Introduction to travel medicine
Download
1 / 50

Introduction to travel medicine - PowerPoint PPT Presentation


  • 691 Views
  • Updated On :

Introduction to travel medicine. Dr Peter A Leggat MD, PhD, DrPH, FAFPHM, FACTM, FFTM Associate Professor, School of Public Health and Tropical Medicine, James Cook University, Australia, & Visiting Professor, School of Public Health, University of the Witwatersrand. About the author.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Introduction to travel medicine' - Gideon


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Introduction to travel medicine l.jpg

Introduction to travel medicine

Dr Peter A Leggat

MD, PhD, DrPH, FAFPHM, FACTM, FFTM

Associate Professor, School of Public Health and Tropical Medicine, James Cook University, Australia, &

Visiting Professor, School of Public Health,

University of the Witwatersrand


About the author l.jpg
About the author

  • Dr Peter Leggat has co-ordinated the Australian postgraduate course in travel medicine since 1993. He has also been on the faculty of the South African travel medicine course, conducted since 2000, and the Worldwise New Zealand Travel Health update programs since 1998. Dr Leggat has assisted in the development of travel medicine programs in several countries and also the Certificate of Knowledge examination for the International Society of Travel Medicine.


Objectives l.jpg
Objectives

  • In this session

    • Define travel medicine

    • Examine some figures for global and local migration

    • Hopefully gain an appreciation of the importance of giving travel health advice

    • Discuss some of components that are needed in order to give correct advice to traveller


What is travel medicine l.jpg
What is travel medicine?

It is a science and an art


What is travel medicine5 l.jpg
What is travel medicine?

  • It is that part of health professional practice that:

    • seeks to prevent illnesses and injuries occurring to travellers going abroad

    • manages problems arising in travellers coming back or coming from abroad

    • is concerned about the impact of tourism on health and also advocates for improved health and safety services for tourists

    • is increasing concerned about refugee and migrant health (Primer of Travel Medicine 3rd Ed)


Slide6 l.jpg


Challenge of travel medicine l.jpg
Challenge of travel medicine prevention strategy without unnecessary adverse events, cost or inconvenience”

  • Sea of global migration of people

    • More people travelling

  • People travelling further a field

  • Rapid movement of travellers


Slide8 l.jpg

Travellers from industrialised areas prevention strategy without unnecessary adverse events, cost or inconvenience” to developing areas 1999 (WTO)

2.4

2.8

6.1

Europe

25.0 million

USA / Canada

35.2 million

4.6

Japan

11.4 mio

3.6

7.8

1.6

19

6.8

2.3

4.8

1.3

2.5

1.9

2.6

1.2

AUS / NZ

3.3 million

n million travelers

0.2-1 million travelers

Total:

~ 80 million travelers


Globalization of health and safety l.jpg
Globalization of health and safety prevention strategy without unnecessary adverse events, cost or inconvenience”

Commerce and Health

  • Affects

    • Health of local populations

    • Health determinants

    • Safety and security

  • Results in

    • Global impacts

    • Emerging and re-emerging infectious disease

Influenza

SARS

Terrorism

Tsunami

Pathogens travel as fast as transportation: borders are not respected


Slide10 l.jpg

Travellers are exposed to a variety of hazards prevention strategy without unnecessary adverse events, cost or inconvenience”


The importance of travel health measures l.jpg
The Importance of Travel Health Measures prevention strategy without unnecessary adverse events, cost or inconvenience”

  • 100,000 travelers to the developing world for 1 month…..

    • 50,000 will become ill

    • 8,000 will see a physician

    • 5,000 will stay in bed

    • 1 will die

Steffen, 1994


The importance of travel health measures12 l.jpg
The Importance of Travel Health Measures prevention strategy without unnecessary adverse events, cost or inconvenience”

  • Per 100,000 travellers that have travel insurance …..

    • 8000 will make a claim (8%)

    • 2000 will use emergency assistance (2%)

      • 400 ER or clinic referrals (0.4%)

      • 200 Hospital admissions (0.2%)

      • 50 Aeromedical evacuations (0.05%)

Leggat et al. Travel Med Inf Dis 2005;3:9-17.


