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PubMed1989

Malaria prophylaxis in travellers from Britain.

A short questionnaire about malarial prophylaxis was completed by 376 travellers departing from Gatwick Airport to destinations in Asia, Africa, Australasia and South or Central America. Only 263 (70%) had sought advice, 80% of them from a general practitioner. Of travellers born in Britain, 81% had sought advice compared to 38% of those born abroad (P less than 0.001). Advice about protective measures to reduce mosquito bites had been given to 52% travellers. Although 264 were travelling to areas where prophylaxis is advised, only 167 (63%) were taking antimalarials, while 22% travelling to malaria-free destinations were taking unnecessary prophylaxis. Many British travellers do not take effective antimalarial chemoprophylaxis. This has undoubtedly contributed to the recent increase in incidence of the disease in the U.K. General practitioners should ensure that they give correct advice and the immigrant population need to understand the risk of malaria when they return home.

Africa↗
PubMed1997

Immunizations and travel.

Determining the appropriate immunizations for international travelers is a complex, multifaceted process. This article proposes a stepwise and systematic approach to the immunization needs of the traveler-patient. Vaccines for routine health maintenance as well as special issues of the elderly, pregnant, immunocompromised, and child are important in the initial evaluation. Specific travel immunizations (i.e., those for routine travel, those required by a country, those that are geographically indicated and immunizations for extended stays) comprise the remainder of the immunization interview. Health care providers should also be familiar with cost and risk statistics, both the risk of the traveler contracting an illness overseas and the risk of side effects from the vaccines themselves. With such cost-benefit analysis, the provider can offer the traveler immunizations as well as information.

Adolescent↗
PubMed1997

Traveler's diarrhea.

Traveler's diarrhea occurs with considerable frequency in individuals traveling to underdeveloped countries. It is acquired through the ingestion of fecally contaminated food and water. Traveler's diarrhea is caused by a variety of bacterial, protozoal, viral, and parasitic organisms. Typically self-limiting, traveler's diarrhea is more of an inconvenience than a life-threatening process. Patient education is an important element in the management of traveler's diarrhea; the well-informed traveler can manage most cases empirically without sophisticated medical technology. The presence of fever, bloody stool, abdominal pain, or profound dehydration indicates a more severe infection requiring medical attention.

Anti-Bacterial Agents↗
PubMed2001

Travel-related vaccines.

Travelers are at increased risk for several infections, including familiar infections such as measles that are widely distributed but more common in developing countries. Vaccines can markedly decrease the risk for many of these infections and are an important part of pretravel preparation. Travel provides an opportunity to review and update routine vaccines in adults and assess risk from unusual infections. Global travel is growing. Persons who are elderly, HIV-infected, and immunocompromised account for many of the travelers. Studies that assess the immunogenicity, efficacy, and adverse effects of some of the special vaccines used primarily in travelers generally have been done in young, healthy populations. Findings in young adults do not apply to other populations in whom immune response can be slower, less effective, and less durable. Recent reports of severe adverse events in elderly persons who have received yellow fever vaccine are a reminder that widely used, old vaccines can have unexpected side effects when used in a new population. It is biologically plausible that adverse effects might be more common in the elderly, and epidemiologically plausible that occasional instances of similar adverse events in the past could have been missed. Studies on special and travel vaccines in the elderly are needed urgently to define how these vaccines should be used in older populations and whether alternative means for protection are needed.

Adult↗
PubMed1998

Emerging infectious diseases and travel medicine.

International movement of individuals, populations, and products is one of the major factors associated with the emergence and reemergence of infectious diseases as the pace of global travel and commerce increases rapidly. Travel can be associated with disease emergence because (1) the disease arises in an area of heavy tourism, (2) tourists may be at heightened risk because of their activities, or (3) because they can act as vectors to transport the agent to new areas. Examples of recently recognized diseases with relationship to travel include HIV, Legionnaire's disease, cyclosporiasis, Vibrio cholerae O139 Bengal, hantavirus, and variant Creutzfeldt-Jacob disease. Reemerging diseases include dengue fever, malaria, cholera, schistosomiasis, leptospirosis, and viral hemorrhagic fevers. In addition, tuberculosis, drug-resistant shigellosis, and cholera have been major concerns in refugee and migrant populations. Because of the unique role of travel in emerging infections, efforts are underway to address this factor by agencies such as the CDC, WHO, the International Society of Travel Medicine, and the travel industry.

