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PubMed2006

Problem pathogens: prevention of malaria in travellers.

Human infection with Plasmodium spp leading to clinical episodes of malaria probably began very early in the history of humankind and has persistently inflicted disease among human populations. Malaria is currently considered the world's most important parasitic infection. The global impact of malaria is incalculable and appears to be worsening over the past decades. Although most of this burden of disease is carried by developing tropical countries, cases of imported malaria acquired by international travel are increasingly reported. These numbers are growing because of increased travel to malaria-endemic areas and also due to increased risk of transmission in these areas. Indeed, travel has contributed to the global spread of malaria during the history of humankind. Travellers visiting malaria risk areas should use both personal protective measures and chemoprophylaxis. Non-adherence to chemoprophylactic regimens is frequently secondary to drug side-effects. Therefore, a careful risk-benefit analysis on the use of antimalarial prophylaxis should be carried out in every individual travelling to malaria risk areas. Standby malaria self-treatment represents an alternative in some travellers. However, carefully selected and geographically specific antimalarial drug regimens should be recommended to non-immune people travelling to high-risk areas.

Animals↗
PubMed1988

A two-year survey of the incidence of heat-labile enterotoxin-producing Escherichia coli and other enteric pathogens in travellers returning to the Sheffield area.

A case-controlled study of the incidence of heat-labile enterotoxin-producing Escherichia coli (LT+ETEC) and other enteric pathogens in travellers returning to the Sheffield area was conducted from May 1984 to April 1986. LT+ETEC were found in 35 (5.8%) of 600 travellers to developed countries (mainly popular Mediterranean holiday resorts), 36 (11.3%) of 320 travellers to less-developed countries, and 11 (0.9%) of 1282 control patients whose illness was not associated with recent travel abroad. A seasonal peak of LT+ETEC infection was observed only in travellers to developed countries, with infections being significantly commoner in August to October. There was no significant deviation from expected age/sex distribution of LT+ETEC infection. Strains of LT+ETEC from travellers produced more toxin than strains from control patients, strains from travellers to less-developed countries producing most of all.

Adolescent↗
PubMed2001

[Travel with small children].

Travelling with young children can lead to difficult situations. Accordingly, travel preparations should be geared towards the needs of the youngest with appropriate medical advise. Young children tolerate most means of transportation. When travelling long distances by car, clear rules ought to be established, and many children require antiemetic measures. With regards to traffic safety, compromises during family vacation are not acceptable. Travelling by plane or train is less stressful than travelling by bus or car. As a medical advisor, one ought to be familiar with age limits for certain immunizations and medications (particularly antimalarial agents). Parental knowledge of modern rules for oral rehydration in cases of traveller's diarrhoea is frequently insufficient. Whenever possible, travelling with young children to high risk regions should be avoided.

Child↗
PubMed2001

[Travel medicine for HIV-infected patients].

Many HIV-infected persons travel from temperate zones to (sub)tropical destinations. HIV-specific immigration issues, medical resources abroad and problems regarding travelling with multiple medications have to be anticipated. When prescribing immunizations and specific chemoprophylaxis, the stage of immunodeficiency as well as drug interactions with antiretrovirals and medicaments against opportunistic infections have to be taken into account. Live vaccines may be contraindicated. Immunocompromised HIV-infected travellers have a higher risk for serious courses of diseases by enteropathogens. Therefore a good information about food hygiene is important and a prescription of an antibiotic to take in case of severe diarrhea may be indicated. A new antiretroviral combination therapy should not be started immediately before travelling to the tropics. The possibility to continue an established HIV treatment during travel has to be evaluated cautiously. With good pre-travel advice the risk of severe health problems is low for most HIV-infected travellers.

AIDS-Related Opportunistic Infections↗
PubMed2002

Traveling after heart transplantation.

BACKGROUND: With evolving medical techniques and post-operative care, the quality of life after cardiac transplantation is improving over the recent years. However, the need for continuous immunosuppressive therapy may result in restrictions from some social and recreational activities, including traveling. The aim of this study was to analyze traveling activities and complications in a large cohort of heart transplant recipients, with the intention to develop adequate safety and behavioral guidelines. METHODS: Using a standardized questionnaire, 103 consecutive patients (pts) were asked to report about time and destination of their traveling activities, predominant activities, as well as potential travel-related complications. Documented rejection episodes as well as laboratory data are listed. RESULTS: Feedback was 97% (of 103 pts asked). Out of 100 pts who responded, [82 males, 18 females, mean age 52.3 +/- 12.4 yr, 6.9 +/- 3.8 yr post-heart transplantation (HTX)] 95 reported on traveling activities (95%). Concomitant disease was present in form of diabetes (n=8), renal insufficiency (n=5) and cardiac allograft vasculopathy (n=12). Mean cumulative traveling time was 120 +/- 125 d (3-560 d). Except from domestic journeys, 79 pts chose destinations within Europe, and 29 to overseas countries. Complications were reported by 15 of 95 pts (15.8%), being mostly small accidents and febrile episodes. Rejection episodes or other life threatening events were not observed. There was no significant correlation between observed complications and gender, age, time post-HTX, immunosuppression or comorbidities. CONCLUSIONS: Traveling after HTX appears to be safe and favorably improves quality of life, if certain precautions are met.

