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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 A vaccine is a biological preparation that provides active acquired immunity to a particular infectious or malignant disease. The safety and effectiveness of vaccines has been widely studied and verified.< ...
, 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.Supercourse on Travel Medicine


Mortality and morbidity

Mortality Mortality is the state of being mortal, or susceptible to death; the opposite of immortality. Mortality may also refer to: * Fish mortality, a parameter used in fisheries population dynamics to account for the loss of fish in a fish stock throug ...
studies indicate that
cardiovascular disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, h ...
accounts for most deaths during travel (50–70%), while injury and
accident An accident is an unintended, normally unwanted event that was not directly caused by humans. The term ''accident'' implies that nobody should be blamed, but the event may have been caused by unrecognized or unaddressed risks. Most researcher ...
follow (~25%). Infectious disease accounts for about 2.8–4% of deaths during/from travel. Morbidity studies suggest that about half of people from a developed country who stay one month in a developing country will get sick.
Traveler's diarrhea Travelers' diarrhea (TD) is a stomach and intestinal infection. TD is defined as the passage of unformed stool (one or more by some definitions, three or more by others) while traveling. It may be accompanied by abdominal cramps, nausea, fever, ...
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 Cruise ships are large passenger ships used mainly for vacationing. Unlike ocean liners, which are used for transport, cruise ships typically embark on round-trip voyages to various ports-of-call, where passengers may go on tours known as "sho ...
travel, diving, mass gatherings (e.g. the
Hajj The Hajj (; ar, حَجّ '; sometimes also spelled Hadj, Hadji or Haj in English) is an annual Islamic pilgrimage to Mecca, Saudi Arabia, the holiest city for Muslims. Hajj is a mandatory religious duty for Muslims that must be carried o ...
), and
wilderness Wilderness or wildlands (usually in the plural), are natural environments on Earth that have not been significantly modified by human activity or any nonurbanized land not under extensive agricultural cultivation. The term has traditionally re ...
/remote regions travel. Travel medicine can primarily be divided into four main topics:
prevention Prevention may refer to: Health and medicine * Preventive healthcare, measures to prevent diseases or injuries rather than curing them or treating their symptoms General safety * Crime prevention, the attempt to reduce deter crime and crimin ...
(vaccination and travel advice), assistance (dealing with
repatriation Repatriation is the process of returning a thing or a person to its country of origin or citizenship. The term may refer to non-human entities, such as converting a foreign currency into the currency of one's own country, as well as to the pro ...
and medical treatment of travelers),
wilderness medicine Wilderness medicine is a rapidly evolving field and is of increasing importance as more people engage in hiking, climbing, kayaking, and other potentially hazardous activities in the backcountry. The modern definition of wilderness medicine is "m ...
(e.g. high-altitude medicine, cruise ship medicine, expedition medicine, etc.) and access to health care, provided by travel insurance.


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. Also, the CDC publishes valuable and up-to-date information. Key areas to consider are vaccination and the seven I's: # Insects: repellents, mosquito nets,
antimalarial medication Antimalarial medications or simply antimalarials are a type of antiparasitic chemical agent, often naturally derived, that can be used to treat or to prevent malaria, in the latter case, most often aiming at two susceptible target groups, young c ...
# Ingestions: safety of drinking water, food # Indiscretion:
HIV The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
,
sexually transmitted disease Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are spread by sexual activity, especially vaginal intercourse, anal sex, and oral s ...
# Injuries:
accident An accident is an unintended, normally unwanted event that was not directly caused by humans. The term ''accident'' implies that nobody should be blamed, but the event may have been caused by unrecognized or unaddressed risks. Most researcher ...
avoidance, personal safety, safety around animals # Immersion:
schistosomiasis Schistosomiasis, also known as snail fever, bilharzia, and Katayama fever, is a disease caused by parasitic flatworms called schistosomes. The urinary tract or the intestines may be infected. Symptoms include abdominal pain, diarrhea, bloody ...
# Immunization (pre-travel vaccination) # Insurance: coverage and services during travel, access to health 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.
Meningococcal meningitis Meningococcal disease describes infections caused by the bacterium ''Neisseria meningitidis'' (also termed meningococcus). It has a high mortality rate if untreated but is vaccine-preventable. While best known as a cause of meningitis, it can al ...
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. Malaria prevention consists of preventing or reducing exposure to mosquitos by using screened rooms, air-conditioning, and nets, and use of repellents (usually DEET). In addition, chemoprophylaxis is started before travel, during the time of potential exposure, and for four weeks (
chloroquine Chloroquine is a medication primarily used to prevent and treat malaria in areas where malaria remains sensitive to its effects. Certain types of malaria, resistant strains, and complicated cases typically require different or additional medi ...
, doxycycline, or mefloquine) or seven days (
atovaquone Atovaquone, sold under the brand name Mepron, is an antimicrobial medication for the prevention and treatment of ''Pneumocystis jirovecii'' pneumonia (PCP). Atovaquone is a chemical compound that belongs to the class of naphthoquinones. Atovaq ...
/
proguanil Proguanil, also known as chlorguanide and chloroguanide, is a medication used to treat and prevent malaria. It is often used together with chloroquine or atovaquone. When used with chloroquine the combination will treat mild chloroquine resistan ...
or
primaquine Primaquine is a medication used to treat and prevent malaria and to treat ''Pneumocystis'' pneumonia. Specifically it is used for malaria due to ''Plasmodium vivax'' and '' Plasmodium ovale'' along with other medications and for prevention if oth ...
) after leaving the risk area.


