Imported Malaria cases in Sri Lanka on the rise

Published Date: 2013-04-30 11:44:56
Subject: PRO/EDR> Malaria - Sri Lanka: imported 
Archive Number: 20130430.1682005

MALARIA - SRI LANKA: IMPORTED
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International Society for Infectious Diseases
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Date: Sun 28 Apr 2013
Source: Sunday Observer [edited]
http://www.sundayobserver.lk/2013/04/28/new23.asp


Imported cases of malaria overtaking indigenous cases in Sri Lanka
------------------------------------------------------------------
Health officials have warned that although malaria is on the brink of being eliminated in Sri Lanka, there could be a re-emergence of the disease due to a rise in the number of "imported" cases.

"We had 70 "imported" cases of malaria as against 23 indigenous cases last year [2012]. The imported cases included a large number of refugees who arrived from Benin in West Africa; they were tested at the airport and 50 were found to be positive. The rest were from India and Pakistan," Anti Malaria Campaign (AMC) sources told the Sunday Observer.

They said due to sustained awareness programs by the AMC to eradicate the disease, the parasite reservoir in the island was now absent. "The risk is that the malaria vector is still abundant during long drought periods, especially in the North Central Province in areas such as Hambantota, Anuradhapura, Polonnaruwa, Mullaitivu, and Mannar. If someone brings the parasite with them after visiting a malaria-prone countries such as African countries and India, there is a chance for another outbreak of the disease," they warned.

They said anyone including those in peace keeping missions to such countries should take proper precautions as they could be exposed to the parasite. "We now have a good mechanism to prevent the disease re-entering the country.

"We deploy our officers at airports and other points of entry to the country to take blood samples of anyone entering the country from malaria-prone areas, once these travellers inform us of their arrival prior to their return. The results of the blood tests are given to them within 15 minutes, before they leave the airport. If they test positive, we start them on treatment immediately. Health directors of the Forces support us in this campaign, which has already shown encouraging results, with 14 cases being detected at airports so far this year [2013]," they said.

AMC sources said travellers to malaria-prone countries had been requested to take prophylactic drugs to prevent catching the disease prior to their departure, and also to take the tablets with them when they depart. "The drugs are free and available at our head office at Narahenpita. Different drugs are given for different countries. Also, when they return, if they develop high fever with shivering fits and severe headaches, they should immediately inform the nearest MOH [Ministry of Health] doctor to test them for malaria," they said.

WHO Update on H7N9 Bird flu

Published Date: 2013-04-23 18:50:09
Subject: PRO/AH/EDR> Avian influenza, human (57): H7N9 update 
Archive Number: 20130423.1667644

AVIAN INFLUENZA, HUMAN (57): H7N9 UPDATE 
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ProMED-mail is a program of the
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*****
[1] WHO update @ 22 Apr
Date: Mon 22 Apr 2013
Source: World Health Organisation (WHO), CSR, Disease Outbreak news [edited]
http://www.who.int/csr/don/2013_04_22/en/index.html


Human infection with avian influenza A(H7N9) virus in China - update
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As of 22 April 2013 (18:00 CET), the National Health and Family Planning Commission notified WHO of an additional 2 laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus. Both the patients are reported from Zhejiang province. The 1st patient is a 54-year-old woman who became ill on 16 Apr 2013 and the 2nd patient is a 32-year-old man who became ill on 14 Apr 2013. Additionally, a patient earlier reported from Zhejiang province has died.

To date, a total of 104 [now 108, see below] laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus in China, including 21 [now 22, see below] deaths have been reported to WHO. Contacts of the confirmed cases are being closely monitored. National authorities continue to implement prevention and control measures.

Investigations into the possible sources of infection and reservoirs of the virus are ongoing. Until the source of infection has been identified, it is expected that there will be further cases of human infection with the virus in China. So far, there is no evidence of ongoing human-to-human transmission. WHO does not advise special screening at points of entry with regard to this event, nor does it recommend that any travel or trade restrictions be applied.

