Travel-acquired infections and illnesses in Canadians: surveillance report from CanTravNet surveillance data, 2009-2011

Affiliations

¹ Andrea K. Boggild, MSc, MD, DTMH, FRCPC, is the Clinical Director of the Tropical Disease Unit and a Staff Physician in the Division of Infectious Diseases, University Health Network - Toronto General Hospital; Assistant Professor, Department of Medicine, University of Toronto; and the Parasitology Lead with Laboratory Services, Public Health Ontario, Toronto, Ontario.
² Jennifer Geduld, MHSc, BSc, is Manager, Epidemiology with the Travel and Migration Health Division, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Ontario.
³ Michael Libman, MD, is Director of the Centre for Tropical Diseases, Director of the Division of Infectious Diseases, and member of the Department of Microbiology, McGill University Health Centre, Montreal, Quebec.
⁴ Brian J. Ward, MSc, MDCM, DTM&H, is Professor of Medicine and Microbiology, Division of Infectious Diseases, Department of Microbiology, McGill University Health Centre, Montreal, Quebec.
⁵ Anne E. McCarthy, MD, FRCPC, DTM&H, is Professor of Medicine, University of Ottawa, and Director of the Tropical Medicine and International Health Clinic, The Ottawa Hospital-General Campus, Ottawa, Ontario.
⁶ Patrick W. Doyle, MD, MHSc, FRCPC, is Medical Microbiologist with the Division of Medical Microbiology and Infection Control, Vancouver General Hospital, and Clinical Professor, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia.
⁷ Wayne Ghesquiere, MD, FRCPC, is an Infectious Diseases and Internal Medicine Consultant and Section Chief of Infectious Diseases with the Vancouver Island Health Authority, Victoria, British Columbia, and Clinical Assistant Professor of Medicine, University of British Columbia, Vancouver, British Columbia.
⁸ Jean Vincelette, MD, is Full Clinical Professor with the Département de microbiologie médicale et infectiologie, Hôpital Saint-Luc, Centre hospitalier de l'Université de Montréal, Montreal, Quebec.
⁹ Susan Kuhn, MD, is Head, Section of Pediatric Infectious Diseases, and Associate Professor, Departments of Pediatrics and Medicine, University of Calgary, Calgary, Alberta.
¹⁰ David O. Freedman, MD, is Professor of Medicine and Epidemiology and Director of the UAB Travelers Health Clinic with the Gorgas Center for Geographic Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama.
¹¹ Kevin C. Kain, MD, FRCPC, is Co-Director of the Tropical Disease Unit and a Professor of Medicine, Division of Infectious Diseases, Department of Medicine, University Health Network - Toronto General Hospital and University of Toronto, and Director of the Sandra A. Rotman Laboratories, Sandra Rotman Centre, University Health Network, Toronto, Ontario.

PMID: 25009682
PMCID: PMC4085092

Travel-acquired infections and illnesses in Canadians: surveillance report from CanTravNet surveillance data, 2009-2011

Andrea K Boggild et al. Open Med. 2014.

. 2014 Feb 11;8(1):e20-32.

eCollection 2014.

Authors

Affiliations

¹ Andrea K. Boggild, MSc, MD, DTMH, FRCPC, is the Clinical Director of the Tropical Disease Unit and a Staff Physician in the Division of Infectious Diseases, University Health Network - Toronto General Hospital; Assistant Professor, Department of Medicine, University of Toronto; and the Parasitology Lead with Laboratory Services, Public Health Ontario, Toronto, Ontario.
² Jennifer Geduld, MHSc, BSc, is Manager, Epidemiology with the Travel and Migration Health Division, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Ontario.
³ Michael Libman, MD, is Director of the Centre for Tropical Diseases, Director of the Division of Infectious Diseases, and member of the Department of Microbiology, McGill University Health Centre, Montreal, Quebec.
⁴ Brian J. Ward, MSc, MDCM, DTM&H, is Professor of Medicine and Microbiology, Division of Infectious Diseases, Department of Microbiology, McGill University Health Centre, Montreal, Quebec.
⁵ Anne E. McCarthy, MD, FRCPC, DTM&H, is Professor of Medicine, University of Ottawa, and Director of the Tropical Medicine and International Health Clinic, The Ottawa Hospital-General Campus, Ottawa, Ontario.
⁶ Patrick W. Doyle, MD, MHSc, FRCPC, is Medical Microbiologist with the Division of Medical Microbiology and Infection Control, Vancouver General Hospital, and Clinical Professor, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia.
⁷ Wayne Ghesquiere, MD, FRCPC, is an Infectious Diseases and Internal Medicine Consultant and Section Chief of Infectious Diseases with the Vancouver Island Health Authority, Victoria, British Columbia, and Clinical Assistant Professor of Medicine, University of British Columbia, Vancouver, British Columbia.
⁸ Jean Vincelette, MD, is Full Clinical Professor with the Département de microbiologie médicale et infectiologie, Hôpital Saint-Luc, Centre hospitalier de l'Université de Montréal, Montreal, Quebec.
⁹ Susan Kuhn, MD, is Head, Section of Pediatric Infectious Diseases, and Associate Professor, Departments of Pediatrics and Medicine, University of Calgary, Calgary, Alberta.
¹⁰ David O. Freedman, MD, is Professor of Medicine and Epidemiology and Director of the UAB Travelers Health Clinic with the Gorgas Center for Geographic Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama.
¹¹ Kevin C. Kain, MD, FRCPC, is Co-Director of the Tropical Disease Unit and a Professor of Medicine, Division of Infectious Diseases, Department of Medicine, University Health Network - Toronto General Hospital and University of Toronto, and Director of the Sandra A. Rotman Laboratories, Sandra Rotman Centre, University Health Network, Toronto, Ontario.

