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Ebola virus, yellow fever absent in ill Western travelers
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Malaria and typhoid fever were the most common tropical diseases found in Western travelers, whereas Ebola virus, Lassa fever and yellow fever affected no travelers, new research has found.
“We were quite surprised that these much-feared viral infectious diseases were completely absent,” Mogens Jensenius, MD, PhD, of the University of Oslo in Norway, said in a press release. “People talk about them all the time, but our paper suggests that these are still very, very rare among travelers.”
Jensenius and colleagues from the CDC and universities worldwide conducted an analysis among 82,825 Western travelers who were ill upon return from travel to Central or South America, Africa, Oceania and tropical and subtropical parts of Asia. The patients were identified through the GeoSentinel database, a network established by the International Society of Travel Medicine and the CDC to monitor travel-related morbidity. The data for the study were entered into the GeoSentinel database from June 1996 to August 2011.
Among these travelers, 3,655 (4.4%) were diagnosed with an acute and potentially life-threatening disease that is mostly confined to tropical and subtropical areas of the world. The most common disease was falciparum malaria, which comprised 76.9% of the diagnoses, followed by typhoid fever, which comprised 11.7% of the diagnoses. Paratyphoid fever was responsible for 6.4% of the diseases, and leptospirosis caused 2.4% of the illnesses.
Other illnesses reported included spotted fever group rickettsiosis, dengue hemorrhagic fever/dengue shock syndrome, murine typhus, scrub typhus, relapsing fever, melioidosis, East African trypanosomiasis, knowlesi malaria and Japanese encephalitis.
Most patients (91%) had fever, and 60% were hospitalized. Thirteen patients (0.4%) died: 10 of malaria, two of melioidosis and one of severe dengue. Most of the illnesses (62%) were reported in Europe, 20% were reported in North America, 4% were reported from New Zealand/Australia and 14% were reported from other regions.
“While diagnosis and treatment of malaria and typhoid fever and many other tropical diseases have improved greatly over the years, people can still die from them if they are not treated quickly after their symptoms begin,” Jensenius said. “Doctors and nurses in Western countries need to be vigilant in considering these potentially life-threatening tropical infections in recently returned travelers with fevers, and identify and treat them quickly.”
Disclosure: Jensenius reports no relevant financial disclosures.
Perspective
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David Walker, MD
This study is significant study that includes 15 years of data from all over the developed world of people who have developed life-threatening diseases after traveling in the tropics. These data give an idea of what the big dangers are, which are falciparum malaria and typhoid fever. The data also identify other diseases that are not as common, but are just as life-threatening and, for the most part, are treatable. It’s a warning to physicians who don’t typically see patients with these diseases, to consider the travel history. The finding that malaria and typhoid fever were more common than other feared diseases, such as Ebola virus and yellow fever, is not a surprising finding for physicians who regularly treat patients who have returned from tropical areas. For other physicians, they might be more likely to consider disease such as Ebola and Lassa fever. It’s important to know what’s common when considering a differential diagnosis.
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