At the invitation of the National Health and Family Planning Commission of China, WHO has convened a team of experts who will visit areas affected by avian influenza A(H7N9) in China in order to provide recommendations on the prevention and control of the disease.

--

H1N1 swine flu kills a child in Vietnam

Published Date: 2013-04-23 19:18:43
Subject: PRO/EDR> Influenza (29): Viet Nam H1N1 child, fatal 
Archive Number: 20130423.1667643

INFLUENZA (29): VIET NAM H1N1 CHILD, FATAL
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http://www.promedmail.org
ProMED-mail is a program of the
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[1]
Date: Tue 23 Apr 2013 [edited]
Source: Viet Nam Bridge [edited]
http://english.vietnamnet.vn/fms/society/72320/thanh-hoa--12-year-old-girl-died-of-swine-flu.html


Thanh Hoa: 12-year-old girl died of swine flu
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A little girl from the central province of Thanh Hoa died of the H1N1 influenza strain known as swine flu at the Hanoi-based Central Hospital for Tropical Diseases this morning, 23 Apr 2013, reported the hospital's deputy director Nguyen Hong Ha. It is suspected that the girl caught the flu from her brother-in-law, who is living in Hanoi. About 2 weeks ago, he paid a visit to the home of his parents-in-law in Thanh Hoa. He had influenza at that time and communicated flu to 3 others in the family. 2 people were free from the disease while the girl's flu got worse. On 16 April 2013, she had fever, cough, and shortness of breath. The family took her to the hospital of Vinh Loc district in Thanh Hoa. After one day of treatment, the patient got critical breathing problems and was transferred to the Hospital of Thanh Hoa province.

Only a day later, the respiratory problem became more serious. The X-ray scan showed lesions in her lung. The patient was transferred to the Central Hospital for Tuberculosis and Lung Diseases in Hanoi, where the X-ray scan detected that her lung lesions developed very quickly. She was again transferred to another hospital -- the Central Hospital for Tropical Diseases.

Deputy Director Nguyen Hong Ha of the Central Hospital for Tropical Diseases said the patient was brought to the hospital in the state of severe respiratory distress. Testing results showed that she was positive for type A/H1N1 flu virus. Upon admission, the patient was treated with antiretroviral drugs but she died on the morning of 23 Apr 2013.

On 22 Apr 2013, the Central Hospital for Tropical Diseases also received an 83-year-old man who was transferred from the Agriculture Hospital with symptoms of flu. Dr. Nguyen Van Kinh, Director of the Central Hospital for Tropical Diseases, said that flu patients died because they were brought to the hospital very late, after having complications such as respiratory failure and heavy pneumonia. 

A/H1N1 influenza is the same as the other seasonal flu, with certain mortality. In Viet Nam, the fatality rate from A/H1N1 influenza is very low, only about 0.7 percent. 

Details of RML (Ram Manohar Lohia) Hospital in New Delhi for Yellow Fever Vaccination

Information on Yellow Fever Vaccination at RML Hospital Delhi

1 Place of Vaccination -  College of Nursing, Psychiatry Block, RML Hospital.

2 Day & time of vaccination - Wednesday – 10 AM -11.30 AM Saturday 9.30 AM – 11.00 AM

3 Documents required for registration - Passport in original

4 Charges for providing the vaccination - Rs. 300 /per vaccination

5 Report collection timing Yellow fever certificate is issued immediately after the vaccination 

(i.e. on the same day)

6 Validity of vaccine - 10 days from date of vaccination upto 10 years

7 Contra-indication

• 1. Allergy to chicken and egg proteins
• 2. Infants below 9 months of age
• 3. Pregnant Women
• 4. Immuno-compromised individuals.

Source

Disclaimer - This information is provided from the official website of the RML Hospital in Delhi. We are not responsible for any errors in the same. Please contact the hospital directly to confirm the details.

