Travel behaviours and health outcomes during travel: profiling destination-specific risks in a prospective mHealth cohort of Swiss travellers

BACKGROUND: We used a mobile application to determine the incidence of health events and risk behaviours during travel by country and identify which health risks are significantly elevated during travel compared with at home. METHOD: TOURIST2 is a prospective cohort study of 1000 adult travellers from Switzerland to Thailand, India, China, Tanzania, Brazil and Peru, planning travel of </=4 weeks between 09/2017 and 04/2019. The incidence rate ratio (IRR) in each country was calculated. RESULTS: All countries had significantly higher incidence of health events than at home. The most elevated symptoms were sunburn, itching from mosquitoes, and gastrointestinal disorders (e.g. vomiting, diarrhoea), corresponding with universally high food/drink risk behaviours. Peru had the highest incidence of both overall negative health events and severe health events (172.0/1000 travel-days). Traffic accidents were significantly higher in Peru (IRR: 2.4, 1.2, 4.7), although incidence of transportation risk was highest in India and Thailand. In Tanzania, incidence of negative mental health events was significantly lower than at home, although it was elevated in other countries. Sexual risk behaviours were high in Brazil. CONCLUSIONS: Our study improves the understanding of the non-infectious disease related health challenges travellers face and provides evidence for more personalised traveller support.