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81. Efficacy and safety of a patch vaccine containing heat-labile toxin from Escherichia coli against travellers' diarrhoea: a phase 3, randomised, double-blind, placebo-controlled field trial in travellers from Europe to Mexico and Guatemala. (Abstract)

not protect travellers against diarrhoea caused by ETEC or other organisms. Future vaccines against travellers' diarrhoea might need to include several antigens against various diarrhoeal pathogens, and might need to be able to generate mucosal and higher systemic immunity.Copyright © 2014 Elsevier Ltd. All rights reserved. (...) Efficacy and safety of a patch vaccine containing heat-labile toxin from Escherichia coli against travellers' diarrhoea: a phase 3, randomised, double-blind, placebo-controlled field trial in travellers from Europe to Mexico and Guatemala. Enterotoxigenic Escherichia coli (ETEC) is a major cause of travellers' diarrhoea. We investigated the efficacy and safety of a skin-patch vaccine containing the pathogen's heat-labile toxin (LT) in a population of travellers to Mexico and Guatemala.In

2013 Lancet infectious diseases Controlled trial quality: predicted high

82. Standard pre-travel consultation versus shorter consultation combined with smartphone support: a randomized controlled trial. (Abstract)

of diarrhea (4), malaria prophylaxis (2), and altitude sickness prophylaxis (5). Other consultations consisted mainly of reassurances of worried travelers and provision of data. Knowledge about travel-related risks was higher in the control group before travelling (8.86 ± 1.12 versus 8.34 ± 1.32, p = 0.014), and there was a trend towards higher levels of knowledge also during the trip (8.29 ± 1.35 versus 7.89 ± 1.39 , p = 0.06). Travelers' satisfaction before and during the trip was similar in both groups (...) Standard pre-travel consultation versus shorter consultation combined with smartphone support: a randomized controlled trial. Immediate and long-term recall of a pretravel consultation are suboptimal. We aimed to assess the role of online consultation for travelers.We randomized travelers into two study groups. In the intervention arm, each traveler was given a short pre-travel consultation of 8-12 minutes, combined with the option of smartphone support before and during the trip

2019 Journal of Travel Medicine Controlled trial quality: uncertain

83. A Comparison of Pretravel Health Care, Travel-Related Exposures, and Illnesses among Pediatric and Adult U.S. Military Beneficiaries. (Abstract)

A and B (90% versus 67% of adults; 85% versus 44%), visit friends and relatives (36% versus 16%), report mosquito bites (69% versus 44%), and have close contact with wild or domesticated animals (40% versus 20%) than adults (P < 0.05). Subjects < 10 years of age were less likely to be prescribed antibiotics (28% versus 95%; RR = 0.63; 95% CI: 0.46-0.85) and antidiarrheals (9% versus 100%; RR = 0.10; 95% CI: 0.03-0.29) for travelers' diarrhea (TD) self-treatment than adults. Travel medicine providers (...) A Comparison of Pretravel Health Care, Travel-Related Exposures, and Illnesses among Pediatric and Adult U.S. Military Beneficiaries. We evaluated differences in pretravel care, exposures, and illnesses among pediatric and adult travelers, using a prospective, observational cohort. Eighty-one pediatric travelers were matched 1:1 with adult military dependents by travel region, destination's malaria risk, and travel duration. Pediatric travelers were more likely to have coverage for hepatitis

2019 American Journal of Tropical Medicine & Hygiene

84. Global Geographic Trends in Antimicrobial Resistance: The Role of International Travel. Full Text available with Trip Pro

travelers' diarrhea (other than antibiotic use) and be informed on safe sexual practices. The healthcare systems of low- and middle-income countries require investment to reduce the transmission of resistant strains by improving access to clean water, sanitation facilities and vaccines. Efforts are needed to curb inappropriate antibiotic use worldwide. In addition, more surveillance is needed to understand the role of the movement of humans, livestock and food products in resistance transmission (...) of preventing and treating travelers' diarrhea, other than use of antibiotics, and on safe sexual practices, such as condom use. Healthcare facilities need to be aware of the travel history of patients to provide appropriate treatment to those who are at high risk of exposure and to prevent further spread. Internationally, in countries without reliable and universal access to clean water, sanitation and hygiene, investment is needed to reduce the emergence and spread of resistance and ensure

