Skip to content

Travel Health

Published on:
4 July 2008

Next update: 3 October July 2008
Last updated:4 July 2008, Volume 2, No 27 (PDF file, 327 KB)

Topic Archives: 2007 | 2006 | 2005 | 2004 | 2003 | 2002 |

 

Imported infections, England and Wales: January to March 2008

The data presented in this report should be interpreted in conjunction with the report Illness in England, Wales, and Northern Ireland associated with foreign travel – a baseline report to 2002 [1], especially the content under the section ‘Sources of data on travel-associated illness and their limitations for analysis'. Please note that all data presented are provisional and subject to change; the confirmed final data will be presented on a biennial basis. All data presented in table 1 are for laboratory reports with specimen dates within the first quarter of 2008 unless specified otherwise. Travel-associated infections are generally under reported as information on travel history is incomplete through routine reporting mechanisms. For some infections listed in table 1 – such as malaria, the arboviruses, leishmaniasis, schistosomiasis, filariasis, trypanosomiasis, and Rickettsia spp – it is assumed that although no country of travel is given in the laboratory report, they are all foreign travel-related as they are not known to occur in the UK.

Table 1. Laboratory confirmed reports of infections associated with foreign travel, England and Wales: first quarter 2008

Organism

Total reports for Q1 (Jan - Mar)

Cumulative totals for Jan - Mar

2008*

2007

2008*

2007

Travel-related

All reports

Travel-related

All reports

Travel-related

All reports

Travel-related

All reports

Gastrointestinal Infections

Bacterial

 

Salmonella spp

387
1685
447
2278
387
1685
447
2278

Campylobacter spp

227
8053
259
8377
227
8053
259
8377

Shigella flexneri

11
92
7
77
11
92
7
77

Shigella dysenteriae †

7
12
1
5
-
-
-
-

Shigella sonnei

14
95
22
180
14
95
22
180

Shigella boydii †

17
27
17
29
– 
– 
– 
– 

Other (species unknown)

2
46
– 
21
2
46
– 
21

Salmonella Typhi

34
65
24
59
34
65
24
59

Salmonella Paratyphi (A,B,C)

39
62
26
39
39
62
26
39

Vibrio cholerae O1†

– 
– 
– 
1
– 
– 
– 
– 

Vibrio parahaemolyticus

– 
5
2
6
– 
5
2
6

Protozoal

 

Entamoeba histolytica

3
33
3
32
3
33
3
32

Giardia lamblia

59
657
69
612
59
657
69
612

Cryptosporidium

10
397
14
447
10
397
14
447

Cyclospora spp

2
4
1
4
2
4
1
4

Intestinal helminths

 

Strongyloides spp
– 
6
– 
7
– 
6
– 
7

Hookworm
3
7
2
4
3
7
2
4

Ascaris spp (round worm)

2
12
2
9
2
12
2
9

Trichuris spp (whip worm)

1
5
1
4
1
5
1
4

Hymenolepis spp

– 
– 
1
2
– 
– 
1
2

Taenia spp (tape worm)

– 
16
6
24
– 
16
6
24

Gnathostoma spp

– 
– 
– 
– 
– 
– 
– 
– 

Diphyllobothrium latum (fish tape worm)

– 
1
– 
– 
– 
1
– 
– 

Arthropod-borne infections

Malaria - total ‡

241
241
283
283
241
241
283
283

Plasmodium falciparum

194
194
207
207
194
194
207
207

Pl. vivax

25
25
39
39
25
25
39
39

Pl. malariae

5
5
7
7
5
5
7
7

Pl. ovale

15
15
26
26
15
15
26
26

Pl. unspecified

– 
– 
– 
– 
– 
– 
– 
– 

Mixed

2
2
4
4
2
2
4
4

Other
(P. knowlesi)

– 
– 
– 
– 
– 
– 
– 
– 

Arboviruses

 

