A Clinic Survey of Travel-Associated Illness among Public Health Professionals

Background:

Public health (PH) professionals travel around the world to carry out activities and are potentially at risk for a variety of communicable and noncommunicable diseases. Little data exist on knowledge, attitudes, and practices (KAP) or the health risks related to travel among PH professionals. 

Objective:

To assess the demographics, travel medicine KAP, and health risks faced by PH professionals who travel internationally.

Methods:

During visits to travel medicine clinics, PH professionals were asked to complete anonymous pre- and post-travel surveys that assessed demographics, destination(s), purpose and duration of travel, vaccinations and medications, risk exposures during travel, and sources of health information. Data on persons completing both surveys were analyzed.

Results: From September 2009 through September 2010, 238 PH professionals completed pre-travel surveys, and 122 completed post-travel surveys (response rate = 51.3%).  Participants traveled to 162 countries in Africa, Asia, South America, Central America, and Europe (developing countries = 95.9%, n=117), mean trip length was 17.7 days (range 4-99 days).   The most common purposes of travel were epidemiology/technical assistance (52.5%, n=64), teaching or conducting trainings (15.6%, n=19), and attending professional meetings (13.9%, n=17).  Potentially risky activities during travel included traveling in rural areas (49.2%, n=60), traveling in malarial areas (50.4%, n=62), and handling or coming into contact with animals (17.3%, n=21) and blood or body fluids (10.7%, n=13).  Thirty-three (27.0%) respondents reported illness during travel.  The most common symptoms were diarrhea (20.5%, n=25), sore throat (10.7%, n=13), and nausea/vomiting (9.0%, n=11).  Illness was associated with longer trips (M=24.8 vs. 15.1 days, F=7.995. p=.005), travel to rural areas (39.4% vs. 18.0%, F=4.636. p=.03), less consistent following of safety recommendations (X² for trend = 6.491, p=.09), more stress due to strain on family/relationships (32.3% vs. 14.8%, OR=2.75, 95% CI=.98-7.75), younger age (39.3 vs. 43.2 years, F=3.304, p=.07), and fewer visits to pre-travel health clinics (X² for trend = 6.673, p=.08).  A multivariate model contained one significant predictor: respondents who came to pre-travel clinics more frequently were less likely to report illness during travel (OR=0.490, 95% CI=0.271-0.886, p=.018).

Conclusions: These results show that PH professionals who travel internationally take part in activities with health risks.  Future studies should evaluate PH professionals who do not seek pre-travel health care in order to confirm whether ,  pre-travel visits to health clinics can help reduce the rates of travel-associated illness.  These results can provide a basis for developing evidence-based recommendations to better protect the health of PH professionals who travel internationally