JultikaUniversity of Oulu repository

Abstract

As an emerging infectious disease dengue is putting a constantly growing number of international tourists at risk of the infection. To have a more complete picture of the phenomena among the Finnish travelers, the backgrounds of infections were retrospectively examined to find out the place of exposure, type of traveler and the trip, risk perceptions and protective measures taken. The study period was from January 2016 to May 2019 and reported dengue infections from this period were obtained from the National Infectious Disease Register, which is maintained by the Finnish Institute for Health and Welfare (THL). The questionnaire both in Finnish and Swedish was sent to the participants. The response rate in this study was 61.3 %.

Data was analyzed spatially with QGIS 3.4.8 Madeira and statistically by using R 3.6.0. Descriptive statistics were used to analyze the demographic variables as well as answers given to the questionnaire. In addition, two binary logistic models were fitted to find out statistically significant factors for risk perception and the use of protective measures. Crude attack rates were calculated for different destinations using UNWTO travel data. Further on, the results were compared to existing literature related to this research.

Thailand and Indonesia were identified as destinations with the most abundant number of infections imported to Finland. However, Maldives had the highest crude attack rate per 100,000 travelers. The type of travel during which the infections were acquired was mainly pre-booked holiday of 14 days with time spent mostly on the beach. Most of the travelers were not aware of the dengue risk before the travel and did not seek pre-travel advice. Those who sought pre-travel advice were 34.9 times more likely to use protective measures than those who did not. Moreover, the majority applied some protective measures but not during the right time of the day, and thus the measures were chosen incorrectly.

Based on these results the knowledge about dengue, day-active/urban mosquito and the correct use of protective measures needs increasing. Further on, the risk within touristic destinations requires highlighting and the distinction between malaria and other mosquito-borne diseases could be made clearer. In addition, there is a need to increase the knowledge of dengue among healthcare workers.