165. Expatriates Ill After Travel: Results from the GeoSentinel Surveillance Network
Session: Oral Abstract Session: Infectious Diseases Practice Challenges
Friday, October 21, 2011: 11:45 AM
Room: 151AB
Background: The number of expatriates worldwide is expected to rise with increasing trade, and travel. Expatriates are a distinct group at unique risk for health problems related to their travel exposure.

Methods: We analyzed GeoSentinel data comparing expatriates to non-expatriates for demographics, travel characteristics, and proportionate morbidity (PM) for travel-related illness, expressed as the number of patients with a diagnosis per 1000 ill returned travelers.  Data were analyzed using the chi-square test, prevalence odds ratios (pOR), and 95% confidence intervals. A 2-tailed p value ≤0.05 was considered significant.

Results: The study included 4,155 expatriates and 38,565 non-expatriates.  Expatriates were more likely to be male (60% v 49%), business travelers (37% v 14%) or volunteers (51% v 10%), long-stay travelers (>6 months, 55% v 7%), and to have sought pre-travel advice (66% v 55%); p<0.05 all comparisons. Expatriates in Africa had higher PM than non-expatriates for mosquito-borne (malaria 131 v 78, filariasis 25 v 5) and environmental-contact infections (schistosomiasis 42 v 29, strongyloidiasis 13 v 4).  Expatriates exposed in Asia had higher PM for non-falciparum malaria (48 v 18) and ingestion-related infections (typhoid/paratyphoid 17 v 10, hepatitis E 7 v 2).  Expatriates exposed in Latin America had higher PM for amebiasis (45 v 18), gastrointestinal disorders (125 v 67), and mononucleosis (33 v 5).

Business expatriates had significantly higher odds for typhoid (pOR=4.1), vector-borne infections (malaria pOR=1.9, chikungunya pOR=4.0), tuberculosis (latent pOR=1.7, active pOR=7.8) and animal bites (pOR=2.8). Volunteer expatriates had higher odds for filariasis (pOR=3.7), amebiasis (pOR=2.1), brucellosis (pOR=6.5), and strongyloidiasis (pOR=2.1). Expatriates from lower-income countries received less pre-travel advice (28% v 70%) and had higher PM for febrile (351 v 140) and respiratory (109 v 56) illness than those from high-income countries; p<0.05 all comparisons. 

Conclusion: Expatriate travelers differed from non-expatriates in demographics and travel characteristics, and had higher odds for specific diseases, based on exposure region, travel reason, trip duration, and income level of citizenship country.


Subject Category: T. Travel/tropical medicine and parasitology

Poh-Lian Lim, MD, MPH1, Pauline Han, MA2, Lin H. Chen, MD, FACP3, Susan MacDonald, MDCM, MSc4, Prativa Pandey, MBBS, MD5, DeVon Hale, MD6, Patricia Schlagenhauf, PhD7, Louis Loutan, MD, MPH8, Annelies Wilder-Smith, MD, PhD9,10, Xiaohong Davis, PhD, MA2 and David Freedman, MD, FIDSA11, (1)Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore, (2)Centers for Disease Control and Prevention, Atlanta, GA, (3)Harvard School of Medicine, Cambridge, MA, (4)University Hospital of Northern British Columbia, Prince George, BC, Canada, (5)CIWEC Clinic Travel Medicine Center, Kathmandu, Nepal, (6)University of Utah, Salt Lake City, UT, (7)Zurich University, Zurich, Switzerland, (8)Geneva University Hospital, Geneva, Switzerland, (9)Tan Tock Seng Hospital, Singapore, Singapore, (10)University of Heidelberg, Heidelberg, Germany, (11)University of Alabama at Birmingham, Birmingham, AL


P. L. Lim, None

P. Han, None

L. H. Chen, Xcellerex: Investigator and Research Contractor, Research grant

S. MacDonald, None

P. Pandey, None

D. Hale, None

P. Schlagenhauf, None

L. Loutan, None

A. Wilder-Smith, Novartis: Speaker's Bureau, Speaker honorarium
GSK: Speaker's Bureau, Speaker honorarium
Sanofi Pasteur: Speaker's Bureau, Speaker honorarium

X. Davis, None

D. Freedman, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.