EDCP Mission/Vision

Burden of Internationally Acquired Infections, Maryland, 1997-2001

Dipti Shah, David Blythe
Epidemiology & Disease Control Program
MD Dept of Health & Mental Hygiene, Baltimore, MD

Background: Growth in international commerce, travel, and migration has increased the likelihood of imported infectious disease cases in the United States. In MD, determination of country of acquisition is attempted for all reported infectious disease cases.

Methods: We evaluated all communicable disease reports received by the state health department from 1997-2001, and examined demographics and country of travel for all confirmed cases noted to be acquired internationally.

Results: Of 111,667 cases reported from 1997-2001, 1418 (1.3%) were deemed internationally imported. Median age for these cases was 29 years (range: 1 day to 92 years). 51% were male; 49% female. 36% were Black, 32% White, 17% Asian/Pacific Islander, 3% other races. 11% had unknown race. 27% of cases were hospitalized; <1% died. Over the 5-year period, the most commonly reported internationally acquired infections were malaria (36%), hepatitis B (16%), non-typhoid Salmonella sp. (11%), campylobacteriosis (9%), hepatitis A (9%), and shigellosis (8%). The remaining 11% included travel-associated infections such as typhoid fever, amebiasis, dengue fever, and leprosy. Of all MD malaria cases, 98% were internationally acquired. Site of acquisition was unknown for 2% of cases, although MD has had no documented confirmed indigenous malaria transmission since 1952. Nearly 9% of reported hepatitis A cases and 8% of campylobacteriosis cases were internationally acquired. Smaller percentages of non-typhoid Salmonella sp. and hepatitis B cases were imported (4% and 2%, respectively). For cases where country/region information was available, 54% reported travel to/from Africa, 15% to/from Central America, 13% to/from Asia, and 18% to/from various other regions. The largest proportion of internationally imported cases came from Nigeria (20%) and Ghana (9%).

Conclusions: The burden of internationally acquired infections in MD is substantial, and includes vector-borne, bloodborne, and foodborne illnesses. A sizeable proportion of several common infectious diseases appear to have been acquired internationally, underscoring the need for disseminating appropriate prevention recommendations to travelers.

Submitted to the Infectious Diseases Society of America (IDSA) Annual Meeting 2002; accepted for poster presentation.

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Maryland Department of Health & Mental Hygiene — Epidemiology & Disease Control Program