Epidemiology of travel-related hospitalization.
BACKGROUND
Limited information exists on causes of hospitalization in patients returning from the tropics, and most is focused on febrile diseases. We evaluated all causes of post-travel hospitalization in a tertiary care hospital in Israel.


METHODS
Demographics, diagnoses, and destinations of patients admitted between January 1999 and December 2003 with a history of recent travel were recorded. Demographics and destination of healthy travelers presenting to our pretravel clinic at the same period were recorded.


RESULTS
Of 211 patients admitted, 71% were males, 8% were immigrants/foreign workers, and febrile diseases accounted for 77% of admissions. The most common diagnoses were malaria in 54 (26%), unidentified febrile disease in 34 (16%), and dengue fever in 27 (13%). New World cutaneous leishmaniasis was the most common cause of admission among nonfebrile patients (18 [9%]). Diarrheal diseases accounted for only 11% of admissions. Regarding destination, 101 (48%) patients had been to Asia, 71 (34%) to Africa, and 43 (20%) to the Americas. Of our healthy traveler population, 59% traveled to Asia, 20% to Africa, and 20% to the Americas. Travel to Africa carried the highest risk of being hospitalized (OR 1.85, 95% CI 1.16-2.97; p = .01). Most (59%) patients returning from Africa had malaria. The principal health problem originating in Asia was dengue fever (27%), and from Latin America, cutaneous leishmaniasis (48%). Males comprised 71% of the patients, and 59% of the healthy traveler population (p < .0001). Males were more likely to acquire malaria (OR 2.15, 95% CI 1.13-4.09; p = .02) and leishmaniasis (OR 3.41, 95% CI 0.97-11.89; p = .05).


CONCLUSIONS
Febrile diseases were the most common cause for hospitalization, with malaria, unidentified febrile diseases, and dengue fever being the most common. Diseases were destination related; travel to Africa was associated with a higher rate of hospitalization. Malaria and cutaneous leishmaniasis had a substantially male predominance, probably due to risk-taking behavior.
Department of Internal Medicine C, Sheba Medical Center, Tel Aviv University, Israel.
Shmuel
S
Stienlauf
Gad
G
Segal
Yechezkel
Y
Sidi
Eli
E
Schwartz
D000328:Adult; D000349:Africa; D001208:Asia; D003141:Communicable Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003715:Dengue / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000453:epidemiology; D006306:Health Surveys; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007843:Latin America; D007896:Leishmaniasis / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D012621:Seasons; D017678:Sex Distribution; D014195:Travel / Q000706:statistics & numerical data*