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PubMedDate not supplied

Use of medical chemoprophylaxis and antimosquito precautions in Danish malaria patients and their traveling companions.

BACKGROUND: The number of malaria cases imported to Denmark has been increasing for some years. To analyze the background for this we assessed the use of protective measures in Danish travelers visiting malarious areas. METHOD: Post-travel questionnaires were given during hospitalization to malaria patients, and sent by mail to their traveling companions. RESULTS: In total, 142 persons participated. Only 32% of the travelers used chemoprophylaxis correctly, according to Danish recommendations. Twelve percent of the travelers did not use chemoprophylaxis. Average compliance was 52%. Insufficient drug dosage was reported by 13%, and use of nonrecommended drugs by 7% of the travelers. Thirty-seven percent used insufficient antimosquito precautions, a problem which often coincided with irregular use of chemoprophylaxis. Malaria patients, sole travelers, and travelers with other ethnical background than Danish, were subgroups using insufficient malaria prophylaxis more frequently than healthy traveling companions. CONCLUSION: Insufficient use of the available antimalaria precautions by Danish travelers contributes greatly to maintaining a high incidence of imported malaria. Increased attention from physicians in educating travelers is important for optimizing malaria prophylaxis.

Adult↗
PubMedDate not supplied

Use of malaria prevention measures by North American and European travelers to East Africa.

BACKGROUND: The use of preventive measures, including effective chemoprophylaxis, is essential for protection against malaria among travelers. However, data have shown that travelers and medical advisors are confused by the lack of uniform recommendations and numerous prophylactic regimens of varying effectiveness that are used. METHODS: To assess the use and type of preventive measures against malaria, we conducted a cross-sectional study in 1997 among travelers departing from the Nairobi and Mombasa airports in Kenya with European destinations. RESULTS: Seventy-five percent of the travelers studied were residents of Europe and 25% were residents of North America; all stayed less than 1 year, and visited malarious areas. Most travelers, 97.1%, were aware of the risk and 91.3% sought pretravel medical advice. Although 95.4% used chemoprophylaxis and/or antimosquito measures, only 61.7% used both regular chemoprophylaxis and two or more antimosquito measures. Compliance with chemoprophylaxis was lowest amongst those who used a drug with a daily, as opposed to, a weekly dosing schedule, stayed more than 1 month, attributed an adverse health event to the chemoprophylaxis, and were less than 40 years of age. Among US travelers, 94.6% of those taking chemoprophylaxis were taking an effective regimen, that is, mefloquine or doxycycline. Only 1.9% used a suboptimal drug regimen, such as chloroquine/proguanil. Among European travelers, 69% used mefloquine or doxycycline, and 25% used chloroquine/proguanil. Notably, 45.3% of travelers from the UK used chloroquine/proguanil. Adverse events were noted by 19.7% of mefloquine users and 16.4% of travelers taking chloroquine/proguanil. Neuropsychologic adverse events were reported by 7.8% of users of mefloquine and 1.9% of those taking chloroquine/proguanil. The adverse events, however, had a lesser impact on compliance than frequent dosing schedule. CONCLUSIONS: Health information should be targeted to travelers who are likely to use suboptimal chemoprophylaxis or may be noncompliant with prophylaxis. Uniform recommendations for effective chemoprophylaxis with simple dosing schedules are necessary to reduce rates of malaria among travelers to Africa.

Adult↗
PubMedDate not supplied

Knowledge of malaria, risk perception, and compliance with prophylaxis and personal and environmental preventive measures in travelers exiting Zimbabwe from Harare and Victoria Falls International airport.

