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PubMed1999

Travel insurance and health.

Travel insurance normally underwrites travel, medical, and dental expenses incurred by travelers abroad and arranges aeromedical evacuation of travelers under conditions specified by the travel insurance policy. Because of the costs of medical and dental treatment abroad and the high cost associated with aeromedical evacuation, all travelers should be advised of the need for comprehensive travel insurance and be advised to read their policies carefully to see what is covered and to check for any exclusions. In particular, those travelers who have known preexisting conditions, who are working overseas, or who are going to undertake any form of hazardous recreational pursuit may need to obtain a special travel insurance policy, which may attract a higher premium. Conservatively, it is estimated that between 30-50% of travelers become ill or injured whilst traveling. Relative estimated monthly incidence rates of various health problems have been compiled elsewhere. The risk of severe injury is thought to be greater for people when traveling abroad. These risks should be covered by travel insurance to protect the traveler, however it is not known what proportion of travel agents or airlines give advice routinely on travel insurance. Travel insurance is the most important safety net for travelers in the event of misadventure, and should be reinforced by travel health advisers. Although only 4% of general practitioners (GPs) in a late 1980's study in the United Kingdom would advise a traveler going to Turkey about travel insurance,4 more recent studies have shown about 60% of GPs in New Zealand and 39% of travel clinics worldwide usually advised travelers concerning travel insurance. In addition, 54% of GPs in New Zealand usually also advised travelers about finding medical assistance abroad, but only 19% of GPs recommended travel insurance companies as a source of medical assistance while traveling.

Humans↗
PubMed2005

Travel and health status: a survey follow-up study.

BACKGROUND: To date there is little sound knowledge on the relationship between travel and health status as perceived by the traveller. Our aim was to investigate the frequency and risk factors of travel-associated illnesses and injuries and identify potential protective factors. METHODS: All adults enrolled in a health insurance scheme who planned to travel in 2002 were eligible for participation in a baseline survey. Pre-travel written questionnaires and post-travel telephone interviews were conducted with responders. We analysed travel-associated health problems using descriptive methods and multivariate logistic regression. RESULTS: From 8316 persons who returned a pre-travel questionnaire, a sample of 2384 were chosen, of whom 1471 completed post-travel interviews. 10.1% of all travellers reported travel-associated illnesses, and 1.8% suffered from injuries during travel. Among travellers to European destinations, 6.0% reported an illness as opposed to 16.2% of travellers to overseas destinations. Predictors for travel-associated illness were age <30 years (OR 1.48), duration of travel >4 weeks (OR 3.35) and travel destination. Perceived health status as scored by the travellers improved after travel. The frequency of medical consultations and personal health-related expenses decreased significantly shortly after travel. CONCLUSIONS: In this study, travel had a positive effect on the perceived health status of the traveller. The positive effects of travel seemed to outweigh the impact of health problems. Travel did not lead to increased health-related costs, neither in individual health expenses nor indirectly through increased medical consultation rates.

Adult↗
PubMedDate not supplied

Knowledge, attitudes and practices in travel-related infectious diseases: the European airport survey.

BACKGROUND: The European Travel Health Advisory Board conducted a cross-sectional pilot survey to evaluate current travel health knowledge, attitudes and practices (KAP) and to determine where travelers going to developing countries obtain travel health information, what information they receive, and what preventive travel health measures they employ. Subsequently, the questionnaire used was improved and a cross-sectional, multicenter study was undertaken in airports in Europe, Asia, South Africa and the United States. This paper describes the methods used everywhere, and results from the European airports. METHOD: Between September 2002 and September 2003, 5,465 passengers residing in Europe and boarding an intercontinental flight to a developing country were surveyed at the departure gates of nine major airports in Europe. Questionnaires were self-administered, and checked for completeness and validated by trained interviewers. RESULTS: Although the majority of travelers (73.3%) had sought general information about their destination prior to departure, only just over half of the responders (52.1%) had sought travel health advice. Tourists and people traveling for religious reasons had sought travel health advice more often, whereas travelers visiting friends and relatives were less likely to do so. Hepatitis A was perceived as the most probable among the infectious diseases investigated, followed by HIV and hepatitis B. In spite of a generally positive attitude towards vaccines, 58.4% and 68.7% of travelers could not report any protection against hepatitis A or hepatitis B, respectively. Only one in three travelers to a destination country with at least some malaria endemicity were carrying antimalarial drugs. Almost one in four travelers visiting a high-risk area had an inaccurate risk perception and even one in two going to a no-risk destination were unnecessarily concerned about malaria. CONCLUSIONS: The large variation in destinations, age of the travelers and reasons for traveling illustrates that traveling to a developing country has become common practice. The results of this large-scale airport survey clearly demonstrate an important educational need among those traveling to risk destinations. Initiatives to improve such education should target all groups of travelers, including business travelers, those visiting friends and relatives, and the elderly. Additionally, travel health advice providers should continue their efforts to make travelers comply with the recommended travel health advice. Our common objective is to help travelers stay healthy while abroad, and consequently to also reduce the potential importation of infectious diseases and the consequent public health and other implications.

