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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

research before traveling
Research Before Traveling:

Europe: www.ricksteves.com

Elsewhere: Lonely Planet Guide

CIA World Fact Book

www.cia.gov/cia/publications/factbook

US Department of State

http://travel.state.gov/travel/cis_pa_tw/tw/tw_1764.html

Tourism information

www.towd.com

Medical kits and other travel products

http://www.adventuremedicalkits.com/

http://www.travmed.com/

Do not leave the US without reading about your destination!

online resources for the traveler
Online Resources for the Traveler

Travel Gear: www.magellans.com

Passports: http://travel.state.gov/passport/passport_1738.html

Visas: http://travel.state.gov/visa/visa_1750.html

Tourism info: www.towd.com

Airports/flights:

http://www.flytecomm.com/cgi-bin/trackflight

www.quickaid.com – general airport info

Weather: www.worldclimate.com

www.weather.com

www.accuweather.com

online resources for the traveler7
Online Resources for the Traveler

Money: www.x-rates.com

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

www.aaa.com

http://subway.umka.org/

in general
IN GENERAL:

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

scope of problem yearly
SCOPE OF PROBLEM - Yearly

24M travel to developed areas

6M ill (25%)

6M travel to developing countries

3M ill (50%)

2M exposed to malaria

Mortality: 3000 (.0015%)

2000 MVA

600 Falls

200 ID

100 Misc (CDC, 2008)

before traveling think the trip through
BEFORE TRAVELING:“Think the trip through”

Place

Developing vs. industrialized

Hotels vs. “roughing it”

Season: weather, vectors

Air: jet lag, URI

Ship: LRI, diarrhea

Altitude: HAPE, HACE

bucket shops
“Bucket Shops”

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.

bucket shops15
Travel Club International - http://www.unpublishedairfare.comSpecializing in unpublished airfare to Europe, South America & Asia.

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”
bucket shops16
Sky Bird Travel and Tours - http://www.skybirdtravel.com/Consolidators that supplies international airfares to travel agents.

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”
flyfirstclass com
flyfirstclass.com
  • How to get a good seat!! Double secret information
  • Sign up for airline FF program
  • Go to seatguru.com
  • Pick three choices then call airline and negotiate
books for the traveler
Books for the Traveler

300 Incredible Things for Travelers on the Internet, Ken Leebow $8.95

The Rough Guide to Travel Online (Rough Guides $11.99)

checklist
CHECKLIST:

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 _______

Eyeshades_______

checklist26
CHECKLIST:

Neck cushion _______

Ear plugs _______

Carry-on with UW and coat _______

Hat _______

Sunglasses _______

Label outside of passport with

passport # _______

Magnifying glass and sterile needle _______

Leave irreplaceable valuables at home _______

VISA Photos _______

Snacks _______

Travel adapters _________

slide27

Put all liquids and pastes in a clear bag for Transportation Security Administration. Label all medicines.

slide30

Bring a color copy of your passport. Label the outside of your passport with your passport number

sexually transmitted diseases
Sexually Transmitted Diseases

Sense of anonymity

Less inhibited

Condoms often unused

“Hooking up”

doctor s meds i
Doctor’s Meds: I

A-B

Ampicillin-sulbactam

Quinolone: Lo + Hi dose, Xifaxan

Neosporin/cortisone otic qtts

Quinolone eye qtts

Z-Pak – 2

Tamiflu – course for each traveler

Supplies

Suture – 4-0/nylon

Paper tape, 4x4’s

Ace wrap

doctor s meds ii
Doctor’s Meds: II

Analgesia

Oxycontin or Hydrocodone

Compazine Spansules

Cox-2 [NSAID]

G-I:

Metoclopramide

Anti-motility

Skin:

Steroids: topical and oral

Misc: Long acting injectable steroid

Meds for Jet Lag:

armodefinil / zolpidem / melatonin debate

doctor s meds iii
Doctor’s Meds: III

Motion: Isoptohyascine .025% qtts SL or scop patches, ? methylphenidate

Chronic meds: Put in 2 places for complete trip

Sleep meds: zolpidem

u s department of state
U.S. Department of State

http://travel.state.gov/

vaccines hd
VACCINES: HD

YF

Cholera

Typhoid

MMR

Polio

Rabies

Hep B, A

Plague

Meningococcus

HIB

Influenza

Pneumococcal

Japanese B encephalitis

Gamma globulin

http://wwwnc.cdc.gov/travel/content/vaccinations.aspx

cdc vaccination recommendations
CDC Vaccination Recommendations

http://wwwnc.cdc.gov/travel/content/vaccinations.aspx

meds medical prophylaxis
MEDS: MEDICAL PROPHYLAXIS

Location?