Dengue virus ‡‡

31
31
16
16
31
31
16
16

Chikungunya virus ‡‡

1
1
5
5
1
1
5
5

Ross river virus ‡‡

– 
– 
– 
– 
– 
– 
– 
– 

Sandfly fever virus ‡‡

– 
– 
1
1
– 
– 
1
1

Eastern Equine Encephalitis ‡‡

– 
– 
– 
– 
– 
– 
– 
– 

West Nile virus ‡‡

– 
– 
– 
– 
– 
– 
– 
– 

Leishmaniases

 

Cutaneous

8
8
5
5
8
8
5
5

Visceral

3
3
2
2
3
3
2
2

Unspecified

-
-
4
4
-
-
4
4

Filariases

 

Loa loa

-
-
-
-
-
-
-
-

Wuchereria bancrofti

– 
– 
– 
– 
– 
– 
– 
– 

Mansonella perstans

1
1
– 
– 
1
1
– 
– 

Onchocerca volvulus

– 
– 
– 
– 
– 
– 
– 
– 

Unspecified

– 
– 
– 
– 
– 
– 
– 
– 

Lyme borreliosis §

7

82

NA

89

7

82

NA

89

Trypanosomiasis

–

–

1

1

-

-

1

1

Miscellaneous

Schistosome infections

 

Schistosoma mansoni

2
2
– 
– 
2
2
– 
– 

Schistosoma haematobium

7
7
3
13
7
7
3
13

Schistosoma intercalatum

– 
– 
– 
– 
– 
– 
– 
– 

Schistosoma spp

8
8
1
6
8
8
1
6

Other infections

 

Leptospirosis §

2
7
2
10
2
7
2
10

Legionnaires' disease**

19
56
11
55
19
56
11
55

Coxiella burnetii (Q fever)

– 
6
– 
6
– 
6
– 
6

Rickettsia spp ‡‡

10
10
11
11
10
10
11
11

All data extracted from Labbase 10.06.08 unless otherwise specified.
* All data for 2008 are provisional and may be subject to change.
† Data on cholera, S.boydii and S.dysenteriae supplied by the CfI Laboratory of Enteric Pathogens.
‡ Data for malaria supplied by the HPA Malaria Reference Laboratory and are provisional. Trends are best interpreted on an annual basis.
§ Data for Lyme borreliosis and leptospirosis supplied by the Zoonoses Surveillance Reference Unit, CDSC Wales, on behalf of the Leptospira Reference Unit, Hereford and the Lyme Disease Reference Unit, Southampton.
** Data on legionnaires' disease supplied by the Legionella Section of the Respiratory Diseases Department of CfI.
‡‡ Data from the Special Pathogens Reference Unit, Centre for Emergency Preparedness and Response.
NA Not available

Gastrointestinal infections

Gastrointestinal infections are the most common travel-associated infection; they can affect travellers worldwide. 'Travellers' diarrhoea' (TD) affects between 20% and 60% of overseas travellers [2]; the risk depends on the country visited. Although TD can occur in travellers all year round, there is a seasonal distribution, with the highest number of cases reported during the summer months [figure 1].

Figure 1. Laboratory reports of organisms† typically causing travellers' diarrhoea by quarter, England and Wales: 2004 - 2008


† Organisms include: Salmonella spp (non typhoid), Campylobacter spp, V. parahaemolyticus, Shigella spp, Cryptosporidium, Giardia lamblia.
* Provisional

Salmonella spp (non-typhoidal)
There were 1,685 laboratory reports of Salmonella spp, of which 387 (23%) were associated with recent travel abroad. Salmonella Enteritidis was the most common serovar associated with travel abroad (112/387, 29%), of which phage types (PT) 1, 4, 15, 8, 14B and 21 were most commonly reported [table 2].

Table 2. Laboratory reports of Salmonella Enteritidis associated with foreign travel, England and Wales: first quarter 2008.

