Travel medicine and respiratory diseases

In a global world, knowledge of imported infectious diseases is essential in daily practice, both for the microbiologist-parasitologist and the clinician who diagnoses and treats infectious diseases in returned travelers. Tropical and subtropical countries where there is a greater risk of contracting an infectious disease are among the most frequently visited tourist destinations. The SEIMC considers it appropriate to produce a consensus document that will be useful to primary care physicians as well as specialists in internal medicine, infectious diseases and tropical medicine who help treat travelers returning from tropical and sub-tropical areas with infections...

BACKGROUND: Influenza viruses are among the major causes of serious human respiratory tract infection worldwide. In line with the high disease burden attributable to influenza, these viruses play an important, but often neglected, role in travel medicine. Guidelines and recommendations regarding prevention and management of influenza in travellers are scarce. Of special interest for travel medicine are risk populations and also circumstances that facilitate influenza virus transmission and spread, like travel by airplane or cruise ship and mass gatherings...

BACKGROUND: Fever in the returned traveller is a potential medical emergency warranting prompt attention to exclude life-threatening illnesses. However, prolonged evaluation in the emergency department (ED) may not be required for all patients. As a quality improvement initiative, we implemented an algorithm for rapid assessment of febrile travelers (RAFT) in an ambulatory setting. METHODS: Criteria for RAFT referral include: presentation to the ED, reported fever and travel to the tropics or subtropics within the past year...

Background.  The 2014-2015 Ebola epidemic in West Africa had global impact beyond the primarily affected countries of Guinea, Liberia, and Sierra Leone. Other countries, including the United States, encountered numerous patients who arrived from highly affected countries with fever or other signs or symptoms consistent with Ebola virus disease (EVD). Methods.  We describe our experience evaluating 25 travelers who met the US Centers for Disease Control and Prevention case definition for a person under investigation (PUI) for EVD from July 20, 2014 to January 28, 2015...

BACKGROUND: Patients with respiratory disease are at risk of excessive hypoxemia in the hypobaric commercial aircraft cabin environment, and the consensus is that this is easily corrected with supplementary oxygen. However, despite the risks of hypercapnia with increasing inspired oxygen in some patients being well established, this issue is not currently addressed in medical guidelines for air travel. CASE REPORT: A 76-yr-old woman with chronic type 2 respiratory failure underwent hypoxic challenge testing (HCT) to assess in-flight oxygen requirements...

Much of the research in high-altitude medicine has been concerned with non-indigenous travellers; no study has examined the work-related health issues of high altitude mountain guides (Sherpas) in Nepal. This pilot study was performed to investigate the work-related health issues of people working as Sherpas by evaluating their perceptions of their general health and its relation to work. An occupational and general health questionnaire was tailored for the Sherpas following a focus group with five Sherpa workers...

Three years after the identification of Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia, the first case of MERS in China was reported on May 29, 2015. Although the Chinese government issued the MERS Prevention and Control Plan in 2013, a novel edition was released on June 5, 2015 to better cope with the current epidemic situation. The revised Plan refines the descriptions in case-finding and establishment of case-monitoring systems. In addition, tougher regulations on close contacts of confirmed patients and suspected cases are introduced in this new Plan...

BACKGROUND: The largest-ever outbreak of Ebola virus disease (EVD), ongoing in West Africa since late 2013, has led to export of cases to Europe and North America. Clinicians encountering ill travelers arriving from countries with widespread Ebola virus transmission must be aware of alternate diagnoses associated with fever and other nonspecific symptoms. OBJECTIVE: To define the spectrum of illness observed in persons returning from areas of West Africa where EVD transmission has been widespread...

Although infection with Toxocara canis or T. catis (commonly referred as toxocariasis) appears to be highly prevalent in (sub)tropical countries, information on its frequency and presentation in returning travelers and migrants is scarce. In this study, we reviewed all cases of asymptomatic and symptomatic toxocariasis diagnosed during post-travel consultations at the reference travel clinic of the Institute of Tropical Medicine, Antwerp, Belgium. Toxocariasis was considered as highly probable if serum Toxocara-antibodies were detected in combination with symptoms of visceral larva migrans if present, elevated eosinophil count in blood or other relevant fluid and reasonable exclusion of alternative diagnosis, or definitive in case of documented seroconversion...

