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PubMed1987

HIV infection and international travel.

Screening international travelers for human immunodeficiency virus (HIV) antibodies does little to prevent the spread of the acquired immune deficiency syndrome. Individuals who are seropositive for HIV antibodies and wish to travel abroad will be subject to varying restrictions, depending on the severity of their illness and the entrance requirements for specific countries. International travel is not a risk factor for HIV infection, since routes of HIV transmission appear to be uniform worldwide. However, prudent precautions are recommended because international travel may modify an individual's risk profile.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Leucopenia and abnormal liver function in travellers on malaria chemoprophylaxis.

Of 2887 travellers between the years 1984-1985, 451 on prophylactic antimalarials were studied retrospectively for adverse haematological or hepatic drug reactions and compared to 296 drug non-users. Travellers using amodiaquine, chloroquine, or pyrimethamine for less than 10 weeks had significantly lower total leucocyte counts than non-users. This was due to diminution of lymphocytes, not neutrophils. Travellers using amodiaquine for less than 10 weeks also had significantly higher serum aspartate aminotransferase (SGPT) levels than non-users. Amodiaquine was associated with a 3.1-times increased risk (95% confidence limits 1.8-5.4) of abnormal SGPT values. We consider toxic products, including metabolites of amodiaquine, the most likely cause of amodiaquine-related hepatotoxicity in travellers.

Adolescent↗
PubMed1979

Prophylactic doxycycline for travelers' diarrhea: results of a prospective double-blind study of Peace Corps volunteers in Morocco.

A second randomized double-blind study to determine the efficacy of doxycycline, 100 mg daily, for the prevention of travelers' diarrhea was carried out among 50 Peace Corps Volunteers during their first 10 wk in Morocco. The volunteers took either doxycycline or placebo for 3 wk, and were observed for an additional 7 wk. Eleven of 24 taking the placebo and 2 of 26 taking doxycycline had travelers' diarrhea during the treatment period (P less than 0.01). One week after cessation of the doxycycline, however, persons in that group developed an increase in frequency of travelers' diarrhea (P less than 0.05) so that by 3 wk after the drug was stopped, there were no differences between groups. Enterotoxigenic E. coli, most of which were sensitive to doxycycline, were the most frequently isolated pathogens during the entire study. This study corroborates the effectiveness of doxycycline prophylaxis for travelers' diarrhea.

Adult↗
PubMed1983

Brief prophylaxis with doxycycline for the prevention of traveler's diarrhea.

A prospective, randomized double-blind trial of doxycycline prophylaxis for traveler's diarrhea was conducted on 145 volunteers during a 2.5-day visit to Mexico. Traveler's diarrhea occurred in 15 (21%) of the placebo group and in 3 (4%) of the doxycycline group (p = 0.002). There was no rebound increase in the incidence of acute diarrhea after departure from the high risk area in the doxycycline-treated group. A variety of bacterial pathogens were isolated from individuals symptomatic with traveler's diarrhea. Nausea alone (8%) or nausea with vomiting (4%) occurred in the doxycycline-treated group only and were the only side effects observed (p = 0.003). We conclude that doxycycline is safe and efficacious for the prophylaxis of traveler's diarrhea for short-term exposure in a high risk area.

Adolescent↗
PubMed1984

Brucellosis in a group of travelers to Spain.

An epidemiologic investigation, initiated when Brucella melitensis infection was detected in a high school student, identified five unrecognized cases in classmates. Before the investigation, four infected students had symptoms of brucellosis for one to ten weeks, made nine visits to physicians, and were confined to the school infirmary or hospitals for 27 days. The other two students were asymptomatic when Brucella agglutination testing demonstrated elevated titers, and treatment was quickly instituted when symptoms occurred. Travel to Spain was implicated because cases were clustered in six of 27 travelers compared with none of 23 control students. Food-history questionnaires showed more frequent consumption of cheese by infected than noninfected travelers. This cluster of cases demonstrates the risk of brucellosis in travelers to endemic areas and illustrates the value of an epidemiologic investigation of cases.

Adolescent↗
PubMed1980

Malaria prophylaxis in travelers.

Each year increasing numbers of Americans travel to countries where the risk of acquiring malaria is considerable. Appropriate advice from family physicians about malaria prophylaxis is important to prevent malaria in American travelers. All travelers to malarious areas should receive chloroquine prophylaxis. Physicians should consider the diagnosis of malaria when fever develops in travelers returning from malarious areas.

Africa↗
PubMed1982

[Traveler's diarrhea].