Country of travel

Salmonella Enteritidis phage types (PTs)

Total

PT 1

PT 4

PT 15

PT 8

PT 14B
PT
21

Other

PT not
known

Egypt

– 

4

10

– 

– 

2

2

2

20

Portugal

2

– 

– 

4

– 

– 

1

1

8

India

2

– 

– 

– 

– 

2

1

1

6

Maldives

1

– 

– 

– 

– 

– 

5

– 

6

Spain

1

– 

– 

2

2

– 

1

– 

6

Singapore

3

– 

– 

– 

– 

– 

1

– 

4

Morocco

1

1

– 

– 

– 

– 

– 

1

3

Thailand

1

1

– 

– 

– 

– 

1

– 

3

Cuba

– 

– 

– 

– 

– 

– 

2

– 

2

Cyprus

1

1

– 

– 

– 

– 

– 

– 

2

Dominican Republic

1

1

– 

– 

–

– 

–

– 

2

Guatemala

– 

2

– 

– 

–

– 

– 

– 

2

Kenya

– 

– 

1

– 

– 

– 

– 

1

2

Malta

– 

– 

– 

– 

– 

1

1

– 

2

Tunisia

– 

– 

– 

– 

2

– 

– 

– 

2

Other (N=25)

3

2

1

2

2

1

1

3

15

Country
not stated

8

– 

– 

3

5

3

6

2

27

Total

24

12

12

11

11

9

22

11

112

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



Other serovars reported were S. Typhimurium (53/387, 14%), S. Virchow (27, 7%), S. Stanley (16, 4%), and S. Kentucky (10, 3%) [table 3].

Table 3. Laboratory reports of other Salmonella spp associated with foreign travel, England and Wales: first quarter 2008.

Country of travel

S Typhimurium

S Virchow

S Kentucky

S Newport

Other

Total

Thailand

9

3

9

– 

20

41

India

12

2

– 

– 

23

37

Egypt

3

8

1

6

17

35

Kenya

1

4

– 

– 

7

12

The Gambia

– 

3

– 

1

7

11

Pakistan

1

2

2

–

6

11

Mauritius

4

– 

– 

–

3

7

Nigeria

– 

– 

– 

1

6

7

Malaysia

2

– 

– 

– 

4

6

Morocco

2

– 

– 

1

2

5

South Africa

2

– 

– 

– 

3

5

Africa

1

– 

– 

– 

3

4

Spain

2

– 

– 

– 

2

4

Bangladesh

– 

1

– 

– 

2

3

Barbados

1

– 

– 

– 

2

3

Tunisia

2

– 

– 

– 

1

3

Gabon

– 

1

– 

– 

1

2

Other (N=33)

6

–

– 

– 

40

46

Country not stated

5

3

4 

1 

20

33

Total

53

27

16

10

169

275

Campylobacter spp
There were 8,053 laboratory reports of Campylobacter spp, of which 227 (3%) were associated with recent travel abroad. Campylobacter infections are mostly associated with travel to Spain and the Middle East in the summer months, reflecting UK travel patterns, but during the winter months, India is more often reported [table 4].

Table 4. Laboratory reports of Campylobacter spp associated with foreign travel, England and Wales: first quarter 2008.

Country of travel

Campylobacter spp

India

77

Spain

22

Morocco

15

Egypt

12

Thailand

12

Bangladesh

6

Pakistan

5

Caribbean

4

Hong Kong

3

Portugal

3

South America

3

Other (N=40)

58

Country not stated

7

Total

227

 

 

 

 

 

 

 

 

 

 


Shigella spp
In total, there 272 reports of shigella infection in the first quarter of 2008, of which 51 (19%) were associated with foreign travel. Travel history information was available for 62% of both S. boydii and S. dysenteriae reports, but for only 31% for S. sonnei and S. flexneri . Countries of travel are listed for each species in table 5.

