Pretravel plans and discrepant trip experiences among travelers attending a tertiary care centre family travel medicine clinic

Jacqueline K. Wong; Nancy Nashid; Lisa G. Pell; Ray E. Lam; Debra M. Louch; Michelle E. Science; Shaun K. Morris

doi:10.1371/journal.pone.0262075

Peer Review History

Original SubmissionDecember 10, 2020
28 Jun 2021 Decision Letter - Mark Simonds Riddle, Editor PONE-D-20-38921 Pretravel plans and discrepant trip experiences among travelers attending a tertiary care centre family travel medicine clinic PLOS ONE Dear Dr. Wong, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please review and consider all points raised by reviewers to strengthen the acceptability of this manuscript for publication consideration. In addition, please recommend the following changes: - figure 2 can be incoporated into table 2 or table 3 for descriptive purposes. - please address in discussion/limitations section the potential bias of the study sample who completed post-travel and the attendant limitations. - please address whether the changes would have resulted in different vaccination, chemoprophylaxis, or other empric medication prescriptions (motion sickness, altitude, anti-diarrheals, lepto prophy, etc) and the frequency which this would have needed to occur. While it is appreciated that the focus was on pre-travel counseling, it's difficult to entangle this part of the travel medicine practice from provision of vaccines and medications. Please submit your revised manuscript by Aug 12 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. 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The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. 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(Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Main comments: The authors have compared pretravel consultation information and and post-trip surveys from 119 participants, finding that 92% reported discrepant trip experiences, two thirds of which would have required alternative pretravel counselling. While there are no major methodological problems, there are a relatively small number of participants, and the impact and potential biases related to losses to follow-up between pre- and post-travel cases need to be better discussed. Also, the results may be of some interest to readers, but the clinical relevance and details of the changes to the pretravel counselling that would have been warranted based on changes in trip characteristics should be listed so that their importance can be assessed. Minor issue: Line 102 says that consent was obtained in writing, and then line 115 says that consent was obtained over the phone or in-person. Why the discrepancy? Reviewer #2: I would recommend the paper for publication. The paper addresses the subject of travel and pretravel counseling at a very timely moment when more countries are relaxing travel restrictions and individuals are again making International travel plans. The information contained in the sample that was collected during a period of unrestricted travel from October 2014 and November 2015 will be comparable to, and reflective of, the anticipated unrestricted travel environment that is expected in the coming months and years. The study design is sound and the diversity of the patient population benefits the study. The post-travel follow-up seems adequate and the authors did not lose many patients in follow-up. With a median age of 36.3 years, the study population does skew younger and it would have been advantageous to include an older population, especially people who take cruise vacations. It is clear that the frequency of changing travel plans necessitates pre-travel counseling, but the study would be improved if there was longer follow-up, especially whether the change in travel plans meant the traveler would have needed a different immunization regime. It would have also been helpful to know if the change in travel plans impacted which endemic illness zone the traveler entered and the effect it had on their required post-travel medications. The time constraint involved with each pre travel visit, will preclude extended counseling required and perhaps the author could discuss this in detail more. Overall, the study will help identify changing travel patterns among travelers and the health risk associated with it. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. 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Revision 1
21 Sep 2021 Author Response Editor’s Comments: Please review and consider all points raised by reviewers to strengthen the acceptability of this manuscript for publication consideration. In addition, please recommend the following changes: -Thank you for reviewing our manuscript and providing the opportunity to resubmit a revised version. Figure 2 can be incorporated into table 2 or table 3 for descriptive purposes. -We agree that the information in Figure 2 can be concisely incorporated elsewhere. Table 3 (Completed Trip Characteristics) has been updated to reflect this change. Please address in discussion/limitations section the potential bias of the study sample who completed post-travel and the attendant limitations. -This is an important limitation to provide further elaboration, and additional details have been included in the discussion section (lines 311-315). We agree that those who completed post-travel surveys likely differed from those who did not, as there were differences in the demographic characteristics between these two groups. The current literature assessing the impact of various traveler characteristics on risk perceptions is limited. Please address whether the changes would have resulted in different vaccination, chemoprophylaxis, or other empiric medication prescriptions (motion sickness, altitude, anti-diarrheals, lepto prophy, etc.) and the frequency which this would have needed to occur. While it is appreciated that the focus was on pre-travel counseling, it's difficult to entangle this part of the travel medicine practice from provision of vaccines and medications. -We