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By: Azza soliman soliman
Under supervision of
Prof Dr. Mona Aboserea
Faculty of medicine
zagaz
Traveler medicine
It is the branch of
medicine that deals with
the prevention and
management of health
problems of international
travelers.
 The specialty of travel medicine is dynamic and
vast in its medical knowledge requirements, as it
focuses on the prevention and management of
health issues related to global travel. Areas of
expertise include vaccinations, epidemiology,
region-
 specific travel medicine, pre-travel management,
travel-related illnesses, and post-travel
management. This increasing globalization of
travel.
now over 1 billion annually
(with ~80% from developed-to-
low/middle–income countries),
facilitates increased health
exposures in different
environments and the potential
spread of disease
 Travel medicine includes pre-travel consultation and
evaluation, contingency planning during travel, and
post-travel follow-up and care.
 Information is provided by the WHO that addresses
health issues for travelers for each country as well as
the specific health risks of air travel itself Also, the
CDC publishes valuable and up-to-date information.
Disciplines (DIRECTIONS)
The field of travel medicine
encompasses a wide variety of
disciplines including
 Epidemiology
 infectious disease
 public health
 tropical medicine
 high altitude physiology
 travel related obstetrics,
 psychiatry, occupational medicine, military
and migration medicine, and environmental
health.
 Special itineraries and activities include
 cruise ship travel, diving, mass gatherings
(e.g. the Hajj), and wilderness/remote
regions travel.
 Travel medicine has subsequently become
a dynamic multidisciplinary specialty that
encompasses aspects of infectious disease,
public health, tropical medicine, wilderness
medicine, and appropriate immunization.
Travel medicine can primarily be divided
into four main topics:
prevention (vaccination and travel
advice),
assistance (dealing with repatriation
and medical treatment of travelers),
 wilderness medicine (e.g. high-
altitude medicine, cruise ship
medicine, expedition medicine, etc.)
and access to health care, provided by
travel insurance.
 Key areas to consider are vaccination and the
six I's:
 Insects: repellents, mosquito nets,
antimalarial medication
 Ingestions: safety of drinking water, food
 Indiscretion: HIV, sexually transmitted
disease
 Injuries: accident avoidance, personal safety
 Immersion: schistosomiasis
 Insurance: coverage and services during
travel, access to health care
 the area of the world visited,
 the length of stay, activities and
location of travel within these
areas,
the underlying health of the
traveler.
 Yellow fever is endemic to certain areas in
Africa and South America. The CDC site
delineates the risk areas and provides
information about vaccination and
preventive steps.
 Meningococcal meningitis is endemic in the
tropical meningococcal belt of Africa.
Vaccination is required for pilgrims going to
Mecca .
 Malaria prevention
 If she is pregnant or breast-feeding. the travel
itinerary and the sequence in which countries will
be visited and transited;
 the length of stay in each country; whether travel
will be rural or urban;
 the style of travel (first-class hotels vs. local
homes);
 the reason for travel;
 whether the traveler has any underlying health
problems, allergies, or previous immunizations;
 And, in the case of a female traveler, whether
she is planning pregnancy
Most travel-related illnesses are
preventable by
 immunizations,
prophylactic medications,
or pre travel health education.
 Immunizations for international travel can be
categorized as:
 1. Routine: childhood and adult vaccinations (e.g.,
diphtheria/ tetanus, polio/MMR)
 2. Required: those needed to cross international
borders as required by international health
regulations (e.g., yellow fever and meningococcal
disease)
 3. Recommended: according to risk of infection
(e.g., typhoid, hepatitis A, rabies)
 Routine vaccinations are the immunizations
that are routinely provided as a part of one’s
normal health maintenance. These vaccines are
necessary for protection from diseases that
remain common in many parts of the world,
although infrequently in the United States. If
you are uncertain if you are up-to-date on
routine immunizations, check with your medical
provider.
 Recommended vaccinations are
predicated on a number of factors
including one’s travel destinations,
planned activities, season, previous
immunizations, urban/rural location,
one’s age, and current health status.
 In general, 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.
aging
immune compromised,
 pregnant,
immigrant,
 chronically ill,
students, and disabled travelers are essential.
 Yellow Fever


 Yellow fever, which occurs only in tropical Africa,
certain countries in South America, Panama, and
Trinidad and Tobago, can be prevented by a single
subcutaneous injection of a live attenuated virus
vaccine. A certificate of yellow fever vaccination is
valid for 10 years after a 10- day waiting period,
 although protection probably lasts longer. The
vaccine is not recommended for infants less than
nine months of age.
