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PubMed1997

Travel medicine: a perspective on the emerging problem of travel-related infections.

Travel Medicine has come a long way since it was started in the 1980s. Today, with the advances in electronic communications and efficient international travel, the demand for up-to-date information on international health situation is more urgent than before. Disease outbreaks can be updated and be available immediately across to the whole world in a matter of hours via the Internet. Travel medicine specialists no longer can give the excuse that they are unaware of such a situation because it is posted all over the net. Advances in vaccine development and the work of international agencies like the World Health Organization and the Centres for Disease Control have helped further the strategies and the knowledge we have in travel health risks. For the traveller, this means that they should no longer be travelling to a destination without knowing the health hazards and without taking the appropriate prophylaxis and precautions.

Centers for Disease Control and Prevention, U.S.↗
PubMed1999

Traveling time and traveling length in critical percolation clusters.

We study traveling time and traveling length for tracer dispersion in two-dimensional bond percolation, modeling flow by tracer particles driven by a pressure difference between two points separated by Euclidean distance r. We find that the minimal traveling time t(min) scales as t(min) approximately r(1.33), which is different from the scaling of the most probable traveling time, t* approximately r(1.64). We also calculate the length of the path corresponding to the minimal traveling time and find l(min) approximately r(1.13) and that the most probable traveling length scales as l* approximately r(1.21). We present the relevant distribution functions and scaling relations.

Journal Article↗
PubMed1993

Etiology of traveller's diarrhea in Spanish travellers to developing countries.

A cohort of 337 Spanish travellers to developing countries is presented. They all consulted us for traveller's diarrhea (TD). Bacteriological, parasitological and virological examinations were performed. A bacterial cause was found in 61.65% of travellers. Toxigenic and classical pathogenic Escherichia coli strains were the main bacterial agents. In comparison with other studies, Spanish travellers harboured Y. enterocolitica and EPEC organisms as a cause of TD. G. lamblia and E. histolytica were the most frequently isolated protozoa. Helminths were found in only 9 patients. No rotavirus infections were diagnosed. Previous antibiotic treatment had been taken by 161 patients. The percentage of isolated enteropathogens was similar in travellers who had previously taken antibiotic treatment and those who had not.

Adolescent↗
PubMedDate not supplied

Sex and travel: studies of sexual behaviour, disease and health promotion in international travellers--a global review.

Sexually transmitted diseases (STDs) continue to be the most common notifiable infectious conditions worldwide. Their unacceptably high incidence is underlined by the recent emergence of a (presently) incurable and lethal STD--human immunodeficiency virus (HIV) infection--which merits its description as a pandemic, and with which other STDs interact in an epidemiological synergy. Data that quantify the association between STDs/HIV infection with travel and difficult to obtain; nevertheless figures are presented that reveal the lower limit to be large enough to be of considerable concern. Studies from around the world show, overall, although knowledge of STDs is increasing amongst travellers, the level of knowledge has little to do with actual behaviour, with a modest increase in the use of condoms, but abundant evidence that a wide variety of sexual behaviours take place among travellers and with local inhabitants. Certain travellers, by virtue of their behavioural interactions with 'core-groups' of efficient transmitters, may have a high risk of acquisition of an STD/HIV. Worldwide, sexual health promotion for travellers is in its infancy; indeed, it could more accurately be merely described as 'sexual education'. A fresh approach is recommended, which includes comprehensive programme planning and outcome, impact, and process evaluations.

Female↗
PubMed1998

Is international travel useful for general practitioners? A survey of international travel scholarships.

BACKGROUND: The Royal College of General Practitioners has offered international travel scholarships for the past decade. Each year a number of general practitioners travel from the UK to work or study assisted by the scheme, while others come to this country for similar purposes. AIM: To investigate the value of international scholarships for recipients and others. METHOD: All those receiving awards in 1988-94 were surveyed by postal questionnaire. RESULTS: Fifty-one out of 58 award winners (88%) replied. Almost all cited some of a wide variety of personal benefits from international travel, and some established continuing links with colleagues overseas. Many gave examples of useful results for others, both patients and colleagues. Scholarships appear to have made a significant contribution to careers, especially for those based outside Britain. CONCLUSION: Relatively modest travel scholarships were viewed both favourably in hindsight and produced a wide range of benefits to recipients, colleagues, and patients. International travel should probably be considered more widely in career planning.

