concern, although late failures were infrequent. Genetic analysis did not support parasitological resistance to ACT, suggesting prospective pharmacokinetic studies should assess adequacy of partner drug dosage and duration in non-immune populations.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Cutaneous leishmaniasis caused by Leishmania (Viannia) guyanensis complex in a traveller returning from Bolivia.
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-25
    Matteo Piccica,Marina Gramiccia,Trentina Di Muccio,Massimo Meli,Luigi Gradoni,Alessandro Bartoloni,Lorenzo Zammarchi

    更新日期:2019-11-01
  • Lutzomyia - Just a name, a fly, or a disease vector?
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-25
    Dieter Stürchler

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • The LGBT traveller - Love, liberty and local laws.
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-24
    Jane Chiodini

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Complex choices: Which malaria chemoprophylaxis can be recommended for the pregnant traveller?
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-24
    Patricia Schlagenhauf,Martin P Grobusch,Karin Leder,Stephen Toovey,Dipti Patel

    更新日期:2019-11-01
  • Recrudescence of chronic Plasmodium falciparum malaria 13 years after exposure.
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-13
    Arif Ismail,Francois Auclair,Anne E McCarthy

    更新日期:2019-11-01
  • Absence of molecular evidence for Candidatus Neoehrlichia mikurensis presence in symptomatic patients in Poland.
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-11
    Anna Moniuszko-Malinowska,Justyna Dunaj,Martin O Andersson,Izabela Swiecicka,Justyna M Drewnowska,Piotr Czupryna,Sambor Grygorczuk,Monika Król,Joanna Zajkowska,Sławomir Pancewicz

    更新日期:2019-11-01
  • Leishmaniasis in Pakistan: A call for action.
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-11
    Aisha Khan,Muhammad Sohail Afzal,Haroon Ahmed

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Sequence analysis of reassortants within H3N2 subtype influenza A virus circulated in Hong Kong, 2014-2017.
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-11-08
    Liang Chen,Jiasheng Xiong,Li Peng,Pengfei Yang,Hao Yu,Qingli Yan,Yan Cheng,Genming Zhao,Yue Chen,Qingwu Jiang,Chenglong Xiong

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • 更新日期:2019-11-01
  • An immigrant teen from Bangladesh with fever, abdominal pain, and ascites: A diagnostic challenge.
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-03-03
    Dalia Eid,Jose M Prince,Morris C Edelman,Stefan H F Hagmann

    更新日期:2019-11-01
  • Lack of Vibrio cholerae among French pilgrims during the 2017 and 2018 Hajj.
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : null
    Van-Thuan Hoang,Thi-Loi Dao,Tran Duc Anh Ly,Khadidja Belhouchat,Kamel Larbi Chaht,Tassadit Drali,Saber Yezli,Badriah Alotaibi,Didier Raoult,Philippe Parola,Pierre-Edouard Fournier,Vincent Pommier de Santi,Philippe Gautret

    更新日期:2019-11-01
  • Increasing incidence and changing epidemiology of brucellosis in China (2004-2016).
    Travel Med. Infect. Dis. (IF 4.868) Pub Date : 2019-08-03
    Kun Li,Lihong Zhang,Muhammad Shahzad,Khalid Mehmood,Jiakui Li

    更新日期:2019-11-01
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