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PubMed2002

Prevention and self-treatment of travelers' diarrhea.

Of the 50 million people who travel from the industrialized world to developing countries every year, between 20% and 50% will develop at least one episode of diarrhea, making it the most common ailment of travel. Although usually a mild illness, travelers' diarrhea can result in significant morbidity and hardship while overseas. Precautions can be taken to minimize the risk of developing diarrhea. If diarrhea does develop despite precautions, effective treatment, usually a combination of an antibiotic and an antimotility agent, can be taken along and started by the traveler at the onset of symptoms.

Antibiotic Prophylaxis↗

PubMed2001

Vaccines for international travel.

American travelers increasingly are selecting exotic destinations in the developing world. This poses a challenge to primary care clinicians who wish to provide recommendations to their patients regarding optimal protection from infectious disease risks. Recommendations should be individualized for each traveler and journey, accounting for personal health, health risks of specific destinations, style of travel, and activities anticipated. This article updates practitioners on the essentials of immunization before international travel.

Adolescent↗

PubMed2000

Travel and risk of venous thrombosis.

In 1998 the term economy class syndrome was coined to describe the association between travel and thrombosis. A fair risk estimate, however, has not been done. We report the results of a prospective study, in which we kept the effect of bias to a minimum. We compared travel history in 788 patients with venous thrombosis with that of controls with similar symptoms but in whom the disease had been excluded. For air travel alone, the odds ratio was 1.0 (95% CI 0.3-3.0); also, no association was recorded for other methods of transportation. We have shown that, there is no increased risk of deep vein thrombosis among travellers.

Adolescent↗

PubMed2000

Atovaquone-proguanil versus chloroquine-proguanil for malaria prophylaxis in non-immune travellers: a randomised, double-blind study. Malarone International Study Team.

BACKGROUND: Chloroquine plus proguanil is widely used for malaria chemoprophylaxis despite low effectiveness in areas where multidrug-resistant malaria occurs. Studies have shown that atovaquone and proguanil hydrochloride is safe and effective for prevention of falciparum malaria in lifelong residents of malaria-endemic countries, but little is known about non-immune travellers. METHODS: In a double-blind equivalence trial, 1083 participants travelling to a malaria-endemic area were randomly assigned to two treatment groups: atovaquone-proguanil plus placebos for chloroquine and proguanil, or chloroquine, proguanil, and placebo for atovaquone-proguanil. Follow-up was by telephone 7 and 60 days after travel and at a clinic at 28 days. Serum samples were tested for antibodies to a malaria circumsporozoite protein. Blood and serum samples of participants with a potential malaria diagnosis were tested in a reference laboratory. FINDINGS: 7 days after travel, at least one adverse event was reported by 311 (61%) of 511 participants who received atovaquone-proguanil and 329 (64%) of 511 who received chloroquine-proguanil. People receiving atovaquone-proguanil had a lower frequency of treatment-related gastrointestinal adverse events (59 [12%] vs 100 [20%], p=0.001), and of treatment-related adverse events of moderate or severe intensity (37 [7%] vs 56 [11%], p=0.05). There were fewer treatment-related adverse events that caused prophylaxis to be discontinued in the atovaquone-proguanil group than in the chloroquine-proguanil group (one [0.2%] vs ten [2%], p=0.015). INTERPRETATION: Overall the two preparations were similarly tolerated. However, significantly fewer adverse gastrointestinal events were observed in the atovaquone-proguanil group in than in the chloroquine-proguanil group.

Adolescent↗

PubMedDate not supplied

Transmission of infectious diseases during commercial air travel.

Because of the increasing ease and affordability of air travel and mobility of people, airborne, food-borne, vector-borne, and zoonotic infectious diseases transmitted during commercial air travel are an important public health issue. Heightened fear of bioterrorism agents has caused health officials to re-examine the potential of these agents to be spread by air travel. The severe acute respiratory syndrome outbreak of 2002 showed how air travel can have an important role in the rapid spread of newly emerging infections and could potentially even start pandemics. In addition to the flight crew, public health officials and health care professionals have an important role in the management of infectious diseases transmitted on airlines and should be familiar with guidelines provided by local and international authorities.

Aerospace Medicine↗

PubMed2006

Activation of coagulation system during air travel: a crossover study.