Education, Medical, Continuing↗
PubMed1999

Electronic network for monitoring travellers' diarrhoea and detection of an outbreak caused by Salmonella enteritidis among overseas travellers.

The Traveller's Diarrhoea Network, by which the Infectious Disease Surveillance Center is electronically connected with two major airport quarantine stations and three infectious disease hospitals, was launched in February 1988 in Japan. The data on travellers' diarrhoea detected is reported weekly by e-mail. Two clusters of infection among travellers returning from Italy were reported by two airport quarantine stations at the end of September 1998. A total of 12 salmonella isolates from 2 clusters were examined. All were identified as Salmonella enteritidis, phage type 4 and showed identical banding patterns on pulsed-field gel electrophoresis. A case-control study showed that the scrambled eggs served at the hotel restaurant in Rome were the likely source of this outbreak. This outbreak could not have been detected promptly and investigated easily without the e-mail network. International exchange of data on travellers' diarrhoea is important for preventing and controlling food-borne illnesses infected abroad.

Adult↗
PubMed2005

Travellers returning to Sweden with falciparum malaria: pre-travel advice, behaviour, chemoprophylaxis and diagnostic delay.

We have investigated pre-travel advice, behaviour, chemoprophylaxis and diagnostic delay in travellers returning to Sweden with falciparum malaria. Questionnaires were distributed to patients having been notified with falciparum malaria from 1994 to 2001. Of 408 notified patients, 237 (58%) returned the questionnaires; 62% were males and 43% above the age of 45 y. Africa was the travel destination in 90% of the cases, and 27% had travelled to Kenya. 69% had spent more than 1 night in the countryside, and 6% had stayed in modern urban areas only. 40% took an adequate dose of chemoprophylaxis, although this proportion decreased from 55% to 12% during the study period. Nine per cent used both bed nets and mosquito repellents regularly. The median time from onset of symptoms to contact with health care professionals was 2 d, and from that contact to start of malaria treatment the median time was less than 24 h.

Adolescent↗
PubMed1999

An Advisory Committee Statement (ACS). Committee to Advise on Tropical Medicine and Travel (CATMAT). Statement on meningococcal vaccination for travellers.

The Committee to Advise on Tropical Medicine and Travel (CATMAT) provides Health Canada with ongoing and timely medical, scientific, and public-health advice relating to tropical infectious disease and health risks associated with international travel. Health Canada acknowledges that the advice and recommendations set out in this statement are based upon the best current available scientific knowledge and medical practices, and is disseminating this document for information purposes to both travellers and the medical community caring for travellers. Persons administering or using drugs, vaccines, or other products should also be aware of the contents of the product monograph(s) or other similarly approved standards or instructions for use. Recommendations for use and other information set out herein may differ from that set out in the product monograph(s) or other similarly approved standards or instructions for use by the licensed manufacturer(s). Manufacturers have sought approval and provided evidence as to the safety and efficacy of their products only when used in accordance with the product monographs or other similarly approved standards or instructions for use.

Adolescent↗
PubMed2000

Do British travel agents provide adequate health advice for travellers?

Travel-related illness is a burden for primary care, with more than two million travellers consulting a general practitioner each year. The annual cost of travel-related illness in the United Kingdom is 11 million Pounds. Travel agents are in a unique position to influence this burden as the most common and most serious problems are preventable with simple advice and/or immunisation. This study, using covert researchers, suggests this potential is not being fully utilised.

Female↗
PubMed1994

[Health concerns of Israelis traveling to Third World countries--experience of a travel advisory clinic].

Following army service young Israelis often travel to remote third world regions for prolonged periods. During such tours, they are exposed to a variety of medical problems, including infections, environmental diseases, political violence and inability to obtain proper medical care. From May 1991 to Nov. 1992, 1,969 travelers aged 20-25 years old, and 926 older than 25, were given medical advice, vaccines and medications prior to travel. A clinic specializing in "emporiatrics" has been established to deal with pre- and post-travel medical problems associated with tourism.

