title: Travellers and influenza: risks and prevention.
abstract: BACKGROUND
  Influenza viruses are among the major causes of serious human respiratory tract infection worldwide. In line with the high disease burden attributable to influenza, these viruses play an important, but often neglected, role in travel medicine. Guidelines and recommendations regarding prevention and management of influenza in travellers are scarce. Of special interest for travel medicine are risk populations and also circumstances that facilitate influenza virus transmission and spread, like travel by airplane or cruise ship and mass gatherings.
  
  
  METHODS
  We conducted a PUBMED/MEDLINE search for a combination of the MeSH terms Influenza virus, travel, mass gathering, large scale events and cruise ship. In addition we gathered guidelines and recommendations from selected countries and regarding influenza prevention and management in travellers. By reviewing these search results in the light of published knowledge in the fields of influenza prevention and management, we present best practice advice for the prevention and management of influenza in travel medicine.
  
  
  RESULTS
  Seasonal influenza is among the most prevalent infectious diseases in travellers. Known host-associated risk factors include extremes of age and being immune-compromised, while the most relevant environmental factors are associated with holiday cruises and mass gatherings.
  
  
  CONCLUSIONS
  Pre-travel advice should address influenza and its prevention for travellers, whenever appropriate on the basis of the epidemiological situation concerned. Preventative measures should be strongly recommended for travellers at high-risk for developing complications. In addition, seasonal influenza vaccination should be considered for any traveller wishing to reduce the risk of incapacitation, particularly cruise ship crew and passengers, as well as those participating in mass gatherings. Besides advice concerning preventive measures and vaccination, advice on the use of antivirals may be considered for some travellers.
authors.affiliation: Institute for Tropical Diseases, Havenziekenhuis, Rotterdam, The Netherlands marco.goeijenbier@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Goeijenbier
authors.affiliation: Institute for Tropical Diseases, Havenziekenhuis, Rotterdam, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: van Genderen
authors.affiliation: Research institute of the McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: B J
authors.initials: BJ
authors.lastname: Ward
authors.affiliation: Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.|Institute of Public Health, University of Heidelberg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Wilder-Smith
authors.affiliation: Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Centre for Travelers Health, University of Zurich Travel Health Centre, Zurich, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Steffen
authors.affiliation: ARTEMIS One Health Research Institute Utrecht, The Netherlands.|Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine, Hannover, Germany.
authors.forename: A D M E
authors.initials: AD
authors.lastname: Osterhaus
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D003140:Communicable Disease Control / Q000379:methods*; D006801:Humans; D007251:Influenza, Human / Q000517:prevention & control*; D012307:Risk Factors; D012621:Seasons; D014195:Travel; D057236:Travel Medicine; D014611:Vaccination
chemical_list: D000998:Antiviral Agents
keywords: Travel medicine; influenza; mass gatherings; seasonality; vaccination