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PubMed2005

Update on travelers' health.

As an international traveler, contact your health care provider at least 4 to 6 weeks before departure to obtain needed vaccinations and prophylactic medications. Be aware of the occurrence of any disease outbreaks in the countries you are visiting. While traveling, don't forget that one of the most important practices in preventing illness from infections is handwashing. Wash your hands carefully and frequently with soap and water, and if soap and water are not available use an alcohol-based hand rub. Be a responsible traveler by becoming informed about health risks and what to do to avoid them before you travel.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Grey nomads--health and health preparation of older travellers in remote Australia.

BACKGROUND: Many older Australians now tour remote Australia (so called 'grey nomads'). Anecdote suggests they place a burden on limited remote health services, however, this burden is poorly documented. METHODS: Two groups were approached to participate in the survey: travellers aged 50 years or over and staying in caravans, motor homes or tents at Fitzroy Crossing, Western Australia; and local primary health care providers. RESULTS: All 260 travellers approached responded. The prevalence of chronic diseases in those aged 65 years or over was 68%; 57% had sufficient chronic medications for the entire trip; 19% had a list of long term medications; and 9% of those with chronic diseases had a health summary from their usual general practitioner. Sixty-four local health providers responded: 95% rated health summaries highly (particularly if they included an active problem list, past history, current medications, and allergies). DISCUSSION: Older patients are poorly prepared for travel in remote Australia. They have a chronic disease rate no less than the national prevalence and could represent a drain on local health resources. Solutions might include GP review before travel, bringing sufficient medication for the trip, review of vaccination requirements, and a health summary.

Age Factors↗
PubMed2006

[Diarrhoea in the traveller].

Diarrhoeic diseases caused by water and food contaminated by enteropathogens continue to be an important cause of morbidity in countries with a low level of development. Some 50,000 cases of diarrhoea in travellers are estimated in the world every day, and this is the main cause of consultation by travellers who return from undeveloped zones. The principal determinant of risk is the place of destination; there are significant differences between different regions with respect to risk and to the aetiology of the diarrhoea. The most frequent cause of diarrhoeas is of bacterial origin, which represents between 60 and 85% of the cases, while parasites represent 10% and some 5% are produced by viruses. Although it normally follows a benign course, complications can arise, with mortality being only exceptionally associated to this disease. Prevention is essentially based on strictly following elemental hygienic measures and avoiding the ingestion of foodstuffs and drinks with a risk of contamination. Prophylaxis with antibiotics is only advisable in journeys of short duration, in which the risk and/or seriousness of diarrhoeas, above all in immunosuppressed patients, are higher than the possible collateral effects. The treatment of diarrhoea in the traveller is based on adequate hydration, and the use of microbians is reserved for moderate and serious situations, with quinolones being the drug of choice. Rifaximine is a new drug approved for the treatment of diarrhoeas in the traveller, above all in areas with enteropathogens that are resistant to quinolones.

Diarrhea↗
PubMed2006

A randomized, double-blind, multicenter study of rifaximin compared with placebo and with ciprofloxacin in the treatment of travelers' diarrhea.

Rifaximin was compared with placebo and ciprofloxacin for treatment of travelers' diarrhea in a randomized, double-blind clinical trial. Adult travelers (N = 399) consulting travel clinics in Mexico, Guatemala, and India were randomized to receive rifaximin 200 mg three times a day, ciprofloxacin (500 mg two times a day and placebo once a day), or placebo three times a day for 3 days. Patients recorded in daily diaries the time and consistency of each stool and documented symptoms for 5 days after treatment. Stool samples were collected for microbiologic evaluations before and after treatment. The median time to last unformed stool (TLUS) in the rifaximin group (32.0 hours) was less than one half that in the placebo group (65.5 hours; P = 0.001; risk ratio 1.6; 95% confidence interval 1.2, 2.2; primary efficacy endpoint). The median TLUS in the ciprofloxacin group was 28.8 hours (P = 0.0003 versus placebo; P = 0.35 versus rifaximin). Rifaximin was less effective than ciprofloxacin for invasive intestinal bacterial pathogens. Oral rifaximin is a safe and effective treatment of travelers' diarrhea caused by noninvasive pathogens.

