Title: Introduction to travel medicine
1Introduction to travel medicine
- Dr Peter A Leggat
- MD PhD DrPH FAFPHM FACTM FFTM
- Associate Professor School of Public Health and
Tropical Medicine James Cook University
Australia - Visiting Professor School of Public Health
- University of the Witwatersrand
2About the author
- Dr Peter Leggat has co-ordinated the Australian
postgraduate course in travel medicine since
1993. He has also been on the faculty of the
South African travel medicine course conducted
since 2000 and the Worldwise New Zealand Travel
Health update programs since 1998. Dr Leggat has
assisted in the development of travel medicine
programs in several countries and also the
Certificate of Knowledge examination for the
International Society of Travel Medicine.
3Objectives
- In this session
- Define travel medicine
- Examine some figures for global and local
migration - Hopefully gain an appreciation of the importance
of giving travel health advice - Discuss some of components that are needed in
order to give correct advice to traveller
4What is travel medicine
- It is a science and an art
5What is travel medicine
- It is that part of health professional practice
that - seeks to prevent illnesses and injuries occurring
to travellers going abroad - manages problems arising in travellers coming
back or coming from abroad - is concerned about the impact of tourism on
health and also advocates for improved health and
safety services for tourists - is increasing concerned about refugee and migrant
health (Primer of Travel Medicine 3rd Ed)
6- the art of travel medicine is selecting the
necessary prevention strategy without unnecessary
adverse events cost or inconvenience
-
(Steffen 1994)
7Challenge of travel medicine
- Sea of global migration of people
- More people travelling
- People travelling further a field
- Rapid movement of travellers
8Travellers from industrialised areas to
developing areas 1999 (WTO)
2.4
2.8
Europe 25.0 million
6.1
USA / Canada 35.2 million
4.6
Japan 11.4 mio
3.6
7.8
1.6
19
6.8
2.3
1.3
4.8
2.5
1.9
2.6
1.2
AUS / NZ 3.3 million
n million travelers
0.2-1 million travelers
Total
80 million travelers
9Globalization of health and safety
- Affects
- Health of local populations
- Health determinants
- Safety and security
- Results in
- Global impacts
- Emerging and re-emerging infectious disease
Commerce and Health
Influenza
SARS
Terrorism
Tsunami
Pathogens travel as fast as transportation
borders are not respected
10Travellers are exposed to a variety of hazards
11The Importance of Travel Health Measures
- 100000 travelers to the developing world for 1
month.. - 50000 will become ill
- 8000 will see a physician
- 5000 will stay in bed
- 1 will die
Steffen 1994
12The Importance of Travel Health Measures
- Per 100000 travellers that have travel insurance
.. - 8000 will make a claim (8)
- 2000 will use emergency assistance (2)
- 400 ER or clinic referrals (0.4)
- 200 Hospital admissions (0.2)
- 50 Aeromedical evacuations (0.05)
Leggat et al. Travel Med Inf Dis 200539-17.
13The Importance of Travel Health Measures
- Mortality
- Cardiovascular Disease (50 to 70)
- Accidents/Trauma (20-25) esp. MVAs
- Infectious diseases (2.8-4)
- (Reid and Cossar BMBull. 1993257-268 Prociv
MJA. 199516327-30 Baker et al. PHR
1992107155-159 MacPherson et al JTM. 2000
2000227-233 Steffen Trans RSTMH 199185
156-162 )
14Travel medicine is a continuum
- Travellers do get sick or injured abroad or when
they come back - The commitment to travel health can therefore be
regarded as a continuum
15The Continuum of Travel Medicine
Preventive Medicine
Pre-Travel
Visitors
During Travel
Contingency Planning
Post-Travel
Treatment Rehabilitation
16What do we need to do in order to be giving the
correct advice to travellers
17Travel Health Advice needs Information
- Information is power in Travel Medicine
18Travel Health Advice needsTraining
- Training gives you a framework for using that
information
19Travel Health Advice needsExperience
- Experience helps put the information and training
in perspective
20Travel Health Advice needsto be Documented
- Documentation is important for Quality assurance
and reinforcing travel health advice
21Travel Health Advice needsTravellers
- Marketing is essential in travel health whether
in general practice or in specialist travel
clinics
22Giving the correct advice to travellers
- Giving the correct health advice to travellers
needs - Information
- Training
- Experience
- Documentation
- Travellers
23Travel Health Advice needs Information
- Guidelines
- Policies
- Textbooks including an World Atlas
- Journals
- Professional organisations
- Staff/colleagues
- Electronic Databases
- WWW
24International Guidelines
- WHO
- International Health Regulations
- International Travel and Health
- www.who.int/ith
- Yellow fever requirements
25National Guidelines
- Travel Health Guidelines
- Malaria Guidelines
- Immunisation Guidelines
- Antibiotic Guidelines
- Journals
- Seminars
26You need access to www-sites
- International Society of Travel Medicine
- www.istm.org
- US Centers for Disease Control and Prevention
- www.cdc.gov/travel
- US Guidelines
- Similar government sites for UK and Canada
- World Health Organization
- http//www.who.int/ith
- The former yellow book is now published as the
blue book online
27It is very useful to have access to a
multicountry travel medical advisory service
- CDC Travel Health see http//www.cdc.gov/travel/i
ndex.htm - MASTA see http//www.masta.org
- TRAVAX see http//www.travax.nhs.uk
- Shorelands see http//www.tripprep.com
28Professional Organisations
- Local professional groups
- and
- THE ISTM
29ISTM
- International Society of Travel Medicine
- International Network
- International Clinic Directory
- Useful for marketing/recognition
- www.istm.org
- Listserve
- Outbreak alerts
- Journal
- Geosentinel
- Certificate of Travel Health
- Great Conferences!!
