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Background Cutaneous leishmaniasis (CL) may be emerging among international travellers and migrants. Limited data exist on mucocutaneous leishmaniasis (MCL) in travellers. We describe the epidemiology of travel-associated CL and MCL among international travellers and immigrants over a 20-year period through descriptive analysis of GeoSentinel data. Methods Demographic and travel-related data on returned international travellers diagnosed with CL or MCL at a GeoSentinel Surveillance Network site between 1 September 1997 and 31 August 2017 were analysed. Results A total of 955 returned travellers or migrants were diagnosed with travel-acquired CL (n = 916) or MCL during the study period, of whom 10% (n = 97) were migrants. For the 858 non-migrant travellers, common source countries were Bolivia (n = 156, 18.2%) and Costa Rica (n = 97, 11.3%), while for migrants, they were Syria (n = 34, 35%) and Afghanistan (n = 22, 22.7%). A total of 99 travellers (10%) acquired their disease on trips of ≤ 2 weeks. Of 274 cases for which species identification was available, Leishmania Viannia braziliensis was the most well-represented strain (n = 117, 42.7%), followed by L. major (n = 40, 14.6%) and L. V. panamensis (n = 38, 13.9%). Forty cases of MCL occurred, most commonly in tourists (n = 29, 72.5%) and from Bolivia (n = 18, 45%). A total of 10% of MCL cases were acquired in the Old World. Conclusions Among GeoSentinel reporting sites, CL is predominantly a disease of tourists travelling mostly to countries in Central and South America such as Bolivia where risk of acquiring L. V. braziliensis and subsequent MCL is high. The finding that some travellers acquired leishmaniasis on trips of short duration challenges the common notion that CL is a disease of prolonged travel. Migrants from areas of conflict and political instability, such as Afghanistan and Syria, were well represented, suggesting that as mass migration of refugees continues, CL will be increasingly encountered in intake countries.

Background\ud \ud More than 30,000 malaria cases are reported annually among international travellers. Despite improvements in malaria control, malaria continues to threaten travellers due to inaccurate perception of risk and sub-optimal pre-travel preparation.\ud \ud Methods\ud \ud Records with a confirmed malaria diagnosis after travel from January 2003 to July 2016 were obtained from GeoSentinel, a global surveillance network of travel and tropical medicine providers that monitors travel-related morbidity. Records were excluded if exposure country was missing or unascertainable or if there was a concomitant acute diagnosis unrelated to malaria. Records were analyzed to describe the demographic and clinical characteristics of international travellers with malaria.\ud \ud Results\ud \ud There were 5689 travellers included; 325 were children

A 34-year-old pilot flying for an exploration company in arid Chad was reported as being “very ill with malaria.” He was jaundiced in spite of having been given a quinine drip three times a day. The drip was administered by a heroic local doctor who leopard-crawled into the exploration camp under threat of rebel fire three times a day. The patient had not taken malaria prophylaxis and no laboratory confirmation of the diagnosis had been made. The camp was a seven-hour arduous drive from N’djamena and the pilot was too ill to fly himself out.

The traveller who presents with fever on return requires a comprehensive assessment. This paper outlines the salient features in assessing these patients. A detailed history, examination and knowledge of diseases prevalent in the areas that were visited is essential if one is to arrive at a diagnosis and institute appropriate treatment or referral.Malaria remains the first differential diagnosis in travellers returning from an endemic area irrespective of precautions taken.The most common illnesses that result in a fever in travellers are presented and a resource list is provided.

