title: Risk and spectrum of diseases in travelers to popular tourist destinations.
abstract: BACKGROUND
  Traveling to tropical regions is related to increased health risks. Travelers' diarrhea is the most frequent health problem, but the range of travel-related diseases also includes potential life-threatening diseases such as malaria. The actual risk of European travelers acquiring specific infectious diseases and other hazards in the tropics is to a large extent unknown and is therefore often adopted from that of the indigenous population. The objective of this study was to elucidate the risk for travel-related diseases, symptoms, and accidents in a population of Europeans who travel to popular tourist destinations.
  
  
  METHODS
  From July 2003 to June 2004, 794 travelers consulting the travel clinic of the Berlin Institute of Tropical Medicine were recruited for a questionnaire-based observational study before traveling to Kenya, Tanzania, Senegal, the Gambia, India, Nepal, Thailand, or Brazil.
  
  
  RESULTS
  Overall, illness was reported by 42.9% of travelers, with 10.2% reporting more than one adverse health event. Most frequently gastrointestinal symptoms were noted (34.6%), followed by respiratory symptoms (13.7%). More than 5% experienced an accident. Travel to the Indian subcontinent nearly doubled the risk of becoming ill; travel to Thailand significantly decreased the risk. Additional risk factors were a long duration of staying abroad, young age, and traveling under basic conditions. Of all travelers, 80% did not follow the traditionally recommended dietary restrictions. Among travelers visiting malaria-endemic areas, 20% did not carry any antimalarial drugs with them, not continuous chemoprophylaxis or standby medication.
  
  
  CONCLUSIONS
  Because of the rising travel activity, especially to tropical countries, the importance of qualified pretravel advice consultation is increasing. To improve the travelers' health, attention needs to be paid to individual risk factors, the prevention and therapy of travelers' diarrhea, malaria prophylaxis, management of respiratory illness, and personal safety.
authors.affiliation: Berlin Institute of Tropical Medicine, Berlin, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Rack
authors.forename: Ole
authors.initials: O
authors.lastname: Wichmann
authors.forename: Bai
authors.initials: B
authors.lastname: Kamara
authors.forename: Matthias
authors.initials: M
authors.lastname: Günther
authors.forename: Jakob
authors.initials: J
authors.lastname: Cramer
authors.forename: Christian
authors.initials: C
authors.lastname: Schönfeld
authors.forename: Tatjana
authors.initials: T
authors.lastname: Henning
authors.forename: Ute
authors.initials: U
authors.lastname: Schwarz
authors.forename: Marion
authors.initials: M
authors.lastname: Mühlen
authors.forename: Thomas
authors.initials: T
authors.lastname: Weitzel
authors.forename: Barbara
authors.initials: B
authors.lastname: Friedrich-Jänicke
authors.forename: Behruz
authors.initials: B
authors.lastname: Foroutan
authors.forename: Tomas
authors.initials: T
authors.lastname: Jelinek
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003140:Communicable Disease Control / Q000379:methods; D003141:Communicable Diseases / Q000453:epidemiology; D003906:Developing Countries; D003967:Diarrhea / Q000453:epidemiology* / Q000517:prevention & control; D005060:Europe; D005260:Female; D006266:Health Education / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012309:Risk-Taking; D011795:Surveys and Questionnaires; D014195:Travel