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Meta-Analysis
. 2023 Sep 5;30(5):taad081.
doi: 10.1093/jtm/taad081.

Travel-related respiratory symptoms and infections in travellers (2000-22): a systematic review and meta-analysis

Thibault Lovey  1 , Robin Hasler  2 , Philippe Gautret  3 , Patricia Schlagenhauf  1   4
Affiliations
Meta-Analysis

Travel-related respiratory symptoms and infections in travellers (2000-22): a systematic review and meta-analysis

Thibault Lovey et al. J Travel Med. .

Abstract

Background: Respiratory tract infections (RTIs) are common in travellers due to the year-round or seasonal presence of respiratory pathogen and exposure to crowded environments during the itinerary. No study has systematically examined the burden of RTI infections among travellers. The aim of this systematic review and meta-analysis is to evaluate the prevalence of RTIs and symptoms suggestive of RTIs among travellers according to risk groups and/or geographic region, and to describe the spectrum of RTIs.

Methods: The systematic review and meta-analysis was registered in PROSPERO (CRD42022311261). We searched Medline, Embase, Scopus, Cochrane Central, Web of Science, Science Direct and preprint servers MedRxiv, BioRxiv, SSRN and IEEE Xplore on 1 February 2022. Studies reporting RTIs or symptoms suggestive of RTIs in international travellers after 1 January 2000 were eligible. Data appraisal and extraction were performed by two authors, and proportional meta-analyses were used to obtain estimates of the prevalence of respiratory symptoms and RTIs in travellers and predefined risk groups.

Findings: A total of 429 articles on travellers' illness were included. Included studies reported 86 841 symptoms suggestive of RTIs and 807 632 confirmed RTIs. Seventy-eight percent of reported respiratory symptoms and 60% of RTIs with available location data were acquired at mass gatherings events. Cough was the most common symptom suggestive of respiratory infections, and the upper respiratory tract was the most common site for RTIs in travellers. The prevalence of RTIs and respiratory symptoms suggestive of RTIs were 10% [8%; 14%] and 37% [27%; 48%], respectively, among travellers. Reporting of RTIs in travellers denoted by publication output was found to correlate with global waves of new respiratory infections.

Interpretation: This study demonstrates a high burden of RTIs among travellers and indicates that travellers' RTIs reflect respiratory infection outbreaks. These findings have important implications for understanding and managing RTIs among travellers.

Keywords: Communicable diseases; prevalence; respiratory tract infections; risk factors; travel.

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Figures

Figure 1
Figure 1
PRISMA flow diagram 2020
Figure 2
Figure 2
Time-series plot of the absolute annual frequency of included studies with the date of the first observed case of the four epidemics/pandemics of respiratory infections of the twenty-first century
Figure 3
Figure 3
Cumulative cases from 2000 to 2022 for symptoms suggestive of respiratory illness (A) and respiratory infections (B) in the 17 United Nations subregional geoschemes. Note: Specific groups (Airplane, Cruise or Merchant Vessel, Refugee and Asylum-Seeker and Mass gatherings events) are not displayed
Figure 4
Figure 4
Meta-analysis estimating the prevalence of respiratory symptoms in travellers from 2000 to 2022 with subgroup analysis by UN region and specific groups
Figure 5
Figure 5
Meta-analysis estimating the prevalence of respiratory cases in travellers from 2000 to 2022 with subgroup analysis by UN region and specific groups
See this image and copyright information in PMC

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References

    1. World Tourism Organization (UNWTO) , editor. The Economic Contribution of Tourism and the Impact of COVID-19. World Tourism Organization (UNWTO), 2021. DOI:10.18111/9789284423200. - DOI
    1. Trimble A, Moffat V, Collins AM. Pulmonary infections in the returned traveller. Pneumonia 2017; 9:1. - PMC - PubMed
    1. Baker RE, Mahmud AS, Miller IF et al. Infectious disease in an era of global change. Nat Rev Microbiol 2022; 20:193–205. - PMC - PubMed
    1. Dollard P, Griffin I, Berro A et al. Risk assessment and management of COVID-19 among Travelers arriving at designated U.S. airports, January 17–September 13, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1681–5. - PMC - PubMed
    1. Dao TL, Hoang VT, Ly TDA et al. Infectious disease symptoms and microbial carriage among French medical students travelling abroad: a prospective study. Travel Med Infect Dis 2020; 34:101548. - PMC - PubMed