Cover Page

Infectious Diseases: A Geographic Guide

Second Edition

Edited by

Eskild Petersen MD, DMSc, DTM&H

Institute of Clinical Medicine, Aarhus University, Denmark
and
Senior Consultant, Department of Infectious Diseases, The Royal Hospital,
Muscat, Sultanate of Oman

 

Lin H. Chen MD, FACP, FASTMH

Travel Medicine Center, Division of Infectious Diseases,
Mount Auburn Hospital, Cambridge, Massachusetts,
and Harvard Medical School
Boston, Massachusetts, USA

 

Patricia Schlagenhauf-Lawlor PhD, FFTM, RCPSS (Glasg), FISTM

University of Zürich, WHO Collaborating Centre for Travellers’ Health,
Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland

 

 

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List of contributors

Gulzhan Abuova
Department of Infectious Diseases,
South‐Kazakhstan State Pharmaceutical Academy,
Shymkent, Kazakhstan

Seif S. Al‐Abri
Directorate General for Communicable Disease Surveillance,
Ministry of Health, Sultanate of Oman

Rodrigo Nogueira Angerami
Epidemiological Surveillance Section, Division of Infectious Diseases,
Hospital of Clinics, University of Campinas and Department of Public Health,
School of Medical Sciences, University of Campinas,
Campinas, São Paulo, Brazil

Jaffar A. Al‐Tawfiq
Johns Hopkins Aramco Healthcare, Dhahran,
Kingdom of Saudi Arabia

Patrick Ayeh‐Kumi
School of Biomedical and Allied Health Sciences,
University of Ghana, Accra, Ghana

Frank J. Bia
Department of Internal Medicine,
Infectious Disease Section, Yale School of Medicine,
New Haven, Connecticut, USA

Barbra M. Blair
Division of Infectious Diseases,
Beth Israel Deaconess Medical Center, Boston,
Massachusetts, USA; Harvard Medical School,
Boston, Massachusetts, USA

Lucille Blumberg
Epidemiology and Outbreak Response Unit,
National Institute for Communicable Diseases,
Johannesburg, Sandringham, South Africa

Tom Boyles
Infectious Diseases, Department of Medicine,
University of Cape Town, Cape Town, South Africa

Clive M. Brown
Quarantine and Border Health Services Branch,
Division of Global Migration and Quarantine,
Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Michael G. Bruce
Arctic Investigations Program, DPEI, NCEZID,
CDC, Anchorage, Alaska, USA

Gerd D. Burchard
Bernhard Nocht Institute for Tropical Medicine,
Hamburg, Germany

Bin Cao
Department of Infectious Diseases and Clinical Microbiology,
Beijing Chao‐Yang Hospital, Beijing, China;
Institute of Respiratory Medicine,
Capital Medical University, Beijing, China

Francesco Castelli
University Department of Infectious and Tropical Diseaases,
University of Brescia, Brescia, Italy

Eric Caumes
Department of Infectious and Tropical Diseases,
Hôpital Pitié‐Salpêtrière, Université Pierre et Marie Curie,
Paris, France

Lin H. Chen
Travel Medicine Center, Division of Infectious Diseases,
Mount Auburn Hospital, Cambridge, Massachusetts, USA;
Harvard Medical School, Boston, Massachusetts, USA

Francis E.G. Cox (in memoriam)
Department of Disease Control, London School of Hygiene and Tropical Medicine,
London, UK

Peter J. de Vries
Department of Internal Medicine, Tergooi Hospital,
Hilversum, The Netherlands

Alexander Erovichenkov
Department of Infectious Diseases,
Russian Medical Academy of Postgraduate Education,
Moscow, Russia

Birgitta Evengard
Division of Infectious Diseases,
Department of Clinical Microbiology,
Umeå University, Umeå, Sweden

Philip R. Fischer
Department of Pediatric and Adolescent Medicine,
Mayo Clinic, Rochester, Minnesota, USA

Philippe Gautret
Unité de Recherche sur les maladies Infectieuses et Tropicales Emergentes,
Aix‐Marseille Université, Marseille, France

Matthew German
Li Ka Shing Knowledge Institute, St Michael’s Hospital,
Toronto, Ontario, Canada

Pier Francesco Giorgetti
University Department of Infectious and Tropical Diseaases,
University of Brescia, Brescia, Italy