 Like all other live virus vaccines, yellow fever
vaccine should not be administered to
immunocompromised patients and should be
avoided during pregnancy. However, pregnant
women and HIV-positive individuals with CD4
counts greater than 200 should discuss immunization
with their health-care provider if they are at high
risk of infection.
 WHO also recognizes the Saudi Arabian
requirement for meningococcal vaccine
for pilgrims visiting Mecca for Hajj or Umrah.
 These travelers must show documentation of
vaccination against meningococcal meningitis
A,C,Y,W-135 when applying for a visa for Hajj
or Umrah. Documentation must also be
shown to the Saudi Arabian
 passport authority upon entry to the country
Timing of vaccines

 Many travelers visit a physician only a short time before their
anticipated date of departure. When necessary, inactivated
vaccines may be administered simultaneously at separate sites
with separate syringes.
 Theoretically, live vaccines should be administered 30 days
apart because of possible impairment of the immune response.
However, this restriction does not apply to oral polio virus
(OPV), MMR, and varicella, which may be given together.
 All immunizations should be recorded in the international
certificate of vaccination booklet and carried with the passport.
Pre travel health education.
Travelers should ascertain the associated
travel health information for their specific
itinerary several months in advance of
departure. This should include general health
information such as vaccine requirements,
prophylactic medications, disease outbreaks,
political environment, and medical resources.
 A medical kit is an essential item that should be
carried by all travelers to developing countries or
where local availability of such resources remains in
doubt.
 The kit should include standard first-aid items,
simple medications for common ailments, and any
items specific for that traveler. In addition, consider
having a list of medications along with a medical
attestation signed by a physician authenticating the
need of those medications for personal use.
 Antiseptic wound cleanser
 Antihistamines
 Adhesive bandages/bandages
 Eye drops/rewetting drops
 Hand antiseptic
 Insect repellent
 Insect bite treatment
 Medical tape
 Nasal decongestant
 Oral rehydration powder
 Scissors, safety pins/closure devices
 Simple analgesics (eg, ibuprofen,
acetaminophen)
 Sterile gauze/dressing
 Thermometer (oral/rectal)
 Antidiarrheal medication
 Antifungal medication
 Malaria prophylaxis
 Personal medications (current medical
illnesses)
 Sleeping medications/sedatives
 Water purifier/disinfectant
 Malaria protection
Compliance with antimalarial
chemoprophylaxis regimens and use
of personal protection measures to prevent
mosquito bites are keys to prevention
of malaria.
Travelers’ diarrhea
Diarrhea is the most frequent health
impairment among travelers, with
a risk of 7% of travelers to the
developed countries and risks of 0–
90% of travelers to some parts of the
developing world.
The most common symptoms, in
addition to diarrhea and
fecal urgency are
 abdominal cramps, nausea,
vomiting, and general malaise,
 often resulting in incapacitation for
more than 10% of the international
excursion.
The most frequent etiologic agents at most
destinations are enterotoxigenic Escherichia coli
(ETEC), and enteroaggregative E. coli (EAEC). The
most common causes of travelers’ diarrhea,
 in addition to E. coli, are Shigella spp., Salmonella
spp., Campylobacter spp. Vibrio parahaemolyticus (in
Asia), rotavirus (in Latin America), and protozoa
(Giardia, Cryptosporidium, and Cyclospora spp., and
Entamoeba histolytica), but no pathogen is identified
in over half of patients. Noroviruses,
 which cause the majority of acute viral gastroenteritis
cases worldwide, are increasingly being recognized as
a cause of outbreaks and illness among travelers.
When counseling travelers about
diarrhea, health-care providers must
consider several issues:
food and water precautions,
hand hygiene,
chemoprophylaxis,
Self-treatment of illness,
 and immunization
Although malaria is the most important vector-borne
infection in travelers, others also require attention. Of these,
Dengue is an increasing problem, as noted by a dramatic rise
in the infection globally, particularly in the Caribbean,
Central and South America, and Southeast Asia.
 Tick-borne encephalitis is acquired by the bite of an
infected tick or rarely, by ingesting unpasteurized dairy
products in endemic foci between latitude 39° and65°.
 In addition to insect precautions, some vector-borne
diseases can be prevented by prophylactic medication. For
example, loiasis can be prevented by taking 300 mg (adult
dose) of diethylcarbamazine once each week while in a very
heavily infested
 In areas such as Central or West Africa.
