Fever after Returning Home from Travel is Alarming

Fever after Returning Home from Travel is Alarming

International travel can pose various risks to health, depending on the characteristics of both the traveller and the travel.Travellers may encounter sudden and significant changes in altitude, humidity, microbes and temperature, which can result in ill-health. In addition, serious health risks may arise in areas where accommodation is of poor quality, hygiene and sanitation are inadequate, medical services are not well developed and clean water is unavailable.

People traveling to areas of where Hepatitis A is prevalent, including, but not limited to: Africa, Asia (except Japan), the Mediterranean basin, Eastern Europe, the Middle East, Central and South America, Mexico, and parts of the Caribbean .People living in or relocating to any community in the US or abroad with one or more recorded Hepatitis A outbreaks within the past five years .Occasionally, travellers who have returned from endemic areas to North America or Europe develop Buruli ulcer disease (BU), which can pose a significant diagnostic challenge for clinicians unfamiliar with the disease.

Since more than 5 million U.S. travelers visit the Caribbean annually, vigilance with respect to dengue in returning travelers from this area, particularly during the months of July through November, cannot be overemphasized. Florida, which was the site of an outbreak 70 years ago, is an entry portal to the southeastern United States, to which travelers return and where the vectors reside.Accordingly, the Walter Reed Army Institute of Research, with the Department of Defense and the Centers for Disease Control and Prevention, has partnered with the Caribbean Epidemiology Centre to enhance the Caribbean's current dengue surveillance. It's only a hop, skip, and a jump away.

Globe-trotting animals and insects also can spread illness. West Nile virus probably made its way to New York City when an infected mosquito hitched a ride on an airplane from the Middle East. West Nile surfaced in Africa in the 1930s, and if it weren't for air travel, would likely have remained there. Instead, the disease is now found in Asia, Europe, the Middle East and most of North and South America.

American Society of Microbiology (ASM) found that many people passing through major US airports don't wash their hands after using the public facilities. More than 30 percent of people using restrooms in New York airports, 19 percent of those in Miami's airport, and 27 percent of air travelers in Chicago aren't stopping to wash their hands.It take an outbreak of a frightening, potentially fatal infectious disease like severe acute respiratory syndrome (SARS) or a gastrointestinal illness on a cruise ship to get people to follow Mom's advice to "wash your hands after using the bathroom.

Traveler's diarrhea occurs when you have food, ice, water, or other drinks that contain organisms from human bowel movements. Cooked or uncooked food may be contaminated. The cause of the infection can be a virus, parasite, or bacteria.Traveler's diarrhea is a sudden intestinal infection that you may get when you travel to another country. Other names for this problem are gastroenteritis, Montezuma's revenge, turista, or the GI trots.About 20 to 50% of international travelers get traveler's diarrhea. High-risk destinations include low-income countries in Latin America, Africa, the Middle East, and Asia.

With respect to specific diagnoses, malaria was one of the three most frequent causes of systemic febrile illness among travelers from every region, although travelers from every region except sub-Saharan Africa and Central America had confirmed or probable dengue more frequently than malaria. Among travelers returning from sub-Saharan Africa, rickettsial infection, primarily tick-borne spotted fever, occurred more frequently than typhoid or dengue. Travelers from all regions except Southeast Asia presented with parasite-induced diarrhea more often than with bacterial diarrhea.

Worldwide, 300-500 million people are infected with malaria each year.Malaria is rare in the United States, with only about 1,300 cases reported each year over the last 10 years. Most of these cases occurred in travelers, military personnel, and immigrants who had become infected by malaria parasites outside the United States.Once malaria parasites enter the bloodstream, they travel to the liver and multiply. Every few days, thousands of parasites are released from the liver into the blood, where they destroy red blood cells. Some parasites also remain in the liver and continue to multiply, releasing more parasites into the blood every few days.

