Imported fever in returning travellers and migrants in Spain, 2009-2021. Analysis by the +REDIVI network.
Pedro Guevara-Hernández, Jara Llenas-García, Marta Díaz-Menéndez, Nuria Serre-Delcor, Clara Crespillo-Andújar, Fernando Salvador, José Manuel Ruiz-Giardin, Josune Goikoetxea-Agirre, Diego Torrús-Tendero, Fernando de la Calle-Prieto, Inés Oliveira-Souto, Pau Bosch-Nicolau, Philip Wikman, José A Pérez-Molina, +Redivi study group
Author Information
Pedro Guevara-Hernández: Infectious Diseases Unit-Internal Medicine Department, Vega Baja Hospital, Orihuela, Spain. Electronic address: pegueher@gmail.com.
Jara Llenas-García: Infectious Diseases Unit-Internal Medicine Department, Vega Baja Hospital, Orihuela, Spain; Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain; CIBERINFEC, Carlos III Health Institute, Madrid, Spain. Electronic address: jarallenas@gmail.com.
Marta Díaz-Menéndez: CIBERINFEC, Carlos III Health Institute, Madrid, Spain; National Referral Unit for Imported Diseases and International Health, High Level Isolation Unit, La Paz-Carlos III-CB University Hospital (IdiPaz), Madrid, Spain. Electronic address: marta.diazmenendez@gmail.com.
Nuria Serre-Delcor: CIBERINFEC, Carlos III Health Institute, Madrid, Spain; Tropical Diseases and Global Health Unit Drassanes-Vall d'Hebron, Infectious Diseases Department, Vall d'Hebron Hospital, PROSICS Barcelona, Barcelona, Spain. Electronic address: nuria.serre@vallhebron.cat.
Clara Crespillo-Andújar: CIBERINFEC, Carlos III Health Institute, Madrid, Spain; National Reference Centre for Tropical Diseases. Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain. Electronic address: clara.crespillo@gmail.com.
Fernando Salvador: CIBERINFEC, Carlos III Health Institute, Madrid, Spain; Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain. Electronic address: fernando.salvador@vallhebron.cat.
José Manuel Ruiz-Giardin: CIBERINFEC, Carlos III Health Institute, Madrid, Spain; Infectious Diseases Unit-Internal Medicine Department. Fuenlabrada University Hospital, Madrid, Spain. Electronic address: josemanuel.ruiz@salud.madrid.org.
Diego Torrús-Tendero: Imported Diseases and Global Health Reference Unit, Dr. Balmis University General Hospital, Alicante, SpainISABIAL; Parasitology Area, Miguel Hernández University, Spain. Electronic address: torrus_die@gva.es.
Fernando de la Calle-Prieto: National Referral Unit for Imported Diseases and International Health, High Level Isolation Unit, La Paz-Carlos III-CB University Hospital (IdiPaz), Madrid, Spain. Electronic address: fcalle.prieto@salud.madrid.org.
Inés Oliveira-Souto: CIBERINFEC, Carlos III Health Institute, Madrid, Spain; Tropical Diseases and Global Health Unit Drassanes-Vall d'Hebron, Infectious Diseases Department, Vall d'Hebron Hospital, PROSICS Barcelona, Barcelona, Spain. Electronic address: ines.oliveira@vallhebron.cat.
Pau Bosch-Nicolau: CIBERINFEC, Carlos III Health Institute, Madrid, Spain; Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain. Electronic address: pau.boschnicolau@gmail.com.
Philip Wikman: Clinical Medicine Department, Miguel Hernández University, Elche, Spain; Infectious Diseases Unit-Internal Medicine Department, Elda University Hospital, Spain. Electronic address: pwikman@umh.es.
José A Pérez-Molina: CIBERINFEC, Carlos III Health Institute, Madrid, Spain; National Reference Centre for Tropical Diseases. Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain. Electronic address: jperezm@salud.madrid.org.
BACKGROUND: Travellers and migrants commonly present to health services with febrile syndrome, which can have different causes, including some that are life-threatening. A better understanding of these causes may help guide management and determine appropriate empirical treatments. OBJECTIVES: The aim was to identify the leading causes of fever and to assess their association with the region of travel and type of travellers. METHODS: This prospective, multicentre study was conducted within the +REDIVI network. Data were collected on febrile syndrome cases among migrants, travellers, and people visiting friends and relatives (VFRs) from 2009 to 2021. Comparative analyses were performed according to patient categories and regions of travel/origin. RESULTS: Of the 4186 patients with febrile syndrome, the most frequent diagnosis was malaria (31.0 %), followed by dengue fever (12.0 %) and nonspecific fever of less than three weeks' duration (11.6 %). Malaria predominated in people coming from sub-Saharan Africa (58.4 %), while dengue fever was more common in the rest of the regions (19.0 % in South America, 25.0 % in Central America and the Caribbean, 34.2 % in Southeast Asia, and 18.1 % in South-Central Asia). By type of traveller, tuberculosis was more frequent in migrants, malaria in VFRs, and dengue and other arboviral infections in travellers and VFRs. CONCLUSIONS: Geographical area of travel and type of traveller are the main determinants of imported fever aetiology. Malaria remains the most common cause of febrile syndrome, especially in VFRs from sub-Saharan Africa, while dengue fever prevails in the other tropical regions.
