healthy travel for business or pleasure l.
Skip this Video
Loading SlideShow in 5 Seconds..
Healthy Travel for Business or Pleasure PowerPoint Presentation
Download Presentation
Healthy Travel for Business or Pleasure

Loading in 2 Seconds...

play fullscreen
1 / 72

Healthy Travel for Business or Pleasure - PowerPoint PPT Presentation

  • Uploaded on

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 :

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

Healthy Travel for Business or Pleasure

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
healthy travel for business or pleasure

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
Talk objectives

To advise you of:

  • General precautions to take before and during travel to prevent illness and injury (Falco)
  • Specific infectious diseases and other health threats (Subramani)
  • For Travelers on official BNL business– procedures services and obligations (Edwards)
the key to safe travel
The Key to Safe Travel


  • Addressing health issue and taking preventive actions before travel
  • Playing it safe when traveling
    • Preventing injuries
    • Preventing diseases
for all individuals going on a long trip domestic or international
For all individuals going on a long trip– domestic or international

Make sure you’re healthy enough to travel

  • Any health conditions addressed and stable– heart disease, diabetes, high blood pressure, arthritis--see your doctor/practitioner and dentist if haven’t recently, and do so several weeks before travel.
    • Don’t be shy about speaking with physician about travel-associated stress/anxiety/phobias
  • See your dentist if due or symptoms
  • Have enough regular medications for trip
  • Up-to-date on routine vaccinations
    • dT (tetanus/diptheria) every 10 years (and one-time TdaP as adulty for pertussis protection)
    • Make sure immune to measles/mumps/rubella (history/titers) or adequately vaccinated (at least 2 MMR vaccinations over lifetime)
    • Flu vaccine if flu season (Nov.-April; year-round in tropics)
    • Pneumococcal vaccine if over 65 or chronic illnesses/no spleen)
    • One Inactivated Polio Vaccination (IPV) some time during adulthood, especially if traveling to the Indian sub-continent, or Africa.
if traveling outside the u s
If traveling outside the U.S.
  • Check health or business insurance policy for overseas coverage
  • When in doubt, get traveler’s health insurance (and consider trip cancellation insurance)– check with travel agent or web resources (Edwards).
  • Check with travel agent or web resources for medical care clinics where you’ll be going. (; Edwards).
  • Check State Department web site for information about crime and civil unrest where you’ll be going
  • Consider putting together a travel kit with medications and medical supplies you might need on trip (Edwards will discuss OMC’s travel kit)
special preventive measures travel to developing world
Special preventive measures—Travel to developing world

Consult CDC travel web site: 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?

location specific vaccine recommendations
Location-specific vaccine recommendations


  • Entire developing world, especially Asia, Africa, and Latin America
  • Oral or injected—both are effective and low frequency of serious side effects
    • Oral– live vaccine: 4 capsules over one week. Good for 5 years.
    • Single shot—cell surface component of typhoid (not-live): good for 2 years

Hepatitis B: contaminated injection and other equipment used for health care-related procedures and blood transfusions from unscreened donors. Unprotected sex and sharing illegal drug injection

while you re traveling

While you’re traveling

Measures you should take

To prevent deep vein thrombosis

To prevent injury

To prevent illness—Dr. Subramani

deep vein thrombosis
Deep Vein Thrombosis

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.

Risk factors:

Older than age 40


Chronic diseases: cardiovascular, cancer, kidney disease--nephrotic syndrome


Varicose veins

Contraceptive use

Estrogen replacement therapy


Family history and Personal History

deep vein thrombosis cont d
Deep Vein Thrombosis (cont’d)


Frequent stretching, walking around (every 2 hours)

Increase water intake: avoid dehydration

Limit alcohol and caffeine consumption

Avoid sleeping pills because sleep minimizes mobility

deep vein thrombosis cont d15
Deep Vein Thrombosis (cont’d)

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.

injury prevention
Injury prevention

Quiz: What are the 2 most common causes of traveler deaths abroad?

  • Motor vehicle accidents
  • ….
preventing injury from motor vehicles and other travel adventures
Preventing Injury from Motor Vehicles and other Travel Adventures

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:

Use seat belts (and helmets—bikes, motorbikes/cycles).