Adolescent↗
PubMed2006

[Medical problems of the elderly traveler].

Prior good medical preparation and counseling enable senior citizens to travel abroad in safety. The recommendations for travel vaccinations apply also to the elderly traveler. In addition, adequate protection against viral influenza and pneumococci must be ensured. In the case of travelers to Mediterranean countries, suitable protection against mosquito bites should be provided (leishmaniasis). Those with previous diseases should carry with them a copy of a recent resting ECG, and a list of medicaments with the international generic names.

Age Factors↗
PubMed2006

[Histoplasmosis among travellers to Central America].

BACKGROUND: In April 2004, the Norwegian Institute of Public Health was notified about an outbreak of a respiratory illness among participants on a cultural-historical theme tour to Central America. One patient was examined in a Swedish hospital where the clinician suspected histoplasmosis, which later was verified by serology and by culture of Histoplasma capsulatum. In order to describe the outbreak and identify the possible source of infection, a clinical and epidemiological study was conducted. MATERIAL AND METHODS: A questionnaire on symptoms, treatment and participation in various activities was sent to all the tour participants. Reminders were sent by e-mail. In addition, some participants underwent a more detailed clinical examination. RESULTS: 19 of the 21 travellers completed the questionnaire. All travellers had visited several caves inhabited by bats in El Salvador and Guatemala. During the last 10 days of the journey, 16 of the respondents (84%) acquired a respiratory illness that lasted for more than 3 weeks. The diagnosis was confirmed by serology in 8 of the 14 tested cases. Antibacterial therapy was given to 11 patients and antifungal therapy to 3 patients. Only one patient was hospitalised. INTERPRETATION: The described outbreak of histoplasmosis was probably caused by exposure to Histoplasma capsulatum during a visit in bat-infested caves. Due to the increasing popularity of adventure and theme travels, this disease may become more frequent in our population. The condition should be considered in travellers with prolonged respiratory illness after visits to caves or other closed environments with little circulation of air that are potentially contaminated with bat or bird droppings. Persons with immunosuppression may develop severe illness, and should consider avoiding places with increased risk.

Adult↗
PubMed1991

Imported Plasmodium falciparum malaria in American travelers to Africa. Implications for prevention strategies.

Data from the US National Malaria Surveillance System were analyzed to assess characteristics of travelers who acquired Plasmodium falciparum infections in Africa and evaluate the impact of chloroquine resistance on the incidence of imported malaria. Although the number of cases acquired in East Africa has stabilized, the number of imported P falciparum infections acquired in West Africa increased threefold from 1985 to 1988, and the proportion of travelers who reported failure of chloroquine prophylaxis increased from 10% to 48%. Fifty-eight percent of patients who acquired malaria in West Africa had not used chemoprophylaxis. To curb the rising incidence of P falciparum infections in American travelers, the Centers for Disease Control revised malaria prophylaxis recommendations to include the use of mefloquine in areas of chloroquine resistance. Use of malaria protection measures by travelers to West Africa must also be improved.

Africa, Eastern↗
PubMed1990

The risk of developing decompression sickness during air travel following altitude chamber flight.

Approximately 35,000 students are trained annually in United States Air Force (USAF) altitude chambers. Students who depart the training site via aircraft on the same day as their altitude chamber exposure may place themselves at increased risk for decompression sickness (DCS). Air travel as a passenger in the immediate post-chamber flight period is unrestricted by current USAF regulations. A retrospective study was conducted to assess the potential risk involved in such post-chamber flight travel. During the years 1982-87, there were 292 cases of DCS involving altitude chamber students which were subsequently treated with hyperbaric oxygen therapy. Only seven cases were found wherein the student was asymptomatic prior to air travel and subsequently developed DCS. Because the percentage of students who postpone travel is unknown, a precise relative risk could not be determined. Although the number of cases where sequential chamber and aircraft hypobaric exposures has initiated DCS is small, the potential for such occurrences remains a health concern.

Aerospace Medicine↗
PubMed1990

[Diarrhea in returning travellers (etiology, diagnosis and therapy)].

