Knowledge and Behavior of Tourists to Manu National Park, Peru, in Relation to Leishmaniasis

Abstract

Travelers to more distant, exotic, and tropical destinations are often exposed to a range of health hazards and need to be advised of the appropriate health issues. Advice on travel health consists mainly of information about appropriate behavior (hygiene, food, sexual encounters) and immunizations/prophylaxis, and concentrates on the prevention of diseases such as gastrointestinal infections, vectorborne infections, sexually transmitted infections/acquired immunodeficiency syndrome or hepatitis. Cutaneous leishmaniasis, a disease with a worldwide annual incidence of 300,000 cases from a population of 200 million at risk, 1 is very rarely included. Endemic in a number of tropical and subtropical areas around the globe, many doctors in the "Western" world (where most tourists come from) do not know and, therefore, do not recognize the disease in returning travelers, 2,3 let alone advise them about prevention. Sometimes, even published health advice 4 does not contain preventive measures. As a result, few tourists are informed about the condition.Leishmaniasis is a parasitic disease transmitted by infected sandflies. After being bitten, an ulcerous skin lesion develops that is usually self-healing after a number of weeks, leaving a typical scar the size of the ulcer. Numerous tourists have returned from overseas trips to endemic areas with such a reminder of their "Aleppo Boil" or "Oriental Sore." Unfortunately, one parasite species, Leishmania braziliensis, can develop a mucocutaneous stage within months, years or even decades after the primary lesion. 5,6 In this stage, individuals harboring the parasite develop mucosal lesions in the nose and mouth and -if untreated -disfiguring tissue destruction. L. braziliensis is prevalent in the rainforests of Central and South America. Coincidentally, these rainforests represent major tourist attractions, such as the national parks in Costa Rica and Peru. 2,7 Although mainly a disease of the local population, visitors to endemic areas (tourists, researchers, military personnel) can become infected rapidly if no precautions are taken, such as the

Leishmaniasis, an emerging infection in travelers

“…A survey conducted among 373 travelers in Manu National Park, Peru, revealed that only 6% of them had heard of leishmaniasis, although 96.5% had received pre-travel advice and 97.5% used protective measures. 41 In another survey conducted among 58 American travelers with New World CL, 53% reported that they have heard about leishmaniasis, however only 29% were aware of protective measures; of note, 63% of the 47% travelers who had never heard about leishmaniasis had received pre-travel advice. 17 Travel and immigration may also contribute to the introduction of new Leishmania species in an already endemic area.…”

Leishmaniasis in travelers: A literature review

“…A survey conducted among 373 travelers in Manu National Park, Peru, revealed that only 6% of them had heard of leishmaniasis, although 96.5% of the latter had received pre-travel advice and 97.5% used protective measures [179]. In another survey conducted among 58 American travelers with New World CL, 53% reported that they have heard about leishmaniasis, however only 29% were aware of protective measures.…”

Providing Japanese health care information for international visitors: digital animation intervention

“…Host countries have a stake in providing information to international visitors about healthy living and health systems [ 5 ], illness prevention [ 6 , 25 ] and procedures to access health facilities [ 5 , 12 , 26 ]. Travelers have a healthy and enjoyable experience when timely and critical knowledge is available before visiting other countries [ 27 , 28 ]. Hosts can also use such information when their friends or relatives visit them and ask about health issues [ 29 – 31 ].…”