Travel medicine

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Travel medicine or emporiatrics is the branch of medicine that deals with the prevention and management of health problems of international travelers.

Globalization and travel

Globalization facilitates the spread of disease and increases the number of travelers who will be exposed to a different health environment. Major content areas of travel medicine include the global epidemiology of health risks to the traveler, vaccinology, malaria prevention, and pre-travel counseling designed to maintain the health of the approximately 600 million international travelers. It has been estimated that about 80 million travelers go annually from developed to developing countries.[1]

Mortality and morbidity

Mortality studies indicate that the cardiovascular disease accounts for most deaths during travel (50-70%), while injury and accident follow (~25%). Infectious disease accounts for about 2.8-4% of deaths during/from 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.[2] Traveler's diarrhea is the most common problem encountered.

Disciplines

The field of travel medicine encompasses a wide variety of disciplines including epidemiology, infectious disease, public health, tropical medicine, high altitude physiology, travel related obstetrics, psychiatry, occupational medicine, military and migration medicine, and environmental health.

Special itineraries and activities include cruise ship travel, diving, mass gatherings (e.g. the Hajj), and wilderness/remote regions travel.

Basically, the travel medicine can divide into 4 main topics: the prevention (vaccination and travel advice), the assistance medicine (dealing with repatriation and medical treatment of travelers), the wilderness medicine (e.g. high-altitude medicine, cruise ship medicine, expedition medicine, etc.) and the insurance medicine.

Focus

Travel medicine includes pre-travel consultation and evaluation, contingency planning during travel, and post-travel follow-up and care. Information is provided by the WHO that addresses health issues for travelers for each country as well as the specific health risks of air travel itself.[3] Also, the CDC publishes valuable and up-to-date information. (see external links). Key areas to consider are vaccination and the six I’s:

  1. Insects: repellents, nets, medication
  2. Ingestions: safety of water, food
  3. Indiscretion: HIV, sexually transmitted disease
  4. Injuries: accident avoidance, personal safety
  5. Immersion: schistosomiasis
  6. Insurance: coverage and services during travel, access to care

Specific disease problems

Yellow fever is endemic to certain areas in Africa and South America. The CDC site delineates the risk areas and provides information about vaccination and preventive steps. [4]

Meningococcal meningitis is endemic in the tropical meningococcal belt of Africa. Vaccination is required for pilgrims going to Mecca. Detailed information is available on the CDC site. [5]

Malaria prevention is done by preventing or reducing exposure to mosquitos (screened rooms, air-conditioning, nets) use of repellents (usually DEET). In addition chemoprophylaxis is started before the travel, during the time of potential exposure, and for 4 weeks (chloroquine, doxycycline, or mefloquine) or 7 days (atovaquone/proguanil or primaquine) after leaving the risk area. See detailed CDC site.[6]

Medication Kit

The traveler should have a medication kit to provide for necessary and useful medication. Based on circumstances it should include also malaria prophylaxis, condoms, and medication to combat traveler's diarrhea. In addition, a basic first aid kit can be of use.

Studies have shown there are four main medical problems that travellers develop - diarrhoea or gut problems, respiratory problems, wounds and pain. The medical kit should at least address these common things.

Research has also shown that the best treatment for travellers diarrhoea is to take an antibiotic (e.g. ciprofloxacin) plus a stopper ( e.g. loperamide). Due to bacterial resistance, different parts of the world require different antibiotics. It is best to consult a travel doctor to sort out the best medical kit for the exact destination and medical history of the person travelling.

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