The transmission of respiratory tract infections (RTIs) is very high among the Hajj congregation in Mecca, Saudi Arabia. Despite recommendations for vaccinations, pilgrims remain at increased risk of RTIs. In this paper we systematically reviewed available studies assessing the uptake and effectiveness of vaccinations against RTIs among Hajj pilgrims and enumerated important demographic factors, if described, associated with vaccine uptake. Of the 42 included studies, 29 reported on the uptake and effectiveness of influenza vaccine among pilgrims, eight studies reported the uptake of other vaccines, notably pneumococcal, diphtheria and bacillus Calmette-Guérin vaccines, and the remaining five studies described both influenza and non-influenza vaccines...

BACKGROUND: Travel is important in the acquisition and dissemination of infection. We aimed to assess European surveillance data for travel-related illness to profile imported infections, track trends, identify risk groups, and assess the usefulness of pre-travel advice. METHODS: We analysed travel-associated morbidity in ill travellers presenting at EuroTravNet sites during the 5-year period of 2008-12. We calculated proportionate morbidity per 1000 ill travellers and made comparisons over time and between subgroups...

Respiratory infections are responsible for up to 11% of febrile infections in travellers or immigrants from tropical and subtropical regions. The main pathogens are the same as in temperate climate zones: Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, influenza viruses, Legionella pneumophila. However, some pulmonary diseases can be attributed to bacterial, parasitic, viral or fungal pathogens that are endemic in tropical and subtropical regions. The most commonly imported infections are malaria, dengue, and tuberculosis...

The importation of infectious diseases during a mass gathering may result in outbreaks. Infectious diseases associated with mass gatherings vary depending on the type and location of the mass gathering. The annual Hajj to Makkah in Saudi Arabia is one of the largest annual religious mass gatherings in the world. Preparation for the Hajj encompasses multiple sectors to develop comprehensive plans. These plans include risk assessment, utilizing existing medical infrastructure, developing electronic and paper-based surveillance activity, and the use of information technology...

The emergence of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and of the Middle East Syndrome Cornavirus (MERS-CoV) caused widespread fear and concern for their potential threat to global health security. There are similarities and differences in the epidemiology and clinical features between these two diseases. The origin of SARS-COV and MERS-CoV is thought to be an animal source with subsequent transmission to humans. The identification of both the intermediate host and the exact route of transmission of MERS-CoV is crucial for the subsequent prevention of the introduction of the virus into the human population...

Since the emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in mid-2012, there has been controversy over the respiratory precaution recommendations in different guidelines from various international bodies. Our understanding of MERS-CoV is still evolving. Current recommendations on infection control practices are heavily influenced by the lessons learnt from severe acute respiratory syndrome. A debate on respiratory precautions for MERS-CoV was organised by Infection Control Association (Singapore) and the Society of Infectious Disease (Singapore)...

BACKGROUND: More than 15 000 French soldiers are continuously deployed abroad. Along with combat-related injuries, they are exposed to non-combat-related diseases with an underestimated burden. Our objectives were to assess the incidence and impact of health problems on their operating capacity. METHODS: A prospective multicenter study was conducted over more than three months in Lebanon, Côte d'Ivoire and Afghanistan including exclusively French soldiers. RESULTS: We collected 4349 consultations (Afghanistan {n = 719}, Lebanon {n = 1401} and Côte d'Ivoire {n = 2229}) encompassing 4600 health problems...

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Hajj is the annual pilgrimage to Mecca in the Kingdom of Saudi Arabia, and is one of the largest mass gathering events in the world. Acute respiratory tract infections are very common during Hajj, primarily as a result of close contact among pilgrims, intense congestion, shared accommodation and air pollution. A number of vaccines are (or have been) recommended for Hajj pilgrims in recent years. Several additional vaccines could significantly reduce the morbidity and mortality at Hajj and should be considered in health recommendations for pilgrims...

Air travel poses medical challenges to passengers with respiratory disease, principally because of exposure to a hypobaric environment. In 2002 the British Thoracic Society published recommendations for adults and children with respiratory disease planning air travel, with a web update in 2004. New full recommendations and a summary were published in 2011, containing key recommendations for the assessment of high-risk patients and identification of those likely to require in-flight supplemental oxygen. This paper highlights the aspects of particular relevance to primary care practitioners with the following key points: (1) At cabin altitudes of 8000 feet (the usual upper limit of in-flight cabin pressure, equivalent to 0...

BACKGROUND: Worldwide, 2.75 billion passengers fly on commercial airlines annually. When in-flight medical emergencies occur, access to care is limited. We describe in-flight medical emergencies and the outcomes of these events. METHODS: We reviewed records of in-flight medical emergency calls from five domestic and international airlines to a physician-directed medical communications center from January 1, 2008, through October 31, 2010. We characterized the most common medical problems and the type of on-board assistance rendered...