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PubMedDate not supplied

Risks of hepatitis B in travelers as compared to immunization status.

BACKGROUND: Our objective was to determine the risks of infection with hepatitis B among European travelers and to compare this with the immunization status in various risk groups. METHODS: A cross-sectional telephone questionnaire survey of randomly selected subjects, in nine European study populations was used. A total of 9, 008 individuals were involved, with approximately 1,000 interviews conducted in each country in the native languages. Situations with a high risk of hepatitis B infection, such as invasive medical procedures, attending to a bleeding person, and skin perforating cosmetic practices, particularly when performed in countries with medium/high transmission risk, and vaccination status of travelers, were the main outcome measures. RESULTS: Depending upon the destination, 6.6-11.2% of travelers were classified as at high risk of hepatitis B, with 24.4% vaccinated; between 60.8-75.8% of travelers at potential risk, with 19.2% vaccinated; and 33.4% of travelers where no hepatitis B risk was identified. Significantly more travelers who only visited medium/high endemicity regions exposed themselves to a high risk of contracting hepatitis B, (40, 10.5%) compared to travelers who only visited low endemicity regions (225, 6.6%; p <.01). CONCLUSIONS: A significant proportion of travelers surveyed unwittingly exposed themselves to the risk of hepatitis B infection while at medium/high risk destinations. The majority of at-risk travelers had not been vaccinated, regardless of their destination. Improved advice and clear recommendations to avoid transmission are needed.

Adolescent↗
PubMedDate not supplied

Psychiatric problems in returning travelers: features and associations.

BACKGROUND: Travelers may return from the tropics with psychological problems. The literature regarding features and associations of these psychological problems is limited. METHODS: Case histories of 15 consecutive returning travelers seen at our psychiatric service during the last 8 years. RESULTS: The median age of this group was 25 years, 10 were males, and the length of trip ranged from 10 days to 8.5 months. None of these travelers had prior psychopathology. The most common presentation was anxiety (with or without depression, n = 11), 3 suffered from acute psychosis, and 1 had pure depression. Eight of the travelers have used illicit drugs, which in 5 cases probably served as a trigger. Antimalarials may have played a role in 3 travelers. Six travelers needed antidepressants and supportive therapy, 3 neuroleptics, and 1 psychotherapy. These treatments lasted for 6 months and over in 6 of the travelers. CONCLUSION: Psychiatric problems among travelers to the tropics are multifarious in nature, multifactorial, have a strong relation to drug abuse, and may require a long and intensive therapy. Travelers should be better educated about the risks of using illicit drugs.

Adult↗
PubMedDate not supplied

Travel health advice for backpackers.

There has been an increasing trend for people to travel internationally, further afield, but fewer people are now going on programmed package tours. One of these groups of travelers comprises backpackers, who are distinct from endurance hikers or trekkers and longer-term and more remote expeditioners. Backpackers comprise individuals who travel alone or in a small group on a limited budget, and usually stay in hostels (hostelers), campsites, or similar low-cost accommodation, and carry their belongings in personal load-carrying equipment, most notably backpacks. Individual travel through backpacking, especially hosteling, appears to have become more popular for three probable reasons: travelers are seeking more cost-effective means of traveling and accommodation; they are looking to travel to regions where there is less likelihood of meeting fellow travelers; and they are looking for travel with more risk attached.

Clothing↗
PubMedDate not supplied

Drug abuse in travelers to southeast Asia: an on-site study.