Bad oysters causing gastroenteritis in Austalia

Archive Number: 20130404.1619875

A ProMED-mail post
http://www.promedmail.org

Date: Wed 3 Apr 2013

Source: Sydney Morning Herald [edited]
http://www.smh.com.au/national/gastro-outbreak-fears-for-melbourne-sydney-20130403-2h6t8.html


There are fears a gastroenteritis outbreak caused by contaminated oysters in Tasmania over the Easter weekend has spread interstate.

Tasmania's Director of Public Health, Dr Roscoe Taylor, confirmed on Wed 3 Apr 2013 that Victoria's health department was "investigating cases of gastro that may be related to eating Barilla Bay oysters supplied on 25 Mar 2013."

The announcement comes hours after Tasmania's Department of Health and Human Services confirmed that more than 60 Tasmanians had contracted gastroenteritis after eating oysters traced to Barilla Bay Seafoods and grown at Dunalley in the state's south. A spokesman for the department confirmed that the contaminated oysters were also sold in Melbourne and Sydney. It is believed that up to 20 people in Melbourne have reported the illness; however, tests have not yet confirmed whether they are linked to the Barilla Bay oysters.

"There are reports of Victorian people having gastro," the spokesman said. "There is a smoking gun, but as yet, there is no direct link proved by testing at this stage."

Barilla Bay Seafoods halted the sale of its oysters on Sun 31 Mar 2013 pending investigations, and all potentially contaminated shellfish have been withdrawn across Australia. The department said it did not yet know what caused the contamination. It is not believed to be related to a sewage spill at nearby Pitt Water and Island Inlet which forced the closure of several leases last week. However, it is still investigating how a lease owned by Barilla Bay in a separate growing area came to be contaminated.

The department said the batches of oysters that caused the gastro outbreak were harvested on 27-29 Mar 2013 and may have been sold up to and including Easter Sunday [31 Mar 2013].

Barilla Bay Seafoods was not available for comment; however, the executive officer for Oysters Tasmania, Tom Lewis, said he believed the contamination was isolated. "All evidence at the moment is pointing towards just oysters from one lease that were harvested between Monday and Friday of last week. So, it's a really small, isolated incident from everything we know at the moment," he said. "My feeling is if it was broader than that, we would be seeing evidence of that already, and we're not."

"Victorian consumers should contact Victoria Health for more information about gastro symptoms," Dr Taylor said in a statement.

YELLOW FEVER Vaccination campaign in PERU

Archive Number: 20130405.1625144

A ProMED-mail post
http://www.promedmail.orgDate: Thu 4 Apr 2013

Source: Pachamama Radio [in Spanish, transl. Mod.TY, edited]
http://www.pachamamaradio.org/04-04-2013/5-mil-vacunas-contra-la-fiebre-amarilla-se-distribuiran-en-melgar.html


The Melgar provincial Health Network has about 5 million doses of yellow fever vaccine to carry out a health campaign, according to a press conference by the Director of the Institute Julio Cesar Quiroz Abarca.

The doses will be distributed to the different health centers and posts within the province's jurisdiction and the Phara, Crucero and Limbani areas, he said. This [the vaccination campaign] is due to the detection of a yellow fever case in the province.

--
Communicated by:
ProMED-mail from HealthMap Alerts


[This campaign is in response to the 27 Mar 2013 case reported in the ProMED-mail post of 28 Mar 2013 (archive number 20130328.1608650). It is gratifying to see this rapid response to the fatal case. As mentioned by the moderator in the previous report, the Puno region is in the Peruvian Amazon basin, where yellow fever (YF) virus is endemic. All people living in this region are at risk of yellow fever virus infection transmitted from non-human primates to humans by forest mosquitoes and thus should be vaccinated, and soon will be. 