2019 Journal of Travel Medicine

85. Incidence of health problems in travelers to Southeast Asia: A prospective cohort study. (Abstract)

included in the final analysis. The incidence of acute diarrhea per month per 1,000 travelers was 217 (95% confidence interval (95%CI 189-248) episodes; skin problems 197 (95%CI 170-227); respiratory symptoms 133 (95%CI 111-158); fever 49 (95%CI 36-65); and potential rabies exposure 34 (95%CI 24-48). The incidence of acute diarrhea episodes per month per 1,000 travelers was significantly higher during the first two weeks of travel compared with subsequent weeks of travel: 325 (95%CI 291-362) versus 132 (...) (95%CI 110-1157), (p<0.05). The incidence of outpatient visits and hospitalizations per month per 1,000 travelers was 49 (95%CI 36-65) and 5 (95%CI 2-10) respectively.In this prospective cohort study we observed substantial burden of acute diarrhea, skin and respiratory symptoms among travelers to Southeast Asia. The higher incidence of diarrhea in the first 2 weeks of travel should be further investigated.© International Society of Travel Medicine 2019. Published by Oxford University Press. All

2019 Journal of Travel Medicine

86. Mass Gatherings and Diarrheal Disease Transmission among Rural Communities in Coastal Ecuador. (Abstract)

discovery rate ≤ 0.05: 1.02, 1.43). Stratified analysis revealed heightened risks associated with events where crowding and travel were most likely (2-week lag IRR 1.51; CI, adjusted for false discovery rate ≤ 0.05: 1.09, 2.10). Our findings suggest that community-scale mass gatherings may play an important role in endemic diarrheal disease transmission and could be an important focus for interventions to improve community health in low resource settings.© The Author(s) 2019. Published by Oxford (...) Mass Gatherings and Diarrheal Disease Transmission among Rural Communities in Coastal Ecuador. Mass gatherings exacerbate infectious disease risks by creating crowded, high-contact conditions, and straining the capacity of local infrastructure. While mass gatherings have been extensively studied in the context of epidemic disease transmission, the role of gatherings in incidence of high-burden, endemic infections has not been previously studied. Here, we examine diarrheal incidence among

2019 American Journal of Epidemiology

87. Hyperimmune bovine colostral anti-CS17 antibodies protect against enterotoxigenic Escherichia coli diarrhea in a randomized, doubled-blind, placebo-controlled human infection model. Full Text available with Trip Pro

Hyperimmune bovine colostral anti-CS17 antibodies protect against enterotoxigenic Escherichia coli diarrhea in a randomized, doubled-blind, placebo-controlled human infection model. Enterotoxigenic Escherichia coli (ETEC) commonly cause diarrhea in children living in developing countries and in travelers to those regions. ETEC are characterized by colonization factors (CFs) that mediate intestinal adherence. We assessed if bovine colostral IgG (bIgG) antibodies against a CF, CS17, or antibodies (...) against CsbD, the minor tip subunit of CS17, would protect subjects against diarrhea following challenge with a CS17-expressing ETEC strain.Adult subjects were randomized (1:1:1) to receive oral bIgG against CS17, CsbD, or placebo. Two days prior to challenge, subjects began dosing 3 times daily with the bIgG products (or placebo). On day 3, subjects ingested 5 × 109 cfu ETEC strain LSN03-016011/A in buffer. Subjects were assessed for diarrhea for 120 hours postchallenge.A total of 36 subjects began

2019 Journal of Infectious Diseases Controlled trial quality: uncertain

88. Risk factors for contagious gastroenteritis in adult patients with diarrhoea in the emergency department - a prospective observational multicentre study. Full Text available with Trip Pro

