Malaria incidence and prevention among European and North American travellers to Kenya

A longitudinal survey was conducted among travellers departing from Nairobi airport to determine the use of malaria prevention measures and assess the risk for malaria while travelling in Kenya. Among 5489 European and North American travellers, 68 different drug regimens were used for prophylaxis, and 48% of travellers used both regular chemoprophylaxis and more than 1 antimosquito measure during travel; 52% of 3469 travellers who used chemoprophylaxis did so without interruption during their travel and for 4 weeks after departure. Compliance was lowest among travellers who visited friends and relatives, who were young, or who stayed more than 3 weeks. Sixty-seven (1%) travellers experienced symptoms of malaria, but the diagnosis could be verified for only 16 of these. Long-stay travellers appeared to be at higher risk for malaria than short-stay travellers, and health information needs to be targeted especially to the former. Similar investigations are needed among international travellers to other malaria-endemic countries. With comparable data available, consistent and effective malaria prevention guidelines can be developed.     

Recurrent, itching and creeping skin lesions in (former) travellers to the tropics: strongyloidiasis

Two patients, a woman aged 24 and a man aged 86, had suffered from recurrent, itchy, linear, creeping skin lesions, notably on the thighs, buttocks and lower abdomen, for 9 months and more than 50 years, respectively. The woman had been in South America, and the man had worked on the Burma railway as a prisoner of war during World War II. In both patients 'larva currens' was observed. The clinical diagnosis of 'strongyloidiasis' was supported by eosinophilia and raised antibody titres against Strongyloides stercoralis in the blood. No larvae could be detected in either patient. Treatment with albendazole, and ivermectin, respectively, resulted in disappearance of the complaints. S. stercoralis is found in many parts of the world. In the Netherlands the major risk groups in which strongyloidiasis should be considered are people from, and visitors to, South-America (Surinam) and South-East Asia (Indonesia, former prisoners of war).     

Malaria risk perception, knowledge and prophylaxis practices among travellers of African ethnicity living in Paris and visiting their country of origin in sub-Saharan Africa

An observational prospective cohort study assessed malaria risk perception, knowledge and prophylaxis practices among individuals of African ethnicity living in Paris and travelling to their country of origin to visit friends or relatives (VFR). The study compared two groups of VFR who had visited a travel clinic (TC; n=122) or a travel agency (TA; n=69) before departure. Of the 47% of VFR citing malaria as a health concern, 75% knew that malaria is mosquito-borne and that bed nets are an effective preventive measure. Perception of high malaria risk was greater in the TA group (33%) than in the TC group (7%). The availability of a malaria vaccine was mentioned by 35% of VFR, with frequent confusion between yellow fever vaccine and malaria prevention. Twenty-nine percent took adequate chemoprophylaxis with complete adherence, which was higher among the TC group (41%) than the TA group (12%). Effective antivector protection measures used were bed nets (16%), wearing long clothes at night (14%) and air conditioning (8%), with no differences between the study groups except in the use of impregnated bed nets (11% of the TC group and none of the TA group). Media coverage, malaria chemoprophylaxis repayment and cultural adaptation of preventive messages should be improved to reduce the high rate of inadequate malaria prophylaxis in VFR.     

Refugee health in the tropics. Malaria control in Afghan refugee camps: novel solutions

Malaria is one of the major communicable diseases to occur in refugee camps. Prevention of mortality by establishing good case management is always the priority. Various types of personal protection or vector control measures may be applied depending on local transmission conditions and stage of the emergency. The range of interventions applied in Afghan refugee camps, the factors influencing choice and the relevance to emergencies in other parts of the world are described.     

Emerging resistance to newer antimicrobial agents among Shigella isolated from Finnish foreign travellers

In Finland, most cases of shigellosis are related to travel abroad. Antimicrobial drug resistance of 1814 Shigella strains isolated from Finnish patients during 1990-2005 was studied using discs of 12 antimicrobial agents. Since 2000, the E-test has been performed to determine ciprofloxacin minimum inhibitory concentrations of nalidixic acid-resistant isolates. The proportion of multi-resistant strains (resistant to >or =4 antimicrobials) was highest among isolates from China and India, but is increasing significantly in other parts of Asia. Resistance to nalidixic acid has become common among the strains from the Far East, and the first isolates also resistant to ciprofloxacin were detected during 2004-2005. All the ciprofloxacin-resistant isolates belonged to the S. flexneri 2a serotype. All the nalidixic acid-resistant S. flexneri strains had reduced susceptibility to ciprofloxacin, whereas 23% of the nalidixic acid-resistant S. sonnei strains were still completely susceptible to ciprofloxacin.     

