Travel medicine

Pretravel management prevention of illness is approached according to the traveler’s itinerary, and factors such as behaviors that are dependent on the traveler.

Only a small number of travelers seek pre-travel health advice.

The composition of travelers continues to become more diverse and medically complex, creating different perspective on travel-associated medical concerns,

required medical knowledge, precautions.

Travel medicine has become a multidisciplinary specialty that encompasses aspects of infectious disease, public health, tropical medicine, wilderness medicine, and appropriate immunization.

The increasing globalization of travel, with now over 1 billion annually.

Travelers with chronic or recurrent dental, OB/GYN, or other health-related problems have increased risk of becoming ill.

Personal health information should be obtained:

Personal health status

Medications and allergies

Past medical history

Medical or physical limitations.



Common conditions seen during travel include:






Alcohol intoxication






Upper and lower respiratory infections



Diarrhea and subsequent dehydration



Minor orthopedic injuries



Geographic specific illnesses



Exacerbation of common medical illnesses



Major orthopedic injuries, 



cardiac crisis, 



Diabetic crisis 



cerebrovascular accident (CVA) .



To prevent the spread of infectious diseases on cruise ships include: obtaining appropriate immunizations, frequent handwashing throughout the trip, using portable alcohol hand cleanser after touching handrails, elevator buttons, salt shakers, or any other surface that may have been touched by hundreds of people that day. 


Vaccine preventable disease in travelers is not restricted to exotic diseases in developing countries: measles.

Influenza is the most common vaccine preventable disease of travelers.

Vaccinations require a period of days or weeks to become effective.

CDC clearly delineates what one needs to know about vaccinations for a desired travel destination: separating vaccines into 3 categories: required, recommended, and routine.

Vaccines may be necessary for protection from diseases that remain common in many parts of the world, although infrequently in the United States.

Routine vaccinations are routinely provided as a part of one’s normal health maintenance.

These vaccinations are recommended to protect travelers from illnesses present in other parts of the world and to prevent the importation of infectious diseases across international borders.

The rate of serologically confirmed influenza cases is estimated at 8.9 per 100 person-months of travel.

The most common health risk for travelers, especially those visiting developing countries, is traveler’s diarrhea (TD).

Travel by cruise ship often congregates large groups of people, and in such settings, diseases such as influenza, measles, rubella, Norwalk virus, gastrointestinal illnesses can spread from person-to-person contact.

In 2010 estimated international travelers, including 28.5 million US travelers.

Greater than 1 billion people crossed international barriers in 2014.

About 80% travelers are from developed-to-low/middle–income countries.

Americans make more than 400 million trips to other countries.

CDC estimates 30-60% of these travelers, estimated at greater than 15 million people, become ill as a result of their travel.

20-70% of individuals report health problems while traveling.

More than half of individuals traveling to the developing world develop a health related problem with 8% requiring medical attention upon returning home.

Risk of acquiring travel-related infections is higher in immunocompromised patients due to deficits in their immune systems and potential attenuated responses to vaccines.

Travel related risk factors are food, vectors and body fluids.

Greater than 60% of travelers avoid pretravel counseling where vaccines , prophylactic and therapeutic medications can prevent many infections.

The most common processes among travelers are malaria (24%), dengue fever (6%), traveler’s diarrhea (4%), and typhoid fever (2%).

The rate of serologically confirmed influenza cases has been estimated at 8.9 per 100 person-months of travel.

The risk for non-immune travelers to developing countries is most significant for symptomatic hepatitis A,and an estimated attack rate of 3.5 cases per 100,000 travelers to high or intermediate endemic regions.

The risk of symptomatic hepatitis B is most likely for long-stay travelers and expatriates, at 25-420 cases per 100,000 travelers.

Enteric fever and typhoid and paratyphoid has a risk of three cases per hundred thousand travelers per month on the Indian subcontinent and is 10 times lower in Africa and parts of Latin America.

Antibacterial drugs she’s not be given within three days of a dose of live oral typhoid or 14 days prior to oral cholera vaccine.

The cholera-prevention vaccines require 2 doses.

Special considerations for aging, immune compromised, pregnant, immigrant, chronically ill, students, and disabled travelers are essential.

Yellow fever vaccination is recommended for travel to certain countries in sub-Saharan Africa and tropical South America.

Tuberculosis risk is significant among international travelers, especially with visits to Asia, Africa, Latin America and Russia.

M tuberculosis infection among travelers to areas where the prevalence of TB is high, the risk of infection is 2.8 per 1000 person months of travel for non-health care workers and 9.8 per 1000 person-months of travel for those with direct patient contact (Cobelens).

Oseltamivir routinely provided to persons traveling to regions where disease is endemic.

Chloroquine drug of choice where chloroquine sensitive malaria exists.

In areas where chloroquine resistant malaria exists atovaquone/proguani, mefloquine, and doxycycline have similar efficacy for malaria prevention.

Swedish residents traveling abroad developed measles and pertussis with an incidence estimated at three cases per hundred thousand travelers per month each.

The risk of yellow fever is high in areas of current epidemic transmission.

The risk for meningococcal meningitis, rabies, cholera, polio, varicella, and Japanese encephalitis is small even for travel to highly endemic areas.

The choice of vaccines is based on exposure to vaccine preventable diseases, the travel itinerary, the severity of disease, if acquired, and any risks presented by the vaccine itself.

The risk of infection varies within the risk country.

Risk taking behavior related to travel style, accommodations, food, use of repellents, sexual behavior, and outdoor activities affect the risk of infection.

Vaccines considered for international travelers:


Hepatitis A



Japanese encephalitis



Hepatitis B



Live attenuated

Yellow fever



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