Travelers transport infectious diseases across international borders and travel has been implicated as a factor

in the global emergence and reemergence of infectious diseases.13 The rapid dissemination of infectious diseases via travelers was clearly demonstrated by the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 and the current Pexidartinib concentration 2009 influenza A (H1N1) pandemic.14,15 The Asia-Pacific region has seen a higher than average growth in international tourist arrivals with 184.3 million international tourist arrivals in 2007, a 10.4% increase from 2006 compared to the global average increase of 6.6%.16 Of departing flights from Australia in 2006, 51.7% were to destinations in Asia.17 Despite increased tourist arrivals in the Asia-Pacific region, data on the burden of selleck kinase inhibitor infectious diseases in travelers within this region are limited. Our study aimed to assess the proportion

of travelers reporting symptoms of infection and identify significant independent predictors of symptoms of infection in a representative sample of travelers departing Sydney and Bangkok airports. Cross-sectional surveys of travelers were conducted prior to their departure from international airports in Sydney, Australia, bound for destinations in Asia, and from Bangkok, Thailand, bound for Australia. A two-stage cluster sampling technique was developed at each study site to randomly sample travelers. In the first stage at the Sydney site, sample sizes for each destination were calculated based on the proportion of travelers departing Australia

to destinations in South-Eastern and Eastern Asia.17,18 Airline carriers were approached for permission to interview their customers and airlines were selected by their share of total passenger movements and represented both Australian and non-Australian carriers. Flight timetables of all approved airline carriers were obtained from airline websites and all flights to destinations of interest were sought. Two airlines declined to participate and were excluded from the study. While airline selection is unlikely to influence the outcomes reported, no data exist on traveler differences Idoxuridine by airline. An interviewing timetable was devised to broadly represent flights on all available days and times of departure per carrier for each destination. The second stage of the cluster sampling method involved the distribution of questionnaires to every fifth passenger joining the check-in queues of the selected flights. Bilingual interviewers attended check-in counters 3 hours before scheduled departure until 1 hour before departure. A similar method was employed at the Bangkok airport, with selected flights proportionate to the number of traveler arrivals at Australian airports from Thailand and representative of Thai, Australian, and other carriers. Overall, approximately 175 flights were sampled between July and September 2007 at the Sydney site comprising 2.