Tick- and mite-borne typhus, relapsing fever,
bartonellosis, and plague
 can be prevented by using doxycycline
prophylaxis, 100 mg daily, during exposure.
For the most part, prophylaxis of these latter
infections is not recommended except for a
very select group of individuals at high risk
for infection.
 During international travel, individuals often feel a
sense of anonymity, may be less sexually inhibited, and
may therefore put themselves at greater risk for the
acquisition of sexually transmitted disease.
 The risk is increased by exposure to multiple or
professional partners. Safer sexual practices,
including the use of condoms throughout intimacy,
are particularly important in the era of
HIV/AIDS. Immunization against hepatitis B is a
must for those who may engage in casual sex while
abroad.

 Schistosomiasis, a helminthic disease that infects over 200
million people in parts of South America, the Caribbean,
Africa, the Middle East and Southeast Asia, can be avoided
by advising travelers to stay out of slow-moving, fresh water
in developing countries in these areas of the world.
 Swimming in the ocean or freshwater pools without
snails is safe. Barefoot walking exposes the traveler to a
variety of hazards, including tungiasis (sandflea), snake bites,
cutaneous larva migrans from dog and cat hookworms,
human hookworm infection, and strongyloidiasis. Sandals
provide only partial protection; closed footwear should be
fully protective.
 Excessive sun exposure can cause erythema
and sunburn, chemical hypersensitivity, eye
damage, bleaching of the skin, and
predisposition toward skin cancers, including
 malignant melanoma. The least potent
sunscreen that should be used is one with a sun
 protection factor (SPF) of 15, offering 93% protection.
Adaptation to a hot climate can take from one to several
weeks, depending on the ambient temperatures and humidity.
 Clothing should be made of natural fibers such as cotton
and linen to allow air to circulate.
 Light colors reflect light and are preferable to dark
fabrics. Since sweat contains both water and salt, it is
important to replace salt by eating salty foods or adding extra
salt to food.
 In hot weather and in the absence of strenuous exercise,
the average person must replace at least 11/2 liters of fluid per
day.

 It is more the exception than the rule that physicians ask “Where have
you been?” of travelers who become ill after their return.
 Therefore, before departure travelers should be warned that if they
become ill on return, regardless of how carefully they have followed
recommended precautions, they should immediately inform their
physicians that they have traveled recently. This advice is particularly
important for
 febrile travelers, since no antimalarial drug guarantees
protection against malaria.

• Any questions???????
THANK YOU

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Traveler medicine

  • 1. By: Azza soliman soliman Under supervision of Prof Dr. Mona Aboserea Faculty of medicine zagaz
  • 3. It is the branch of medicine that deals with the prevention and management of health problems of international travelers.
  • 4.  The specialty of travel medicine is dynamic and vast in its medical knowledge requirements, as it focuses on the prevention and management of health issues related to global travel. Areas of expertise include vaccinations, epidemiology, region-  specific travel medicine, pre-travel management, travel-related illnesses, and post-travel management. This increasing globalization of travel.
  • 5. now over 1 billion annually (with ~80% from developed-to- low/middle–income countries), facilitates increased health exposures in different environments and the potential spread of disease
  • 6.  Travel medicine includes pre-travel consultation and evaluation, contingency planning during travel, and post-travel follow-up and care.  Information is provided by the WHO that addresses health issues for travelers for each country as well as the specific health risks of air travel itself Also, the CDC publishes valuable and up-to-date information.
  • 7. Disciplines (DIRECTIONS) The field of travel medicine encompasses a wide variety of disciplines including  Epidemiology  infectious disease  public health  tropical medicine  high altitude physiology  travel related obstetrics,  psychiatry, occupational medicine, military and migration medicine, and environmental health.
  • 8.  Special itineraries and activities include  cruise ship travel, diving, mass gatherings (e.g. the Hajj), and wilderness/remote regions travel.  Travel medicine has subsequently become a dynamic multidisciplinary specialty that encompasses aspects of infectious disease, public health, tropical medicine, wilderness medicine, and appropriate immunization.
  • 9. Travel medicine can primarily be divided into four main topics: prevention (vaccination and travel advice), assistance (dealing with repatriation and medical treatment of travelers),  wilderness medicine (e.g. high- altitude medicine, cruise ship medicine, expedition medicine, etc.) and access to health care, provided by travel insurance.