BACKGROUND: Travel associated malaria is a major health risk for visitors to malaria endemic destinations. To examine the knowledge of malaria prevention, risk perception, current prophylactic behavior, and compliance with chemoprophylaxis and personal and environmental protection measures we conducted a study in a cohort of travelers exiting Zimbabwe from two international airports during a peak malaria transmission period. METHODS: Data were collected by pretested self-administered questionnaires from 595 adults in the departure lounges of Harare and Victoria Falls International airports. Excluded were children and travelers from the African continent. A multilingual research assistant supervised data collection. RESULTS: The majority of travelers obtained health advice prior to travel. Patterns of protective behavior and compliance with prophylaxis were inconsistent with a high perception of malaria threat and good knowledge. About 23% of travelers failed to use chemoprophylaxis during their visit. In the group of travelers who used chemoprophylaxis, 18% were noncompliant. Fifteen drug combinations were in use. Full compliance with medication plus use of personal preventive measures always was estimated as 13%. Forgetfulness was the main cause of noncompliance, followed by deliberate omission due to side effects. Of 57 travelers who reported side effects from current medication, over half used mefloquine. CONCLUSIONS: There is a need to examine how people process personal risk and communications about risk. We must recognize the competition between precautionary measures against malaria and other life demands that are imposed by travel, especially in young long stay travelers and persons visiting primarily for business purposes. Mediating a protective response will also depend on judgments about the effectiveness of the action, strengthening travelers intentions toward adherence, and increasing efficacy perception by individuals and their peers. Conflicts in prophylactic recommendations need to be resolved. As ecotourism develops in Zimbabwe and other malaria regions, stakeholders in this rapidly growing industry must be made aware of the important role they can play in protecting clients from malaria.

Adult↗
PubMedDate not supplied

Pretravel health advice among international travelers visiting Cuzco, Peru.

BACKGROUND: Cuzco, a Peruvian city of historical interest located 3,326 m above sea level, is a frequent destination for tourists. We conducted a descriptive study to assess the extent and sources of pretravel health advice received by international travelers before their arrival to Cuzco. METHODS: Data were collected as part of a health survey among travelers. Between August and November 2002, travelers between 15 and 65 years old were invited to fill out a questionnaire in the departing area of Cuzco's international airport. RESULTS: A total of 5,988 travelers participated. The mean age was 35.4 years (SD 11.4 yr); 50.6% were female and 50.8% were single. Tourism was the reason for traveling in 90.2% of the participants, and 89.3% of them were traveling with companions. Pretravel health information was received by 93.6%. The median number of information sources was two, with books (41.5%), travel medicine clinics (38.8%), the Internet (23.3%), and general practitioners (22.7%) as the main sources. Most frequently received recommendations were about safe food and water consumption (85%), use of insect repellents (66.0%), sunburn protection (64.4%), and condom use (22%). Only 16.5% took medication to prevent altitude sickness, and 14.2% took medication to prevent traveler's diarrhea. Variables independently associated with receiving pretravel health information from a health care professional were female gender, country of residence other than the United States, length of stay in Cuzco > 7 days, length of stay in other Peruvian cities > 7 days, tourism as the main reason for visiting Cuzco, traveling with companions, and consulting of more than one source of information. CONCLUSIONS: Most travelers arriving to Cuzco had received pretravel health information, and the majority obtained it from more than one source. Recommendations addressed for specific health risks, such as altitude sickness prophylaxis, were received by few travelers.

Adolescent↗
PubMedDate not supplied

Risk of travel-associated typhoid and paratyphoid fevers in various regions.

BACKGROUND: Although enteric fever (typhoid and paratyphoid fevers) is a major global public health problem, comparable data on the risks of contracting travel-associated enteric fever in various regions of the world are scarce. METHODS: From the Swedish database on notifiable communicable diseases, we retrieved all case records from 1997 to 2003 on typhoid and paratyphoid fevers. The data set was compared with data on travel patterns obtained from a comprehensive travel database with information from interviews with more than 16,000 Swedish residents with recent overnight travel outside Sweden. RESULTS: The overall risk of being notified with enteric fever after travel was 0.42 in 100,000 travelers. The highest risk for typhoid fever was seen in travelers from India and neighboring countries (41.7 in 100,000), the Middle East (5.91 in 100,000), and Central Africa (3.33 in 100,000), whereas the risk was comparatively low in East Asia (0.24 in 100,000). Almost the same risk areas stood out for paratyphoid fever: India and neighbors (37.5 in 100,000), the Middle East (3.64 in 100,000), and East Africa (3.33 in 100,000). The epidemiology of paratyphoid fever was considerably affected by a large outbreak of paratyphoid B in a Turkish tourist resort in 1999. The youngest children were at highest risk for typhoid fever (odds ratio 44.2), whereas youths ages 7 to 18 years were at highest risk for paratyphoid fever (odds ratio 9.7). CONCLUSIONS: Detailed risk data for enteric fever after travel could form the basis for travel advice. Vaccination against typhoid fever should always be considered for travelers to the Indian subcontinent, the Middle East, and Africa but should not routinely be given to travelers to the Malay Peninsula.