The importance of travel health measures13 l.jpg
The Importance of Travel Health Measures prevention strategy without unnecessary adverse events, cost or inconvenience”

  • Mortality

    • Cardiovascular Disease (50 to 70%)

    • Accidents/Trauma (20-25%), esp. MVAs

    • Infectious diseases (2.8-4%)

      (Reid and Cossar, BMBull. 1993;257-268; Prociv, MJA. 1995;163:27-30; Baker et al., PHR 1992;107:155-159; MacPherson et al, JTM. 2000; 2000:227-233; Steffen, Trans RSTM&H 1991;85: 156-162 )


Travel medicine is a continuum l.jpg
Travel medicine is a continuum prevention strategy without unnecessary adverse events, cost or inconvenience”

  • Travellers do get sick or injured abroad or when they come back

  • The commitment to travel health can therefore be regarded as a continuum


Slide15 l.jpg

The Continuum of Travel Medicine prevention strategy without unnecessary adverse events, cost or inconvenience”

Preventive Medicine

Pre-Travel

Visitors

During Travel

Contingency Planning

Post-Travel

Treatment & Rehabilitation



Travel health advice needs information l.jpg

Travel Health Advice needs Information advice to travellers?

“Information is power in Travel Medicine”


Travel health advice needs training l.jpg

Travel Health Advice needs advice to travellers?Training

Training gives you a framework for using that information


Travel health advice needs experience l.jpg

Travel Health Advice needs advice to travellers?Experience

Experience helps put the information and training in perspective


Travel health advice needs to be documented l.jpg

Travel Health Advice needs advice to travellers?to be Documented

Documentation is important for Quality assurance and reinforcing travel health advice


Travel health advice needs travellers l.jpg

Travel Health Advice needs advice to travellers?Travellers

Marketing is essential in travel health, whether in general practice or in specialist travel clinics


Giving the correct advice to travellers l.jpg
Giving the correct advice to travellers advice to travellers?

  • Giving the correct health advice to travellers needs:

    • Information

    • Training

    • Experience

    • Documentation

    • Travellers


Travel health advice needs information23 l.jpg
Travel Health Advice needs Information advice to travellers?

  • Guidelines

  • Policies

  • Textbooks, including an World Atlas

  • Journals

  • Professional organisations

  • Staff/colleagues

  • Electronic Databases

  • WWW


International guidelines l.jpg
International Guidelines advice to travellers?

  • WHO

  • International Health Regulations

  • International Travel and Health

    • www.who.int/ith

    • Yellow fever requirements


National guidelines l.jpg
“National Guidelines” advice to travellers?

  • Travel Health Guidelines

  • Malaria Guidelines

  • Immunisation Guidelines

  • Antibiotic Guidelines

  • Journals

  • Seminars


You need access to www sites l.jpg
You need access to www-sites advice to travellers?

  • International Society of Travel Medicine

    • www.istm.org

  • US Centers for Disease Control and Prevention

    • www.cdc.gov/travel

    • US Guidelines

    • Similar government sites for UK and Canada

  • World Health Organization

    • http://www.who.int/ith

    • The former “yellow book” is now published as the “blue book” online


It is very useful to have access to a multicountry travel medical advisory service l.jpg
It is very useful to have access to a multicountry travel medical advisory service

  • CDC Travel Health, see http://www.cdc.gov/travel/index.htm

  • MASTA, see http://www.masta.org

  • TRAVAX, see http://www.travax.nhs.uk

  • Shorelands, see http://www.tripprep.com


Professional organisations l.jpg
Professional Organisations medical advisory service

  • Local professional groups

    and

  • THE ISTM


Slide29 l.jpg
ISTM medical advisory service

  • International Society of Travel Medicine

    • International Network

      • International Clinic Directory

      • Useful for marketing/recognition

    • www.istm.org

    • Listserve

      • Outbreak alerts

    • Journal

    • Geosentinel

    • Certificate of Travel Health

    • Great Conferences!!


Journals l.jpg
Journals medical advisory service

Weighing the Evidence


Weighing the evidence l.jpg
Weighing the evidence medical advisory service

  • “Travel medicine prevention should be based on epidemiological data.” Robert Steffen, 1991

  • What are the likely risks of a person travelling to particular destinations?

  • What are the likely benefits of intervention?


Giving the correct advice to travellers32 l.jpg
Giving the correct advice to travellers medical advisory service

  • Giving the correct health advice to travellers needs:

    • Information

    • Training

    • Experience

    • Documentation

    • Travellers


Pre travel health advice needs training l.jpg
Pre-Travel Health Advice needs Training medical advisory service

  • Helps give structure and consistency

    • Provides a framework for practice

    • Discusses evidence for practice

  • Policy and Procedures Manual

    • Consistent approach to travel health


Part of the commitment is to also have a consistent and structured approach to travel health advice l.jpg
Part of the commitment is to also have a consistent and structured approach to travel health advice

  • WHO Checklist (www.who.int/ith)