Adolescent↗
PubMedDate not supplied

Hepatitis B risks and immunization coverage among American travelers.

BACKGROUND: Hepatitis B is endemic in much of Asia, Africa, and parts of South America, regions that are increasingly popular destinations for American travelers. The frequency of hepatitis B risks during travel has been examined for Europeans but not Americans. Further, limited data are available to describe the domestic hepatitis B risk factors of American travelers, the proportion vaccinated, and whether immunization activities target travelers at highest risk. We conducted a survey of international travelers to address these issues. METHODS: A survey was mailed to 884 American international travelers, of whom 618 (70%) responded. The survey covered demographic and travel characteristics, sources of pre-travel health advice, immunization status, and items needed to assess hepatitis B vaccination candidacy. Travel-specific items concerned the most recent trip to a hepatitis B endemic region. Hepatitis B risk during the most recent trip was classified as high, potential, or none based on potential exposure to blood or bodily fluids. RESULTS: Only 31% of respondents visited any health practitioner to obtain pre-travel health advice; 13% visited a travel medicine specialist. Totally 45% of respondents reported (3)1 domestic or travel-related hepatitis B risk, and 8% were at high risk during travel. Risk factors were more common among younger travelers and those with longer travel durations. Travel medicine specialists were more likely than nonspecialists to provide hepatitis B vaccine (40% vs 21%, p= 0.01). Travelers with risk factors were no more likely to be vaccinated in specialist or nonspecialist settings. Upon departure, only 19% of all travelers and 30% of travelers with risk factors had received three or more hepatitis B vaccine doses. CONCLUSIONS: Most US travelers to hepatitis B endemic regions do not secure pre-travel health advice, and most have not received three doses of hepatitis B vaccine. A substantial share are candidates for hepatitis B vaccination based on their domestic activities, and/or face hepatitis B risks during travel.

Adolescent↗
PubMedDate not supplied

Pediatric travel consultation in an integrated clinic.

BACKGROUND: In May 1997, a pediatric travel service was created within a larger integrated University-County Health Department international travel clinic. The purpose of the service was to further enhance the travel advice and care provided to children and their parents or guardians. The current study was designed to describe the care of children in this setting and to compare the care of children seen in the Pediatric Travel Service with that of children seen by other providers. METHODS: All pediatric patients (defined as individuals < or = 18 years of age) receiving care in the travel clinic were considered candidates for inclusion in the analysis. Patients seen by the Pediatric Travel Service were compared to those seen by other staff members in the travel clinic (referred to as Regular Clinic). The following information was noted: basic demographic data, medical history including allergies, prior immunization records, intended place and duration of travel, and immunizations and medications prescribed at the time of visit. Travel advice covering water and food precautions, preventive measures against insect bites, injury prevention, malaria prevention, prevention of parasitic infections, and environmental-related problems was provided to all patients in both groups when necessary. RESULTS: Between May 1997 and December 1999, 287 pediatric age individuals were given pretravel care by the Pediatric Travel Service (median age, 6 years; range, 1 month-18 years). During the same time period, 722 pediatric age travelers (median age, 14 years; range, 8 months-18 years) were evaluated in the Regular Clinic by other staff members. Travel destinations most commonly traveled by both groups in descending order were: Africa, Central America and Mexico, South America, and Southeast Asia. When compared to travelers seen in the Regular Clinic, individuals in the Pediatric Travel Service group were more likely to travel for humanitarian work, and for parental work relocation. Persons in the Regular Clinic were more likely to travel to Mexico and Central America. They were also more likely to travel on vacation and for missionary work or study. Hepatitis B and tetanus-diphtheria booster vaccinations were given more frequently to travelers seen in the Regular Clinic. Also, ciprofloxacin and antimotility agents were more commonly prescribed in this group. No differences were noted in the duration of travel or in the time interval between clinic visit and departure. CONCLUSION: While general travel advice was considered to be similar in both clinic groups, some differences were observed in the frequency of administration of certain vaccines and prescriptions of medications. These differences were likely due to a difference in age in the two study groups. The high volume and success of the clinic suggest that integrated pediatric and adult travel services in a coordinated setting can be effective.