Adolescent↗
PubMed1990

Serum antibody responses to bacterial enteropathogens in Swedish travelers to south-east Asia.

The possibility that serological analysis may be more sensitive than bacteriological examinations of stool samples to detect enteric infections was evaluated in 80 Swedish travellers to South-East Asia. Serum and faecal specimens were collected before, during and after their travel. Serological analyses of pre-travel and any later serum specimen identified infection with enterotoxinogenic Escherichia coli (ETEC), Salmonella or Campylobacter jejuni in 28% of the travellers. The seroconversion rate was 72% in travellers excreting the homologous pathogen in their stool; all symptomatic cases and half of those who had an asymptomatic infection seroconverted. Bacteriological examinations of stool samples collected repeatedly during travel identified an enteropathogen in 20% of the travellers. However, the isolation rate decreased to 11%, when only a single routine faecal specimen was examined. Our findings suggest that serological analyses of pre- and post-travel specimens are sufficiently specific and may be at least as sensitive as conventional bacteriology to identify infections with bacterial enteropathogens in travellers. However, reliable serodiagnosis requires collection of pre-travel sera and might therefore only be useful in prospective studies of travellers' diarrhoea.

Adult↗
PubMed1999

[Vaccination status and illnesses in foreign travelers].

Millions of German citizens travel outside Europe every year. How they prepare themselves for these travels from a medical viewpoint, or whether they fall ill during these travels is inadequately researched. The German National Health Interview and Examination Survey showed that 11% of the people questioned travelled to Africa, Asia, South or Central America within the last three years. The highest proportion of these travellers was in the 20-59 year age group. Men travelled more frequently than women. The travellers also had better vaccination coverage against tetanus and polio compared to those who had not travelled. 30% of the travellers to endemic areas for malaria had received malaria prophylaxis and 30% who travelled to endemic areas for yellow fever were protected by vaccination. 28% of those questioned said they experienced general health problems related to their travel, mostly due to mild diarrhea.

Adolescent↗
PubMed2002

A survey of the health experiences of international business travelers. Part One--Physiological aspects.

Occupational health professionals need to know more about the health, worklife, and family life of international business travelers (IBTs). This descriptive correlational study, in two parts, examines the physiological and psychosocial experiences associated with business travel for a sample of 140 employees from western Canada's oil and gas industry. Results for Part One show that 76% of IBTs report travel related health problems, 74% have jet lag, 45% have travelers' diarrhea and gastrointestinal complaints, 12% to 16% have climate adaptation problems, and 2% report accidents and minor injuries. High risk behaviors include not carrying a first aid travel kit (54%); drinking more alcohol than ordinarily (21%); and neglecting food, water, and antimalarial precautions (6% to 14%). Other risk factors include age, length of stay, destination, pre-travel medical examinations, pre-travel advice, and eating and accommodation facilities. Findings show that IBTs are at risk for travel related physiological health problems. Implications for practitioners call for increased occupational health expertise in pre-travel preparation, follow up post-travel and regular health surveillance for employees who travel on international business.

Adult↗
PubMed2003

Perception and predictability of travel fatigue after long-haul flights: a retrospective study.

