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Introduction to Travel Medicine. Travel and Tourism Large and growing industry More than 500 millions persons annually cross international borders on.

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Presentation on theme: "Introduction to Travel Medicine. Travel and Tourism Large and growing industry More than 500 millions persons annually cross international borders on."— Presentation transcript:

1 Introduction to Travel Medicine

2 Travel and Tourism 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

3 3 International Travel

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

5 What might happened to travelers Infections Accidents Disasters

6 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 7 Infectious Disease Risks to the Traveler Malaria Diarrhea Leishmaniasis Rabies Dengue Meningococcal Meningitis Schistosomiasis Tuberculosis Leptospirosis Polio Yellow Fever Measles JEV ETC.

8 8 Injury Deaths and International Travel N = 601 Hargarten S et al, Ann Emerg Med, :

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 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? Essential questions to assess predisposing risks and host risk factors

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 12 Travel Notices & Announcements

13 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 15 The Patient: Other Issues Reproductive –Pregnant –Breastfeeding –Preconception Risk-taking behaviors

16 16 Immunizations to Consider for Adult Travelers 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 * 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

20 20 Travel Medications: Prophylaxis & Self Treatment Malaria –chloroquine, atovaquone/proguanil (Malarone), doxycycline, mefloquine (Lariam), primaquine Diarrhea –quinolone Altitude –acetazolamide Motion sickness –scopolamine, dimenhydrinate ( Dramamine)

21 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

22 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

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

24 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

25 25 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

26 26 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

27 27 Food and Water Precautions Bottled water Selection of foods –well-cooked and hot Avoidance of –salads, raw vegetables –unpasteurized dairy products –street vendors –ice

28 28 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

29 29 Animal Precautions Animal avoidance Rabies –Specific animal threats –Medical evaluation of bites/scratches –Post exposure immunization and immunoglobulin Envenomations –Snakes, scorpions, spiders –Maritime animals

30 30 Deaths Related to International Travel N = 2463 Hargarten S et al, Ann Emerg Med, :

31 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

32 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)

33 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

34 Have a Nice Vacation


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