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Travel medicine oremporiatrics is the branch ofmedicine that deals with the prevention and management of health problems of internationaltravelers.[1]
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 globalepidemiology 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.[2]
Mortality studies indicate thatcardiovascular disease accounts for most deaths during travel (50–70%), whileinjury andaccident 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.[2]Traveler's diarrhea is the most common problem encountered.
The field of travel medicine encompasses a wide variety of disciplines includingepidemiology,infectious disease,public health,tropical medicine, high altitudephysiology, travel relatedobstetrics,psychiatry,occupational medicine, military and migration medicine, andenvironmental health.[3]
Special itineraries and activities includecruise ship travel,diving, mass gatherings (e.g. theHajj), andwilderness/remote regions travel.
Travel medicine can primarily be divided into four main topics:prevention (vaccination and travel advice), assistance (dealing withrepatriation and medical treatment of travelers),wilderness medicine (e.g. high-altitude medicine, cruise ship medicine,expedition medicine, etc.) and access to health care, provided bytravel insurance.
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.[4] Also, theCDC publishes valuable and up-to-date information. Key areas to consider are vaccination and the seven I's:
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.[5]
Meningococcal meningitis is endemic in the tropical meningococcal belt of Africa. Vaccination is required for pilgrims going toMecca.[6] Detailed information is available on the CDC site.[7]
Malaria prevention consists of preventing or reducing exposure to mosquitos by using screened rooms, air-conditioning, and nets, and use of repellents (usuallyDEET). In addition, chemoprophylaxis is started before travel, during the time of potential exposure, and for four weeks (chloroquine,doxycycline, ormefloquine) or seven days (atovaquone/proguanil orprimaquine) after leaving the risk area.[8]
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 combattraveler's diarrhea. In addition, a basicfirst 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).[9] 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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