title: The changing epidemiology of human African trypanosomiasis among patients from nonendemic countries--1902-2012.
abstract: BACKGROUND
  Although human African trypanosomiasis (HAT) is uncommon among patients from non-endemic countries (NEC), there has been an increase in the number of cases reported in recent years.
  
  
  METHODS
  A systematic review of the literature was performed. The number of incoming tourists to HAT endemic countries was obtained from the United Nations World Tourism Organization. All HAT cases diagnosed in patients from NEC were included. Immigrants and refugees were excluded. We compared patients during and after the colonial period, and analyzed the relationship between the number of incoming travellers and the number of HAT cases.
  
  
  RESULTS
  Between 1902 and 2012, HAT was reported in 244 patients. Most HAT cases were reported before 1920, and after the year 2000. In the colonial era the average age of patients was lower (32.5±7.8 vs. 43.0±16.1 years, P<0.001), the proportion of females was lower (10.0% vs. 23.9%, P<0.01], most cases were diagnosed in expatriates, missionaries and soldiers (74.3%), and Gambian trypanosomiasis accounted for 86/110, (78%) of cases. In the post-colonial era most patients 91/125 (72.8%) were short-term tourists to game parks in Eastern and South-Eastern Africa (mainly in Tanzania); Rhodesian trypanosomiasis accounted for 94/123 (76.4%) of cases. Between 1995 and 2010 there has been a constant linear increase in the number of incoming tourists to Tanzania, and HAT cases occurred in small outbreaks rather than following a similar linear pattern.
  
  
  CONCLUSIONS
  In recent decades HAT patients from NEC are older, and more likely to be tourists who acquired the disease while visiting game-parks in Eastern and South-Eastern Africa. While Rhodesian trypanosomiasis is relatively uncommon among Africans, it now accounts for most cases reported among patients from NEC. Returning febrile travellers without an alternative diagnosis should be evaluated for HAT. Cases among travellers may serve as sentinels for Rhodesian trypanosomiasis "hot spots" in Africa.
authors.affiliation: Unit of Infectious Diseases and Internal Medicine B, Rambam Medical Center and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
authors.forename: Ami
authors.initials: A
authors.lastname: Neuberger
authors.affiliation: The Center for Geographic Medicine and Internal Medicine A and C, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Meltzer
authors.affiliation: The Center for Geographic Medicine and Internal Medicine A and C, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Leshem
authors.affiliation: Internal Medicine A, Rambam Medical Center, Haifa, Israel.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Dickstein
authors.affiliation: The Center for Geographic Medicine and Internal Medicine A and C, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Stienlauf
authors.affiliation: The Center for Geographic Medicine and Internal Medicine A and C, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Eli
authors.initials: E
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D019353:Endemic Diseases / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D014195:Travel; D014353:Trypanosomiasis, African / Q000453:epidemiology*; D055815:Young Adult