• Karin Leder, Joseph Torresi, Michael D Libman, Jakob P Cramer, Francesco Castelli, Patricia Schlagenhauf, Annelies Wilder-Smith, Mary E Wilson, Jay S Keystone, Eli Schwartz, Elizabeth D Barnett, Frank von Sonnenburg, John S Brownstein, Allen C Cheng, Mark J Sotir, Douglas H Esposito, David O Freedman, and GeoSentinel Surveillance Network.
• Victorian Infectious Disease Service, Royal Melbourne Hospital, Monash University, Austin Hospital, Melbourne University. karin.leder@monash.edu
• Ann. Intern. Med. 2013 Mar 19; 158 (6): 456468456-68.

BackgroundInternational travel continues to increase, particularly to Asia and Africa. Clinicians are increasingly likely to be consulted for advice before travel or by ill returned travelers.ObjectiveTo describe typical diseases in returned travelers according to region, travel reason, and patient demographic characteristics; describe the pattern of low-frequency travel-associated diseases; and refine key messages for care before and after travel.DesignDescriptive, using GeoSentinel records.Setting53 tropical or travel disease units in 24 countries.Patients42 173 ill returned travelers seen between 2007 and 2011.MeasurementsFrequencies of demographic characteristics, regions visited, and illnesses reported.ResultsAsia (32.6%) and sub-Saharan Africa (26.7%) were the most common regions where illnesses were acquired. Three quarters of travel-related illness was due to gastrointestinal (34.0%), febrile (23.3%), and dermatologic (19.5%) diseases. Only 40.5% of all ill travelers reported pretravel medical visits. The relative frequency of many diseases varied with both travel destination and reason for travel, with travelers visiting friends and relatives in their country of origin having both a disproportionately high burden of serious febrile illness and very low rates of advice before travel (18.3%). Life-threatening diseases, such as Plasmodium falciparum malaria, melioidosis, and African trypanosomiasis, were reported.LimitationsSentinel surveillance data collected by specialist clinics do not reflect healthy returning travelers or those with mild or self-limited illness. Data cannot be used to infer quantitative risk for illness.ConclusionMany illnesses may have been preventable with appropriate advice, chemoprophylaxis, or vaccination. Clinicians can use these 5-year GeoSentinel data to help tailor more efficient pretravel preparation strategies and evaluate possible differential diagnoses of ill returned travelers according to destination and reason for travel.Primary Funding SourceCenters for Disease Control and Prevention.

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