International tourism is constantly expanding and traveller's diarrhea has become a common disease. Although traveller's diarrhea may already have ceased after return, more and more general practitioners are confronted with patients complaining of GUT-symptoms associated with the journey. To manage these patients the precise knowledge of the etiology of traveller's diarrhea and the forms leading to chronic diarrhea is mandatory. This review deals with the etiology of diarrhea after returning home from tropical/subtropical areas and gives special emphasis on adequate diagnosis and treatment. It also points to the importance of parasites as cause of chronic traveller's diarrhea. Parasitic disease needs more often antibiotic treatment than infectious diarrhea due to bacterial agents. We summarize the etiology, the diagnostic and therapeutic approach.

Algorithms↗
PubMed1990

Enteric fever among Israeli travelers in Nepal: the need for typhoid vaccination.

Enteric fever is still an endemic disease in many developing countries. Most authorities recommend typhoid vaccination for travelers from developed countries to developing countries, particularly in the Indian subcontinent. The Ministry of Health in Israel, however, does not recommend typhoid vaccination to Israeli travelers going to any developing countries. In a study undertaken at a Western-run clinic in Kathmandu, Nepal, we found the rate of typhoid fever infection to be seven times higher among 243 Israeli travelers treated at the clinic for all causes than among 2,866 other Western tourists. The typhoid vaccination rate of the Israeli tourists was 6% compared with 91% for the other Western tourists. We could not detect any differences between the Israeli tourists and the others except for the vaccination status. We conclude that the high rate of enteric fever among Israelis is due to the lack of typhoid vaccination, and we recommend typhoid vaccine for all travelers to the Indian subcontinent.

Adult↗
PubMed1989

Survey of general practitioners' advice for travellers to Turkey.

Fifty general practitioners replied to a survey of the advice that they would offer to a tourist planning a package holiday in western Turkey. The range of prophylactic immunizations and other medication recommended by the respondents was wide, suggesting that some tourists travel without adequate protection, while some receive unnecessary injections. Most of the doctors would offer little other health advice to the traveller. General practitioners receive conflicting guidance on prophylactics for travellers, and it is suggested that the disagreements should be resolved. Wider availability of written advice for the traveller would also be valuable.

Data Collection↗
PubMed1979

Immunization and health advice for international travelers.

Physicians are increasingly being called upon to advise travelers regarding health matters. Travel to virtually all parts of the world can be medically safe, given a modest investment of effort to provide appropriate immunizations and education of travelers regarding precautionary steps regarding food, drink and other matters. Instruction regarding the self administration of a few simple drugs is reasonalbe for most patients anticipating prolonged travel in tropical areas.

Beverages↗
PubMedDate not supplied

Traveler's diarrhea-I. Definition, etiology and epidemiology.

With the development of rapid and convenient means of transportation, several million persons travel from industrialized countries to developing countries every year. From USA alone, approximately 4 million persons visit Mexico annually. These travelers are at risk to develop several infections during their stay abroad, but the most commonly experienced illness is diarrhea. The attack rate of diarrhea in travelers may be as high as 25 to 50 percent; 30 percent of those who get diarrhea are ill enough to be confined to bed and another 40% have to change their scheduled travel plans. The disease affects all ranks and it has achieved worldwide fame by its several euphemisms. Various epithets used to describe this illness include GI trots, Aden gut, Barsa belly, Turkey trot, Delhi belly, Hongkong dog, Montezuma's revenge, gyppsy tummy and turista. There have been considerable advances in our understanding about the etiology and epidemiology of this disease in the last two decades and the purpose of this review is to highlight some of this new information.

Diarrhea↗
PubMed1986

[Enteropathogens in travellers returning from the tropics].

Diarrhea is not only the most common health hazard during travel in the tropics but also the most frequent condition which prompts returning travellers to see a physician. The prevalence of bacterial and parasitic enteropathogens in people attending our outpatient department after returning from the tropics has been studied and the laboratory results of stool examinations have been compared with clinical symptoms. Of the 173 persons enrolled, 19 (11%) harboured bacterial pathogens and pathogenic protozoans (Giardia lamblia and Entamoeba histolytica) were found in 26 (15%). The data of 156 patients were evaluated. Enteropathogenic bacteria and/or protozoa were found in 29 (46%) of the 63 patients presenting with diarrhea at the time of investigation. In contrast, 10 (11%) of the 93 asymptomatic subjects had enteropathogenic organisms in the feces (p less than 0.01). The results appear to confirm that bacteriological stool examinations of travellers returning from the tropics without diarrhea are not usually indicated, even if a history of transient travellers' diarrhea is reported. Parasitological investigations are justified in this group only if asymptomatic carriage of Giardia or E. histolytica is considered an indication for specific treatment.

