title: Illness in travelers returned from Brazil: the GeoSentinel experience and implications for the 2014 FIFA World Cup and the 2016 Summer Olympics.
abstract: BACKGROUND
  Brazil will host the 2014 FIFA World Cup and the 2016 Olympic and Paralympic Games, events that are expected to attract hundreds of thousands of international travelers. Travelers to Brazil will encounter locally endemic infections as well as mass event-specific risks.
  
  
  METHODS
  We describe 1586 ill returned travelers who had visited Brazil and were seen at a GeoSentinel Clinic from July 1997 through May 2013.
  
  
  RESULTS
  The most common travel-related illnesses were dermatologic conditions (40%), diarrheal syndromes (25%), and febrile systemic illness (19%). The most common specific dermatologic diagnoses were cutaneous larva migrans, myiasis, and tungiasis. Dengue and malaria, predominantly Plasmodium vivax, were the most frequently identified specific causes of fever and the most common reasons for hospitalization after travel. Dengue fever diagnoses displayed marked seasonality, although cases were seen throughout the year. Among the 28 ill returned travelers with human immunodeficiency virus (HIV) infection, 11 had newly diagnosed asymptomatic infection and 9 had acute symptomatic HIV.
  
  
  CONCLUSIONS
  Our analysis primarily identified infectious diseases among travelers to Brazil. Knowledge of illness in travelers returning from Brazil can assist clinicians to advise prospective travelers and guide pretravel preparation, including itinerary-tailored advice, vaccines, and chemoprophylaxis; it can also help to focus posttravel evaluation of ill returned travelers. Travelers planning to attend mass events will encounter other risks that are not captured in our surveillance network.
authors.affiliation: Global Health and Population, Harvard School of Public Health, Boston.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Wilson
authors.forename: Lin H
authors.initials: LH
authors.lastname: Chen
authors.forename: Pauline V
authors.initials: PV
authors.lastname: Han
authors.forename: Jay S
authors.initials: JS
authors.lastname: Keystone
authors.forename: Jakob P
authors.initials: JP
authors.lastname: Cramer
authors.forename: Aluisio
authors.initials: A
authors.lastname: Segurado
authors.forename: DeVon
authors.initials: D
authors.lastname: Hale
authors.forename: Mogens
authors.initials: M
authors.lastname: Jensenius
authors.forename: Eli
authors.initials: E
authors.lastname: Schwartz
authors.forename: Frank
authors.initials: F
authors.lastname: von Sonnenburg
authors.forename: Karin
authors.initials: K
authors.lastname: Leder
mesh_terms: D001938:Brazil / Q000453:epidemiology; D003141:Communicable Diseases / Q000453:epidemiology*; D003715:Dengue / Q000453:epidemiology*; D003967:Diarrhea / Q000453:epidemiology*; D005334:Fever / Q000209:etiology; D006801:Humans; D007815:Larva Migrans / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology*; D016780:Malaria, Vivax / Q000453:epidemiology; D012306:Risk; D012621:Seasons; D012876:Skin Diseases, Parasitic / Q000453:epidemiology*; D014195:Travel; D058285:Tungiasis / Q000453:epidemiology
keywords: Brazil; dengue; dermatologic; mass gatherings; travelers