Illness in Returned Travelers
http://www.100md.com
《新英格兰医药杂志》
To the Editor: Freedman et al. (Jan. 12 issue)1 has called attention to hazards for travelers. As the authors state, the study does not reflect the full epidemiology of travelers' diseases. There is a great danger that patients and practitioners who anticipate and strive to prevent the serious threats to health for travelers will mistakenly consider only infectious diseases. Physicians advising patients who are planning travel to tropical countries must warn them of the real burden of illness: premature death from injury.
In earlier studies of deaths of Americans overseas, some 10,000 deaths were analyzed according to cause, age, and place of occurrence.2,3 There were 601 deaths from injuries and only 25 deaths caused by infectious diseases. Death rates from injuries in developing countries were considerably higher than those in the United States. Similar findings came from an earlier study involving Peace Corps volunteers.4
Travel clinics would be seriously remiss if they did not counsel travelers on the dangers of injuries. Advice to avoid motorcycles, small vehicles, unscheduled aircraft, and swimming in unfamiliar waters is essential to help protect travelers.5
David M. Bishai, M.D., Ph.D.
Tim Baker, M.D., M.P.H.
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD 21205
dbishai@jhsph.edu
References
Freedman DO, Weld LH, Kozarsky PE, et al. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med 2006;354:119-130.
Hargarten SW, Baker TD, Guptill K. Overseas fatalities of United States citizen travelers: an analysis of deaths related to international travel. Ann Emerg Med 1991;20:622-626.
Baker TD, Hargarten SW, Guptill K. The uncounted dead -- American civilians dying overseas. Public Health Rep 1992;107:155-159.
Hargarten SW, Baker SP. Fatalities in the Peace Corps: a retrospective study: 1962 through 1983. JAMA 1985;254:1326-1329.
Murat JE. Road vehicle accidents during travel and their prevention. Med Trop (Mars) 1997;57:522-526.
The authors reply: We concur with the point made by Bishai and Baker. The literature indicates that about 25 percent of overseas deaths are from injury, with the remainder largely from natural causes.1,2 MacPherson et al. estimated that about 36 percent of all overseas deaths are preventable.1 As travel patterns have changed and adventure travel has increased, new studies are needed. An unanswered question is whether the risk of dying from causes other than natural ones while traveling overseas is different from that while staying home.
David O. Freedman, M.D.
University of Alabama at Birmingham
Birmingham, AL 35294
freedman@uab.edu
Leisa H. Weld, Ph.D.
Phyllis Kozarsky, M.D.
Centers for Disease Control and Prevention
Atlanta, GA 30333
References
MacPherson DW, Guerillot F, Streiner DL, Ahmed K, Gushulak BD, Pardy G. Death and dying abroad: the Canadian experience. J Travel Med 2000;7:227-233.
Prociv P. Deaths of Australian travellers overseas. Med J Aust 1995;163:27-30.
In earlier studies of deaths of Americans overseas, some 10,000 deaths were analyzed according to cause, age, and place of occurrence.2,3 There were 601 deaths from injuries and only 25 deaths caused by infectious diseases. Death rates from injuries in developing countries were considerably higher than those in the United States. Similar findings came from an earlier study involving Peace Corps volunteers.4
Travel clinics would be seriously remiss if they did not counsel travelers on the dangers of injuries. Advice to avoid motorcycles, small vehicles, unscheduled aircraft, and swimming in unfamiliar waters is essential to help protect travelers.5
David M. Bishai, M.D., Ph.D.
Tim Baker, M.D., M.P.H.
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD 21205
dbishai@jhsph.edu
References
Freedman DO, Weld LH, Kozarsky PE, et al. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med 2006;354:119-130.
Hargarten SW, Baker TD, Guptill K. Overseas fatalities of United States citizen travelers: an analysis of deaths related to international travel. Ann Emerg Med 1991;20:622-626.
Baker TD, Hargarten SW, Guptill K. The uncounted dead -- American civilians dying overseas. Public Health Rep 1992;107:155-159.
Hargarten SW, Baker SP. Fatalities in the Peace Corps: a retrospective study: 1962 through 1983. JAMA 1985;254:1326-1329.
Murat JE. Road vehicle accidents during travel and their prevention. Med Trop (Mars) 1997;57:522-526.
The authors reply: We concur with the point made by Bishai and Baker. The literature indicates that about 25 percent of overseas deaths are from injury, with the remainder largely from natural causes.1,2 MacPherson et al. estimated that about 36 percent of all overseas deaths are preventable.1 As travel patterns have changed and adventure travel has increased, new studies are needed. An unanswered question is whether the risk of dying from causes other than natural ones while traveling overseas is different from that while staying home.
David O. Freedman, M.D.
University of Alabama at Birmingham
Birmingham, AL 35294
freedman@uab.edu
Leisa H. Weld, Ph.D.
Phyllis Kozarsky, M.D.
Centers for Disease Control and Prevention
Atlanta, GA 30333
References
MacPherson DW, Guerillot F, Streiner DL, Ahmed K, Gushulak BD, Pardy G. Death and dying abroad: the Canadian experience. J Travel Med 2000;7:227-233.
Prociv P. Deaths of Australian travellers overseas. Med J Aust 1995;163:27-30.