John Sinnott, MD, FACP Associate Dean, International Affairs Director, Division of Infectious Disease University of South Florida College of Medicine. Travel Medicine for Physicians. Let’s Look at Travel. Research Before Traveling:. Europe: www.ricksteves.com Elsewhere: Lonely Planet Guide
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John Sinnott, MD, FACPAssociate Dean, International AffairsDirector, Division of Infectious DiseaseUniversity of South Florida College of Medicine
Travel Medicine for Physicians
Elsewhere: Lonely Planet Guide
CIA World Fact Book
US Department of State
Medical kits and other travel products
Do not leave the US without reading about your destination!
Travel Gear: www.magellans.com
Tourism info: www.towd.com
www.quickaid.com – general airport info
Communications: http://www.countrycallingcodes.com/ - International calling code directory
North America: www.allareacodes.com
www.frequentflyer.oag.com – toll-free number site with hotels, car-rentals, airlines, etc.
Phone cards: www.nobel.com
Electrical systems: www.kropia.com/electric.htm
Foreign languages: www.babelfish.altavista.com
Metric conversions: www.sciencemadesimple.com
On the Ground: www.amtrak.com
Trauma - Cars, falls, swimming
Social - Sex, drugs = hazards
General - Label meds, travel light
ID - Malaria, zoonoses
Eating - Hot food served hot, CO H2O
Wildlife - Avoid animals, insects
24M travel to developed areas
6M ill (25%)
6M travel to developing countries
3M ill (50%)
2M exposed to malaria
Mortality: 3000 (.0015%)
100 Misc (CDC, 2008)
Developing vs. industrialized
Hotels vs. “roughing it”
Season: weather, vectors
Air: jet lag, URI
Ship: LRI, diarrhea
Altitude: HAPE, HACE
Global Touch - http://www.globaltouch.net/ - Offers consolidator tickets to travel agents and the public.
Justfares.com - http://www.justfares.com - Offers flights online or via live agents.
OZ Flights - http://www.ozflights.co.uk/ - Offers flights from UK to Australia and New Zealand.
Corporate Flyer - http://www.flyfirstclass.com/ - Discounted business and first class international airline tickets.
Flight Coordinators - http://www.flightcoordinators.com/ - Offers international flights from the US.
Executive Class Travel - http://www.executivetravelservice.com - Offers discounts on first class and business class tickets.
IBN United - http://www.ibnunited.com/Air consolidator to selected European and Middle East destinations.
Holiday Deal Finder - http://www.holidaydealfinder.co.ukOffers both scheduled air and charter flights from UK airports.
AirFareOutlet.ca - http://www.AirfareOutlet.caOffers Air from major Canadian gateways, to destinations around the world. Compares consolidator fares against published fares.
BizTravelDeals.com - http://www.biztraveldeals.comOffers First class, and Business class, consolidator airfares to all global destinations.“Bucket Shops”
Airline Tickets Direct - http://www.airlineticketsdirect.comBooks flights to or from Canada with major Canadian airlines.
DiscoveryWorld.com - http://www.discoveryworld.com/Offering airfares to Europe, Asia, Australia, Africa, South and Central America leaving from all major US gateways.
Airtravel Network - http://www.airtravel.netProvides airfare to several international destinations“Bucket Shops”
300 Incredible Things for Travelers on the Internet, Ken Leebow $8.95
The Rough Guide to Travel Online (Rough Guides $11.99)
Labeled meds _______
Liquid meds and pastes in baggie _______
Xerox passport ( 6 mos) _______
Get Visa _______
RX eyeglasses _______
MD, phone # _______
MED evac insurance _______
Trip Insurance _______
Vaccine Card _______
Int’l Drivers License _______
Neck cushion _______
Ear plugs _______
Carry-on with UW and coat _______
Label outside of passport with
passport # _______
Magnifying glass and sterile needle _______
Leave irreplaceable valuables at home _______
VISA Photos _______
Travel adapters _________
Put all liquids and pastes in a clear bag for Transportation Security Administration. Label all medicines.
Bring a color copy of your passport. Label the outside of your passport with your passport number
Sense of anonymity
Condoms often unused
Take enough medicine not just to treat yourself, but to treat fellow travelers
Quinolone: Lo + Hi dose, Xifaxan
Neosporin/cortisone otic qtts
Quinolone eye qtts
Z-Pak – 2
Tamiflu – course for each traveler
Suture – 4-0/nylon
Paper tape, 4x4’s
Oxycontin or Hydrocodone
Steroids: topical and oral
Misc: Long acting injectable steroid
Meds for Jet Lag:
armodefinil / zolpidem / melatonin debate
Motion: Isoptohyascine .025% qtts SL or scop patches, ? methylphenidate
Chronic meds: Put in 2 places for complete trip
Sleep meds: zolpidem
Hep B, A
Japanese B encephalitis
Malaria – Malarone [atovaquone + proguanil], Mefloquine, Doxy
GI – Quinolone vs. Xifaxan
Misc - Doxy
Acute Dx/TX: 770-488-7100
50% of travelers affected in some areas
80% bacterial, 15% viral, 5% other
Enterotoxogenic E. coli – gastro enteritis
Salmonella – gastro enteritis
Shigella – dysentery, small volume muco purulent
Camplyobacter – dysentery
S. aureus – acute vomiting
Current Medical Diagnosis and Treatment, 2007.
Benign, self-limited disease
One week into travel
For inflammatory bowel Dz, HIV, IBS, immunosuppression: give prophylaxis
In others: treat symptomatically
Current Medical Diagnosis and Treatment, 2007.
Cause: E. coli, salmonella, shigella, campylobacter, norovirus
Transmission: fecal oral
Incubation: 1 hr or 3 d
TX: metaclopramide, quinolone ;;;zithro in Asia
Small volume muco-purulent stoolsShigella, Campylobacter
T > 101, abdominal pain,
HIV, IC >65
Rifaxin 3D or
Zithromax X 3D
Adapted from: Figure 14-1 and 14-6, 559. Current Medical Diagnosis and Treatment, 2008
CDC Health Information for International Travel 2008. Found at http://wwwn.cdc.gov/travel/YellowBookListofMaps.aspx.
With sugar and salt (raw sugar or molasses can be used instead of sugar)
1 liter (.3 gallon) of clean water
1/2 tsp SALT
8 level tsps sugar or substituteNeed 3 L/ D, drink q5 min
Werner D. Where There is No Doctor: A Village Healthcare Handbook for Africa, p161.
Hot foods served hot
Look at the kitchen
Dairy- Milk, Ice cream
Raw fish, seafood and worms in the time of cholera…..
Anisakiasis:* caused by larval stages of marine nematodes, or “herring worms”
Hallmark: sudden abdominal pain, 1 to 24 hr after consumption of raw fish
Nausea, vomiting, fever, often with worm regurgitated
Pseudoterranova decipiens: pathogen of seals, sea lions, walruses
Anisakis simplex: pathogen of porpoises, whales
1- to 4-cm-long larval worm in 50% of cases
Pacific > Atlantic
Raw Beef, Raw Pork, and Dysentery
Steak Tartare and Toxoplasmosis and salmonella
*Hawkes S, Hart GJ, et al. 1995. Risk behavior and STD acquisition in geniourinary clinic attenders who have travelled. Genitourin. Med. 71:351-354.
Boil – five minutes
Bleach – 1 drop/1 glass
Air travel ⇨ walk vs rest
Medical alert bracelet
Heat exhaustion, stroke
Eat at once or before travel
Sleep med (?) – short acting/long acting
Tell flight attendant
Stay hydrated, if awake, walk
Set watch to local time on landing
DO NOT SLEEP! DO NOT SLEEP!
Go to sleep at your normal time in new place!
Use a sleeping aid and? Provigil
Cephalic and gastric phase
Anticipatory motion sickness
General concept is to learn to like motion1] Isopto- hyascine qtts
2] ephedrine or CNS stimulant
Path: Lanuche trapped under suit ⇨ severe itching
DX: Papules/pustules under suit
Rx: Vinegar/Urine stat
Wash clothes(Sinnott J, S Med J 14,44,1996)
Path: Nematocyst allergy
DX: See jellyfish or feel sting
6 Hr: Vinegar (?Urine, NH3, Baking Soda) Not ETOH
Late: Topical steroid
Path: Venomous spines ⇨ FB
Rx: Hot H20 110-113o
Caveat: Near joint/tendon
Path: Venomous Puncture
Rx: Hot water
Prevent: Shuffle feet
NSAID and steroid topical
Steroid oral, hydration
HIV Test Kit