International travel health/community medicine/public health

1. Travellers Health
BY- DR. SAURAV KUMAR

3. CONTENTS :
1.Definitions
2.Goals
3.Epidemiology
4.Prevention
5.IHR

4. What is Emporiatrics?
•The term ‘Emporiatrics’ was derived from the Greek word ‘Emporos’
meaning one who goes on ship as a passenger and ‘Latrike’ meaning
medical treatment.
•The term coined to describe the science of the health of travellers.

5. What is Travellers Health?
It is a science which deals with promoting and protecting the health of
international travellers, providing them the advice related to the travel
they are about to undertake.

6.  Fairfield Hospital started the first ever travel clinic in 1980s.
 There is a strong overlap with public health, occupational
health and general practice

7. Goals of travellers health
 1. prevention
 2.Assistance
 3.High altitude medicine
 4.Travel insurance and access to health care.

8. Epidemiology of travellers
 According to World tourism organization report in 2017
international tourism arrivals inflated by 7% to attain a total of 1322
million(globally), 20 million Indian.
 It is estimated that half of the people from a developed country that
stay one month on a developing country get sick.

9.  Post travel illness surveillance collected from 2011- 2013
suggested that diarrhoea and ARI are the most common
diseases reported.
 Cardiovascular diseases were the most single cause of
death, nearly 50% contribution

11. Type of Travellers
 1. Documented-
Tourist
Official
 2.Un documented –
Refugees

12. Who’s responsibility is Emporiatrics
 The medical professional
 The travellers themselves
 The travel organizations
 Government policy
 Airlines and shipping companies

13. Travel health Risk
 Food and water
 Environmental hazards
 Altitude
 Marine hazards
 Accident
 psychological

14. Factors affecting individuals risk
 1. Travel
a) Destination
b) Country of origin
c) Duration of stay
d) literacy
e)Travel condition
f) Season

15.  2. Travellers-
a) age and gender
b)Health education
c) past medical history
d)immunization status
e)Special group

16. The travellers triad
TRIP
TIME TRAVELLER

17.  Traveller- medical condition of the traveller, past
medical history, immunization history and past travel.
 Trip- Reason, rural vs urban, accommodation and
activities.
 Time- duration, season and frequency.

18. Various condition experienced during
travel
 Jet lag
 Travellers diarrhoea
 Motion sickness
 Altitude sickness
 Middle east respiratory syndrome

19. Preventive measure and Precaution
 General precautions-
-Health insurance
-Personal health information
-Medical kit
-Medical assistance on board

20.  Specific precaution-
- vaccine for travellers
- Chemoprophylaxis

21. Risk management
 Identifying risk for individual or group
 Advising about risk reduction strategy
 Recommending and providing risk reduction intervention
 Encouraging behavioural change to change risk level

22. Risk reduction intervention
 Information enabling behaviour modification
 Vaccination
 Medication
 Travel insurance

23. Travel consultation
 Understand basic current epidemiology
 Be aware of outbreak and emergent issue
 Provide written material targeting specific risk
 Be able to communicate using electronic media

24. Individualized advice
 Personal advice is more likely to be understood, remembered or
facilitate behavioural change.
 It depend on the place of travel and time of travel .

25. Medical travel kit
 These are designed to assist travellers in meeting medical
needs when their access to quality medical care is
compromised
 A) Essential
 B) Additional
 C) Additional for less developed countries
 D) Comprehensive medical kit

26.  A) Essential –
-Items to treat cuts, scratches, burn.
-paracetamol
-Repellent
 B) Additional for Europe, USA, Japan
-Anti-nauseants
-Broad spectrum antibiotics
-Antacid
-Laxatives

27.  C) Additional items for less developed countries
- Loperamide
- rehydration solution
- Tinidazole
- Norflox
 D) Comprehensive medical kit-
- Sterile needle, syringes and alcohol swab
- Anti histaminic
- Antifungal and antibiotic cream

28. vaccination
 3R
 1) Routine vaccination
- Childhood standard
 2) Required vaccination
- Cross borders vaccination
 3) Recommended
- Based on individual risk

29. Category A
 Europe/ North America/ Japan/ UK/ Singapore
 Should be fully vaccinated and up to date
-Diphtheria/ tetanus/ whooping cough
-MMR
- routine paediatric vaccine
- polio
- Influenza

30. Category B
 Considered low to intermediate risk
 Israel/ Korea/ Malaysia
 Category A plus
-Hepatitis
- Typhoid

31. Category C
 Considered to be higher risk-
 Africa/ Asia
 Category B plus
- YF
-Japanese encephalitis
- Meningitis
- Rabies

32. Chemoprophylaxis for malaria
 Daily anti-malarial have to be initiated the day before arrival to
the destination.
 Chloroquine should started 1 week before travel
 Mefloquine should started 2-3 week before travel

33. International health regulation
 The IHR is an agreement among 196 countries,
including all WHO member countries, to work together
for health security of the world

34. The purpose and scope of IHR
 To prevent, protect, control and provide a public health response
to the international spread of disease
 To establish a single code of procedures and practices for
routine public health measures

35. IHR
Surveill
ance
Work
together
Report
specific
disease
Public
health
event
ASSES
S
RESPON
D
DETEC
T
REPOR
T

36. Major Changes in IHR (2005)
 Widened scope: to report all major events, that may
constitute Public Health Emergency of International Concern
(PHEIC)
 Notification by designated National IHR Focal Points
 National core capacities for detection and response
 Real time event management system

37. Is an event notifiable to WHO?
 Is the public health impact of the event serious?
 Is the event unusual or unexpected?
 Is there a significant risk of international spread?
 Is there a significant risk of international restrictions to travel
and trade?

39. Travel Notice
Notice Action Risk
watch Follow minor precaution Baseline risk
Alert Follow enhanced
precaution
Moderate risk
Warning Avoid all non essential
travel
High risk