Incidence of illness and injury among visitors to various regions of the world
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1 Incidence of illness and injury among visitors to various regions of the world CISTM Heli Siikamäki MD, PhD, Specialist in Internal Medicine and Infectious Diseases DTM, Special Competence in International Health Care, FFTM RCPS(Glasg) Coordinating doctor, SOS International Senior consultant, Helsinki University Hospital, Finland
2 What do we know about health problems of travellers DURING travel?
3 Prospective studies on health problems DURING travel Reported health problems Sought medical care Hospitalized Deaths 12-65% 3-11% % No data Kendrick USA 1972, Reid UK 1980, Peltola Finland 1983, Steffen Switzerland 1987, Cossar Scotland UK 1990, Getz Norway 1990, Ahlm Sweden 1994, Bruni Switzerland 1997, Scovillle USA 1997, Hill USA 2000, Evans UK 2001, Rack Germany 2005, Fleck Germany 2006
4 Prospective studies on health problems DURING travel Most common symptoms Accidents or injuries Gastrointestinal symptoms Respiratory symptoms 0.5 7% 11 59% 2 26% Kendrick USA 1972, Reid UK 1980, Peltola Finland 1983, Steffen Switzerland 1987, Cossar Scotland UK 1990, Getz Norway 1990, Ahlm Sweden 1994, Bruni Switzerland 1997, Scovillle USA 1997, Hill USA 2000, Evans UK 2001, Rack Germany 2005, Fleck Germany 2006
5 What do the prospective studies represent? - Sample size travellers - Based on post-travel questionnaires or interviews present proportionate morbidity
6 What do we NOT know?
7 GAPS IN KNOWLEDGE IN TRAVEL MEDICINE Data on all travellers health problems while abroad? NOMINATOR DENOMINATOR = INCIDENCE of travellers health problems? Data on all travellers to the same regions during the same time period?
8 Finland population 5,5 million the Official Statistics of Finland
9 ? NOMINATOR DENOMINATOR = Incidence? The Official Statistics of Finland: - Numbers of travellers - Duration of travel Travel days by regions and countries
10 Finnish travellers Stay healthy during travel Fall ill or get injured during travel Do not seek medical care Seek medical care Do not use travel insurance a 30% Make an insurance claim after travel b 75% Use travel insurance 70% Are reported to an assistance organisation during travel 25% Are handled by other assistance organisations c a Insurance survey % b Eurooppalainen insurance company c EMA Group, MedFlight Finland Are handled by SOS International 95% (77% of inpatient cases, 99.8% of outpatient cases)
11 SOS International: Data of Finnish travellers seeking medical care while abroad NOMINATOR DENOMINATOR = Incidence of most serious health problems while abroad Official Statistics of Finland: - Numbers of travellers - Duration of travel Travel days by regions and countries
12 Finnish travellers who sought medical care abroad handled by SOS International (SOS) cases Excluded because of incomplete information 378 / 0.7% Final study group cases Outpatient cases (84%) Inpatient cases (16%)
13 Available data in SOS database Age Sex Time of illness or injury Country of illness or injury Inpatient or outpatient Main diagnosis Repatriation Death
14 RESULTS Diagnoses 60 % infections 14 % injuries 5 % skin diseases 5 % musculoskeletal and connective tissue diseases 3 % diseases of digestive tract 2 % vascular diseases 6 % other
15 Diagnoses of infection cases N (%) Acute gastroenteritis (38.0) Respiratory infections (34.5) Other Infections (27.5) TOTAL (100)
16 Not included: Calculation of incidence Nordic and Baltic countries and Russia Trips shorter Finnish Social Insurance covers proportionally more cases than elsewhere To be compatible with the OSF data: Children (<15 y) The elderly (> 74 y)
17 Percentages (pies) and incidences / travel days (boxes) of infections and injuries A = Eastern and western Europe, B = Southern Europe and Eastern Mediterranean, C = Africa, D = Asia and Oceania, E = the Americas
18 Overall incidence of illness or injury / travel days in various geographic regions
19 Repatriation N (%) TOTAL (100) Returned home as planned (96.3) Transport arranged (3.1) Air ambulance transport 113 (0.2) Death* 199 (0.4) *168 died outside hospital, diagnoses not available
20 Conclusions Incidence figures allow comparisons Geographic regions differ in incidence and disease pattern Infections are the most common health problems of travellers Acute gastroenteritis and respiratory infections are the most common diagnoses Travelling within Europe is not without risks The risks are higher in southern than in eastern and western Europe
21 The study group Heli Siikamäki Pia Kivelä Jukka Ollgren Mikael Fotopoulos Anu Kantele Siikamäki H, Kivelä P, Fotopoulos M, Ollgren J, Kantele A. Illness and injury of travellers abroad: Finnish nationwide data from 2010 to 2012, with incidences in various regions of the world. Eurosurveillance, Volume 20, Issue 19, 14 May 2015 Available online (open access):
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