Journal of travel medicine最新文献

A 24-year-old Swiss medical student with an extensive travel history presented to the general practitioner with solitary erythematous migratory swellings on her lower leg. A diagnosis was finally reached after 6 months, when a creeping eruption presented on her eyelid.

In 19 patients on immunosuppressive monotherapy who received rabies pre-exposure prophylaxis (PrEP) whilst immunocompetent, all but one showed boostability (antibodies > 0.5 IU/mL) 7 days after post-exposure prophylaxis (PEP) 1-20 years post-PrEP. Tailoring guidelines for specific immunocompromised patient groups is advisable and may improve vaccine coverage and optimize rabies immunoglobulin use.

Background: Many travellers sustain an animal-associated injury (AAI) that may lead to rabies. To avert infection the WHO recommends starting post-exposure prophylaxis (PEP) within 24 hours of the AAI. Many travellers experience PEP delay (60%). The reason for this is unclear, but delay leads to unnecessary health risks, anxiety, and potentially death. Therefore, this study aims to analyse which factors contribute to PEP delay while abroad.

Methods: A quantitative observational study was conducted among Dutch travellers between 2019 and 2024 using case records from the Eurocross Assistance database. The records consisted of information provided by the traveller during the trip. A multivariable logistic regression analysis with backward selection was performed to identify the factors contributing to PEP delay.

Results: Of the 1410 AAI notifications, 838 travellers required PEP of whom 59.4% experienced PEP delay. The analysis showed higher odds of delay for travellers requiring rabies immunoglobulins (RIG) (OR:6.46; 95%-CI:4.26-9.79), and those travelling to South America (OR:22.39; 95%-CI:9.78-51.21), Central America (OR:11.54; 95%-CI:4.57-29.16), North America (OR:5.53; 95%-CI:2.04-14.96), Europe (OR:4.08; 95%-CI:2.17-7.67), Africa (OR:3.34; 95%-CI:1.59-7.02), Eastern Mediterranean (OR:2.54; 95%-CI:1.38-4.67), and the Western Pacific (OR:2.37; 95%-CI:1.36-4.12) compared to Southeast Asia.PEP delay was mainly due to conflicting medical advice and unavailability of treatment. Absence of RIG led to repatriation of 65 (7.8%) travellers to the Netherlands. The median delay for RIG was 2 days (range: 0-10), and 0 days for rabies vaccinations (range: 0-15). The highest median delay for RIG was observed in Central and South America (4.5 days; range: 1-10 and 1-7, respectively), while no delay was observed in Southeast Asia.

Conclusions: Travellers to Central- and South America are at particularly high risk of PEP delay, primarily due to conflicting medical advice and unavailability of RIG. Our findings suggest that destination-specific pre-exposure prophylaxis advice may reduce preventable delays and improve rabies prevention outcomes.

Background: Two vaccines have been licensed to prevent chikungunya, a live attenuated vaccine (IXCHIQ) manufactured by Valneva and a virus-like particle chikungunya vaccine (VIMKUNYA) manufactured by Bavarian Nordic. One or both vaccines are now available in many countries globally, including Brazil, Canada, United Kingdom, United States and some European countries and territories.

Key findings: While the absence of a head-to-head study limits comparative inferences, the two vaccines have several different characteristics that should be considered when advising individual travellers. We outline key information on the vaccines including immunogenicity and safety data, recommendations for use in travellers and guidance for use in pregnancy and breastfeeding.

Conclusion: Knowledge of the profiles and key features of the live attenuated and virus-like particle vaccines will enable healthcare providers to better advise travellers who are considering chikungunya vaccination.

Strongyloides stercoralis can cause life-threatening infections. Subcutaneous veterinary formulations of ivermectin (IVM) may be the only option for severe treatment, but the dosage and duration are empirical. This article, based on a clinical case, discusses ivermectin concentrations and proposes clinical and parasitological follow-up to guide parenteral therapy in severe strongyloidiasis.

Background: Military deployments to dengue-endemic regions present ongoing risks to health and mission readiness. This review synthesizes a century of evidence on the incidence, clinical features, diagnostics, and prevention of dengue in military personnel, aiming to guide future health policies, research, and Force Health Protection strategies.

Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a search of PubMed and Google Scholar (March 15-April 5, 2025) identified 32 English-language studies (1905-2024) reporting primary data on dengue in military personnel. Studies were selected based on predefined criteria and narratively synthesized.

Results: A review of 32 studies involving 51,213 military personnel across 41 deployment settings identified 73,156 dengue cases, with outbreaks dating back to 1904. A notable spike occurred between 2012 and 2017, likely due to increased deployments to endemic regions and better surveillance. In 2023 alone, 4,903 US cases were confirmed. Diagnostic methods have advanced from early clinical recognition to modern Non-structural Protein 1 (NS1) antigen and Polymerase Chain Reaction (PCR) tests. Common symptoms included high fever, intense headache, and myalgia. Despite efforts such as integrated vector control and Personal Protective Measures (PPMs), and new vaccines (Qdenga®, Takeda), prevention remains limited by inconsistent use of integrated vector control and PPMs, low vaccine uptake, and eligibility constraints.

Conclusion: Dengue continues to threaten operational readiness in tropical deployments. Strengthening integrated vector control, PPMs, vaccination, and real-time surveillance is crucial to reduce its impact and control other co-endemic diseases like malaria, yellow fever, chikungunya, and Zika. Future research should focus on evaluating integrated vaccine and vector control strategies aimed at enhancing Force Health Protection among military personnel.