4,5 Otherwise meningococcal disease usually has been considered to be rare among travelers (Figure 2).6 A single retrospective survey has attempted to quantify the Opaganib ic50 risk of meningococcal disease among international travelers originating in industrialized countries.7 Health authorities

in 56 of 108 contacted countries (51.9%) completed questionnaires concerning reported cases of meningococcal disease, and tourism data were derived from statistics provided by the World Tourism Organization and national tourism authorities for the study period (1986–1989). On the basis of 13 cases imported to 56 countries, a monthly incidence rate of 0.4 per million was extrapolated, which corresponds to approximately 0.4 per 100,000 population per year.7 When this rate is compared with the commonly quoted annual incidence rate of 0.5 to 10 cases per 100,000 population in industrialized countries,8,9 it appears that ordinary travel does not result in an increased risk for meningococcal disease. As in the general population,

infections in travelers can occur in healthy persons without any apparent risk factors and regardless of the type of traveling or the travel destination. In the past few years, a number of anecdotal reports of meningococcal disease among travelers have been published (Table 1).10–15 buy GDC-0068 An additional six cases, which so far are unpublished, have been detected in the GeoSentinel, a worldwide communication and data collection network for the surveillance of travel-related Lenvatinib order morbidity.16 Among them, two occurred after a visit to Disney World (Pat Schlagenhauf, personal communication). This demonstrates that, among travelers, meningococcal disease may occur in all parts of the world and in various types of travelers—trekkers, leisure and business travelers, students, and pilgrims—and in all age groups. As in the population affected at home, children and young travelers were most frequently affected. Some of the cases of meningococcal disease in travelers reported in recent years confirm what we know from

data in other populations: environmental risk is increased by staying in dormitories,11,15 educational or military institutions,17,18 and refugee camps19 and by attending sporting events20,21 and discotheques.22 Clusters of meningococcal disease caused by the same strain have occurred in children whose connection was riding the same school bus,23 which indicates there could be potential for transmission aboard tour buses. Almost 30 years ago during an outbreak situation, six trekkers fell ill in Nepal.24 The sum of these examples illustrates that the risk of meningococcal disease in travelers can vary based on destination, mode of transport, type of accommodation, and reason for travel/destination activities. While high-risk groups can be determined primarily on theoretical and general epidemiological considerations, there is no zero risk in any traveler.