Warner Jennifer C, Hatziioanou Diane, Osborne Jane C, Bailey Daniel J, Brooks Timothy J G, Semper Amanda E
Rare & Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, UK.
Field Services Midlands, UK Health Security Agency, Birmingham, UK.
J Travel Med. 2023 Apr 5;30(2). doi: 10.1093/jtm/taad003.
Every year, many thousands of travellers return to the United Kingdom (UK) from visits to other countries and some will become unwell due to infections acquired abroad. Many imported infections have similar clinical presentations, such as fever and myalgia, so diagnostic testing is an important tool to improve patient management and outcomes. The aim of this study was to examine the demographics, travel history, presenting symptoms and diagnostic outcomes of referrals to the UK's specialist diagnostic Rare & Imported Pathogens Laboratory (RIPL) for the period 2015-2020.
Anonymised clinical and laboratory data were extracted from RIPL's Laboratory Information Management System and cleaned prior to descriptive analysis of the data. Travel history data were mapped to one of eight world regions, whereas symptom data were categorised into presenting syndromes. Diagnostic data were categorised as either positive, equivocal or negative.
During the period 2015-2020, RIPL received 73 951 samples from 53 432 patients suspected of having infections that are rare in the UK. The most common age group for unwell returning travellers was 30-39 years and the most commonly reported travel destination was Southern and SE Asia. Dengue virus was the most diagnosed infection overall, followed by chikungunya, Zika, leptospirosis and spotted fever group Rickettsia. Dengue virus was among the top three most frequent diagnoses for all world regions except Europe and represented 62.5% of all confirmed/probable diagnoses.
None of the top five infections diagnosed by RIPL in travellers are vaccine-preventable, therefore understanding traveller demographics, destination-specific risk factors and encouraging preventative behaviours is the best available strategy to reduce the number of returning travellers who become infected. Prompt referral of acute samples with a detailed travel history, including purpose of travel and activities undertaken as well as dates and destinations can be a valuable tool in designing public health interventions and diagnostic algorithms.
每年，成千上万的旅行者从其他国家返回英国，其中一些人会因在国外感染疾病而身体不适。许多输入性感染具有相似的临床表现，如发热和肌痛，因此诊断检测是改善患者管理和治疗结果的重要工具。本研究的目的是调查2015年至2020年期间转诊至英国专门诊断罕见及输入性病原体的实验室（RIPL）的患者的人口统计学特征、旅行史、症状表现和诊断结果。
从RIPL的实验室信息管理系统中提取匿名的临床和实验室数据，并在对数据进行描述性分析之前进行清理。旅行史数据被映射到八个世界区域之一，而症状数据被归类为症状综合征。诊断数据被分类为阳性、可疑或阴性。
在2015年至2020年期间，RIPL收到了来自53432名疑似感染英国罕见疾病患者的73951份样本。身体不适的回国旅行者最常见的年龄组是30 - 39岁，最常报告的旅行目的地是南亚和东南亚。登革热病毒是总体上诊断最多的感染，其次是基孔肯雅热、寨卡病毒、钩端螺旋体病和斑点热群立克次体。除欧洲外，登革热病毒在所有世界区域的诊断频率均位列前三，占所有确诊/疑似诊断的62.5%。
RIPL诊断出的旅行者中排名前五的感染均无法通过疫苗预防，因此了解旅行者的人口统计学特征、特定目的地的风险因素并鼓励预防行为是减少回国后感染的旅行者数量的最佳策略。及时转诊带有详细旅行史（包括旅行目的、所进行的活动以及日期和目的地）的急性样本，对于设计公共卫生干预措施和诊断算法可能是一个有价值的工具。
