Travel Medicine. By Dr. Mona Shawki Moustafa Lecturer of Occupational Health and Industrial Medicine Community Medicine Department Faculty of Medicine-Alexandria University-Egypt. Travel medicine:
Dr. Mona Shawki Moustafa
Lecturer of Occupational Health and Industrial Medicine
Community Medicine Department
Faculty of Medicine-Alexandria University-Egypt
It is the branch of medicine that deals with the prevention and management of health problems of international travelers.
The number of people traveling internationally is increasing every year.
According to statistics of the World Tourism Organization, international tourist arrivals in the year 2006 exceeded 846 million
Causes for international travel in the year 2006
As more people travel and individuals travel more frequently, the specialty of travel medicine becomes more important.
Thus, most clinicians need some basic information to determine the extent of health advice their patients should access prior to their journeys.
International travel can pose various risks to health, depending on the characteristics of both the traveler and the travel.
Morbidity studies suggest that about half of the people from a developed country that stay one month in a developing country will get sick.
Mortality studies indicate that:
Key factors in determining the risks to which travelers may be exposed are:
The durationof the visit may determine whether the traveler may be subjected to marked changes in temperature, humidity, or prolonged exposure to atmospheric pollution and likelihood of exposure to infectious agents which will influence decisions on the need for certain vaccinations or anti-malarial medication.
Travelers' health is the responsibility of:
A clinician should provide the traveler with:
Knowledge that enables them to protect themselves from potential health risks.
Emphasize the importance of a pre-travel consultation and educates the patient that international travel can pose special health risks that should be addressed.
Evaluate the traveler including the medical history, the assessment of the epidemiology of endemic diseases or health risks at the destination, and the behavioral risks that may be taken.
Educate the traveler about importance of having a medical kit during his journey and construct him about its contents.
Provide post-travel medical care. The extent of the care given is personally determined according to condition of traveller and travel circumstances.
Recognize common disease symptoms and syndromes of international travelers.
Travel health advice should be individually tailored to the person.
Vaccines for travelers include:
(1) Vaccines used routinely, particularly for children.
(2) Vaccines that may be advised before travel.
(3) Vaccines that, in some situations, are mandatory.
Hepatitis B (HBV)
Haemophilus influenzae type b (Hib)
Poliomyelitis (OPV or IPV)
Selective use for travelers:
Hepatitis A (HAV)
The International Health Regulations mandates yellow fever vaccination for two different reasons:
(1) to protect the individual in areas where there is a risk of yellow fever infection.
(2) to protect vulnerable countries from importation of the yellow fever virus.
Infected (endemic) zone:
In this zone, the three requirements for perpetuation of yellow fever are present; the virus, the vector and suitable environmental conditions.
The objective of the control measures is to prevent exportation of the disease and diminish local spread.
Yellow fever endemic zone
Measures applied to infected zone:
a- should be away from the city.
b-Apply insecticides periodically to control mosquito.
Between endemic zone and latitude 43N and 43S.
Only the vector and suitable environmental conditions are present, but there is no virus.
Measures applied to infectable zone:
Yellow fever vaccine
Seek medical advice for infants 6-9 months who are travelling to high risk areas
This kit will include:
Contents of a basic medical kit (First-aid items):
Responsibilities of the Travel Industry
The mode of travel is an integral part of the travel experience.
According to the World Tourism Organization, of the 846 million international tourist arrivals in 2006, air transport represented 45% of arrivals and marine transport accounted for 7%.
Travel by air
The volume of air traffic has risen steeply in recent years.
Moreover, the number of long-distance flights has increased.
According to the International Civil Aviation Organization, the passenger traffic is projected to double between 2006 and 2020.
Air travel, in particular over long distances, exposes passengers to a number of factors that may have an effect on their health and well-being.
Health risks associated with air travel can be minimized if the traveler plans carefully and takes some simple precautions before, during and after the flight.
The humidity in aircraft cabins is low (less than 20%).
