Travel Medicine

Travel medicine is the branch of medicine that deals with the prevention and management of health problems of international travelers.

Impact of globalization on the spread of disease

Globalization facilitates the spread of disease and increases the number of travelers who will be exposed to a different health environment. Major content areas of travel medicine include the global epidemiology of health risks to the traveler, the use of vaccines to prevent disease, chemoprophylaxis of specific communicable diseases such as malaria, treatment of travel-related disease, and pre-travel counseling designed to maintain the health of international travelers. In 2004 approximately 16% of adult US residents (CDC, unpublished data) spent at least one night outside the US. In the same year, there were 62 million trips outside the US, a 24% increase over the 52 million in 1995^[1]

Mortality and morbidity

Mortality studies indicate that the cardiovascular disease accounts for most deaths during travel (50-70%), while injury and accident follow (~25%). Infectious disease accounts for about 2.8-4% of deaths during/from travel. Morbidity studies suggest that about half of the people from a developed country that stay one month in a developing country will get sick. Traveler's diarrhea is the most common problem encountered.

Disciplines

The field of travel medicine encompasses a wide variety of disciplines including epidemiology, infectious disease, public health, tropical medicine, high altitude physiology, travel related obstetrics, psychiatry, occupational medicine, military and migration medicine, and environmental health.

Special itineraries and activities include cruise ship travel, diving, mass gatherings (e.g. the Hajj), and wilderness/remote regions travel.

Basically, travel medicine can divide into 4 main topics: prevention (vaccination and travel advice), assistance medicine (dealing with repatriation and medical treatment of travelers), wilderness medicine (e.g. high-altitude medicine, cruise ship medicine, expedition medicine, etc.) and insurance medicine.

Focus

Travel medicine includes pre-travel consultation and evaluation, contingency planning during travel, and post-travel follow-up and care. Information is provided by the WHO that addresses health issues for travelers for each country as well as the specific health risks of air travel itself.^[2] Also, the CDC publishes valuable and up-to-date information.^[3]

Key areas to consider are vaccination and the six I’s:

Insects: repellents, nets, medication

Ingestions: safety of water, food

Indiscretion: HIV, sexually transmitted disease

Injuries: accident avoidance, personal safety

Immersion: schistosomiasis

Insurance: coverage and services during travel, access to care

Specific disease problems

Yellow fever is endemic to certain areas in Africa and South America. The CDC site delineates the risk areas and provides information about vaccination and preventive steps.^[4]

Meningococcal meningitis is endemic in the tropical "meningitis belt" of Africa. Vaccination is required for pilgrims going to Mecca. Detailed information is available on the CDC site.^[5]

Malaria prevention is best accomplished by preventing or reducing exposure to mosquitos through use of screened rooms, air-conditioning, mosquito nets, and topical repellents containing DEET. In addition, chemoprophylaxis is started before travel, continued during the time of potential exposure, and for a period after completing travel that depends on which medication was chosen. See detailed CDC site.^[6]

Medication Kit

The traveler should have a medication kit to provide for necessary and useful medication. Based on circumstances it should include also malaria prophylaxis, condoms, and medication to combat traveler's diarrhea. In addition, a basic first aid kit can be of use.

Studies have shown there are four main medical problems that travellers develop - diarrhoea or gut problems, respiratory problems, wounds and pain. The medical kit should at least address these common things.

Research has also shown that the best treatment for travellers diarrhea is to take an antibiotic (e.g. ciprofloxacin) plus a stopper ( e.g. loperamide). Due to bacterial resistance, different parts of the world require different antibiotics. It is best to consult a travel doctor to sort out the best medical kit for the exact destination and medical history of the person travelling.

International travel is usually very safe but there are things you should do to stay safe and healthy. In this video, experts show you how to avoid problems when visiting developing nations. This includes being cautious about the food you eat and the water you drink, and to be aware of vehicles and road conditions to prevent problems.

Each year more Americans travel overseas. Health experts suggest that you take several key steps to be proactive, prepared, and protected against injury or illness while outside of the United States, especially in developing nations.

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In this video from BigThink, public health expert Josh Ruxin cautions that neglected tropical diseases, such as intestinal worms, can raise the rate of HIV/AIDS infection and potentially other diseases:

References

1. ↑ Centers for Disease Control CDC Yellow Book chapter 2
2. ↑ World Health Organization WHO Travel Health Risks Page
3. ↑ Centers for Disease Control CDC Travel Health Page
4. ↑ Centers for Disease Control CDC Yellow Fever Reference
5. ↑ Centers for Disease Control CDC Meningitis Reference
6. ↑ Centers for Disease Control CDC Malaria Reference

External links

Countries - World Health Organization - includes information on outbreaks and health information

Travelers' Health - Centers for Disease Control and Prevention - includes information on outbreaks, specific diseases, recommended vaccinations

Traveler's Health - MedlinePlus

Centers for Disease Control Safe Food and Water Reference

Organizations