1128. The Imported Fever Service; a UK-wide System for Improved Diagnosis and Management of Fever in Returned Travellers
Session: Oral Abstract Session: Lab Diagnostics
Friday, October 4, 2013: 2:36 PM
Room: The Moscone Center: 300
Background:

Febrile illness in returned travellers can rarely be diagnosed on clinical grounds alone. Poor integration and lack of awareness of diagnostic services delays diagnosis, with clinical and public health consequences. The Imported Fever Service (IFS) was established in 2012 as a UK-wide specialist diagnostic and clinical advice service for acute imported fevers. We summarise the first 9 months’ activity.

Methods:

The IFS combines a 24-hour clinical advice service with a diagnostic service capable of rapidly detecting ‘exotic’ pathogens, including viruses causing Viral Haemorrhagic Fever (VHF). After establishing the diagnostic and referral framework the IFS went live in June 2012. For each referral, clinical management advice is offered and, based on the patient’s travel history, a panel of tests is performed. Each panel costs $190, VHF testing is free.

Results:

Between June 2012 and February 2013, there were 143 IFS referrals, from 84 UK hospitals. 43 (30%) diagnoses were made as a result of referral to the service, with a median turnaround time of 3 days (<24hrs for VHF testing). Referred patients had travelled to Africa (32%), Asia (24%) and Europe (15%). Presenting complaints included neurological (24%), undifferentiated fever (23%) and respiratory (14%). The IFS diagnosed: murine typhus (n=7), rickettsial spotted fever, dengue, Lyme disease (n=4 each), Q fever, sandfly fever, leptospirosis (n=3 each), Tick-Borne encephalitis, scrub typhus, Chikungunya, Hantavirus and Crimean Congo Haemorrhagic Fever (CCHF) (1-2 cases each). The service was instrumental in coordinating infection control and public health responses to cases of CCHF and autochthonous Hantavirus infection. Clinical advice from the service assisted local diagnosis of non-infectious problems masquerading as travel-related infection.

Conclusion:

The IFS is the first service of its kind. Using geographical panels of tests and input from clinicians experienced in imported infections, the IFS was able to rapidly reach a diagnosis in 30% of returned travellers with otherwise undiagnosed fever. These diagnoses informed timely clinical, infection control and public health decisions. The range of pathogens identified and modest cost demonstrates the IFS model is feasible, effective and could be reproduced in other countries

Jonathan Lambourne, MD, PhD1,2, Amanda Semper, PhD1, Meera Chand, MD1,3, Jane Osborne, PhD1, Behzad Nadjm, MD4,5, Catherine Roberts, MD6, Katherine Russell, MD3,7, Surabhi Taori, MD, PhD1, Malur Sudhanva, MD1,8, Peter Chiodini, MD, PhD4, Nicholas Beeching, MD9 and Tim Brooks, MD, PhD1, (1)Phe Microbiology Services, Rare and Imported Pathogens Laboratory, Salisbury, United Kingdom, (2)Clinical Microbiology & Virology, Uclh NHS Foundation Trust, London, United Kingdom, (3)Microbiology Services, Public Health England, London, United Kingdom, (4)Hospital for Tropical Diseases, London, United Kingdom, (5)Oxford University Clinical Research Unit, Hanoi, Vietnam, (6)Imperial College London, London, United Kingdom, (7)Health Protection Services, Public Health England, London, United Kingdom, (8)Virology, Kings College Hospital NHS Foundation Trust, London, United Kingdom, (9)Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom

Disclosures:

J. Lambourne, None

A. Semper, None

M. Chand, None

J. Osborne, None

B. Nadjm, None

C. Roberts, None

K. Russell, None

S. Taori, None

M. Sudhanva, None

P. Chiodini, None

N. Beeching, None

T. Brooks, None

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