TRAVEL
MEDICINE
FK UMS
RS PKU MUHAMMADIYAH SURAKARTA 1
Travellers from industrialised areas
to developing areas 1999 (WTO)
2.8 2.4
USA / Canada Europe 6.1
4.6
35.2 million 3.6 25.0 million Japan
19 7.8 6.8 1.6 11.4 mio
2.3
1.3 4.8
2.5
1.9
1.2 2.6
AUS / NZ
3.3 million
n million travelers
0.2-1 million travelers
Total: ~ 80 million travelers
Globalization of health and safety
• Affects
– Health of local Commerce and Health
populations
– Health determinants
Influenza
– Safety and security SARS
Terrorism
• Results in
– Global impacts Tsunami
– Emerging and re-
emerging infectious
disease
Pathogens travel as fast as transportation:
borders are not respected
The Importance of Travel
Health Measures
• 100,000 travelers to the developing
world for 1 month…..
– 50,000 will become ill
– 8,000 will see a physician
– 5,000 will stay in bed
– 1 will die
Steffen, 1994
The Continuum of Travel Medicine
Preventive Medicine
Pre-Travel Visitors
Contingency During Travel Planning
Post-Travel
Treatment &
Rehabilitation
The Patient: Medical Issues
• Age-specific issues
• Underlying illness,
immunosuppression
• Systems review
• Medical history
• Medication use
• Vaccination history
• Allergies
• Contraindications to vaccines and
medications 6
The Patient: Other Issues
• Reproductive
– Pregnant
– Breastfeeding
– Preconception
• Risk-taking behaviors
7
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
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Deaths Related to International Travel
Cardiovascular
Medical
Injury
Homicide/Suicide
Infectious Disease
Other
N = 2463
9
Hargarten S et al, Ann Emerg Med, 1991. 20:622-626
Infectious Disease Risks to
the Traveler
• Malaria • Schistosomiasis
• Diarrhea • Tuberculosis
• Leishmaniasis • Leptospirosis
• Rabies • Polio
• Dengue • Yellow Fever
• Meningococcal • Measles
Meningitis
ETC. 10
Injury Deaths and International Travel
Motor Vechicle
Drowning
Air Crash
Homicide/Suicide
Poisoning
Other
N = 601
11
Hargarten S et al, Ann Emerg Med, 1991. 20:622-626
Other Risks to the Traveler
• Accidental injury
• Environmental hazards
• Crime and assault
• Psychiatric problems
• Animal bites, stings and envenomations
• Dermatologic disorders
• Altitude
• …….
ETC. 12
Immunizations to Consider for Adult
Travelers
Routine Travel related
Diphtheria* Hepatitis A
Tetanus* Hepatitis B
Pertussis* Typhoid
Measles + Rabies
Mumps+ Meningococcal disease
Rubella + Polio
Varicella Japanese encephalitis
Pneumococcus Yellow Fever
Influenza
13
Travel Medications:
Prophylaxis & Self Treatment
• Malaria
– chloroquine, atovaquone/proguanil (Malarone),
doxycycline, mefloquine (Lariam), primaquine
• Diarrhea
– quinolone, azithromycin
• Altitude
– acetazolamide
• Motion sickness
– scopolamine, dimenhydrinate (Dramamine)
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Patient Counseling
• Sufficient time for patient education
• Fitness for travel
– Understanding impact on existing
conditions
– Advisability of destinations
15
Travel Preparation
• Travel health insurance
– Medical care
– Hospitalization
– Evacuation
• Obtaining medical care abroad
• Awareness of travel notices
• Hand washing and hygiene 16
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
17
Food and Water Precautions
• Bottled water
• Selection of foods
– well-cooked and hot
• Avoidance of
– salads, raw vegetables
– unpasteurized dairy products
– street vendors
– ice
18
Vector
Precautions
• Covering exposed skin
• Insect repellent
• Long outer clothing
• 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 19
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
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Animal Precautions
• Animal avoidance
• Rabies
– Specific animal threats
– Medical evaluation of bites/scratches
– Post exposure immunization and
immunoglobulin
• Envenomations
– Snakes, scorpions, spiders
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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
– Situational awareness
– Location avoidance
22
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
23
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
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