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PubMed1990

Recommendations for the prevention of malaria among travelers.

Recommendations for the prevention of malaria among travelers have been developed by CDC in consultation with representatives from the Offices of Medical Services of the Department of State and the Peace Corps; the Division of Experimental Therapeutics of the Walter Reed Army Institute of Research; the Office of the Surgeon General, U.S. Army; the Office of the Surgeon General, U.S. Air Force; and the Bureau of Medicine and Surgery, U.S. Navy. Resistance of Plasmodium falciparum to chloroquine has spread to most areas with malaria. Alternative drugs to chloroquine are either associated with adverse reactions, are of limited efficacy, or require complex and detailed instructions for use that reduce compliance. These factors have contributed to a threefold increase in the number of reported P. falciparum infections among U.S. travelers to malarious areas since 1980. A new drug, mefloquine (Lariam), is expected to be highly effective against both chloroquine-resistant and Fansidar-resistant P. falciparum infections. Mefloquine is now recommended as the drug of choice for travelers at risk of infection with chloroquine-resistant P. falciparum. Alternative drugs for travelers who cannot take mefloquine include 1) doxycycline alone or 2) chloroquine alone, with Fansidar available for standby treatment while medical care is sought for evaluation of febrile illness when travelers are in a malarious area. Prospective travelers and health-care providers are advised to call the CDC Malaria Hotline at (404) 332-4555 for detailed recommendations for the prevention of malaria.

Adult↗

PubMedDate not supplied

From the Centers for Disease Control. Recommendations for the prevention of malaria among travelers.

Adult↗

PubMed1990

Traveler's diarrhea: methods of prevention and treatment.

Traveler's diarrhea can often be avoided by following safe food and water practices while traveling in developing countries. Prophylactic agents are generally not indicated in the prevention of traveler's diarrhea. Should traveler's diarrhea develop, fluid replacement is the principal therapeutic modality. Other useful treatments include bismuth subsalicylate or anti-motility agents such as loperamide or diphenoxylate. Early empiric use of antimicrobial agents including trimethoprim-sulfamethoxazole or quinolone agents offers an excellent means of treating traveler's diarrhea and preventing its potential complications. Travelers who develop dysentery, high fever, or prolonged diarrhea lasting more than 10-14 days should seek medical attention for specific diagnosis and appropriate antimicrobial therapy.

Diarrhea↗

PubMed1989

A travelers' clinic in an academic setting.

The Department of Family and Community Medicine at the University of Arizona has operated a travelers' clinic since 1983, staffed primarily by faculty and residents from the sections of preventive medicine, occupational medicine, and family medicine. We describe the clinic experience in providing preventive medical services to international travelers. Summer months are the busiest. Destinations of the travelers show a clear predominance of travel to less-developed countries, and this is reflected in the immunizations and prescriptions provided. After their trips, travelers reported a low incidence of diarrhea of generally low severity. The travelers' clinic is also a positive experience for resident physicians who help staff it, particularly those specializing in general preventive medicine.

Adolescent↗

PubMed1993

Traveller Gypsies and childhood immunization: a study in east London.

The immunization status of the children of Traveller Gypsies presenting to two general practices and a paediatric accident and emergency department in east London between July 1988 and February 1990 was compared with that of a control group presenting to the same services. Study of parental reports and other records for 72 Traveller Gypsy children and 106 control children aged 10 months to six years revealed that Traveller Gypsy children had significantly lower completion rates for pertussis, measles, diphtheria/tetanus and poliomyelitis vaccines than the control group. The difference between the uptake of the first and third diphtheria/tetanus, pertussis and poliomyelitis vaccines was significantly greater among the Traveller Gypsy children than among the control group. The low immunization rates are due to poor access to services as well as rejection of certain vaccines by Traveller Gypsies. The 1990 general practitioner contract and reforms to the health service may result in decreased access for Traveller Gypsies unless steps are taken by family health services and district health authorities to meet the health care needs of this group. Possible solutions to this problem include outreach services to caravan sites, opportunistic immunization, better records and targeted health education.

Child↗

PubMed1996

Evaluation of travel and use as a risk factor for seropositivity to Ehrlichia risticii in horses of New York state.

OBJECTIVES: To determine whether mean annual frequency and destination of equine travel was associated with exposure to Ehrlichia risticii and whether these associations were modified by horses' place of residence. DESIGN: Cross-sectional study. SAMPLE POPULATION: 511 equine operations containing 2,587 horses were visited in New York state from a target population of 39,000 operations. PROCEDURE: Each horse was tested for serum antibodies against E risticii, using indirect fluorescent antibody. Information on the horse's travel history, farm's management practices, and surrounding ecology was obtained by personal interview and resource maps. Statistical analyses were performed on 2 cohorts of animals: all horses enrolled in the study and horses born on the property or that resided at least 4 years on the farm. Three county-based risk regions (RR) were identified by use of cluster analysis. RESULTS: Mean seroprevalence for each of the 3 RR was 2.4 (low risk), 8.5 (moderate risk), and 18.5% (high risk) for cohort 1 and 2.5, 8.0, and 18.4% for cohort 2. Among cohorts 1 and 2, pleasure riding and breeding trips were associated with exposure to E risticii, but horse residence (low, moderate, or high RR) was an effect modifier for these associations. Among cohort 1 and stratifying the analysis according to the RR for the travel destination, trail riding at low RR and trail riding at high RR were associated with exposure. Among cohort 2 and stratifying the analysis according to the RR for the travel destination, breeding trips were associated with exposure, and strong effect modification was present for horse residence (low, moderate, or high RR). CONCLUSIONS: Only certain types of travel to specific RR were associated with higher risk of exposure to E risticii. In many instances, travel was not associated, or was associated, with a reduced risk of exposure.

Animals↗

PubMed1996

[Side effects of travel vaccinations. Data collection via telephone survey in Berlin].

The local and systemic side effects of some frequently administered travel vaccines were analysed in a prospective study on 3488 travelers using a standardised telephone interview procedure. The vaccines studied were yellow fever, diphtheria toxoid (d), tetanus diphtheria toxoid (Td), oral polio (OPV) and oral typhoid. Combined vaccinations studied were Td + OPV. Td + yellow fever. d + OPV and d + yellow fever. After single vaccination 30% of those inoculated reported slight local reactions. 3% had moderate local reactions and 18% complained about systemic side effects. After combined vaccinations 47% suffered from slight local reactions, 7% had moderate local reactions and 22% developed systemic side effects. Of all vaccines studied Td produced the highest frequency of local reactions. The combined vaccinations containing yellow fever vaccine were less well tolerated than the corresponding single vaccines. Systemic and local side effects were experienced more frequently by women, except in the case of diphtheria toxoid. Young travelers had more frequent and more severe side effects than older travelers after yellow fever vaccination, and after the combinations of Td + yellow fever. Td + OPV and d + yellow fever vaccinations. The side effects observed were mostly mild and none of the vaccinated travelers consulted a doctor for side effects. After travel vaccinations there are frequent, but well tolerated local and systemic side effects. Combined vaccinations are also well tolerated; their components determine the incidence of side effects.

Adult↗

PubMed1997

Effect of travel and rest on performance of professional basketball players.

