title: Fever in returned travelers: results from the GeoSentinel Surveillance Network.
abstract: BACKGROUND
  Fever is a marker of potentially serious illness in returned travelers. Information about causes of fever, organized by geographic area and traveler characteristics, can facilitate timely, appropriate treatment and preventive measures.
  
  
  METHODS
  Using a large, multicenter database, we assessed how frequently fever is cited as a chief reason for seeking medical care among ill returned travelers. We defined the causes of fever by place of exposure and traveler characteristics.
  
  
  RESULTS
  Of 24,920 returned travelers seen at a GeoSentinel clinic from March 1997 through March 2006, 6957 (28%) cited fever as a chief reason for seeking care. Of patients with fever, 26% were hospitalized (compared with 3% who did not have fever); 35% had a febrile systemic illness, 15% had a febrile diarrheal disease, and 14% had fever and a respiratory illness. Malaria was the most common specific etiologic diagnosis, found in 21% of ill returned travelers with fever. Causes of fever varied by region visited and by time of presentation after travel. Ill travelers who returned from sub-Saharan Africa, south-central Asia, and Latin America whose reason for travel was visiting friends and relatives were more likely to experience fever than any other group. More than 17% of travelers with fever had a vaccine-preventable infection or falciparum malaria, which is preventable with chemoprophylaxis. Malaria accounted for 33% of the 12 deaths among febrile travelers.
  
  
  CONCLUSIONS
  Fever is common in ill returned travelers and often results in hospitalization. The time of presentation after travel provides important clues toward establishing a diagnosis. Preventing and promptly treating malaria, providing appropriate vaccines, and identifying ways to reach travelers whose purpose for travel is visiting friends and relatives in advance of travel can reduce the burden of travel-related illness.
authors.affiliation: Mount Auburn Hospital, Cambridge, MA, USA. mary_wilson@harvard.edu
authors.forename: Mary E
authors.initials: ME
authors.lastname: Wilson
authors.forename: Leisa H
authors.initials: LH
authors.lastname: Weld
authors.forename: Andrea
authors.initials: A
authors.lastname: Boggild
authors.forename: Jay S
authors.initials: JS
authors.lastname: Keystone
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Kain
authors.forename: Frank
authors.initials: F
authors.lastname: von Sonnenburg
authors.forename: Eli
authors.initials: E
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D005334:Fever / Q000150:complications / Q000453:epidemiology / Q000209:etiology*; D005843:Geography; D014943:Global Health; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008288:Malaria / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D018571:Sentinel Surveillance; D014195:Travel; D014330:Tropical Medicine / Q000706:statistics & numerical data