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  1. 1. Dr. Gopalrao M.D. Ph.D. Professor & Head,Community Medicine Department
  2. 2.  It is a science which deals with promoting and protecting the health of international travelers, providing them the advice related to the travel they are about to undertake. It is a fast developing specialty as the international travel is fast increasing. Every year 660 million people travel internationally.
  3. 3.  Practice of “Emporiatrics” Rapid development over the last 25 years Fairfield Hospital in Melbourne started travel clinic in early-mid 80s - one of the world’s first travel clinics Now a recognised clinical entity primarily involved in risk management Strong overlap with public health and occupational health and general practice
  4. 4.  Knowledge of morbidity and mortality of travellers Understanding of epidemiology and geography of communicable diseases Awareness of non-communicable risks Vaccines, indications, side-effects Knowledge of post-travel illness presentation and management Geography , esp of major tourist destinations Ability to communicate complex issues in simple ways Understanding of when to refer
  5. 5. Food and WaterInsectsAnimals and BirdsEnvironmental hazards Soil Sun Heat/humidity Cold/ dryAltitudeMarine hazardsRespiratory HazardsSex and body-fluid exposureVehicular and other AccidentsDVT risk
  6. 6. TRAVELER  Reason for travel  Behavior I  Age and gender n  Health educationTRAVEL d i  Medical history Destination v - Allergies Country of origin i - Immunosuppressed Duration of stay d - Pre-existing u disease Itinerary a Travel conditions  Immunization l status Season r  Special needs i - Pregnant women s - Children k - Elderly
  7. 7.  Pregnancy Children Elderly Expats and long-term travellers VFR Cardiac or Lung disease Diabetes HIV infections Immunocompromised
  8. 8.  Cruise ships Diving Extended stay Extreme travel Mass gatherings Wilderness
  9. 9.  Person; medical conditions past and present, allergies, medications, vaccine history, previous travel Trip: reason, style and comfort level, rural vs urban, accomodation, activities, exposures, budget Time: duration, season, frequency
  10. 10.  Identifying risks for individuals or groups Advising about risk reduction strategies Recommending and providing risk reduction interventions Encouraging behavioural change to change risk level
  11. 11.  Information enabling behaviour modification vaccinations medications (including antimalarials) other - travel insurance, pre existing medical problems, nets, syringes, med ical kits
  12. 12.  Understand basic current epidemiology Be aware of outbreaks and emergent issues Provide written material targeting specific risks Be able to communicate using electronic media
  13. 13.  Cornerstone of clinical decision process Opportunity to define the risk profile Requires appropriate time, and done in advance of travel. May need multiple visits, allow a plan Good documentation essential Discussion of costs and priorities Consider family requirements
  14. 14.  Tailored advice to the traveller, itinerary and time Travellers vary by age, sex, pregnancy, medical history, immune status, current health, medications, vaccination history, allergies and prior travel experience Itineraries vary by length of stay, activities, environmental exposures, types of accommodation, season and budget Time variation is obviously important Advice should be understandable, re-inforced and in various media Personal advice is more likely to be understood, remembered or facilitate behavioural change.
  15. 15.  Advice and recommendations should be within the travellers budget Costs should be made clear and should presented in some priority order Alternate strategies may need to be discussed
  16. 16.  Additional items for less developed countries (gastro kit) ◦ Rehydration solution ◦ Loperamide ◦ Tinidazole ◦ Norfloxacin – or azithromycin for children Comprehensive medical kit ; Asia, Africa and South America ◦ All of the above ◦ Sterile needles and syringes. Alcohol swabs ◦ Antihistamines ◦ Antifungal and antibiotic cream
  17. 17.  Essential items for all travelers ◦ Items to treat cuts, scratches, burns, strains, splinters ◦ Paracetamol ◦ Repellent ◦ Consider condoms Additional items for Europe, USA, Japan ◦ Antinauseants, eg prochlorperazine ◦ Broad-spectrum antibiotic for respiratory infection ◦ Antacids ◦ Sudafed ◦ Minor sedative ◦ Laxative
  18. 18.  These are designed to assist travelers in meeting medical needs when their access to quality medical care is compromised. All travel medicine consultants recommend that travelers carry some form of medical first aid kit. A range is available, and often needs to be tailored to meet the specific requirements of the traveler and their proposed itinerary. Many travel clinics sell medical first aid kits; these often contain prescription items.
  19. 19.  No antimalarial gives 100% prevention P vivax and P ovale may be present months after return No global consensus Fever in returned travellers is malaria until proved otherwise Patient compliance and education is essential
  20. 20. 3 prong approach behavioral modification ◦ awareness of malarial risk ◦ minimising exposure to mosquitoes emphasis on extreme significance of early diagnosis & treatment antimalarial chemoprophylaxis
  21. 21.  Avoid outdoor exposure, dawn to dusk Wear long sleeved loose clothing after dusk, light colours Avoid perfumes and colognes Use repellent with 20-40% DEET Use knockdown sprays, coils, vapours, etc indoors Sleep under nets impregnated with permethrin
  22. 22.  Category A – considered low risk ◦ Western Europe/North America/Japan/UK/NZ/Singapore Should be fully vaccinated & up to date with ◦ Diphtheria/tetanus/whooping cough ◦ Routine paediatric vaccines ◦ MMR ◦ Polio ◦ Chicken pox ◦ Influenza
  23. 23.  Category B Travel – considered to be low to intermediate risk ◦ Eastern Europe/Israel/Korea/Malaysia/Pacific Is/South Africa Vaccinations should be as for Category A, plus: ◦ Hepatitis A & B ◦ Typhoid ◦ QFT
  24. 24.  Catergory C Travel – considered to be of higher risk ◦ African sub-continent/Central & South America/East Asia/SE Asia/Melanesia Vaccinations should be as for Category B, plus: ◦ Polio booster ◦ Japanese B Encephalitis ◦ Rabies ◦ Meningitis ◦ Yellow Fever Malaria Prevention
  25. 25.  Routine ( background) vaccine Childhood, standard Required ( compulsory) vaccine Cross borders, entry requirements IHR Recommended ( elective based on risk) Travel vaccinesSome vaccines can be in more than category. Not all the same or available in all countries
  26. 26.  Yellow fever Plague Cholera Typhoid Meningococcal meningitis SARS Influenza
  27. 27.  For visiting some countries or on incoming travel the traveler must have a valid vaccination certificate attached to the passport. At the entry point or exit ie. airports, ports, land entry points, the authorities will check the certificates. No valid certification traveler may face quarantine or deportation.