Andrea K. Boggild, MSc, MD; Douglas H. Esposito, MD, MPH; Phyllis E. Kozarsky, MD; Vernon Ansdell, MD; Nicholas J. Beeching, MD; Daniel Campion, MB, MPH; Francesco Castelli, MD; Eric Caumes, MD; Francois Chappuis, MD, PhD; Jakob P. Cramer, MD, MSc; Effrossyni Gkrania-Klotsas, PhD; Martin P. Grobusch, MD, PhD; Stefan H.F. Hagmann, MD; Noreen A. Hynes, MD, MPH; Poh Lian Lim, MD, MPH; Rogelio López-Vélez, MD, PhD; Denis J.M. Malvy, MD, PhD; Marc Mendelson, MD, PhD; Philippe Parola, MD, PhD; Mark J. Sotir, PhD; Henry M. Wu, MD; Davidson H. Hamer, MD; for the GeoSentinel Surveillance Network *
Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the CDC, the National Health Service, the National Institute for Health Research, the Department of Health, or Public Health England.
Financial Support: GeoSentinel, the Global Surveillance Network of the International Society of Travel Medicine, is supported by cooperative agreement U50/CCU412347 from the CDC. Dr. Gkrania-Klotsas was supported by the National Institute for Health Research Cambridge Biomedical Research Centre. Dr. Beeching was funded in part by the National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, a partnership among the University of Liverpool, the Liverpool School of Tropical Medicine, and Public Health England.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0074.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Boggild (e-mail, andrea.boggild@utoronto.ca). Data set: Not available.
Requests for Single Reprints: Davidson H. Hamer, MD, Center for Global Health and Development, Boston University, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118; e-mail, dhamer@bu.edu.
Current Author Addresses: Dr. Boggild: Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street, 13EN-218, Toronto, Ontario M5G 2C4, Canada.
Drs. Esposito and Sotir: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop E-03, Atlanta, GA 30333.
Drs. Kozarsky and Wu: Emory Clinic TravelWell, 7th Floor MOT, 550 Peachtree Street, Atlanta, GA 30308.
Dr. Ansdell: Kaiser Permanente Honolulu Clinic, 1010 Pensacola Street, Honolulu, HI 96814.
Dr. Beeching: Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom.
Dr. Campion: InterHealth Worldwide, International Health Centre, 63–67 Newington Causeway, London SE1 6BD, United Kingdom.
Dr. Castelli: University Department of Infectious and Tropical Diseases, University of Brescia, Spedali Civili General Hospital, Piazza Spedali Civili 1, 25123 Brescia, Italy.
Dr. Caumes: Hôpital Pitié-Salpêtrière, Service des Maladies Infectieuses et Tropicales, Pavillon Laveran, 47–53 Boulevard de l'Hôpital, 75013 Paris, France.
Dr. Chappuis: Geneva University Hospitals, Division of Tropical and Humanitarian Medicine, Rue Gabrielle-Perret-Gentil 6, CH-1211, Geneva 14, Switzerland.
Dr. Cramer: University Medical Centre Hamburg Eppendorf, Department of Medicine, Division of Infectious Diseases and Tropical Medicine, Bernhard-Nocht-Klinik, Bernhard Nocht Strasse 74, D-20359 Hamburg, Germany.
Dr. Gkrania-Klotsas: Box 25, Department of Infectious Diseases, Cambridge University Hospital NHS Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom.
Dr. Grobusch: Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, the Netherlands.
Dr. Hagmann: Bronx-Lebanon Hospital Center, Division of Pediatric Infectious Diseases, 1650 Grand Concourse, Bronx, NY 10457.
Dr. Hynes: Johns Hopkins School of Medicine, Division of Infectious Diseases, 1830 East Monument Street, Room 419, Baltimore, MD 21205.
Dr. Lim: Travellers' Health & Vaccination Clinic, Institute of Infectious Diseases & Epidemiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
Dr. López-Vélez: Infectious Diseases Department, Ramón y Cajal Hospital, Carretera de Colmenar km 9.1, Madrid 28034, Spain.
Dr. Malvy: Division of Tropical Medicine and Clinical International Health, Department of Infectious and Tropical Diseases, Chu Pellegrin, Place Amélie Raba-Léon, F-33 075 Bordeaux Cedex, France.
Dr. Mendelson: Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, G16.68 Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa.
Dr. Parola: University Hospital Institute for Infectious Diseases and Tropical Medicine, Aix-Marseille University, Boulevard Jean Moulin, Marseille 13005, France.
Dr. Hamer: Center for Global Health and Development, Boston University, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118.
Author Contributions: Conception and design: A.K. Boggild, D.H. Esposito, P.E. Kozarsky, V. Ansdell, E. Gkrania-Klotsas, M.P. Grobusch, S.H.F. Hagmann, N.A. Hynes, P.L. Lim, M.J. Sotir, D.H. Hamer.
Analysis and interpretation of the data: A.K. Boggild, D.H. Esposito, P.E. Kozarsky, V. Ansdell, D. Campion, F. Castelli, J.P. Cramer, E. Gkrania-Klotsas, M.P. Grobusch, S.H.F. Hagmann, N.A. Hynes, P.L. Lim, D.J.M. Malvy, M. Mendelson, P. Parola, M.J. Sotir, D.H. Hamer.
Drafting of the article: A.K. Boggild, D.H. Esposito, P.E. Kozarsky, V. Ansdell, N.J. Beeching, M.P. Grobusch, N.A. Hynes, M.J. Sotir, D.H. Hamer.
Critical revision of the article for important intellectual content: A.K. Boggild, D.H. Esposito, P.E. Kozarsky, V. Ansdell, N.J. Beeching, D. Campion, F. Castelli, E. Caumes, F. Chappuis, J.P. Cramer, E. Gkrania-Klotsas, S.H.F. Hagmann, N.A. Hynes, P.L. Lim, D.J.M. Malvy, M. Mendelson, M.J. Sotir, H.M. Wu, D.H. Hamer.
Final approval of the article: A.K. Boggild, D.H. Esposito, P.E. Kozarsky, V. Ansdell, N.J. Beeching, D. Campion, F. Castelli, E. Caumes, J.P. Cramer, E. Gkrania-Klotsas, M.P. Grobusch, S.H.F. Hagmann, N.A. Hynes, P.L. Lim, R. López-Vélez, D.J.M. Malvy, M. Mendelson, P. Parola, M.J. Sotir, H.M. Wu, D.H. Hamer.
Provision of study materials or patients: A.K. Boggild, V. Ansdell, N.J. Beeching, F. Castelli, E. Caumes, F. Chappuis, J.P. Cramer, E. Gkrania-Klotsas, M.P. Grobusch, S.H.F. Hagmann, P.L. Lim, R. López-Vélez, D.J.M. Malvy.
Statistical expertise: A.K. Boggild, M.J. Sotir.
Obtaining of funding: D.H. Hamer.
Administrative, technical, or logistic support: D.H. Esposito, M.J. Sotir, D.H. Hamer.
Collection and assembly of data: A.K. Boggild, V. Ansdell, N.J. Beeching, F. Castelli, E. Gkrania-Klotsas, M.P. Grobusch, P. Parola, H.M. Wu.
The largest-ever outbreak of Ebola virus disease (EVD), ongoing in West Africa since late 2013, has led to export of cases to Europe and North America. Clinicians encountering ill travelers arriving from countries with widespread Ebola virus transmission must be aware of alternate diagnoses associated with fever and other nonspecific symptoms.
To define the spectrum of illness observed in persons returning from areas of West Africa where EVD transmission has been widespread.
Descriptive, using GeoSentinel records.
57 travel or tropical medicine clinics in 25 countries.
805 ill returned travelers and new immigrants from Sierra Leone, Liberia, or Guinea seen between September 2009 and August 2014.
Frequencies of demographic and travel-related characteristics and illnesses reported.
The most common specific diagnosis among 770 nonimmigrant travelers was malaria (n = 310 [40.3%]), with Plasmodium falciparum or severe malaria in 267 (86%) and non–P. falciparum malaria in 43 (14%). Acute diarrhea was the second most common diagnosis among nonimmigrant travelers (n = 95 [12.3%]). Such common diagnoses as upper respiratory tract infection, urinary tract infection, and influenza-like illness occurred in only 26, 9, and 7 returning travelers, respectively. Few instances of typhoid fever (n = 8), acute HIV infection (n = 5), and dengue (n = 2) were encountered.
Surveillance data collected by specialist clinics may not be representative of all ill returned travelers.
Although EVD may currently drive clinical evaluation of ill travelers arriving from Sierra Leone, Liberia, and Guinea, clinicians must be aware of other more common, potentially fatal diseases. Malaria remains a common diagnosis among travelers seen at GeoSentinel sites. Prompt exclusion of malaria and other life-threatening conditions is critical to limiting morbidity and mortality.
Centers for Disease Control and Prevention.
Boggild AK, Esposito DH, Kozarsky PE, Ansdell V, Beeching NJ, Campion D, et al. Differential Diagnosis of Illness in Travelers Arriving From Sierra Leone, Liberia, or Guinea: A Cross-sectional Study From the GeoSentinel Surveillance Network. Ann Intern Med. ;162:757–764. doi: 10.7326/M15-0074
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© 2018
Published: Ann Intern Med. 2015;162(11):757-764.
DOI: 10.7326/M15-0074
Diarrhea, Gastroenterology/Hepatology, HIV, Hospital Medicine, Infectious Disease.
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