606. Influenza-like illness in travelers to the developing world
Session: Poster Abstract Session: Oh One World: Infections from Near and Far
Thursday, October 27, 2016
Room: Poster Hall
Background: International travelers are at risk for development of influenza-like illness (ILI) during travel to less developed regions. While pre-travel counseling and immunization may help in preventing development of ILI during travel, little is known of traveler and trip characteristics most likely to influence development of ILI when traveling to the developing world.

Methods: TravMil is a prospective observational study enrolling subjects presenting to 6 military travel clinics. We analyzed pre- and post- travel surveys from travelers visiting regions outside of the continental United States, Western or Northern Europe, Canada or New Zealand between January 2010 and March 2016. ILI was defined as self-reported fever associated with either a sore throat or cough. Characteristics of trip and traveler were analyzed to determine risk factors for development of ILI.

Results: 2932 trips were recorded (55% male, median age 45 years [IQR 29, 63], 69% white, 51% traveling for vacation, 29% traveling for military purpose, median duration of travel 17 days [IQR 12, 29]). 11% were complicated by ILI lasting a median of 5 days (IQR 3, 10); 70% and 17% of these reported upper and lower respiratory tract infection respectively, and 12% reported both. 740 included # of self-reported influenza vaccinations (#IV) in the preceding 5 years (median 5, IQR 3,5). On univariate analysis, travelers with ILI were more often female (55% vs 43%, p<0.01), traveling for vacation (61% vs 50%, p<0.01), to Asia (44% vs 33%, p<0.01), with longer duration of travel (21 [IQR 14, 40] vs 16 days [IQR 11, 28], p<0.01) and decreased #IV (4 [IQR 2, 5] vs 5 [IQR 3, 5], p<0.01). Those with ILI were less often active duty military (30% vs 39%, p<0.01), traveling for military purpose (22% vs 30%, p<0.01), for medical support (4% vs 7%, p<0.05), or to Africa (25% vs 33%, p<0.01). However, none remained significant on multivariate analysis; an OR of 0.85 (CI 0.72 - 1.01, p=0.07) was seen with #IV.

Conclusion: ILI remains common in travelers, regardless of traveler characteristics, purpose of travel, destination, or season of year. In this highly immunized population, a trend toward decreased ILI rates with increased #IV was observed. This remains an important area of emphasis in pre-travel counseling.


Stuart Wood, MD1, Kalyani Telu, MS2, David Tribble, MD, DrPH, FIDSA3, Anuradha Ganesan, MD, MPH4, Anjali Kunz, MD5, Mary Fairchok, MD4, Elizabeth Schnaubelt, MD6, Jamie Fraser, MPH7, Indrani Mitra, MS4, Mark Johnson, MD, MTM&H8, Tahaniyat Lalani, MD9 and Heather Yun, MD, FIDSA10, (1)Infectious Disease, SAMMC, San Antonio, TX, (2)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD, (3)Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, (4)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (5)Madigan Army Medical Center, Tacoma, WA, (6)LRMC, Landstuhl, Germany, (7)Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, (8)Naval Health Research Center, Naval Medical Center San Diego, San Diego, CA, (9)Naval Medical Center Portsmouth, Portsmouth, VA, (10)San Antonio Military Medical Center, Joint Base San Antonio-Fort Sam Houston, TX

Disclosures:

S. Wood, None

K. Telu, None

D. Tribble, None

A. Ganesan, None

A. Kunz, None

M. Fairchok, None

E. Schnaubelt, None

J. Fraser, None

I. Mitra, None

M. Johnson, None

T. Lalani, None

H. Yun, None

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