Participate only in activities/sports/swimming/driving compatible with personal skill level.

specific infectious diseases

Specific Infectious Diseases

JaishreeSubramani, M.D., M.P.H.

diseases spread by mosquitos

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.

malaria cont d
Malaria (cont’d)

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.

travel in chloroquine resistant areas29
Travel in Chloroquine Resistant areas

Atovaquone/proguanil (Malarone)

  • 250 mg atovaquone and 100 mg proguanil hydrochloride.
  • Begin 1-2 days before travel and continue daily for 7 days after leaving the area..
  • Daily, at the same time each day .
  • Contraindicated in persons with severe renal impairment
  • Contraindicated in children <5 kg, pregnant women, and women breastfeeding.
  • Side effects- abdominal pain, nausea, vomiting, and headache
dengue and dengue hemorrhagic fever
Dengue and Dengue Hemorrhagic Fever
  • Dengue viruses are transmitted from person to person by Aedes mosquitoes .
  • Dengue fever "break bone fever“- acute onset of high fever, 3-14 days after the bite.
  • Frontal headache, retro-orbital pain ,muscle/joint pain, nausea, vomiting, and often a maculopapular rash.(1 wk)
  • weakness, malaise (several weeks).
  • Bleeding into the skin ,gums, intestines seen in DHF
  • DHF if not treated can be fatal
treatment of dengue fever
Treatment of Dengue fever
  • Fluids
  • Rest
  • Antipyretics (avoid aspirin)
  • Monitor blood pressure, hematocrit, platelet count, level of consciousness
  • Continue monitoring after fever subsides.
  • No vaccines are currently available
yellow fever36
Yellow fever
  • Transmitted to humans through the bite of infected mosquitoes. (Yellow fever virus, a flavivirus)
  • Ranges in severity from a self-limited febrile illness to severe hepatitis and hemorrhagic fever.
  • Acute stage-fever and chills, severe headache, back pain, general muscle aches, nausea, fatigue, and weakness .
  • Intermediate stage-hemorrhagic symptoms .
  • Late stages- patients can develop hypotension, shock.
  • Vaccine available, Treatment –supportive.
viruses transmitted by mosquitoes
Viruses transmitted by mosquitoes
  • Chikungunya fever
  • Japanese Encephalitis (flavivirus)
  • St. Louis encephalitis
  • West Nile encephalitis .
  • Western equine encephalitis .
food water borne diseases
  • Escherichia coli infections
  • Shigellosis or bacillary dysentery
  • Giardiasis (microscopic parasite,Tx -tinidazole, metronidazole )
  • Cryptosporidiosis(50% associated with swimming pools)

Nitazoxanide- Adult dosage 500 mg BID x 3 days.

  • Noroviruses (Raw shellfish ,oysters)
  • Hepatitis A. (vaccine available)
  • Less common salmonella, cholera, rotavirus infections, and a variety of protozoan and helminthic parasites.
travelers diarrhea40
Travelers’ Diarrhea
  • Clinical syndrome resulting from microbial contamination of ingested food and water.
  • Most of these are bacterial in origin. 80%-85%
  • Parasites about 10% & viruses 5% .
bacterial enteric pathogens
  • Enterotoxigenic Escherichia coli (ETEC)
  • Enteroaggregative E. coli (EAEC)
  • Campylobacter jejuni
  • Salmonella
  • Shigella.
  • Vibrio
travelers diarrhea42
Travelers’ Diarrhea
  • Abrupt onset of loose, watery or semi-formed stools with abdominal cramps and rectal urgency.
  • Nausea, bloating, and fever, may be present.
  • Generally self-limited and lasts 3-4 days even without treatment.
  • Medical attention to be sought for diarrhea with high fever or blood.
prevention of td
Prevention of TD
  • Wash hands thoroughly with soap and water.
  • Eat foods that are freshly cooked and served piping hot .
  • Avoid water and beverages diluted with non-potable water (reconstituted fruit juices, ice, and milk).
  • Avoid raw or undercooked meat and seafood and raw fruits and vegetables.
  • Bismuth subsalicylate (BSS), which is the active ingredient in Pepto-Bismol reduces the incidence of TD from 40% to 14%.
bismuth subsalicylate
Bismuth subsalicylate
  • Two chewable tablets four times per day .
  • Blackening of the tongue and stool and may cause nausea, constipation, and rarely tinnitus.
  • To be avoided by travelers with aspirin allergy, renal insufficiency, gout and by those taking anticoagulants, probenecid, or methotrexate.
  • Caution in administering BSS to children with viral infections, such as varicella or influenza, because of risk of Reye syndrome.

(ciprofloxacin or levofloxacin-3 days of antibiotic)


(loperamide (lomotil) and diphenoxylate)


(only beverages that are sealed or carbonated) .


