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Abstract

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Conclusion
  7. Declaration of Interests
  8. References

Background

Globally, the Swiss have one of the highest proportions of the population traveling to tropical and subtropical countries. Large travel clinics serve an increasing number of customers with specific pre-travel needs including uncommon destinations and preexisting medical conditions. This study aims to identify health characteristics and travel patterns of travelers seeking advice in the largest Swiss travel clinic so that tailored advice can be delivered.

Methods

A descriptive analysis was performed on pre-travel visits between July 2010 and August 2012 at the Travel Clinic of the Institute of Social and Preventive Medicine, University of Zurich, Switzerland.

Results

A total of 22,584 travelers sought pre-travel advice. Tourism was the main reason for travel (17,875, 81.5%), followed by visiting friends and relatives (VFRs; 1,715, 7.8%), traveling for business (1,223, 5.6%), and “other reasons” (ie, volunteer work, pilgrimage, study abroad, and emigration; 1,112, 5.1%). The main travel destination was Thailand. In the VFR group, the highest proportions of traveling children (258, 15.1%) and of pregnant or breastfeeding women (23, 3.9%) were observed. Mental disorders were more prominent in VFRs (93, 5.4%) and in travel for “other reasons” (63, 5.7%). The latter stayed for the longest periods abroad; 272 (24.9%) stayed longer than 6 months. VFR travelers received the highest percentage of yellow fever vaccinations (523, 30.5%); in contrast, rabies (269, 24.2%) and typhoid vaccinations (279, 25.1%) were given more often to the “other travel reasons” group.

Conclusions

New insights into the characteristics of a selected and large population of Swiss international travelers results in improved understanding of the special needs of an increasingly diverse population and, thus, in targeted preventive advice and interventions.

Among the billion international travels per year,[1] 10 million international trips were undertaken by the 8 million residents of Switzerland.[2] This includes an estimated 1.5 million journeys to tropical and subtropical areas.

The exposure and susceptibility of travelers to health risks are related to the destination,[3] reason for travel,[4-6] travel duration,[7] behavioral factors, and preexisting medical conditions.[8, 9] Crucial to adequate pre-travel health advice is well-founded knowledge of these characteristics. Clients with a need for specific advice are often seen at the largest Swiss Travel and Vaccination Clinic [Zentrum für Reisemedizin (ZRM)], an institution of the University of Zurich. It has been shown that travelers with a higher risk are more likely to seek pre-travel advice at specialized clinics,[10] the majority being referred by practicing physicians.[11] There is a limited number of publications on characteristics of travelers counseled in travel clinics,[12-18] but such data on Swiss travelers seeking advice in specialized clinics are largely unknown. In this article, we present the travel plans, demographic attributes, and reported health conditions of individuals who sought pre-travel advice at ZRM between July 2010 and August 2012.

Methods

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Conclusion
  7. Declaration of Interests
  8. References

Data Collection

At ZRM, all individuals completed an electronic form available in German, English, French, and Italian in a closed electronic system before their consultations. The forms included information on gender, age, date of birth, nationality, country of residence, travel destination, reason for travel [tourism, business, visiting friends and relatives (VFR, not limited to ethnic determinants) or “other reason”], travel style (luxury, middle class, or backpacking), departure date, length of stay, medical history including chronic diseases, allergies, and pregnancies. “Other reasons for travel” included, for example, volunteer work, religious reasons, studying abroad, and emigration. Physicians verified the information and added data on prescribed vaccinations, antimalarials, antibiotics, other medications and/or materials, for example, for personal protection against mosquito bites or deep vein thrombosis.

Data Cleaning and Analysis

Travel destinations were captured by an automated algorithm. Spellings that were not captured by the initial coding were manually assigned the country-specific code. Information on visited cities and/or geographical areas was assigned the corresponding country code. Countries were categorized into regions using the Center for Disease Control and Prevention classification.[19] Destinations that could not be uniquely allocated to one country (eg, Borneo could be Malaysia, Brunei, or Indonesia) were included only in geographical regions.

Countries were classified into low, medium, medium/high, high, and “extreme” medical risk categories according to International SOS.[20] When several countries were visited during a trip, only the one with the highest medical risk was considered. Age was categorized according to competence of the immune system. The percentage of pregnant and breastfeeding women was calculated in the group of women of childbearing age (15–49 years).

For a few medical conditions, clients could tick checkboxes directly. However, to identify additional preexisting medical conditions, all remarks were checked manually.