    • Information on local conditions

    • Prevention

    • Accident avoidance

    • Medical and dental check-up

  • NZPHR-Prevention

    • Vaccinations

    • Health Advice

    • Prescription

Source: http://www.who.int/ith


Vaccinate ihc l.jpg
VACCINATE structured approach to travel health advice(IHC)

  • Always National schedule

  • Often hepatitis A

  • Sometimes Japanese encephalitis meningococcal disease polio rabies yellow fever Influenza Pneumococcal disease

    Other vaccines (adapted* from NZPHR; 1996;3(8):57-59)


Advise and discuss l.jpg
ADVISE AND DISCUSS structured approach to travel health advice

  • Insects repellents, nets, permethrin

  • Ingestions care with food and water diet/teeth (including airlines/jetlag/DVT)*

  • Indiscretions STI’s, HIV

  • Injuries accident avoidance, personal safety

  • Immersion schistosomiasis

  • Insurance* health and travel insurance* finding medical assistance o/s* (adapted* from NZPHR; 1996;3(8):57-59)


Prescribe script dr s letter bracelet l.jpg
PRESCRIBE structured approach to travel health advice(Script/Dr’s letter/bracelet)

  • Always regular medication medical kit (first aid)*

  • Sometimes antimalarial medication diarrheal self-treatment condoms (NZPHR; 1996;3(8):57-59)


Courses l.jpg
Courses structured approach to travel health advice

  • Increasing number of travel medicine academic programs globally (see educational opportunities at www.istm.org)

  • Get relevant endorsements

    • Aviation medical examiner

    • Diving medical certification (SPUMS)

    • Certificate of Travel Health (ISTM)

    • Occupational health training


Courses39 l.jpg
Courses structured approach to travel health advice

  • Weighing the evidence

  • Contributing to the discipline through research (also through GeoSentinel)

  • Despite training, still need to keep up to date and to keep seeing travellers to help build experience


Giving the correct advice to travellers40 l.jpg
Giving the correct advice to travellers structured approach to travel health advice

  • Giving the correct health advice to travellers needs:

    • Information

    • Training

    • Experience

    • Documentation

    • Travellers


Travel health advice needs experience41 l.jpg
Travel health advice needs experience structured approach to travel health advice

  • Let’s just do it!

  • Affiliation with a group with experience can be useful

    • Travel clinic group

    • Travel medical advisory group (eg MASTA, Worldwise, Travax etc)

    • University

  • Those NZ GPs that were interested in travel medicine were significantly more likely to have had tropical medicine/developing country experience (Leggat et al. JTM 1999; 7: 55-58.)


Slide42 l.jpg

Travel is part of experience structured approach to travel health advice


Travel is part of experience l.jpg
Travel is part of experience structured approach to travel health advice

  • Professionals working in travel medicine need to travel and have that personal experience to communicate to travellers

  • Helps to put travel health advice in context and helps to build a positive travel experience


Giving the correct advice to travellers44 l.jpg
Giving the correct advice to travellers structured approach to travel health advice

  • Giving the correct health advice to travellers needs:

    • Information

    • Training

    • Experience

    • Documentation

    • Travellers


Travel health advice needs to be documented45 l.jpg
Travel health advice needs to be documented structured approach to travel health advice

  • Standardised forms/questionnaires

  • Informed consent

  • International Health Certificate/Vaccination record

  • Doctor’s letter/copy of prescription/medialert bracelet

  • Written advice/videos/Books/Health advisory documents


Correct advice is even better if the advice is actually followed by the traveller l.jpg
Correct advice is even better if the advice is actually followed by the traveller

  • Documentation

  • Follow-up

  • Use staff resources

  • Reinforce health advice


Giving the correct advice to travellers47 l.jpg
Giving the correct advice to travellers followed by the traveller

  • Giving the correct health advice to travellers needs:

    • Information

    • Training

    • Experience

    • Documentation

    • Travellers


Travel health advice needs travellers48 l.jpg
Travel Health Advice needs Travellers followed by the traveller

  • Inform own patients concerning the need for seeking travel health advice, and seeking this advice early

  • Market travel health advice

    • Direct, if possible

    • Join group/affiliate

    • Links/promotion with traveller groups, travel agents, travel insurance, consulates etc

    • Join travellers health networks, such as ISTM, IAMAT etc


Take home points l.jpg
Take home points followed by the traveller

  • More people are traveling to more destinations, becoming exposed to the health and safety of that destination and also having the potential to impact on the health and safety of that destination, especially through emerging infectious disease

  • Travelers’ health is a continuum and includes the pre-travel health, contingency planning while abroad and caring the traveler after travel

  • Travel health advice needs information (including a capacity to undertake a risk assessment), training, experience, documentation and travelers


ad