Adolescent↗
PubMed2006

Assistance provided abroad to insured travellers from Australia following the 2004 Asian tsunami.

BACKGROUND: On 26 December 2004, the Asian tsunami hit countries around the Indian Ocean rim, particularly around its earthquake-associated epicentre off Indonesia. A number of popular tourist destinations for Australian travellers are located in this region. This study was designed to investigate travel insurance claims reported by travellers from Australia following the Asian tsunami and to examine the role of travel insurance and emergency assistance companies. METHODS: In December 2005, all claims reported, following the Asian tsunami on 26 December 2004, to a major Australian travel insurance company were examined for those claims associated with the Asian tsunami. RESULTS: Twenty-two tsunami-related claims were submitted of which nine travellers (40.9%) used the travel insurance company's emergency assistance service. Four travellers (18.2%) cancelled their trip to Asia, mainly to Thailand. Five travellers (27.3%), who were already abroad, also curtailed their trip as a result of the tsunami. Half of travellers (50.0%) were claiming loss of personal belongings. Of those using the emergency assistance service, five travellers (22.7%) sought policy and claiming advice, two (9.1%) sought assistance with flight rearrangements, and one (4.5%) sought situation advice. There was also assistance provided following the death of one insured traveller as a direct consequence of the tsunami, which included a lump sum payment to the deceased estate. The mean refund, where a travel insurance claim was paid, was Australian dollars (AUD)2234 (SD=AUD5755). CONCLUSIONS: This study highlights the importance of travellers taking out appropriate travel insurance, which provides for emergency assistance. Travel insurance agencies do play some role after emergencies, such as the Asian tsunami. This assistance predominantly involves dealing with cancellation of travellers' intended visits to the affected area, but does also involve some assistance to travellers affected by the crisis. Travellers should be advised to seek travel health advice well before departure overseas and to ensure that they are aware of travel advisories for their destination.

Adult↗
PubMedDate not supplied

Health problems in a large cohort of Americans traveling to developing countries.

BACKGROUND: Millions of Americans visit developing countries each year, however, little is known about their health during travel. This study describes health problems in a large cohort of American travelers during and after their trip. METHODS: A 2-year survey of 784 travelers (95% follow-up) was conducted for persons traveling for < or = 90 days. At the pretravel visit, travelers were given a postcard to record adverse health events. Following travel, standardized telephone interviews were performed for any positive responses, or if the card was not returned. All travelers were contacted 2 months after return to determine late occurring illness and compliance with antimalarials. RESULTS: Travelers had a mean age of 44 years, a median duration of 19 days, and visited 123 countries. An illness was reported by 64% (1.6 illnesses per traveler). Ill travelers were more often female, and traveled longer than those who were not ill; depending upon destination, each day of travel increased by 3 to 4% the chance of becoming ill. Diarrhea was most common, occurring in 46%; 34% met a strict definition for traveler's diarrhea. Respiratory illness occurred in 26%, skin disorders in 8%, acute mountain sickness in 6%, motion sickness in 5%, accidents and injuries in 5%, and isolated febrile episodes in 3%. Medical care was sought by 8% of all travelers and 12% of those reporting illness. On return, 26% of travelers were ill, 56% of whom became ill after return. Diarrhea, respiratory illness, skin disorders, and febrile syndromes were most common, and 46% of those who were ill sought medical care. Complete compliance with antimalarials was 80%. Noncompliant individuals usually discontinued medications on return. Side effects were reported by 4% of those taking chloroquine, 11% of those taking chloroquine plus proguanil, and 14% of those taking mefloquine, with half of these neuropsychiatric. The incidence of documented malaria was 3.8 cases per 1,000 travelers. CONCLUSIONS: Many travelers experience adverse health events during and after travel to the developing world. Attention to the prevention and therapy of traveler's diarrhea, prophylaxis of malaria, management of respiratory illness, personal safety, and access to medical care during travel, and, recognition of clinical syndromes after return, will help to improve the traveler's health.

