Healthy Travel for Business or Pleasure. The OMC Clinical Staff Joe Falco, M.D., M.P.H., Jai Subramani, M.D., M.P.H. & Pat Edwards, ANP., COHN-S/CM With thanks to Carol Davis, D.O., M.P.H. May 7, 2008. Talk objectives. To advise you of :
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The OMC Clinical Staff
Joe Falco, M.D., M.P.H., Jai Subramani, M.D., M.P.H. & Pat Edwards, ANP., COHN-S/CM
With thanks to Carol Davis, D.O., M.P.H.
May 7, 2008
To advise you of:
Make sure you’re healthy enough to travel
Consult CDC travel web site: www.cdc.gov/travel-- general recommendations and travel alerts
Visit a travel medicine clinic at least 6 – 8 weeks before travel (OMC for official business travelers; see list for others)
Be prepared to provide Travel Medicine specialist with relevant info
Who is traveling? Provide the age, sex, health, and vaccination history of everyone going on the trip. Patients should bring (and always travel with) a copy of their own vaccination records. All routine vaccinations should be reviewed and updated.
Where are you traveling? Provide itineraries, names and orders of countries you plan to visit. Necessary vaccinations and medications are determined based on CDC guidelines for a particular area. When are you traveling? The season may affect likelihood of contracting certain diseases (e.g.; monsoon season, flu season).
Why are you traveling? (Business vs. personal or adventure travel)
What will you be doing during travel?
How will you be traveling and living while abroad?
How long will you be staying or living abroad?
Hepatitis internationalB: contaminated injection and other equipment used for health care-related procedures and blood transfusions from unscreened donors. Unprotected sex and sharing illegal drug injection
Measures you should take
To prevent deep vein thrombosis
To prevent injury
To prevent illness—Dr. Subramani
DVT: Blood clot that can form in the veins of the legs, potentially traveling to the lungs. Triggered by immobility during airplane, train, vehicular travel lasting more than 4 hours.
Older than age 40
Chronic diseases: cardiovascular, cancer, kidney disease--nephrotic syndrome
Estrogen replacement therapy
Family history and Personal History
Frequent stretching, walking around (every 2 hours)
Increase water intake: avoid dehydration
Limit alcohol and caffeine consumption
Avoid sleeping pills because sleep minimizes mobility
Use foot rests as much as possible to keep one’s thighs clear of the seat.
Wear elastic compression stockings that are designed to reduce the risks of DVT.
CDC recommends those at higher risk for clots take anticoagulant medication.
Quiz: What are the 2 most common causes of traveler deaths abroad?
Observe local ordinances and regulations.
Use public transportation whenever possible.
Consult with travel agent or guide books re: reputable taxi & limo services and other means of transportation
Avoid high crime areas and be aware of political situation and civil unrest: http://www.travel.state.gov/travel/warnings.html
Use seat belts (and helmets—bikes, motorbikes/cycles).
Participate only in activities/sports/swimming/driving compatible with personal skill level.
JaishreeSubramani, M.D., M.P.H.
Rural travel risk>> Urban
Transmitted by Anopheles mosquito
Caused by four species of protozoa
Symptoms: fever, chills, headaches, nausea, vomiting, body aches, general malaise. Also possible: jaundice, liver enlargement, increased breathing rate, anemia, seizures, coma, blood coagulopathy, cardiovascular shock and collapse, acute kidney failure, death.
Avoid mosquitoes by taking protective measures.
Use protective clothing: long sleeved shirts/pants.
Use DEET repellant.
Use bed netting if rural or if locked windows not available.
Prophylactic medications when indicated are widely used based on CDC recommendations for intended destinations.
Nitazoxanide- Adult dosage 500 mg BID x 3 days.
(ciprofloxacin or levofloxacin-3 days of antibiotic)
(loperamide (lomotil) and diphenoxylate)
(only beverages that are sealed or carbonated) .
(e.g.; Giardiasis- Flagyl)
Transmitted by freshwater snails. (Sub-Saharan areas)
Caused by schistosoma flukes .
Infected freshwater snails release larvae that are
capable of penetrating the unbroken skin of the human
host. (wading, swimming)
Schistosomiasis is most prevalent in sub-Saharan Africa.
Most common in African and South Asian countries.
Primarily affects lungs (but can affect other body systems) TB transmitted when actively infected person coughs or sneezes. Person inhaling bacteria in droplets may become infected.
People in good health not generally easily infected. At risk: those with weak immune system.
The risks of contacting TB on an airplane are no worse than in other enclosed space.
Symptoms: Cough>3 weeks, chest pain, blood in sputum, weakness, fatigue, weight loss, appetite loss, chills, fever, night sweats.
Travelers who suspect they may be exposed to TB for extended periods of time while traveling (> three months) should have a skin test before leaving (or a baseline from a past exam) and repeat test 12 weeks after returning.
Avoid high risk behaviors including tattoos, piercing, dental work, sexual encounters.
Infections spread via blood inoculations- HIV, Hepatitis B and Hepatitis C
Pat Edwards, ANP, COHN-S/CM
Visit the OMC 6 weeks prior to travel to discuss protective measures.
Receive a travel kit.
Vaccinations and prescriptions for appropriate medications. (Applies to employees, but not contractors, visitors, or guests.)