We have studied 8,495 regular season games in the National Basketball Association over eight seasons (1987-1988 through 1994-1995) to analyze the effects of travel and rest on performance. We found that more time between games improved performance, an effect that was constant over time and statistically significant. More than 1 day between games increased the home team's score by 1.1 points and the visitor's by 1.6 points. Peak performance occurred with 3 days between games. The negative effects of little time between games may be due to lack of time for physical recovery, rather than any effects of circadian rhythm (jet lag). We found few consistent effects of distance traveled or direction of travel. We did find a suggestion of circadian rhythm effects in a subanalysis of games on either coast in which the visitor traveled across the country, while the home team did not travel (n = 101). In these games, the visiting team did four points better (p = 0.07) when they traveled west to east rather than east to west, almost nullifying the home-court advantage. This effect, like similar findings for Monday Night Football games, may be due to West Coast visitors playing night games at an earlier time according to their "internal clock". An incidental finding in our study was that the home-court advantage decreased over 8 years, from about six points to three points (due to relatively lower field-goal percentages and fewer free throws by the home team).

Basketball↗

PubMed1997

[The so-called "economy class" syndrome or travel thrombosis].

Thrombosis and pulmonary embolism associated with air travelling is known as "economy class syndrome". However, as it is observed even using other means of transportation, it can generally be described as "traveller's thrombosis". Our own observations include 5 patients with thrombo-embolic disease, which occurred after long-distance travel. In respect to the large number of travellers, the reported incidence of associated thrombosis seems to be remarkably low, and there is no epidemiological evidence about travel and thromboembolic disease. On the other hand, retrospective analysis of patients with manifest thrombosis of any origin reveals in about 5% the circumstances of transportation as possible agent. Anyhow, according to literature the risk of thrombosis could be regarded as quite low. Preventive action during long-distance travelling should be taken into consideration in patients with high risk of thromboembolism.

Aircraft↗

PubMed1997

[How to manage vaccinations in the elderly traveler].

Along with the growth of travels, the ageing of the population multiplies the number of older travellers. 13% of travellers could be at least 65 years old. It is admitted that there is no upper age limit to perform immunizations. Immunizations are all the more useful for older people because age generally aggravates infectious diseases. With age the immune response decreases definitely, especially that depending on cellular immunity, as well as the humoral response, as it has been observed with vaccinations against tetanus, flu, pneumococcal infections and hepatitis B. The first series of immunizations could be more affected by age than boosters. But a lot of questions still remain unanswered. Is there a maximum age beyond which the immune response would be unadapted to such an extent that it would be necessary to modify the immunization protocols as well as the periodicity of boosters? 75 years? 80 years? Is this age the same for all individuals? Is that a matter of a lower level of the antibody response, or rather of a slower, delayed response? The planning of older travellers immunizations meets another difficulty: their often vague knowledge of past immunization records and infectious diseases. One is often reduced to conjectures. Thus men, who have served in the army since the beginning of World War II are supposed to have got the first series of immunization against tetanus and diphtheria, but how can we restore their immunity (once we have defined the maximum age) when boosters have been either insufficient or missing? Conversely for women born before 1945, who were probably never immunized, a first series of immunization is warranted. On the other hand, since the immunization against poliomyelitis only came into effect in the sixties, most older adults have never been immunized but have acquired in the past a natural immunity from their contact with wild polio viruses. Naturally acquired antipoliovirus immunity doesn't seem to have decreased with age, unlike antidiphtheria and antitetanus immunity, as shown by recent serologic studies. Thus would a single booster with inactivated polio vaccine be sufficient to reinforce the immunity of most older travellers who have never been immunized? Considering these uncertainties, one could think of carrying out a serologic assessment prior to establishing an immunization program, as it has already been recommended for the immunization against hepatitis A. What would its feasibility be? There are quite a lot of questions to discuss. May this round table help define these questions and specify which investigations would be necessary to solve them, as well as program more rationally the immunizations of the older traveller.

Aged↗

PubMed1997

[Cardiovascular risk for the traveler].

The incidence of cardiovascular events during travel is rising with the age of the population and number of traveling seniors. Cardiovascular events are the second most frequent reason for medical evacuation and the cause of 50% of deaths recorded during commercial air travel. In most cases the underlying disorder is coronary artery disease which is readily destabilized by stress and fatigue associated with travel. Inflight conditions that can cause problems include altitude-related hypoxia, pressurization, and cramped seating in most sections of the plane. Upon arrival the traveler is exposed to a variety of climatic, food, and environmental factors that can trigger manifestations of latent heart disease. Prophylactic drugs for tropical infectious disease (especially antimalarials of the quinidine group) should be used with caution due to possible adverse interaction with medications used to treat heart disease. A pre-travel examination is necessary to ascertain cardiovascular status and define simple preventive precautions.