Adult↗
PubMed2005

Travelers' diarrhea: antimicrobial therapy and chemoprevention.

The use of preventive measures and self-treatment for travelers' diarrhea is routine in regions where the occurrence of diarrhea is predictably high. People traveling to these areas who do not exercise care in their selection of consumed foods and beverages will suffer high rates of illness. Such diarrhea normally affects the traveler for a day, although it can result in chronic postinfectious irritable bowel syndrome. Although systemic antibacterial drugs are effective in preventing diarrhea, their use is not routinely recommended because of side effects and their importance as a therapy for extra-intestinal infections. This review focuses on current and future uses of antibacterial drugs in the prevention and therapy of travelers' diarrhea. Minimally absorbed (< 0.4%) rifaximin can effectively reduce the occurrence of travelers' diarrhea without side effects. Bismuth subsalicylate is a useful alternative, although it is less effective than rifaximin for the prevention of travelers' diarrhea and the required doses are less convenient. All people who travel to high-risk areas should take curative antimicrobial agents with them for self-treatment of illness: rifaximin 200 mg three times a day for 3 days, or an absorbable agent such as a fluoroquinolone or azithromycin taken in a single dose initially, with the need for a second or third dose determined by clinical response. Loperamide (up to 8 mg per day for < or = 2 days) can be given with the antibiotic to offer rapid symptomatic improvement. In the future, the ability to evaluate the genetic risk of illness acquisition might allow person-specific recommendations to be made.

Anti-Infective Agents↗
PubMed1997

Travel times and radiotherapy uptake in two English counties.

OBJECTIVES: To examine whether longer travel times for radiotherapy are associated with reduced overall uptake of radiotherapy treatment, or with reduced uptake of palliative as opposed to radical radiotherapy. DESIGN: Correlations of weighted average travel times for radiotherapy with overall radiotherapy uptake, and of travel times to one cancer centre with the ratio of palliative to radical radiotherapy at that centre. SETTING: The fourteen local authority (county) Districts of Bedfordshire and Hertfordshire. SUBJECTS: Residents of Bedfordshire and Hertfordshire registered by the Cancer Registries as attending hospital with a diagnosis of cancer, and registered as receiving radiotherapy treatment. Residents recorded by single cancer centre as receiving radical or palliative radiotherapy at that centre. RESULTS: There was no significant correlation between travel times for treatment and overall radiotherapy uptake (r = 0.40, P = 0.18), or with the ratio of palliative to radical radiotherapy at a single centre (r = -0.29, P = 0.34). Both measures of uptake showed considerable variability. Longest travel times were about one hour. CONCLUSIONS: Travel times up to one hour do not appear to reduce radiotherapy uptake, and the variability observed is likely to be due to other factors. The recommendation of the Chief Medical Officer's expert advisory group on cancers, that radiotherapy should be provided in larger cancer centres, is unlikely to result in lower radiotherapy uptake with travel times of this order.

England↗
PubMed2002

[Travel-induced thrombosis: an update].

Travel-related disorders are a well known problem. In the last years many cases of deep venous thrombosis (DVT) and pulmonary thromboembolism (VTE) were published after several hours lasting journeys by airplane, but also by car, bus and railway. This condition was termed "travel-thrombosis" or "economy class syndrome" for long haul flights. At present the precise incidence for travel-thrombosis is not known. Accepted contributing factors for the development of travel-thrombosis are sitting in a cramped position for several hours, low humidity due to climatisation with the risk for dehydration and increased blood viscosity, reduced fluid intake as well as travellers related risk factors. Whether the special situation in the cabin of an airplane, e.g. mild hypoxia, is an essential contributing factor for DVT and VTE, is controversially discussed. This review will present very recent guidelines of an expert meeting concerning the risk groups for travel-thrombosis (low, moderate and high risk). In addition recommendations for prophylaxis of travel-thrombosis adapted to the different risk groups (leg exercise, adequate fluid intake, compression stockings, low molecular weight heparins) are given.

