Travelers healthTravelers health

Dr. Khaled Mahmoud Abd ElazizDr. Khaled Mahmoud Abd Elaziz Associate Prof. of public health and preventive Associate Prof. of public health and preventive

medicine Faculty of Medicine- Ain Shams medicine Faculty of Medicine- Ain ShamsUniversityUniversity

This lecture will cover the following itemsThis lecture will cover the following items

Importance of travelers healthImportance of travelers healthPreparation of travelingPreparation of travelingPre travel advicesPre travel advicesImmunization required for travelersImmunization required for travelersDisease chemoprophylaxisDisease chemoprophylaxisHealth education during travelingHealth education during travelingWhat traveler should do on returning to What traveler should do on returning to

homelandhomeland

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Travelers’ Health RisksTravelers’ Health Risks

Of 100,000 travelers to a developing country Of 100,000 travelers to a developing country for 1 month:for 1 month:– 50,000 will develop some health problem 50,000 will develop some health problem – 8,000 will see a physician8,000 will see a physician– 5,000 will be confined to bed5,000 will be confined to bed– 1,100 will be incapacitated in their work1,100 will be incapacitated in their work– 300 will be admitted to hospital300 will be admitted to hospital– 50 will be air evacuated50 will be air evacuated– 1 will die1 will dieSteffen R et al. J Infect Dis 1987; 156:84-91Steffen R et al. J Infect Dis 1987; 156:84-91

الملريا النيجيرية تقتل لبعب شطرنج مصري ورئيس الملريا النيجيرية تقتل لبعب شطرنج مصري ورئيس ! ! البعثةالبعثة

حتوفي أمس العميد محمد لبيب عضو مجلس ادارة الحتحاد المصري للشطرنج حتوفي أمس العميد محمد لبيب عضو مجلس ادارة الحتحاد المصري للشطرنج ورئيس بعثة المنتخب في نيجيريا‏, واللعب عصام علي أحمد لعب المنتخب ورئيس بعثة المنتخب في نيجيريا‏, واللعب عصام علي أحمد لعب المنتخب الوطني الذي شارك أيضا في دورة اللعاب الفريقية بنيجيريا أثر اصابتهما الوطني الذي شارك أيضا في دورة اللعاب الفريقية بنيجيريا أثر اصابتهما بعدوي الملريا أثناء وجودهما بنيجيريا.. وكان الفقيدان قد عادا إلي مصر مع بعدوي الملريا أثناء وجودهما بنيجيريا.. وكان الفقيدان قد عادا إلي مصر مع البعثة حاملن للميكروب دون أن يكتشف ذلك أحد واحتفل اللعب بفوزه البعثة حاملن للميكروب دون أن يكتشف ذلك أحد واحتفل اللعب بفوزه بميدالية ذهبية في المنافسات في الشطرنج الجماعي‏, وهو بطل العرب مرحتين بميدالية ذهبية في المنافسات في الشطرنج الجماعي‏, وهو بطل العرب مرحتين متتاليتين في المنافسات الفردية‏, كما أنه بطل افريقيا لمرحتين أيضا وكان عضوا متتاليتين في المنافسات الفردية‏, كما أنه بطل افريقيا لمرحتين أيضا وكان عضوا

وهو متزوج وله طفلن حتبلغ الولي عامين وهو متزوج وله طفلن حتبلغ الولي عامين 9898دائما بالمنتخب الوطني منذ عامدائما بالمنتخب الوطني منذ عامارحتفاع ارحتفاع أشهر.. وحتؤكد زوجته انه كان يعاني من أشهر.. وحتؤكد زوجته انه كان يعاني من 33وليزيد عمر الثاني عليوليزيد عمر الثاني علي

بشكل بشكل ‏, وحتم التعامل مع هذه العراض ‏, وحتم التعامل مع هذه العراض درجة حرارحته فور عودحته مباشرةدرجة حرارحته فور عودحته مباشرة ومع حتدهور حالته حتم نقله مساء الحد الماضي ومع حتدهور حالته حتم نقله مساء الحد الماضي عادي علي أنه مجرد سخونةعادي علي أنه مجرد سخونة

إلي مستشفي الحميات بالسكندرية حيث واصلت حالته حتدهورها حتي لفظ إلي مستشفي الحميات بالسكندرية حيث واصلت حالته حتدهورها حتي لفظ أنفاسه اليخيرة صباح أمس.أنفاسه اليخيرة صباح أمس.