Adult↗
PubMed2001

From periodic travelling waves to travelling fronts in the spike-diffuse-spike model of dendritic waves.

In the vertebrate brain excitatory synaptic contacts typically occur on the tiny evaginations of neuron dendritic surface known as dendritic spines. There is clear evidence that spine heads are endowed with voltage-dependent excitable channels and that action potentials invade spines. Computational models are being increasingly used to gain insight into the functional significance of a spine with an excitable membrane. The spike-diffuse-spike (SDS) model is one such model that admits to a relatively straightforward mathematical analysis. In this paper we demonstrate that not only can the SDS model support solitary travelling pulses, already observed numerically in more detailed biophysical models, but that it has periodic travelling wave solutions. The exact mathematical treatment of periodic travelling waves in the SDS model is used, within a kinematic framework, to predict the existence of connections between two periodic spike trains of different interspike interval. The associated wave front in the sequence of interspike intervals travels with a constant velocity without degradation of shape, and might therefore be used for the robust encoding of information.

Action Potentials↗
PubMed2001

An outbreak of travel-associated Legionnaires disease and Pontiac fever: the need for enhanced surveillance of travel-associated legionellosis in the United States.

Travel-associated outbreaks of legionnaires disease (LD) and combined outbreaks of LD and Pontiac fever (PF) are rarely identified. During one travel-associated combined outbreak at a hotel, a cohort study of potentially exposed persons and an environmental investigation were performed. Two LD and 22 PF cases were identified. Legionella pneumophila serogroup 6 (Lp6) isolates from the index patient and the hotel whirlpool spa were found to be identical by amplified fragment-length polymorphism typing. Disease occurred in 10 of 26 guests who were exposed to the spa versus 2 of 29 guests who were exposed only to the pool area (38% vs. 7%; P=.005). Immunoglobulin M (IgM) antibody to the outbreak Lp6 strain was more common among persons with PF (4 of 9) than among non-ill persons (2 of 32) (44% vs. 6%; P=.02). Spa exposure correlated with disease (P=.001) and IgM seropositivity (P=.007). New laboratory techniques facilitate outbreak investigation; to expedite outbreak interruption and measure the impact of travel-associated legionellosis, surveillance must be improved.

Adolescent↗
PubMed1994

Is travel prophylaxis worth while? Economic appraisal of prophylactic measures against malaria, hepatitis A, and typhoid in travellers.

OBJECTIVES: To estimate the costs and benefits of prophylaxis against travel acquired malaria, typhoid fever, and hepatitis A in United Kingdom residents during 1991. DESIGN: Retrospective analysis of national epidemiological and economic data. MAIN OUTCOME MEASURES: Incidence of travel associated infections in susceptible United Kingdom residents per visit; costs of prophylaxis provision from historical data; benefits to the health sector, community, and individuals in terms of avoided morbidity and mortality based on hospital and community costs of disease. RESULTS: The high incidence of imported malaria (0.70%) and the low costs of providing chemoprophylaxis resulted in a cost-benefit ratio of 0.19 for chloroquine and proguanil and 0.57 for a regimen containing mefloquine. Hepatitis A infection occurred in 0.05% of visits and the cost of prophylaxis invariably exceeded the benefits for immunoglobulin (cost-benefit ratio 5.8) and inactivated hepatitis A vaccine (cost-benefit ratio 15.8). Similarly, low incidence of typhoid (0.02%) and its high cost gave whole cell killed, polysaccharide Vi, and oral Ty 21a typhoid vaccines cost-benefit ratios of 18.1, 18.0, and 22.0 respectively. CONCLUSIONS: Fewer than one third of travellers receive vaccines but the total cost of providing typhoid and hepatitis A prophylaxis of 25.8m pounds is significantly higher than the treatment costs to the NHS (1.03m pounds) of cases avoided by prophylaxis. Neither hepatitis A prophylaxis nor typhoid prophylaxis is cost effective, but costs of treating malaria greatly exceed costs of chemoprophylaxis, which is therefore highly cost effective.

Antimalarials↗
PubMed1985

Changes during travel in the composition and antibiotic resistance pattern of the intestinal Enterobacteriaceae flora: results from a study of mecillinam prophylaxis against travellers' diarrhoea.

