Illness in travelers returned from Brazil: the GeoSentinel experience and implications for the 2014 FIFA World Cup and the 2016 Summer Olympics

Abstract

Background: Brazil will host the 2014 FIFA World Cup and the 2016 Olympic and Paralympic Games, events that are expected to attract hundreds of thousands of international travelers. Travelers to Brazil will encounter locally endemic infections as well as mass event-specific risks.

Methods: We describe 1586 ill returned travelers who had visited Brazil and were seen at a GeoSentinel Clinic from July 1997 through May 2013.

Results: The most common travel-related illnesses were dermatologic conditions (40%), diarrheal syndromes (25%), and febrile systemic illness (19%). The most common specific dermatologic diagnoses were cutaneous larva migrans, myiasis, and tungiasis. Dengue and malaria, predominantly Plasmodium vivax, were the most frequently identified specific causes of fever and the most common reasons for hospitalization after travel. Dengue fever diagnoses displayed marked seasonality, although cases were seen throughout the year. Among the 28 ill returned travelers with human immunodeficiency virus (HIV) infection, 11 had newly diagnosed asymptomatic infection and 9 had acute symptomatic HIV.

Conclusions: Our analysis primarily identified infectious diseases among travelers to Brazil. Knowledge of illness in travelers returning from Brazil can assist clinicians to advise prospective travelers and guide pretravel preparation, including itinerary-tailored advice, vaccines, and chemoprophylaxis; it can also help to focus posttravel evaluation of ill returned travelers. Travelers planning to attend mass events will encounter other risks that are not captured in our surveillance network.

Keywords: Brazil; dengue; dermatologic; mass gatherings; travelers.

Figure 1.

Map of Brazil (includes shading for yellow fever and malaria and all major cities where World Cup and Olympic and Paralympic Games will be held). Sources: http://cdc-malaria.ncsa.uiuc.edu, http://wwwnc.cdc.gov/travel/pdf/yellow-fever-vacc-brazil.pdf, http://www.rio2016.org/en/the-games/maps/venues-map, http://www.fifa.com/worldcup/destination/cities/index.html.

Figure 2.

Dengue fever diagnoses of ill returned travelers exposed in Brazil seen at GeoSentinel clinics, by month, 2008–2012 (n = 48).

Figure 3.

Cutaneous larva migrans: a 26-year-old man returned from Jamaica with a severely pruritic serpiginous rash.

Figure 4.

Myiasis: a 50-year-old man returned from Belize feeling intermittent stabbing pain and movement within his arm lesions.

Figure 5.

Tungiasis: a 21-year-old woman returned from Peru with painful nodules on her toes.