title: Travel and migration associated infectious diseases morbidity in Europe, 2008.
abstract: BACKGROUND
  Europeans represent the majority of international travellers and clinicians encountering returned patients have an essential role in recognizing, and communicating travel-associated public health risks.
  
  
  METHODS
  To investigate the morbidity of travel associated infectious diseases in European travellers, we analysed diagnoses with demographic, clinical and travel-related predictors of disease, in 6957 ill returned travellers who presented in 2008 to EuroTravNet centres with a presumed travel associated condition.
  
  
  RESULTS
  Gastro-intestinal (GI) diseases accounted for 33% of illnesses, followed by febrile systemic illnesses (20%), dermatological conditions (12%) and respiratory illnesses (8%). There were 3 deaths recorded; a sepsis caused by Escherichia coli pyelonephritis, a dengue shock syndrome and a Plasmodium falciparum malaria.GI conditions included bacterial acute diarrhea (6.9%), as well as giardiasis and amebasis (2.3%). Among febrile systemic illnesses with identified pathogens, malaria (5.4%) accounted for most cases followed by dengue (1.9%) and others including chikungunya, rickettsial diseases, leptospirosis, brucellosis, Epstein Barr virus infections, tick-borne encephalitis (TBE) and viral hepatitis. Dermatological conditions were dominated by bacterial infections, arthropod bites, cutaneous larva migrans and animal bites requiring rabies post-exposure prophylaxis and also leishmaniasis, myasis, tungiasis and one case of leprosy. Respiratory illness included 112 cases of tuberculosis including cases of multi-drug resistant or extensively drug resistant tuberculosis, 104 cases of influenza like illness, and 5 cases of Legionnaires disease. Sexually transmitted infections (STI) accounted for 0.6% of total diagnoses and included HIV infection and syphilis. A total of 165 cases of potentially vaccine preventable diseases were reported. Purpose of travel and destination specific risk factors was identified for several diagnoses such as Chagas disease in immigrant travellers from South America and P. falciparum malaria in immigrants from sub-Saharan Africa. Travel within Europe was also associated with health risks with distinctive profiles for Eastern and Western Europe.
  
  
  CONCLUSIONS
  In 2008, a broad spectrum of travel associated diseases were diagnosed at EuroTravNet core sites. Diagnoses varied according to regions visited by ill travellers. The spectrum of travel associated morbidity also shows that there is a need to dispel the misconception that travel, close to home, in Europe, is without significant health risk.
authors.affiliation: InterHealth and National Travel Health Network and Centre, London, UK.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Field
authors.forename: Philippe
authors.initials: P
authors.lastname: Gautret
authors.forename: Patricia
authors.initials: P
authors.lastname: Schlagenhauf
authors.forename: Gerd-Dieter
authors.initials: GD
authors.lastname: Burchard
authors.forename: Eric
authors.initials: E
authors.lastname: Caumes
authors.forename: Mogens
authors.initials: M
authors.lastname: Jensenius
authors.forename: Francesco
authors.initials: F
authors.lastname: Castelli
authors.forename: Effrossyni
authors.initials: E
authors.lastname: Gkrania-Klotsas
authors.forename: Leisa
authors.initials: L
authors.lastname: Weld
authors.forename: Rogelio
authors.initials: R
authors.lastname: Lopez-Velez
authors.forename: Peter
authors.initials: P
authors.lastname: de Vries
authors.forename: Frank
authors.initials: F
authors.lastname: von Sonnenburg
authors.forename: Louis
authors.initials: L
authors.lastname: Loutan
authors.forename: Philippe
authors.initials: P
authors.lastname: Parola
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005334:Fever / Q000453:epidemiology; D005767:Gastrointestinal Diseases / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D012871:Skin Diseases / Q000453:epidemiology; D014195:Travel; D057236:Travel Medicine; D055815:Young Adult