Adolescent↗
PubMedDate not supplied

Health advice provided to hostelers from Australia: influence of a travelers' information evening.

BACKGROUND: Little is known about the health advice provided to hostelers and the role and influence of hosteling organizations' travelers' information evenings in giving travel health advice. This study was designed to investigate these in relation to the Australian context. METHODS: In 1997, hostelers attending travelers' information evenings in two regional centers and one metropolitan location in Queensland were asked to complete self-administered questionnaires. RESULTS: Of 158 questionnaires, 110 (69.6%) were returned. Missing data have been excluded from the analysis. About two-thirds of the hostelers attending the travelers' information evening reported being age 35 years or younger (43/65, 66.2%). Almost two-thirds of attendees were female (42/65, 64.6%). The hostelers responding to this study were fairly evenly divided between regional centers (54/110, 49.1%) and the metropolitan center (56/110, 50.9%). Hostelers indicated that they were traveling to Europe and the United Kingdom (53/62, 85.5%), Canada (17/62, 27.4%), Asia (15/62, 24.2%), United States (10/52, 19.2%), and other destinations (7/51, 13.7%), mostly Africa. Hostelers were significantly more likely to have obtained travel health advice (x = 5.02, df = 1, p <.05) if they were traveling within 6 weeks. Hostelers indicated that they obtained advice from general practitioners (41/67, 61.2%), travel agents (29/67, 43.3%), books (22/67, 32.8%), travel clinics (10/67, 14.9%), and other sources (6/67, 9.0%). Most hostelers indicated that they learnt something new about healthy travel from the travelers' information evening (76/100, 76.0%). Of those hostelers who had not sought travel health advice or who had not planned to seek travel health advice prior to the travelers' information evening, almost all indicated that they now would seek travel health advice (32/33, 97.0%). CONCLUSIONS: This cross-sectional study found that most hostelers attending an international hosteling organization's travelers' health information session in Australia were in the younger age groups and were predominantly female. Most of these hostelers had sought travel health advice from general practitioners, travel agents, and books. The information provided by the healthy travel session of the travelers' information evenings appeared to be of some benefit to hostelers, particularly as it appeared to have prompted most hostelers who had not yet sought travel health advice to do so.

Adult↗
PubMed1999

Training, experience and interest of general practitioners in travel medicine in New Zealand.

BACKGROUND: In New Zealand, general practitioners (GPs) are a major group of travel health advisers. This study was designed to investigate the prevalence of training, experience, and interest in travel medicine or related areas, interest in undertaking training in travel medicine and how training might be best delivered. METHOD: Four hundred GPs were randomly selected from the register of the New Zealand Medical Council and sent self-administered questionnaires. Two reminders were sent. RESULTS: Three hundred and thirty-two (83%) GPs responded and these GPs advised an average of two travelers per week. Most GPs (257/282, 91%) reported that they had no training in travel medicine/related area. Training in travel medicine/related areas was significantly associated with age group (x2=14.09, df=6, p<.05), with the proportion of GPs with training in travel medicine/related area tending to be higher in the 45-49 and 50-54 years age groups, and also with GP college membership/fellowship (x2=6.39, df=1, p<.05). Forty-one percent (121/298) of respondents stated that they had previous experience working in tropical medicine/developing country. There was a significant association between GPs having experience working in tropical medicine/developing countries and training in travel medicine (x2=14. 19, df=1, p<.001) and those who were non-New Zealand graduates (x2=7. 84, df=1, p<.01). Forty-four percent (131/300) of respondents stated that they had an interest in travel medicine. Nearly two thirds of respondents (200/309, 65%) indicated that they would be interested in undertaking various types of travel medicine training, with a short course most commonly identified (159/309). The interest for training in travel medicine was significantly associated with those GPs with an interest in travel medicine (x2=26.45, df=1, p<.001), in younger age groups (x2=41.30, df=6, p<.001), a lower mean number of years since graduation (t value=5.70, df=297, p<.001), a higher mean proportion of patients who were travelers (t value=23.15, df=303, p<. 01), and a higher mean number of travelers seen per week (t value=22. 94, df=303, p<.01). The most common postgraduate qualification amongst GPs was membership/fellowship of a GP college (85/282, 30%), which was significantly more prevalent amongst the older age groups (x2=18.18, df=8, p<.05). Membership of travel medicine was very low. CONCLUSIONS: This cross-sectional study found that most GPs in New Zealand did not have any formal training in travel medicine, although more than two fifths of GPs indicated an interest in travel medicine and experience in tropical medicine/related area. GPs mainly wanted continuing medical education (CME) on travel medicine in the form of short and certificate level courses. As membership in GP colleges and other organizations was limited, other providers of CME should also be considered for providing more of these courses, such as universities and pharmaceutical companies. Providers of CME may target less experienced GPs and those GPs who may be seeing more travelers and use various approaches. Undergraduate and postgraduate medical curricula may also need to include more training in travel medicine.

