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PubMed1996

Protecting travelers against infections: immunizations and other preventive strategies.

Every year thousands of Americans travel abroad and risk encountering diseases to which they are not normally exposed. With pretravel counseling from their physician, travelers can substantially reduce or eliminate the risk of many common travel-related infectious diseases. Patients should be informed about required and recommended vaccinations, chemoprophylaxis and other preventive measures, and strategies for self-treatment, should an infection arise during travel. Up-to-date travel health resources, including sites on the World Wide Web, can assist physicians in advising patients about immunizations and other preventive measures recommended for travel to endemic areas.

Antimalarials↗
PubMed2004

[Biomedical impact of traveling for Chilean elderly].

BACKGROUND: In Chile there is a program named "Vacations for Elderly during Low Season". AIM: To characterize participants of this program and to measure the impact of traveling in their health and wellbeing. MATERIAL AND METHODS: Two anonymous and voluntary questionnaires were applied to 4200 participants, before and after a ten days vacation package. RESULTS: Before traveling, questionnaires were answered by 802 subjects, and after traveling by 4057 (69% women, 22% older than 75 years old, 15.8% living alone). The presence and maintaining of good health were most appreciated at this age and 59% classified their health as good or excellent. Twenty five percent referred sensory problems (seeing or hearing), 12% reported urinary incontinence and 21% presented falls in the last three months; depression screening (GDS-5) was positive in 16%. Chronic disease prevalence was similar to the general Chilean elderly population. After traveling they reported significant improvements in the items sociability, wellbeing, mood, appetite, insomnia and ostheoarthritic pain. CONCLUSIONS: Elderly who traveled were mainly women, who thought that maintaining good health is the most precious value. After traveling they improved significantly different aspects of wellbeing. Promotion of this kind of recreation programs is an important tool for integration and enhancement of quality of life in elderly subjects in our country.

Aged↗
PubMed1998

Testing for anti-circumsporozoite and anti-blood-stage antibodies for epidemiologic assessment of Plasmodium falciparum infection in travelers.

The purpose of this investigation was to assess the role of serology for establishing incidences of Plasmodium falciparum malaria and of exposure to P. falciparum in epidemiologic studies of travelers using chemoprophylaxis. The design was a prospective cohort study involving 548 short-term Dutch travelers to areas endemic for P. falciparum malaria. Sera were collected before departure and, together with the medical history, 2-6 weeks after return. All sera were tested for anti-circumsporozoite (CS) antibodies by an R32tet32-ELISA; sera of subjects reporting febrile illness during travel or after return or with anti-CS responses were tested for anti-blood-stage antibodies by an indirect fluorescence antibody test (IFAT). Five subjects (0.9%) reported P. falciparum malaria confirmed by thick blood smear examination (documented cases) and six (1.0%) reported treatment for malaria without a documented diagnosis (presumptive cases). Conversions in the IFAT were detected in six subjects, including all five documented cases and one presumptive case. Anti-CS antibodies were detected in seven subjects (1.3%), including three documented cases and four of 442 subjects with no history of fever or malaria treatment (0.9%). Incidence rates per 1,000 person-months of travel (95% confidence interval) of infection with P. falciparum, whether or not suppressed by chemoprophylaxis, were 16.9 (8-31) for all destinations and 91.6 (33-200) for West Africa. In epidemiologic studies of P. falciparum malaria in travelers, testing for antibodies to blood stages can increase the sensitivity and specificity of case detection; testing for antibodies to sporozoites may be useful for the assessment of exposure to P. falciparum in travelers using chemoprophylaxis, but the sensitivity is limited.

Adult↗
PubMed1998

[Immunization for adults in foreign travel].

In 1997, 62.2 Mio. Germans traveled abroad according to the research society for holiday & travel--7.4 Mio. traveled outside of Europe. The journey of 26.3 Mio. Germans was associated with an increased risk related to their health. Therefore, the number of travelers is increasing who attend their family physician searching information about necessary vaccination and other options of prevention. Unfortunately, there is a lack of knowledge about health risks and their prevention when traveling abroad. The consulting physician therefore needs reliable sources of information to keep his knowledge up to date. Similar to any other medical speciality, only the continuously educated physician can offer travel medicine with high quality.

Adult↗
PubMed1999

International travel and vaccinations.

