Multicenter EuroTravNet/GeoSentinel study of travel-related infectious diseases in Europe

Abstract

We analyzed prospective data on 17,228 European patients who sought treatment at GeoSentinel sites from 1997 to 2007. Gastrointestinal illness (particularly in tourists), fever (those visiting friends and relatives [VFRs]), and skin disorders (in tourists) were the most common reasons for seeking medical care. Diagnoses varied by country of origin, region visited, or categories of travelers. VFRs who returned from sub-Saharan Africa and Indian Ocean islands were more likely to experience falciparum malaria than any other group. Multiple correspondence analysis identified Italian, French, and Swiss VFRs and expatriate travelers to sub-Saharan Africa and Indian Ocean Islands as most likely to exhibit febrile illnesses. German tourists to Southeast and south-central Asia were most likely to seek treatment for acute diarrhea. Non-European travelers (12,663 patients from other industrialized countries) were less likely to acquire certain travel-associated infectious diseases. These results should be considered in the practice of travel medicine and development of health recommendations for European travelers.

Figure 1

Proportion (%) of different categories of returned patients among 17,228 patients seen in GeoSentinel sites in Europe,* compared with 12,663 non-European patients sampled from the GeoSentinel database (1997–2007). *This proportion includes 11,848 from Germany, 2,818 from Switzerland, 971 from Italy, 931 from France, 289 from the United Kingdom, and 371 from other European countries.

Figure 2

Regions visited by the 17,228 European travelers according to their countries of residence or citizenship. The right column presents these categories within the comparator groups of 12,663 non-European patients sampled from the GeoSentinel database (1997–2007).

Figure 3

Odds ratios (ORs), European (n = 13,488) versus non-European (n = 6,900), by diagnosis and type of ill traveler, adjusted for travel duration. Each plot represents the estimated OR, and 95% confidence intervals are presented by lines. Only significant ORs based on the comparison of groups of >75 ill patients given a diagnosis are shown. The 3 main exposure regions are presented (Africa and Indian Ocean islands (red dots and squares), South and Central America and Caribbean (black dots), Southeast and south-central Asia (blue dots). *All dermatologic diagnoses also include leishmaniasis, animal-related injuries requiring rabies post-exposure prophylaxis (PEP), and larva migrans. GU-STD, genitourinary and sexually transmitted diseases. Dots, classic tourist travelers; square, immigrant travelers visiting friends and relatives (VFRs).