Since there are _Aedes aegypti_ that are efficient YF virus vectors present in the general lowlands of the eastern Peru area abundant enough to transmit dengue viruses, there is risk of spill-over of the sylvan transmission cycle into the urban one. That makes YF vaccination of people living in these areas an important preventive measure. 

WEST NILE VIRUS - USA: (MISSISSIPPI)

Archive Number: 20130409.1633975

A ProMED-mail post
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Date: Mon 8 Apr 2013
Source: dJournal [edited]
http://djournal.com/view/full_story/22187796/article-First-case-of-West-Nile-virus-reported-in-Mississippi-for-2013


Today [8 Apr 2013] the Mississippi State Department of Health (MSDH) reports the state's 1st human case of West Nile virus (WNV) for 2013. The reported case is in Madison County. The MSDH only reports laboratory-confirmed cases to the public. In 2012, Mississippi had 247 WNV cases and 5 deaths.

"This is actually not the 1st time we have had cases reported this early in Mississippi. We have had cases in March before and as early as January in previous years. This serves as a reminder that WNV [transmission] can occur year-round, even if we are not in the peak summer months of July, August, and September," said MSDH Deputy State Epidemiologist Dr Paul Byers. "Also, the timeframe of when the 1st case is reported has no effect on the type of WNV activity we'll see in a particular season. The 1st cases of the 2012 were reported in June, and we went on to set a record for the highest number of human cases in one season."

Mississippians should take appropriate precautions to reduce the risk of contracting WNV [infections] and other mosquito-borne illnesses year-round: remove sources of standing water, especially after rainfall; if you will be in mosquito-prone areas, wear protective clothing (such as long-sleeved shirts and pants) during peak times from dusk until dawn; and use a recommended mosquito repellent according to manufacturer's directions.

Symptoms of WNV infection are often mild and may include fever, headache, nausea, vomiting, a rash, muscle weakness, or swollen lymph nodes. In a small number of cases, infection can result in encephalitis or meningitis, which can lead to paralysis, coma, and possibly death.

China Detains 10 for H7N9 bird Flu Rumors, Death Toll at 9

Apr 10, 2013
Reuters Health Information
Source

SHANGHAI/BEIJING (Reuters) Apr 10 - Chinese police detained at least 10 people for spreading rumors about the H7N9 bird flu virus, state media said on Wednesday, as the death toll from the new strain rose to nine.

Authorities detained the people in six provinces - Shaanxi, Guizhou, Jiangsu, Zhejiang, Anhui and Fujian - some of whom had posted "fake information" online about new cases of the virus in their areas, the official Xinhua news agency said.

The death toll and number of infections in China from the strain of bird flu first found in humans last month has ticked up daily.

Nine people have died out of 33 confirmed cases of the virus, all in eastern China, according to data from the National Health and Family Planning Commission. State media quoted authorities as saying a vaccine should be ready within months.

Until Wednesday, the source of the virus was not known but Chinese researchers said they had traced it to wild birds and chickens, Xinhua reported.

One man detained in Anhui province was given seven days of administrative detention for fabricating posts on microblogs about infections, Xinhua said.

The Xi'an city public security bureau in Shaanxi province is investigating another man's posts, "to prevent untrue information from causing public panic", Xinhua said.

Scientists around the world have praised China for its handling of the deadly outbreak, but many Chinese people are skeptical of the government's pronouncements about the H7N9 virus, given a history of public health scandals and cover-ups.

The government initially tried to conceal an outbreak of Severe Acute Respiratory Syndrome (SARS), which emerged in China in 2002 and killed about one in 10 of the 8,000 people it infected worldwide.

Chinese Internet users have questioned why the government waited weeks to announce cases of the bird flu strain, but health officials said it took time to identify the virus, which was previously unknown in humans.

China's Communist Party is very keen to maintain social stability, but it has struggled to clamp down on rumors, which often spread quickly on the Internet.

Authorities have detained people in the past for rumors, including 93 people accused of circulating information about the apocalypse last December.