BACKGROUND: Drug abuse constitutes a major sociomedical problem throughout the world. A unique subgroup with a higher potential of drug abuse are young travelers to Southeast Asia. Less than a handful of studies have focused on this population, and even fewer have been carried out on site. Our aim was to characterize the phenomenon of drug abuse among Israelis and other nationals, and to define risk factors that would predict which travelers are prone to abusing drugs. METHODS: Data was collected through questionnaires that were distributed in Southeast Asia to 430 travelers. Medical students administered the questionnaires across India, Thailand, Nepal, Vietnam, and Laos during 2002 and 2003. RESULTS: Questionnaires from 231 Israelis and 199 other nationals (mostly from the United Kingdom, Sweden, Australia, and Germany) were analyzed. These travelers had a mean age of 25.3 years. We found that 54.3% of the travelers abused drugs during the trip. Israelis (66.2%) abused drugs more frequently than did non-Israelis (40.7%, p < .001). Males abused drugs significantly more than females did, as did secular more than religious people; however, those with an academic degree abused drugs less than others. For 23.5% of the Israelis, the trip was their first encounter with drugs. Of the entire cohort, 72% abused cannabis products, and most of them (49.6%) did it on daily basis. The use of "hard" drugs (eg, lysergic acid diethylamide) was more common among non-Israelis than among the Israelis (37% and 20%, respectively; p < .006). Much higher rates of drug abuse (70.1%) were found in India than in other Southeast Asian countries. Logistic regression identified that prior use of drugs, Israeli nationality, travel to India, cigarette smoking, and traveling alone were significant predictors of drug abuse. CONCLUSIONS: There is a disturbingly high rate of drug abuse in travelers to certain Southeast Asian countries, both among Israeli and other nationals. For many youngsters, this is their first encounter with drugs, and many plan to continue abusing drugs upon their repatriation. Travelers to Southeast Asia should be a major target group for primary, preventive, antidrug campaigns worldwide.

Adult↗
PubMedDate not supplied

Illnesses in travelers returning from the tropics: a prospective study of 622 patients.

BACKGROUND: Although between 8 and 19% of travelers consult a doctor after returning from the tropics, the full spectrum of health complaints is unknown. METHODS: We analyzed the relative frequency of travel-associated health complaints in all travelers (immigrants returning from visiting their home countries, expatriates, business travelers, and tourists) consulting our department between November 2002 and May 2003. RESULTS: A total of 622 patients were studied (256 women, 366 men; median age 38 yr; 45.3% tourists, 33.8% immigrants, 14.1% expatriates, 6.7% business travelers). The median duration of travel was 36.9 days. The main destinations were Africa (57.6%) and Asia (26.4%). A total of 637 diseases were diagnosed, distributed as follows: skin diseases (23.4%), gastrointestinal infections (19.1%), respiratory tract infections (11.5%), malaria (8.8%), schistosomiasis (7.2%), viral hepatitis (4.1%), urinary tract infections (3.5%), sexually transmitted infections (3.5%), tuberculosis (2.7%), dengue fever (2.5%), and others (13.8%). Malaria and intestinal tract infections accounted for 21% and 23% of diagnoses in the 257 febrile travelers, respectively. Overall, 230 diagnoses (36.1%) corresponded to imported tropical diseases, the main imported diseases being malaria, schistosomiasis, amebiasis, gastrointestinal disorders caused by intestinal nematodes, and dengue fever. CONCLUSIONS: Tropical diseases are not the leading cause of consultation in travelers returning from the tropics. Immigrants are the travelers most at risk of common tropical diseases, with the noteworthy exceptions of dengue fever and invasive schistosomiasis.

Adolescent↗
PubMed1985

Epidemiological aspects of acute viral hepatitis A in Swedish travellers to endemic areas.

A decreased incidence of hepatitis A (HA) in Swedish travellers to the northern part of the Mediterranean area was observed after 1972, from 1/3 000 travellers who did not receive gammaglobulin in the period 1970-72 to 1/14 200 travellers between 1979 and 1981 and 1/20 000 travellers in 1982. No such decrease in incidence was observed in travellers going to the southern part of the Mediterranean area. Differences in the incidences of HA in travellers to individual countries in southern Europe were also noticed. The risk of Swedish travellers to remote destinations, such as tropical Africa and Asia, contracting HA is still very high, being 1/150-100 travellers not receiving gammaglobulin. It was observed that years with high incidences of HA in travellers to certain destinations also saw increased incidences of HA in Sweden.

Adolescent↗
PubMed1988

A prospective study of serum antibody responses to enterotoxinogenic Escherichia coli in Swedish travellers.

Serological responses to relevant enterotoxinogenic Escherichia coli (ETEC) antigens were studied in 85 Swedish travellers to subtropical and tropical areas. Serum samples were collected from the travellers before and then after 3-5 weeks, i.e. within a week after return to Sweden, when a faecal specimen was also taken. 40% of the participants had traveller's diarrhoea during their visit abroad, while 21% reported "loose stools" and 39% had no such problems. ETEC was rarely isolated from the stool of any of the travellers on their return to Sweden (6%). Salmonellae, Shigellae or Campylobacter jejuni were isolated from 13 (15%) of the travellers, 12 of whom were healthy when the specimens were collected and 4 of whom had been healthy during travel as well. Significant serum antibody responses to E. coli heat-labile enterotoxin (LT) and colonization factor antigens CFA I or II were seen in 33% and 20% of the travellers, respectively. Anti-LT responses were comparable in participants with traveller's diarrhoea or "loose stools" and in the healthy ones, whereas anti-CFA responses were more frequent in those with symptomatic infections. Of 34 Swedes in a non-travelling control group none responded to LT and one to CFA I or CFA II.