30Journals
Weighing the Evidence
31Weighing the evidence
- Travel medicine prevention should be based on
epidemiological data. Robert Steffen
1991 - What are the likely risks of a person travelling
to particular destinations - What are the likely benefits of
intervention
32Giving the correct advice to travellers
- Giving the correct health advice to travellers
needs - Information
- Training
- Experience
- Documentation
- Travellers
33Pre-Travel Health Advice needs Training
- Helps give structure and consistency
- Provides a framework for practice
- Discusses evidence for practice
- Policy and Procedures Manual
- Consistent approach to travel health
34Part of the commitment is to also have a
consistent and structured approach to travel
health advice
- WHO Checklist (www.who.int/ith)
- Information on local conditions
- Prevention
- Accident avoidance
- Medical and dental check-up
- NZPHR-Prevention
- Vaccinations
- Health Advice
- Prescription
Source http//www.who.int/ith
35VACCINATE (IHC)
- Always National schedule
- Often hepatitis A
- Sometimes Japanese encephalitis
meningococcal disease polio
rabies yellow
fever Influenza
Pneumococcal disease - Other vaccines (adapted from NZPHR
19963(8)57-59)
36ADVISE AND DISCUSS
- Insects repellents nets permethrin
- Ingestions care with food and water diet/teeth
(including airlines/jetlag/DVT) - Indiscretions STIs HIV
- Injuries accident avoidance personal safety
- Immersion schistosomiasis
- Insurance health and travel insurance finding
medical assistance o/s (adapted from NZPHR
19963(8)57-59)
37PRESCRIBE (Script/Drs
letter/bracelet)
- Always regular medication medical kit
(first aid) - Sometimes antimalarial medication diarrheal
self-treatment condoms (NZPHR
19963(8)57-59)
38Courses
- Increasing number of travel medicine academic
programs globally (see
educational opportunities at www.istm.org) - Get relevant endorsements
- Aviation medical examiner
- Diving medical certification (SPUMS)
- Certificate of Travel Health (ISTM)
- Occupational health training
39Courses
- Weighing the evidence
- Contributing to the discipline through research
(also through GeoSentinel) - Despite training still need to keep up to date
and to keep seeing travellers to help build
experience
40Giving the correct advice to travellers
- Giving the correct health advice to travellers
needs - Information
- Training
- Experience
- Documentation
- Travellers
41Travel health advice needs experience
- Lets just do it!
- Affiliation with a group with experience can be
useful - Travel clinic group
- Travel medical advisory group (eg MASTA
Worldwise Travax etc) - University
- Those NZ GPs that were interested in travel
medicine were significantly more likely to have
had tropical medicine/developing country
experience (Leggat et al. JTM 1999 7 55-58.)
42Travel is part of experience
43Travel is part of experience
- Professionals working in travel medicine need to
travel and have that personal experience to
communicate to travellers - Helps to put travel health advice in context and
helps to build a positive travel experience
44Giving the correct advice to travellers
- Giving the correct health advice to travellers
needs - Information
- Training
- Experience
- Documentation
- Travellers
45Travel health advice needs to be documented
- Standardised forms/questionnaires
- Informed consent
- International Health Certificate/Vaccination
record - Doctors letter/copy of prescription/medialert
bracelet - Written advice/videos/Books/Health advisory
documents
46Correct advice is even better if the advice is
actually followed by the traveller
- Documentation
- Follow-up
- Use staff resources
- Reinforce health advice
47Giving the correct advice to travellers
- Giving the correct health advice to travellers
needs - Information
- Training
- Experience
- Documentation
- Travellers
48Travel Health Advice needs Travellers
- Inform own patients concerning the need for
seeking travel health advice and seeking this
advice early - Market travel health advice
- Direct if possible
- Join group/affiliate
- Links/promotion with traveller groups travel
agents travel insurance consulates etc - Join travellers health networks such as ISTM
IAMAT etc
49(No Transcript)
50Take home points
- More people are traveling to more destinations
becoming exposed to the health and safety of that
destination and also having the potential to
impact on the health and safety of that
destination especially through emerging
infectious disease - Travelers health is a continuum and includes the
pre-travel health contingency planning while
abroad and caring the traveler after travel - Travel health advice needs information (including
a capacity to undertake a risk assessment)
training experience documentation and travelers