Medication kit

The traveler should have a medication kit to provide for necessary and useful medication. Based on circumstances, it should also include malaria prophylaxis, condoms, and medication to combat
traveler's diarrhea Travelers' diarrhea (TD) is a stomach and intestinal infection. TD is defined as the passage of unformed stool (one or more by some definitions, three or more by others) while traveling. It may be accompanied by abdominal cramps, nausea, fever, ...
. In addition, a basic
first aid kit A first aid kit or medical kit is a collection of supplies and equipment used to give immediate medical treatment, primarily to treat injuries and other mild or moderate medical conditions. There is a wide variation in the contents of first aid ...
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 Ciprofloxacin is a fluoroquinolone antibiotic used to treat a number of bacterial infections. This includes bone and joint infections, intra abdominal infections, certain types of infectious diarrhea, respiratory tract infections, skin infe ...
) 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.


See also

*
Air travel Air travel is a form of travel in vehicles such as airplanes, jet aircraft, helicopters, hot air balloons, blimps, gliders, hang gliders, parachutes, or anything else that can sustain flight.
*
American Society of Tropical Medicine and Hygiene The American Society of Tropical Medicine and Hygiene (ASTMH) is an Arlington, Virginia-based non-profit organization of scientists, clinicians, students and program professionals whose longstanding mission is to promote global health through the ...
*
Carte Jaune The International Certificate of Vaccination or Prophylaxis (ICVP), also known as the Carte Jaune or Yellow Card, is an official vaccination report created by the World Health Organization (WHO). As a travel document, it is a kind of ''medical p ...
international certificate of vaccination *
Global Infectious Disease Epidemiology Network Global Infectious Diseases and Epidemiology Online Network (GIDEON) is a web-based program for decision support and informatics in the fields of Infectious Diseases and Geographic Medicine. Due to the advancement of both disease research and dig ...
(GIDEON) * Health hazards of air travel *
Institute of Tropical Medicine Antwerp The Institute of Tropical Medicine ( nl, Instituut voor Tropische Geneeskunde, ITG; french: Institut de médecine tropicale, or IMT), officially known as Prince Leopold Institute of Tropical Medicine, is one of the world's leading institutes for ...
* International health *
Jet lag Jet lag is a physiological condition that results from alterations to the body's circadian rhythms caused by rapid long-distance trans-meridian (east–west or west–east) travel. For example, someone flying from New York to London, i.e. from ...
*
Royal Society of Tropical Medicine and Hygiene The Royal Society of Tropical Medicine and Hygiene, more commonly known by its acronym RSTMH, was founded in 1907 by Sir James Cantlie and George Carmichael Low. Sir Patrick Manson, the Society's first President (1907–1909), was recognised as "t ...
*
Tropical disease Tropical diseases are diseases that are prevalent in or unique to tropical and subtropical regions. The diseases are less prevalent in temperate climates, due in part to the occurrence of a cold season, which controls the insect population by f ...
* Walter Reed Tropical Medicine Course – Silver Spring, Maryland, US *
Wilderness acquired diarrhea Wilderness-acquired diarrhea is a variety of traveler's diarrhea in which backpackers and other outdoor enthusiasts are affected. Potential sources are contaminated food or water, or "hand-to-mouth", directly from another person who is infected. Ca ...


References


External links


CDC Travelers' Health
- includes information on destinations, outbreaks, and recommended or required vaccinations
International Association for Medical Assistance to Travellers (IAMAT)

International Society of Travel Medicine

WHO - List of Country Members
- includes information on outbreaks and health profiles {{Authority control Medical specialties Travel