Travelers’ health problems and behavior: prospective study with post-travel follow-up

Abstract

BackgroundThe annual number of international tourist arrivals has recently exceeded one billion, yet surprisingly few studies have characterized travelers’ behavior, illness, and risk factors in a prospective setting. Particularly scarce are surveys of data spanning travel, return, and follow-up of the same cohort.This study examines behavior and illness among travelers while abroad, after return home, and at follow-up. Patterns of behavior connected to type of travel and illness are characterized so as to identify risk factors and provide background data for pre-travel advice.MethodsVolunteers to this prospective cohort study were recruited at visits to a travel clinic prior to departure. Data on the subjects’ health and behavior were collected by questionnaires before and after journeys and over a three-week follow-up. In addition, the subjects were asked to fill in health diaries while traveling.ResultsThe final study population consisted of 460 subjects, 79 % of whom reported illness during travel or on arrival: 69 % had travelers’ diarrhea (TD), 17 % skin problems, 17 % fever, 12 % vomiting, 8 % respiratory tract infection, 4 % urinary tract infection, 2 % ear infection, 4 % gastrointestinal complaints other than TD or vomiting, and 4 % other symptoms. Of all subjects, 10 % consulted a doctor and 0.7 % were hospitalized; 18 % took antimicrobials, with TD as the most common indication (64 %). Ongoing symptoms were reported by 25 % of all travelers upon return home.During the three-week follow-up (return rate 51 %), 32 % of respondents developed new-onset symptoms, 20 % visited a doctor and 1.7 % were hospitalized.Factors predisposing to health problems were identified by multivariable analysis: certain regions (Southern Asia, South-Eastern Asia, and Eastern Africa), female gender, young age, and long travel duration.ConclusionsDespite proper preventive measures like vaccinations, malaria prophylaxis, and travel advice, the majority of our subjects fell ill during or after travel. As the symptoms mostly remained mild, health care services were seldom needed. Typical traveler profiles were identified, thereby providing a tool for pre-travel advice. The finding that one third reported new-onset illness during follow-up attests to the importance of advising clients on potential post-travel health problems already during pre-travel visits.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1682-0) contains supplementary material, which is available to authorized users.

Self-reported illness among Boston-area international travelers: A prospective study

“…The most common symptoms reported by our travelers (diarrhea, headache, cough/runny nose, myalgia/fatigue, fever/chills, and rash) were consistent with previous studies [2–5] as well as a recent survey of Finnish travelers [11]. Health problems led to changing or stopping travel plans in 25% of all travelers during travel and 21% after travel, which may have resulted in an adverse impact on their travel experience or work productivity.…”

What proportion of international travellers acquire a travel-related illness? A review of the literature

“…7,9,10,12,13,15 Travellers who attend a pre-travel consultation receive education on mitigation of health risks during travel and prevention of infectious diseases, including personal protective measures, chemoprophylaxis, and vaccination. 16 Attendance at a pre-travel consultation may result in decreased illness if clinicians provide travellers with prevention information 17 and the travellers adhere to these preventive measures.…”

“…This latter hypothesis is supported by findings in Vilkman et al : travellers were enrolled at the pre-travel consultation, and 84% visited Asia or Africa, while only 3% visited North America or Europe; almost 80% of travellers became ill while abroad. 13 In addition, in the United States, many health insurance plans do not pay for pre-travel health consultations and vaccines, which may result in a selection bias among the studies that enrolled travellers at the pre-travel consultation since they likely included only travellers with the means to pay out-of-pocket for their preventive care. In Europe, a similar bias may arise due to country variation on whether pre-travel consultation is provided by the public or the private sector.…”

“…7,10,12,13 These four studies included data abstraction at the pre-travel consultation to obtain baseline characteristics, administered at least one post-travel questionnaire, enrolled travellers going to a variety of destinations and included data from the last 20 years to reflect recent rises in international travel. In these four studies, between 43–79% of travellers reported developing a travel-related illness; these were predominantly tourists from the United States and Europe that attended a pre-travel consultation and became ill during or after travel to Asia or Africa (more specifically, India, Tanzania, or Kenya).…”

Conducta práctica ante un niño febril al regresar de un viaje

“…Estos tres grandes grupos de enfermedades también se registran en todos los demás estudios, casi siempre retrospectivos, efectuados en América del Norte [6,7] o en Europa [8][9][10] . Todos señalan también una variación del riesgo según el destino o el tipo de estancia, de manera que los viajeros con más riesgo de contraer una infección grave eran los que tenían como objetivo la visita a unos amigos o a la familia.…”