  • 10.  Key areas to consider are vaccination and the six I's:  Insects: repellents, mosquito nets, antimalarial medication  Ingestions: safety of drinking water, food  Indiscretion: HIV, sexually transmitted disease  Injuries: accident avoidance, personal safety  Immersion: schistosomiasis  Insurance: coverage and services during travel, access to health care
  • 11.  the area of the world visited,  the length of stay, activities and location of travel within these areas, the underlying health of the traveler.
  • 12.  Yellow fever is endemic to certain areas in Africa and South America. The CDC site delineates the risk areas and provides information about vaccination and preventive steps.  Meningococcal meningitis is endemic in the tropical meningococcal belt of Africa. Vaccination is required for pilgrims going to Mecca .  Malaria prevention
  • 13.  If she is pregnant or breast-feeding. the travel itinerary and the sequence in which countries will be visited and transited;  the length of stay in each country; whether travel will be rural or urban;  the style of travel (first-class hotels vs. local homes);  the reason for travel;  whether the traveler has any underlying health problems, allergies, or previous immunizations;  And, in the case of a female traveler, whether she is planning pregnancy
  • 14. Most travel-related illnesses are preventable by  immunizations, prophylactic medications, or pre travel health education.
  • 15.  Immunizations for international travel can be categorized as:  1. Routine: childhood and adult vaccinations (e.g., diphtheria/ tetanus, polio/MMR)  2. Required: those needed to cross international borders as required by international health regulations (e.g., yellow fever and meningococcal disease)  3. Recommended: according to risk of infection (e.g., typhoid, hepatitis A, rabies)
  • 16.  Routine vaccinations are the immunizations that are routinely provided as a part of one’s normal health maintenance. These vaccines are necessary for protection from diseases that remain common in many parts of the world, although infrequently in the United States. If you are uncertain if you are up-to-date on routine immunizations, check with your medical provider.
  • 17.  Recommended vaccinations are predicated on a number of factors including one’s travel destinations, planned activities, season, previous immunizations, urban/rural location, one’s age, and current health status.  In general, 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.
  • 18. aging immune compromised,  pregnant, immigrant,  chronically ill, students, and disabled travelers are essential.
  • 19.  Yellow Fever    Yellow fever, which occurs only in tropical Africa, certain countries in South America, Panama, and Trinidad and Tobago, can be prevented by a single subcutaneous injection of a live attenuated virus vaccine. A certificate of yellow fever vaccination is valid for 10 years after a 10- day waiting period,
  • 20.  although protection probably lasts longer. The vaccine is not recommended for infants less than nine months of age.  Like all other live virus vaccines, yellow fever vaccine should not be administered to immunocompromised patients and should be avoided during pregnancy. However, pregnant women and HIV-positive individuals with CD4 counts greater than 200 should discuss immunization with their health-care provider if they are at high risk of infection.
  • 21.  WHO also recognizes the Saudi Arabian requirement for meningococcal vaccine for pilgrims visiting Mecca for Hajj or Umrah.  These travelers must show documentation of vaccination against meningococcal meningitis A,C,Y,W-135 when applying for a visa for Hajj or Umrah. Documentation must also be shown to the Saudi Arabian  passport authority upon entry to the country
  • 22. Timing of vaccines   Many travelers visit a physician only a short time before their anticipated date of departure. When necessary, inactivated vaccines may be administered simultaneously at separate sites with separate syringes.  Theoretically, live vaccines should be administered 30 days apart because of possible impairment of the immune response. However, this restriction does not apply to oral polio virus (OPV), MMR, and varicella, which may be given together.  All immunizations should be recorded in the international certificate of vaccination booklet and carried with the passport.
  • 23. Pre travel health education. Travelers should ascertain the associated travel health information for their specific itinerary several months in advance of departure. This should include general health information such as vaccine requirements, prophylactic medications, disease outbreaks, political environment, and medical resources.
  • 24.  A medical kit is an essential item that should be carried by all travelers to developing countries or where local availability of such resources remains in doubt.  The kit should include standard first-aid items, simple medications for common ailments, and any items specific for that traveler. In addition, consider having a list of medications along with a medical attestation signed by a physician authenticating the need of those medications for personal use.
  • 25.  Antiseptic wound cleanser  Antihistamines  Adhesive bandages/bandages  Eye drops/rewetting drops  Hand antiseptic  Insect repellent
  • 26.  Insect bite treatment  Medical tape  Nasal decongestant  Oral rehydration powder  Scissors, safety pins/closure devices  Simple analgesics (eg, ibuprofen, acetaminophen)  Sterile gauze/dressing  Thermometer (oral/rectal)
  • 27.  Antidiarrheal medication  Antifungal medication  Malaria prophylaxis  Personal medications (current medical illnesses)  Sleeping medications/sedatives  Water purifier/disinfectant
  • 28.  Malaria protection Compliance with antimalarial chemoprophylaxis regimens and use of personal protection measures to prevent mosquito bites are keys to prevention of malaria.
