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Travel Health

Published on:
3 July 2009

Next update: 2 October 2009
Last updated: 3 July 2009, Volume 3, No 26 (PDF file 270 kB)

Topic Archives: | 2009 | 2008 | 2006 | 2005 | 2004 | 2003 | 2002 |

Imported infections, England and Wales: January to March 2009

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'. All data presented are provisional and subject to change; the confirmed final data will be presented on an annual basis. All data presented in table 1 are for laboratory reports with specimen dates within the first quarter of 2009 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 2009

Organism

Total reports for Q1 (Jan - Mar)

Cumulative totals for Jan - Mar

2009*

2008

2009*

2008

Travel-related

All reports

Travel-related

All reports

Travel-related

All reports

Travel-related

All reports

Gastrointestinal Infections

Bacterial

 

Salmonella spp

320
1222
390
1701
320
1222
390
1701

Campylobacter spp

225
9953
233
8272
225
9953
233
8272

Shigella flexneri

17
93
11
94
17
93
11
94

Shigella dysenteriae †

10
13
7
12
10
13
7
12

Shigella sonnei

18
207
14
96
18
207
14
96

Shigella boydii †

15
21
17
27
15
21
17
27

Other (species unknown)

1
39
2
47
1
39
2
47

Salmonella Typhi

29
60
34
65
29
60
34
65

Salmonella Paratyphi (A,B,C)

23
51
39
62
23
51
39
62

Vibrio cholerae O1†

–
–
–
–
–
–
–
–

Vibrio parahaemolyticus

1
2
–
5
1
2
–
5

Protozoal

 

Entamoeba histolytica

1
28
3
33
1
28
3
33

Giardia lamblia

44
661
61
671
44
661
61
671

Cryptosporidium

15
578
10
397
16
579
10
397

Cyclospora spp

2
3
2
4
2
3
2
4

Intestinal helminths

 

Strongyloides spp

–
5
–
6
–
5
–
6

Hookworm

1
2
3
8
1
2
3
8

Ascaris spp (round worm)

1
10
2
13
1
10
2
13

Trichuris spp (whip worm)

1
3
1
5
1
3
1
5

Hymenolepis spp

–
2
–
–
–
2
–
–

Taenia spp (tape worm)

3
17
1
17
3
17
1
17

Gnathostoma spp

–
1
–
–
–
1
–
–

Diphyllobothrium latum (fish tape worm)

–
5
–
1
–
5
–
1

Arthropod-borne infections

Malaria - total ‡

283
283
241
241
283
283
241
241

Plasmodium falciparum

229
229
194
194
229
229
194
194

Pl. vivax

26
26
25
25
26
26
25
25

Pl. malariae

10
10
5
5
10
10
5
5

Pl. ovale

17
17
15
15
17
17
15
15

Pl. unspecified

–
–
–
–
–
–
–
–

Mixed

1
1
2
3
1
1
2
3
 

Arboviruses

 

Dengue virus ‡‡

19
19
31
31
19
19
31
31

Chikungunya virus ‡‡

3
3
2
2
3
3
2
2

Ross river virus ‡‡

–
–
–
–
–
–
–
–

Sandfly fever virus ‡‡

–
–
–
–
–
–
–
–

Eastern Equine Encephalitis ‡‡

–
–
–
–
–
–
–
–

West Nile virus ‡‡

–
–
–
–
–
–
–
–

Leishmaniases

 

Cutaneous

–
–
–
8
–
–
–
8

Visceral

–
2
–
3
–
2
–
3

Unspecified

–
1
1
3
–
1
1
3

Filariases

 

Loa loa

–
1
–
–
–
1
–
–

Wuchereria bancrofti

–
–
–
–
–
–
–
–

Mansonella perstans

–
1
–
1
–
1
–
1

Onchocerca volvulus

–
–
–
–
–
–
–
–

Unspecified

–
1
–
–
–
1
–
–

Trypanosomiasis

–
–
–
–
–
–
–
–

Miscellaneous

Schistosome infections

 

Schistosoma mansoni

–
–
–
2
–
–
–
2

Schistosoma haematobium

5
22
2
7
5
22
2
7

Schistosoma spp

1
6
–
8
1
6
–
8

Other infections

Legionnaires' disease**

17
48
19
56
17
48
19
56

Rickettsia spp ‡‡

17
17
10
10
17
17
10
10

Lassa fever ‡‡

3
3
–
–
3
3
–
–

Gastrointestinal infections

Gastrointestinal infections are the most common travel-associated infection, affecting travellers worldwide. “Travellers' diarrhoea” affects between 20% and 60% of overseas travellers [2] and may be viral, bacterial or protozoal in origin; the risk of illness usually depends on the country visited.

Salmonella spp (non-typhoidal)

There were 1222 laboratory reports of Salmonella spp, of which 320 (26%) were associated with recent travel abroad. Salmonella serovar Enteritidis was the most common serotype associated with travel abroad (104/320, 33%), of which phage type (PT) 1 was the most commonly reported (22/104, 21%), followed by S. Typhimurium (49 reports, 15%) and S. Virchow (21 reports, 7%). The 10 most reported countries of travel for Salmonella are listed in table 2.

Table 2. Laboratory reports of other Salmonella spp associated with foreign travel, England and Wales: first quarter 2007

Country of travel

S Enteritidis

S Typhimurium

S Virchow

Other Salmonella spp

Total

India

7

8

1

29

45

Egypt

30

2

1

8

41

Thailand

4

3

3

15

25

Kenya

4

2

1

7

14

The Gambia

– 

–

5

8

13

Pakistan

–

1

1

9

11

Morocco

5

3

–

2

10

Tunisia

8

1

–

–

9

Bangladesh

–

1

3

5

9

Mauritius

4

3

–

1

8

Other countries (N=47)

32

17

4

41

94

Country not stated

10

8

2

21

41

Total

104

49

21

146

320

 

Campylobacter spp

There were 9953 laboratory reports of Campylobacter spp, of which 225 (2%) were associated with recent travel abroad (table 3).

Table 3. Laboratory reports of Campylobacter spp associated with foreign travel, England and Wales: first quarter 2009.

Country of travel

Campylobacter spp

India

60

Thailand

21

Morocco

20

Spain

19

Egypt

11

Pakistan

9

France

5

South Africa

4

Sri Lanka

4

Mexico

4

Other countries (N=39)

57

Country not stated

11

Total

225

 

 

 

 

 

 

 

 

 

 

 

Shigella spp

In total, there 373 reports of shigella infection in the first quarter of 2009, of which 61 (16%) were associated with foreign travel. Travel history information was available for 74% for both S. boydii and S. dysenteriae reports, but for only 22% for S. sonnei and S. flexneri. Countries of travel are listed for each species in table 4.

Table 4. Laboratory reports of Shigella spp associated with foreign travel, England and Wales: first quarter 2009

Country of travel

Shigella species

Total

S. flexneri

S. sonnei*

S. boydii

S. dysenteriae

Shigella sp

6

7

2

– 

–

15

India

2

3

6

3

–

14

Pakistan

2

1

4

4

–

11

Bangladesh

1

–

1

–

–

2

Sub-Saharan Africa

5

2

2

3

1

13

Spain

1

–

–

–

–

1

United Arab Emirates

–

2

–

–

–

2

Kuwait

–

1

–

–

–

1

Papua New Guinea

–

1

–

–

–

1

Country not stated

–

2

–

–

–

2

Total

17

19

15

10

1

62

* One case of S. sonnei had more than one country of travel so is included twice in table.

Cryptosporidium

There were 578 reports of cryptosporidium infection, of which 15 (3%) were associated with recent foreign travel. Countries of travel reported were India (three), Pakistan (two), and Egypt, Chile, Kenya, Cyprus, USA, Asia (unspecified), Cameroon, Malawi and Syria (one each); one report had no country stated. Sentinel surveillance submission forms to the UK Cryptosporidium Reference Unit (CRU) during the same time frame included 13 (8% of total) travel abroad-related cases [3]. Countries of travel reported to CRU were Bulgaria (one Cryptosporidium parvum), Burma (one Cryptosporidium hominis), Chile (one C. hominis), Egypt (one C. hominis), India (three C. hominis, one C. meleagridis), Malawi and Ethiopia (one not typable), Pakistan (one C. hominis), South Africa (one C. parvum), Spain (one C. parvum) and one had no country of travel stated (C. parvum).

Giardia lamblia

There were 661 giardia infections reported, of which 44 (7%) were associated with recent foreign travel. Countries of travel reported were India (17), Egypt (five), Pakistan (three), Nepal (three); 13 other countries (spread worldwide) were reported (17 reports; some travelled to more than country) and two reports had no country stated.

Other intestinal protozoa

Other intestinal protozoa reported were Entamoeba histolytica; one out of a total of 28 was associated with recent foreign travel to Singapore. There were three reports of Cyclospora, of which one was associated with travel to Peru and one had been on a cruise (destinations not stated).

Enteric fever

During the first quarter of 2009, there were 60 reports of S. Typhi and 51 reports of S. Paratyphi A.

Forty-eight percent (29/60) of S. Typhi and 45% S. Paratyphi (23/51) reports were associated with recent foreign travel. Countries of travel are listed in table 5. 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 [4].

Table 5. Laboratory reports of enteric fever associated with foreign travel, England and Wales: first quarter 2009

Resort country

Salmonella spp

Total

S. Paratyphi A

S. Typhi

India

10

10

20

Pakistan

6

10

16

Bangladesh

1

2

3

Nigeria

–

2

2

Angola

–

1

1

Egypt

–

1

1

Panama

1

–

1

Philippines

1

–

1

South Africa

–

1

1

South America unspecified

1

–

1

Sri Lanka

1

–

1

Country not stated

2

2

4

Total

23

29

52

 

Intestinal helminths

In the first quarter of 2009 there were 47 reports of intestinal helminth infections, of which six were reported to be associated with recent foreign travel. Three cases of infection with Taenia saginata stated recent travel to India (one), Thailand (one), and one had no country stated. One case of hookworm infection was associated with travel to Papua New Guinea; one case of Ascaris lumbricoides was associated with travel to Viet Nam and one case of Trichuris trichiura had no country stated. 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.

 

Arthropod-borne infections

Malaria
During the first quarter of 2009, there were 283 cases of malaria reported in the United Kingdom, a 17% increase compared to the same period in 2008. The majority (81%, 229 cases) were caused by the parasite, Plasmodium falciparum and 9% (26 cases) were caused by P. vivax. Where region of travel was known (139/187), 74% of malaria cases caused by P. falciparum were reported to be acquired in West Africa, and 65% (15/23) of P. vivax cases were reported to be acquired in Asia.

Dengue
Nineteen cases (all probable) were reported by the HPA Special Pathogens Reference Unit (SPRU) in the first quarter. All but one had information about foreign travel. Six cases were associated with travel to Thailand, three to India; the remaining cases had travelled to Australia, Brazil, Cambodia, Fiji, French Guiana, Indonesia, Malaysia, Singapore, and Trinidad and Tobago (all one case each).

Chikungunya
Three cases of chikungunya (one probable and two suspected) were reported by SPRU during the first quarter. Countries of travel reported were India, Malaysia and Pakistan.

Leishmaniasis
There were three cases of leishmaniasis reported in the first quarter, two presumed to be visceral leishmaniasis and one of unknown type; none of them had a country of travel stated.

Other infections

Schistosomiasis
Of 28 reports of infection with Schistosoma spp, 22 were S. haematobium and six were unknown. Only six reported recent travel abroad of which two had been to Africa (one S. sp and one S. haematobium), the remainder were S. haematobium with reported travel to Malawi (one), Tanzania (one) and one had no country stated.

Rickettsial infections
There were 17 cases of rickettsial infection reported by the SPRU in the first quarter. Fifteen were spotted fever (one confirmed, eight probable, and six suspected) of which five cases had no country of travel, seven had travelled to South Africa (one also to Mozambique); other countries reported were India, Senegal and Afghanistan (one report each). There were two reports of epidemic typhus (one confirmed, one suspected) and both had no country of travel stated.

Legionnaires' disease
There were 48 cases of Legionnaires' disease reported in the first quarter, of which 17 (35%) were associated with foreign travel. Three of the 17 cases were associated with travel to the United Arab Emirates and one case was part of an outbreak in Italy.

 

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. Personal communication. Rachel Chalmers, Head of UK Cryptosporidium Reference Unit, NPHS Wales, 24 June 2009.

4. Health Protection Agency. Foreign travel-associated illness – a focus on those visiting friends and relatives, 2008 report. London : HPA, 2008. Available at: http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1231419800356.