With the increase in global travel, no disease is beyond the reach of any population. Traveling patients should be advised to follow food and water precautions and encouraged to receive the recommended immunizations. Travel medicine plays a vital role not only in limiting the morbidity of travel-related illnesses but also in limiting the spread of diseases. This article addresses the common issues related to travel, reviews the care of the immunocompromised traveler, and updates the available vaccinations and prophylactic regimens available to limit sickness abroad.

Communicable Disease Control↗
PubMed1998

[Legionnaires' disease in travellers].

The outbreak of pneumonia involving delegates to the 1976 American Legion convention at a Philadelphia hotel was the first example of travel-associated legionnaires' disease. Travel is now well known as a common risk factor for legionnaires' disease. This travel-associated disease is a preoccupation among European countries because of morbidity among citizens of the European Union. The definition of the case of legionellosis is a patient who presents an acute lower respiratory tract infection with focal signs of pneumonia and/or radiological features, and microbiological evidence of Legionella infection. A case is considered to be travel associated if the patient has spent one or more nights away from home during the ten days before becoming ill. An European Surveillance Scheme for Travel-Associated Legionnaires' Disease was established in 1987 to identify clusters and outbreaks of cases of the disease. This group centralizes the case reports of twenty-nine collaborating centres in twenty-five countries. Outbreaks of legionnaires' disease were described in hotels, camps or cruise ships. In 1996, the number of travel-associated cases of legionnaires' disease represented 16% of the total number cases. The increase of the number of reported cases may reflect improved surveillance and increased ascertainment. In Europe in 1996, the diagnosis of legionellosis was confirmed by detection of Legionella pneumophila sero-group 1 antigen in urine (36%), seroconversion (fourfold rise in antibody titre, 33%) and culture of the organism (16%). Fifteen per cent of legionellosis was diagnosed by the identification of a single high antibody titre. In France a coordination between Public Health Institutions (Réseau National de Santé Public and DDASS), clinicians, laboratories and National Reference Center was established to improve prevention and control of legionnaires' disease outbreaks. Legislation obliges to report each case. When more two cases in the same area are notified an epidemiological investigation must be done. The knowing of the source of the contamination and its eradication allows to prevent new cases and outbreaks. Outbreaks of Legionnaires' disease are even now mediatic and this fact leads to maintain attention for the quality of diagnosis and epidemiology investigation due to touristic and economic consequences for the implicated countries.

Antibodies, Bacterial↗
PubMed1999

Emerging infectious diseases and risk to the traveler.

This article examines the relationship between travel and emerging infections. The authors begin with an overview of disease emergence and follow with a brief infection-by-infection examination of selected emerging pathogens of particular relevance to travelers and the medical care providers who counsel them. Emphasis is given to those agents that clearly have emerged as significant new or increased risk to travelers; or are of sufficiently new interest, even in the face of inadequate data in travelers, to be of potential immediate concern. The authors also discuss several novel pathogens, such as Ebola virus, that are clearly of insignificant or minimal risk to travelers, but are the subject of frequent questions from patients requesting pre-travel advice from medical providers.

Humans↗
PubMed1999

Evaluation of fever in the returned traveler.

The differential diagnosis of a febrile illness in the returned traveler is extensive. The most commonly encountered tropical infections are malaria, dysentery, hepatitis, and dengue fever; a substantial number of febrile illnesses are never diagnosed. Malaria is by far the most important infection to consider in the returned traveler who presents with fever. As international travel continues to increase in popularity, the ongoing need for clinicians to broaden their knowledge of travel-related diseases is evident. The ability to recognize and manage tropical diseases in travelers is essential because the morbidity and mortality of these infections are often preventable with prompt therapy. When expertise in this area is lacking, febrile returned travelers should be referred to a tropical disease unit or an infectious disease consultant for urgent assessment.

Diagnosis, Differential↗
PubMed1999

Medical advice for commercial air travelers.

Family physicians are often asked to advise patients who are preparing to travel. The Air Carrier Access Act of 1986 has enabled more passengers with medical disabilities to choose air travel. All domestic U.S. airlines are required to carry basic (but often limited) medical equipment, although several physiologic stresses associated with flight may predispose travelers with underlying medical conditions to require emergency care. Recommendations for passengers with respiratory, cardiac or postsurgical conditions must be individualized and should be based on objective testing measures. Specific advice for patients with diabetes, postsurgical or otolaryngologic conditions may make air travel less hazardous for these persons. Air travel should be delayed after scuba diving to minimize the chance of developing decompression sickness. Although no quick cure for jet lag exists, several simple suggestions may make travel across time zones more comfortable.