Table 5. Laboratory reports of Shigella spp associated with foreign travel, England and Wales: first quarter 2008

 

Country of travel

Shigella species

 

Total

S Boydii

S. sonnei

S. dysenteriae

S. flexneri

Shigella unspecified

India

2

8

5

4

1

20

Egypt

2

4

– 

–

1

7

Pakistan

1

3

–

1

–

5

Cambodia

1

–

2

–

–

3

Madagascar

–

–

1

–

–

1

Nepal

1

–

–

–

–

1

Afghanistan

–

–

–

1

–

1

Cameroon

–

–

1

–

–

1

Morocco

1

–

–

–

–

1

Sudan

–

1

–

–

–

1

Ghana

–

1

–

–

–

1

Hong Kong

1

– 

–

–

–

1

Kenya

–

–

1

–

–

1

Dominican Republic

 –

–

1

–

–

1

Philippines

1

–

–

–

–

1

Cape Verde

–

–

1

–

–

1

East Africa

–

–

1

–

–

1

Somalia

1

–

–

–

 –

1

Uganda

–

–

–

–

–

1

Country not stated

–

–

–

1

–

1

Total

11

17

14

7

2

51

Cryptosporidium
During the first quarter, there were 397 reports of Cryptosporidium reported via Co-Surv, of which 10 reports (2.5%) stated recent travel abroad. Countries of travel reported were Pakistan (two), Morocco, Egypt, Africa, France, Nepal, Cameroon, Viet Nam, and Australia and Korea (all one each). Sentinel surveillance submission forms to the UK Cryptosporidium Reference Unit (CRU) during the same time frame included 14 (12.5%) travel abroad-related cases [Rachel Chalmers, Head of UK Cryptosporidium Reference Unit, NPHS Wales, personal communication, 17 June 2008]. Travel-related cases were identified as Cryptosporidium hominis (Pakistan, four; India, two; Africa unspecified, two; Ethiopia, one; Zimbabwe, one; Kenya, one), C. parvum (Egypt, one; India, one), and C. meleagridis (Nepal, one). Travel-related Cryptosporidium is under-estimated by routine surveillance.

Giardia lamblia
There 657 giardia infections reported, of which 59 (9%) were associated with recent foreign travel. Countries of travel are listed in table 6.

Table 6. Laboratory reports of Giardia lamblia associated with foreign travel, England and Wales: first quarter 2008

Country of travel

Giardia reports

India

17

Thailand

7

Egypt

5

Congo

2

Madagascar

2

Other (N=22)

24

Country not stated

2

Total

59

Other intestinal protozoa

Other intestinal protozoa reported were Entamoeba histolytica; three out of a total of 33 were associated with recent foreign travel; countries reported were India, Ghana, and Viet Nam (one report each). There were four reports of infection with Cyclospora, of which two were associated with recent foreign travel (Sudan and Cambodia).

Enteric fever
During the first quarter of 2008, there were 65 reports of S. Typhi and 62 reports of S. Paratyphi (58 S. Paratyphi A, and four S. Paratyphi B).

Sixty-two per cent (34/65) of S. Typhi and 63% of S. Paratyphi (39/62) reports were associated with recent foreign travel. Countries of travel are listed in table 7. The Indian sub-continent remains the most reported region of travel for cases of enteric fever and is mainly associated with those visiting friends and relatives in their country of ethnic origin [3].

Table 7. Laboratory reports of enteric fever associated with foreign travel, England and Wales: first quarter 2008

 

Resort country

Salmonella spp

 

Total

S. Paratyphi A

S. Paratyphi B

S. Typhi

India

16

1

11

28

Pakistan

8

–

8

16

Bangladesh

6

–

8

14

Nepal

–

–

4

4

Afghanistan

–

–

1

1

Australia

1

–

 

1

China

–

1

–

1

The Gambia

6

–

2

8

Total

37

2

34

73

Intestinal helminths
In the first quarter of 2008, there were 547 reports of intestinal helminth infection, of which six were associated with recent foreign travel [table 8]. Helminth infections can persist in the body for months and it may not be possible to say for certain where these infections were acquired; they are probably associated with new entrants to the UK as well as short-term travellers.

Table 8. Intestinal helminths associated with recent foreign travel, England and Wales: first quarter 2008

Organism

Country of travel (reports)

Ascaris spp

Morocco (2)

Hookworm spp

Borneo (1) Not stated (2)

Trichuris spp

Bangladesh (1)


Arthropod borne infections

Malaria
During the first quarter of 2008, there were 241 cases of malaria reported in the United Kingdom, 80% (194 cases) of which were caused by the parasite, Plasmodium falciparum and 10% (25 cases) were caused by P. vivax. Where country of travel was known, 77% (114/149) of malaria cases caused by P. falciparum were reported to be acquired in West Africa, and 74% (14/19) of P. vivax cases were reported to be acquired in Asia.

Dengue
Thirty-one cases (includes 10 confirmed and 21 probable) were reported by the HPA Special Pathogens Reference Unit (SPRU) in the first quarter. Of those, 24 had information about country of travel. The majority of cases reported recent travel to Asia: eight to South East Asia (including Indonesia, Malaysia, Philippines, Thailand, and Viet Nam) and seven to the Indian sub-continent (India and Sri Lanka). Other countries of travel reported included Barbados, Brazil, Mexico, Tonga, and Namibia.

Chikungunya
There was one case of confirmed chikungunya infection reported by the HPA Special Pathogens Reference Unit (SPRU) that had reported recent travel to Sri Lanka.

Leishmaniasis
There were 11 cases of leishmaniasis reported in the first quarter, eight of which were presumed to be cutaneous leishmaniasis and three were visceral leishmaniasis; there was no country of travel reported for any of the cases.

Lyme borreliosis
In the first quarter of 2008, there were 82 laboratory confirmed reports of Lyme borreliosis, compared with 89 reports in the same quarter of 2007.

A travel history was reported by seven individuals (five males, two females) with travel to the United States, Hungary, Sweden, Germany and the Czech Republic; one patient was a Swedish resident and one resident in Eastern Europe. Two of those reporting travel histories were known to have had pre-existing infections. Five reported having received a tick bite.

The full range of clinical and epidemiological information is not available at this stage and the information provided will be subject to further revision.

Other infections

Schistosomiasis
There were 17 reports of infection with Schistosoma spp, of which seven were S. haematobium and two were S. mansoni. Only two S. haematobium reports had information about travel; one travelled to Malawi and the other to Zimbabwe.

Rickettsial infections
There were 10 cases of rickettsial infection reported by the SPRU in the first quarter. One was confirmed as epidemic typhus with travel to Thailand and one confirmed as spotted fever with no travel history; eight were probable spotted fever (four had no country of travel, the others reported travel to Kenya, Mauritius, Africa (unspecified), and India).

Legionnaires' disease
There were 73 cases of legionnaires' disease reported in the third quarter, of which 29 (40%) were associated with foreign travel. Most cases are sporadic but five of the travel-associated cases were involved in four different outbreaks occurring in Tunisia, China, Italy, and two cases occurred on a cruise.

Leptospirosis
In the first quarter of 2008, there were seven cases of leptospirosis (two L. icterohaemorrhagiae, one L. hardjo and three for which the serovar has not been identified). All the cases were males in the 25 to 64 year age group. Two cases are known to have acquired their infections overseas, one in the Dominican Republic (L. icterohaemorrhagiae) and one in Nigeria (serovar undetermined). The nature of the activities undertaken or the risk factors involved are unknown.

References
1. Health Protection Agency. Illness in England, Wales, and Northern Ireland associated with foreign travel – a baseline report to 2002. London: HPA, 2004. Available at http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1203496904956?p=1158945066450.

2. National Travel Health Network and Centre. Prevention of food and waterborne diseases (information sheet): London: NaTHNaC, November 2006. Available at http://www.nathnac.org/pro/factsheets/food.htm.

3. Health Protection Agency. Pilot of enhanced surveillance of enteric fever in England, Wales and Northern Ireland, 1 May 2006 to 30 April 2007. London: Health Protection Agency, March 2008. Available at http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1206575041711.

.