前往疟疾疫区的出国劳工对疟疾相关知识、态度及行为调查

〔目的〕了解前往疟疾疫区的出国劳工对疟疾防治知识的知晓状况,为建立有效的疟疾宣传教育模式提供依据。〔方法〕对2009年6—11月到广东国际旅行卫生保健中心进行出国体检的265名前往疟疾疫区的劳工(不含船员)采用自行设计的问卷进行调查。〔结果〕前往疟疾疫区的劳工265人中初中及初中以下文化程度占46.7%,高中以上文化程度占37.9%。出国后将从事野外和户外工作占46.4%。有6.9%的人认为疟疾为非传染病,36.0%不清楚疟疾是否有传染性;仅49.4%知道蚊虫与疟疾相关;47.5%知道发热为疟疾的主要临床表现;仅22.9%的人知道目前常用的防疟方法是防蚊和携带紧急情况下使用的治疗药物,19.2%的人知道可口服药物进行疟疾预防。〔结论〕出国劳工对疟疾防治知识认识匮乏,在出国劳工中开展疟疾宣传教育活动是十分必要的。     

Risk factors for psychological stress among international business travellers

OBJECTIVES: This study investigated sources of self reported psychological stress among international business travellers at the World Bank, following up on a previous study showing that travellers submitted more insurance claims for psychological disorders. Hypotheses were that work, personal, family, and health concerns, as well as time zone travel, contribute to travel stress. METHODS: A travel survey was developed from focus groups and consisted of questions about these potential sources of travel stress. Surveys were sent to a random sample of staff, stratified by number of travel missions, age range, and sex. Canonical correlation analyses estimated the association between key survey items on sources of stress and two measures of travel stress. RESULTS: 498 staff completed the survey. More than a third reported high to very high travel stress. Correlations between predictors and travel stress showed that social and emotional concerns (such as impact of travel on family and sense of isolation) contributed the most to such stress, followed by health concerns, and workload upon return from travel. Surprisingly, time zone travel did not contribute to the self reported stress of these travellers. There were few modifiers of stress, although respondents suggested that a day of rest after travel and reduced workloads would help. CONCLUSIONS: The current study confirms clinical impressions about several correlates of travel stress. Similar research with travellers in other organisations could help to determine whether the findings from this study are valid and what measures can be taken to reduce the psychological health risks to travellers.

 

     

Malaria clusters among illegal Chinese immigrants to Europe through Africa

Between November 2002 and March 2003, 17 cases of malaria (1 fatal) were observed in illegal Chinese immigrants who traveled to Italy through Africa. A further cluster of 12 was reported in August, 2002. Several immigrants traveled by air, making the risk of introducing sudden acute respiratory syndrome a possibility should such illegal immigrations continue.     

Varicella among immigrants from the tropics, a health problem

The incidence of varicella in Tamil refugees in Denmark was evaluated. Of 256 Tamils, 44% developed varicella infection in the first few months after arrival, representing 38% of the adults, and 68% of the children. During approximately four months' observation in Denmark, 75% of the refugees with no history of varicella developed a typical infection whereas only 2% of those with a history of varicella developed the disease. Tropical refugees with a negative history of varicella must therefore be considered nonimmune. Nine of 44 fertile women were pregnant. Two acquired the varicella infection during the first-trimester, none in relation to delivery. By organizing a health-check on arrival, prophylactic measures can reduce the health hazard of varicella infection in refugees from the tropics.     

Mental health insurance claims among spouses of frequent business travellers

Objectives: Following up on two earlier publications showing increased psychological stress and psychosocial effects of travel on the business travellers this study investigated the health of spouses of business travellers. Methods: Medical claims of spouses of Washington DC World Bank staff participating in the medical insurance programme in 1997–8 were reviewed. Only the first of each diagnosis with the ninth revision of the international classification of diseases (ICD-9) recorded for each person was included in this analysis. The claims were grouped into 28 diagnostic categories and subcategories. Results: There were almost twice as many women as men among the 4630 identified spouses. Overall, male and female spouses of travellers filed claims for medical treatment at about a 16% higher rate than spouses of non-travellers. As hypothesised, a higher rate for psychological treatment was found in the spouses of international business travellers compared with non-travellers (men standardised rate ratios (RR)=1.55; women RR=1.37). For stress related psychological disorders the rates tripled for both female and male spouses of frequent travellers (≥ four missions/year) compared with those of non-travelling employees. An increased rate of claims among spouses of travellers versus non-travellers was also found for treatment for certain other diagnostic groups. Of these, diseases of the skin (men RR=2.93; women RR=1.41) and intestinal diseases (men RR=1.31; women RR=1.47) may have some association with the spouses'' travel, whereas others, such as malignant neoplasms (men RR=1.97; women RR=0.79) are less likely to have such a relation. Conclusion: The previously identified pattern of increased psychological disorders among business travellers is mirrored among their spouses. This finding underscores the permeable boundary between family relations and working life which earlier studies suggested, and it emphasises the need for concern within institutions and strategies for prevention.     