Aerospace Medicine↗
PubMed2000

Factors associated with the vaccination of international travelers: a multivariate analysis.

Travel medicine practice in the United States has not been extensively studied. This study included 1078 consecutive patients who presented to a university-based travel medicine clinic from 1990 through 1994. Analyses of patient demographics, clinic attendance, itineraries, and vaccinations were conducted. Mean patient age (+/- SD) was 37.4 +/- 16.2 years; 626 (58.1%) of the patients were male. Travel duration was 103.1 +/- 242.3 days (median, 21 days), and lead time (defined as the time between clinic presentation and departure for the purpose of this study) was 23.8 +/- 26.5 days (median, 16 days). Destination was the strongest independent factor affecting vaccination practices. A lead time of 31 or more days was associated with significantly elevated odds ratios for all immunobiologicals except immune globulin. These findings underscore the need to educate the traveling public, healthcare providers, and the travel industry about the benefits of seeking medical consultation at least 1 month prior to international travel.

Adolescent↗
PubMedDate not supplied

Evaluation of the returned traveler.

Recognition of clinical syndromes in returned travelers is an important part of providing care to international travelers. The first step is to take a history with attention to pre-travel preventive measures, the patient's itinerary, and potential exposure to infectious agents. The patient should then be examined to document physical signs, such as fever, rash, or hepatosplenomegaly, and to have basic laboratory data obtained. This evaluation will provide most physicians with the necessary information to generate a differential diagnosis. Each diagnosis should be matched against the incubation period of the disease, the geographic location of illness, the frequency of illness in returned travelers, and the pre-travel preventive measures. Careful attention to these aspects of patient care should result in the appropriate diagnosis and therapeutic intervention for the ill returned traveler.

Clinical Laboratory Techniques↗
PubMed1992

Travel and ciguatera fish poisoning.

BACKGROUND: Ciguatera fish poisoning is a distinctive clinical syndrome associated with the consumption of contaminated marine fish. It is endemic in many popular travel destinations, including the Caribbean and Pacific Islands, where travelers are at risk. METHODS: Clinical review of 23 patients (60% were travelers) with ciguatera fish poisoning in whom consultation was provided between 1987 and 1990. RESULTS: Seven patients acquired ciguatera fish poisoning during international travel to the following destinations: Bahamas (n = 4), Dominican Republic (n = 1), British Virgin Islands (n = 1), and United States (n = 1). Suspected fish included grouper, red snapper, and amberjack. Two patients required emergency care, and four patients developed chronic symptoms. Severity was associated with chronicity, duration of peak symptoms, and worsening of symptoms with sexual activity. Chronicity was associated with severity, long latency period, and duration of peak symptoms. The three patients with complete resolution were scuba divers. Amitriptyline was the drug most often providing benefit for chronic symptoms. CONCLUSIONS: Ciguatera fish poisoning is a health risk to travelers to endemic regions, and their risk likely equals that of indigenous population groups. Barracuda should never be eaten, and travelers should exercise caution when considering other fish dishes, notably, grouper and red snapper.

Animals↗
PubMed2005

Traveller's diarrhoea.

BACKGROUND: There has been little if any change in the incidence of traveller's diarrhoea over the past 20 years. OBJECTIVE: This article aims to provide a basic understanding on why travellers are more likely to experience diarrhoea during travel. DISCUSSION: In a 20 minute pretravel consultation time is precious, and providing information on traveller's diarrhoea often has a low priority over prescribing the necessary vaccinations and discussing antimalarials. Travellers do not follow the rules of eating and drinking safely, and diarrhoea is common. 'What to do in the event of illness' is an important consideration. Presumptive treatment should be offered to all travellers whose itinerary and activities put them at risk.

Antidiarrheals↗
PubMed2005

Traveler's diarrhea.