Data were analyzed anonymously with Stata 12.0.[21] Univariate and bivariate analyses were performed. Differences in proportions were assessed using a chi-square test. For continuous variables with a non-normal distribution the median was reported and non-parametric tests (Wilcoxon–Mann–Whitney test) were performed. A logistic regression was performed to adjust for potential confounders, where applicable. A map illustrating the most common destinations was produced using ArcGIS 10.1.[22]

Ethical Issues

For this non-interventional retrospective study no ethics committee approval was required.

Results

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Conclusion
  7. Declaration of Interests
  8. References

Traveler Demographics

Between July 2010 and August 2012, a total of 35,177 clients consulted the ZRM, but 6,160 were excluded from this analysis because they only needed a second or booster vaccine dose and 6,433 were non-travelers, for example, requesting influenza immunization. During this period, 22,584 pre-travel advice consultations were provided and, hence, they were in this analysis. Out of these, 20,073 clients came once to ZRM for pre-travel counseling; 1,114 came twice; and 90 clients came at least three times.

Slightly more than half of the included population was female (Table 1). The median age was 33.2 years (range 19 days to 89 years); 3.8% travelers were younger than 16 years, including 41 (0.2%) infants younger than 1 year, 70 (0.3%) children aged 1 to 2, 153 (0.7%) children aged 2 to 5, and 600 (2.7%) children aged 5 to 15 years. Advice seekers between 60 and 70 years of age accounted for 1,674 (7.3%) consultations and 419 (1.9%) clients were 70 years or older. Almost 10% of tourists and VFRs were 60 years or older, but among VFR travelers a particularly high proportion was younger than 16 years old.

Table 1. Demographics and health characteristics of travelers (n = 22,584) presenting for pre-travel advice at the Travel Clinic of the Institute of Social and Preventive Medicine, University of Zurich between July 2010 and August 2012
 Reason for travela 
All (n = 22,584) n (%)Tourists (n = 17,875) n (%)Business (n = 1,223) n (%)VFR (n = 1,715) n (%)Other (n = 1,112) n (%)   p Value
  1. HIV = human immunodeficiency virus; IMID = immune-mediated inflammatory disease; VFR = visiting friends and relatives.

  2. a

    Reason for travel was missing in 659 visits.

  3. b

    In 11 gender unknown.

  4. c

    Chi-square test.

  5. d

    Age unknown in 13 persons.

  6. e

    Including thyroid gland, cardiovascular diseases, HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), diabetes mellitus, organ transplantation in medical history, benign and malignant tumors, immune-mediated inflammatory diseases, mental disorders, epilepsy, therapy with anticoagulation (phenprocoumon), migraine, gout, osteoporosis, attention deficit hyperactivity disorders, prostatic hyperplasia, Alzheimer's disease, and Parkinson's disease.

  7. f

    Include depression, schizophrenia, anxiety disorders, and eating disorders.

  8. g

    Include cardiac diseases, hyperlipidemia, hypertension, or history of stroke.

  9. h

    IMID include rheumatical, neurological, dermatological, gastroenterological, and endocrinological diseases.

  10. i

    HIV, diabetes mellitus, tumor, transplant [immunosuppressive therapy (without immune-mediated inflammatory diseases)].

  11. j

    Only women between the age of 15 and 49 were included (n = 9005), based on women reporting to be pregnant or maybe pregnant or breastfeeding, in 4 the reason for traveling was unknown.

  12. k

    Fisher's exact test.

Genderb
Male10,825 (48.0)8,420 (47.1)826 (67.5)799 (46.6)470 (42.3)<0.001c
Female11,748 (52.0)9,454 (52.9)396 (32.4)914 (53.3)641 (57.6)
Age (years)d
<16864 (3.8)506 (2.8)16 (1.3)258 (15.1)45 (4.1)<0.001c
16–<6019,641 (87.0)15,660 (87.7)1,144 (93.6)1,314 (76.7)1,017 (91.5)
≥602,066 (9.2)1,699 (9.5)62 (5.1)142 (8.3)50 (4.5)
Preexisting medical condition
Chronic diseasee
Overall3,431 (15.3)2,703 (15.2)175 (14.4)291 (17.0)168 (15.2)0.212c
Mentalf987 (4.4)767 (4.3)46 (3.8)93 (5.4)63 (5.7)0.018c
Epilepsy179 (0.8)145 (0.8)6 (0.5)16 (0.9)12 (1.1)0.420c
Cardiog397 (1.8)317 (1.8)26 (2.1)24 (1.4)18 (1.6)0.496c
IMIDh412 (1.8)337 (1.9)20 (1.6)28 (1.6)15 (1.4)0.499c
Other immunocompromisedi244 (1.1)175 (1.0)12 (1.0)33 (1.9)14 (1.3)0.003c
Allergy/asthma5,970 (26.4)4,747 (26.6)378 (30.9)391 (22.8)332 (29.9)<0.001c
Pregnancy/breastfeedingj115 (1.3)78 (1.1)3 (0.9)23 (3.9)7 (1.3)<0.001k

Travel Purposes and Patterns

Tourism was the most common travel reason (81.5%). Others included VFR (7.8%), business (5.6%), and “other reasons for travel” (5.1%, Table 2).

Table 2. Travel patterns of travelers (n = 22,584) presenting for pre-travel advice at ZRM between July 2010 and August 2012
 Reason for travela 
All (n = 22,584) n (%)Tourists (n = 17,875) n (%)Business (n = 1,223) n (%)VFR (n = 1,715) n (%)Other (n = 1,112) n (%)p Valueb
  1. VFR = visiting friends and relatives; ZRM = Zentrum für Reisemedizin.

  2. a

    Reason for travel was missing in 659 visits.

  3. b

    Chi-square test.

  4. c

    During one trip several destinations may have been traveled to.

  5. d

    Travel destination unknown in 366 visits.

  6. e

    As defined by International SOS, highest risk country per trip was taken into account.[20]

  7. f

    Travel style unknown in 366 visits.

  8. g

    Duration of stay unknown in 619 visits.

  9. h

    Time between travel advice and departure unknown in 845 visits.

Destination regionscSoutheast Asia 5,367 (18.8)Southeast Asia 4,813 (20.7)South Asia 261 (16.7)West Africa 395 (21.3)Tropical South America 218 (16.5) 
Tropical South America 4,435 (15.5)Tropical South America 3,650 (15.7)West Africa 239 (15.2)Tropical South America 319 (17.2)East Africa 163 (12.3)
East Africa 3,774 (13.2)East Africa 3,063 (13.2)East Africa 226 (14.4)Central Africa 311 (16.8)Southeast Asia 162 (12.2)
Destination countriesd, c  (top 5 destinations)Thailand 2,462 (6.1)Thailand 2,255 (6.5)India 226 (11.8)Cameroon 150 (7.1)India 121 (6.9) 
India 2,409 (5.9)India 1,928 (5.6)Brazil 73 (3.8)Brazil 119 (5.6)South Africa 75 (4.3)
Tanzania 2,046 (5.0)Tanzania 1,840 (5.3)China 72 (3.8)Ghana 107 (5.1)Thailand 67 (3.8)
Brazil 1,724 (4.3)Brazil 1,427 (4.1)Kenya 72 (3.8)Kenya 98 (4.7)Brazil 66 (3.8)
Peru 1,548 (3.8)Vietnam 1,418 (4.1)Nigeria 69 (3.6)India 95 (4.5)Ecuador 61 (3.5)
Travel to medical risk arease
Low risk270 (1.3)170 (1.0)20 (1.7)12 (0.7)68 (6.3)<0.001
Medium risk1,636 (7.6)1,366 (7.8)43 (3.6)96 (5.6)131 (12.1) 
Medium/high risk9,600 (44.4)8,210 (46.6)452 (37.4)515 (30.2)423 (39.1) 
High risk6,849 (31.2)5,725 (32.5)276 (22.8)587 (34.4)261 (24.1) 
Extreme risk3,271 (15.1)2,157 (12.2)419 (34.6)496 (29.1)199 (18.4) 
Travel stylef
Luxury3,411 (15.4)2,383 (13.5)404 (33.3)142 (8.3)67 (6.1)<0.001
Middle class10,551 (47.5)8,046 (45.4)653 (53.7)1,260 (73.8)551 (50.0) 
Backpacking8,256 (37.2)7,293 (41.2)158 (13.0)305 (17.9)485 (44.0) 
Duration of stay (days)g
1–7773 (3.5)344 (2.0)329 (27.6)51 (3.0)28 (2.6)<0.001
8–144,957 (22.6)3,982 (22.6)336 (28.2)420 (24.8)111 (10.2) 
15–289,629 (43.8)8,300 (47.1)209 (17.5)806 (47.7)164 (15.0) 
29–904,203 (19.1)3,366 (19.1)156 (13.1)338 (20.0)285 (26.1) 
>902,403 (10.9)1,623 (9.2)163 (13.7)76 (4.5)503 (46.1) 
Presentation at travel center before departure (days)h
1–72,289 (10.5)1,627 (9.3)235 (19.9)261 (15.5)106 (10.1)<0.001
8–143,107 (14.3)2,345 (13.4)272 (23.0)302 (17.9)124 (11.8) 
15–212,842 (13.1)2,285 (13.1)180 (15.2)230 (13.7)101 (9.6) 
22–282,452 (11.3)1,995 (11.4)131 (11.1)173 (10.3)103 (9.8) 
>2811,048 (50.8)9,191 (52.7)365 (30.9)718 (42.6)621 (58.9) 

Median travel duration was 21 days (range 1–1,680). Pre-travel advice was sought on a median 29 days (range 0–788) before the trip; 1.2% of travelers presented to ZRM the day before, or on the day of traveling (Table 2).

The top travel destination was Thailand (Table 2, Figure 1). Overall, 61.6% of clients traveled to one country, while 32.0% planned to visit two to four countries during one trip; the remaining had five or more countries (maximum of 16) in their travel plan. In Africa, the majority traveled to one country (72.6%), whereas in America and Oceania, about half of the travelers visited at least two countries. In Asia, many travelers planned to visit only one country (62.4%), except for Southeast Asia, where 45.4% had more than one country listed as their destination.

image

Figure 1. Travel destinations of Zentrum für Reisemedizin (ZRM) clients.

Download figure to PowerPoint

Three quarters of trips were classified as medium/high or high medical risk, and 15.1% of journeys were planned to countries of “extreme” medical risk (Table 2).

Medical Conditions

A total of 15.3% travelers had preexisting medical conditions (Table 1). Out of the travelers aged 60 and above, 43.3% (n = 890) were affected by a chronic disease, compared to 12.9% (n = 2,513) aged 16 to 60 years, and 3.3% (n = 28) with an age below 16 years (p < 0.001). Over a quarter reported an allergic disorder/asthma (Table 1).

Differences of Travel Patterns Between Travel Groups

While the median journey of tourists and VFR travelers lasted 21 days, business travelers stayed for shorter (median 14 days) durations and “other travelers” stayed remarkably longer (median 84 days, p < 0.0001). The percentage of business travelers who undertook trips of seven or fewer days was 27.6. Almost a quarter of “other travelers” stayed longer than 6 months.

Business travelers were more likely to travel luxuriously than the other groups. More than 40% of tourists and “other travelers” preferred a backpacking style (Table 2). More than 90% (n = 1,863) of travelers aged 60 years and above indicated a middle or luxury travel style, while more than 40% (n = 7,957) of travelers between 16 and 60 years preferred a low-budget style.

Whereas some 10% of tourists and “other travelers” visited ZRM 1 week or less before departure, a higher percentage of business and VFR travelers consulted the Travel Clinic at a much later time point (Table 2). While only around 1% of tourists, VFR travelers, and “other travelers” came on the departure day or 1 day before, business travelers presented more often on a last-minute basis (2.5%).

Differences in Travel Destinations Between Travel Groups

While Thailand was the most popular country among tourists, the top destination of business travelers and “other travelers” was India; most VFR travelers went to Cameroon (Table 2).

Business and VFR travelers visited “extreme” medical risk countries more often than the remaining groups (Table 2).

Differences in Preexisting Medical Conditions Between Travel Groups

While chronic diseases were equally distributed among the different travel groups, mental disorders were more prevalent in travelers “for other reasons” and VFR travelers. Fewer VFR travelers reported an allergic disorder/asthma than tourists, business travelers, and travelers “for other reasons” (Table 1).

Vaccinations

Hepatitis A was the most commonly administered vaccination, followed by yellow fever vaccination. Vaccinations against tetanus/diphtheria and typhoid fever were also common (Table 3).

Table 3. Administered vaccinations in travelers (n = 22,584) presenting for pre-travel advice at ZRM between July 2010 and August 2012
 Reason for travela 
All (n = 22,584) n (%)Tourists (n = 17,875) n (%)Business (n = 1,223) n (%)VFR (n = 1,715) n (%)Other (n = 1,112) n (%)   p Value
  1. MMR = mumps, measles, rubella; VFR = visiting friends and relatives; ZRM = Zentrum für Reisemedizin.

  2. a

    Reason for travel was missing in 659 visits.

  3. b

    Chi-square test.

  4. c

    Fisher's exact test.

Yellow fever4,985 (22.1)3,763 (21.1)298 (24.4)523 (30.5)199 (17.9)<0.001b
Hepatitis A6,612 (29.3)5,359 (30.0)375 (30.7)419 (24.4)281 (25.3)<0.001b
Hepatitis B2,651 (11.7)2,101 (11.8)150 (12.3)172 (10.0)145 (13.0) 0.072b
Typhoid fever3,918 (17.4)2,995 (16.8)229 (18.7)341 (19.9)279 (25.1)<0.001b
Tetanus/diphtheria4,664 (21.3)3,791 (21.2)297 (24.3)356 (20.8)220 (19.8) 0.038b
Polio3,213 (14.2)2,470 (13.8)235 (19.2)263 (15.3)148 (13.3)<0.001b
Rabies2,227 (9.9)1,666 (9.3)147 (12.087 (5.1)269 (24.2)<0.001b
Japanese encephalitis187 (0.8)129 (0.7)23 (1.9)5 (0.3)29 (2.6)<0.001b
Meningococcal ACWY254 (1.1)105 (0.6)28 (2.3)32 (1.9)71 (6.4)<0.001b
MMR2,564 (11.4)2,026 (11.3)171 (14.0)184 (10.7)117 (10.5) 0.021b
Varicella46 (0.2)37 (0.2)2 (0.2)1 (0.1)2 (0.2)  0.67c

One quarter of VFR travelers and “other travelers” received a hepatitis A vaccination compared with about one third of tourist and business travelers. A remarkably higher percentage of VFR travelers obtained a yellow fever vaccination compared with the other three groups. Typhoid and rabies vaccinations were given much more often to “other travelers” compared with the remaining groups. Even after taking travel duration, travel style, and visit to high-risk countries into account, this difference remained.

Business travelers were more often vaccinated against tetanus/diphtheria, polio and mumps, measles, and rubella (MMR, Table 3).

Discussion

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Conclusion
  7. Declaration of Interests
  8. References

Demographic Aspects

At ZRM, almost 10% of advice seekers were aged 60 or above, which is a reflection of the general Swiss travel population as shown by a Zurich airport survey looking at travelers to tropical and subtropical destinations.[23] This study also demonstrated that only a small proportion of Swiss travelers consulted a specialized Travel Clinic (228/946, 24%), while, for example, 412 (44%) consulted their general practitioner, and 156 (17%) sought information on the Internet.

Destinations

The primary destination of ZRM clients was found to be Thailand (6.1%), which is similar to findings from a Swedish study.[12] On the contrary, Senegal was the top travel destination in a French study;[13] India, in a study of 18 US Travel Clinics;[24] the Dominican Republic, in a Boston airport study;[14] and sub-Saharan Africa, in a Spanish study.[16] Cameroon and other countries where yellow fever vaccination is mandatory or recommended are probably over-represented in our travel population since ZRM is an authorized yellow fever vaccination clinic.

Although Switzerland completes three to four times more trading deals with China compared with India,[25] this was not represented in the business travelers seeking advice at ZRM, where three times more business travelers were going to India (11.8%) compared with China (3.8%). This could be explained by the special situation in Zurich where the technical university of Zurich [Eidgenössische Technische Hochschule (ETH)] maintains close collaboration and exchange with India.

Compared with the other groups, a relatively high percentage of business travelers visited “extreme” medical risk countries (34.6%) according to the SOS International classification.[20] This was perhaps because business potential is greater in countries with generally lower standards, including provision of medical services. But where in these countries of “extreme” medical risk did business travelers go? Were these travelers really exposed to “extreme” medical risks? Did the traveler go to Nigeria for business meetings and did he stay in a five-star hotel in Lagos or was he an election monitor in rural Sudan? Information on travel to medical risk areas (eg, stay in rural or urban areas) could not be collected. This would also be of interest in VFR travelers where it is perceived that travelers nowadays are more likely to visit their families in urban areas with higher living standards, as compared with rural areas in the past.

Furthermore, no detailed information on travel destinations to risk areas within a country, where specific diseases are prevalent, for example, malaria or dengue fever, was recorded.

Medical Conditions

Not only travelers visiting uncommon destinations and undertaking unusual travel activities, but also those requiring special attention owing to preexisting medical conditions seek advice in this highly specialized Travel Clinic.[11] Thus, customers at ZRM are unlikely to be a typical sample of travelers.