BACKGROUND: The impact of travel fatigue and jet lag varies between individuals and may significantly affect the ability of some to perform their occupational role following a transmeridian flight. It would be advantageous in an occupational setting to be able to predict prior to travel those who may suffer most. METHODS: A Traveler Profile Questionnaire was developed to assess the perceived severity of travel fatigue in 100 subjects making transmeridian flights. RESULTS: The questionnaire provided an internally consistent measure of fatigue and confirmed that subjects experienced greater symptoms of travel fatigue following east/west flights when compared with north/south. Easterly travel was rated marginally worse than travel in a westerly direction. The respondents scores as measured by the Circadian Type Inventory (Folkard 1987) and Composite Morningness Questionnaire (Smith 1989) were used to identify whether such tools could be used as indicators of susceptibility to the effects of travel fatigue. After allowing for a gender difference, increased rigidity in sleeping habits as shown by a decrease in the Flexibility/Rigidity score on the Circadian Type Inventory was associated with an increase in the composite 'severity' score for travel fatigue derived from ratings of specific physiological symptoms. CONCLUSIONS: The Traveler Profile Questionnaire, while internally consistent was nonetheless insufficient to be used in a predictive capacity to identify those individuals who would suffer most from the effects of travel fatigue.

Adult↗
PubMedDate not supplied

Travel medicine 2005.

Travel Medicine is a rapidly evolving field of medicine that is becoming ever more important in this era of globalization. Traditionally, medical preparation for individuals traveling to countries outside the United States has focused on traveler's diarrhea prevention and treatment, malaria prevention, and travel vaccination. Now, other concerns such as travel safety must also be considered. New developments in the area of travel medicine include the use of azithromycin instead of quinolones for diarrhea acquired in Southeast Asia. Azithromycin may also be the best option for children and patients who cannot take quinolones regardless of destination. In addition, rifaximin, a non-absorbable antibiotic, has recently been marketed for traveler's diarrhea. The best malaria prophylaxis options currently include atovaquone-proguanil (Malarone) in addition to chloroquine, mefloquine, and doxycycline. Hepatitis A is the most important travel vaccine, and a new combined hepatitis A and B vaccine (Twinrix) is useful for travelers needing protection against both types of hepatitis. A vaccine for typhoid is now available in either oral or injectable versions. Other important vaccines to consider when traveling internationally are those for Japanese encephalitis, influenza, meningitis, rabies, varicella and yellow fever vaccines. These may be warranted depending on duration of travel and destination risk.

Diarrhea↗
PubMed1983

Hepatitis A in Swedish foreign travellers.

Scandinavians present antibodies to hepatitis A virus (anti-HAV) in low frequency or under 25% in ages up to 50 years. This means that Scandinavians ought to be particularly vulnerable when travelling to hyperendemic hepatitis A areas. About one million Swedes travel to the Mediterranean area each year and about 75% of these travellers receive gammaglobulin before departure. Since hepatitis A is a notifiable disease in Sweden it is possible to compare the incidence of this disease in travellers during different periods of time. In the early seventies the prevalence of hepatitis A in Mediterranean travellers was one case in about 3000 travellers, while in 1980 the calculated prevalence had declined to one case in about 6000 travellers without gammaglobulin prophylaxis. The declining prevalence of hepatitis A in Swedish travellers to the northern part of the Mediterranean area is probably due to increased socio-economic and hygienic standard in the countries concerned. The relatively low prevalence of hepatitis A infection among Swedish travellers to the northern part of the Mediterranean area is in sharp contrast to the high prevalence found in Northern Africa and the Middle East (one case in about 300 travellers) as well as in Tropical Africa and Asia (one case in about 100 travellers).

Hepatitis A↗
PubMed1997

Epidemiology, preventive services, and illnesses of international travelers.

Medical preparation of travelers to overseas locations is an important part of military medical care. We reviewed pre-travel records of patients attending the travel clinic at the National Naval Medical Center (NNMC) and used a post-travel questionnaire to determine the most frequent medical problems associated with international travel. Among 1,416 individuals who received pre-travel care at NNMC, there were 760 (54%) males and 656 (46%) females, the median patient age was 48 years, the most common reason for travel was pleasure, and the median duration of travel was 21 days. The most common destinations were Asia (27%), Africa (15%), Europe (13%), Central America/Caribbean (12%), and South America (11%). The median number of immunizations prescribed was three. Malaria chemoprophylaxis was prescribed to 45%. The average cost of vaccines and medications to medically prepare a traveler was $67. Among 271 (82%) who returned the post-travel questionnaire, the most common illnesses reported were diarrhea (23%) and upper respiratory infections (19%); medical treatment was sought by 9%. Properly informed, military physicians can provide a valuable service at a reasonable cost to reduce the risk of travel-acquired medical problems and illnesses.

