Volume 97, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We report two cases of severe influenza infection imported by tourist patients from their country of origin and developed during travel. While studies have reported cases of influenza infections acquired during travel, here we examine two cases of severe influenza infection contracted in the country of origin that led to diagnosis and therapeutic problems in the destination country. No international recommendation exists concerning influenza vaccination before travel, and few countries recommend it for all travelers. Our study suggests that travel should be canceled when infectious signs are observed before departure. Influenza is a very common infection that is often benign, but sometimes very severe. The most severe cases include shock, acute respiratory distress syndrome (ARDS), myocarditis, rhabdomyolysis, and multiple organ failure. Management can require exceptional therapies, such as extracorporeal membrane oxygenation. A number of studies have focused on influenza infection in travelers. Cases of influenza acquired during travel have been reported in this literature, but no study has examined cases of influenza imported from the country of origin and developed while abroad. The latter situation may lead to 1) diagnostic problems during the nonepidemic season or in places where diagnostic techniques are lacking and 2) therapeutic difficulties resulting from the unavailability of techniques for the management of severe influenza infection in tourist areas. Here, we report two cases of extremely severe influenza infection imported by tourists from their country of origin and developed during travel.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Nicholson KG, Wood JM, Zambon M, 2003. Influenza. Lancet Lond Engl 362: 17331745.
    [Google Scholar]
  2. Whelan J, Rimmelzwaan GF, van den Hoek A, Belderok S-M, Sonder GJB, 2016. Influenza in long-term Dutch travelers in the tropics: symptoms and infections. BMC Infect Dis 16: 158.
    [Google Scholar]
  3. Boggild AK et al., GeoSentinel Surveillance Network, 2012. Latitudinal patterns of travel among returned travelers with influenza: results from the GeoSentinel surveillance network, 1997–2007. J Travel Med 19: 48.
    [Google Scholar]
  4. Mutsch M, Tavernini M, Marx A, Gregory V, Lin YP, Hay AJ, Tschopp A, Steffen R, 2005. Influenza virus infection in travelers to tropical and subtropical countries. Clin Infect Dis Off Publ Infect Dis Soc Am 40: 12821287.
    [Google Scholar]
  5. Goeijenbier M, van Genderen P, Ward BJ, Wilder-Smith A, Steffen R, Osterhaus ADME, 2016. Travellers and influenza: risks and prevention. J Travel Med 24: taw078.
    [Google Scholar]
  6. Filleul L, Brottet E, Gauzere B, Winer A, Vandroux D, Michault A, Jaffar-Bandjee M, Larrieu S, 2012. Reunion, a sentinel territory for influenza surveillance in Europe. Euro Surveill 17: pii 20212.
    [Google Scholar]
  7. Filleul L et al., 2016. A major impact of the influenza seasonal epidemic on intensive care units, Réunion, April to August 2016. Euro Surveill 21: pii 03405.
    [Google Scholar]
  8. Leitmeyer K, Adlhoch C, 2016. Review article: influenza transmission on aircraft: a systematic literature review. Epidemiology 27: 743751.
    [Google Scholar]
  9. Neatherlin J et al., 2013. Influenza A(H1N1)pdm09 during air travel. Travel Med Infect Dis 11: 110118.
    [Google Scholar]
  10. Browne A, Ahmad SS-O, Beck CR, Nguyen-Van-Tam JS, 2016. The roles of transportation and transportation hubs in the propagation of influenza and coronaviruses: a systematic review. J Travel Med 23: tav002.
    [Google Scholar]
  11. Marshall CA, Morris E, Unwin N, 2016. An epidemiological study of rates of illness in passengers and crew at a busy Caribbean cruise port. BMC Public Health 16: 314.
    [Google Scholar]
  12. Álvarez-Lerma F, Marín-Corral J, Vila C, Masclans JR, González de Molina FJ, Martín Loeches I, Barbadillo S, Rodríguez A, H1N1 GETGAG/SEMICYUC Study Group, 2016. Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome. Crit Care 20: 337.
    [Google Scholar]
  • Received : 05 Apr 2017
  • Accepted : 12 Aug 2017
  • Published online : 02 Oct 2017
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error