Malaria – Malarone [atovaquone + proguanil], Mefloquine, Doxy

GI – Quinolone vs. Xifaxan

Misc - Doxy

malaria prophylaxis 1 o
MALARIA PROPHYLAXIS: 1o

Bed nets

Repellents

Clothing

Meds

chemoprophylaxis
Chemoprophylaxis

www.who.int/ith/

www.CDC.gov

CDC: 877-394-8747

Acute Dx/TX: 770-488-7100

traveler s diarrhea
Traveler’s Diarrhea

50% of travelers affected in some areas

travelers diarrhea
Travelers Diarrhea

80% bacterial, 15% viral, 5% other

Bacterial

Enterotoxogenic E. coli – gastro enteritis

Salmonella – gastro enteritis

Shigella – dysentery, small volume muco purulent

Camplyobacter – dysentery

S. aureus – acute vomiting

Viruses

Norovirus

Parasitic ?

Current Medical Diagnosis and Treatment, 2007.

general features
General Features

Benign, self-limited disease

One week into travel

Prophylaxis recommended

For inflammatory bowel Dz, HIV, IBS, immunosuppression: give prophylaxis

In others: treat symptomatically

Current Medical Diagnosis and Treatment, 2007.

gastroenteritis nvd for dummies
Gastroenteritis [NVD] for Dummies

Cause: E. coli, salmonella, shigella, campylobacter, norovirus

Transmission: fecal oral

Incubation: 1 hr or 3 d

SSx: NVD

Dx: clinical

TX: metaclopramide, quinolone ;;;zithro in Asia

dysentery
Dysentery

Small volume muco-purulent stoolsShigella, Campylobacter

slide60

Acute Diarrhea w/ no lab

T > 101, abdominal pain,

Bloody diarrhea

HIV, IC >65

NO

YES

Rehydration

+

Rifaxin 3D or

Quinolone 5D

Zithromax X 3D

Rehydration

Adapted from: Figure 14-1 and 14-6, 559. Current Medical Diagnosis and Treatment, 2008

slide61

CDC Health Information for International Travel 2008. Found at http://wwwn.cdc.gov/travel/YellowBookListofMaps.aspx.

self rehydration therapy for diarrhea
Self-Rehydration Therapy for Diarrhea

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.

safe eating
Safe Eating:

Clean rims

Bottled water

Carbonated drinks

Black coffee

Hot foods served hot

Look at the kitchen

Go local

unsafe we speak english credit cards accepted
UNSAFE:“We speak English! Credit Cards Accepted!”

Ice

Vendors

Raw food

Pastries

Unpeeled fruit

Dairy- Milk, Ice cream

exotic and trendy cuisine
Exotic and Trendy Cuisine

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.

disinfecting h 2 o
Disinfecting H2O

Boil – five minutes

Bleach – 1 drop/1 glass

CL tablets

environment
Environment

Air travel ⇨ walk vs rest

Jacket

Medical alert bracelet

Heat exhaustion, stroke

Hat

Sunglasses

Hydration

on the plane level 2 anesthesia
On the Plane: Level 2 Anesthesia

No caffeine

Window/Bulkhead/Emergency exit

Eat at once or before travel

Sleep med (?) – short acting/long acting

Neck pillow

Sleep mask

Ear plugs

Pillows, blankets

Tell flight attendant

Stay hydrated, if awake, walk

on arrival
On Arrival:

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

?? melatonin

motion sickness
Motion Sickness

Cephalic and gastric phase

85% gastric

Anticipatory motion sickness

General concept is to learn to like motion1] Isopto- hyascine qtts

2] ephedrine or CNS stimulant

3] corticosteroids

saltwater sea lice
SALTWATER: Sea Lice

Path: Lanuche trapped under suit ⇨ severe itching

DX: Papules/pustules under suit

Rx: Vinegar/Urine stat

Steroids later

Wash clothes(Sinnott J, S Med J 14,44,1996)

saltwater jellyfish
SALTWATER: Jellyfish

Path: Nematocyst allergy

DX: See jellyfish or feel sting

6 Hr: Vinegar (?Urine, NH3, Baking Soda) Not ETOH

Late: Topical steroid

Oral steroids

saltwater sea urchin puncture
SALTWATER: Sea Urchin Puncture

Path: Venomous spines ⇨ FB

inflammation

Rx: Hot H20 110-113o

Pain meds

Remove spines

Caveat: Near joint/tendon

Infection

saltwater sting ray
SALTWATER: Sting Ray

Path: Venomous Puncture

Rx: Hot water

Scrub

Antibiotics

Pain meds

Prevent: Shuffle feet

sunburn severe
SUNBURN: SEVERE

Cool shower

NSAID and steroid topical

Steroid oral, hydration

doctor s meds iv
Doctor’s Meds: IV

HIV Test Kit

Ace Bandage

Band Aids

Paper Tape

colloquialisms for travelers diarrhea
Colloquialisms for Travelers Diarrhea

Cypress Rush

Egypt Tummy

Casablanca Crud

Basra Belly

Karachi Crouch

Delhi Belly

Montezuma’s Revenge

Thai-dal Wave

Turista

Backdoor Sprint

Aztec Two-step

  • Greek Gallop
  • Hong Kong Dog
  • Aden Gut
  • Malta Dog
  • Rangoon Runs
  • Tokyo Trots
  • Tourist Trot
  • Trotsky’s Revenge
  • Turkey Trots
  • Maladie de la Mer Rouge