Adult↗
PubMed2006

Predicting travel attitudes among university faculty after 9/11.

The authors interviewed a random sample of 306 university faculty as part of an annual university poll. Items focused on air travel concerns following 9/11, positive aspects of travel, and future travel intentions. Demographic factors were not significant predictors for men or women faculty. Faculty expressed positive attitudes toward travel, for example agreeing that travel allows them to demonstrate competency. Concerns about missing connections and delays elicited a larger percent of negative reactions than concerns about hijackings or security. Gender differences were not observed on individual items, but in regression analyses a composite of self-reported travel risk factors was more predictive of future travel plans for women than for men, although women expected to travel as much in the future as men. The results are consistent with positive psychology and speak to applied aspects of travel and tourism.

Attitude↗
PubMed2005

Malaria risk in travelers.

Imported malaria has been an increasing problem in several Western countries in the last 2 decades. To calculate the risk factors of age, sex, and travel destination in Swedish travelers, we used data from the routine reporting system for malaria (mixture of patients with and without adequate prophylaxis), a database on travel patterns, and in-flight or visa data on Swedish travelers of 1997 to 2003. The crude risk for travelers varied from 1 per 100,000 travelers to Central America and the Caribbean to 357 per 100,000 in central Africa. Travelers to East Africa had the highest adjusted odds ratio (OR = 341, 95% confidence intervals [CI] 134-886) for being reported with malaria, closely followed by travelers to central Africa and West Africa. Male travelers as well as children <1-6 years of age had a higher risk of being reported with malaria (OR = 1.7, 95% CI 1.3-2.3 and OR = 4.8, 95% CI 1.5-14.8) than women and other age groups.

Adolescent↗
PubMed2000

Occurrence and self-treatment of diarrhea in a large cohort of Americans traveling to developing countries.

There is little information available regarding traveler's diarrhea that affects a large number of Americans who differ widely in age and travel destination, and little or no information exists on self-treatment. This paper describes the clinical features, self-treatment, and outcome of diarrhea in 784 (95% follow-up) Americans who traveled for < or = 90 days, and who received detailed pre-travel advice. Diarrhea was reported by 46%. Of these, 34% (n = 270) had traveler's diarrhea (TD) defined as > or = 3 unformed stools/day +/- enteric symptoms or < 3 stools/day with > or = 1 enteric symptom, and 11% (n = 88) had loose motions (LM). Diarrhea was often severe and nearly a quarter of people with TD experienced fever and vomiting and 35% were required to alter their plans. The duration of travel and the destination itself were the strongest influences on diarrhea. Most travelers treated the illness themselves, whether or not they had LM (72%) or TD (83%). Those with LM took an antimotility agent or bismuth subsalicylate alone more frequently than those with TD (71% versus 48%, P < 0.002). Conversely, antibiotics were taken more frequently by those with TD (47% versus 27%, P < 0.03). Overall, 83% indicated self-treatment was effective (91% with LM and 80% with TD). Diarrhea is common despite pre-travel advice. Because travelers usually treat themselves, they should be provided with clear instructions on appropriate self-treatment.

Adolescent↗
PubMed1995

Deaths of Australian travellers overseas.

OBJECTIVE: To determine the number and causes of deaths of Australian citizens who died overseas in a 12-month period. DESIGN: Retrospective survey of deaths reported to the Australian Department of Foreign Affairs and Trade by Australian embassies, high commissions and consulates for the period July 1992 to June 1993. Data on Australians travelling overseas were obtained from the Australian Bureau of Statistics. RESULTS: During the year 1992-1993, 2,299,500 Australians travelled overseas for less than 12 months (short term travellers), with an estimated mean trip duration of 6.3 weeks. Another 65,450 left for more than 12 months (long term travellers), and 27,910 left permanently (residents). Of the 421 recorded deaths, 289 were in short term travellers, 108 in long term travellers/residents and 24 in members of work parties. The annual crude mortality rate for short term travellers and work party members was estimated at about 0.1%. Men outnumbered women almost 4:1. Death rates increased with age, reflecting underlying medical problems in older travellers, with heart disease being the leading cause (146 deaths, 35%). Fatal trauma predominated in younger people. Accidents, mainly in traffic, accounted for 77 deaths (18%) and infections for 10 (2.4%), including two cases of malaria. Death rates varied between geographical regions, with New Zealand being the safest destination. CONCLUSIONS: The risk of an Australian dying while travelling overseas is probably little different from that while staying home. The low level of fatal infections may result from preventive measures. Travellers should be aware of the danger of accidents, particularly traffic accidents, while overseas.