Communicable Disease Control↗
PubMed2003

Tuberculosis in association with travel.

Throughout history, tuberculosis has been spread by the movement of human populations. Modern travel continues to be associated with risk of tuberculosis infection and disease. TB transmission has been documented on commercial aircraft, from personnel or passengers to other personnel and passengers, but the risk of transmission is low. As in other settings, the likelihood of transmission is proportional to duration and proximity of contact. Travellers from low incidence to high incidence countries have an appreciable risk of acquiring TB infection similar to that of the general populations in the countries they visit, but the risk is higher if they work in health care. Two-step tuberculin skin testing prior to departure, followed by single-step tuberculin testing after return, is recommended for all such travellers. For travellers from high incidence to low incidence countries the risk of acquiring new TB infection is low. Tuberculin screening is not beneficial and not recommended. Chest X-ray screening is expensive and complex but may be beneficial for long-term migrants. For short-term travellers, such as the pilgrims to Mecca in Saudi Arabia, there is no practical or feasible intervention to detect or prevent TB. Emphasis should be placed on public awareness and education campaigns to facilitate passive diagnosis of symptomatic cases. Mycobacterium tuberculosis (MTB) continues to be a common concern for the global traveller.

Aerospace Medicine↗
PubMed2003

Travellers with pre-existing medical conditions.

Medical conditions that influence travel include those that compromise the immunity of the traveller and chronic underlying diseases or infirmities. The former includes HIV, transplantation, malignancy and its treatment, IgA deficiency, asplenia and use of immunocompromising drugs like corticosteroids. Chronic conditions include diabetes mellitus, end stage renal disease, diseases associated with compromised cardiac or pulmonary function and certain gastrointestinal diseases including cirrhosis. This review includes practical approaches to each of these conditions with attention to risk assessment and avoidance, vaccination when appropriate and not a risk to the compromised host, and arming the traveller with self-therapy and chemoprophylaxis. Since travellers with underlying conditions are often taking various medications the travel health practitioner must be alert for possible drug/drug interactions and must adjust dosages depending on the level of compromised renal or hepatic function. Finally, education of such travellers is paramount; they must understand that risk avoidance is critical and preventative modalities such as vaccination and chemoprophylaxis are never 100% efficacious.

Diabetes Mellitus↗
PubMed2003

Viral hepatitis in international travellers: risks and prevention.

Viral hepatitis is caused by a number of unrelated hepatotrophic viruses, known and unknown. Five hepatitis viruses namely HAV, HBV, HCV, HDV and HEV have been well characterized and the epidemiology and disease pattern of each agent has been defined. In the West, HAV, HBV and HCV are major causes of viral hepatitis. In the East, HEV is the most common cause of viral hepatitis. HAV is ubiquitous in childhood in such countries and accounts for less than 4% of disease in adults. Viral hepatitis becomes a problem to an international traveller when he envisages a journey from low endemic to high endemic area and is susceptible to the infection endemic at his destination. Millions of such potentially susceptible travellers from Europe, the USA, Canada, Japan, Australia, and New Zealand visit endemic areas every year for various reasons. Viral hepatitis is the most common reported immunization-preventable disease among travellers to developing countries. Imported viral hepatitis incapacitates the incumbents for an average of 4-10 weeks. Considering the magnitude of the travel, the number of cases of viral hepatitis and case fatality of around 2%, the disease causes significant morbidity and mortality in such communities. It has been estimated that viral hepatitis occurs 100 times more frequently than typhoid fever and 1,000 times more often than cholera in travellers to developing countries. Hepatitis A is the most common form of viral hepatitis in travellers and cumulative data have shown a risk of 3-6 cases/1,000 persons/month of stay whereas the risk of acquiring hepatitis B is 10 times lower.

Hepatitis A↗
PubMed2003

Travel epidemiology: the Saudi perspective.

