Emporiatrics

Greek origin
“emporos”: One who goes on shipboard as a
passenger
+
“iatrike”: medicine)
It’s the term coined to: Describe the science of the
health of travellers.
 Definition
• It is a science which deals with promoting and protecting

the health of international travelers, providing them the

advice related to the travel they are about to undertake.

• It is a fast developing specialty as the international travel

is fast increasing.

• Every year 660 million people travel internationally.

 Travel Medicine
• Practice of “Emporiatrics”
• Rapid development over the last 25 years
• Fairfield Hospital in Melbourne started the first ever
travel clinic in early-mid 80’s
• Now a recognized clinical entity primarily involved
in risk management
• Strong overlap with public health and occupational
health and general practice
GLOBAL ESTIMATES
According to WHO,there are approximately
600million international travellers anually

Morbidity studies conducted by WHO

suggest that about half of the people from a
developed country that stay one month in a
developing country gets sick.
 Why a Special Branch for Travelers’ Health?
Travellers face special health risks:
▫ They are subject to disorders induced by Rapid changes of
environment such as upsets in the circadian rhythms, motion
sickness, and diarrhea;
▫ In developing countries they are exposed to Infectious diseases
that do not exist in their home countries such as malaria,
giardiasis, and dengue; and,
▫ They are Separated from familiar and accessible sources of
medical care.
▫ Never before in history have so many people travelled and have
 Types of Travellers:
• Business men and
• Tourists Documented
▫ VFR
▫ Non VFR
They often travel by air or railways (The records of which are
available)
• Immigrants, Undocumented
• Refugees, and
• Migrant laborers
Who frequently travel by other means
So Who’s Responsibility is Emporiatrics?

• Meeting the health needs of these travellers who are

moving rapidly between countries and continents is
a responsibility shared by:
▫ the medical professionals,
▫ by the travellers themselves,
▫ by travel organizations,
▫ by airline and shipping companies, and
▫ by host governments for policy making
Risk to be considered and discussed
• Food and Water
• Insects
• Animals and Birds
• Environmental hazards
▫ Soil
▫ Sun
▫ Heat/humidity
▫ Cold/ dry
• Altitude
• Marine hazards
• Respiratory Hazards
• Sex and body-fluid exposure
• Vehicular and other Accidents
• DVT risk
Factors Affecting TRAVELER

Individual Risk  Reason for travel

 Behavior

I  Age and gender

n  Health education
TRAVEL d  Medical history
 Destination i
- Allergies
v
 Country of origin - Immunosuppressed
i
 Duration of stay d - Pre-existing disease

 Itinerary u  Immunization
a status
 Travel conditions
l  Special needs
 Season
r - Pregnant women

i - Children

s - Elderly
k
 World Map

Tropical areas
The Traveller’s Triad

Trip

Time Traveller
“This Person, This Trip, This Time”
• Person: medical conditions past and present,
allergies, medications, vaccine history, previous
travel
• Trip: reason, style and comfort level, rural vs urban,
accommodation, activities, exposures, budget
• Time: duration, season, frequency
Risk Management

• Identifying risks for individuals or groups

• Advising about risk reduction strategies

• Recommending and providing risk reduction

interventions

• Encouraging behavioral change to change risk level

Risk Reduction Interventions

• Information enabling behaviour modification

• Vaccinations

• Medications (including antimalarials)

• Other- travel insurance, pre existing medical

problems, nets, syringes, medical kits

 Medical travel kits
• These are designed to assist travelers in meeting medical
needs when their access to quality medical care is
compromised.
• All travel medicine consultants recommend that travelers
carry some form of medical first aid kit. A range is available,
and often needs to be tailored to meet the specific
requirements of the traveler and their proposed itinerary.
• Many travel clinics sell medical first aid kits; these often
contain prescription items.
 Medical travel kits
• Essential items for all travelers
• Items to treat cuts, scratches, burns, strains, splinters
• Paracetamol
• Repellent
• Consider condoms

• Additional items for Europe, USA, Japan

• Antinauseants, eg prochlorperazine
• Broad-spectrum antibiotic for respiratory infection
• Antacids
• Minor sedative
 Medical travel kits
• Additional items for less developed countries (gastro kit)
▫ Rehydration solution
▫ Loperamide
▫ Tinidazole
▫ Norfloxacin – or azithromycin for children
• Comprehensive medical kit ; Asia, Africa and South America
▫ All of the above
▫ Sterile needles and syringes. Alcohol swabs
▫ Antihistamines
▫ Antifungal and antibiotic cream
Malarial Prophylaxis

3 prong approach
• Behavioural modification
▫ Awareness of malarial risk
▫ Minimising exposure to mosquitoes

• Emphasis on extreme significance of early

diagnosis & treatment
• Antimalarial chemoprophylaxis
Personal Protection from Mosquitoes

• Avoid outdoor exposure, dawn to dusk

• Wear long sleeved loose clothing after dusk, light
colors
• Avoid perfumes and colognes
• Use repellent with 20-40% DEET
• Use knockdown sprays, coils, vapours, etc indoors
• Sleep under nets impregnated with permethrin
 Vaccinations
• Category A – considered low risk
▫ Western Europe/North America/Japan/UK/NZ/Singapore

• Should be fully vaccinated & up to date with

▫ Diphtheria/tetanus/whooping cough
▫ Routine paediatric vaccines
▫ MMR
▫ Polio
▫ Chicken pox
▫ Influenza
Vaccinations
• Category B Travel – considered to be low to
intermediate risk
▫ Eastern Europe/Israel/Korea/Malaysia/Pacific Is/South
Africa

• Vaccinations should be as for Category A, plus:

▫ Hepatitis A & B
▫ Typhoid
 Vaccinations
• Category C Travel – considered to be of higher risk
▫ African sub-continent/ Central & South America/ East Asia/ SE
Asia
• Vaccinations should be as for Category B, plus:
▫ Polio booster
▫ Japanese B Encephalitis
▫ Rabies
▫ Meningitis
▫ Yellow Fever
• Malaria Prevention
Vaccine Classification- 3Rs

• Routine (background) vaccine

Childhood, standard

• Required (compulsory) vaccine

Cross borders, entry requirements IHR

• Recommended (elective based on risk)Travel

vaccines

Some vaccines can be in more than category. Not all the same or
available in all countries
 In May 2005, The 58th World Health Assembly
adopted the revised International Health
Regulations, “IHR”

• To prevent, protect against, control and provide a

public health response to the international spread
of disease in ways that are commensurate with
and restricted to public health risks, and which
avoid unnecessary interference with international
traffic.
International Health Regulations IHR (2005)

• The International Health Regulations are a formal

code of conduct for public health emergencies of
international concern.
• They're a matter of responsible citizenship and
collective protection.
• They involve all 193 World Health Organization
member countries.
 International Health Regulations IHR (2005)

• They are an international agreement that gives rise to

international obligations. They focus on serious public
health threats with potential to spread beyond a
country's border to other parts of the world.
• Such events are defined as public health emergencies of
international concern, or PHEIC. The revised
International Health Regulations outline the assessment,
the management and the information sharing for
PHEICs.
 International Health Regulations IHR (2005)
• IHRs serve a common interest.
• First of all, they address serious and unusual disease events
that are inevitable in our world today.
• They serve a common interest by recognizing that a health
threat in one part of the world can threaten health
anywhere, or everywhere.
• And they are a formal code of conduct that helps contain or
prevent serious risks to public health, while discouraging
unnecessary or excessive traffic or trade restrictions for,
quote, "public health," purposes.
 k you!!
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