Adolescent↗
PubMed1993

American cutaneous leishmaniasis in U.S. travelers.

OBJECTIVE: To characterize the exposures and practices of U.S. travelers who acquired cutaneous leishmaniasis in the Americas and to highlight problems they encountered in seeking medical care from U.S. physicians. DESIGN: A retrospective review of Centers for Disease Control and Prevention Drug Service records and a telephone survey of patients. PATIENTS: Fifty-nine civilian U.S. travelers with American cutaneous leishmaniasis for whom the Drug Service released sodium stibogluconate between 1 January 1985 and 30 April 1990; 58 travelers (98%) were interviewed. MAIN MEASUREMENTS: Travel destination, exposure duration, knowledge about leishmaniasis, and time from noticing skin lesions to release of drug. RESULTS: Overall, travelers acquired leishmaniasis in as many as 14 countries; 33 of 59 travelers (56%) were infected in Mexico or Central America. Twenty-seven travelers (46%) were conducting field studies and 23 (39%) were tourists, visitors, or tour guides. At least 15 persons (26% of the 58 interviewed travelers) were in forested areas for 1 week or less; at least 6 of these persons had a maximum exposure of 2 days. Ten persons (17%) were home at least 1 month before they noticed skin lesions. Patients consulted from one to seven physicians (mean, 2.1 physicians) before leishmaniasis was diagnosed. Overall, the median time from noticing lesions to the release of drug was 112 days (range, 13 to 1022 days); however, the median was only 55 days for 13 patients (22%) unusually knowledgeable about leishmaniasis and was a maximum of 60 days for 16 patients (28%) (including 7 of the 13 unusually knowledgeable patients) who generally consulted physicians exceptionally knowledgeable about infectious and tropical diseases. CONCLUSIONS: Travelers to forested areas in Mexico and Central and South America and their physicians need to be educated about the risk for acquiring leishmaniasis even during short stays, as well as about effective preventive measures; and appropriate medical management [corrected].

Adolescent↗
PubMed2002

[Many travellers suffer of side-effects of malaria prophylaxis].

There is still uncertainty about the frequency of side effects associated with the use of malaria prophylaxis. The biggest concern has been that of meflokin. The aim of the study was to compare different symptoms in travellers taking different prophylactic malaria drugs with a control group travelling to the same area. Travellers seeking advice at a vaccination clinic in the south of Sweden were asked to fill in questionnaires before and after returning from their travel. 303 participants returned both questionnaires, a response rate of 62%. The results showed that a greater proportion of the travellers taking malaria prophylaxis reported symptoms in comparison with that of the control group (59% vs. 41%). Also, in comparison to the control group, travellers taking chemoprophylaxis more often felt that their trip had been negatively affected by the reported symptoms. Neuropsychiatric symptoms were most common in the group taking meflokin although no significant difference between the different regimes was found. These symptoms were very rare in the control group. Gastrointestinal symptoms were most frequent in the group taking chloroquine and proguanil. A low proportion of those symptoms were connected to the chemoprofylaxis according to the travellers. Travellers taking meflokin more frequently associated their symptoms with the drug. The travellers, being most worried about taking malaria prophylaxis prior to the trip, reported symptoms more often than those not feeling any anxiety.

Antimalarials↗
PubMed1992

Immunisation and health advice for travellers: the role of the general practitioner.

