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Introduction to Travel Medicine

Introduction to Travel Medicine. Large and growing industry More than 500 millions persons annually cross international borders on commercial airplanes (early 90s) Pleasure, business, study etc Short term travelers, repeated visit, reside or prolonged periods Risk of morbidity and mortality.

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Introduction to Travel Medicine

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  1. Introduction toTravel Medicine

  2. Large and growing industry More than 500 millions persons annually cross international borders on commercial airplanes (early 90s) Pleasure, business, study etc Short term travelers, repeated visit, reside or prolonged periods Risk of morbidity and mortality Travel and Tourism

  3. International Travel

  4. Transportations Accommodation Food and beverages Handicrafts, gifts Others related industry Travel and Tourism

  5. What might happened to travelers Infections Accidents Disasters

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

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

  9. Essential questions to assess predisposing risks and host risk factors • What is your destination(s) state : countries, city/resort/off-the-tourist-trail, itinerary • What is the purpose of your visit : tourism/business or other professional visit (specify)/visit (to relatives/expatriates), other reasons (military, airline crew, adoption, etc.)

  10. Essential questions to assess predisposing risks and host risk factors • What standard of hygiene do you expect throughout your visit : high (e.g., five-star hotels)/low (e.g., low budget travel) • Are you planning any special activities : e.g. high altitude trekking, diving, hunting, camping, etc. • What is your planned date of departure? • How long do you intend to stay abroad?

  11. Potential travelers should also answer at least the following set of questions on their health status and medical history : • Do you currently use any medication? If yes, which ones? • Are you currently unwell? • Do you feel feverish? If yes, do you know what your temperature is? • Do you suffer from any chronic illness If yes, which ones? • Are you allergic to eggs or medication? If yes, describe.

  12. Travel Notices & Announcements

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

  14. Potential travelers should also answer at least the following set of questions on their health status and medical history : • Are you pregnant or breast-feeding? Provide details • Have you ever had seizures? Provide details • Have you ever had psychiatric or psychological problems? Provide details • Have you ever had jaundice or hepatitis? Provide details • Are you or anybody in your household infected by HIV? Do you have any other immunodeficiency illness? Provide details

  15. The Patient: Other Issues • Reproductive • Pregnant • Breastfeeding • Preconception • Risk-taking behaviors

  16. Routine Diphtheria* Tetanus* Pertussis* Measles + Mumps+ Rubella + Varicella Pneumococcus Influenza Travel related Hepatitis A Hepatitis B Typhoid Rabies Meningococcal disease Polio Japanese encephalitis Yellow Fever Immunizations to Consider for Adult Travelers * Td or Tdap + MMR

  17. Vaccine for Adult Travelers Routine • Updated as needed : diphtheria-tetanus, measles-mumps-rubella • Routine for defined groups : influenza, hepatitis B, pneumococcal, varicella Required by some countries • Yellow fever • Meningococcal

  18. Vaccine for Adult Travelers Recommended for travelers to developing countries • Standard for travelers to developing countries : hepatitis A, typhoid, poliovirus • Special for travelers to developing countries : cholera, hepatitis B, meningococcal, Japanese B encephalitis, plague, rabies

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

  20. Sources and Acquisition of Infection during Travel • Food and drinks • Soil and water • Animals and arthropods • Other human • Air travel • Infections acquired en route • Infections acquired in temperate and industrialized area

  21. Sources and Acquisition of Infection during Travel Food and drinks • Traveler’s diarrhea • Hepatitis A • Typhoid fever • Cholera Soil and Water • Enteric infections • Soil associated fungus (Histoplasma capsulatum) • Leptospirosis

  22. Sources and Acquisition of Infection during Travel Animals and arthropods • Rabies • Hantavirus • Dengue • Malaria Other Human • STD • Airborne infections

  23. Sources and Acquisition of Infection during Travel Air Travel • Venous thrombosis and pulmonary emboli • Influenza, Tuberculosis Infections acquired en route • Influenza, rubella Infections acquired in temperate and industrialized area • Colorado Tick fever • HFRS • Murray Valley encephalitis

  24. 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

  25. 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

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

  27. 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

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

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

  30. Key concepts: Travel-related illness and Death • Injury are an important cause of travel related death • Most infections acquired during travel to tropical and developing countries are cause by pathogens that are widely distributed • Risk of infection from exposure to many widely distributed pathogens )e.g. hepatitis A, typhoid fever, salmonellosis) is substantially higher during travel to developing countries than during life at home

  31. Key concepts: Travel-related illness and Death • Unusual infections can be found in temperate and industrialized countries, including United States • Recreational activities ( swimming, hiking) facilitate exposure to many pathogens • Activities that pose no risk at home may be hazardous in other environment (e.g. eating raw foods, swimming in fresh water, going barefooted, sustaining mosquito bites, petting stray animals)

  32. Key concepts: Travel-related illness and Death • Expensive hotels and posh restaurants are no guarantee of safe food and beverages • Disease during and immediately after travel may be unrelated to exposures during travel (acute appendicitis, pyelonephritis) • Infections can be acquired en route and on brief layover • Travel-associated diseases include non infectious diseases (pulmonary emboli related to prolonged seating, drug reactions0

  33. Have a Nice Vacation

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