Center for Infectious Diseases, School of Public Health, Houston, Texas, USA.
Clin Infect Dis. 2011 Sep;53(6):523-31. doi: 10.1093/cid/cir468. Epub 2011 Aug 10.
Mexico and Central America are important travel destinations for North American and European travelers. There is limited information on regional differences in travel related morbidity.
We describe the morbidity among 4779 ill travelers returned from Mexico and Central America who were evaluated at GeoSentinel network clinics during December 1996 to February 2010.
The most frequent presenting syndromes included acute and chronic diarrhea, dermatologic diseases, febrile systemic illness, and respiratory disease. A higher proportion of ill travelers from the United States had acute diarrhea, compared with their Canadian and European counterparts (odds ratio, 1.9; P < .0001). During the 2009 H1N1 influenza outbreak from March 2009 through February 2010, the proportionate morbidity (PM) associated with respiratory illnesses in ill travelers increased among those returned from Mexico, compared with prior years (196.0 cases per 1000 ill returned travelers vs 53.7 cases per 1000 ill returned travelers; P < .0001); the PM remained constant in the rest of Central America (57.3 cases per 1000 ill returned travelers). We identified 50 travelers returned from Mexico and Central America who developed influenza, including infection due to 2009 H1N1 strains and influenza-like illness. The overall risk of malaria was low; only 4 cases of malaria were acquired in Mexico (PM, 2.2 cases per 1000 ill returned travelers) in 13 years, compared with 18 from Honduras (PM, 79.6 cases per 1000 ill returned travelers) and 14 from Guatemala (PM, 34.4 cases per 1000 ill returned travelers) during the same period. Plasmodium vivax malaria was the most frequent malaria diagnosis.
Travel medicine practitioners advising and treating travelers visiting these regions should dedicate special attention to vaccine-preventable illnesses and should consider the uncommon occurrence of acute hepatitis A, leptospirosis, neurocysticercosis, acute Chagas disease, onchocerciasis, mucocutaneous leishmaniasis, neurocysticercosis, HIV, malaria, and brucellosis.
墨西哥和中美洲是北美和欧洲旅行者的重要旅游目的地。有关旅行相关发病率的区域性差异的信息有限。
我们描述了 1996 年 12 月至 2010 年 2 月期间，在 GeoSentinel 网络诊所接受评估的 4779 名从墨西哥和中美洲返回的患病旅行者的发病率。
最常见的表现综合征包括急性和慢性腹泻、皮肤病、发热性全身性疾病和呼吸道疾病。与加拿大和欧洲旅行者相比，来自美国的患病旅行者中急性腹泻的比例更高（优势比，1.9；P<.0001）。在 2009 年 3 月至 2010 年 2 月期间的 2009 年 H1N1 流感爆发期间，与前几年相比，从墨西哥返回的患病旅行者中与呼吸道疾病相关的发病率（PM）有所增加（每 1000 名患病返回旅行者中有 196.0 例，而每 1000 名患病返回旅行者中有 53.7 例；P<.0001）；其余中美洲地区的 PM 保持不变（每 1000 名患病返回旅行者中有 57.3 例）。我们发现 50 名从墨西哥和中美洲返回的旅行者患有流感，包括感染 2009 年 H1N1 株和流感样疾病。疟疾的总体风险较低；在 13 年中，只有 4 例疟疾在墨西哥获得（PM，每 1000 名患病返回旅行者中有 2.2 例），而在洪都拉斯有 18 例（PM，每 1000 名患病返回旅行者中有 79.6 例），在危地马拉有 14 例（PM，每 1000 名患病返回旅行者中有 34.4 例）。间日疟是最常见的疟疾诊断。
为访问这些地区的旅行者提供建议和治疗的旅行医学从业者应特别注意可通过疫苗预防的疾病，并且应该考虑到罕见的急性甲型肝炎、钩端螺旋体病、神经囊虫病、急性恰加斯病、盘尾丝虫病、粘膜皮肤利什曼病、神经囊虫病、艾滋病毒、疟疾和布鲁氏菌病。