Risk factors for contagious gastroenteritis in adult patients with diarrhoea in the emergency department - a prospective observational multicentre study. Infectious gastroenteritis is common in the emergency department (ED). Patients infected with either Norovirus or toxigenic Clostridium difficile require special isolation procedures. The aims were to describe the aetiology of infectious gastroenteritis in the ED, evaluate whether current isolation procedures, based on clinical judgement (...) are sufficient, and to identify information that might be used to identify patients requiring isolation.Prospective, observational, multicentre study. We collected information on symptoms, vital signs, travel history, the recent use of antibiotics, and infectious contacts and tested faecal samples for Norovirus, C. difficile, and enteropathogenic bacteria.The study enrolled 227 patients, of whom 163 (71%) delivered a faecal sample for Norovirus analysis (13% positive), 171 (74%) for C. difficile (13

2019 BMC Infectious Diseases

89. Illness among US Resident Student Travelers after Return to the United States: A GeoSentinel Analysis, 2007-2017. Full Text available with Trip Pro

-181) after travel; 98% were outpatients. Of 581 confirmed diagnoses, the most common diagnosis category was gastrointestinal (45%). Acute diarrhoea was the most common gastrointestinal diagnosis (113 of 261; 43%). Thirty-one (7%) students had vector-borne diseases [14 (41%) malaria and 11 (32%) dengue]. Three had vaccine-preventable diseases (two typhoid; one hepatitis A); two had acute human immunodeficiency virus infection.Students experienced travel-related infections, despite the majority (...) Illness among US Resident Student Travelers after Return to the United States: A GeoSentinel Analysis, 2007-2017. The number of US students studying abroad more than tripled during the past 20 years. As study abroad programmes' destinations diversify, students increasingly travel to resource-limited countries, placing them at risk for infectious diseases. Data describing infections acquired by US students while travelling internationally are limited. We describe illnesses among students who

2018 Journal of Travel Medicine

90. A case of multi-drug resistant ESBL-producing Shigella sonnei acute acalculous cholecystitis and gastroenteritis in a returned traveller. Full Text available with Trip Pro

A case of multi-drug resistant ESBL-producing Shigella sonnei acute acalculous cholecystitis and gastroenteritis in a returned traveller. The first case of Shigella-associated acalculous cholecystitis is described. A 27-year-old woman presented to hospital with diarrhoea and acute acalculous cholecystitis one day after return to Australia from Vietnam. Her feces culture grew multi-drug resistant ESBL-producing Shigella sonnei and she improved with antimicrobial therapy and intravenous fluids.

2018 Journal of Travel Medicine

91. A Global Survey of Gastroenterologists' Travel Advice to Patients with Inflammatory Bowel Disease on Immunosuppressive Agents and Management of Those Visiting Tuberculosis-Endemic Areas. (Abstract)

provided pre-travel advice, and to assess their management strategies for patients on biological therapies visiting tuberculosis[TB]-endemic areas.A 57-question survey was distributed to IBD physicians in 23 countries. We collected physicians' demographics, and using a standardized Likert scale, assessed physicians' agreement with stated treatment choices.A total of 305 gastroenterologists met inclusion criteria. Overall, 52% would discuss travel-related issues: travellers' diarrhoea [TD], travel (...) A Global Survey of Gastroenterologists' Travel Advice to Patients with Inflammatory Bowel Disease on Immunosuppressive Agents and Management of Those Visiting Tuberculosis-Endemic Areas. With increasing use of biological therapies and immunosuppressive agents, patients with inflammatory bowel disease[IBD] have improved clinical outcome and international travel in this group is becoming common. Adequate pre-travel advice is important. We aim to determine the proportion of gastroenterologists who

2018 Journal of Crohn's & colitis

92. Travelling with medicines in 2018 Full Text available with Trip Pro

Travelling with medicines in 2018 30116076 2018 11 14 0312-8008 41 4 2018 Aug Australian prescriber Aust Prescr Travelling with medicines in 2018. 102-104 10.18773/austprescr.2018.034 Zwar Nicholas N School of Medicine, University of Wollongong, NSW. eng Journal Article Review 2018 08 01 Australia Aust Prescr 7804938 0312-8008 Pharmaceutical Benefits Scheme contraception diabetes diarrhoea travel Conflict of interest: none declared 2018 8 18 6 0 2018 8 18 6 0 2018 8 18 6 1 ppublish 30116076 (...) 10.18773/austprescr.2018.034 austprescr-41-102 PMC6091776 Aust Prescr. 2017 Oct;40(5):168-173 29109599 Aust Prescr. 2015 Dec;38(6):186-7 26843708 Clin Infect Dis. 2012 Feb 15;54(4):455-62 22144534 Travel Med Infect Dis. 2014 Sep-Oct;12(5):505-10 25132182 BMJ Open. 2013 Aug 17;3(8):e002923 23955188