Travelers' diarrhea is of concern to practitioners in temperate countries in two ways: people ask advice for effective prophylaxis before they leave for tropical regions, and returning travelers often complain of diarrhea after a journey to the tropics. Diarrhea at the beginning of a trip to southern regions is mainly due to bacterial pathogens; later, a parasitic origin for diarrhea becomes an increasing possibility. A rational and economic diagnostic approach to the diarrhea of returning travelers does not necessarily and always include bacteriological stool cultures. Situations warranting a wait-and-see symptomatic treatment are discussed. The authors believe that chemoprophylaxis for traveler's diarrhea should not be prescribed as a general measure.

Bacterial Infections↗
PubMed1981

Medical aspects of air travel.

Air travel is convenient but can exacerbate underlying medical conditions. Most problems can be related to changes in atmospheric pressure, hypoxia, air sickness and jet lag. International travelers should be counseled about traveler's diarrhea and malaria if they are flying to endemic areas. Pregnancy is not in itself a contraindication to flying. Common-sense recommendations and reassurance can help assuage concerns about prolonged air travel.

Aerospace Medicine↗
PubMed1995

Behavioural aspects of travellers in their use of malaria presumptive treatment.

The use of stand-by treatment for malaria by travellers depends on their knowledge, attitudes and behaviour. We examined the behavioural aspects of a cohort of travellers from Switzerland to low-risk malarial areas who, on recruitment, were provided with a kit containing medication for stand-by treatment, guidelines on the diagnosis of malaria, and materials for collection of blood samples for later confirmation of malaria. All subjects were urged to seek medical advice at the first signs of possible malarial symptoms. Illness (fever as the main indicator) was reported by 123 of the 1187 participants, often accompanied by shivering/chills (36.6%), headache (35.0%), gastrointestinal symptoms (69.9%), and myalgia and/or arthralgia (41.5%). Two-thirds of those ill failed to seek medical attention despite their symptoms and pretravel advice. Only 9 (7.3%) were actually beyond the reach of medical attention. The stand-by treatment was self-administered by 6 travellers, only one of whom had confirmed malaria. Two non-serious adverse events were reported. All users consulted a physician after administering the presumptive treatment. This stand-by approach is limited by inappropriate behaviour and poor malaria awareness among travellers. These negative factors can be mitigated by development of an improved kit containing a simple test for self-diagnosis.

Adult↗
PubMed1995

[Medical problems of Israelis travelling to tropical countries].

Questionnaires were sent to 1500 Israelis who traveled overseas following evaluation and preparation in a travel advisory clinic. Of 517 who responded, 227 were males, and the mean age was 25 years. The most commonly encountered medical problems were insect bites (25%), diarrhea (67%), skin conditions (23%), high altitude problems (19%), tropical diseases (11%) and respiratory tract diseases (12%). Of the 476 who took antimalarial prophylaxis, there were possible side effects in 81 (17%). Insect repellents and water purification were used by 435 and 312 travelers, respectively, and condoms by 103. Young Israelis commonly tour for prolonged periods through Asia, Africa and Latin America, and often acquire a wide spectrum of medical diseases, both infectious and noninfectious. A program of professional consultation and immunization is important in the prevention of travel-related disease.

Adult↗
PubMed1993

[Travel medicine].

Travel Medicine was inherited from Tropical Medicine and was organised around the development of intercontinental travels. It concerns all types of travellers, especially tourists, migrants and expatriates. It must be universal, scientific, but first of all preventive. Its aims to the information of all professionals concerned by health and tourism. Its goal is also the training of physicians and the education of travellers regarding their own responsibilities.

Health Education↗
PubMed1993

[Development and trends from 1986 to 1993 of the attitude of intercontinental travellers on departure from France, with respect to malaria prophylaxis].

Simultaneously to information campaigns on malaria prevention in France, 5 successive surveys were performed from 1986 to 1993 on the knowledge and attitudes of travellers regarding malaria prevention. French travellers (principally towards Sub Saharan Africa) know the risk of malaria and the measures of prevention (96%). Chimioprophylaxis using chloroquine has been progressively replaced by mefloquine and then by the association mefloquine-proguanil; 25% of travellers know mosquito prevention measures (repellents and impregnated bed nets) and 27% know the stand-by treatment. Passive attitude of travellers has been modified (in part due to their education) and tend to emphasize today their own responsibility.

Africa South of the Sahara↗
PubMed1995

Effect of distance and travel time on rural women's compliance with screening mammography: an UPRNet study. Upper Peninsula Research Network.

BACKGROUND: The purpose of this study was to determine whether the distance and time required for rural women to travel for a mammogram is associated with their compliance with screening mammography recommendations. METHODS: Women who were > or = 40 years old and visiting family physician offices for any reason were given a questionnaire regarding their frequency of mammography during the past 4 years, the distance and travel time from their homes to the nearest mammography unit, their attitudes and knowledge about mammography, and demographics. The study was conducted in the 12 family practices of the Upper Peninsula Research Network (UPRNet), a Michigan rural family practice research network. RESULTS: Eighty-eight percent (N = 416) of the women in the study had previously had mammography, but 41% were not compliant with American Cancer Society guidelines regarding mammography screening. After controlling for confounding, none of the measures of travel time or distance were associated with mammography compliance. CONCLUSIONS: In this rural population, mammography compliance is not affected by distance, travel time, or transportation. A population-based study in a more remote area is needed to further explore geographic barriers to mammography compliance among rural women.

Adult↗
PubMed1994

Illness in returned travellers.

International travel is an integral and increasing part of modern life. Travel-related illness is common, diverse and associated with varying incubation periods. A travel history should routinely be taken from every patient with a diagnostic problem, particularly if fever is present. This article focuses on common problems among returned Australian travellers.

Acute Disease↗
PubMed1994

[Epidemiology, clinical aspects, prevention and self care in travelers' diarrhea].

Travellers' diarrhea is the most frequently occurring health problem in travellers to tropical and subtropical regions. The main risk factors for this condition are substandard hygiene, contaminated food and drink. Usually the illness begins during the first week of travel and lasts on average four days with mild symptomatology. The causative agent is usually bacterial (40% enterotoxic E. coli), and strict observance of hygiene rules and careful selection of food and drink is an effective strategy to avoid travellers' diarrhea. Prophylactic use of antibiotics is rarely indicated, but self-therapy is of central importance. Adequate oral rehydration is essential, and in uncomplicated cases, antimotility drugs can provide adults with rapid symptomatic relief. Additional antibiotic treatment can be recommended.

Diarrhea↗
PubMedDate not supplied

Self-reported illness among travelers to the Russian Far East.

This study evaluated the risk of travelers to the Russian Far East developing acute gastrointestinal or respiratory symptoms. Passengers and crew on 10 commercial airline flights from the Russian Far East to the United States were asked to complete a health questionnaire that asked age, sex, country of residence, length of stay, foods and beverages consumed, and about gastrointestinal or "flu" symptoms. Questionnaires were returned by 353 of 662 persons (53.3 percent). The most frequently reported symptoms were diarrhea (N = 18; 5.1 percent) and "flu" symptoms (N = 15; 4.2 percent). Among those people who reported symptoms, most were sick for 3 days or less, although 10 (27.0 percent) were still sick at the time that they entered the United States. Age and sex were not associated with symptoms. Persons who drank untreated tap water were more likely to have gastrointestinal symptoms (relative risk = 2.7; 95 percent confidence interval = 1.2, 5.9) while those who drank bottled or canned fruit juice were protected (relative risk = 0.4; 95 percent confidence interval = 0.2, 0.8). The incidence of "flu" symptoms was similar to the rate for the general population of the United States while the incidence of gastrointestinal symptoms was increased and only slightly less than the rate among travelers to developing countries. Travelers may wish to restrict consumption of untreated tap water and increase consumption of fruit juices. Additional work is needed to identify the pathogens responsible for acute illness among travelers to the Russian Far East.

Adult↗
PubMed1993

[Principles and practice of malaria chemoprophylaxis and of malaria emergency medication for travelers].

Malaria chemoprophylaxis and stand-by medication, avoidance of being bitten by mosquitoes, and instruction on the mode of infection, symptoms of disease and appropriate steps if malaria is suspected, are all crucial for malaria prevention in travellers. Drugs used for chemoprophylaxis do not prevent infection but help to avoid multiplication of parasites and disease. If a traveller is on stand-by medication, he decides himself according to symptoms when to take it; nevertheless, he is advised to see a doctor afterwards. Length of stay in an endemic area, health status of the traveller, malaria transmission rate and drug resistance determine the strategy of malaria prevention to be chosen. Risk-benefit analysis of a chemoprophylactic regimen compares the risk of severe side effects of the drug with that of a life-threatening malaria attack. Stand-by medication presents an alternative, if the former outweighs the latter. The Swiss Working Group on Medical Counselling for Travellers updates guidelines for malaria prophylaxis. Recommendations for individual countries are regularly published by the Swiss Health Authorities (BAG). If chemoprophylaxis fails or if a malaria attack is not fully covered by stand-by medication, diagnosis and treatment can cause problems.

Antimalarials↗
PubMedDate not supplied

Sex and travel.

Sexually transmitted diseases have been associated with travellers since they were first described. The scale of international travel has increased enormously in the past 50 years, enabling sexually transmitted pathogens to spread with unprecedented speed. This article assesses the importance of international travel as a risk factor for human immunodeficiency virus (HIV) infection among heterosexuals in the UK, and suggests possible strategies for the prevention of HIV infection in travellers.

Cross-Sectional Studies↗