Journal of travel medicine最新文献

Background: Cholera and typhoid fever are often co-endemic, making vaccine coadministration practical. However, due to lack of immunogenicity data, current guidelines advise against coadministration of the oral inactivated whole-cell recombinant cholera toxin B-subunit vaccine (WC-rCTB) and the oral live Salmonella Typhi Ty21a vaccine.

Methods: Healthy adults (18-65 years) were randomized 1:1:1 to receive WC-rCTB with Ty21a (group Ch + Ty), WC-rCTB alone (group Ch) or Ty21a alone (group Ty). Peripheral blood mononuclear cells (PBMC) were isolated on Days 0, 5 and 7 from all, plus on Days 12 and 14 from WC-rCTB recipients, to assess antibody-secreting cells (ASC) specific to rCTB and to typhoidal O9,12-structures by ELISPOT. Vibriocidal antibodies were assessed, and anti-rCTB IgA/IgG and anti-S. Typhi lipopolysaccharide (LPS) IgA/IgG/IgM were measured by ELISA in Day 0 and 28 ± 3 serum samples. Adverse events (AEs) were recorded during one month.

Results: The final study population included 63 volunteers, 21 per group. A nonsignificant trend toward stronger rCTB-specific ASC (IgA + IgG + IgM) peak responses were observed in group Ch + Ty compared to group Ch (geometric mean, GM 94 versus 32 ASC/106 PBMC, p = 0.096). Serum anti-rCTB IgA and IgG fold-rises (postvaccination versus prevaccination) were higher in group Ch + Ty than in group Ch (IgA p = 0.039, IgG p = 0.028), whereas vibriocidal fold-rises were comparable between the two groups (p = 0.847). ASC (IgA + IgG + IgM) peak responses to typhoidal O9,12-structures were comparable between groups Ch + Ty and Ty (GM 183 versus 210 ASC/106 PBMC, p = 0.684). Serum anti-S. Typhi LPS IgA, IgG and IgM fold-rises were also similar across Ch + Ty and Ty groups (all p-values ≥0.145). AEs were comparable in single and coadministration groups.

Conclusions: Coadministration of the oral cholera and typhoid vaccines demonstrated favourable safety and robust immunogenicity for both vaccines, supporting their simultaneous use without spacing precautions.

Background: The growing number of international travelers aged ≥60 years reflects global demographic changes and improved life expectancy. However, this group faces specific health risks due to age-related physiological changes and comorbidities, which may influence the presentation and management of travel-related illnesses. This study aimed to describe the epidemiological and clinical characteristics of imported diseases among older travelers compared with younger adults in Spain.

Methods: A retrospective observational study was conducted using data from the Spanish National Network (+Redivi). We analyzed records of travelers who sought medical care after returning to Spain between January 2011 and December 2023 in six different centres. Demographic data, travel history, and final diagnoses were compared between individuals aged ≥60 years and those <60 years. Descriptive and inferential statistics were performed using R software (v4.2.2).

Results: Among 29,573 total tourist travellers , 1,230 (4.2%) involved individuals aged ≥60 years. In the traveler subgroup, 546 older and 7,704 younger adults were compared. Older travelers more often undertook very short (<15 days, 46.3%) or prolonged (>360 days, 11.4%) trips and sought pre-travel advice less frequently (36.1%, p<0.001). Sub-Saharan Africa and South America were the main regions of infection acquisition. Gastrointestinal disorders were the leading cause of consultation in all groups, but older adults more frequently presented with skin (22.2%) and respiratory (3.8%) symptoms. The most frequent diagnoses in the older cohort included Plasmodium falciparum malaria (4.8%), strongyloidiasis (3.3%), and chikungunya (3.5%).

Conclusions: Older travelers represent a distinct and growing population within travel medicine, characterized by specific patterns of exposure and infection. These findings highlight the need for tailored pre-travel counseling and preventive strategies that consider comorbidities, vaccine limitations, and extended travel durations to reduce morbidity in this vulnerable group.

Facemask use was observed systematically during the Arbaeen in 2020 and 2024. Respectively, in 2020 and 2024, 18.6% and 2.4% wore their facemasks correctly, while 10.6% and 1.3% wore them incorrectly. Despite frequent incorrect usage, facemask use was more prevalent during the COVID-19 pandemic.