2018 Australian Prescriber

93. The effectiveness of empirical anti-parasitic treatment in returning travellers with persistent abdominal symptoms. Full Text available with Trip Pro

The effectiveness of empirical anti-parasitic treatment in returning travellers with persistent abdominal symptoms. Persistent abdominal symptoms (PAS) are common among returning-travellers. In the absence of sensitive tests to identify intestinal parasites, gastrointestinal (GI) symptoms often remain a diagnostic challenge. In this study we examined the effectiveness of empirical anti-parasitic treatment in returning-travellers with PAS despite no positive stool-test.A retrospective study (...) among returning travellers who approached the clinic between the years 2014 and 2016 with GI complaints without a positive stool-test. The empirical treatment included broad-spectrum anti-parasitic agents-oral Tinidazole and Albendazole. A follow-up questionnaire was performed at least 6 months post-treatment.A total of 102 patients responded the questionnaire-50% women; average age 31.14 (±12.20) years. The average duration of complaints before treatment was 16.52 (±30.06) months. Common GI

2018 Journal of Travel Medicine

94. Incidence and spectrum of health problems among travellers to Myanmar. Full Text available with Trip Pro

likely than Thais to travel as backpackers and perform outdoor activities such as trekking, cycling or swimming. The average length of stay in Myanmar among non-Thais was significantly longer than that of Thais (26.58 days vs 7.08 days, P < 0.001). Health problems were reported by 22.9% of non-Thais; the most common was diarrhoea (21.0%) followed by upper respiratory tract symptoms (9.2%), fever (3.4%) and skin problems (3.0%). Only 12.6% of Thais reported health problems, the most common being upper (...) respiratory tract symptoms (7.6%), followed by diarrhoea (3.1%), fever (2.8%) and skin problems (2.0%). Most health problems were mild and self-limited in both groups. Only one Thai and eight non-Thai travellers required a doctor's visit during their trip to Myanmar, and two non-Thais required hospitalization.Health problems are not very common among travellers to Myanmar. Overall, health problems were reported among 18.2% of travellers in our study. Most problems were mild, with spontaneous recovery

2018 Journal of Travel Medicine

95. Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) among travellers to Africa: destination-specific data pooled from three European prospective studies. Full Text available with Trip Pro

Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) among travellers to Africa: destination-specific data pooled from three European prospective studies. One third of travellers to low- and middle-income regions of the tropics and subtropics become colonized by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). The risk varies by destination and, for each traveller, may be substantially further increased by travellers' diarrhoea (TD) and antibiotic use (...) . Despite the risk of TD in Africa, ESBL-PE acquisition rates in all studies are lower there than in Asia. Africa has become increasingly popular as a destination for international travellers, yet minimal data are available from the continent's subregions and countries.We analysed subregion- and country-specific data on carriage and risk factors for ESBL-PE colonization pooled from three prospective studies conducted between 2009 and 2013 among Finnish and Dutch travellers. The data were subjected

2018 BMC Infectious Diseases

96. Antimicrobial resistance profiles of Shigella dysenteriae isolated from travellers returning to the UK, 2004-2017. Full Text available with Trip Pro

sequenced isolates, 3.0 % (20/201) had either blaCTX-M-15 or blaCMY-4.Increasing MDR, along with resistance to the fluroquinolones and the third generation cephalosporins, in Shigella dysenteriae causing travellers' diarrhoea provides further evidence for the need to regulatethe use of antimicrobial agents and continuous monitoring of emerging AMR. (...) Antimicrobial resistance profiles of Shigella dysenteriae isolated from travellers returning to the UK, 2004-2017. Antimicrobial resistance (AMR) profiles of 754 strains of Shigella dysenteriae isolated between 2004 and 2017 from UK travellers reporting symptoms of gastrointestinal (GI) disease were reviewed to look for evidence of emerging AMR associated with travellers' diarrhoea.A travel history was provided for 72.7 % (548/754) of cases, of which 90.9 % (498/548) reported travel outside

