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Travel Health for the Globetrotting Student

Travel Health for the Globetrotting Student Gary W. Brunette, MD, MS Travelers’ Health Team Centers for Disease Control and Prevention Outline Travel Patterns Infectious Disease Risks Other Risks to the Traveler Traveler Assessment Itinerary Review Sources of Information

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Travel Health for the Globetrotting Student

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  1. Travel Health for the Globetrotting Student Gary W. Brunette, MD, MS Travelers’ Health Team Centers for Disease Control and Prevention

  2. Outline • Travel Patterns • Infectious Disease Risks • Other Risks to the Traveler • Traveler Assessment • Itinerary Review • Sources of Information • Travel Vaccines • Travel Medications • Counseling

  3. U.S. Residents Traveling Abroad* *ITA, includes travel to Canada and Mexico

  4. Open Doors (Institute of International Education)

  5. Open Doors (Institute of International Education) (students receiving credit for study abroad)

  6. Travelers’ Health Risks Of 100,000 travelers to a developing country for 1 month: • 50,000 will develop some health problem • 8,000 will see a physician • 5,000 will be confined to bed • 1,100 will be incapacitated in their work • 300 will be admitted to hospital • 50 will be air evacuated • 1 will die Steffen R et al. J Infect Dis 1987; 156:84-91

  7. Deaths Related to International Travel N = 2463 Hargarten S et al, Ann Emerg Med, 1991. 20:622-626

  8. Injury Deaths and International Travel N = 601 Hargarten S et al, Ann Emerg Med, 1991. 20:622-626

  9. Malaria Diarrhea Leishmaniasis Rabies Dengue Meningococcal Meningitis Schistosomiasis Tuberculosis Leptospirosis Polio Yellow Fever Measles JEV Infectious Disease Risks to the Traveler ETC.

  10. Malaria • Mosquito-borne disease • Parasite: Plasmodium • May lead to severe complications or death • ~500 million cases/year worldwide • Risk in over 100 countries • Prophylactic medication • before, during and after travel

  11. Malaria Risk Areas

  12. Rabies • Acute viral encephalomyelitis • Invariably fatal • Humans contract rabies by being bitten or occasionally by being scratched by an infected animal. • 40,000 deaths per year

  13. Distribution of Rabies

  14. Polio • Viral infection • Acute onset flaccid paralysis • Transmitted via fecal-oral route or pharyngeal spread • High transmission areas are India, Pakistan, Afghanistan, Nigeria, Niger.

  15. Polio Risk Areas

  16. Yellow Fever • Mosquito-borne viral infection • Aedes aegypti • Varying severity: • influenza-like syndrome to severe hepatitis and hemorrhagic fever • 200,000 YF infections cause 30,000 deaths per year

  17. Distribution of Yellow Fever

  18. Other Health Risks to the Traveler • Accidental injury • Animal bites, stings and envenomations • Crime and assault • Environmental hazards • Deep vein thrombosis (DVT) • Jet lag

  19. Deep Vein Thrombosis (DVT) • Thrombus (blood clot) within a deep vein, commonly in the thigh or calf • tenderness/redness plus pain & swelling in affected area • potential risk of pulmonary embolism • WRIGHT Project (2007): • x2 risk associated with flights >4 hrs • result of immobility and restrictions in blood flow

  20. Measures to Prevent DVTs • Regular activity • exercises: moving ankle and knee joints • standing and short walks • Loose fitting clothing

  21. Jet Lag • Physiological condition due to alterations to the circadian rhythm. • Recovery rate of "one day per time zone" • Symptoms can vary widely: • Disturbed sleep (insomnia, early waking, excessive sleepiness) • Irritability, mild depression • Difficulty concentrating • Headaches • Muscle soreness • Stomach problems, constipation or diarrhea

  22. Measures to Prevent Jet Lag • Arrive early, give your body time to adjust • Adequate sleep and rest before trip • Drink plenty of fluids and eat lightly • Avoid alcohol and caffeine • Adjust to destination cycles early: • sleep if it's night time at destination • stay awake if it's day time at destination • At destination, try not to sleep until night time

  23. The Pre-Travel Medical Visit • Important to see a medical provider • travel medicine specialist • 4 – 6 weeks before departure • Risk Assessment • Risk Management • Immunizations • Medications • Counseling

  24. The Patient: Medical Issues • Age-specific issues • Underlying illness, immunosuppression • Systems review • Medical history • Medication use • Vaccination history • Allergies • Contraindications to vaccines and medications

