title: Travelers' health problems and behavior: prospective study with post-travel follow-up.
abstract: The annual number of international tourist arrivals has recently exceeded one billion, yet surprisingly few studies have characterized travelers' behavior, illness, and risk factors in a prospective setting. Particularly scarce are surveys of data spanning travel, return, and follow-up of the same cohort. This study examines behavior and illness among travelers while abroad, after return home, and at follow-up. Patterns of behavior connected to type of travel and illness are characterized so as to identify risk factors and provide background data for pre-travel advice.
  
  
  
  Volunteers to this prospective cohort study were recruited at visits to a travel clinic prior to departure. Data on the subjects' health and behavior were collected by questionnaires before and after journeys and over a three-week follow-up. In addition, the subjects were asked to fill in health diaries while traveling.
  
  
  
  The final study population consisted of 460 subjects, 79 % of whom reported illness during travel or on arrival: 69 % had travelers' diarrhea (TD), 17 % skin problems, 17 % fever, 12 % vomiting, 8 % respiratory tract infection, 4 % urinary tract infection, 2 % ear infection, 4 % gastrointestinal complaints other than TD or vomiting, and 4 % other symptoms. Of all subjects, 10 % consulted a doctor and 0.7 % were hospitalized; 18 % took antimicrobials, with TD as the most common indication (64 %). Ongoing symptoms were reported by 25 % of all travelers upon return home. During the three-week follow-up (return rate 51 %), 32 % of respondents developed new-onset symptoms, 20 % visited a doctor and 1.7 % were hospitalized. Factors predisposing to health problems were identified by multivariable analysis: certain regions (Southern Asia, South-Eastern Asia, and Eastern Africa), female gender, young age, and long travel duration.
  
  
  
  Despite proper preventive measures like vaccinations, malaria prophylaxis, and travel advice, the majority of our subjects fell ill during or after travel. As the symptoms mostly remained mild, health care services were seldom needed. Typical traveler profiles were identified, thereby providing a tool for pre-travel advice. The finding that one third reported new-onset illness during follow-up attests to the importance of advising clients on potential post-travel health problems already during pre-travel visits.
authors.affiliation: Department of Bacteriology and Immunology, University of Helsinki, Haartmaninkatu 3, (P.O. Box 21), 00014, Helsinki, Finland.|Inflammation Center, Clinic of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Aurora Hospital, Nordenskiöldinkatu 20, (P.O. Box 348), Helsinki, Finland.
authors.forename: Katri
authors.initials: K
authors.lastname: Vilkman
authors.affiliation: Department of Bacteriology and Immunology, University of Helsinki, Haartmaninkatu 3, (P.O. Box 21), 00014, Helsinki, Finland.
authors.forename: Sari H
authors.initials: SH
authors.lastname: Pakkanen
authors.affiliation: Inflammation Center, Clinic of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Aurora Hospital, Nordenskiöldinkatu 20, (P.O. Box 348), Helsinki, Finland.
authors.forename: Tinja
authors.initials: T
authors.lastname: Lääveri
authors.affiliation: Inflammation Center, Clinic of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Aurora Hospital, Nordenskiöldinkatu 20, (P.O. Box 348), Helsinki, Finland.
authors.forename: Heli
authors.initials: H
authors.lastname: Siikamäki
authors.affiliation: Inflammation Center, Clinic of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Aurora Hospital, Nordenskiöldinkatu 20, (P.O. Box 348), Helsinki, Finland. anu.kantele@hus.fi.|Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland. anu.kantele@hus.fi.|Aava Travel Clinic, Medical Centre Aava, Annankatu 32, 00100, Helsinki, Finland. anu.kantele@hus.fi.|Unit of Infectious Diseases, Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden. anu.kantele@hus.fi.
authors.forename: Anu
authors.identifier: 0000-0002-0004-1000
authors.initials: A
authors.lastname: Kantele
mesh_terms: D000293:Adolescent; D000328:Adult; D000351:Africa, Eastern; D000367:Age Factors; D000368:Aged; D001210:Asia, Southeastern; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014195:Travel; D014611:Vaccination; D055815:Young Adult
keywords: Antimalarials; Antimicrobials; Malaria; Risk factors; Travel; Travelers’ behavior; Travelers’ diarrhea; Travelers’ health; Vaccinations