The Kingdom of Saudi Arabia occupies four-fifths of the Arabian Peninsula, with a land area of 2 million square kilometres. Saudi Arabia holds a unique position in the Islamic world, as the custodian of the two holiest places of Islam, in Mecca and Medina. Annually, some 2 million Muslims from over 140 countries embark on Hajj. This extraordinary en masse migration is a unique forum for the study of travel epidemiology since the Hajj carries various health risks, both communicable and non-communicable, often on a colossal scale. Non-communicable hazards of the Hajj include stampede and motor vehicle trauma, fire-related burn injuries and accidental hand injury during animal slaughter. Communicable hazards in the form of outbreaks of multiple infectious diseases have been reported repeatedly, during and following the Hajj. Meningococcal meningitis, gastroenteritis, hepatitis A, B and C, and various zoonotic diseases comprise some of the possible infectious hazards at the Hajj. Many of these infectious and non-infectious hazards can be avoided or averted by adopting appropriate prophylactic measures. Physicians and health personnel must be aware of these risks to appropriately educate, immunize and prepare these travellers facing the unique epidemiological challenges of Hajj in an effort to minimize untoward effects. Travel epidemiology related to the Hajj is a new and exciting area, which offers valuable insights to the travel specialist. The sheer scale of numbers affords a rare view of migration medicine in action. As data is continually gathered and both national and international policy making is tailored to vital insights gained through travel epidemiology, the Hajj will be continually safeguarded. Practitioners will gain from findings of travel related epidemiological changes in evolution at the Hajj: the impact of vaccinating policies, infection control policies and public health are afforded a real-world laboratory setting at each annual Hajj, allowing us to learn from this unique phenomenon of migration medicine.

Animals↗
PubMed2003

Malaria: still a threat to travellers.

Each year, some 25-30 million international travellers from non-tropical regions visit malaria endemic countries. Up to 10,000 cases of malaria are imported into industrialised countries with an average case fatality rate of around 1%. Malaria still poses a real threat to travellers, particularly in areas with high transmission such as sub-Saharan Africa, Papua New Guinea and the South Pacific islands. The spread of malaria resistant to an increasing number of drugs forces us to adjust chemoprophylaxis regimens. Although new drugs are available and can protect travellers effectively, the number of imported cases to Europe and North America remains substantial. An increasing proportion of imported cases is seen in migrants and foreign-born residents visiting friends and relatives (VFR) in endemic countries. New easy-to-use drugs, better understanding of risk perception of travellers, finding new and innovative ways to reach at risk travellers such as VFRs are among the new challenges to improve malaria prevention for international travellers.

Animals↗
PubMed2004

Enteroaggregative Escherichia coli diarrhea in travelers: response to rifaximin therapy.

BACKGROUND AND AIMS: We have recently shown that enteroaggregative Escherichia coli (EAEC) strains commonly cause travelers' diarrhea. The study was designed to determine whether U.S. travelers with EAEC diarrhea responded to rifaximin therapy. METHODS: In a multicenter placebo-controlled clinical trial of travelers' diarrhea without non-EAEC pathogens we evaluated 2 doses of rifaximin. EAEC was sought in stool samples in enrolled subjects by HEp-2 cell assay. Response to rifaximin (both groups combined) and placebo were evaluated in EAEC-positive and EAEC-negative patient groups. RESULTS: Compared with placebo, rifaximin shortened the postenrollment illness in travelers with EAEC diarrhea (median, 22 vs. 72 hours; P = 0.03). In subjects with EAEC-negative diarrhea, the median duration of post-treatment diarrhea was shorter with rifaximin (33 hours) than with placebo (52 hours), but this difference was not significantly different (P = 0.14). CONCLUSIONS: Improvement of EAEC-mediated diarrhea with antibiotic treatment supports the pathogenicity of this organism in travelers to developing countries. The study provides information on the value of the poorly absorbed drug rifaximin in therapy of travelers' diarrhea.

Anti-Infective Agents↗
PubMedDate not supplied

Health of displaced Albanian Kosovars in the former Yugoslav Republic of Macedonia: fitness to travel and health outcomes assessment.

