What is Emporiatrics ? “Emporiatrics or travel medicine is thebranch of medicine that deals with theprevention & management of health problemsof international travellers”
Basically, travel medicine can divide into 4 main topics:
GLOBAL ESTIMATES According to WHO,there are approximately600million international travellers anually Morbidity studies conducted by WHOsuggest that about half of the people from adeveloped country that stay one month in adeveloping country gets sick.
FOOD/WATER BORNE DISEASES Due To Contaminated Food Or Water Include :-Travellers diarroheaTyphoidHepatitis ACholeraleptospirosis
TRAVELLERS DIARRHOEA Travellers diarrhoea (TD) is the most common illness affecting travelers• It occurs within the first 14 days of travel, if it is caused by enterotoxic E. coli• Typically, traveler’s diarrhea is self-limiting and will last 3-5 days.
Epidemiology• Each year 20%–50% of international travelers( >10 million people) develop travelers diarrhea• It is more common in the developing world, where rates exceed 60%, than in developed countries.
TYPHOID Typhoid,is a worldwide bacterial disease,transmitted by the ingestion of food or watercontaminated with the feces of an infectedperson, which contain thebacterium Salmonella enterica
EPIDEMOLOGY• With an estimated 16–33 million cases of typhoid fever annually resulting in 216,000 deaths in endemic areas• Its incidence is highest in children and young adults between 5 and 19 years old.
PROPHYLAXIS & TREATMENT• Hygeinic food and water precautions should suffice• antibiotics such as ciprofloxacin & levofloxacin can be used• over the counter medicine like loperamide or which slows down overactive bowels should suffice mild to moderate diarrhea
Hepatitis A• Hep A is transmitted via contaminated food and water and person-to-person.• Morbidity increases with age and reports show 2% mortality in those greater than 40 years of age.• Countries like South America, Mexico, China, India, Africa, and even Greenland have an elevated prevalence of Hep A.• Vaccines are very effective and well tolerated and should be administered 2-4 weeks prior to visit.
VECTOR-BORNE DISEASES (A) MALARIA Malaria in humans is caused by 1 of 4 protozoan species of the genus Plasmodium:• P. falciparum• P.Vivax• P. Ovale• P. malariae
• All species are transmitted by an infective female Anopheles mosquito EPIDEMIOLOGY• Malaria transmission occurs in Africa, Central &South America, parts of the Caribbean, Asia• causes 350–500 million infections worldwide and approx 1 million deaths annually
PREVENTIVE MEASURES FOR TRAVELERS(a)MOSQUITO AVOIDANCE METHODS Mosquito bites can be reduced by remaining in well-screened areasusing mosquito bed netsusing a pyrethroid-containing insect spraywearing clothes that cover most of the bodymosquito repellent should be applied to exposed parts of the skin (20-40% DEET)
(b)Chemoprophylaxis Prophylaxis should begin 7 days before travel, during, and for 4 weeks after leaving the areasMedications Used for ChemoprophylaxisAtovaquone & Proguanil.Chloroquine & HydroxychloroquineDoxycyclineMefloquine
Yellow Fever• Yellow fever is an acute viral hemorrhagic disease cause by flavivirus• The infection is transmitted by the bite of female mosquito Aedes aegypti
EPIDEMIOLOGY• Yellow fever is endemic in tropical and areas of South America and Africa• WHO reports 200,000 cases of disease and 30,000 deaths a year• An estimated 90% of the infections occur on the African continent• In 2008, the largest number of cases was recorded in Togo.
INTERNATIONAL CERTIFICATE OF VACCINATION Yellow fever Vaccination certificate is the only compulsory health certificate needed for international travel This certificate has validity of 10 yrs The vaccine used is attenuated live vaccine Protective effect starts 10days after vaccination&lasts for atleast 10yrs
Injection of protective vaccination into the deltoid muscle
AIR-BORNE DISEASES (a)Meningococcal meningitis Meningitis is a fatal bacterial infectioncausing inflammation of lining of the brainand spinal cord.Transmission by respiratory droplets , closepersonal contact
EPIDEMOLOGY Meningitis risk is high in countries below sahara desert, The region stretching from senegal in west africa to ethiopia in east africa is called the “MENINGITIS BELT”
VACCINATION• Travellers at significant risk of infection should take either BIVALENT OR TETRAVALENT vaccines• Bivalent vaccine for (A&C strains)• Tetravalent vaccine for (A,C,Y,w-135 strains)• Vaccines take 7-10 days to take effect
TUBERCULOSIS(TB) TB is an airborne droplet respiratorydisease caused by M.TUBERCULOSIS EPIDEMIOLOGY Endemic in Sub-Saharan Africa,Russia&Asia.
Other Diseases Transmitted Through Blood Or InjuriesBLOOD BORNE DISESES1.HIV2.HEPATITIS B&C3.STD’SINJURY RELATED1.TETANUS
Pretravel consultation Effective counseling begins with individual risk assesment for every traveller,taking into account:destination country & related Risks,detailed itinerary, including specific citiestypes of accommodationseason&style of travel
Additional factors to be considered are ; other medical conditions, medications being taken (to assess potential drug interactions), the cost of the medicines, & the potential side effects conditions such as pregnancy malarial drug resistance at the destination may modify the risk assessment Advice and recommendations should be within the travellers budget
MEDICAL TRAVEL KITS These are designed to assist travelers in meetingmedical needs when access to quality medical care iscompromised.Comprehensive medical kit --- Asia, Africa & South America – Sterile needles and syringes – Antihistamines – Antifungal and antibiotic cream – Antinauseants, eg prochlorperazineAdditional items for less developed countries (gastro kit) – Loperamide – Tinidazole – Norfloxacin or azithromycin for children – ORS
Essential items for all travelers – Items to treat cuts, scratches, burns, strains, splinters – Paracetamol – Mosquito repellents – Consider condoms – Hand sanitizers “THE YELLOW BOOK” The Yellow Book is published every two years by CDC as a reference for those who advise international travelers about health risks
SUMMARYCommon Illnesses Associated With TravellersVarious Edemic Areas&associated DiseasesHealth Measures&prophylaxis Needed for preventionHealth AdvicesMedical Travel Kits