OMC hours: M-F 8:00 AM – 5:00 PM
Clinician will discuss any current health issues and related travel concerns
Traveler with a medical condition must consult with personal physician to determine
Fitness for travel
Restrictions or special accommodations that are required.
If a travel upgrade or special accommodation is needed, note from personal/treating physician is required.
Note should indicate:
Upgrade or accommodation requested
Medical condition prompting this need and why it makes upgrade necessary.
Anticipated duration of the condition and whether permanent.
If the OMC clinician confirms need for upgrade, will request memo to Fiscal Services Division Manager
Memo indicates the upgrade or accommodation requested and its anticipated duration.
Upgrade requests are generally renewed by OMC every 6 months.
All such upgrades are closely scrutinized due to financial impact
Prior to departure, the traveler should review all materials in the OMC provided Travel Kit.
Prior to departure, the traveler is advised to contact their health insurance carrier/ BNL Benefits Department (x2877) for questions regarding health coverage abroad.
The traveler should carry a medical insurance card, claim forms, doctor’s note (if possible) and a list of medications with their generic names.
If a US citizen gets severely ill or injured abroad, they should contact the US consulate to assist in medical services, notification and transfer of funds.
The BNL Benefits Department can be reached using a toll free number 1-800-353-5321. International medical and expatriation organizations are available for additional assistance. (See Travel Websites)
5 pk Aspirin 325 mg tabs
5 pk Extra Strength Acetaminophen 500 mg Tabs
5 pk Ibuprofen Tabs
5 pk Benedryl 25 mg capsules (or equivalent)
5 pk non-pseudophedrine cold and sinus tabs
2 Pepto-Bismol tabs
1 Dramamine 50 mg (or equivalent)
Cipro 500 mg antibiotic – 6 tabs for travelers diarrhea
Diarrest tabs or equivalent (for diarrhea)
Bacitracin zinc neomycin sulfate polymixin B sulfate ointment- 4 packs
Band- aids and small dressings
Other items you may need (not included in kit):
Oral re-hydration solution packets
Antibacterial hand wipes
Water Purification tablets
Altitude sickness preventive medication
Mole skin for foot blisters
Full supply of all routine prescriptive meds.
Healthcare products for women
If the traveler arrives home ill -stay home and call OMC at
x 3670 for advice.
Calls personal physician and discusses medical condition.
Traveler should see PCP and discusses symptoms and recent travel.
Informs OMC of findings from consult with PCP.
The traveler does not come to BNL until advised to do so by OMC.
When advised to do so by OMC, the traveler comes to OMC for back to work clearance. If possible, the traveler should bring a note from PCP.
1. CDC website for prospective travel regions: http://www.cdc.gov/travel
2. The U.S. Department of State for Travel Warnings and Consular Information Sheets: http://www.travel.state.gov/travel/warnings.html
3. The IAMAT websitehttp://www.iamat.org (International association for Medical assistance to Travelers) provides elective membership to the individual traveler, giving local worldwide travel clinics at reasonable cost.
4. World Health Organization website for further travel advice. http://www.who.int/ith
5. International Society of Travel Medicine website. http://www.istm.org
6. Travelers may want to consult for http://www.medexassist.com travel insurance and emergency medical assistance information.
Nassau Health Care Corporation (Adult/Peds)
Dr. Doraiswamy2201 Hempstead TurnpikeEast Meadow, NY 11554 Phone: 516-572-8811
Freed, Lieber, Nussbaum Pediatrics (Children Only)
635 Belle Terre Rd
Port Jefferson, NY 11776
Eastern Infectious Disease Associates14 Technology DriveSuite 10East Setauket, NY 11733 Phone: 631-689-5400
Long Island Infectious Disease Association120 New York Avenue Suite 5WHuntington, NY 11743 Phone: 631-423-9809
JFK Airport Medical Office230-59 International Airport Centers Blvd. Bldg C, Suite 225Jamaica, NY 11413 Phone: 718-244-1644http://www.airportmedicaloffices.com
Kennedy Medical OfficesJFK International Airport Building 198Jamaica, NY 11430 Phone: 718-656-5344http://www.kennedymedical.com
Travel & Immunization ClinicLong Island Jewish Medical Center410 Lakeville Road, Ste 107Lake Success, NY 11042 Phone: 718-470-7290
Winthrop Travel CenterWinthrop University Hospital222 Station Plaza N, Suite 432Mineola, NY 11501 Phone: 516-663-3819
Long Island Jewish Medical Center410 Lakeville RoadRoom 107New Hyde Park, NY 11042 Phone: 718-470-7290
County Medical Care, PC3505 Veterans HighwaySuite BRonkonkoma, NY 11779 Phone: 631-467-3621
Branch Pediatrics300 Middle Country RoadSmithtown, NY 11787 Phone: 631-979-6466
Sara Mendelsohn, MD, MPH Travel Medicine of Long Island2500 Route 347 - 17BStony Brook, NY 11790 or
800 Woodbury Road - Unit KWoodbury, NY 11797 Phone: 631-246-9140
Stony Brook Center for Occupational and Environmental Medicine
2500 Nesconset Highway #16c
Stony Brook NY 11790
Phone: 631 444 6250