207 - Travel Related Risk Behaviors and Antibiotic Use among Older Travelers

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Presenting Author(s)

VC

Varea H. Costello

Infectious Diseases Staff
Walter Reed Medical Center
Virginia Beach, Virginia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

DT

David R. Tribble

Science Director, Infectious Disease Clinical Research Program
Uniformed Services University of the Health Sciences
Bethesda, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CE

Christa Eickhoff

Infectious Disease Staff
Naval Medical Center Portsmouth
Portsmouth, Virginia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DT

Drake H. Tilley

Staff Physician
Naval Medical Center San Diego
San Diego, CA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
GU

Gregory Utz

Research Physician, Site PI
Naval Medical Center San Diego, Infectious Disease Clinical Research Program, Bethesda, MD, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
San Diego, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KT

Kalyani Telu

SAS Programmer Analyst
Henry M. Jackson Foundation for the Advancement of Military Medicine, In Support of USU Infectious Disease Clinical Research Program
Bethesda, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AG

Anuradha Ganesan

Infectious Disease Physician Walter Reed National Military Medical Center
Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Walter Reed National Military Medical Center
Bethesda, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JF

Jamie A. Fraser

Head Clinical Research Manager
Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
Bethesda, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
TL

Tahaniyat Lalani

Research Physician, IDCRP Research Area Director, Associate Professor USU
Naval Medical Center Portsmouth
Portsmouth, Virginia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Older travelers (≥ 60 years) are a unique risk population for travel related infections and adverse events from antibiotics. We evaluated the differences in travel characteristics, exposures, illnesses and antibiotic use among older travelers and those between 18 – 59 y using a prospective, observational cohort of US Department of Defense (DoD) beneficiaries traveling outside the US for ≤ 6.5 months (TravMil).

Methods: Adult DoD beneficiaries were enrolled pre-travel. Itineraries limited to Western/Northern Europe, Canada, or New Zealand and active duty personnel on military travel were excluded. Demographics, itineraries and prescriptions were abstracted. A post-travel survey collected information on exposures and illnesses (travelers’ diarrhea (TD), influenza-like illness (ILI) or febrile illness). Categorical variables were analyzed using chi-square or Fishers exact test and the Mann-U Whitney test was used for continuous variables.

Results: Of the 1468 travelers, 755 were ≥ 60y and 719 were < 60y. Asia (35%) and South/Central America (28%) were the most common travel regions. Older travelers were more likely to be Caucasian (80% vs. 67%), male (52% vs. 39%) and travel for tourism (84% vs. 51%) (p< 0.05). Younger travelers were more likely engage in risk behaviors (e.g. consume poorly cooked meat or seafood (16% vs 9%) or street vendor food (26% vs 8.6%), wade in fresh water (24% vs. 18%), and non-compliance with malaria prophylaxis (22% vs 12%) (p< 0.05). Older travelers had a lower incidence of TD (18% vs 24%), and a higher proportion of cases with loose stool or mild TD that did not interfere with daily activities (63% vs. 51%) (p< 0.05). Inappropriate antibiotic use for loose stool or mild TD were similar among the two age groups (67% vs 59%). Non-significant trends of lower incidence and mild infections were observed for ILI and febrile illness in older travelers.

Conclusion: Older travelers were less likely to engage in risk behaviors, had a lower TD incidence and reported mild diarrheal symptoms. Inappropriate antibiotic use for loose stool or mild TD was common in both age groups. Enhancing antibiotic stewardship is important for older travelers to prevent potential side effects, drug interactions and antibiotic resistance.