Adult↗
PubMed1999

Health advice given by general practitioners for travellers from New Zealand.

AIMS: To investigate where general practitioners (GP's) in New Zealand view travel health advice best given and where they refer for this advice, the prevalence of travel health advice reported to be given, and the prevalence of written advice, including a doctor's letter. METHOD: This was a descriptive cross-sectional study, using self-report questionnaires, sent to 400 GPs randomly selected from the register of the New Zealand Medical Council. RESULTS: Three hundred and thirty-two GPs (83%) responded. Most GPs reported that they saw travel medicine as best practised in general practice (241/308, 78%) or in a combination of locations, usually including general practice (28/308, 9%). Most GPs (223/308, 72%) did not refer travellers for travel health advice. Health advice concerning malaria (310/310, 100%), immunisation (309/310, 100%), travellers' diarrhoea (296/305, 97%), insect avoidance (287/ 299, 96%), sexually transmitted diseases/human immunodeficiency virus (233/283, 82%), water purification (235/293, 80%) and other areas (35/75, 47%) was given. Written advice was usually given by 23% of GPs (69/302). Written advice was significantly more likely to be provided by those GPs with an interest in travel medicine (chi2=5.67, df=1, p<0.005), experience in tropical medicine/developing countries (chi2=6.69, df=1, p<0.001), a policy on travel medicine (chi2=21.4, df=1, p<0.001), a written policy on travel medicine (chi2=302.0, df=1, p<0.001), who saw a higher number of travellers per week (t=-2.51, df=296, p<0.05) and who saw a significantly higher proportion of patients who were travellers (t=-3.27, df=-295, p=0.001). Almost all GPs (303/310, 98%) reported giving their travelling patients a doctor's letter at least sometimes but only 7% (23/310) always gave travellers a doctor's letter. GPs with training in travel medicine/related area were significantly more likely to provide travellers with a doctor's letter (chi=11.61, df=3, p<0.01). CONCLUSIONS: This study confirmed that GPs in New Zealand see travel health advice as best given in general practice. Travel health advice, as recommended by New Zealand guidelines, should continue to be given. With limited time in general practice to advise travellers, GPs should also consider giving written advice, including a doctor's letter, more often. Epidemiological and specialist support by public health units and commercial groups, continuing medical education and training in travel medicine for GPs are among the major considerations. Further studies are needed concerning the adequacy and currency of destination-specific advice for travellers.

Chi-Square Distribution↗
PubMed1998

Safety advice for travelers from New Zealand.

BACKGROUND: Accidents and injuries are important preventable causes of morbidity and mortality for travelers. This study was designed to investigate the prevalence of advice given by general practitioners (GPs) on personal safety, health and travel insurance, and finding medical assistance abroad in the event of misadventure or ill health. METHOD: Four hundred general practitioners were randomly selected from the register of the New Zealand Medical Council and sent self-administered questionnaires. Two reminders were sent. RESULTS: Three hundred and thirty-two (83%) GPs responded. Advice to travelers on health and travel insurance (164/273, 60%), personal safety (127/255, 50%), and finding medical assistance abroad (165/308, 54%) was given by half or just over half of GPs. Giving advice on medical assistance abroad was significantly associated with giving advice on health and travel insurance (x2 = 18.89, df = 1, p<.001) and personal safety (x2 = 25.26, df = 1, p<.001). Seeing a higher proportion of patients who were travelers was significantly associated with giving advice on health and travel insurance (t-value = -3.39, df = 267, p = .001) and personal safety abroad (t-value = -2.63, df = 249, p < .01). Those GPs with previous experience in tropical medicine/developing countries were significantly more likely to advise travelers on personal safety abroad (x2 = 6.55, df = 1, p<.05) and about seeking medical assistance abroad (x2 = 4.11, df = 1, p<.05). Those GPs in older age groups (45-49 years and over) were significantly more likely to advise travelers on health and travel insurance (x2 = 16. 31, df = 8, p<.05) and personal safety abroad (x2 = 19.88, df = 8, p<.05). Those GPs with an interest in travel medicine were significantly more likely to advise travelers about seeking medical assistance abroad (x2 = 11.07, df = 1, p<.001) and health and travel insurance (x2 = 16.31, df = 8, p<.05). When advising travelers about seeking medical assistance abroad, GPs most commonly recommended contacting travel insurance companies (60/308, 19%), a specific medical service (48/308, 16%), tour company (30/308, 10%), specific doctor (29/308, 9%), New Zealand embassy (27/308, 9%), local medical service (23/307, 7%), personal contact (21/307, 7%), and other sources (12/307, 4%). CONCLUSIONS: This cross-sectional study found that only around half of New Zealand GPs were giving advice to travelers on personal safety, health and travel insurance, and finding medical assistance abroad. Continuing education providers should reinforce the need for this advice to be given to all travelers. There was also considerable variability in what New Zealand GPs recommended to travelers about seeking medical assistance abroad, including several nonmedical sources.