! ! الملريا النيجيرية تقتل لبعب شطرنج مصري ورئيس البعثةالملريا النيجيرية تقتل لبعب شطرنج مصري ورئيس البعثة

وقد أكدت زوجة اللعب أنه لم وقد أكدت زوجة اللعب أنه لميحصل علي التطعيم الخاص يحصل علي التطعيم الخاص بالوقاية من مرض الملريا قبل بالوقاية من مرض الملريا قبل سفره إلي البطولة الفريقية.سفره إلي البطولة الفريقية.

On October 27, 2003, Essam Ahmed Ali On October 27, 2003, Essam Ahmed Ali (1964-2003), an International Master and (1964-2003), an International Master and Egypt’s top chess player, died of malaria Egypt’s top chess player, died of malaria after returning home from the All Africa after returning home from the All Africa Games chess tournament in Nigeria. The Games chess tournament in Nigeria. The 60-year old head of the Egyptian chess 60-year old head of the Egyptian chess delegation, Mohammed Labib, died of the delegation, Mohammed Labib, died of the same disease the next day. same disease the next day.

Both were Both were incorrectly diagnosed in Egypt incorrectly diagnosed in Egypt afterafter becoming ill. Both were bitten by an becoming ill. Both were bitten by an infected mosquito that gave them malaria.infected mosquito that gave them malaria.

Travel medicine is a continuumTravel medicine is a continuum

Travellers do get sick or injured abroad Travellers do get sick or injured abroad or when they come backor when they come back

The commitment to travel health can The commitment to travel health can therefore be regarded as a continuumtherefore be regarded as a continuum

The Continuum of Travel MedicineThe Continuum of Travel Medicine

During TravelDuring Travel

Preventive Medicine

Contingency Planning

Treatment & Rehabilitation

Pre-TravelPre-Travel

Post-TravelPost-Travel

Pre travel advicePre travel advice

Chronic condition.. Examination one month Chronic condition.. Examination one month before travellingbefore travelling

Patients with chronic medication should carry Patients with chronic medication should carry sufficient supply of their medication (insulin, sufficient supply of their medication (insulin, digitalis, anticoagulants)digitalis, anticoagulants)

Extra pair of sunglassesExtra pair of sunglasses Traveler’s kit Traveler’s kit Thermometer Bandages, gauze, adhesive tape, Thermometer Bandages, gauze, adhesive tape,

antacids, antiseptics, antimalarialm oral antacids, antiseptics, antimalarialm oral laxative, anti diarrheals, insect repellents, Salt laxative, anti diarrheals, insect repellents, Salt tables in humid conditionstables in humid conditions

Pre travel advicePre travel advice

Chronic condition.. Examination one Chronic condition.. Examination one month before travellingmonth before travelling

Patients with chronic medication should Patients with chronic medication should carry sufficient supply of their carry sufficient supply of their medication (insulin, digitalis, medication (insulin, digitalis, anticoagulants)anticoagulants)

Extra pair of sunglassesExtra pair of sunglasses

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Travel Emergency KitTravel Emergency Kit

Copy of medical records and extra pair of glassesCopy of medical records and extra pair of glasses Prescription medicationsPrescription medications Over-the counter medicines and suppliesOver-the counter medicines and supplies

– AnalgesicsAnalgesics– Decongestant, cold medicine, cough suppressantDecongestant, cold medicine, cough suppressant

