Professional Documents
Culture Documents
Travel Health (December 2014 Version)
Travel Health (December 2014 Version)
60
55
50
45
Year
3
*ITA, includes travel to Canada and Mexico
International Travel
80 900
70 800
700
60 US nonresident
Inbound (ITA)
US Resident travel in millions
30 Worldwide arrivals
300 (WTO)
20
200
10 100
0 0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
4
Where Do U.S. Residents Travel?
30
20
%
10
0
ada op
e
/ NZ
ico ic a a n / PI s ia
ri ca ean a st
s x r p a
n u r
Au Me
e Ja ni rA Af b E
Ca E Am e a th
e ri b
dd
l e
r S O c O Ca M i
o
C
5
Source: HealthStyles Survey 2005
VFRs: Visiting Friends and Relatives
1US Census Bureau, Census 2000 Brief, The Foreign-Born Population: 2000, issued
Dec 2003 (Previous: US Census Bureau, Profile of the Born Outside the United States
Population 2000, issues Dec 2003???
2 Angell & Cetron, 2005
From: Survey of International Air Travelers, Office of travel and tourism Industries,
USDOC 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
The Patient: Medical Issues
• Age-specific issues
• Underlying illness,
immunosuppression
• Systems review
• Medical history
• Medication use
• Vaccination history
• Allergies
• Contraindications to vaccines and
medications 8
The Patient: Other Issues
• Reproductive
– Pregnant
– Breastfeeding
– Preconception
• Risk-taking behaviors
9
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
10
Travel Health Resources
• CDC Travelers’ Health Website
– www.cdc.gov/travel
• World Health Organization
– www.who.int/int
• State Department
– travel.state.gov
• International Society of Travel Medicine
– www.istm.org
• Health Information for International Travel
– CDC “Yellow Book”
• International Travel and Health
– WHO “Green Book” 11
Travelers’ Health Website
www.cdc.gov/travel
12
Regional Destinations
• Region-specific pages
• Goal to move to country-specific format
13
Travel Notices & Announcements
14
Deaths Related to International Travel
Cardiovascular
Medical
Injury
Homicide/Suicide
Infectious Disease
Other
N = 2463
15
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 • JEV
ETC. 16
Injury Deaths and International Travel
Motor Vechicle
Drowning
Air Crash
Homicide/Suicide
Poisoning
Other
N = 601
17
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. 18
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
* Td or Tdap 19
+ MMR
Travel Medications:
Prophylaxis & Self Treatment
• Malaria
– chloroquine, atovaquone/proguanil (Malarone),
doxycycline, mefloquine (Lariam), primaquine
• Diarrhea
– quinolone, azithromycin
• Altitude
– acetazolamide
• Motion sickness
– scopolamine, dimenhydrinate (Dramamine)
20
Patient Counseling
21
Travel Preparation
• Travel health insurance
– Medical care
– Hospitalization
– Evacuation
• Bottled water
• Selection of foods
– well-cooked and hot
• Avoidance of
– salads, raw vegetables
– unpasteurized dairy products
– street vendors
– ice
24
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 25
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 26
Animal Precautions
• Animal avoidance
• Rabies
– Specific animal threats
– Medical evaluation of bites/scratches
– Post exposure immunization and
immunoglobulin
• Envenomations
– Snakes, scorpions, spiders
– Maritime animals
27
Injury and Crime
• Vehicles
– Risk of road and pedestrian accidents
– Night travel
– Seat belts and car seats
• Post-travel checkup
– Long term travelers
– Adventure travelers
– Expatriates in developing world
• Post-travel care
– Fever, chills, sweats
– Persistent diarrhea
– Weight loss
30
Questions?
31
Other Resources
32
Journals
• American Journal of Tropical Medicine and
Hygiene
• Bulletin of the World Health Organization
• Emerging Infectious Diseases Journal
• Eurosurveillance Weekly
• Journal of Travel Medicine
• Morbidity and Mortality Weekly Report
• Tropical Medicine and International Health
• Vaccine
33
Books
• Textbook of Travel Medicine and Health, 2nd
Ed.
– DuPont, H.L. and Steffen R. (editors)
• The Travel and Tropical Medicine Manual,
3rd Ed.
– Jong, E.C., McMullen, R.
• Travel Medicine
– Keystone, J.S., Kozarsky, P.E., et al
34
Websites
Eurosurveillance
www.eurosurveillance.org
Travax EnCompass
www.travax.com
GIDEON
www.gideononline.com
International SOS
www.internationalsos.com
Medical Advisory Service for Travelers Abroad (MASTA)
http://www.masta.org/
Armed Forces Medical Intelligence Center
www.afmic.detrick.army.mil/
Central Intelligence Agency
www.cia.gov/cia/publications/factbook/ 35