Business travel-associated illness: a GeoSentinel analysis

• Published in: Journal of travel medicine 2018, Vol.25 (1)
• Main Authors: Chen, Lin H, Leder, Karin, Barbre, Kira A, Schlagenhauf, Patricia, Libman, Michael, Keystone, Jay, Mendelson, Marc, Gautret, Philippe, Schwartz, Eli, Shaw, Marc, MacDonald, Sue, McCarthy, Anne, Connor, Bradley A, Esposito, Douglas H, Hamer, Davidson, Wilson, Mary E
• Format: Article
• Language: English
• Subjects: Adult; Adults; Africa South of the Sahara - epidemiology; Aged; Asia - epidemiology; Business; Business travel; Commerce; Diarrhea; Diarrhea - epidemiology; Europe - epidemiology; Fatalities; Female; Fever; Health care; Health problems; Human health and pathology; Humans; Illnesses; Infectious diseases; Life Sciences; Malaria; Malaria - epidemiology; Malaria - mortality; Male; Melioidosis; Middle Aged; Morbidity; North America - epidemiology; Occupational Medicine; Plasmodium falciparum; Rabies; Sentinel Surveillance; Sexually Transmitted Diseases - epidemiology; Travel; Tropical diseases; Typhoid; Vaccination; Vector-borne diseases; Waterborne diseases; Young Adult
• ISSN: 1708-8305; 1195-1982; 1708-8305
• DOI: 10.1093/jtm/tax097

Abstract Background Analysis of a large cohort of business travelers will help clinicians focus on frequent and serious illnesses. We aimed to describe travel-related health problems in business travelers. Methods GeoSentinel Surveillance Network consists of 64 travel and tropical medicine clinics in 29 countries; descriptive analysis was performed on ill business travelers, defined as persons traveling for work, evaluated after international travel 1 January 1997 through 31 December 2014. Results Among 12 203 business travelers seen 1997–2014 (14 045 eligible diagnoses), the majority (97%) were adults aged 20–64 years; most (74%) reported from Western Europe or North America; two-thirds were male. Most (86%) were outpatients. Fewer than half (45%) reported a pre-travel healthcare encounter. Frequent regions of exposure were sub-Saharan Africa (37%), Southeast Asia (15%) and South Central Asia (14%). The most frequent diagnoses were malaria (9%), acute unspecified diarrhea (8%), viral syndrome (6%), acute bacterial diarrhea (5%) and chronic diarrhea (4%). Species was reported for 973 (90%) of 1079 patients with malaria, predominantly Plasmodium falciparum acquired in sub-Saharan Africa. Of 584 (54%) with malaria chemoprophylaxis information, 92% took none or incomplete courses. Thirteen deaths were reported, over half of which were due to malaria; others succumbed to pneumonia, typhoid fever, rabies, melioidosis and pyogenic abscess. Conclusions Diarrheal illness was a major cause of morbidity. Malaria contributed substantial morbidity and mortality, particularly among business travelers to sub-Saharan Africa. Underuse or non-use of chemoprophylaxis contributed to malaria cases. Deaths in business travelers could be reduced by improving adherence to malaria chemoprophylaxis and targeted vaccination for vaccine-preventable diseases. Pre-travel advice is indicated for business travelers and is currently under-utilized and needs improvement.