Still, some commentators have noted that reports of a flu-like condition killing one person near Shanghai had been circulating on Chinese microblogs weeks before the government confirmed it was a case of H7N9.

"From this you can see if the government tried to cover up like in 2003, but more and more of these posts surfaced, there would be no way to conceal it," social media watcher and journalist Wu Heng told Reuters.

"CAN BE CONTROLLED"

The latest H7N9 victim was from Anhui province, Xinhua reported. Among the new cases are several from Shanghai, Jiangsu and Zhejiang provinces, at least one of whom is dangerously ill, the news agency said.

"The outbreak overall is in a state that can be controlled," the State Council, or cabinet, said in a statement issued online after a meeting overseen by Premier Li Keqiang.

The China Securities Journal reported on Wednesday that a vaccine for H7N9 has been authorized by China Food and Drug Administration and is expected to be introduced to the market in the first half of this year.

The source was "traceable to wild birds from east Asia and chickens from east China", Xinhua reported, citing the Chinese Academy of Sciences.

The World Health Organization (WHO) has been investigating two "family clusters" of people suspected of having been infected with the H7N9 virus to see it its being spread between people.

The virus was found not to have infected anyone in the first cluster. The second cluster is still under investigation, the WHO said, though tests have been inconclusive and experts say the poor quality samples may make it impossible to determine.

The virus is severe in most humans, leading to fears that if it becomes easily transmissible, it could cause a deadly pandemic.

However, a WHO spokesman told a news briefing in Geneva there was no firm evidence of human-to-human transmission occurring which could spark a pandemic. Chinese health authorities have said the same thing.

The NEW BIRD FLU - AVIAN INFLUENZA, HUMAN (18): CHINA (JIANGSU) H7N9

Archive Number: 20130402.1616911

*************************************************
A ProMED-mail post
http://www.promedmail.org

Date: Tue 2 Apr 2013
Source: The Washington Post, Associated Press report [edited]
http://www.washingtonpost.com/business/how-lesser-known-bird-flu-strain-killed-2-isnt-known-yet-but-human-spread-seen-as-unlikely/2013/04/01/ee4e7176-9b2e-11e2-9219-51eb8387e8f1_print.html
China reported Tuesday [2 Apr 2013] that 4 more people in one province were seriously sickened by a bird flu virus new to humans, while cities along the eastern seaboard stepped up public health measures to guard against a disease that has already caused 2 deaths.
The health bureau of eastern Jiangsu province said in a notice on its website that 3 women, aged 45, 48 and 32, and an 83-year-old retired man, from different cities in the province were all critically ill with H7N9 avian influenza virus infection, a diagnosis confirmed by the provincial disease prevention centre. Based on the bureau's statement, only one of the patients appeared to come into daily contact with birds, the 45-year-old woman, who was described as a poultry butcher. The 4 cases did not appear to be connected, and people who have had close contact with the patients have not reported having fevers or respiratory problems, it said. The provincial health bureau said it was strengthening measures to monitor suspicious cases and urged the public to stay calm, joining Beijing and China's financial capital, Shanghai, in rolling out new steps to respond to the relatively unknown virus.
The 4 latest cases follow 3 earlier ones reported Sunday [31 Mar 2013], including 2 men who died in Shanghai, resulting in the city activating an emergency plan that calls for heightened monitoring of suspicious flu cases. Under the contingency plan, schools, hospitals and retirement facilities are to be on the alert for fevers, and administrators are to report to health authorities if there are more than 5 cases of flu in a week. Cases of severe pneumonia with unclear causes are to be reported daily by hospitals to health bureaus, up from the weekly norm. The plan also called for stronger monitoring of people who work at poultry farms or are exposed to birds. The level-3 response plan, the 2nd-lowest in a 4-stage scale, reflects higher concern after the H7N9 bird flu virus led to the deaths of 2 men in Shanghai and seriously sickened a woman in the city of Chuzhou, 360 km (230 miles) [to the] west.
"The health bureau will take effective and powerful measures to prevent and control the disease, to make sure the flu epidemic is effectively guarded against, and to safeguard the health of the city's residents," said Xu Jianguang, head of the Shanghai Health Bureau.
The H7N9 avian influenza virus has previously been considered not easily transmitted to humans, unlike the more virulent H5N1 strain, which began ravaging poultry across Asia in 2003 and has since killed 360 people worldwide.
Health officials said this week there was no evidence that any of the 3 earlier cases, who were infected over the past 2 months, had contracted the disease from each other and no sign of infection in the 88 people who had closest contact with them.
Health authorities in Beijing also upped the capital's state of readiness, ordering hospitals to monitor for cases of bird flu and pneumonia without clear causes, the official Xinhua News Agency reported.