Adult↗
PubMed1998

Travel brochures need to carry better health advice.

Most people travelling abroad on holiday from the United Kingdom consult a travel brochure and book with a travel agent. Travel brochures are therefore potentially an important source of travel health advice. We assessed the quantity and quality of health advice of 143 travel brochures for 1994/5 winter and 1995 summer seasons available from a high street travel agent. Only 11% carried health information in a prominent location, 64% put health information at the end (often in small print), and 25% contained no health information at all. Much advice was superficial, and only a minority mentioned safe drinking water (24%), safe food (22%), or safe sex (3%). Better health advice more prominently displayed is needed in travel brochures. Public health practitioners should collaborate with travel companies and travel agents to improve the quality and quantity of health information provided to travellers.

Communicable Disease Control↗
PubMed2001

Adherence to travel health guidelines: the experience of Nigerian immigrants in Houston, Texas.

The objective of this study was to learn about the travel health practices of Nigerians in Houston, Texas, and to describe factors affecting adherence to recommendations for the prevention of malaria, typhoid, and hepatitis A set forth by the Centers for Disease Control and Prevention (CDC). Data were collected through focus group discussions and one-on-one interviews with travelers and health care providers. Data collection and analysis relied on a process-based framework that included questions about health and health-maintenance strategies before, during, and after travel. The cost of travel health services and the availability of vaccines and medications were important structural barriers to adherence. Perceptions of individual susceptibility and disease severity varied across the infections of interest. Travelers perceive themselves to be at risk for malaria, but are generally not concerned about its consequences. A notable exception is the fear of becoming symptomatic post-travel in the United States. Typhoid was less salient than malaria, and few had heard of or worried about acquiring hepatitis A. Stigma associated with the acquisition of travel-related conditions and the perceived incompetence of physicians to treat illnesses related to overseas travel, and malaria in particular, also affect preventive decisions and strategies. The results of the study have broad relevance for the traveling public and for programs and services that seek to improve travel health and travel health care.

Journal Article↗
PubMed1996

Travel of U.S. Citizens after Coronary Artery Bypass Surgery.

Background: International travel with concurrent medical problems is commonplace. This study was undertaken to determine travel morbidity rates in coronary artery bypass surgery (CABS) patients. Methods: A survey of 10,096 CABS patients indicated that 40% (n=4286) of them reported travel during the study year of 1988. The patients who reported traveling and those patients who did not travel were stratified by gender and by age (30 to 54, 55 to 64, and 65 to 80 years). Results: The male patients who traveled reported a 6.1% incidence of chest pain during travel. The comparable female patients reported an 8.7% incidence of chest pain (p <.05). Hospitalization and myocardial infarction rates of patients during travel were low (0.6% and 0.2%, respectively). In the older age groups (55 to 64 years and 65 to 80 years), males who traveled were less likely to report angina than the male patients who did not travel (p <.05). Conclusions: A history of CABS and the stress of travel do not appear to be associated with "high" hospitalization rates or special medical problems.

Journal Article↗
PubMed1996

Prevalence of Hepatitis A Antibody in Travelers from Hawaii.

Background: Hepatitis A is the most frequent vaccine-preventable infection in travelers to developing countries. Hepatitis A vaccine and immune serum globulin (IG) offer safe, effective protection against hepatitis A. Some travelers are already immune, however, and it is useful to try to identify subgroups with an anticipated high prevalence of antibody to hepatitis A (anti-HAV). Screening for antibody in these groups would often be a cost-effective alternative to routine use of hepatitis A vaccine or IG prior to travel. Methods: Prospective travelers to developing countries from Hawaii (n = 476) were tested for anti-HAV. Total antibody was measured by an enzyme immunoassay. Age, sex, birthplace, previous travel experience, and past history of hepatitis or jaundice were recorded for each traveler. Results: Overall prevalence of anti-HAV was 35.3%. Antibody prevalence increased progressively with age and varied significantly with birthplace and travel experience. Antibody prevalence was particularly high in travelers with a history of hepatitis or jaundice. Conclusions: Screening for preexisting immunity to hepatitis A is often worthwhile in extended stay or repeat travelers. This study suggests that screening may also be a cost-effective alternative to routine use of hepatitis A vaccine or IG in those travelers (i) born in the United States (including Hawaii) before 1930; (ii) born in Europe, Australasia, or Japan before 1950, (iii) born in developing countries; (iv) with increased travel experience; and (v) with a history of hepatitis or jaundice.