Acute diarrhea affects millions of persons who travel to developing countries each year. Food and water contaminated with fecal matter are the main sources of infection. Bacteria such as enterotoxigenic Escherichia coli, enteroaggregative E. coli, Campylobacter, Salmonella, and Shigella are common causes of traveler's diarrhea. Parasites and viruses are less common etiologies. Travel destination is the most significant risk factor for traveler's diarrhea. The efficacy of pretravel counseling and dietary precautions in reducing the incidence of diarrhea is unproven. Empiric treatment of traveler's diarrhea with antibiotics and loperamide is effective and often limits symptoms to one day. Rifaximin, a recently approved antibiotic, can be used for the treatment of traveler's diarrhea in regions where noninvasive E. coli is the predominant pathogen. In areas where invasive organisms such as Campylobacter and Shigella are common, fluoroquinolones remain the drug of choice. Azithromycin is recommended in areas with quinolone-resistant Campylobacter and for the treatment of children and pregnant women.

Acute Disease↗
PubMed2005

Imported giardiasis: impact of international travel, immigration, and adoption.

From the Swedish national database, regarding notified Giardia cases, we could for the period 1997-2003 identify 3,697 cases of travel-associated giardiasis, 4,151 cases in newly arrived immigrants and refugees, and 455 cases in internationally adopted children. These were compared with data sets on the number of international travelers, immigrants/refugees, and adopted children. The overall risk of being notified with giardiasis in returning travelers was 5.3 of 100,000, with the highest incidences in travelers from the Indian Subcontinent (628 of 100,000), East Africa (358 of 100,000), and West Africa (169 of 100,000). A large proportion of the travel-related cases were seen in persons with family roots in the country of infection-a risk group deserving special attention. The overall risk in immigrants and refugees was 1,180/100,000 with the highest risk in persons from Afghanistan (3,800 of 100,000) and Iraq (2,990 of 100,000). The incidence was highest among internationally adopted children (8,110 of 100,000), with geographical risks not entirely correlating to those in travelers and immigrants.

Adolescent↗
PubMed2006

[Deep-vein thrombosis and pulmonary embolism due to air travel].

In recent years, the association between air travel and the incidence of deep-vein thrombosis or pulmonary embolism has become clearer. Epidemiologic studies reveal an increased relative risk of thromboembolism after flights of more than 8 hours and especially in subjects at higher risk for this disease, due, for example, to congenital thrombophilia or the use of oral contraceptives. However, the absolute risk of deep-vein thrombosis or pulmonary embolism after prolonged air travel is very small. Studies have shown that a combination of factors present during prolonged air travel may account for increased activation of coagulation. There is no definitive proof that elastic stockings are effective in reducing the incidence of clinically relevant thromboembolism during air travel. Acetylsalicylic acid is not effective in the prevention of thrombosis during air travel and may be dangerous. Prophylactic subcutaneous low molecular weight heparin may be effective to prevent air travel-associated thrombosis. However, pending more solid evidence, this strategy should only be used cautiously, e.g. only in patients with a high risk of thrombosis who are planning a long flight.

Aerospace Medicine↗
PubMed2006

Hemorrhage from an enlarged emphysematous bulla during commercial air travel.

Pulmonary bullae are a common late complication in patients with emphysema. Non-communicating emphysematous bullae may expand during air travel when the ambient pressure is reduced, resulting in various forms of barotrauma including pneumothorax and air embolism. We report a 62-yr-old man with emphysema who developed hemoptysis during international commercial air travel. CT scan of the chest obtained after the travel showed air-fluid level in an enlarged bulla. He underwent resection of the bulla and had a full recovery. This is a unique presentation of stretch injury of a bulla as a form of pulmonary barotrauma occurring during commercial air travel. With the most recent ruling by the Federal Aviation Administration to allow patients with advanced chronic obstructive lung disease to travel by air with their own supplemental oxygen devices, physicians need to be aware of this type of pulmonary barotrauma and properly advise such patients who are planning to travel by air.

Aerospace Medicine↗
PubMed1991

Prevention and treatment of travel-related illness.

Traveler's diarrhea, malaria, acquired immunodeficiency syndrome and jet lag are among the issues for the traveler preparing for a trip to or returning from developing countries. With appropriate measures, most travel-related diseases can be prevented. Diarrheal diseases, schistosomiasis, sexually transmitted diseases and AIDS can be prevented with proper avoidance behavior. Diseases such as hepatitis, rabies, yellow fever and meningitis can be prevented with immunization. Chemoprophylaxis can prevent malaria, altitude sickness and sinus barotrauma. Diagnosing an illness in a returning traveler requires a high index of suspicion regarding diseases that might have been acquired during travel. Resources for accessing up-to-date information concerning prophylaxis, diagnosis and treatment of travel-related illnesses are available.

Adult↗