– Antibiotic/antifungal/hydrocortisone creams Antibiotic/antifungal/hydrocortisone creams

– Pepto-Bismol tablets, antacidPepto-Bismol tablets, antacid– Band-Aids, gauze bandages, tape, Ace wrapsBand-Aids, gauze bandages, tape, Ace wraps– Insect repellant, sunscreen, lip balmInsect repellant, sunscreen, lip balm– Tweezers, scissors, thermometerTweezers, scissors, thermometer

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Regional DestinationsRegional Destinations Region-specific pagesRegion-specific pages Goal to move to country-specific formatGoal to move to country-specific format

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Travel Notices & AnnouncementsTravel Notices & Announcements

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Infectious Disease Risks to Infectious Disease Risks to the Travelerthe Traveler

MalariaMalaria DiarrheaDiarrhea LeishmaniasisLeishmaniasis RabiesRabies DengueDengue Meningococcal Meningococcal

MeningitisMeningitis

SchistosomiasisSchistosomiasis TuberculosisTuberculosis LeptospirosisLeptospirosis PolioPolio Yellow FeverYellow Fever MeaslesMeasles JEVJEV

ETC.

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Motor Vechicle

Drowning

Air Crash

Homicide/Suicide

Poisoning

Other

Injury Deaths and International TravelInjury Deaths and International Travel

N = 601

Hargarten S et al, Ann Emerg Med, 1991. 20:622-626

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Immunizations to Consider for Adult Immunizations to Consider for Adult TravelersTravelers

RoutineRoutine

Diphtheria*Diphtheria*

Tetanus*Tetanus*

Pertussis*Pertussis*

Measles +Measles +

Mumps+Mumps+

Rubella +Rubella +

VaricellaVaricella

PneumococcusPneumococcus

InfluenzaInfluenza

Travel relatedTravel related

Hepatitis AHepatitis A

Hepatitis BHepatitis B

TyphoidTyphoid

RabiesRabies

Meningococcal diseaseMeningococcal disease

PolioPolio

Japanese encephalitisJapanese encephalitis

Yellow FeverYellow Fever

* Td or Tdap+ MMR

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ImmunizationsImmunizations Yellow fever: Tropical Africa and South AmericaYellow fever: Tropical Africa and South America Live attenuated vaccine SC injection, Valid 10 years and Live attenuated vaccine SC injection, Valid 10 years and

starts 10 days after immunization.starts 10 days after immunization. TD: Booster dose every 10 years TD: Booster dose every 10 years Typhoid:TAB vaccine in 2 doses 4 weeks apartTyphoid:TAB vaccine in 2 doses 4 weeks apart Rabies: pre exposure vaccination for joggers Rabies: pre exposure vaccination for joggers

vetenerians, animal handlers, field workers.vetenerians, animal handlers, field workers. Meningicoccal meningitis: sub saharan Africa, Meningicoccal meningitis: sub saharan Africa,

mandatory to piligrmiages KSAmandatory to piligrmiages KSA Hepatitis A vaccination: disease is endemic in most Hepatitis A vaccination: disease is endemic in most

developing countries. 2 doses the first is 2 weeks developing countries. 2 doses the first is 2 weeks before travelling and the second after 6-12 monthsbefore travelling and the second after 6-12 months

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Chemoprophylaxis Chemoprophylaxis MalariaMalaria Cholorquine: in choloriquine sensitive malaria Cholorquine: in choloriquine sensitive malaria

species 300 mg once weekly 2 w before species 300 mg once weekly 2 w before departure, during stay, 4weeks after returndeparture, during stay, 4weeks after return

Cholorquine resistant sepices: Mefloquine 250 Cholorquine resistant sepices: Mefloquine 250 mg once weekly, one week before travelmg once weekly, one week before travel

No drug is 100%protective must be combined No drug is 100%protective must be combined with presonal protective measureswith presonal protective measures