Tropical diseases are infectious diseases that either occur uniquely in tropical and subtropical regions (which is rare) or, more commonly, are either more widespread in the tropics or more difficult to prevent or control.Since the advent of air travel, people more frequently visit these regions and contract many of these diseases, most notably malaria and hepatitis. Any nontropical condition however should never be overlooked in those returning from the tropics.

A 19-year-old African-American woman presented to the emergency department with a four-day history of worsening headaches, fever, chills, nausea and vomiting 10 days after a two-week visit to Sierra Leone and Guinea, West Africa. She had not sought prophylaxis or medical advice before her trip.Symptoms or problems that developed during travel and that have not subsided by the time a person has returned home warrant medical attention. Some symptoms may develop weeks or months after a person has returned; fever after international travel is especially common.

Although enteric fever (typhoid and paratyphoid fevers) is a major global public health problem, comparable data on the risks of contracting travel-associated enteric fever in various regions of the world are scarce.Result shown that the overall risk of being notified with enteric fever after travel was 0.42 in 100,000 travelers.

At least 20% of travelers report respiratory symptoms during or shortly after travel. Common causes of fever and respiratory symptoms, including the respiratory viruses, Mycoplasma, and Streptococcus pneumoniae, are similar in travelers and nontravelers. Influenza, among the most common infections, is associated with travel to the Northern Hemisphere from December through February, travel involving visits to friends or relatives, and trip duration of more than 30 days.Influenza is also a risk for travelers to the Southern Hemisphere from June through September.

Fever in travelers returning home is a marker of potentially grave illness, according to researchers who report the findings from global surveillance of travel-related illnesses.

"Predominant causes of fever in returned travelers vary by destination," lead investigator Dr. Mary E. Wilson told Reuters Health. "Febrile illnesses in returned travelers are often serious. Malaria, especially falciparum, remains the most important infection to identify."

Wilson, of Harvard Medical School, Boston, and colleagues studied data gathered at 31 clinics on six continents that specialize in travel or tropical medicine, to get a picture of what illnesses afflict travelers. Their findings are published in the medical journal Clinical Infectious Diseases.

Of nearly 25,000 travelers seen at the clinics over a 10-year period, 28 percent cited fever as their chief reason for seeking care. Overall, 26 percent of patients with fever were hospitalized, compared with only 3 percent of patients who did not have fever.

Travelers who visited friends and relatives in sub-Saharan Africa, south-central Asia, or Latin America were more likely to develop fever than other groups.

Malaria, diagnosed in 21 percent of those with fever, was the most common culprit. Other causes of fever, among them dengue, rickettsia and hepatitis, varied by region visited.

More than 17 percent of travelers with fever had a vaccine-preventable infection or falciparum malaria, which can be prevented by taking anti-malarial pills. Four of the 12 deaths in febrile travelers were due to malaria.

"In an era of increasing travel, clinicians often see ill returned travelers and the potential causes of fever are numerous," Wilson commented. "Findings from this large, multicenter study yield clues to help clinicians identify more likely diagnoses and focus on those that are serious and treatable."

To protect travelers who are making the Hajj and to help them meet entry requirements in Saudi Arabia, the University of Michigan Health System 's Michigan Visiting Nurses is offering vaccinations against bacterial meningitis on an appointment basis at its Ann Arbor office. Patients should call 1 (800) 880-0020 to schedule an appointment.

Fever after returning from a malaria-endemic area is a medical emergency and travellers should seek medical attention immediately.Travellers should be advised to have a medical examination on their return if they:

When you travel abroad, your need for a particular vaccine depends on many factors, including your age, the season, the countries you'll be visiting, the length of your stay, the reason for your trip, your accommodations, your lifestyle and your overall health. Keep in mind that some vaccines aren't appropriate for children, pregnant women and people with certain medical conditions. In addition, some can cause serious side effects. Be sure to talk to your doctor about the vaccines you'll need.

WHO recommendations relating to travellers coming from and going to countries experiencing outbreaks of highly pathogenic H5N1 avian influenza.WHO advises travellers to avoid contact with high-risk environments in affected countries.


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