appreciate the opportunity to provide additional details that may help clinicians who read our manuscript. Regarding over the counter medications (such as those for motions sickness and anti-diarrheals), these would normally have been discussed in the clinical encounter however were not captured in the pre-travel counseling research data. Furthermore, questions in the post-travel survey were not developed to include the details necessary to determine if these additional medication recommendations would have been warranted (e.g. amount of time spent on a boat or the type of boat). Therefore, these medications have not been included in the discussion of specific medication recommendations. -For the other prescription medications (vaccinations, malaria prophylaxis, altitude-sickness medications) these are now included in the methods section (lines 154-157). The impact on pre-travel medication prescriptions has been detailed in lines 251-263, and Figure 2 has been updated as well. In some scenarios, our assessment was limited by a lack of sufficient detail about actual travel or activities provided in the post-travel surveys, and this limitation has been included in the discussion (lines 322-325). The majority of the time however, the discrepancies would not have resulted in additional medications/vaccinations being prescribed. Reviewers’ Comments: Reviewer #1: Main comments: The authors have compared pretravel consultation information and post-trip surveys from 119 participants, finding that 92% reported discrepant trip experiences, two thirds of which would have required alternative pretravel counselling. While there are no major methodological problems, there are a relatively small number of participants, and the impact and potential biases related to losses to follow-up between pre- and post-travel cases need to be better discussed. -We thank this reviewer for their comments. As suggested in the Editor’s comments, the limitations due to cohort size and loss to follow-up has been further elaborated on in the discussion section (lines 311-315). Also, the results may be of some interest to readers, but the clinical relevance and details of the changes to the pretravel counselling that would have been warranted based on changes in trip characteristics should be listed so that their importance can be assessed. -Translating our findings into clinically relevant information has been a focus of this revised manuscript. In addition to the impact on pre-travel medication prescriptions suggested by the Editor’s comments, we also elaborated on the frequency of unexpected animal exposure (details in lines 251-263). Minor issue: Line 102 says that consent was obtained in writing, and then line 115 says that consent was obtained over the phone or in-person. Why the discrepancy? -We thank the reviewer for identifying this inconsistency. The clarification has been provided in line 115. Reviewer #2: I would recommend the paper for publication. The paper addresses the subject of travel and pretravel counseling at a very timely moment when more countries are relaxing travel restrictions and individuals are again making International travel plans. The information contained in the sample that was collected during a period of unrestricted travel from October 2014 and November 2015 will be comparable to, and reflective of, the anticipated unrestricted travel environment that is expected in the coming months and years. The study design is sound and the diversity of the patient population benefits the study. The post-travel follow-up seems adequate and the authors did not lose many patients in follow-up. With a median age of 36.3 years, the study population does skew younger and it would have been advantageous to include an older population, especially people who take cruise vacations. It is clear that the frequency of changing travel plans necessitates pre-travel counseling, but the study would be improved if there was longer follow-up, especially whether the change in travel plans meant the traveler would have needed a different immunization regime. It would have also been helpful to know if the change in travel plans impacted which endemic illness zone the traveler entered and the effect it had on their required post-travel medications. The time constraint involved with each pre travel visit, will preclude extended counseling required and perhaps the author could discuss this in detail more. Overall, the study will help identify changing travel patterns among travelers and the health risk associated with it -We thank this reviewer for their comments and are appreciative of the suggestion for future study improvements, including longer study follow-up and discussions around post-travel medication counseling. They have identified important opportunities to elaborate on the discrepant travel plans and the need for alternative immunization regimens as similarly mentioned in the Editor’s comments (details now included in lines 251-263). With regards to the clinically relevant limitation of knowing the change in travel plans and impact on endemic illness zones, this has also been included in the discussion section (lines 322-325). Attachments Attachment Submitted filename: Response to Reviewers - Sep 21.doc https://doi.org/10.1371/journal.pone.0262075.r002
19 Dec 2021 Decision Letter - Mark Simonds Riddle, Editor Pretravel plans and discrepant trip experiences among travelers attending a tertiary care centre family travel medicine clinic PONE-D-20-38921R1 Dear Dr. Wong, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Mark Simonds Riddle Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0262075.r003
Formally Accepted
25 Jan 2022 Acceptance Letter - Mark Simonds Riddle, Editor PONE-D-20-38921R1 Pretravel plans and discrepant trip experiences among travelers attending a tertiary care centre family travel medicine clinic Dear Dr. Wong: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Mark Simonds Riddle Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0262075.r004

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