Aerospace Medicine↗
PubMed2003

[Aliens Act regulations and consequences of inability to travel].

The question as to whether a foreign national is (un)able to travel or not is often in the foreground of the decision-making process concerning a possible termination of their stay in the Federal Republic of Germany. Authorities responsible for aliens and administrative courts often require accredited medical reports to be able to decide whether inability to travel is actually the case. There are no clear legal criteria with regard to the definition of this term and an explicit provision by law is also missing. In cases where the decision has been made against inability to travel (i.e. a person is said to be able to travel), there may be considerable risks for the person concerned. Where the decision has been made in favour of inability to travel (i.e. the person is said to be unable to travel), a protective system based on the Aliens' Act takes effect. This article gives an overview of the legal consequences arising from a determined inability to travel; the legal difficulties with regard to the definition of this term; and the requirements to be made concerning clarity of a prognosis regarding possible risks. The pertinent legislation as well as opinions expressed in expert literature are presented.

Emigration and Immigration↗
PubMed2001

Sexually transmitted diseases in travelers.

Prevention of sexually transmitted diseases (STDs) is a low priority among travel clinic services, despite increasing evidence that travelers have an increased risk of acquiring such infections. A proportion of 5%-50% of short-term travelers engage in casual sex while abroad, and this rate is even higher among long-term travelers. Few publications are available on STD preventive interventions among travelers. Education and counseling are recognized as key components of risk reduction. New efforts should be put forth with regard to identifying effective tools to promote safer sexual behaviors and to reduce the spread of infection by promoting condom use. Travelers at increased risk should be identified for targeted interventions; research to validate proposed markers of increased risk is prospectively needed. Hepatitis B infection is the only STD that is preventable by vaccination. The feasibility and cost-effectiveness of STD screening in travelers after exposure is a virtually unexplored field, though it may represent an important component of STD control strategies in developed countries.

Biomarkers↗
PubMed2003

African tick bite fever in travelers to rural sub-Equatorial Africa.

To estimate the incidence of, identify risk factors for, and describe the clinical presentation of travel-associated African tick bite fever (ATBF), a rapidly emerging disease in travel medicine, we prospectively studied a cohort of 940 travelers to rural sub-Equatorial Africa. Diagnosis was based on suicide polymerase chain reaction and the detection of specific antibodies to Rickettia africae in serum samples by multiple-antigen microimmunofluorescence assay, Western blotting, and cross-adsorption assays. Thirty-eight travelers, 4.0% of the cohort and 26.6% of those reporting flulike symptoms, had ATBF diagnosed. More than 80% of the patients had fever, headache, and/or myalgia, whereas specific clinical features such as inoculation eschars, lymphadenitis, cutaneous rash, and aphthous stomatitis were seen in < or = 50% of patients. Game hunting, travel to southern Africa, and travel during November through April were found to be independent risk factors. Our study suggests that ATBF is not uncommon in travelers to rural sub-Saharan Africa and that many cases have a nonspecific presentation.

Africa↗
PubMed2004

Sexually transmitted infections in travelers: implications for prevention and control.

Sexually transmissible diseases (STDs), the most common notifiable infectious conditions, remain major threats to reproductive and public health worldwide. Travelers are particularly vulnerable to STDs, because of voluntary or involuntary sexual behavior while abroad, and are significant vectors who introduce new pathogens and resistant strains to unaffected parts of the world. This article outlines some key issues that travel medicine specialists and other clinicians should revisit when providing services to travelers. We discuss obstacles to promoting sexual health, including the diversity of the target group, unanticipated opportunities for sexual risk, ambivalent cooperation by the travel and tourism industries, poorly developed travel health sectors, illegal migration and sex tourism, and lack of research about the association between travel and STDs. We also outlined some programmatic aspects of public health that should be identified and addressed for the promotion of sexual health among travelers.

Humans↗
PubMed2005

Looking for evidence that personal hygiene precautions prevent traveler's diarrhea.

In the 50 years during which traveler's diarrhea has been studied, it has always been assumed that personal hygiene precautions can prevent or reduce the likelihood of developing traveler's diarrhea. However, 7 of 8 studies that specifically addressed this issue showed no correlation between the types of food selected and the risk of acquiring traveler's diarrhea. The eighth study showed a correlation between a few dietary mistakes and a decreased risk of acquiring traveler's diarrhea. A further increase in the number of dietary mistakes, however, did not continue to increase the risk of acquiring traveler's diarrhea. Personal hygiene precautions, when performed under the direct supervision of an expatriate operating his or her own kitchen, can prevent traveler's diarrhea, but poor restaurant hygiene in most developing countries continues to create an insurmountable risk of acquiring traveler's diarrhea.

