title: Travel-associated disease among US residents visiting US GeoSentinel clinics after return from international travel.
abstract: BACKGROUND
  US residents make 60 million international trips annually. Family practice providers need to be aware of travel-associated diseases affecting this growing mobile population.
  
  
  OBJECTIVE
  To describe demographics, travel characteristics and clinical diagnoses of US residents who present ill after international travel.
  
  
  METHODS
  Descriptive analysis of travel-associated morbidity and mortality among US travellers seeking care at 1 of the 22 US practices and clinics participating in the GeoSentinel Global Surveillance Network from January 2000 to December 2012.
  
  
  RESULTS
  Of the 9624 ill US travellers included in the analysis, 3656 (38%) were tourist travellers, 2379 (25%) missionary/volunteer/research/aid workers (MVRA), 1580 (16%) travellers visiting friends and relatives (VFRs), 1394 (15%) business travellers and 593 (6%) student travellers. Median (interquartile range) travel duration was 20 days (10-60 days). Pre-travel advice was sought by 45%. Hospitalization was required by 7%. Compared with other groups of travellers, ill MVRA travellers returned from longer trips (median duration 61 days), while VFR travellers disproportionately required higher rates of inpatient care (24%) and less frequently had received pre-travel medical advice (20%). Illnesses of the gastrointestinal tract were the most common (58%), followed by systemic febrile illnesses (18%) and dermatologic disorders (17%). Three deaths were reported. Diagnoses varied according to the purpose of travel and region of exposure.
  
  
  CONCLUSIONS
  Returning ill US international travellers present with a broad spectrum of travel-associated diseases. Destination and reason for travel may help primary health care providers to generate an accurate differential diagnosis for the most common disorders and for those that may be life-threatening.
authors.affiliation: Division of Pediatric Infectious Diseases, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY, USA, shagmann@bronxleb.org.
authors.forename: Stefan H F
authors.initials: SH
authors.lastname: Hagmann
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Pauline V
authors.initials: PV
authors.lastname: Han
authors.affiliation: Department of Medicine and Pediatrics, University of Minnesota, Minneapolis, MN, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Stauffer
authors.affiliation: Division of Infectious Diseases, Bronx-Lebanon Hospital Center, Bronx, NY, USA, Present address: Division of Infectious Diseases, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Andy O
authors.initials: AO
authors.lastname: Miller
authors.affiliation: Division of Gastroenterology and Hepatology, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Connor
authors.affiliation: Department of Internal Medicine, University of Utah Medical Center, Salt Lake City, UT, USA.
authors.forename: DeVon C
authors.initials: DC
authors.lastname: Hale
authors.affiliation: Division of Infectious Diseases, Jacobi Medical Center, Albert-Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Coyle
authors.affiliation: St. Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, Salt Lake City, UT, USA and.
authors.forename: John D
authors.initials: JD
authors.lastname: Cahill
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA, Present address: GlaxoSmithKline Biologicals, Brussels, Belgium.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Marano
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Douglas H
authors.initials: DH
authors.lastname: Esposito
authors.affiliation: Emory University Atlanta, GA, USA.
authors.forename: Phyllis E
authors.initials: PE
authors.lastname: Kozarsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000453:epidemiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D038622:Internationality; D008297:Male; D008875:Middle Aged; D018571:Sentinel Surveillance; D014195:Travel / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Diagnosis; epidemiology; morbidity; prevention; surveillance; travel.