Martin P. Grobusch
Center for Tropical Medicine and Travel Medicine,
Department of Infectious Diseases,
Division of Internal Medicine, Academic Medical Center, University of Amsterdam,
Amsterdam, The Netherlands

Davidson H. Hamer
Center for Global Health and Development,
Boston University Schools of Public Health and Medicine,
Boston, Massachusetts, USA; Tufts University Friedman
School of Nutrition Science and Policy, Boston, Massachusetts, USA

David Harley
National Centre for Epidemiology and Population Health,
Australian National University,
Canberra, Australia

Christoph Hatz
Epidemiology, Biostatistics and Prevention Institute,
University of Zürich, Zürich, Switzerland;
Department of Medicine and Diagnostic Services,
Swiss Tropical and Public Health Institute, Basel, Switzerland

Luiz Jacintho da Silva (in memoriam)
Division of Infectious Diseases, Department of Internal Medicine, School of Medical Sciences,
University of Campinas, Campinas, São Paulo, Brazil

Kamran Khan
Li Ka Shing Knowlege Institute, St Michael’s Hospital, Toronto, Ontario, Canada;
Department of Medicine, Division of Infectious Diseases, University of Toronto,
Toronto, Ontario, Canada

Mikio Kimura
Shin‐Yamanote Hospital, Japan Anti‐Tuberculosis Association,
Higashi‐Murayama, Tokyo, Japan

Anders Koch
Department of Epidemiology Research,
Statens Serum Institut and Department of Infectious Diseases,
Rigshospitalet University Hospital, Copenhagen, Denmark

Karin Ladefoged
Department of Internal Medicine, Queen Ingrid’s Hospital,
Nuuk, Greenland

Karin Leder
Travel Medicine and Immigrant Health, Victorian Infectious Disease Service,
Royal Melbourne Hospital and Infectious Disease Epidemiology Unit,
Department of Epidemiology and Preventive Medicine,
Monash University, Australia

Michael Libman
J.D. MacLean Centre for Tropical Diseases;
Division of Infectious Diseases; and Department of Microbiology,
McGill University, Montreal, Quebec, Canada

Rogelio López‐Vélez
National Referral Unit for Tropical Diseases, Infectious Diseases Department,
Ramón y Cajal University Hospital, Madrid, Spain

Larry I. Lutwick
Department of Infectious Diseases, Microbiology and Immunology,
Stryker School of Medicine, Western Michigan University, Kalamazoo,
Michigan, USA; Editor, ID Cases; Moderator,
ProMED Program for Monitoring Emerging Diseases

Lawrence C. Madoff
Editor, ProMED‐mail; International Society for Infectious Diseases,
Division of Infectious Diseases and Immunology,
University of Massachusetts Medical School, Boston,
Massachusetts, USA

Boubacar Maiga
Department of Epidemiology of Parasitic Diseases,
Faculty of Medicine, Pharmacy and Odonto‐Stomatology,
Malaria Research and Training Center, USTTB, Bamako, Mali

Audrone Marcinkute
University Hospital, Santariškių Klinikos and Clinic of Infectious Diseases,
Vilnius University, Vilnius, Lithuania

Karen J. Marienau
US Public Health Service (Ret.), St Paul, Minnesota, USA

Anthony J. McMichael (in memoriam)
National Centre for Epidemiology and Population Health,
Australian National University, Canberra, Australia

Ziad A. Memish
Ministry of Health, Riyadh, Kingdom of Saudi Arabia

Marc Mendelson
Division of Infectious Diseases and HIV Medicine,
Department of Medicine, Groote Schuur Hospital, University of Cape Town,
Cape Town, South Africa

Maria D. Mileno
Warren Alpert Medical School, Brown University,
Providence, Rhode Island, USA

Brian T. Montague
Division of Infectious Diseases, University of Colorado,
Aurora, Colorado, USA

Terri L. Montague
Western Nephrology, Arvada, Colorado, USA

Nadjet Mouffok
Service des Maladies Infectieuses,
Centre Hospitalier Universitaire d’Oran, Oran, Algeria

Holy Murphy
CIWEC Hospital and CIWEC Clinic Travel Medicine Center,
Kathmandu, Nepal

Andreas Neumayr
Department of Medicine and Diagnostic Services,
Swiss Tropical and Public Health Institute, Basel, Switzerland;
University of Basel, Basel, Switzerland

