Inapparent Infection by Emerging Infectious Diseases During International Travel Open Access
Chen, Lillian (Spring 2019)
Abstract
Background: Each year, high volumes of individuals travel around the globe, including many to tropical areas and developing countries where certain infectious diseases are endemic. Travel infection reporting and surveillance often fails to capture asymptomatic infections, though the majority of many common and important travel-related infections occur asymptomatically. At least two gaps need to be addressed: 1) The epidemiology of emerging infectious diseases in many travel destinations is poorly understood. 2) There is a lack of understanding of risks and rates of asymptomatic infection related to travel.
Objectives: 1) Assess incidence of symptomatic and asymptomatic infection in returned international travelers, 2) Define behaviors that increase or decrease risk for travel related infection.
Methods: In this pilot study, a prospective cohort of international travelers (ages 18 and above) was established at Emory’s TravelWell Center. Patient demographics, travel history, upcoming itinerary, and planned protective measures were recorded in a questionnaire; exposures and symptoms were documented by a post-travel questionnaire. Arbovirus-reactive IgG was detected by ELISA in pre- and post-travel (≥28 days) serum specimens.
Results: 50 participants were recruited in the study (ages 21-71, median: 45.50) with most of the trips lasting 1-2 weeks and a primary purpose of leisure and sightseeing. Of the 28 participants that completed the post-travel follow-up, 13 had symptoms during or following their travel. The most common symptoms reported were diarrhea and abdominal pain (8, 62%). Having a trip of more than 2 weeks has a significant association with experiencing travel-related symptoms (RR: 4.38; 95% CI: 1.69, 11.33; p-value: 0.002) and graduate degree holders were significantly more likely to be ZIKV or DENV positive than those with college or below degrees (OR: 6.42; CI: 1.09; 37.74; p-value: 0.040).
Conclusions: Of returned travelers, 41% experienced at least one symptom associated with travel and 3 (6%) individuals seroconverted for ZIKV or DENV. Ongoing serologic evaluation of travelers will reveal incidence rates of asymptomatic flavivirus infection. Further work is needed to define the role of asymptomatic infection in traveler health. This prospective study of travelers coupled with biobanking and testing is a promising approach to understand global epidemiology of infectious diseases.
Table of Contents
Chapter 1: Introduction……………………..……………………..…………………..………..7
Chapter 2: Literature Review……………………..……………………..………………...…..10
Chapter 3: Manuscript……………………..……………………..…………………..………..14
Chapter 4: Conclusions and Recommendations………………………..……………...……..24
References……………………..……………………..………………………..………………..25
Tables and Figures……………………..……………………..………………………………..29
About this Master's Thesis
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