Age Distribution↗

PubMed1997

[Sexually transmitted diseases and travel].

Travelers are highly exposed to acquiring sexually transmitted diseases especially since the most popular destinations are high risk areas. While this risk applies to all travelers, it is highest for the "sex" tourist who is typically a male with a mean age of 38 years. Awareness of risks is still incomplete, especially with regard to HIV. Several studies have shown that only 20% to 70% of travelers use condoms. This finding accounts for the high incidence of sexually transmitted diseases in returning travelers: 2% to 10%. The risk of HIV infection is particularly high for persons living abroad. Based on available data, we can define the typical profile of the high risk traveler who should be targeted for prevention. Prevention depends on providing adequate information before departure, especially concerning HIV infection. Use of a condom throughout sexual contact is a basic safety rule. However condom quality is poor in many developing countries. Returning travelers should seek medical advice if manifestations involving the anogenital regions should appear.

Adult↗

PubMed1999

Comparing measures of travel distances in primates: methodological considerations and socioecological implications.

Travel costs can influence numerous aspects of the lives of primates, including net energy balance (and therefore reproductive success of females) and maximum group size. Despite their potential impact, there has been no systematic comparison of different measures of travel distance. We compared three measures of travel distance in 30 min (actual distance of individuals, straight-line distance of individuals, and straight-line distance of groups) and their ratios in a small group and a large group of vervet monkeys (Cercopithecus aethiops) and between the large group of vervets and a group of patas monkeys (Erythrocebus patas) of roughly similar size. The large group of vervets traveled farther than the small group regardless of the measure used, but the ratios of the different measures were not significantly different between those groups. Patas monkeys traveled significantly farther than the large group of vervets regardless of the measure used. In both vervets and patas, straight-line distances of individuals (ISLD) and groups (GSLD) underestimated actual distances traveled by individuals (IAD), but the degree to which they did so differed between species. IAD is more accurate than the other two measures and is preferred for studies of energetics and individual reproductive success, although ISLD or GSLD may be substituted when the ratios of IAD/ISLD or IAD/GSLD do not differ between groups or species. The ratio of IAD/ISLD was larger in vervets than in patas, suggesting that individual vervets meander more over short periods of time than patas. The ratio of ISLD/GSLD was larger in patas than in vervets, suggesting that patas move at angles or across the group's center-of-mass whereas vervets move more consistently along with others in their group. This has implications for the formation of spatial subgroups and alliances within groups.

Animals↗

PubMed1979

Travel for primary care: expectation and performance in a rural setting.

Data and findings are presented pertaining to the expressed travel limits for general medical care of a rural population and the degree to which their observed travel behavior reflects these limits. Considerable variation in expressed reasonable and maximum travel distances and times was observed among respondents in a countywide cross-section sample of the resident population in western Maine. A substantial proportion of the respondents' visits for general medical care exceeds their reasonable travel limits and some visits exceed the travel limits they considered maximal. Additionally, a comparison of expectations from this study with those of a similar population in another section of the county reveals significant differences. The findings suggest that health planning could be considerably enhanced by a better understanding of patient preferences for medical care travel behavior, the origins of these preferences, and their relationship to the use of available medical care opportunities. This is particularly true if stated goals of incorporating patient preferences into the health planning process are to be realized.

Attitude to Health↗

PubMed2002

How far ahead do we look when required to step on specific locations in the travel path during locomotion?