Introduction Sub Saharan Africa, a very high-risk destination for travellers, is an important destination for South African workers. The concomitant occupational exposure to infectious diseases raises concern about the adequate risk-related preparation of business travellers, particularly those moving to remote areas. Occupational health practitioners in South Africa are concerned about expatriates whose ‘last-minute’ consultation pattern may preclude adequate disease prevention and appropriate preparation for travel. The South African Society of Travel Medicine established a national sentinel surveillance system and, with the National Institute for Occupational Health, investigated the pre-travel consultation patterns in business travellers. Methods A retrospective study was conducted on records of 20 000 travellers attending 24 sentinel general and travel medicine practices in main South African centres from January 2005 to December 2006. Reason for travel, destination, and the time between consultation and departure were collated. Data were analysed using STATA. Results Business travellers comprised 42% of the travellers consulting clinics and had a mean ‘consultation to departure’ period of 15.2 days. Over half the business travellers (54%) consult less than a week before departure, while 92% consult less than a month before departure. Other countries in Africa are the destination for 73% of business travellers. Discussion This is the first national surveillance of South African corporate and leisure travellers seeking travel advice. Since Africa is the destination for most business travellers consulting travel medicine clinics in South Africa, the period of consultation prior to departure is of particular concern with regard to malaria prophylaxis and completion of multiple dose vaccine schedules. The findings of this sentinel surveillance indicate the need for detailed comparison of time to departure with vaccines and malaria prophylaxis; for targeted advice to the corporate industries deploying employees in Africa; and to define accelerated schedules to maximise protection for the ‘last-minute’ business traveller.

The FIFA World Cup is to be held on the African continent for the first time in 2010. In excess of 350,000 visitors and participants are expected for the event, which will take place in eight cities around South Africa during June and July 2010. It is a unique opportunity for South Africa to showcase the beauty and diversity of its many tourist attractions. While South Africa has successfully hosted a number of large international gatherings, this event poses specific challenges, given its size and diversity of attendees. There is potential for transmission of imported or endemic communicable diseases, especially those that have an increased transmission rate as a result of close proximity of multiple potential carriers, eg, seasonal influenza. Unfortunately, such high‐profile events may also attract deliberate release of biological or other agents. A number of opportunities arise to reduce the risk of acquiring communicable diseases during a mass gathering such as the World Cup, including the pretravel consultation, enhanced epidemic intelligence to timeously detect incidents, the provision of standard operating procedures for epidemic response, and training and pre‐accreditation of food suppliers to reduce food‐borne disease outbreaks. International mass gatherings pose specific challenges not only to implementing control measures due to the mobility of the attendees but also with regard to recognition and management of infectious diseases in travelers returning to their countries of origin.1 There is huge commitment to make the event safe for all who visit the country. Since 1984, all but one of South Africa's winter influenza epidemics have occurred during the time of year that the 2010 World Cup will be staged.2 The … Corresponding Author: Lucille H. Blumberg, MBBCh, MMed (Micro), DTM&H, FFTM (Glasgow), National Institute for Communicable Diseases, Private Bag X4, Sandringham 2131, South Africa. E‐mail: lucilleb{at}nicd.ac.za

Background The efficacy of intravenous quinine, which is the mainstay for treating severe malaria in children, is decreasing in South East Asia and Africa. Artemisinin derivatives are a potential alternative to quinine. However, their efficacy compared to quinine in treating severe malaria in children is not clearly understood. The objective of this review was to assess the efficacy of parenteral artemisinin derivatives versus parenteral quinine in treating severe malaria in children. Methods All randomized controlled studies comparing parenteral artemisinin derivatives with parenteral quinine in treating severe malaria in children were included in the review. Data bases searched were: The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2007), MEDLINE (1966 to February 2008), EMBASE (1980 to February 2008), and LILACS (1982 to February 2008). Dichotomous variables were compared using risk ratios (RR) and the continuous data using weighted mean difference (WMD). Results Twelve trials were included (1,524 subjects). There was no difference in mortality between artemisinin derivatives and quinine (RR = 0.90, 95% CI 0.73 to 1.12). The artemisinin derivatives resolved coma faster than quinine (WMD = -4.61, 95% CI: -7.21 to -2.00, fixed effect model), but when trials with adequate concealment only were considered this differences disappeared. There was no statistically significant difference between the two groups in parasite clearance time, fever clearance time, incidence of neurological sequelae and 28th day cure rate. One trial reported significantly more local reactions at the injection site with intramuscular quinine compared to artemether. None of the trials was adequately powered to demonstrate equivalence. Conclusion There was no evidence that treatment of children with severe malaria with parenteral artemisinin derivatives was associated with lower mortality or long-term morbidity compared to parenteral quinine. Future studies require adequately powered equivalence trial design to decide whether both drugs are equally effective.

Game parks in Tanzania have long been considered to be at low risk for African trypanosomiasis; however, nine cases of the disease associated with these parks were recently reported. The outbreak was detected through TropNetEurop, a sentinel surveillance network of clinical sites throughout Europe.