浙江口岸出入境人员艾滋病知识调查分析

[目的]了解浙江口岸出入境人员对艾滋病知识的掌握程度,为今后开展出入境人员艾滋病预防控制工作提供指导方向。[方法]对2005年在浙江口岸出入境的中国籍人员采用现场问卷的方法进行调查,用SPSS软件分析数据。[结果]在被调查的278人中,高中以上文化程度占了66．9％；从事职业以船员最多,占27．3％；出国目的以劳务和旅游为主,占78．4％；不同的文化程度与职业对艾滋病知识的知晓情况有差异；对艾滋病人的态度持援助和同情态度,分别为36．3％和29．5％；地方疾病控制部门是出入境人员有关艾滋病咨询的首选,检验检疫部门排在其后,出入境人员对检验检疫部门的需求以提供防治知识宣传和免费病毒检测为主,分别为69．8％和28．4％。[结论]浙江口岸出入境人员结构组成优于普通人群,对艾滋病知识的知晓和防范意识明显较高,但仍然存在着一定的认知误区,需要我们进一步加强宣传工作,重点关注劳务人员、同性恋等人群,改进工作和服务质量,杜绝艾滋病在国境口岸的传播。     

Animal-associated injuries and related diseases among returned travellers: a review of the GeoSentinel Surveillance Network

BACKGROUND: Increased travel to exotic destinations around the world is escalating the risk of exposure to animal-associated injuries with a risk of acquiring rabies. METHODS: We have examined data reported to GeoSentinel Surveillance Network to highlight characteristics of animal-associated injuries in travellers. RESULTS: A total of 320 cases were reported from 1998 to 2005. Travellers were predominantly tourists from developed countries with median travel duration of 23 days. A pre-travel encounter was recorded in 45.0% of the cases. A significantly greater proportion of patients with animal-related injuries were female compared to other travel associated diagnosis (54.7% versus 47.4%) and were most likely patients aged <15 years (6.2% versus 2.6%). The proportionate morbidity for sustaining an animal bite was higher among travellers visiting Southeast Asia (3.9%) and the rest of Asia (2.2%) compared to Australia-New Zealand (1.9%), Africa (1.0%), Latin America (0.8%), North America (0.9%) and Europe (1.2%). Seventy-five percent of cases occurred in countries endemic for rabies. Dogs were involved in 51.3% of cases, monkeys in 21.2%, cats in 8.2%, bats in 0.7% and humans in 0.7%. The higher likelihood for animal-related injuries among female travellers was dependant on the animal species involved, with monkeys accounting for the majority of injuries. In contrast, males were more likely to be injured by dogs. Only 66.1% of all patients reported with animal-related injury received rabies post-exposure prophylaxis. CONCLUSIONS: This data shows that animal-associated injuries are not uncommon among returned travellers presenting to GeoSentinel sites. The highest proportion of injuries was recorded in travellers to Asia, mostly in regions, which are endemic for rabies, and this had led to a requirement for PEP.     

Recovery from relapse among successful weight maintainers

BACKGROUND: Little is known about the natural history of weight change among persons who are successful at losing weight. OBJECTIVE: This study evaluated the occurrence of weight regain and recovery among 2400 persons in the National Weight Control Registry (NWCR) who had lost an average (+/- SD) of 32.1 +/- 17.8 kg and had kept it off for 6.5 +/- 8.1 y. DESIGN: Participants were evaluated prospectively over 2 y. RESULTS: The mean reported weight change from entry into the NWCR to 2 y later was 3.8 +/- 7.6 kg. At year 2, 96.4% of the sample remained > or =10% below their maximum lifetime weight. However, small regains were common, and few persons were able to re-lose weight after any weight regain. Of the participants who gained any weight between baseline and year 1 (n = 1483; 65.7%), only 11.0% returned to their baseline weight or below at year 2. Of the participants who relapsed, which was defined as a weight regain of > or =5% at year 1 (n = 575, or 25.5% of the sample), only 4.7% returned to their baseline weight or below at year 2, and only 12.9% re-lost at least half of their year 1 gain by year 2. Logistic regression showed that recovery was related to gaining less at year 1 and to smaller increases in depressive symptoms between baseline and year 1. CONCLUSION: Although successful weight losers continued to maintain a large percentage of their weight losses over 2 y, recovery from even minor weight regain was uncommon.