Business travel-associated illness: a GeoSentinel analysis†
Authors: Chen Lin H , Leder Karin , Barbre Kira A , Schlagenhauf Patricia , Libman Michael , Keystone Jay , Mendelson Marc , Gautret Philippe , Schwartz Eli , Shaw Marc , MacDonald Sue , McCarthy Anne , Connor Bradley A , Esposito Douglas H , Hamer Davidson , Wilson Mary E ,   GeoSentinel Surveillance Network, Licitra Carmelo , Klochko Alena , Perret Perez Cecilia , Yansouni Cedric , Coyle Christina , Rapp Christoph , Ficko Cecile , Lalloo David , Beeching Nicholas , Malvy Denis , Duvignaud Alexandre , Hale Devon , Leung Daniel , Benson Scott , Gkrania-Klotsas Effrossyni , Warne Ben , Barnett Elizabeth , Hochberg Natasha , Javelle Emilie , Caumes Eric , Perignon Alice , Castelli Francesco , Matteelli Alberto , Chappuis Francois , Mockenhaupt Frank , Harms-Zwingenberger Gundel , von Sonnenburg Frank , Rothe Camilla , Ásgeirsson Hilmir , Glans Hedvig , Murphy Holly , Pandey Prativa , Siu Hugo , Manuel Valdez Luis , Cramer Jakob , Jordan Sabine , Vinnemeier Christof , Hajek Jan , Ghesquiere Wayne , Haulman Jean , Roesel David , Vincelette Jean , Barkati Sapha , Torresi Joe , Cahill John , McKinley George , Yates Johnnie , Kain Kevin , Boggild Andrea , Grobusch Martin , Goorhuis Bram , Jensenius Mogens , Hynes Noreen , Kelly Paul , Hagmann Stefan , van Genderen Perry , Vincent Peter , Hoang Phu Phi Truong , Kozarsky Phyllis , Wu Henry , Lim Poh-Lian , Weber Rainer , Lopez-Velez Rogelio , Norman Francesca , Borwein Sarah , Kanagawa Shuzo , Kato Yasuyuki , Anderson Susan , Kuhn Susan , Piyaphanee Watcharapong , Silachamroon Udomsak , Stauffer William , Walker Pat , Yoshimura Yukiriro , Tachikawa Natsuo 
Published: January 2018

Abstract

Background
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.

Methods
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.

Results
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 diarrhea (8%), viral syndrome (6%), acute bacterial diarrhea (5%) and chronic diarrhea (4%). Species was reported for 973 (90%) of 1079 patients with malaria, predominantly Plasmodium falciparum acquired in sub-Saharan Africa. Of 584 (54%) with malaria chemoprophylaxis information, 92% took none or incomplete courses. Thirteen deaths were reported, over half of which were due to malaria; others succumbed to pneumonia, typhoid fever, rabies, melioidosis and pyogenic abscess.

Conclusions
Diarrheal illness was a major cause of morbidity. Malaria contributed substantial morbidity and mortality, particularly among business travelers to sub-Saharan Africa. Underuse or non-use of chemoprophylaxis contributed to malaria cases. Deaths in business travelers could be reduced by improving adherence to malaria chemoprophylaxis and targeted vaccination for vaccine-preventable diseases. Pre-travel advice is indicated for business travelers and is currently under-utilized and needs improvement.