Low humidity may cause skin dryness and discomfort of the eyes, mouth, nose and exposed skin but presents no risk to health.
Use a skin moisturizing lotion, nasal saline, and spectacles rather than contact lenses.
Travelers by air rarely suffer from motion (travel) sickness except in the case of severe turbulence.
The symptoms caused by the disruption of the body’s “internal clock” and circadian rhythms it controls.
Disruption occurs when crossing multiple time zones.
Jet lag cannot be prevented
Travel by air is not a natural activity for humans and many people experience some degree of psychological difficulty when flying.
The main problems encountered are:
These may occur together or separately at different times before and during the period of travel.
Disinsection is a public health measure that is mandated by the current International Health Regulations.
Many countries require disinsection of aircraft (to kill insects) arriving from countries in order to:
Countries where disinsection generally takes place include those in Latin America, the Caribbean, Australia, and the South Pacific regions.
Airlines are required to provide:
Equipment carried on a typical international flight would include:
Travel by air is normally contraindicated in the following cases:
Contraindications to air travel (cont)
Those suffering from:
According to International Labor Organization Convention:
“Concerning Health Protection and Medical Care for Seafarers” (1987), vessels carrying more than 100 crew members on an international voyage of three days or longer must provide a physician for care of the crew.
Travel by sea
I. Communicable diseases:
II. Non-communicable diseases.
Communicable diseasesGastrointestinal disease
Factors that have contributed to outbreaks include:
Because of temperature and weather variations, changes in diet and physical activities, and generally increased levels of stress compared with life at home, the cruise ship traveler – particularly the elderly traveler – may experience worsening of existing chronic health conditions.
Travel may involve major changes in:
Include costal waters, fresh water lakes, rivers, swimming pools and spas.
Recreational Water Hazards
-Chilling leading to coma & death.
-Thermal shock leading to cramps & cardiac arrest.
-Decompression sickness in divers.
-Acute exposure to heat & ultraviolet radiation.
-Cumulative exposure to sun (skin cancer & cataract).
Recreational water hazards:
Ingestion or inhalation of or contact with
4. Travelers should be advised to wear protective gloves and footwear and avoid contact with corals and other marine animals.
Travelers may protect themselves from mosquitoes and other vectors by using:
Traffic accidents are the most frequent cause of death among travelers.
They constitute significant risk in many countries, particularly developing countries
Accidents constitute special risk for travelers in developing countries because:
Travelers can reduce the possibility of accidents through :
Travelers, both drivers and pedestrians, should be extremely attentive and careful on the roads.
Have full insurance cover for medical treatment of both illness and injuries.
Carry an international driving license as well as your national driving license.
Intentional Injuries (violence)
Violence and collective violence are leading worldwide public health problems and are growing concerns of travelers.
The 20th century was one of the most violent periods in history.
Rates of violent deaths in low to middle-income countries are more than 3 times those in higher-income countries, although there are great variations within countries, depending on regional demographic differences.
1. Government is unstable, even for short periods of time.
2. Recent coups have taken place.
3. Marked social inequality.
4. Rapid demographic changes.
5. Government is under control by a single group that identifies itself by a particular ethnic background or religious fundamentalism.
Access to clean water and sanitary disposal of waste are limited in many areas, so infections related to fecal contamination of food and water remain common and widespread.
Vaccine-preventable diseases such as measles, mumps, rubella, and diphtheria persist in the region.
More common infections in returned travelers are gastrointestinal:
Diarrhea (acute and chronic) and occasionally typhoid fever, amebiasis, and brucellosis.
Chronic and latent infections in immigrants (and long-term residents) from this region include tuberculosis, schistosomiasis, fascioliasis, hepatitis B and C, intestinal parasites, and echinococcosis.
Food- and water-borne infections:
Sexually transmitted and blood-borne infections:
Airborne and person-to-person transmission:
Soil- and water-associated infections:
Airborne and person-to-person transmission:
Sexually transmitted and blood-borne infections: