Description

With the summer holidays fast approaching it is appropriate that The National Travel Health Network and Centre (NaTHNaC) has published a comprehensive report on infection acquired abroad1 and so has some interesting data on UK travel trends, mortality in travellers and a brief section on non-infectious morbidity (road accidents, DVT’s and PE’s). It does not mention violent trauma which unfortunately is increasingly reported not just by the media but also by travel medicine literature.2 60 million visits abroad were made by UK residents in 2002. This is three times more than those who travelled in 1981.

It should come as no surprise that food poisoning and travellers’ diarrhoea are the most commonly reported travel associated infections. However a point that is constantly repeated throughout the report is that travel history is under-reported and that existing surveillance systems are inadequate. It is not usually possible to distinguish imported disease in travellers from imported disease in immigrants or foreign visitors. There is little information about prophylactic measures to determine their effectiveness and better inform pre-travel advice. Most surveillance does not collect information on outcome.

Despite the limitations of current surveillance, the report presents an impressive array of data with excellent charts and graphs. It records some interesting trends. In the past 20 years imported typhoid infections have declined while paratyphoid infections have increased. Most imported cholera is acquired in the Indian subcontinent. Imported Hepatitis A has declined since 1990. Small numbers of Hepatitis E are reported each year.

Malaria is the most common arthropod-borne imported infection with the predominant Plasmodium species having changed from vivax to falciparum in recent years. Two thirds of UK falciparum cases occur amongst the African population living in London. And most have taken no prophylaxis in highly malarious areas.

Over half of UK-born heterosexuals diagnosed with HIV were probably infected abroad, ten percent in Thailand. Sentinel surveillance of gonorrhoea suggests that 10-20% of cases may have had sexual contact abroad in the preceding three months.

The extent of travel-associated tuberculosis is unknown whereas in contrast there is excellent European wide surveillance of Legionellosis which works well with health authorities and the travel industry. The emergence of SARS in 2003 and its rapid worldwide spread emphasises the importance of travel in the global epidemiology of disease.

The few cases of imported rabies occur in people who have failed to receive appropriate preand/ or post-exposure prophylaxis. There are chapters on other anthropoid-borne infections, schistosomiasis, viral haemorrhagic fever, Lyme disease and leptospirosis.

This is an excellent report which highlights and provides suggested solutions for improvement in surveillance. I recommend it as an education read. It is a subject on which we may concentrate in a future edition. NaTHNaC have a web site at www.nathnac.org.

There are a number of case reports in this issue and we would like to encourage submission of more of these. Case reports have become less acceptable to journals publishing research and this is probably quite correct. However they do play an important educational role. They give the reader an opportunity to consider a clinical scenario and think about the diagnostic and therapeutic options. We all have educationally valuable cases. They do not have to be rare and unusual diagnoses. Please think about writing them up and submitting them.