  25. Travel Itinerary • Full itinerary • Dates, duration, stopovers • Seasonal considerations • Styles of travel • Rural vs. urban • Budget vs. luxury • Accommodation • Hotel vs. camping • Activities • Business vs. tourism • Adventure, safari • Missionary/Humanitarian/NGO

  26. Travel Health Resources • CDC Travelers’ Health Website • www.cdc.gov/travel • Health Information for International Travel • CDC “Yellow Book” • World Health Organization • www.who.int/int • International Travel and Health • WHO “Green Book” • State Department • travel.state.gov • International Society of Travel Medicine • www.istm.org

  27. Travelers’ Health Websitewww.cdc.gov/travel

  28. Travel Notices & Announcements

  29. Destination Pages • Country-specific pages

  30. Routine immunizations Required immunizations for travel Recommended immunizations for travel Immunizations for Adult Travelers

  31. Routine Immunizations • Diphtheria* • Tetanus* • Pertussis* • Measles + • Mumps+ • Rubella + • Varicella • Pneumococcus • Influenza * Td or Tdap + MMR

  32. Required Immunizations for Travel • Yellow Fever • Meningococcal

  33. Recommended Immunizations for Travel • Hepatitis A • Hepatitis B • Typhoid • Japanese encephalitis • Polio • Rabies

  34. Travel Medications:Prophylaxis & Self Treatment • Malaria • chloroquine, atovaquone/proguanil (Malarone), doxycycline, mefloquine (Lariam), primaquine • Diarrhea • quinolone, azithromycin • Altitude • acetazolamide • Motion sickness • scopolamine, dimenhydrinate (Dramamine)

  35. Patient Counseling • Sufficient time for patient education • Tailored to suit traveler • Fitness for travel • Understanding impact on existing conditions • Advisability of destinations

  36. Travel Preparation • Travel health insurance • Medical care • Hospitalization • Evacuation • Obtaining medical care abroad • Awareness of travel notices

  37. Environmental Precautions • Air Travel • Jet Lag • Sun Protection • Extreme Heat and Cold • dehydration, heat stroke • hypothermia, frostbite • Altitude • Water recreation • Drowning, boating & diving accidents • Risk of schistosomiasis or leptospirosis • Biological and chemical contamination

  38. Food and Water Precautions • Bottled water • Selection of foods • well-cooked and hot • Avoidance of • salads, raw vegetables • unpasteurized dairy products • street vendors • ice

  39. Vector Precautions • Covering exposed skin • Insect repellent containing DEET 25 – 50% • Treatment of outer clothing with permethrin • Use of permethrin-impregnated bed net • Use of insect screens over open windows • Air conditioned rooms • Use of aerosol insecticide indoors • Use of pyrethroid coils outdoors • Inspection for ticks

  40. Bloodborne and STD Precautions • Prevalence of • STDs • Hepatitis B • Hepatitis C • HIV • Unprotected sexual activity • Commercial sex workers • Tattooing and body piercing • Auto accidents • Blood products • Dental and surgical procedures

  41. Animal Precautions • Animal avoidance • Rabies • Specific animal threats • Medical evaluation of bites/scratches • Post exposure immunization and immunoglobulin • Envenomations • Snakes, scorpions, spiders • Maritime animals

  42. Injury and Crime • Vehicles • Risk of road and pedestrian accidents • Night travel • Seat belts and car seats • Use of drugs and alcohol • Understanding local crime risks • Scam awareness • Situational awareness • Location avoidance

  43. Travel Emergency Kit • Copy of medical records and extra pair of glasses • Prescription medications • Over-the counter medicines and supplies • Analgesics • Decongestant, cold medicine, cough suppressant • Antibiotic/antifungal/hydrocortisone creams • Pepto-Bismol tablets, antacid • Band-Aids, gauze bandages, tape, Ace wraps • Insect repellant, sunscreen, lip balm • Tweezers, scissors, thermometer

  44. Post-Travel Care • Post-travel checkup • Long term travelers • Adventure travelers • Expatriates in developing world • Post-travel care • Fever, chills, sweats • Persistent diarrhea • Weight loss

  45. Student Travel Medicine • Models • In-house medical departments • Local public health clinics • Local clinics • Minimum services: • Travel immunizations • Travel medications • Travel health counseling

  46. Questions?

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