Aeromonas↗
PubMed1989

Pregnancy and travel.

The special problems of travel during pregnancy have become clinically important as more women are traveling to remote places for business or recreation. Optimal maintenance of fetal and maternal health under these circumstances entails specific considerations for which data, unfortunately, remain incomplete. Nevertheless, questions regarding immunizations, antimalarials, therapy for traveler's diarrhea, and even the risks of high altitude or vigorous exercise for the pregnant woman may be examined clinically. With a few important exceptions, sufficient information is available to ensure relatively safe travel in pregnancy provided precautions are taken and preparations are made.

Aircraft↗
PubMed1988

A cost-effectiveness comparison of the use of antimicrobial agents for treatment or prophylaxis of travelers' diarrhea.

We conducted a decision analysis to compare the cost-effectiveness of antimicrobial agents used for treatment with their use for prophylaxis of travelers' diarrhea. Estimates of the likelihood and the cost of various outcomes were obtained from a panel of experts using the Delphi group opinion technique. Treatment with sulfamethoxazole-trimethoprim for three days was compared with daily prophylaxis with sulfamethoxazole-trimethoprim or doxycycline. The cost-effectiveness of prophylaxis with either agent (75% to 83%) was greater than that of treatment (38%). Treatment would become more cost-effective than prophylaxis when the cumulative risk of acquiring travelers' diarrhea was less than 0.05 episodes per person per week or if the effectiveness of prophylaxis fell below 35% for doxycycline and 46% for sulfamethoxazole-trimethoprim. The most important contributor to the mean cost of travelers' diarrhea in this analysis was the cost associated with a day of incapacitation due to illness. On the basis of the results of this decision analysis, we conclude that prophylaxis of travelers' diarrhea is an option that should be considered for individual situations and recommend further studies of its cost-effectiveness.

Anti-Bacterial Agents↗
PubMed1988

International travel amongst patients on chronic anticoagulation therapy.

The travel habits of a group of patients on anticoagulants after heart valve replacements with mechanical prostheses have been investigated. In spite of their advanced mean age (63 at follow-up) more than half of the patients (55%) thought that they could travel without problems. Of those who had been travelling 56% had been to a foreign country. Only 5% had check-ups of prothrombin time when staying abroad. The adoption of the International Normalized Ratio for prothrombin control, patient education and international agreements making it easier to have check-ups of prothrombin time, can result in more patients on anticoagulants, for different reasons, to travel, thus increasing their quality of life.

Anticoagulants↗
PubMed1988

In-flight deaths during commercial air travel. How big is the problem?

Do passenger deaths occur during commercial air travel? If so, how often and from what causes? We reviewed information reported to the International Air Transport Association on in-flight deaths that occurred during commercial air travel for the eight years between 1977 and 1984. Of the 120 airlines in the International Air Transport Association, 42 carriers reported deaths during these eight years. A total of 577 in-flight deaths were recorded, for a reported average of 72 deaths per year. Deaths occurred at average rates of 0.31 per million passengers, 125 per billion passenger-kilometers, and 25.1 per million departures. The majority of those who died were men (66%, 382/577) and middle-aged (mean age, 53.8 years). Most of the individuals (77%, 399/515) reported no health problems prior to travel. Physicians aboard the aircraft offered medical assistance for 43% (247/577) of the deaths. More than half of the deaths (56%, 326/577) seemed to be related to cardiac problems. Sudden unexpected cardiac death was the cause of death in 63% (253/399) of the apparently healthy people and seems to be the major cause of death during air travel. These observations support the initiation of programs to train cabin personnel in the skills of basic cardiopulmonary resuscitation and in the use of automatic external defibrillators.

Adult↗