PMID: 25009682
PMCID: PMC4085092

Abstract

Background: Important knowledge gaps exist in our understanding of migration medicine practice and the impact of pathogens imported by Canadian travellers. We present here a comprehensive, Canada-specific surveillance summary of illness in a cohort of returned Canadian travellers and new immigrants.

Methods: We extracted and analyzed (using standard parametric and nonparametric techniques) data from the Canadian Travel Medicine Network (CanTravNet) database for ill returned Canadian travellers and new immigrants who presented to a Canadian GeoSentinel Surveillance Network site between September 2009 and September 2011.

Results: During the study period, 4365 travellers and immigrants presented to a CanTravNet site, 3943 (90.3%) of whom were assigned a travel-related diagnosis. Among the 3115 non-immigrant travellers with a definitive travel-related diagnosis, arthropod bite (n = 127 [4.1%]), giardiasis (n = 91 [2.9%]), malaria (n = 77 [2.5%]), latent tuberculosis (n = 73 [2.3%]), and strongyloidiasis (n = 66 [2.1%]) were the most common specific etiologic diagnoses. Among the 828 immigrants with definitive travel-related diagnoses, the most frequent etiologies were latent tuberculosis (n = 229 [27.7%]), chronic hepatitis B (n = 182 [22.0%]), active tuberculosis (n = 97 [11.7%]), chronic hepatitis C (n = 89 [10.7%]), and strongyloidiasis (n = 41 [5.0%]). Potentially serious infections, such as dengue fever (61 cases) and enteric fever due to Salmonella enterica serotype Typhi or Paratyphi (36 cases), were common. Individuals travelling for the purpose of visiting friends and relatives (n = 500 [11.6% of those with known reason for travel]) were over-represented among those diagnosed with malaria and enteric fever, compared with other illnesses (for malaria 34/94 [36.2%] v. 466/4221 [11.0%]; for enteric fever, 17/36 [47.2%] v. 483/4279 [11.3%]) (both p < 0.001). For cases of malaria, there was also overrepresentation (compared with other illnesses) from business travellers (22/94 [23.4%] v. 337/4221 [8.0%]) and males (62/94 [66.0%] v. 1964/4269 [46.0%]) (both p < 0.001). Malaria was more likely than other illnesses to be acquired in sub-Saharan Africa (p < 0.001), whereas dengue was more likely than other illnesses to be imported from the Caribbean and South East Asia (both p = 0.003) and enteric fever from South Central Asia (24/36 [66.7%]) (p < 0.001).

Interpretation: This analysis of surveillance data on ill returned Canadian travellers has detailed the spectrum of imported illness within this cohort. It provides an epidemiologic framework for Canadian practitioners encountering ill returned travellers. We have confirmed that travel to visit friends and relatives confers particularly high risks, which underscores the need to improve pretravel intervention for a population that is unlikely to seek specific pretravel advice. Potentially serious and fatal illnesses such as malaria and enteric fever were common, as were illnesses of public health importance, such as tuberculosis and hepatitis B.

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Conflict of interest statement

From 2008 to 2009, Andrea Boggild served as a medical consultant to Shoreland Inc. In the past 2 years, Michael Libman has served on the advisory board of Sanofi Pasteur. In the past 5 years, Brian Ward has served as the medical officer for Medicago Inc., has held investigator-initiated grants shared with industrial partners (specifically GlaxoSmithKline and Medicago Inc.), has held contracts for clinical vaccine trials (with Pfizer, Sanofi Pasteur, GlaxoSmithKline, and Medicago Inc.), has received honoraria approximately 5 times per year for delivering talks (for which he had sole control over content), and has served as an expert witness for vaccine injury compensation programs in Quebec and the United States. Susan Kuhn is a consultant to Shoreland Inc. David Freedman is a consultant to Novartis and Intercell and has served on the Board of Directors of the International Society of Travel Medicine. No competing interests declared by Jennifer Geduld, Anne McCarthy, Patrick Doyle, Wayne Ghesquiere, Jean Vincelette, or Kevin Kain.

Figures

**Figure 1**
Regional exposure for the cohort of travellers. Base map adapted from vectorworldmap.com, version 2.2.

See this image and copyright information in PMC

References

1. UNWTO tourism highlights. 2012 edition. Madrid (Spain): World Tourism Organization; 2012. Available from: www.unwto.org (accessed 2013 Feb 8).
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1. Ryan ET, Wilson ME, Kain KC. Illness after international travel. N Engl J Med. 2002;347(7):505–516. - PubMed
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Travel-acquired infections and illnesses in Canadians: surveillance report from CanTravNet surveillance data, 2009-2011

Affiliations

Travel-acquired infections and illnesses in Canadians: surveillance report from CanTravNet surveillance data, 2009-2011

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical