Fever in Returned Travelers: Results from the GeoSentinel Surveillance Network

Mary E. Wilson,1,2 Leisa H. Weld,3 Andrea Boggild,4,5 Jay S. Keystone,4,5 Kevin C. Kain,4,5 Frank von Sonnenburg,6 and Eli Schwartz,7,8 for the GeoSentinel Surveillance Networka

1Mount Auburn Hospital, Cambridge, and 2Harvard Medical School and Harvard School of Public Health, Boston, Massachusetts; 3Centers for Disease Control and Prevention, Atlanta, Georgia; 4McLaughlin-Rotman Centre, Tropical Disease Unit, University Health Network–Toronto General Hospital and 5University of Toronto, Toronto, Canada; 6Department of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany; and 7Center for Geographic Medicine, Chaim Sheba Medical Center, Tel Hashomer, and 8Sakler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel



     Background.     Fever is a marker of potentially serious illness in returned travelers. Information about causes of fever, organized by geographic area and traveler characteristics, can facilitate timely, appropriate treatment and preventive measures.
     Methods.     Using a large, multicenter database, we assessed how frequently fever is cited as a chief reason for seeking medical care among ill returned travelers. We defined the causes of fever by place of exposure and traveler characteristics.
     Results.     Of 24,920 returned travelers seen at a GeoSentinel clinic from March 1997 through March 2006, 6957 (28%) cited fever as a chief reason for seeking care. Of patients with fever, 26% were hospitalized (compared with 3% who did not have fever); 35% had a febrile systemic illness, 15% had a febrile diarrheal disease, and 14% had fever and a respiratory illness. Malaria was the most common specific etiologic diagnosis, found in 21% of ill returned travelers with fever. Causes of fever varied by region visited and by time of presentation after travel. Ill travelers who returned from sub-Saharan Africa, south-central Asia, and Latin America whose reason for travel was visiting friends and relatives were more likely to experience fever than any other group. More than 17% of travelers with fever had a vaccine-preventable infection or falciparum malaria, which is preventable with chemoprophylaxis. Malaria accounted for 33% of the 12 deaths among febrile travelers.
     Conclusions.     Fever is common in ill returned travelers and often results in hospitalization. The time of presentation after travel provides important clues toward establishing a diagnosis. Preventing and promptly treating malaria, providing appropriate vaccines, and identifying ways to reach travelers whose purpose for travel is visiting friends and relatives in advance of travel can reduce the burden of travel-related illness.