Overall, around 15% of ZRM travelers reported a chronic disease, which is remarkably lower than in the general Swiss population (around 27%): a finding that was apparent across all age groups except for those 60 years and older. Here, the prevalence of chronic conditions is surprisingly similar to ZRM travelers (around 40%).[26] Travelers with chronic diseases are usually in a stable phase of the disease and hence choose to travel overseas. However, they still require special advice.[27]

The burden of mental disorders among ZRM travelers was similar to that seen in the general Swiss population (4.4% vs 5%).[28] Interestingly, mental conditions were seen more often in “other travelers” and VFRs. This higher percentage of mental problems in immigrants from developing countries (who, we hypothesize, account for the majority of VFR travelers in our population) could be explained by the chronic stressful experience of a permanent outsider status in the country of residence and the stress often caused by a low socioeconomic status.[29, 30] The reason for the higher percentage of mental problems in “other travelers” remains less clear.

It was noticeable that the prevalence of allergies/asthma was much lower in VFR travelers compared with the remaining groups. Although there is a paucity of data regarding the prevalence of allergies/asthma in developing countries, it is currently assumed that prevalence rates are lower in individuals from these areas.[31, 32]

However, data on health conditions may be incomplete or incorrect because some questions may have been misinterpreted by clients or some information may deliberately have been withheld from the physician.[33]

Vaccinations

Typhoid and rabies vaccinations were prescribed more often to travelers “for other reasons” than to other groups. According to Swiss recommendations, these vaccinations are indicated for longer international trips and for areas without access to medical care.[34] But in this analysis, the difference remained even after taking travel style, travel duration, and visits to high-risk countries into account, and it is suspected that the difference was partly because of visits to remote areas with limited access to medical care. This illustrates the need to gather more detailed information on travel itineraries.

Looking at performed vaccinations, it was remarkable that a higher percentage of business travelers required tetanus/diphtheria and MMR vaccinations than other travel groups. A reason for this might be that business travelers without an acute travel situation do not have time to visit their general physicians on a regular basis and therefore their vaccination status may not be up to date.

Additional Limitations

Additional limitations could include some questions in the health declaration forms, for example, travel reasons, were insufficiently defined. Especially “other travel reasons,” should be subcategorized, for example into education/research, volunteer work, emigration/long-term stay, and religious reasons. Recording more detailed travel itineraries would also help in a better assessment of the risks in specific countries. This information could be used to better categorize visited areas of risk not only for the individual traveler (eg, urban vs rural stay, stay in an area where specific infections are prevalent) but also for public health aspects, because of an increasing number of infections being imported by travelers to their home countries.[35]

Another important limitation is the underestimation of administered vaccinations, as only travel consultations were considered and not visits for second or booster vaccine doses. However, many travel-related vaccinations were also given during those consultations. Overall, during the 25-month study period, a total of 24,757 vaccine doses were injected; additionally, 4,215 doses of oral Ty21a vaccine were sold for ingestion at home.

It would have been of value to report data on malaria prophylaxis or stand-by treatment. But in our system only medication directly given out from ZRM was captured. Unfortunately, the recorded data did not differentiate between medications given out for prophylaxis or stand-by treatment and prescriptions for external pharmacies were not recorded at all.

Conclusion

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Conclusion
  7. Declaration of Interests
  8. References

European travelers account for the majority of travelers to tropical and subtropical countries.[36] This study provides an insight into the travel destinations, travel patterns, and medical conditions of a selected large population of travelers seeking advice at a large Swiss Travel Clinic. With the Swiss population having one of the highest proportions of international travelers these findings are also of importance in an international context. In light of the high number of international travelers with a need for specific advice, pre-travel information generated from the clients should be more detailed. This would enable the health professionals to give more targeted advice and to select the precise interventions needed. A synthesis of data from different European Travel Clinics, specialized physicians, and general practitioners, ideally by a uniform data collection system, would be a useful extension of the database to help adapt pre-travel advice to the special needs of an important and heterogeneous population.

Declaration of Interests

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Conclusion
  7. Declaration of Interests
  8. References

The authors state that they have no conflicts of interest to declare.

References

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Conclusion
  7. Declaration of Interests
  8. References
image

This place is located on the Lindenhof in the old historic city centre of Zurich, Switzerland. It serves as a recreational space for local people and its elevated position makes it a favorite point for tourists to get an overview of Zurich. Photo Credit: Eric Caumes