Travel and migration associated infectious diseases morbidity in Europe, 2008

Background: Europeans represent the majority of international
travellers and clinicians encountering returned patients have an
essential role in recognizing, and communicating travel-associated
public health risks. Methods: To investigate the morbidity of
travel associated infectious diseases in European travellers, we
analysed diagnoses with demographic, clinical and travel-related
predictors of disease, in 6957 ill returned travellers who
presented in 2008 to EuroTravNet centres with a presumed travel
associated condition. Results: Gastro-intestinal (GI) diseases
accounted for 33% of illnesses, followed by febrile systemic
illnesses (20%), dermatological conditions (12%) and respiratory
illnesses (8%). There were 3 deaths recorded; a sepsis caused by
Escherichia coli pyelonephritis, a dengue shock syndrome and a
Plasmodium falciparum malaria. GI conditions included bacterial
acute diarrhea (6.9%), as well as giardiasis and amebasis (2.3%).
Among febrile systemic illnesses with identified pathogens, malaria
(5.4%) accounted for most cases followed by dengue (1.9%) and
others including chikungunya, rickettsial diseases, leptospirosis,
brucellosis, Epstein Barr virus infections, tick-borne encephalitis
(TBE) and viral hepatitis. Dermatological conditions were dominated
by bacterial infections, arthropod bites, cutaneous larva migrans
and animal bites requiring rabies post-exposure prophylaxis and
also leishmaniasis, myasis, tungiasis and one case of leprosy.
Respiratory illness included 112 cases of tuberculosis including
cases of multi-drug resistant or extensively drug resistant
tuberculosis, 104 cases of influenza like illness, and 5 cases of
Legionnaires disease. Sexually transmitted infections (STI)
accounted for 0.6% of total diagnoses and included HIV infection
and syphilis. A total of 165 cases of potentially vaccine
preventable diseases were reported. Purpose of travel and
destination specific risk factors was identified for several
diagnoses such as Chagas disease in immigrant travellers from South
America and P. falciparum malaria in immigrants from sub-Saharan
Africa. Travel within Europe was also associated with health risks
with distinctive profiles for Eastern and Western Europe.
Conclusions: In 2008, a broad spectrum of travel associated
diseases were diagnosed at EuroTravNet core sites. Diagnoses varied
according to regions visited by ill travellers. The spectrum of
travel associated morbidity also shows that there is a need to
dispel the misconception that travel, close to home, in Europe, is
without significant health risk.