Francesca F. Norman
National Referral Unit for Tropical Diseases,
Infectious Diseases Department, Ramón y Cajal University Hospital,
Madrid, Spain

Prativa Pandey
CIWEC Hospital and CIWEC Clinic Travel Medicine Center,
Kathmandu, Nepal

Daniel H. Paris
Centre for Tropical Medicine and Global Health,
Nuffield Department of Clinical Medicine, University of Oxford,
Oxford, UK; Mahidol‐Oxford Tropical Medicine Research Unit,
Faculty of Tropical Medicine, Mahidol University,
Bangkok, Thailand

Philippe Parola
Unité des Rickettsies, Faculté de Médecine,
Université de la Méditerranée, Marseille, France

Malgorzata Paul
Department and Clinic of Tropical and Parasitic Diseases,
University of Medical Sciences, Poznan, Poland

Androula Pavli
Hellenic Center for Disease Control and Prevention,
Athens, Greece

José‐Antonio Pérez‐Molina
National Referral Unit for Tropical Diseases,
Infectious Diseases Department, Ramón y Cajal University Hospital,
Madrid, Spain

Olga Perovic
Centre for Opportunistic, Tropical and Hospital Infections,
National Institute for Communicable Diseases
and University of Witwatersrand, Johhannesburg, South Africa

Eskild Petersen
Institute of Clinical Medicine, Aarhus University,
Denmark; Department of Infectious Diseases,
The Royal Hospital, Muscat, Sultanate of Oman

Giles Poumerol
World Health Organization, International Health Regulations Department,
Geneva, Switzerland

Natalia Pshenichnaya
Department of Infectious Diseases and Epidemiology,
Rostov State Medical University, Rostov‐on‐Don, Russia

Joanna J. Regan
Maritime Activity Lead, Quarantine and Border Health Services Branch,
Division of Global Migration and Quarantine,
Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Alfonso J. Rodriguez‐Morales
Public Health and Infection Research Group,
Faculty of Health Sciences, Universidad Tecnologica de Pereira,
Pereira, Risaralda, Colombia; Infectious Diseases Research Group,
Hospital Universitario de Sincelejo, Sucre, Colombia

Christopher M. Salas
Warren Alpert Medical School, Brown University,
Providence, Rhode Island, USA

Francisco Santos‐O’Connor
Labour Administration, Labour Inspection and
Occupational Safety and Health Branch,
International Labour Office, Geneva, Switzerland

Patricia Schlagenhauf‐Lawlor
University of Zürich,
WHO Collaborating Centre for Travellers’ Health,
Epidemiology, Biostatistics and Prevention Institute,
Zürich, Switzerland

Marc Shaw
School of Public Health, James Cook University, Townsville,
Australia; WORLDWISE Travellers Health Centres, New Zealand

Laura E. Shevy
Department of Infectious Diseases and International Health,
Geisel School of Medicine at Dartmouth,
Dartmouth Hitchcock Medical Center, Lebanon,
New Hampshire, United States

Ashwin Swaminathan
Departments of Infectious Diseases and General Medicine,
Canberra Hospital, Canberra, Australia;
National Centre for Epidemiology and Population Health,
Australian National University,
Canberra, Australia

Elizabeth A. Talbot
Department of Infectious Diseases and International Health,
Geisel School of Medicine at Dartmouth,
Dartmouth Hitchcock Medical Center,
Lebanon, New Hampshire, United States

Joseph Torresi
Department of Microbiology and Immunology, Peter Doherty Institute
for Infection and Immunity, University of Melbourne, Melbourne, Australia;
Eastern Infectious Diseases and Travel Medicine, Boronia, Victoria, Australia

J. Scott Vega
Maritime Activity, Quarantine and Border Health Services Branch,
Division of Global Migration and Quarantine,
Centers for Disease Control and Prevention, Atlanta,
Georgia, USA

Elvina Viennet
Australian Red Cross Blood Service,
Brisbane, Australia;
National Centre for Epidemiology and Population Health,
Australian National University,
Canberra, Australia

Nicholas J. White
Mahidol‐Oxford Tropical Medicine Research Unit,
Faculty of Tropical Medicine, Mahidol University,
Bangkok, Thailand; Centre for Tropical Medicine and Global Health,
Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK

Mary E. Wilson
Department of Global Health and Population, Harvard T.H.
Chan School of Public Health, Harvard University,
Boston, Massachusetts, USA;
School of Medicine, University of California,
San Francisco, California, USA

Fei Zhou
Department of Infectious Diseases and Clinical Microbiology,
Beijing Chao‐Yang Hospital, Beijing, China; Beijing Institute of Respiratory Medicine,
Capital Medical University, Beijing, China

Foreword to the first edition

Where have you been? In the world of clinical medicine, this is a critical question that opens a treasure chest or sometimes a Pandora’s box of epidemiological information often leading the infectious disease specialist to a correct diagnosis or intervention that otherwise might not be considered. When this key question is forgotten, a poor or preventable outcome may follow. But what happens when the experienced physician or travel medicine specialist, who unfailingly includes this question in his or her initial assessment, hears a patient respond with a lengthy discussion of a complex itinerary, multiple exposures, or unusual symptoms? Sometimes the destination is not familiar, the exposures trigger a distant memory of “something important” but one cannot recall exactly the connection, or a specific finding can generate a limited differential diagnosis. The physician or travel medicine specialist then attempts to locate the missing information in published papers, books, and online references.

Where are you going? In the pretravel setting, this book is an indispensible reference for travel medicine practitioners advising individual long‐term travelers or making recommendations for expatriates who will stay for prolonged periods in a particular geographic area. Long‐term travelers have been shown to have a higher risk of acquiring travel‐associated illness because of their prolonged exposure, suboptimal adherence to preventive measures, and often a lack of knowledge on risks at the destination. The comprehensive regional disease profile presented in this volume will allow for tailored advice for this important group of travelers.

This important new book, Infectious Diseases: A Geographic Guide by Eskild Petersen, Lin H. Chen, and Patricia Schlagenhauf admirably fills the need for a single reference structured to assist the travel medicine practitioner to answer these questions.

Infectious Diseases: A Geographic Guide is organized by geographic regions of the world; for example, South Asia, Central Europe, South America, etc. Each chapter pertaining to a geographic region is then organized into an initial section on important regional infections, a series of very useful and easily scanned tables, a section on antibiotic resistance, a short section on vaccine‐preventable diseases in the region, and finally a section on background data from the region. The tables are organized by presenting clinical syndromes, the way we actually encounter patients, subdivided where appropriate into those that usually occur within four weeks of exposure and those that occur greater than four weeks after exposure. Each table then divides infectious pathogens into those that are frequently encountered, uncommonly encountered, and rarely encountered. The sections on antibiotic resistance are unique and quite useful. This kind of antibiotic resistance information is usually not presented by geographic region but rather by pathogen with a secondary linkage to geographic regions. Having this regional perspective is novel and fits nicely with the evaluation of the ill returned traveler. There are several other very interesting and useful chapters in the introductory and closing sections of the book with inviting titles such as “An historical overview of global infectious diseases and geopolitics,” “Detection of infectious diseases using unofficial sources,” “Microbes on the move: prevention, curtailment, outbreak”, “diagnostic tests and procedures”, “the immunocompromised patient”, “migration and the geography of disease,” and “Climate change and the geographical distribution of infectious diseases.”

The editors of this new text are leaders in the field of international travel medicine and have attracted a brilliant and luminous collection of chapter contributors. The regional chapters are written by individuals living in the region or expatriates with long‐standing affiliations with the area. A strength of this book is the editorial oversight and vision of the editors who skillfully bring together a very diverse, international team to yield a cohesive, multiauthored, yet well‐written textbook.

The global community of the twenty‐first century is connected by ever growing bonds of communication, economic growth, shared aspirations, and increasingly, a globalized enterprise of international treaties, agreements, covenants, and structures. Global health is now part of the daily lexicon of universities, governments, and multinational companies. The basis for this explosive growth over the last half century lies in the movement of people from one place to another. The motivation for movement is varied, but the most important questions that a travel medicine practitioner can ask are: “Where are you going?” in the pretravel setting or “Where have you been?” when seeing the ill returned traveler. Infectious Diseases: A Geographic Guide by Eskild Petersen, Lin H. Chen, and Patricia Schlagenhauf will be the first resource most of us reach for when those questions are fielded.

Alan J. Magill MD FACP FIDSA (deceased)
President of the International Society of Travel Medicine (2009–11)

Foreword to the second edition

The ancient Romans produced some of the most relevant and important questions pertaining to the field of geographic medicine. For those giving pretravel advice, “Quo vadis?” (Where are you going?) is the critical question that enables travel medicine advisors to complete an individual risk assessment to ensure the safety of international travelers. On the other hand, “Ubi eras?” (Where have you been?) is the crucial question for clinicians evaluating the ill returned traveler in order to develop an appropriate differential diagnosis and investigation strategy. Of course, my favorite Latin phrase could apply in almost any situation: “Semper ubi sububi always wear underwear!

Never before in human history has knowledge of infectious disease in a global context, the field of geographic medicine, been so important from personal, public health and clinical perspectives. In 2014, more than a billion tourists crossed the globe, an estimated 200 million individuals traveled internationally for business, and in 2013, 82 million migrants arrived in the North from developing countries. It now takes less than 36 hours to cross the globe, well within the incubation periods of many infectious diseases. Thus, global travel provides an excellent opportunity for the acquisition and spread of infectious diseases. In the past two decades, we have seen SARS spread from South‐east Asia to North America, chikungunya virus from Africa through Asia to the Caribbean and Latin America, MERS co‐virus throughout the Arabian peninsula, and, more recently, Zika virus from the South Pacific to Brazil and beyond in the Western hemisphere. Each of these infections has played havoc with the health of local populations and visitors.

So, what is a healthcare provider to do when faced with an ill traveler returned from some unfamiliar remote destination? How to counsel a volunteer planning to provide healthcare or education in some rural area of a developing country? Is there a single resource that will provide information on the risks of infectious diseases globally by geographic region that also includes an approach to clinical diagnosis by incubation period and presenting symptoms? Yes, in the following chapters of this book.

Infectious Diseases: A Geographic Guide is probably the only print publication that provides both the clinical and epidemiological approach to infectious diseases on a global basis. A passage from the Foreword of the first edition bears repeating: “The editors of this text are leaders in the field of international travel medicine and have attracted a brilliant and luminous collection of chapter contributors. The strength of this book is the editorial oversight and vision of the editors who skillfully bring together a very diverse, international team to yield a cohesive, multi‐authored, yet well‐written textbook.” I couldn’t have said it better than the author of this quote, the late Dr Alan McGill, one of the most accomplished and beloved tropical disease and travel medicine experts of this generation.

This book is divided into chapters by region of the world, written by credible and experienced authors who have worked in or have intimate knowledge of a particular geographic area. The chapters are organized into an initial section on important regional infections, a series of tables organized by presenting clinical syndromes, sections on antibiotic resistance and vaccine‐preventable diseases, and finally a section on background data from the region. From the initial regional overview of infectious diseases, the travel medicine practitioner can readily obtain a perspective on some of the major infectious disease risks facing the traveler‐to‐be. The second and major portion of each chapter is designed for the clinician facing the ill returned traveler or migrant. Tables, organized by presenting clinical syndromes, are subdivided into those that usually occur within four weeks or greater than four weeks after exposure. Each table then divides infectious pathogens into those that are frequently encountered, uncommonly encountered, and rarely encountered. What more could a healthcare provider ask than being able to consult clinically relevant tables setting out key infections that might be responsible for a patient’s symptoms? It almost makes geographic medicine easy when the work of providing a differential diagnosis is laid out so clearly.

In addition to chapters by geographic region, the editors have included a number of excellent and eclectic chapters that provide the reader with a perspective on the epidemiology of travel‐related infections such as infections by air and sea, climate change, and migration, as well as clinically oriented chapters pertaining to diagnostic algorthims, the immune‐compromised patient and emerging infections. For the public health expert, very interesting chapters are included on surveillance systems, novel techniques for tracking infections, and outbreak curtailment. Essentially, Infectious Diseases: A Geographic Guide has something for everyone!

This book belongs on the shelf of every practitioner who provides pretravel health advice, public health officials responsible for outbreak control, and especially for clinicians caring for ill returned travelers and newly arrived migrants. I will have one on my shelf even if I don’t receive a complimentary copy!

Jay S. Keystone CM MD MSc (CTM) FRCPC
Tropical Disease Unit, Toronto General Hospital
University of Toronto, Ontario, Canada