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Travel and vaccination patterns: a report from a travel medicine clinic in northern Sweden
Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
2011 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 43, no 9, 714-720 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Travel Medicine Clinic in Umeå is one of Sweden's largest public providers of vaccination and counselling prior to international travel. During the study period it was the only travel medicine clinic in Umeå. This study describes the demography of the visitors to the clinic and travel destinations and durations, as well as vaccinations administered. METHODS: This was a retrospective study for the period January 2005 to April 2008 based on pre-travel consultation questionnaires and on vaccine expenditure data. A 10% sample of 16,735 first visits prior to international travel was consecutively selected according to the chronology of the visits. RESULTS: Data on 1698 travellers were included in the study. Thailand was the most common destination among visitors, accounting for one third of all destinations. Medical problems affecting pre-travel health planning were rare. Four out of 5 visitors (79%) received only 1 vaccination, mainly for hepatitis A. Travellers to Thailand more often sought travel health advice compared to travellers to Turkey, despite the fact that the 2 destinations were almost equally distributed among travellers from Umeå. We found differences between men and women in money spent on vaccines and in particular in vaccination against Japanese encephalitis. CONCLUSIONS: To assess the optimal vaccination level at a travel medicine clinic is difficult. Decisions are affected by general recommendations and the risk perception of the travel medicine practitioner, as well as the risk perception of the traveller. The sex difference found in this study might be due to gender differences in risk perception and should be further investigated.

Place, publisher, year, edition, pages
2011. Vol. 43, no 9, 714-720 p.
Keyword [en]
Travel medicine, vaccination patterns, travel trends, sex differences, vaccination policies
National Category
Infectious Medicine
URN: urn:nbn:se:umu:diva-64535DOI: 10.3109/00365548.2011.581306ISI: 000293913800007PubMedID: 21585242OAI: diva2:602177
Available from: 2013-01-31 Created: 2013-01-31 Last updated: 2015-11-05Bibliographically approved
In thesis
1. Travel – a risk factor for disease and spread of antibiotic resistance
Open this publication in new window or tab >>Travel – a risk factor for disease and spread of antibiotic resistance
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

As international travel is rapidly increasing, more people are being exposed to potentially more antibiotic resistant bacteria, a changed infectious disease epidemiology, and an increased risk of accidents and crime. Research-based advice is needed to adequately inform travellers about these risks. We studied travellers who sought advice from the Travel Medicine Clinic at the Department of Infectious Diseases, Umeå University Hospital, as well as university students from Umeå, Stockholm, and Gothenburg travelling abroad for study, research, and clinical exchange programs.

From retrospective data at the Travel Medicine Clinic, we found that pre-existing health problems were rare among travellers from Umeå seeking pre- travel health advice and vaccinations. In addition, we found that the travel destination and the sex of the traveller affected vaccination levels. Although hepatitis A is endemic to both Thailand and Turkey, compared to travellers to Thailand few travellers to Turkey visited the clinic for hepatitis A vaccination. The data also revealed that more women than men were vaccinated against Japanese encephalitis despite comparable trips.

A prospective survey study showed that travellers felt that the pre-travel health advice they received was helpful. Two-thirds of the travellers followed the advice given although they still fell ill to the same extent as those who were not compliant with the advice. Factors outside the control of travellers likely affect the travel-related morbidity. Compared to older travellers, younger travellers were less compliant with advice, fell ill to a greater extent, and took greater risks during travel.

In a prospective survey study, we found that healthcare students had higher illness rates and risk exposure when abroad compared to students from other disciplines. This difference was mainly due to the fact that healthcare students more often travelled to developing regions during their study period abroad. When abroad, half of all students increased their alcohol consumption and this was linked to an increased risk of theft and higher likelihood of meeting a new sex partner.

The healthcare students participating in the survey study also submitted stool samples before and after travel. These samples were tested for the presence of antibiotic resistance, both by selective culturing for ESBL-PE (Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae) as well as by metagenomic sequencing. About one-third (35%) of the students became colonised by ESBL-PE following their study abroad. The strongest risk factor for colonisation was travel destination; for example, 70% of students who had travelled to India became colonised. Antibiotic treatment during travel was also a significant risk factor for colonisation.

The stool samples from a subset of study subjects were analysed using metagenomic sequencing. From this we learned that although the majority of resistance genes in the gut microbiome remained unchanged following travel, several clinically important resistance genes increased, most prominently genes encoding resistance to sulphonamide, trimethoprim, and beta-lactams. Overall, taxonomic changes associated with travel were small but the proportion of Proteobacteria, which includes several clinically important bacteria (e.g., Enterobacteriaceae), increased in a majority of the study subjects.

Clearly, there are risks associated with international travel and these risks include outside factors as well as the personal behaviour of travellers. We believe our results can be used to develop better pre-travel advice for tourists as well as university students studying abroad resulting in safer travel.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2015. 66 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1754
Accident Prevention; Alcohol Drinking; Anti-Bacterial Agents; Antimalarials; Beta-Lactamases; Drug-Resistance, Bacterial; Enterobacteriaceae; Health Knowledge, Attitudes, Practice; High-Throughput Nucleotide Sequencing; Medication Adherence; Metagenome; Metagenomics; Patient Compliance; Proteobacteria; Risk Reduction Behaviour; Risk-Taking; Safe Sex; Travel medicine; Travel; Vaccination
National Category
Infectious Medicine Microbiology in the medical area
Research subject
Infectious Diseases; Microbiology
urn:nbn:se:umu:diva-111057 (URN)978-91-7601-348-9 (ISBN)
Public defence
2015-11-27, Sal A5, byggnad 6A, Norrlands universitetssjukhus, Umeå, 09:00 (English)
The Kempe Foundations
Available from: 2015-11-06 Created: 2015-11-02 Last updated: 2015-12-11Bibliographically approved

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