Epidemiology of travel-related hospitalization

Background: Limited information exists on causes of hospitalization in patients returning from the tropics, and most is focused on febrile diseases. We evaluated all causes of post-travel hospitalization in a tertiary care hospital in Israel. Methods: Demographics, diagnoses, and destinations of patients admitted between January 1999 and December 2003 with a history of recent travel were recorded. Demographics and destination of healthy travelers presenting to our pre-travel clinic at the same period were recorded. Results: Of 211 patients admitted, 71% were males, 8% were immigrants/foreign workers, and febrile diseases accounted for 77% of admissions. The most common diagnoses were malaria in 54 (26%), unidentified febrile disease in 34 (16%), and dengue fever in 27 (13%). New World cutaneous leishmaniasis was the most common cause of admission among nonfebrile patients (18 [9%]). Diarrheal diseases accounted for only 11% of admissions. Regarding destination, 101 (48%) patients had been to Asia, 71 (34%) to Africa, and 43 (20%) to the Americas. Of our healthy traveler population, 59% traveled to Asia, 20% to Africa, and 20% to the Americas. Travel to Africa carried the highest risk of being hospitalized (OR 1.85, 95% CI 1.16-2.97; p = .01). Most (59%) patients returning from Africa had malaria. The principal health problem originating in Asia was dengue fever (27%), and from Latin America, cutaneous leishmaniasis (48%). Males comprised 71% of the patients, and 59% of the healthy traveler population (p < .0001). Males were more likely to acquire malaria (OR 2.15, 95% CI 1.13-4.09; p = .02) and leishmaniasis (OR 3.41, 95% CI 0.97-11.89; p = .05). Conclusions: Febrile diseases were the most common cause for hospitalization, with malaria, unidentified febrile diseases, and dengue fever being the most common. Diseases were destination related; travel to Africa was associated with a higher rate of hospitalization. Malaria and cutaneous leishmaniasis had a substantially male predominance, probably due to risk-taking behavior.