BACKGROUND: There is an increased risk of venous thrombosis after air travel, but the underlying mechanism is unclear. Our aim was to ascertain whether flying leads to a hypercoagulable state. METHODS: We did a crossover study in 71 healthy volunteers (15 men, 56 women), in whom we measured markers of activation of coagulation and fibrinolysis before, during, and after an 8-h flight. The same individuals participated in two control exposure situations (8-h movie marathon and daily life) to separate the effect of air travel on the coagulation system from those of immobilisation and circadian rhythm. To study the effect of risk factors for thrombosis, we included participants with the factor V Leiden mutation (n=11), those who took oral contraceptives (n=15), or both (n=15), as well as 30 individuals with no specific risk factors. FINDINGS: After the flight, median concentrations of thrombin-antithrombin (TAT) complex increased by 30.1% (95% CI 11.2-63.2), but decreased by 2.1% (-11.2 to 14) after the cinema and by 7.9% (-16.2 to -1.2) after the daily life situation. We recorded a high response in TAT levels in 17% (11 of 66) of individuals after air travel (3% [2 of 68] for movie marathon; 1% [1 of 70] in daily life). These findings were most evident in the group with the factor V Leiden mutation who used oral contraceptives. We noted a high response in all variables (prothrombin fragment 1 and 2, TAT, and D-dimer) in four of 63 (6.3%) volunteers after the flight, but in no-one after either of the control situations. INTERPRETATION: Activation of coagulation occurs in some individuals after an 8-h flight, indicating an additional mechanism to immobilisation underlying air travel related thrombosis.

Adult↗

PubMed1997

General medical advice for travelers.

Millions of people travel to developing countries, many of which are in the tropics, where the risk of becoming injured or sick is markedly increased and the access to appropriate medical treatment is markedly decreased. There are also common medical problems that all travelers confront, no matter what their itinerary. This article describes several traveling strategies for treating some common medical problems, lowering risk, and being able to get help should an emergency occur. Preparation is the watchword for the traveler.

Circadian Rhythm↗

PubMed1997

Pregnancy and travel.

Travel is not generally contraindicated during pregnancy, but there are some risks. The pregnant traveler needs a careful predeparture evaluation, and her itinerary should not take her far from available medical and obstetric care. The pregnant traveler must avoid diseases (such as malaria and hepatitis E) that can have devastating effects. Travel must be curtailed when there would be potential exposure to certain infectious diseases or extreme environmental conditions.

Contraindications↗

PubMed1998

Screening returning travelers.

Posttravel screening is the clinical and laboratory assessment of an individual aimed at uncovering occult infections, pathology, or health risks, the treatment of which will yield a significant health benefit to the individual. Screening must be tailored to the different risk patterns associated with different travel categories (e.g., missionary, tourist). Screening, predominantly a secondary prevention strategy, is most cost-effective when integrated with primary prevention strategies aimed at preventing future travel related illness (Table 6). The screening process begins with a medical history that allows a definition of risks and a tailored approach to laboratory tests. The screening tests currently available for STDs, tuberculosis, and parasitic infections have been reviewed, and although cost-effectiveness data are not available for most post-travel screening tests, recommended approaches are proposed. Traditionally, screening has been directed at uncovering occult infectious disease (STDs, tuberculosis, and parasitic infections). Important benefits can be gained, however, by including screening questions and tests for those diseases that are the major causes of mortality, both in nontraveling and in traveling North Americans, that is, the atherosclerotic and neoplastic diseases and trauma, especially vehicular.

Feces↗

PubMed1998

Eosinophilia in the returning traveler.

Eosinophilia is one of the most common laboratory abnormalities seen in the returning traveler. Although elevations in peripheral eosinophil levels can occur in a wide variety of disease processes, worldwide, helminth parasites are the major group of infectious agents responsible for eosinophilia. While often directed at helminth infections in their early stages of clinical evolution, the approach to the evaluation of the returning traveler with eosinophilia must consider the many causes of eosinophilia including those not casually related to travel. This article reviews the major parasitic causes of eosinophilia and provides a systematic approach to the evaluation of eosinophilia following travel.

Eosinophilia↗

PubMed1998

The ethnic minority traveler.

Although the ethnic minority traveler is exposed to the same risks as other travelers, there are special considerations that make them vulnerable to certain diseases. In addition, many ethnic minority travelers are traditionally underserved by the medical community and often travel without the benefit of adequate counseling and immunization. The specific disease entities covered in this article include parasitic diseases (e.g. malaria, trypanosomiasis, intestinal helminths), tuberculosis, and other respiratory diseases, dengue, and sexually transmitted diseases and HIV.

Blood Transfusion↗

PubMed1999

Travel vaccines.

Travel-related infectious diseases are exceedingly common, difficult to diagnose, and sometimes preventable. Vaccination is one tool for reducing the risk of infectious disease for some travelers. Both healthcare providers and travelers need to be aware of the new travel vaccines, and new formulations of older vaccines that now are available. This article presents an update on vaccines for cholera, Japanese encephalitis, rabies, rotavirus, typhoid, and malaria.

Communicable Disease Control↗

PubMed2003

Sexually transmitted diseases and travel.

Sexually transmitted diseases (STDs) are infections and resulting clinical syndromes caused by more than 25 infectious organisms transmitted through sexual activity. International travellers are at great risk of contracting any of these STDs, including HIV, if they have been sexually exposed to persons with any of these diseases. Population movement has been shown to be a major contributing factor in the global spread of STDs. Increased sexual promiscuity and casual sexual relationships tend to occur during travel abroad to foreign countries. Travellers should be aware that the risk of STDs is high especially in the developing countries and sexual encounter with casual partners or commercial sex workers (CSWs) carries a high risk of infection. Prevention of STDs during travel can be achieved by complete abstinence from sexual exposure or adopting safe sexual practices such as consistently and correctly using a latex condom during sexual contact.