Background: Traveling to high altitudes (sleeping above 2,500 m) carries a risk of acute mountain sickness (AMS). Proper pre-acclimatization strategies, such as time spent at simulated altitude, can significantly lower this risk. However, the optimal duration of pre-acclimatization remains unknown. Therefore, we examined published research on how different types and durations of pre-acclimatization at simulated altitude influence the AMS risk.

Methods: A literature search was conducted to find controlled studies investigating the effects of normobaric or hypobaric simulated altitude exposures. Inclusion criteria required sufficient details on study design, exposure duration, and outcomes, specifically the incidence of AMS on subsequent ascent. The simulated or real altitude exposure following pre-acclimatization had to last at least 8 hours to accurately assess AMS incidence.

Results: Findings from seven controlled studies using repeated intermittent exposures to simulated altitude were included. The cumulative pre-acclimatization time ranged from 7 to 104 hours; altitudes ranged from 2,200 to 5,000 m. The AMS risk after pre-acclimatization decreased by 12-73% compared to controls, with the degree of reduction depending mainly on the duration at simulated altitude. Extrapolating from these data indicates that, within the analyzed altitude range, about 200 hours of pre-acclimatization may reduce the subsequent AMS risk to nearly zero.

Conclusions: Our analysis suggests that accumulating 200 hours in a hypoxic simulated-altitude environment substantially reduces the risk of AMS when subsequently exposed to terrestrial altitude. The effectiveness of this strategy depends on the intervals between pre-acclimatization exposures, the method used, and the target altitude. Observational studies indicate that time spent at simulated altitude can be complemented by time spent at terrestrial altitude. Importantly, while pre-acclimatization exposures can effectively prevent AMS, they do not, per se, enhance endurance performance or mountaineering skills, and factors such as co-existing mental or physical health conditions may influence risk and the effectiveness of prevention.

Amebic liver abscess with bronchopleural fistula caused by Entamoeba histolytica can mimic severe bacterial sepsis in a returning traveller. Rapid diagnosis via multiplex PCR on abscess fluid enabled targeted therapy within 24 hours, avoiding unnecessary broad-spectrum antibiotics. Intestinal amebiasis should be considered in patients with compatible symptoms and relevant exposure.

Background: International travel contributes to the global spread of antimicrobial resistance (AMR): a substantial proportion of travellers visiting low- and middle-income countries (LMICs) are colonized by multidrug-resistant organisms (MDRO), with those hospitalized abroad at a particular risk. In some, colonization leads to symptomatic MDRO infection. Although children are a recognized risk group, research on travel-acquired MDRO among paediatric patients remains limited.

Methods: At our hospital, patients hospitalized abroad within the past 12 months are routinely screened for MDROs upon admission. To assess MDRO colonization among children following hospitalization abroad, we analysed MDRO screening data from paediatric patients at HUS Helsinki University Hospital 2010-2024, and explored associated risk factors.

Results: Among the 459 paediatric patients screened after hospitalization abroad, 158 (34.4%) were colonized with MDROs. The most common MDROs were extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) (29.0%) and methicillin-resistant Staphylococcus aureus (MRSA) (7.6%). Carbapenemase-producing Enterobacterales (CPE) were identified in 14 children (3.1%).Multivariable analysis identified antibiotic use (p = 0.002), travel type (p < 0.001), and income level of the hospitalization country (p < 0.001) as independent risk factors for colonization. The income level gradient was substantial: 87.5% (21/24) of children hospitalized in low-income countries, 68.1% (49/72) in lower-middle-income, 46.6% (55/118) in upper-middle-income, and 13.5% (33/245) in high-income countries were colonized with MDROs. Clinical MDRO infection was recorded in five of the 158 (3.2%) MDRO carriers.

Conclusions: MDRO colonization is common among children hospitalized abroad, showing a clear gradient increase with decreasing country income level. Screening and infection control measures are warranted after recent care abroad. Particular focus should be placed on those hospitalized in LMICs, and those with additional risk factors such as VFR (visiting friends and relatives) travel, foreign residence, or recent antibiotic use.

A convenience sample of 43 resettled Rohingya refugees screened for schistosomiasis showed 44% seropositivity. None had traveled outside Southeast Asia, indicating regional acquisition. Schistosomiasis is an underrecognized pathogen in this community and refugees should be screened.