Navot-Mintzer D 1,2 , Nitzan O 1 , Tabenkin H 2 , Chazan B 1,2

1. Altitude Illness: Pre-Travel Counseling, Knowledge and Symptoms among Independent Travelers to Leh in North India Navot-Mintzer D1,2, Nitzan O1, Tabenkin H2, Chazan B1,2 1-Travel Medicine Clinic, Clalit Health Services, North District, Afula, Israel. 2- Department of Family Practice, Emek Medical Center, Clalit Health Services, North District and the division of community health, Ben-Gurion University in the Negev, Israel. • Background: • Many travelers visit Leh, a town situated in the Indian Himalaya at an altitude of 3500 m. A great number of visitors fly directly into Leh or arrive from lower-altitude areas. Our current study examined: • The prevalence of altitude illness and related symptoms • The extent of use and effects of medications for prophylaxis and treatment of altitude illness • The extent of pre-travel counseling and travelers knowledge of altitude illness Methods: Israeli travelers staying in Leh in July and August 2008 were asked to complete a short, anonymous questionnaire during their stay. Results: 106 travelers completed the questionnaire, of which 90% reported symptoms related to altitude exposure. The average age of responders was 26.4 years, 56.6% were females. 52.8% of the responders came to Leh by flight and 44.3% by car. The responders report suffering from symptoms related to altitude for an average of four days. Travelers that were at an altitude of 3000m or more previous to their visit to Leh suffered less from acute mountain sickness (AMS) (16.6% vs. 32.7%, p=0.08). Females tended to suffer more from headaches (50.9% vs 32.6%, p=0.07) and from nausea & vomiting (29.8 vs 17.4, p=0.17). The use of Acetazoleamide (Diamox) did not prevent the occurrence of altitude related symptoms, but did shorten their duration (2.6 vs 5 days, p=0.005) and was also associated with a lower rate of AMS. Most travelers stated that their knowledge of the dangers of high altitude was lacking and that counseling should be improved. Duration of Symptoms Pre Counseling (P=0.005) 5 81 79 Percent Received Counseling 2.6 57% Symptoms and Acute Altitude Illness 96 89 48 38 28 24 P=0.09 P=0.05 P=0.14 • Conclusions: • Most travelers to Leh suffer from symptoms related to altitude exposure • Prophylactic treatment reduces the risk of AMS, as reported in previous studies • Acetazolamide causes side effects that are at times difficult to distinguish from altitude related symptoms, but we found that it reduces the duration of altitude related symptoms • Travelers feel that the counseling provided by medical personnel regarding the dangers of altitude is inadequate and that improving counseling may prevent many travelers from unnecessary suffering. Drawing: Dalya Navot-Mintzer