Journal Article↗
PubMed1997

A Study to Determine Susceptibility to Hepatitis A of Travelers from South Africa.

Hepatitis A is an important cause of acute hepatitis in travelers to developing countries. In 1991, 33 million persons living in industrialized countries traveled to developing countries where hepatitis A is highly endemic (World Tourism Organization, unpublished data, 1993). Reports indicate that 40-50% of cases of hepatitis A infection in the United Kingdom,1 Switzerland2 and Sweden3 are associated with recent international travel. The disease is usually benign, but the severity increases with age.4 Because the disease is enterically transmitted, occurrence is related to water quality and level of sanitation. In developing countries, with poor water quality and sanitation, especially in the tropics where hepatitis A is endemic, exposure is virtually universal before the age of 10 years.4 In developed countries with good food and water hygiene, the rate of exposure to hepatitis A in children is low. The rate of seropositivity increases slowly during early adulthood and reaches moderate levels during late adulthood.5 Studies have demonstrated the higher prevalence among people who live in poor, overcrowded conditions.6 Travelers going from low incidence countries to endemic areas are particularly at risk for acquiring hepatitis A, especially if they stay for extended periods.7 The risk that Danish travelers to North Africa would acquire hepatitis A was estimated to be 3.5 per 10,000, and this population accounted for at least 20% of all cases of hepatitis in Denmark. Similarly, Germans traveling or living in tropical countries have a 40 times higher risk of acquiring hepatitis than do groups living at home.8 The pattern in South Africans ranges from minimal exposure to hepatitis A in childhood in populations with good water quality and sanitation (mainly white), to high exposure in those exposed to poor water quality and sanitation in childhood (mainly black). Hepatitis A vaccine has been found to be effective in reducing the incidence of infection in travelers. After the introduction of hepatitis A vaccine into Switzerland in 1992, there has been a reduction by 15% in the cases of imported hepatitis A.9 Hepatitis A vaccine should be offered to South African travelers to high risk areas.10,11 However for the vaccine to be the most cost-effective, it would be important to identify groups of travelers who would benefit from empiric vaccination as opposed to other groups who should undergo screening prior to vaccination. This study was undertaken to establish the seroprevalence of hepatitis A in the South African traveler and to identify groups of travelers that should be vaccinated.

Journal Article↗
PubMed1997

Community mothers' programme: extension to the travelling community in Ireland.

STUDY OBJECTIVE: To see whether the community mothers' programme, using lay volunteer mothers to deliver a childhood development programme, could be extended successfully to the travelling community in Ireland. DESIGN: This was a prospective study of the travelling community; comparisons were made with results of a previous randomised trial of settled mothers. SETTING: A regional health authority in Ireland. PARTICIPANTS: These comprised 39 traveller and 127 settled intervention mother/ infant pairs (randomised controlled trial (RCT) intervention); settled community mothers; 105 settled control pairs (RCT control). All mothers received standard support; traveller and RCT intervention groups also received the services of a community mother. MAIN RESULTS: The travellers' sociodemographic profile differed significantly from the other groups. At the end of the study, traveller and intervention children were exposed to more cognitive games and nursery rhymes. There were significant differences in the proportions who received all three shots of their primary immunisation schedule before 12 months of age and who received "three in one" vaccination, with traveller children doing least well. The diet of traveller children surpassed that of RCT controls in all food groups except fruit; they were less likely to begin cows' milk before 26 weeks of age. Traveller mothers' diet was superior to that of RCT control and similar to RCT intervention mothers. Traveller and RCT intervention mothers were less likely to feel tired, feel miserable, and want to stay indoors than RCT control mothers. CONCLUSIONS: The results of the community mothers' programme in the travelling community are encouraging; poor immunisation uptake remains a challenge.

Accidents↗