The Imported Fever Service; a UK-wide system for improved management and diagnosis of fever in returned travellers

Background: Poor integration of diagnostic services can delay the diagnosis of febrile illness in returning travelers, with significant clinical and public health consequences. The Imported Fever Service (IFS) was established in 2012 as a national specialist diagnostic and clinical advice service for acute imported fevers. We summarise the first 9 months' activity. Methods: The IFS is a collaboration between the Rare and Imported Pathogens Laboratory, the Hospital for Tropical Diseases and the Liverpool School of Tropical Medicine. It combines 24-hour clinical advice and diagnostic services capable of rapidly detecting ‘exotic’ pathogens, including VHFs. For each referral a panel of tests, based on the patient's travel is performed and relevant clinical data are collected. Results: Between June 2012 and February 2013, 143 cases were referred from 84 UK centres. 43 (30%) diagnoses were made following referral to the service. Patients had travelled to Africa (32%), Asia (24%) and Europe (15%). Presenting complaints included neurological (24%), undifferentiated fever (23%) and respiratory (14%). The IFS diagnosed: murine typhus (n=7), spotted fever, dengue (n=4 each), Q fever, sandfly fever, leptospirosis (n=3 each), Tick-Borne encephalitis, scrub typhus, hantavirus and CCHF (1-2 cases each). The service helped infection control and public health responses to CCHF and autochthonous hantavirus cases. Conclusions: Referral to the IFS resulted in rapid diagnosis of illness in 30% of returned travellers with otherwise undiagnosed fever. These diagnoses informed critical clinical, infection control and public health decisions and demonstrate the IFS model is feasible, effective and could be reproduced in other countries.