[Byline: Fu Ting]
-- Communicated by: ProMED-mail Rapporteur Kunihiko Iizuka

In holiday season, PHI Bangalore has no stock of yellow fever vaccine

Kavitha K, March 24, 2013, DHNS:

Are you planning an African safari this summer? A getaway to the Serengeti in Tanzania to film the wildebeest and stalk the Big Five? Be warned. Your plans could go very wrong. All because of a seemingly small yet significant detail called the yellow fever vaccine. Rather, the lack of it in the State’s Public Health Institute.

The Public Health Institute, Bangalore, the only designated centre in the State authorised to administer the vaccine, has been pleading ‘No Stock’ for two months now.

Worse, the ‘No Stock’ syndrome seems to apply only to the PHI, where a dose of the vaccine costs Rs 200. In the open market, pharmacists not only have adequate stock of the vaccine, they also sell a single dose at Rs 1,534.

Desperate travellers have little choice but to fork out a small fortune for the vaccine, which they then carry to the PHI which administers it.

Why isn’t PHI being proactive in procuring the much-in-demand vaccine? “Yes, the number of people asking for the yellow fever vaccine is high during the holiday season. We give nearly 100 vaccinations every Wednesday, but for two months, we have had no stock. The vaccine comes to us from Kasauli in Himachal Pradesh,” says Dr Jaikumar, deputy director and in-charge joint director, PHI Bangalore.

Has the PHI been following up the shortage issue with the Central Research Institute (CRI), Kasauli? “Of course, but I cannot pressurise them,” he adds.

Pharmacies not hit

Paucity in the PHI is contrasted by plentiful stocks in some pharmacies in the City. Nearly 30-40 vaccines are sold a month during the holiday season in these pharmacies. They too say the vaccine is in short supply, but manage to get it on demand. A well-known pharmacy on Residency Road was able to procure three doses of the vaccine Stanmaril, manufactured by Sanofi Pasteur SA, based in Lyon, France, and imported and marketed in India by Sanofi Pasteur India Pvt Ltd, Navi Mumbai, in less than 12 hours of placing a request, at Rs 1,534 a dose.

“Perhaps they have unsold stocks,” suggests Dr Jaikumar.

Those who have air tickets booked and safari schedules blocked prefer buying the vaccine for a hefty price at a pharmacy rather than bite their nails in frustration after making daily calls to the PHI to check on the availability of the vaccine.

Travellers’ travails

“Every time I call the PHI, I am told, ‘No vaccine. We do not know when it will come’. The PHI website has no status updates on the availability of the vaccine,” says Sarah C, who is travelling with her family to Kenya in April.

The vaccination, valid for 10 years once taken, has a 20-day incubation period, which makes it necessary for first-time travellers to plan their vaccination schedule.
Failure to take the vaccination may get one past immigration, but would certainly mean quarantine for 10 days, on return, in a government hospital.

A travel agent said she has been advising her clients to take the vaccine in Mumbai or Chennai.

Interestingly, not many travel agents, including the biggies in the business, are aware of the availability of the yellow fever vaccine in pharmacies in the City.