  • 29. Travelers’ diarrhea Diarrhea is the most frequent health impairment among travelers, with a risk of 7% of travelers to the developed countries and risks of 0– 90% of travelers to some parts of the developing world.
  • 30. The most common symptoms, in addition to diarrhea and fecal urgency are  abdominal cramps, nausea, vomiting, and general malaise,  often resulting in incapacitation for more than 10% of the international excursion.
  • 31. The most frequent etiologic agents at most destinations are enterotoxigenic Escherichia coli (ETEC), and enteroaggregative E. coli (EAEC). The most common causes of travelers’ diarrhea,  in addition to E. coli, are Shigella spp., Salmonella spp., Campylobacter spp. Vibrio parahaemolyticus (in Asia), rotavirus (in Latin America), and protozoa (Giardia, Cryptosporidium, and Cyclospora spp., and Entamoeba histolytica), but no pathogen is identified in over half of patients. Noroviruses,  which cause the majority of acute viral gastroenteritis cases worldwide, are increasingly being recognized as a cause of outbreaks and illness among travelers.
  • 32. When counseling travelers about diarrhea, health-care providers must consider several issues: food and water precautions, hand hygiene, chemoprophylaxis, Self-treatment of illness,  and immunization
  • 33. Although malaria is the most important vector-borne infection in travelers, others also require attention. Of these, Dengue is an increasing problem, as noted by a dramatic rise in the infection globally, particularly in the Caribbean, Central and South America, and Southeast Asia.  Tick-borne encephalitis is acquired by the bite of an infected tick or rarely, by ingesting unpasteurized dairy products in endemic foci between latitude 39° and65°.  In addition to insect precautions, some vector-borne diseases can be prevented by prophylactic medication. For example, loiasis can be prevented by taking 300 mg (adult dose) of diethylcarbamazine once each week while in a very heavily infested
  • 34.  In areas such as Central or West Africa. Tick- and mite-borne typhus, relapsing fever, bartonellosis, and plague  can be prevented by using doxycycline prophylaxis, 100 mg daily, during exposure. For the most part, prophylaxis of these latter infections is not recommended except for a very select group of individuals at high risk for infection.
  • 35.  During international travel, individuals often feel a sense of anonymity, may be less sexually inhibited, and may therefore put themselves at greater risk for the acquisition of sexually transmitted disease.  The risk is increased by exposure to multiple or professional partners. Safer sexual practices, including the use of condoms throughout intimacy, are particularly important in the era of HIV/AIDS. Immunization against hepatitis B is a must for those who may engage in casual sex while abroad. 
  • 36.  Schistosomiasis, a helminthic disease that infects over 200 million people in parts of South America, the Caribbean, Africa, the Middle East and Southeast Asia, can be avoided by advising travelers to stay out of slow-moving, fresh water in developing countries in these areas of the world.  Swimming in the ocean or freshwater pools without snails is safe. Barefoot walking exposes the traveler to a variety of hazards, including tungiasis (sandflea), snake bites, cutaneous larva migrans from dog and cat hookworms, human hookworm infection, and strongyloidiasis. Sandals provide only partial protection; closed footwear should be fully protective.
  • 37.  Excessive sun exposure can cause erythema and sunburn, chemical hypersensitivity, eye damage, bleaching of the skin, and predisposition toward skin cancers, including  malignant melanoma. The least potent sunscreen that should be used is one with a sun
  • 38.  protection factor (SPF) of 15, offering 93% protection. Adaptation to a hot climate can take from one to several weeks, depending on the ambient temperatures and humidity.  Clothing should be made of natural fibers such as cotton and linen to allow air to circulate.  Light colors reflect light and are preferable to dark fabrics. Since sweat contains both water and salt, it is important to replace salt by eating salty foods or adding extra salt to food.  In hot weather and in the absence of strenuous exercise, the average person must replace at least 11/2 liters of fluid per day. 
  • 39.  It is more the exception than the rule that physicians ask “Where have you been?” of travelers who become ill after their return.  Therefore, before departure travelers should be warned that if they become ill on return, regardless of how carefully they have followed recommended precautions, they should immediately inform their physicians that they have traveled recently. This advice is particularly important for  febrile travelers, since no antimalarial drug guarantees protection against malaria. 