Female↗

PubMed2001

Cost analysis of two strategies for preventing hepatitis A virus infection in Spanish travellers to developing countries.

Our objectives were to assess the prevalence of anti-hepatitis A (HAV) antibodies in Spanish travellers to developing countries and to carry out a cost analysis to allow the comparison of two vaccination strategies. Adult subjects were selected from among travellers to developing countries. Information was obtained on age, sex, destination, previous vaccination against HAV and having received immunoglobulin. Blood specimens were obtained for anti-HAV antibody determination. A total of 485 travellers were studied. The prevalence of anti-HAV antibody was 30.5% (95% CI 26-35). Antibody prevalence was inversely correlated with age: 9.8% in 18-25 years of age, rising to 75.4% in those 41-55 years of age. Cost analysis determined that the critical value of prevalence for vaccination with HAV vaccine was 37.5%. It was concluded that the youngest Spanish travellers lack anti-HAV antibodies. Vaccination without screening in those < or = 35 years of age and screening before vaccination for those > 35 years, are the preferred alternatives.

Adult↗

PubMed2003

Forecasting the geographical spread of smallpox cases by air travel.

Instituting air travel restrictions to slow the geographical spread of smallpox cases would have significant consequences and present serious logistical concerns. Public health decision makers must weigh the potential benefits of such restrictions against their negative impact. The goal of this research is to provide a basic analytical framework to explore some of the issues surrounding the use of air travel restrictions as a part of an overall containment strategy. We report preliminary results of a compartmental model for the inter-city spread of smallpox cases resulting from US domestic air travel. Although air traffic can be halted within hours as was shown following the terrorist attacks of 11 September 2001, these results suggest that the consequences of halting domestic air travel may not be outweighed by public health benefits.

Aircraft↗

PubMed2004

SARS preventive and risk behaviours of Hong Kong air travellers.

This study aims to investigate Severe Acute Respiratory Syndrome (SARS)-related behaviours of travellers returning to Hong Kong by air. A total of 820 travellers returning to Hong Kong by air were interviewed about their SARS-related behaviours in April 2003. Three quarters of the respondents wore a mask most/all of the time on board, 15% did so in public places at the travel destination. Perceived susceptibility to SARS at the destination predicted mask-wearing in public places and avoidance of crowded places, and perceived efficacy was a predictor for mask-wearing during flight. Approximately 16% of the respondents stated that they would delay their medical consultation for flu-like symptoms until returning to Hong Kong. Nearly 18.2% stated that they would not wear a mask in public places at the destination if they had flu-like symptoms. Education programmes, special services and effective thermal screening are required to minimize the chance of the spread of SARS by air travellers.

Adolescent↗

PubMed1997

Incidence and clinical symptoms of Aeromonas-associated travellers' diarrhoea in Tokyo.

In a survey examining the causes of travellers' diarrhoea treated in Tokyo between July 1986 and December 1995, Aeromonas species were isolated from 1265 (5.5%) of 23,215 travellers returning from developing countries. Aeromonas species were the fourth most frequent enteropathogen isolated, following enterotoxigenic E. coli (8.5%), Salmonella spp. (7.6%) and Plesiomonas shigelloides (5.6%). Aeromonas species were found in 1191 (5.6%) of 21,257 patients with diarrhoea and in 74 (3.8%) of 1958 healthy individuals without diarrhoea. Mixed infection was observed in 512 (40.5%) cases. No significant difference in the prevalence of Aeromonas by year, season, age distributions, or sex was observed, but a slight difference was noted depending on the country where the travellers visited. Of the 1265 Aeromonas isolates, 893 strains (70.6%) were A. veronii biovar sobria, 330 (26.1%) were A. hydrophila, and 42 (3.3%) were A. caviae. The clinical symptoms of patients from whom Aeromonas species was isolated as the only potential enteric pathogen were almost similar, which were watery diarrhoea (about 60%), abdominal cramps (43%), fever (around 15%), and nausea or vomiting (13%). Although the severity of illness was milder than that of enterotoxigenic E. coli alone, these data suggest that Aeromonas species are important enteric pathogens in travellers' diarrhoea.

Aeromonas↗

PubMed2004

Modeling the spread of annual influenza epidemics in the U.S.: the potential role of air travel.

The role of air travel in the global spread of influenza has been the subject of a significant body of research, but this question has yet to be explored within the U.S. The goal of this research is to explore whether knowledge of U.S. air travel patterns and volumes leads to better forecasting of epidemics. We report the results of a series of simulations for the 1998-1999 through 2000-2001 influenza seasons using a standard compartmental model coupled with air transportation data. These preliminary results suggest that air travel may play an important role in the spread of annual influenza within the U.S., particularly in cities with large air travel volumes.

Aircraft↗