Spatial-temporal gaze behaviour patterns were analysed as normal participants wearing a mobile eye tracker were required to step on 17 footprints, regularly or irregularly spaced over a 10-m distance, placed in their travel path. We examined the characteristics of two types of gaze fixation with respect to the participants' stepping patterns: footprint fixation; and travel fixation when the gaze is stable and travelling at the speed of whole body. The results showed that travel gaze fixation is a dominant gaze behaviour occupying over 50% of the travel time. It is hypothesised that this gaze behaviour would facilitate acquisition of environmental and self-motion information from the optic flow that is generated during locomotion: this in turn would guide movements of the lower limbs to the appropriate landing targets. When participants did fixate on the landing target they did so on average two steps ahead, about 800-1000 ms before the limb is placed on the target area. This would allow them sufficient time to successfully modify their gait patterns. None of the gaze behaviours was influenced by the placement (regularly versus irregularly spaced) of the footprints or repeated exposures to the travel path. Rather visual information acquired during each trial was used "de novo" to modulate gait patterns. This study provides a clear temporal link between gaze and stepping pattern and adds to our understanding of how vision is used to regulate locomotion.

Fixation, Ocular↗

PubMed2001

Preparation of the HIV-infected Traveler to the Tropics.

Pre-travel advice and planning can help the HIV-infected traveler minimize the unavoidable risks of tropical travel. Issues to cover: the diagnosis, staging, and stabilization of HIV infection and its sequelae; adequacy of the supply of medications currently used; optimal sources of medical care in planned destinations; potential HIV-related legal restrictions on travel; special risks associated with the medical geography of the traveler's route and planned activities; the need to avoid food-, water-, and vector-borne diseases; any appropriate vaccination, chemoprophylaxis, and antimicrobial agents; and arrangement for adequate medical follow-up upon the traveler's return.

Journal Article↗

PubMed2006

Travelers' diarrhea: modern concepts and new developments.

Travelers' diarrhea occurs when persons move from industrialized regions to developing countries with reduced hygiene. Bacterial enteropathogens from ingested food are the primary causes. Although it is possible to reduce the occurrence of illness by careful selection of food and beverages, travelers do not seem willing to restrict their diets. Diarrhea is associated with a disability of 24 hours per episode, interfering with travel plans and, of even greater concern, post-diarrhea irritable bowel syndrome (IBS) occurs in up to 10% of patients. The use of rifaximin, a poorly absorbed drug, is likely to become common as an attempt to prevent diarrhea and post-infectious IBS. All travelers to high-risk areas should take with them an effective antibacterial drug (rifaximin, fluoroquinolones, or azithromycin) for self-treatment of diarrhea occurring during travel. Additional work is needed to improve the hygienic conditions found in the developing world into which susceptible persons travel.

Journal Article↗

PubMed2005

"...it's all the same no matter how much fruit or vegetables or fresh air we get": traveller women's perceptions of illness causation and health inequalities.

This paper explores the perceptions of illness causation and health inequalities of Travellers, an ethnic minority group who experience considerable social and health disadvantages in Ireland. In order to allow for subjective meanings to emerge, a qualitative methodology with purposive sampling was employed. Participants in the study were invited to respond to a vignette in a focus group setting. Forty-one Traveller women were recruited to the focus groups through community projects or adult education initiatives. The study not only illustrates the complexity of lay perceptions of ill-health and health inequalities, but raises important questions about the prevalence of depression and of domestic violence in the Travelling community. These Traveller women were very willing to discuss the structural factors that contributed to their health status, attributing ill-health to social and environmental factors, such as accommodation, hardship and discrimination. Further, they broadly rejected behavioural explanations of the heart disease described in the vignette. Traveller women's understandings of health and the factors that determine it are deeply embedded in the social context of their lives and their ethnic identity. These findings are discussed in the context of social identity and ethnicity, and contribute to theoretical debates about the role of that identity in recognising inequality. The study revealed that Traveller women see many shortcomings in health service provision. They need service provision to be culturally sensitive and responsive to their needs.

Adult↗