Evaluation of a programme for ‘Rapid Assessment of Febrile Travelers’ (RAFT): a clinic-based quality improvement initiative

Jazuli, Farah; Lynd, Terence; Mah, Jordan; Klowak, Michael; Jechel, Dale; Klowak, Stefanie; Ovens, Howard; Sabbah, Sam; Boggild, Andrea K

While fatal malaria has been continually imported by febrile returned travellers, it was the 2013-2015 Ebola virus disease (EVD) crisis, during which time fatal and non-fatal cases of EVD were exported from West Africa, that really brought the need for a travel history to the forefront. While we did not have any patients with EVD during our enrolment period, ∼17% of diagnoses (n=26) in this population of febrile returned travellers were notifiable at both the provincial and federal level, including influenza, HIV, salmonellosis, campylobacteriosis, typhoid fever, giardiasis and malaria, indicating public health import and/or potential communicability. 18 Our diagnosis of four febrile returned travellers with acute HIV, syphilis and genital chlamydia infection reinforces the need for a thorough sexual and behavioural history, especially in the context of known disinhibition on the part of travellers. 19 In their crosssectional study of >112 000 ill returned international travellers, Matteelli et al 20 documented STIs in 0.9%, many of which were acute HIV. Common STIs including secondary syphilis, acute HIV, acute HSV1 or HSV2, and gonococcemia can all lead to fever in the returned traveller. As such, these diagnoses should remain on the differential diagnosis and be excluded in the sexually active febrile returned traveller with a compatible history and clinical picture.