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Infection Tracking in Travellers (ITIT)

English title Infection Tracking in Travellers (ITIT)
Applicant Schlagenhauf Patricia
Number 192653
Funding scheme Project funding (Div. I-III)
Research institution Institut für Epidemiologie, Biostatistik und Prävention Universität Zürich
Institution of higher education University of Zurich - ZH
Main discipline Infectious Diseases
Start/End 01.10.2020 - 30.09.2024
Approved amount 526'117.00
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All Disciplines (2)

Discipline
Infectious Diseases
Methods of Epidemiology and Preventive Medicine

Keywords (14)

tourist; Travel; Infection; business; geolocation; sex; malaria; Mass Gathering; QoL; VFR; surveillance; sequelae; arboviral; age

Lay Summary (German)

Lead
Die Bedeutung von reiseassoziierten Infektionen nimmt zu. Zurzeit wird nur ein kleiner Teil der Infektionsfälle erfasst.
Lay summary

 

Inhalt und Ziele des Forschungsprojekts

Die Studie ist eine nicht-interventionelle, prospektive Kohortenstudie, bei der Daten zu reisebedingten Infektionen direkt von den Reisenden mithilfe einer mobilen App erhoben werden. Die Teilnehmer geben ihr digitales Einverständnis und füllen einen einfachen Eingangsfragebogen mit Angaben zu Alter, Geschlecht, Reisezweck, bestehender Erkrankung, Reiseziel und Reisedauer aus. Jeden Tag wird in einem Pop-up-Fenster nach Infektionssymptomen gefragt. Wenn die Antwort "ja" lautet, erscheint eine Dropdown-Liste mit Symptomen, die auf vier Gesundheitsbereichen basieren (Verdauung, Atemwege, Haut sowie allgemeine Symptome). Der Schweregrad der Symptome wird selbst eingeschätzt. Nach einer Pilotstudie mit fünfzig Reisenden am UZH Zentrum für Reisemedizin werden mehr als 10.000 Reisende rekrutiert werden, aus der Schweiz, später aus Europa (über das EuroTravNet-Netzwerk) und auch über die Websites der WHO.

Die Forschungsziele sind 1) die Bewertung des Spektrums von Infektionen, mit denen verschiedene Gruppen von Reisenden konfrontiert sind, 2) die Identifizierung von geschlechts- und altersspezifischen Profilen von Infektionen, 3) die Bewertung der sich verändernden Epidemiologie von Malaria und arboviralen Infektionen (Viren, die von Arthropoden wie Mücken übertragen werden) auf der Grundlage von Geolokalisation, Umweltdaten und Symptomen der Reisenden und 4) die Erforschung der langfristigen gesundheitlichen Auswirkungen von arboviralen Infektionen und Malaria.

 

Wissenschaftlicher und gesellschaftlicher Kontext des Forschungsprojekts

Diese Forschung wird Infektionskrankheitsprofile von Reisenden nach Alter, Geschlecht, Reisezweck, Ort, Klima und Umweltfaktoren evaluieren. Das Projekt wird die Infektionsüberwachung revolutionieren, da die Krankheitssymptome direkt von den Reisenden eingegeben werden.

 

Direct link to Lay Summary Last update: 29.12.2020

Responsible applicant and co-applicants

Employees

Project partner

Associated projects

Number Title Start Funding scheme
166524 Tracking of Urgent Risks in Swiss Travellers (TOURIST) to improve travel advice in Swiss travel clinics 01.04.2017 Project funding (Div. I-III)

Abstract

1.Summary of the Research Plan “Infection Tracking in Travellers (ITIT)” projectBackground and rationale: International travel is growing exponentially. Globally, there will be a projected 1.8 billion traveller arrivals in 2030. Current surveillance of travellers’ health is top-down (i.e. clinicians/laboratories report illness) and only a small proportion of illness events are captured. More data are needed on the types of infections acquired by different groups who have varying purposes of travel such as business/corporate travellers, those visiting friends and relatives (VFR), leisure/tourist travellers and mass gathering event (Hajj, Olympics, World Cup) attendees. More data are needed to profile infections in travellers according to age and sex as men and women have different infection susceptibilities. Infectious diseases, in particular the spread of malaria and “arboviral infections”,(i.e. viruses such as dengue) pose major threats with changing epidemiology influenced by climate, environmental factors and human mobility. The extent and impact of these infections on travellers’ health and their long-term sequelae have scarcely been evaluated. Overall Objectives: Our research objectives in this four-year project, using an App called ITIT, are 1) to evaluate the spectrum of in-travel infection symptoms encountered by different groups of travellers: tourists versus business/corporate versus VFR versus mass gathering travellers. 2) to identify sex and age specific profiles of travel-associated illness 3) to evaluate the changing epidemiology of malaria and arboviral infections based on geo location and environmental data and traveller symptoms (fever, pain +/- rash, +/- red eye) reporting 4) to follow up on long-term sequelae of arboviral infections and malaria, investigate their prevalence, risk factors and impact on Quality of Life.Methods: The proposed study will be a non-interventional, prospective cohort study where data on travel-related infections are collated building on a smartphone App used in prior studies (Tourist 1 and 2). ITIT will have a low questionnaire burden to encourage participation. The informed consent will be a simplified digital consent. The entry questionnaire will collect five variables: age, sex, purpose of travel, destination and duration of travel. Each day, a pop-up window will ask "Did you have any health problems today". If the answer is “yes”, a drop-down list of symptoms will appear. This list of symptoms will be based on the most common symptoms reported by travellers in earlier studies and will be based on 4 health domains (gastrointestinal symptoms, respiratory symptoms, skin infections and rashes, fever, pain and myalgia) with Likert scale, self-rating of severity. Combined with the variables from the brief entry questionnaire this will allow for the profiling of traveler health according to sex, age, geolocation, meteorological and purpose of travel. To fulfill objective 4), a follow-up, questionnaire will be sent to all participants who reported (fever, pain,+/-rash, +/- red eye) one week, two weeks, one- two- six months and one year after travel asking “have your symptoms resolved” with a self-rating of the severity of persisting symptoms and a QoL questionnaire and asking “did you have a medically confirmed diagnosis of any of the following: dengue, chikungunya, Zika, malaria?”. Any participant reporting a confirmed arboviral infection or malaria will receive a standardized invitation to be part of a study cohort evaluating long-term sequelae of these infections. This study will adhere to strict ethical and data protection standards for the App that will inspire trust in the users. All data are anonymous. We will collect symptoms data using a modification of an existing smartphone App (TOURIST). Traveller participation will be encouraged with motivational features such as pop-up windows giving advice on minor illnesses, such as travellers’diarrhoea, insect bites, vomiting, that occur frequently during travel. The information provided in these pop ups will follow “WHO International Travel and Health” advice. After a pilot study of fifty travellers at the University of Zürich Centre for Travel Medicine, we will recruit more than 10,000 travellers, from Switzerland, later Europe (using the EuroTravNet network partner clinics) and also via WHO websites. Impact: This research will define infectious disease profiles of travellers by age, sex, purpose of travel, location, climate and environmental factors and will pave the way for personalized travel health advice. It will revolutionize surveillance by allowing bottom up reporting of illness symptoms by travellers enabling the follow up of sequelae of arboviral infections. These data will allow for preparedness in view of increasing numbers of viremic travellers arriving in Europe and the presence of competent vectors.
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