Their best bet, if the PHI is out of stock, is to refer clients to the King Institute of Preventive Medicine, Guindy, Chennai, or the Institute of Preventive Medicine, Hyderabad.

“Not just the PHI, all designated government health centres across the country have no stock,” says Dr Jaikumar.

While the Institute of Preventive Medicine, Hyderabad, did say on the phone that they were out of stock, a phone call to King Institute in Chennai was answered with, “Yes, we have some vaccines. We cannot tell you how many. You need to come here and find out.”

Going by the growing requests to pharmacies and PHI’s ‘wait and see’ approach, holiday-goers have little choice but to swallow the cynicism and stretch the wallet so that they can board their flight in peace.

Source

Comment: As stated in my last blog the shortage has now spread to the entire country, including the private sector, and the vaccine is no longer available anywhere, in government / private sector in any significant quantities. 

Shortage of Yellow Fever Vaccine in India

There is a severe shortage of Yellow Fever Vaccine in India in the government as well as private sector leading to a lot of difficulty for travelers going to Africa & South America.
We had been getting reports of shortage from Ahmedabad, Chennai & Bangalore, but now the vaccines seems to have disappeared completely from all over India.
We have been unable to procure the vaccine in private sector from the vaccine manufacturer (Sanofi Pasteur) as well. According to highly placed sources in the comapny who declined to be identified, the shortage is the result of government of India delaying the sanction of the new batch of Yellow Fever Vaccine. According to them, the vaccine is likely to remain unavailable till at least May end/ June.
Our stock is likely to get exhausted very soon. We will intimate further availability of the Vaccine as soon as we get fresh stock.
Posted on 6th April 2013

Lancet Study assesses links between travel and STIs

Article type: PRIMARY

From Lancet Infect Dis. 2013;13:205-13.

PMID 23182931

What factors increase the risk of acquiring sexually transmitted infections while travelling?

Background

Travel is thought to be a risk factor for the acquisition of sexually transmitted infections (STIs), but no multicentre analyses have been done. We aimed to describe the range of diseases and the demographic and geographical factors associated with the acquisition of travel-related STIs through analysis of the data gathered by GeoSentinel travel medicine clinics worldwide.

Methods

We gathered data from ill travellers visiting GeoSentinel clinics worldwide between June 1, 1996, and Nov 30, 2010, and analysed them to identify STIs in three clinical settings: after travel, during travel, or immigration travel. We calculated proportionate morbidity for each of the three traveller groups and did logistic regression to assess the association between STIs and demographic, geographical, and travel variables.

Findings

Our final analysis was of 112 180 ill travellers—64 335 patients seen after travel, 38 287 patients seen during travel, and 9558 immigrant patients. 974 patients (0·9%) had diagnoses of STIs, and 1001 STIs were diagnosed. The proportionate STI morbidities were 6·6, 10·2, and 16·8 per 1000 travellers in the three groups, respectively. STIs varied substantially according to the traveller category. The most common STI diagnoses were non-gonococcal or unspecified urethritis (30·2%) and acute HIV infection (27·6%) in patients seen after travel; non-gonococcal or unspecified urethritis (21·1%), epididymitis (15·2%), and cervicitis (12·3%) in patients seen during travel; and syphilis in immigrant travellers (67·8%). In ill travellers seen after travel, significant associations were noted between diagnosis of STIs and male sex, travelling to visit friends or relatives, travel duration of less than 1 month, and not having pretravel health consultations.

Interpretation

The range of STIs varies substantially according to traveller category. STI preventive strategies should be particularly targeted at men and travellers visiting friends or relatives. Our data suggest target groups for pretravel interventions and should assist in post-travel screening and decision making.

Matteelli A, Schlagenhauf P, Carvalho AC, et al. Travel-associated sexually transmitted infections: an observational cross-sectional study of the GeoSentinel surveillance database. Lancet Infect Dis. 2013;13:205-13.