Travel Medicine

Infections in Traveler’s

Umar Zein
Mentawai Islands, Sumatra
Indonesia
Travel medicine

 Associated with an increased risk of

morbidity and mortality
 Associated with tropical and subtropical
countries
The Continuum of Travel Medicine

Pre-Travel Preventive Medicine Visitors

Contingency During Travel Planning

Treatment & Rehabilitation Post-Travel

Interdiciplinary

 Tropical medicine or infectious diseases

 Accident prevention
 Psychiatry
 High attitude pathophysiology
 Behavioral sciences
The purpose of travel medicine

 Reduce the risks by increasing traveler’s

awareness of them
 Promoting the use of preventive measure
Pretravel advice

 Modifying behavior
 Prevention by immunization,
chemoprophylaxis and personal protective
measures
 Medication for self treatment
 PRE-TRAVEL HEALTH ADVICE

 Immunize travelers
 Advise/educate travelers on other
precautions that should be taken against
conditions to which they are likely to be
exposed during travel
 Prescribe appropriate chemoprophylactic
and self-treatment medications
 Modifying behavior
IMMUNISE AGAINST

 Mandatory vaccinations (WHO)

 National schedule vaccinations-update
routine immunizations
 Vaccinations for most or all travelers
 Vaccinations for travelers at special risk+
“Mandatory” vaccines

 Travelers to/from Yellow fever endemic areas

 Travelers going to Mecca for the Hajj

SPECIAL RISK GROUPS

 Travelers who need special assistance or

need assessment as to fitness to fly
 Pregnant travelers/children/HIV travelers
 Altitude/mountaineering/diving
 Adventure/outback travelers
 Travelers to areas of extreme climate
 School/club/other groups
 Occupational/students/military/aviation
 Aid/refugee camp workers
Travel health advice needs
documentation

 Medialert bracelets-allergies, serious

medical conditions
 Written travel health advice (may be part
of doctor’s letter)-consider using a
proforma
 Travelers health record ?
 Other certificates, e.g. diving, airline
 Is the traveler being escorted?
(aeromedical evacuation)
Educational Resources

 Books
 Travel industry guides
 Pharmaceutical companies
 Videos-popular in a number of
clinics in the USA
 152 pp, Small
pocket book
52 pp,
passport sized
booklet

192 pp, reader

730 pp,
manual
 144 pp, Small
pocket book

Disease specific

Specific to special
groups 428 pp, reader
PRESCRIBE
(Script/Dr’s letter/medialert bracelet)

 Always regular medication

medical kit (first aid)*
 Sometimes antimalarial medication
diarrheal self-treatment
condoms/PEP
Other hygiene pdts
(NZPHR; 1996;3(8):57-59)
Medication needs documentation

 Prescription
 Doctor’s letter-consider using a proforma
 Customs/quarantine approvals, if required
 If part of a clinical trial, contact
details/advice regarding adverse
reactions (on a laminated card)
ADVISE AND DISCUSS

 Insects
 Ingestions
 Indiscretions
 Injuries
 Immersions
 Insurance
 ADVISE AND DISCUSS

 Insects repellents, nets, permethrin

 Ingestions care with food and water
diet/teeth (including
airlines/jetlag/DVT)
 Indiscretions STI’s, HIV, drugs?
 Injuries accident avoidance, personal
safety
 Immersion schistosomiasis, drowning
 Insurance* health and travel insurance
finding medical assistance
Risk associated with International
travel

 Age,sex, health status

 Characteristics of the travel
 Destination
 Duration of visit
 Purpose of visit
 Standards of accomodation and food
hygiene
 Behavior of the traveler
Essensials of Diagnosis

 Fever
 Weight loss
 Diarrhea
 Myalgia
 Headache
 Skin rash
Pretravel Evaluation

 The patient’s initial pretravel visit should

occur at least 6 weeks before departure
 A pertinent medical history should be taken
and physical examination performed
 Travel advice should be begin with general-
safety advice
Pretravel Evaluation

 Preparation is the key to disease prevention

 Traveler’s should carry a medical kit with
necessary supplies and medications for self
treatment when able.
Traveler’s medical supply kit

 Bandages  Pain relievers

 Gauze  Cough suppresants
 Tape  Decongestans
 Syringe  Antihistamines
 Needles  Antacids
 Scissors  Antidiarrheal agent
 Tweezers  Topical antibiotics
 Anti-itch lotions
Pilgrims Travel

 More than 200.000 Indonesian moslems

 Annually
 Long time activities
 Physical activities of ritual Hajj
 High risk population
 High risk accident
 High risk of communicable diseases among
pilgrimage