(e.g.; Giardiasis- Flagyl)

typhoid fever
Typhoid Fever
  • acute, life-threatening febrile illness .
  • caused by the bacterium Salmonella typhi .
  • persistent, high fever as high as 103° to 104
  • headache, malaise, anorexia, splenomegaly, a rash of flat, rose-colored spots, and relative bradycardia.
  • Antibiotics should be guided by antimicrobial sensitivity, particularly for travelers to South Asia.
typhoid fever treatment
Typhoid Fever-Treatment
  • Ciprofloxacin still remains the drug of choice.
  • In cases of treatment failure, third-generation cephalosporins such as ceftriaxone can be used.
  • Azithromycin in some cases.
  • Oral hydration.
  • IV hydration.

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.

  • Symptoms- fever, loss of appetite, weight loss muscle pain, diarrhea, nausea, and cough.
  • Can lead to disease of the kidneys, GI tracts, bladder, and lungs.
  • hepatic or intestinal and urinary schistosomiasis
  • Diagnosis of infection is usually confirmed by serologic studies.
  • No vaccine is available
  • Praziquantel is the drug of choice.
respiratory infections
  • VIRAL- e.g. Influenza, Avian flu, Rhino, Adeno
  • ATYPICAL BACTERIA-e.g.. Legionella pneumonia
  • MYCOBACTERIUM.-e.g. Tuberculosis.
  • Caused by bacteria in the genus Legionella.
  • Needs warm stagnant and aerosolized water.
  • Commonly seen in hotel cooling towers and air conditioners, cruise ships..
  • Causes Legionella pneumonia(10-15% can be fatal)
  • Pontiac fever-flu-like illness (full recovery)
  • Treatment -antibiotics include quinolones and macrolides.
  • No vaccine available.
avian influenza a h5n1
Avian Influenza A (H5N1)
  • Human infections with H5N1 viruses are still rare .
  • Asia, Africa, Eastern Europe, and the Middle East between 2003—2007.
  • No sustained human-to-human transmission.
  • Avoid all direct contact with birds, including domestic poultry (such as chickens and ducks) and wild birds.
  • CDC remains in close communication with WHO and continues to monitor .

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.

tuberculosis cont d
Tuberculosis (cont’d)

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.

blood and body fluids for sexually transmitted diseases
Blood and Body fluids for Sexually Transmitted Diseases

Avoid high risk behaviors including tattoos, piercing, dental work, sexual encounters.

Infections spread via blood inoculations- HIV, Hepatitis B and Hepatitis C

the bnl business traveler

The BNL Business Traveler

Pat Edwards, ANP, COHN-S/CM

jet lag
Jet Lag
  • “Fuzzy” out of sorts feeling for travelers crossing multiple time zones.
  • Disruption of body’s circadian rhythm.
  • Contributing factors: Cabin pressure, high altitude, stale air & lack of humidity.
jet lag symptoms
Jet Lag-Symptoms
  • Disturbed sleep
  • Fatigue
  • Daytime sleepiness
  • Irritability
  • Insomnia
  • Poor concentration
  • Headache
  • GI upset
  • Forgetfulness
tips to reduce jet lag
Tips to reduce Jet Lag
  • Adequate rest before flight
  • Reset watch to time zone destination
  • Avoid alcohol and caffeine before and during flight
  • Drink plenty of fluids
  • Create as dark an environment as possible (on plane)
  • Wear comfortable clothing and shoes
  • For morning arrivals plan to stay awake
treatment of jet lag
Treatment of Jet Lag
  • Melatonin (synthetic hormone that promotes sleep)
  • Available OTC
  • Consult with PCP
  • Prescriptive sleeping meds may be recommended for select travelers.
the bnl business traveler63
The BNL Business Traveler

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

the bnl business traveler cont d
The BNL Business Traveler (cont’d)

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

the bnl business traveler cont d65
The BNL Business Traveler (cont’d)

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)

bnl travel kit
BNL Travel Kit

Kit contains:

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 Cepacol

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

travel kit suggestions
Travel Kit Suggestions

Other items you may need (not included in kit):

Insect repellent



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


the bnl business traveler post travel tips
The BNL Business Traveler Post Travel Tips

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.

travel websites see handouts
Travel Websites(See Handouts)

1. CDC website for prospective travel regions:

2. The U.S. Department of State for Travel Warnings and Consular Information Sheets:

3. The IAMAT website (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.

5. International Society of Travel Medicine website.

6. Travelers may want to consult for travel insurance and emergency medical assistance information.

travel medicine services on long island
Travel Medicine Services on Long Island

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

Phone: 631-331-6200

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: 718-244-1644

Kennedy Medical OfficesJFK International Airport Building 198Jamaica, NY 11430    Phone: 718-656-5344

Travel & Immunization ClinicLong Island Jewish Medical Center410 Lakeville Road, Ste 107Lake Success, NY 11042    Phone: 718-470-7290

travel medicine services on long island cont d
Travel Medicine Services on Long Island (cont’d)

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