Adult↗
PubMedDate not supplied

Travelers' knowledge, attitudes and practices on the prevention of infectious diseases: results from a study at Johannesburg International Airport.

BACKGROUND: Although Johannesburg International Airport (JIA) acts as a hub for travel into Africa, little was known of the knowledge, attitudes, and practices (KAP) with respect to infectious disease prevention of departing travelers. METHODS: The study was conducted among departing passengers at JIA from August to October 2003. Travelers aged at least 18 years, resident in non-malarious developed countries and departing from JIA for risk destinations, were given either a malaria (Q-mal, n=219) or vaccine-preventable disease (Q-vac, n=200) questionnaire. European Travel Health Advisory Board traveler KAP questionnaires were used. RESULTS: African destinations accounted for 99% of the total. Traveler mean age was 42 years, with 30% aged 50 years or above. Leisure (42%) and business (37%) were the commonest travel reasons; 8% of subjects were visiting friends or relatives. Forty-six per cent of travelers prepared for their trip at least 1 month in advance; 86% had sought pre-travel health advice, with travel clinics and the Internet being rated highest by travelers for quality of advice. World Health Organization immunization guidelines were followed poorly: only 37% and 27%, respectively, of travelers had demonstrable proof of protection against hepatitis A and B, with 40% of all Q-vac travelers unable to produce a vaccination certificate. Of travelers to yellow fever- endemic countries, 76% were able to produce a valid vaccination certificate; 22% of travelers to countries not endemic for yellow fever had nevertheless been specifically immunized against yellow fever for their journeys. Forty-nine per cent of Q-mal travelers carried either no or inappropriate antimalarials. CONCLUSIONS: Considerable deficiencies in KAP were documented with regard to travel vaccinations and malaria protection in travelers departing JIA. Improved vaccine uptake and antimalarial prescribing are required for travelers to Africa.

Adolescent↗
PubMed1990

A cumulative review of studies on travellers, their experience of illness and the implications of these findings.

A cumulative review of illness experienced by 13,816 travellers returning to Scotland since 1977, shows an overall attack rate of 36%. Alimentary complaints predominated; 18% of travellers had these alone and a further 10% had other symptoms as well as their gastro-intestinal disorder. Higher attack rates were noted in those taking package holidays. Inexperience of travel, smoking, more southerly travel and younger age (particularly those between 20- and 29-years-old) were other contributing factors. A similar pattern emerged from a I year study of hospital in-patients with travel related admissions. Serological studies of 470 travellers showed that 20% had incomplete immunity to poliomyelitis; 25% of those tested (312 travellers) had serological evidence of typhoid immunisation, I.9% (of 760 travellers) had antibodies to Legionella pneumophila, 64% (5II travellers tested) had antibodies to hepatitis A, 87% (288 tested) had adequate levels of tetanus antitoxin but only 40% of the 225 travellers tested had adequate levels of diphtheria antitoxin. Amongst a subgroup of 645 travellers the travel agent was the most frequently consulted source of pre-travel health advice. This carries particular significance for the dissemination of relevant advice in view of the inadequacies found from study of the health information in travel brochures. These findings, viewed against the perspective of the continuing growth in international travel, means that travellers, the medical profession, the travel trade, health educators, global health agencies and health authorities in those countries accepting and encouraging tourists, will be required to recognise the health implications of further tourism development if this problem of illness associated with travel is to be brought under control.

Adolescent↗
PubMed1999

Risk factors for psychological stress among international business travellers.

OBJECTIVES: This study investigated sources of self reported psychological stress among international business travellers at the World Bank, following up on a previous study showing that travellers submitted more insurance claims for psychological disorders. Hypotheses were that work, personal, family, and health concerns, as well as time zone travel, contribute to travel stress. METHODS: A travel survey was developed from focus groups and consisted of questions about these potential sources of travel stress. Surveys were sent to a random sample of staff, stratified by number of travel missions, age range, and sex. Canonical correlation analyses estimated the association between key survey items on sources of stress and two measures of travel stress. RESULTS: 498 staff completed the survey. More than a third reported high to very high travel stress. Correlations between predictors and travel stress showed that social and emotional concerns (such as impact of travel on family and sense of isolation) contributed the most to such stress, followed by health concerns, and workload upon return from travel. Surprisingly, time zone travel did not contribute to the self reported stress of these travellers. There were few modifiers of stress, although respondents suggested that a day of rest after travel and reduced workloads would help. CONCLUSIONS: The current study confirms clinical impressions about several correlates of travel stress. Similar research with travellers in other organisations could help to determine whether the findings from this study are valid and what measures can be taken to reduce the psychological health risks to travellers.

Adaptation, Psychological↗
PubMedDate not supplied

Risk and spectrum of diseases in travelers to popular tourist destinations.

BACKGROUND: Traveling to tropical regions is related to increased health risks. Travelers' diarrhea is the most frequent health problem, but the range of travel-related diseases also includes potential life-threatening diseases such as malaria. The actual risk of European travelers acquiring specific infectious diseases and other hazards in the tropics is to a large extent unknown and is therefore often adopted from that of the indigenous population. The objective of this study was to elucidate the risk for travel-related diseases, symptoms, and accidents in a population of Europeans who travel to popular tourist destinations. METHODS: From July 2003 to June 2004, 794 travelers consulting the travel clinic of the Berlin Institute of Tropical Medicine were recruited for a questionnaire-based observational study before traveling to Kenya, Tanzania, Senegal, the Gambia, India, Nepal, Thailand, or Brazil. RESULTS: Overall, illness was reported by 42.9% of travelers, with 10.2% reporting more than one adverse health event. Most frequently gastrointestinal symptoms were noted (34.6%), followed by respiratory symptoms (13.7%). More than 5% experienced an accident. Travel to the Indian subcontinent nearly doubled the risk of becoming ill; travel to Thailand significantly decreased the risk. Additional risk factors were a long duration of staying abroad, young age, and traveling under basic conditions. Of all travelers, 80% did not follow the traditionally recommended dietary restrictions. Among travelers visiting malaria-endemic areas, 20% did not carry any antimalarial drugs with them, not continuous chemoprophylaxis or standby medication. CONCLUSIONS: Because of the rising travel activity, especially to tropical countries, the importance of qualified pretravel advice consultation is increasing. To improve the travelers' health, attention needs to be paid to individual risk factors, the prevention and therapy of travelers' diarrhea, malaria prophylaxis, management of respiratory illness, and personal safety.

Accidents↗
PubMedDate not supplied

Effect of maximizing a travel medicine clinic's prevention strategies.

BACKGROUND: Even among travelers who undergo evaluation in travel medicine clinics, illnesses develop despite the emphasis placed on prevention. It is possible that travel-associated disease rates may be modified by maximizing access to care and augmenting educational methods of disease prevention. Use of alternative preventive measures such as alcohol hand gel sanitizers may also alter illnesses among travelers. METHODS: We assessed medical outcomes in a travel population cared for in the setting of free vaccinations, medications, and travel medicine consultation, in which personal preventive measures were presented in numerous formats by a physician specializing in infectious diseases. An initial demographic questionnaire was administered at the time of travel consultation. A post-travel telephone interview conducted 2 weeks after return from travel evaluated illness while abroad, illness upon return, and adherence to travel recommendations. An assessment was also performed regarding the utility of an alcohol hand gel sanitizer. RESULTS: One hundred fifty-five travelers were evaluated (primarily older, well-educated US-born travelers, on vacation with family or coworkers). Travelers filled their prescriptions 98% of the time; 77% reported adherence to antimalarial chemoprophylaxis. Sixty-four percent of travelers developed illness abroad, and 20% developed illness upon return. The most frequent complaints were diarrhea and upper respiratory illness. Ten percent of travelers altered their itinerary owing to illness. The use of alcohol hand gel sanitizers did not appear to impact the development of diarrhea or respiratory illnesses. CONCLUSION: In this small group of travelers, access to free consultation, vaccinations, and medications along with presentation of personal protective measures in various formats did not seem to influence the development of illnesses among travelers. Although not rigorously analyzed, alcohol hand gel sanitizers did not seem to alter diarrhea or respiratory tract illness rates. These data highlight the need for new or more effective methods to prevent illness among travelers.

Adolescent↗
PubMed2006

[Travel medicine and vaccination as a task of infection prevention--data of the special consultation hours of the public health department Frankfurt on the Main, Germany, 2002-2004].

UNLABELLED: Infection prevention is one of the main tasks of the Public Health authorities. Because of hundreds of travel associated infections imported by travellers every year and considering increasing travel activities to tropical countries, travel medicine and consultation on the correct prevention measures including vaccination is becoming more and more important. Hence the data of the special consultation hours of the public health department of Frankfurt am Main are reported and discussed with regard to possible improvements. MATERIAL AND METHODS: The public health department of Frankfurt am Main has been offering special consultation hours for travel medicine for many years. Here, data derived from the anamneses of the clients from 2002 - 2004 are reported: personal data such as age, sex, travel destination as well as medical data such as vaccination and malaria prevention. RESULTS: 2002 - 2004, more than 14,000 persons were seen in the consultation hours, more than 66% of them asked for travel health advice, about 25% of them asked for standard vaccination (such as influenza), some others asked for attestation or certification. More than 20,000 doses of vaccines were given, the most important vaccination against hepatitis A (n = 5791), hepatitis B (n = 4064), typhoid fever (n = 2718) and yellow fever (n = 2473). 2814 were informed with regard to malaria prevention, including recipes. 7814 persons with complete data on their reason for travel were subjected to more detailed analysis: 75% of them were holiday tourists, 18% travelled as "hikers", 7% were business travellers and less than 1% of them planned a round-the-world tour. The most frequent travel destinations were: Asian or African countries about 33% each, 25% Middle or South America. Thailand, South Africa with Namibia, Brazil and India were the most important countries. The time from health consultation to the beginning of the journey was too short for full vaccine protection against typhoid fever and meningococcal disease in 10% and against rabies in 44% of the consultants. There were no significant differences between holiday tourists, business and "hikers" travellers. CONCLUSION: According to many studies, only one-third of the travellers going abroad, especially to developing countries, obtain travel health information. Hence, the clients of our consultation hours are a positive selection. Nevertheless, great need for improvement could be seen as well. In many of the clients the time from getting health information and vaccination was too short for obtaining complete vaccination protection. People travelling to countries where most hepatitis A infections are obtained and re-imported home, such as Turkey and Tunisia and other Mediterranean countries almost never came for health advice and vaccination. Therefore, public health authorities should improve and increase their publicity campaigns for travel health and vaccination in order to prevent travel-associated infections and re-importation of such diseases.

Communicable Disease Control↗
PubMedDate not supplied

Ineffectiveness of the current strategy to prevent hepatitis A in travelers.

BACKGROUND: Each year, a large number of Canadians travel to regions of the world where hepatitis A remains endemic. Many of these travelers are not immune and the current preventive strategy relies wholly on self-referral to a travel clinic. All of the costs associated with such a visit are assumed by the traveler. We estimated the effectiveness of this strategy. METHODS: This case-control study included 108 travel-related hepatitis A cases with onset of disease between 1997 and 1999 and 620 controls who traveled during the same period. RESULTS: Hepatitis A was strongly associated with high-risk travel (Odds Ratio = 7.2, 95% Confidence Interval 1.76-29.4), but only 7% of cases were found in this category. The risk of hepatitis A was 5 times lower in travelers who visited a travel clinic than in those who did not (80% efficacy). However, only 14% of the controls visited a travel clinic. As a result, the effectiveness of the current strategy is estimated to be 11% (80% of 14%). CONCLUSIONS: Hepatitis A in travelers can be prevented effectively by attendance at a travel clinic. Unfortunately, most travelers do not visit such clinics prior to departure. Even if all high-risk travelers were to visit a travel clinic and receive vaccination, this would have negligible impact on the number of travel-related hepatitis A cases (approximately 7% reduction). The current strategy for the prevention of hepatitis A in travelers is ineffective and should be reexamined.

Adult↗