Open Medicine
Volume 8, Issue 1, 2014, Pages 20-32

Travel-acquired infections and illnesses in canadians: Surveillance report from CanTravNet surveillance data, 2009-2011 (Article)

Boggild A.K.* , Geduld J. , Libman M. , Ward B.J. , McCarthy A.E. , Doyle P.W. , Ghesquiere W. , Vincelette J. , Kuhn S. , Freedman D.O. , Kain K.C.
  • a Division of Infectious Diseases, University Health Network, Toronto General Hospital, Tropical Disease Unit, Toronto, ON M5G 2C4, Canada, Department of Medicine, University of Toronto, Toronto, ON, Canada, Parasitology Lead with Laboratory Services, Public Health Ontario, Toronto, ON, Canada
  • b Epidemiology with the Travel and Migration Health Division, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, ON, Canada
  • c Centre for Tropical Diseases, McGill University Health Centre, Montreal, QC, Canada, Division of Infectious Diseases, McGill University Health Centre, Montreal, QC, Canada, Department of Microbiology, McGill University Health Centre, Montreal, QC, Canada
  • d University of Ottawa, Ottawa, ON, Canada
  • e Ottawa Hospital-General Campus, Ottawa, ON, Canada, Division of Medical Microbiology and Infection Control, Vancouver General Hospital, Vancouver, BC, Canada
  • f Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada, Vancouver Island Health Authority, Victoria, BC, Canada
  • g University of British Columbia, Vancouver, BC, Canada, Département de microbiologie médicale et infectiologie, Hôpital Saint-Luc, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
  • h Section of Pediatric Infectious Diseases, University of Calgary, Calgary, AB, Canada
  • i Departments of Pediatrics and Medicine, University of Calgary, Calgary, AB, Canada, UAB Travelers Health Clinic, Gorgas Center for Geographic Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, United States
  • j Division of Infectious Diseases, Department of Medicine, University Health Network - Toronto General Hospital and University of Toronto, Toronto, ON, Canada
  • k Sandra Rotman Centre, University Health Network, Toronto, ON, Canada

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.

Author Keywords

[No Keywords available]

Index Keywords

statistics and numerical data Internationality Canada male Emigrants and Immigrants female cohort analysis international cooperation Communicable Diseases Sentinel Surveillance health survey Population Surveillance human Humans migrant Cohort Studies travel
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84902588922&partnerID=40&md5=081ac03f707825376cdcc63f6981ff2e
ISSN: 19112092
Cited by: 31
Original Language: English