INTRODUCTION: During the 1999 conflict in Kosovo, an estimated 850,000 people were displaced from Kosovo. Many thousands of these people arrived in the Former Yugoslav Republic of Macedonia (FYROM), for whom a humanitarian evacuation programme (HEP) was conducted by the United Nations High Commissioner for Refugees (UNHCR) and the International Organization for Migration (IOM). More than 91,000 people were moved to third countries under this programme. METHODS: A health assessment tool was designed, validated, and implemented to document the health status of the refugees prior to departure. The IOM evaluated 41,652 pre-travel "fitness to travel" medical assessments for refugees transported by the Organization. A colour coding system for fitness-to-travel was used to clearly identify refugees to the receiving health authorities according to their health condition at the time of departure. RESULTS: A total of 41,652 fitness-to-travel assessments were performed between 05 April and 25 June 1999, and were entered into a database. There were 21,923 females and 19,566 males. The average age was 25.3 years (women, 26 years; men, 24.3 years). Of these assessments, 4,647 (11.2%) individuals who were deemed fit-to-travel required medical assessment at the host destination, and of those 1,204 required urgent care. The majority of health complaints were acute respiratory tract infections and hypertension. CONCLUSIONS: A rapid and efficient system for fitness-to-travel was created to assist in the management of health issues related to the urgent and mass movement of refugees. The collected health information was of use to health-care planners during the crisis and for those responsible for the health-care of newly arrived refugees. The lessons learned have implications for future similar operations and for the development of research and education programs for both the refugees and the host recipient nations.

Adolescent↗
PubMed2001

The health-development link: travel as a public health issue.

The process of globalization has rendered societies interdependent on one another and has fostered the movement of people, goods and ideas at unprecedented speed and volume. Global travel has grown from 25 million in 1950 to 500 million in 1993, and estimations by 2010 reach 1 billion. The increased intensity and quantity of travel has resulted in greater vulnerability to the domino-type spread of old, new and re-emerging infectious diseases. Travelers and local populations are also vulnerable to death and disability due to accidents, violence and injuries, chronic diseases such as those due to substance abuse (tobacco, alcohol and others), and to undesirable behaviors such as those related to sex-tourism. This article argues that tourism, understood as any type of travel, is one of the most important sectors of the economy in many countries and, therefore, can contribute to community and national development. It also asserts that travel, as a factor in the spread of disease, lies in the realm of public health inquiry. It calls for greater collaboration between the tourism-travel industry and community, national and global leaders to promote and enforce "responsible tourism."

Accident Prevention↗
PubMed2001

[Vaccinations for overseas travelers--new evidence and recommendations].

Vaccinations are an easy and highly effective way to keep travellers healthy. There are few problems with compliance, as all vaccinations are administered pretravel and many vaccines offer protection rates > 95% after a single dose (e.g. hepatitis A, yellow fever). Vaccination of hepatitis A and diphtheriatetanus are recommended for all developing countries. Polio is still indicated for Asia and Africa. Hepatitis B, if possible in combination with A, is recommended for persons travelling for > 30 days, travellers < 35 years, and for people showing special risk behaviour (e.g. high-risk sports, unprotected sexual intercourse). Depending on destination and kind and duration of travel, further vaccinations have to be considered, e.g.: yellow fever (endemic areas, rule of entry), rabies (trekking, travel in remote areas), typhoid fever (Indian sub-continent), meningococcal meningitis (meningitis belt, pilgrims to Saudi-Arabia), tick-borne encephalitis (endemic areas in Europe and Asia), influenza (persons at special risk of complications), Japanese encephalitis (low standard travel in rural areas of Southeast Asia > 30 days), measles (particularly endemic in Africa). Cholera vaccination is virtually never indicated. Several vaccines can be delivered at the same time.

Cholera Vaccines↗
PubMed2001

[Travelers' diarrhea].