Health educationHealth educationTo travelers to endemic areasTo travelers to endemic areas

Protection against mosquito bitesProtection against mosquito bites

1-remain in well screened areas1-remain in well screened areas

2-use of mosquito nets2-use of mosquito nets

3-wearing clothes that covers most of the body3-wearing clothes that covers most of the body

4-mosquito repellents on exposed areas4-mosquito repellents on exposed areas

5-use insecticides pyrethum containing in living 5-use insecticides pyrethum containing in living and sleeping areas during evening and night and sleeping areas during evening and night hours.hours.

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Advice during travelling Advice during travelling FlyingFlying: Jet lag and disturbances of circadian : Jet lag and disturbances of circadian

rhythm, one day re adjusting in every 2 hours rhythm, one day re adjusting in every 2 hours change of time, Motion sicknesschange of time, Motion sickness

Acclimitization:Acclimitization: AltitudeAltitude: high altitude, avoid alcohol tobacco, : high altitude, avoid alcohol tobacco,

excess food or excess exercise, take restexcess food or excess exercise, take rest Heat:Heat: hot countries, exercise in hot weathers 2 hot countries, exercise in hot weathers 2

hours per week for 2 weekshours per week for 2 weeks WaterWater: bottled water, or boiling of water for 5 : bottled water, or boiling of water for 5

minutes with adding of chemicals.minutes with adding of chemicals.

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Advice during travelingAdvice during traveling Food and beveragesFood and beverages Eat well cooked hot foods to avoid most food Eat well cooked hot foods to avoid most food

born infections, avoid cold food or saladsborn infections, avoid cold food or salads Raw fruits could be eaten after washing with Raw fruits could be eaten after washing with

unbroken skinunbroken skin Smoking or salting of meat is not effective, Smoking or salting of meat is not effective,

heating of those products at 55 degrees.heating of those products at 55 degrees. Avoid sun stroke or heat exhausationAvoid sun stroke or heat exhausation Avoid mosquito bitesAvoid mosquito bites Avoid snake bites: Long boots with trousers Avoid snake bites: Long boots with trousers

tucked in them should be worntucked in them should be worn

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Advice during travelingAdvice during traveling Food and beveragesFood and beverages Eat well cooked hot foods to avoid most food Eat well cooked hot foods to avoid most food

born infections, avoid cold food or saladsborn infections, avoid cold food or salads Raw fruits could be eaten after washing with Raw fruits could be eaten after washing with

unbroken skinunbroken skin Smoking or salting of meat is not effective, Smoking or salting of meat is not effective,

heating of those products at 55 degrees.heating of those products at 55 degrees. Avoid sun stroke or heat exhausationAvoid sun stroke or heat exhausation Avoid mosquito bitesAvoid mosquito bites Avoid snake bites:Avoid snake bites: Long boots with trousers Long boots with trousers

tucked in them should be worntucked in them should be worn

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Advice during travelingAdvice during traveling Travelers diarrheaTravelers diarrhea Enterotoxgenic E coli leading causeEnterotoxgenic E coli leading cause Acute viral infections, rota virus, campylobacter Acute viral infections, rota virus, campylobacter

infectionsinfections Replacement of fluids with water, tea, Replacement of fluids with water, tea,

carbonated beverages.carbonated beverages. Electrolyte replacement ORSElectrolyte replacement ORS Bananas and oranges should be takenBananas and oranges should be taken Bland diet with avoidance of alcohol or fatsBland diet with avoidance of alcohol or fats

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Post-Travel CarePost-Travel Care

Post-travel checkupPost-travel checkup– Long term travelersLong term travelers– Adventure travelersAdventure travelers

– Expatriates in developing worldExpatriates in developing world

Post-travel carePost-travel care– Fever, chills, sweatsFever, chills, sweats

– Persistent diarrheaPersistent diarrhea

– Weight lossWeight loss

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