The imported infections among foreign travelers in China: A descriptive study Running title: Imported infections in China

Background Increasing number of travel-related infections were reported in China, but the spectrum, dynamics and disease burden of imported infections among foreign travelers remain vague. Methods We obtained the data on imported infections among foreign travelers from Custom Inbound Screening System (CISS) and the National Notifiable Infectious Disease Reporting System (NNIDRS). All the infections were classified into respiratory, gastrointestinal, vector-borne, blood/sex-transmitted and mucocutaneous diseases. The epidemiological characteristics and disease burden of imported infections among foreign travelers were investigated. Results In total, 17,189 travelers diagnosed with 58 imported infectious diseases were reported from 2014 to 2018, with an overall incidence rate of 122.59 per million. Respiratory infection (7,351 cases, mainly influenza) and Blood/sex-transmitted diseases (6,114 cases mainly Hepatitis B and HIV infection) were the most frequently diagnosed diseases, followed by vector-borne infections (3,128 cases, mainly dengue fever and malaria). The highest case number was imported from Asia and Europe, while the highest incidence rate was from Africa (296.0 per million). When specific diagnosis was compared, both the highest absolute case number and incidence rate were observed for influenza. An obvious seasonal pattern was observed for vector-borne diseases, with the epidemic spanning from July to November. The origin-destination matrices disclosed the movement of imported infection followed specific routes. Conclusions Our study gave a profile of infectious diseases among foreign travelers traveled into China and pinpointed the priority regions, seasons, populations for prevention and control.