Symptoms of Infectious Diseases in Immunocompromised Travelers: A Prospective Study With Matched Controls

Authors

  • Gijs G. Baaten MD, PhD,

    Corresponding author
    1. Department of Infectious Diseases, Public Health Service (GGD) Amsterdam, Amsterdam, The Netherlands
    2. Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, The Netherlands
    3. National Coordination Centre for Traveler's Health Advice (LCR), Amsterdam, The Netherlands
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  • Ronald B. Geskus PhD,

    1. Department of Infectious Diseases, Public Health Service (GGD) Amsterdam, Amsterdam, The Netherlands
    2. Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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  • Joan A. Kint RN,

    1. Department of Infectious Diseases, Public Health Service (GGD) Amsterdam, Amsterdam, The Netherlands
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  • Anna H.E. Roukens MD, PhD,

    1. Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
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  • Gerard J. Sonder MD, PhD,

    1. Department of Infectious Diseases, Public Health Service (GGD) Amsterdam, Amsterdam, The Netherlands
    2. Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, The Netherlands
    3. National Coordination Centre for Traveler's Health Advice (LCR), Amsterdam, The Netherlands
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  • Anneke van den Hoek MD, PhD

    1. Department of Infectious Diseases, Public Health Service (GGD) Amsterdam, Amsterdam, The Netherlands
    2. Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, The Netherlands
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Gijs G. Baaten, MD, PhD, Department of Infectious Diseases, Public Health Service (GGD) Amsterdam, PO Box 2200, 1000 CE Amsterdam, The Netherlands. E-mail: gijsbaaten@hotmail.com

Abstract

Background. Immunocompromised travelers to developing countries are thought to have symptomatic infectious diseases more often and longer than non-immunocompromised travelers. Evidence for this is lacking. This study evaluates whether immunocompromised short-term travelers are at increased risk of diseases.

Methods. A prospective study was performed between October 2003 and May 2010 among adult travelers using immunosuppressive agents (ISA) and travelers with inflammatory bowel disease (IBD), with their non-immunocompromised travel companions serving as matched controls with comparable exposure to infection. Data on symptoms of infectious diseases were recorded by using a structured diary.

Results. Among 75 ISA, the incidence of travel-related diarrhea was 0.76 per person-month, and the number of symptomatic days 1.32 per month. For their 75 controls, figures were 0.66 and 1.50, respectively (p > 0.05). Among 71 IBD, the incidence was 1.19, and the number of symptomatic days was 2.48. For their 71 controls, figures were 0.73 and 1.31, respectively (p > 0.05). These differences also existed before travel. ISA had significantly more and longer travel-related signs of skin infection and IBD suffered more and longer from vomiting. As for other symptoms, no significant travel-related differences were found. Only 21% of immunocompromised travelers suffering from diarrhea used their stand-by antibiotics.

Conclusions. ISA and IBD did not have symptomatic infectious diseases more often or longer than non-immunocompromised travelers, except for signs of travel-related skin infection among ISA. Routine prescription of stand-by antibiotics for these immunocompromised travelers to areas with good health facilities is probably not more useful than for healthy travelers.

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