Regional variation in travel-related illness acquired in Africa, March 1997-May 2011

Abstract

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.

Keywords: Africa; HIV; bacteria; dengue; diarrhea; endemic; enteric; falciparum; helminth; malaria; malariae; ovale; parasites; plasmodium; podcast; rabies; respiratory; schistosomiasis; strongyloidiasis; travel; tuberculosis and other mycobacteria; vaccine; vector; vector-borne infections; viruses; vivax; zoonoses.

Figure 1

Regions of Africa as defined by the United Nations geoscheme (5). For persons whose country of exposure was unascertainable or missing but for whom all recent travel was to the same region of Africa, data were included in the final dataset.

Figure 2

Flowchart for analysis of ill returned travelers from Africa reported in the GeoSentinel Surveillance Network, March 1997–May 2011. The United Nations geoscheme was used to classify Africa into subregions (5).