Diarrhea↗
PubMed2005

Epidemiology of traveler's diarrhea.

Among travelers from developed countries who visit developing countries, >60% may experience traveler's diarrhea, accounting for 40,000 travelers daily or >15 million travelers annually. Traveler's diarrhea is often accompanied by other symptoms, most often abdominal cramps. Although the spontaneous cure occurs after a mean of 4 days, a few patients have symptoms for weeks, and it is increasingly noted that some patients may later develop irritable bowel syndrome. Traveler's diarrhea is life threatening only exceptionally, but it frequently it leads to incapacitation. Both host factors (e.g., age, behavior, nationality, and genetic factors) and environmental factors (primarily the selected destination and hotel) play an important role in risk for traveler's diarrhea.

Developed Countries↗
PubMed2005

Enteric (typhoid) fever in travelers.

The incidence of enteric (typhoid) fever in travelers is estimated to be approximately 3-30 cases per 100,000 travelers to developing countries. Recently, it is become clear that travelers who are visiting friends and relatives, especially travelers to the Indian subcontinent, seem to be the most vulnerable to enteric fever and require special attention for prevention. Recent concerns are the increasing incidence of paratyphoid fever in Asia, which is not covered by available typhoid vaccines, and the emergence of infections caused by antibiotic-resistant strains (including strains resistant to fluoroquinolones). Typhoid vaccination is recommended for most travelers to moderate- to high-risk countries. Because of the nonspecific clinical presentation of enteric fever, a high index of suspicion is important in febrile travelers who have traveled to areas of endemicity.

Bacterial Vaccines↗
PubMedDate not supplied

Epidemiology of travelers' diarrhea: current perspectives.

Identification of the characteristics that make certain travelers more likely to develop diarrhea, the most common illness affecting international travelers, can lead to prevention of the illness and to improved understanding of endemic diarrheal disease in developing countries. Travelers' diarrhea, a syndrome with a spectrum of clinical symptoms, is most frequently characterized by watery diarrhea, cramps, and nausea. The highest attack rates have been reported in travelers from the United States or northern Europe to less-developed, particularly tropical, countries. Among travelers from less-developed countries, diarrhea has been correlated with higher socioeconomic status. The findings that country of origin and socioeconomic status may affect the frequency of previous exposures to enteric pathogens suggest that persons with prolonged exposure acquire immunity and are at lower risk of developing travelers' diarrhea. Although few studies have shown a clear correlation between the eating of specific foods and the development of travelers' diarrhea, the syndrome has been associated with eating in public places.

Diarrhea↗
PubMed2000

Respiratory infections in the traveler.

The growth of travel of recent years has been unprecedented and presents new challenges to health professionals worldwide. More travelers of diverse backgrounds are visiting exotic locales rarely encountered before. This poses new risks to health, in addition to potentially aiding the spread of emerging respiratory infections. Travelers such as immunocompromised individuals and members of ethnic minorities are at significant risk for travel-related infections. Respiratory illnesses are some of the most common infections affecting human beings, yet little information has been published on them in relation to travel. Multidisciplinary approaches and collaboration across different sectors are needed to address the many issues involved in travel-related respiratory infections. This article discusses some of the topical issues of respiratory tract infections occurring in travelers.

Humans↗
PubMed2005

Travel-associated non-typhoidal salmonellosis: geographical and seasonal differences and serotype distribution.

The Swedish database on notifiable communicable diseases was used to identify 24 803 cases of travel-associated non-typhoidal salmonellosis from the period 1997-2003. Serotype data were available for 24 358 (98.2%) of these cases, which were compared with a data set from the same period of 16 255 randomly selected Swedish residents with a history of recent overnight travel outside Sweden. The highest risk of disease was seen in travellers returning from East Africa (471/100 000 travellers; 95% CI 294-755), or the Indian subcontinent (474/100 000; 95% CI 330-681). Children aged 0-6 years were at higher risk than travellers of other ages (OR 2.4; 95% CI 2.1-2.8). Some distinct seasonal patterns could be distinguished, with highest (adjusted) risk in December in East Asia, and in August in Europe. Marked geographical differences in serotype distribution were noted. Salmonella Enteritidis was especially dominant in Europe, but was much less common in Africa, Asia and America, where the variety of circulating serotypes was greater. Overall, the two data sets provided important information on travel risks which are also likely to apply to travellers from other western countries.

Adolescent↗