Diarrhea is the most common health problem of travelers to tropical destinations, affecting up to over 50%, with however considerable regional and seasonal variation. Orally acquired bacterial pathogens, particularly enterotoxigenic Escherichia coli, are the most frequent etiology of travelers' diarrhea occurring during the first three weeks of travel. Protozoal infections, e.g. giardia and Entamoeba histolytica, are more often the cause of diarrhea and prolonged problems of intestinal motility of the returning traveler--as are postinfectious irritable bowel syndromes. Prevention seems theoretically simple by avoiding any potentially contaminated food and drinks, but the principle of 'cook it, boil it, peel it, or avoid it is obviously a goal difficult to achieve. Several antibiotics have shown to be able to prevent diarrhea for a short period of time, but the potential of adverse effects and selection of resistant pathogens calls for a restrictive use for short trips of particularly vulnerable subjects only. The use of probiotics--e.g. Saccharomyces boulardi, Streptococcus faecium--gave conflicting results--both in prevention and treatment. The basics of treatment is appropriate fluid replacement--mostly by the oral route. Although this measure can safely bridge the time until spontaneous remission, it fails to reduce the duration of illness. Appropriate antibiotics are fairly effective to reduce the duration of travelers' diarrhea, especially if combined with loperamid. The administration of the later is contraindicated in small children. The most commonly used and well documented antibiotics belong to the fluoroquinolones. Alternatives for pediatric use are azithromycin and cotrimoxazole. Considering the mostly short duration of travelers' diarrhea the administration of antibiotics can be limited to cases of acute febrile dysentery and violent diarrhea when rapid relief is essential. In cases of febrile diarrhea malaria must be considered if the patient has been exposed to the risk of transmission.

Acute Disease↗
PubMed2005

[Knowledge, attitudes and practices among travellers to tropical and subtropical countries].

Passengers with destinations in developing countries have been interviewed prior to departure on Zurich Airport. A total of 946 questionnaires were evaluated, 337 on travel related malaria prior to visiting an endemic country, 609 on vaccinations. This corresponds to a response rate of 72.3%. Among the respondents 550 (58.1%) had received travel health advice by a doctor. Overall, 25.5% were immunized against hepatitis A. While 70.4% of those who had obtained travel health advice carried medication against malaria, only 31.3% of those without such advice did so. Travel health advice resulted in a significantly increased appreciation of the risk of hepatitis A or malaria at the destination. Considerations on healthy travel should become a cornerstone in travel planning; special risk groups have been identified.

Adolescent↗
PubMed2006

The scaling laws of human travel.

The dynamic spatial redistribution of individuals is a key driving force of various spatiotemporal phenomena on geographical scales. It can synchronize populations of interacting species, stabilize them, and diversify gene pools. Human travel, for example, is responsible for the geographical spread of human infectious disease. In the light of increasing international trade, intensified human mobility and the imminent threat of an influenza A epidemic, the knowledge of dynamical and statistical properties of human travel is of fundamental importance. Despite its crucial role, a quantitative assessment of these properties on geographical scales remains elusive, and the assumption that humans disperse diffusively still prevails in models. Here we report on a solid and quantitative assessment of human travelling statistics by analysing the circulation of bank notes in the United States. Using a comprehensive data set of over a million individual displacements, we find that dispersal is anomalous in two ways. First, the distribution of travelling distances decays as a power law, indicating that trajectories of bank notes are reminiscent of scale-free random walks known as Lévy flights. Second, the probability of remaining in a small, spatially confined region for a time T is dominated by algebraically long tails that attenuate the superdiffusive spread. We show that human travelling behaviour can be described mathematically on many spatiotemporal scales by a two-parameter continuous-time random walk model to a surprising accuracy, and conclude that human travel on geographical scales is an ambivalent and effectively superdiffusive process.

Diffusion↗
PubMed2000

The impact of travel on cancer patients' experiences of treatment: a literature review.

This literature review aims to identify the impact of travel on cancer patients' experiences of treatment. With centralization of cancer services, patients may have to travel considerable distances from their homes and families, to receive specialist cancer treatment. Centralization of cancer services may have advantages in terms of concentrating clinical expertise, enhancing the range of ancillary facilities and rationalising the provision of expensive specialist equipment, but it is not known to what extent patients are affected by additional travel and the prospect of separation from their social networks. A systematic literature search using MEDLINE, SSCI, SOCA and PSYCHLIT, identified 11 relevant studies from six countries. The review showed a paucity of research on the implications of receiving cancer treatment far from home. Most studies can be criticised on methodological grounds. The evidence that travel distance and difficulty increases psychological distress, and reduces compliance with treatment and take up of treatment is largely inconclusive. However, travel to cancer treatment is described as inconvenient and a practical hardship for many patients. It may be perceived, or experienced as, a barrier to treatment. Future studies should evaluate the impact of travel to treatment on quality of life and perceived social support.

Attitude to Health↗