2018 Journal of Medical Microbiology

97. Real-time incidence of travel-related symptoms through a smartphone-based app remote monitoring system: a pilot study. Full Text available with Trip Pro

Real-time incidence of travel-related symptoms through a smartphone-based app remote monitoring system: a pilot study. Trip Doctor®, a Smartphone-based app monitoring system, was developed to detect infections among travelers in real-time. For testing, 106 participants were recruited (62.2% male, mean age 36 years (SD = 11)). Majority of trips were for tourism and main destinations were in South East Asia. Mean travel duration was 14 days (SD = 10). Diarrhea was the most frequently reported

2018 Journal of Travel Medicine

98. Business travel-associated illness: a GeoSentinel analysis. Full Text available with Trip Pro

Business travel-associated illness: a GeoSentinel analysis. Analysis of a large cohort of business travelers will help clinicians focus on frequent and serious illnesses. We aimed to describe travel-related health problems in business travelers.GeoSentinel Surveillance Network consists of 64 travel and tropical medicine clinics in 29 countries; descriptive analysis was performed on ill business travelers, defined as persons traveling for work, evaluated after international travel 1 January 1997 (...) through 31 December 2014.Among 12 203 business travelers seen 1997-2014 (14 045 eligible diagnoses), the majority (97%) were adults aged 20-64 years; most (74%) reported from Western Europe or North America; two-thirds were male. Most (86%) were outpatients. Fewer than half (45%) reported a pre-travel healthcare encounter. Frequent regions of exposure were sub-Saharan Africa (37%), Southeast Asia (15%) and South Central Asia (14%). The most frequent diagnoses were malaria (9%), acute unspecified

2018 Journal of Travel Medicine

99. Recommendations for Management of Endemic Diseases and Travel Medicine in Solid-Organ Transplant Recipients and Donors: Latin America. (Abstract)

and references for each recommendation, which is available in the online version of the article, published in this journal as a supplement. The supplement contains 10 reviews referring to endemic or travel diseases (eg, tuberculosis, Chagas disease [ChD], leishmaniasis, malaria, strongyloidiasis and schistosomiasis, travelers diarrhea, arboviruses, endemic fungal infections, viral hepatitis, and vaccines) and an illustrative section with maps (http://www.pmourao.com/map/). Contributors included experts from (...) Recommendations for Management of Endemic Diseases and Travel Medicine in Solid-Organ Transplant Recipients and Donors: Latin America. The Recommendations for Management of Endemic Diseases and Travel Medicine in Solid-Organ Transplant Recipients and Donors: Latin America clinical practice guideline is intended to guide clinicians caring for solid-organ transplant (SOT) donors, candidates and recipients regarding infectious diseases (ID) issues related to this geographical region, mostly

2018 Transplantation

100. Diagnostic Value of Platelet and Leukocyte Counts in the Differential Diagnosis of Fever in the Returning Traveler. Full Text available with Trip Pro

Diagnostic Value of Platelet and Leukocyte Counts in the Differential Diagnosis of Fever in the Returning Traveler. Malaria, arbovirus infection and travelers' diarrhea are among the most common etiologies of fever after a stay in the tropics. Because the initial symptoms of these diseases often overlap, the differential diagnostic remains a challenge. The aim of this study was to establish the effectiveness of platelet and leukocyte counts in the differential diagnosis of fever (...) in the returning traveler. Between 2013 and 2016, patients with a clinical suspicion of malaria, who had thick blood smears performed were retrospectively included. The microbiological etiology of each episode was established based on molecular detection in the case of arbovirus infection, the detection of pathogens in stool samples for diarrhea and other gastrointestinal symptoms and the thick and thin blood smear results for malaria. A total of 1,218 episodes were included. Malaria, arbovirus infection

2018 American Journal of Tropical Medicine & Hygiene

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