A randomized double-blind study was carried out in a group of Danish students visiting Mexico for 2 weeks to investigate the efficacy of mecillinam when given orally in preventing travellers' diarrhoea. The subjects took either 200 mg mecillinam daily as a single dose or placebo for 14 days. Nine (56%) out of 16 taking placebo and 3 (19%) out of 16 taking mecillinam developed travellers' diarrhoea (p less than 0.05). The pathogenic aetiology was not ascertained. A complete change in the Enterobacteriaceae flora took place during travel. A highly antibiotic-resistant Enterobacteriaceae flora was acquired in Mexico in subjects on mecillinam prophylaxis as well as on placebo. Selection of mecillinam-resistant bacteria was minimal.

Adult↗
PubMedDate not supplied

Travel health insurance: indicator of serious travel health risks.

BACKGROUND: Travel health risks documented by questionnaire surveys obtained (e.g., during homebound flights) are incomplete since they miss most patients who need to be repatriated. METHODS: All patient claim files were reviewed from 1997 to 1998, of the largest Swiss travel insurance company. RESULTS: Among 242 claims, 69.4% were due to illness, 30.6% due to accidents; infections were the most frequent illnesses, the extremities were the most frequently traumatized part of the body. Although the illness-to-accident ratio was 1:5 in industrialized countries and the Caribbean, it exceeded 3:0 in some developing regions. Accident proneness was noted in the first week abroad. CONCLUSION: Even if no denominator data are available, this analysis offers an insight in travel health risks, allowing comparison of the occurrences of very different, serious, health problems abroad.

Accidents↗
PubMed1996

[Travel outside the home and perceived problems with such travel, among elderly people in a small town].

To study travel outside the home by elderly people and perceived problems with such travel, a questionnaire was sent to 238 men and women aged 60-year-old and over living in a small town in Kanagawa prefecture. Public transportation in this town consists mainly of buses, and the bus ride from the nearest train station takes about 50 minutes. A total of 190 people responded (83.3%, after exclusion of those who had died, moved away, or were in the hospital). Of those 190 people, 166 (74 men and 92 women) went out by themselves and their responses were analyzed. About 50% of both men and women said that they go to the hospital once or twice a month and go out for hobbies less than several times a year. The means of transportation differed according to sex and age: 80% of men in their 60s said that they drive alone, but many men in their 70s and older said that they ride buses or walk. Women in all the age studied said that they ride buses or drive with others. More than 50% of men and women reported problems with transportation: men reported anxiety about driving alone and women reported difficulties with the poor means of transportation or when walking upstairs or uphill. Many men and women in their 80s said that they would rather not be driven places by others or be helped by others while riding trains or buses. These findings show the patterns of travel outside the home by elderly people of different ages, and the problems these people perceive with regard to various modes of transportation. They should be useful in the design of transportation suitable to older people.

Activities of Daily Living↗
PubMed2006

[Prevention of diseases in the traveller; the returning traveller].

In recent years there has been a spectacular increase in international journeys and the WHO calculates that by the year 2015 the number of long distance journeys will have doubled in comparison with twenty years before. Travelling involves a series of risks, which become higher the poorer the social and health situation of the country of destination. According to different studies, between 20 and 70% of travellers suffer from some type of health problem during their journey. The main causes of mortality during a journey are, in order of importance, accidents, cardiovascular diseases and transmissible diseases. This article sets out the current criteria and recommendations regarding general health advice, recommended vaccinations, anti-malaria chemoprophylaxis and special physiological (children and the pregnant women) and clinical (chronic diseases) situations of interest to travellers, in order to prevent health problems and as far as possible to guarantee a safe and profitable journey.

Humans↗
PubMed1989

[Travel medicine: status of current recommendations for preventive measures in international travel].

More than 140,000 Austrians per year travel to warm climate countries of the Third World. They have to face the risk to acquire communicable diseases during their stay. Therefore, precise recommendations concerning prophylactic measures are important and necessary. This review deals with the range of actual health advice for Austrian travellers and tries to give a rationale. In detail, active and passive immunizations are discussed and, in addition, the actual situation on malaria chemoprophylaxis is described as relevant for international travel.

Antimalarials↗