More and more travellers go to ever more widespread destinations. Diverse sources of advice exist on the protection of travellers against medical hazards encountered abroad. This study attempts to show that the General Practitioner (GP) is the best person to give pre-travel health advice on immunisation and malaria prophylaxis. A postal questionnaire was sent to all 681 GPs in the Greater Glasgow area, to assess their views on the provision of health advice for travellers; in addition we asked whether they knew about the free access to a computerised database on travel health advice (Travax) provided by the Communicable Diseases (Scotland) Unit, and what their view was of the usefulness of this service. The overwhelming majority (87%) of responding GPs felt that pre-travel health advice was best provided in the primary care setting. This group of GPs appear enthusiastic about providing health advice for travellers, in accord with the apparent preference of travellers themselves, and 85% indicated that they would find the travel health advice service a useful aid.

Family Practice↗
PubMed2004

Travel immunizations.

Advising travelers on vaccine-preventable illnesses is increasingly becoming the responsibility of primary care physicians. The approach to vaccine recommendations should be based on a thorough assessment of the risks for travel-related diseases, the time available before trip departure, and current knowledge of the epidemiology of vaccine-preventable diseases. Routine childhood vaccinations should be reviewed in all travelers and updated as necessary. Yellow fever vaccination may be required for entry by countries that lie within a yellow fever zone or for travelers coming from an endemic area to prevent introduction of the disease. Immunization against hepatitis B virus should be considered in travelers who expect to have close contact with local populations that have high rates of hepatitis B transmission. Japanese encephalitis vaccine should be offered to travelers who plan prolonged trips to rural areas in southeast Asia or the Indian subcontinent during the transmission season. Typhoid fever immunization is recommended for travelers who may be exposed to potentially contaminated food and drink. Preexposure rabies vaccination should be considered in travelers who plan a prolonged duration of stay in a remote area or who engage in activities that might involve working near animals or that could attract animals. Physicians should be aware of the adverse events and contraindications associated with each travel vaccine.

Humans↗
PubMed1992

[Travel medicine].

The medical advice for travellers into tropical and subtropical climatic zones is essentially a task of the physician. Thereby the medical advice and the prophylactic measures should restrict themselves not only to risks of infection, but they must--as far as possible--comprise all health risks. The travellers who bear with themselves a health risk deserve particular attention on the side of the physician. Precarious from the medical point of view are travels with infants and babies as well as travels of pregnant women. The personal, age- and sex-specific health situation, the subjective behaviour as well as style of travelling and lifestyle play an essential role. The personal situation of the traveller is to be taken into consideration concerning the risk of the travel, so that the advice regarding the travel can in every case be only an individual medical action. According recommendations in the field of tropical medicine the performance of protective inoculations the prescription of a suitable chemoprophylactic drug against malaria as well as if the occasion arises of a medicine cabinet for travelling is necessary. The postexpositional after-care after the return, the so-called returners' examination should not be neglected.

Communicable Disease Control↗
PubMed1991

American travel deaths in Mexico. Causes and prevention strategies.

About 3 to 4 million Americans travel to Mexico every year, yet their mortality experience has never been analyzed. Fatalities among US travelers to Mexico during the years 1975 and 1984 were examined using a previously unanalyzed data source. The leading cause of death to all US travelers to Mexico was injuries (51%), with 18% of deaths resulting from motor vehicle crashes. Of all travelers' deaths, 37% were due to circulatory diseases and less than 1% were due to infectious diseases. While the proportion of all deaths from motor vehicle crashes was similar for US citizens traveling in Mexico and US residents, travelers had significantly higher proportions of injury deaths due to aircraft crashes and drowning. Injury, rather than infectious diseases, appears to pose the greatest risk of death to travelers to Mexico. Physicians and travel clinics need to place greater emphasis on injury prevention when giving advice to clients traveling to Mexico.

Accidents, Traffic↗
PubMed1996

[Recent evolution of travel medicine in France and in the world].

The purpose of this study is to show the different steps which have to led to the individualization of this discipline. The necessity of Travel Medicine is a result of the rapid expansion in international and intercontinental travel, in the development of means of prevention of risks linked to this increased travel, in modification made in the doctor-traveler relationship, and in the updating of everchanging epidemiological data. A strategy was developed in France, taking into account all components involved, leading to the creation of the French Travel Medicine Society in 1993. This society can be as an example abroad. The International Society of Travel Medicine was founded in 1992, Atlanta. Travel Medicine has always existed, but the organisation of its structures and especially the training of specialists has to be reconsidered. The main goal of Travel Medicine is the prevention, through information, of medical risks while travelling. This discipline is first and foremost a matter of Public Health. Investigation of this domain is far from complete.

France↗