O'Brien Daniel P, Leder Karin, Matchett Elizabeth, Brown Graham V, Torresi Joseph
Victorian Infectious Diseases Service, Centre for Clinical Research Excellence, Royal Melbourne Hospital, Victoria, Australia.
J Travel Med. 2006 May-Jun;13(3):145-52. doi: 10.1111/j.1708-8305.2006.00033.x.
Data comparing returned travelers and immigrants/refugees managed in a hospital setting is lacking.
We prospectively collected data on 1,106 patients with an illness likely acquired overseas who presented to two hospital-based Australian infectious diseases units over a 6-year period.
Eighty-three percent of patients were travelers and 17% immigrants/refugees. In travelers, malaria (19%), gastroenteritis/diarrhea (15%), and upper respiratory tract infection (URTI) (7%) were the most common diagnoses. When compared with immigrants/refugees, travelers were significantly more likely to be diagnosed with gastroenteritis/diarrhea [odds ratio (OR) 8], malaria (OR 7), pneumonia (OR 6), URTI (OR 3), skin infection, dengue fever, typhoid/paratyphoid fever, influenza, and rickettsial disease. They were significantly less likely to be diagnosed with leprosy (OR 0.03), chronic hepatitis (OR 0.04), tuberculosis (OR 0.05), schistosomiasis (OR 0.3), and helminthic infection (OR 0.3). In addition, travelers were more likely to present within 1 month of entry into Australia (OR 96), and have fever (OR 8), skin (OR 6), gastrointestinal (OR 5), or neurological symptoms (OR 5) but were less likely to be asymptomatic (OR 0.1) or have anaemia (OR 0.4) or eosinophilia (OR 0.3). Diseases in travelers were more likely to have been acquired via a vector (OR 13) or food and water (OR 4), and less likely to have been acquired via the respiratory (OR 0.2) or skin (OR 0.6) routes. We also found that travel destination and classification of traveler can significantly influence the likelihood of a specific diagnosis in travelers. Six percent of travelers developed a potentially vaccine-preventable disease, with failure to vaccinate occurring in 31% of these cases in the pretravel medical consultation.
There are important differences in the spectrum of illness, clinical features, and mode of disease transmission between returned travelers and immigrants/refugees presenting to hospital-based Australian infectious diseases units with an illness acquired overseas.
缺乏在医院环境中对归国旅行者与移民/难民进行管理的数据比较。
我们前瞻性收集了1106例可能在海外感染疾病的患者的数据，这些患者在6年期间前往澳大利亚两家医院的传染病科室就诊。
83%的患者为旅行者，17%为移民/难民。在旅行者中，疟疾（19%）、胃肠炎/腹泻（15%）和上呼吸道感染（URTI）（7%）是最常见的诊断。与移民/难民相比，旅行者被诊断为胃肠炎/腹泻的可能性显著更高[比值比（OR）8]、疟疾（OR 7）、肺炎（OR 6）、URTI（OR 3）、皮肤感染、登革热、伤寒/副伤寒热、流感和立克次体病。他们被诊断为麻风病（OR 0.03）、慢性肝炎（OR 0.04）、结核病（OR 0.05）、血吸虫病（OR 0.3）和蠕虫感染（OR 0.3）的可能性显著更低。此外，旅行者更有可能在进入澳大利亚1个月内就诊（OR 96），并出现发热（OR 8）、皮肤（OR 6）、胃肠道（OR 5）或神经系统症状（OR 5），但无症状（OR 0.1）或贫血（OR 0.4）或嗜酸性粒细胞增多（OR 0.3）的可能性更低。旅行者的疾病更有可能通过媒介（OR 13）或食物和水（OR 4）感染，而通过呼吸道（OR 0.2）或皮肤（OR 0.6）途径感染的可能性更低。我们还发现旅行目的地和旅行者分类可显著影响旅行者特定诊断的可能性。6%的旅行者患上了潜在可通过疫苗预防的疾病，其中31%的病例在旅行前医疗咨询中未接种疫苗。
前往澳大利亚医院传染病科室就诊的患有海外感染疾病的归国旅行者与移民/难民在疾病谱、临床特征和疾病传播方式上存在重要差异。
