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travel medicine (traveler's health)

CDC travel recommendations: [23] History: 1) what vaccinations or prophylaxis was taken? 2) what was the purpose of travel? 3) was travel to rural or urban areas? 4) what were the departure & arrival dates? Etiology: === Risk factors for acquiring endemic infection === 1) staying in endemic area for more than 1 month 2) < 30 years of age 3) working with indigenous people, especially in the tropics 4) for most developed countries & for short stays, risk is small 5) risk of acquiring infection on commercial transportation is very low [1] === Febrile traveler returning from developing country === 1) incubation period < 2 weeks a) malaria (most common cause) b) typhoid fever c) dengue d) rickettsial disease e) hepatitis A f) yellow fever g) Loeffler syndrome 2) incubation period > 4 weeks a) malaria b) tuberculosis (case of cough & malaise but no fever) c) brucellosis d) mononucleosis syndrome 1] Epstein-Barr virus 2] Cytomegalovirus 3) it may be difficult to determine the incubation period in a patient who has been abroad for an extended period 4) other travel-associated infections a) leptospirosis b) Chikungunya fever c) histoplasmosis d) coccidioidomycosis e) legionellosis f) coronaviruses: SARS, MERS-CoV g) Japanese encephalitis h) hemorrhagic fever viruses - Ebola virus - Marburg virus - Lassa virus [1] i) Penicillium marneffei j) Zika virus k) cutaneous diphtheria [21] === Special etiologies === 1) traveler's diarrhea 2) consider malaria in any patient with fever with travel to an endemic zone within 1 year 3) transient pulmonary infiltrates with eosinophilia (Loffler syndrome) 4) several types of infections may occur 5 or more years after leaving an endemic area. Complications: - venous thromboembolism [4,5,6] a) risk increases with distance of travel b) immobilization more important than travel per se [6] - travel-associated infection - many international tourists return home colonized with multidrug-resistant enterobacteriaceae (MRE) [12] - 31% for travelers to Latin America, 48% for travelers to sub-Saharan Africa, & 72% for travelers to Asia - destinations most commonly associated with MRE were Vietnam, India, Peru, & Togo - most of those colonized with MRE cleared the organisms within 1 month of return - 20% remained colonized at 2 months - rarely individuals remained colonized at 1 year [12] - circadian misalignment occurs when traveling east - major league teams 3.5% less likely to win when they travel east across at least two time zones [19] - insulin pumps over-deliver > 1/2 unit on takeoff & under-deliver a somewhat less on landing [25] Management: === Immunizations === 1) varies with site of travel 2) general recommendations (review status & immunize if indicated) a) measles, mumps & rubella vaccine (MMR) - do not give live vaccine to pregnant women (MMR) - ~1/2 of those eligible for MMR actually receive it [20] b) influenza vaccine c) pneumococcal vaccine (recheck indications i.e. smoking ...) d) hepatitis: hepatitis A vaccine, hepatitis B vaccine e) varicella (chickenpox) f) Tdap 3) review status of polio vaccination - travel to developing countries - CDC requires inactivated poliovirus vaccine booster for travel to Cameroon, Pakistan, & Syria [10] - inactivated poliovirus vaccine booster recommended for travel to Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia, & Nigeria [10] 4) yellow fever vaccine may be required - Africa, South America 5) typhoid fever a) typhoid attenuated oral vaccine (QOD for 4 doses) b) single dose typhoid polysaccharide vaccine (typhim Vi) c) travel to developing countries (not Taiwan) 6) cholera vaccine a) marginal effectiveness b) significant side effects 7) meningiococcal vaccines for travel to sub-Saharan Africa 8) hepatitis: a) hepatitis A vaccine &/or immune globulin 1] travel to developing countries 2] not needed for travel to western Europe, Australia ... 3] one month prior to travel, 2nd dose 6-12 months later b) hepatitic B vaccine 1] travel to all developing countries 2] includes Southern Europe 3] accelerated schedule available [1] 9) Japanese B encephalitis vaccine a) not required b) advisable for persons visiting rural Southeast Asia & China for periods of a month or longer, particularly during summer months (rainy season) c) allergic reactions may occur 10) rabies pre-exposure prophylaxis a) workers in endemic areas b) 3 injections over one month c) serologic testing for effectiveness every 6 months d) booster vaccinations as guided by serologic testing & with exposure to rabies 11) tick-borne encephalitis vaccine (not available in U.S.) 12) adults with solid & hematologic cancers traveling to an area of risk should follow the CDC standard recommendations for the destination - non-live vaccines are safe - hepatitis A vaccine, typhoid vaccine, inactivated polio vaccine, hepatitis B vaccine, rabies vaccine, meningococcal vaccine, Japanese encephalitis vaccine [24] === also see more specific terms === Notes: - caution: - some Brand names are used for different drugs in different countries (see Brand names for drugs in different countries) - CDC travel recommendations: [23] 1) (877) FYI-TRIP

Related

air travel airline travel & medications altitude sickness Brand names for drugs in different countries drug importation foreign drug traveler's diarrhea

Specific

Antarctic expedition jet lag medical tourism

References

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  2. Prescriber's Letter 7(8):48 2000
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  4. Chandra D et al Travel and risk for venous thromboembolism. Ann Intern Med 2009 Aug 4; 151:180. PMID: 19581633
  5. Kelman CW et al Deep vein thrombosis and air travel: record linkage study. BMJ. 2003 Nov 8;327(7423):1072. PMID: 14604926 http://bmj.bmjjournals.com/cgi/content/full/327/7423/1072 - Schwarz T et al Venous thrombosis after long-haul flights. Arch Intern Med. 2003 Dec 8-22;163(22):2759-64. PMID: 14662630 - Martinelli I et al Risk of venous thromboembolism after air travel: interaction with thrombophilia and oral contraceptives. Arch Intern Med. 2003 Dec 8-22;163(22):2771-4. PMID: 14662632 - Hughes RJ et al Frequency of venous thromboembolism in low to moderate risk long distance air travellers: the New Zealand Air Traveller's Thrombosis (NZATT) study. Lancet. 2003 Dec 20;362(9401):2039-44. PMID: 14697802
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  7. Prescriber's Letter 19(4): 2012 COMMENTARY: Venous Thromboembolism During Travel SPECIAL REPORT: Preventing Travel-Related Illnesses PATIENT EDUCATION HANDOUT: Preventing Blood Clots When You Travel Detail-Document#: 280424 (subscription needed) http://www.prescribersletter.com
  8. Hill DR, Ericsson CD, Pearson RD et al The practice of travel medicine: guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006 Dec 15;43(12):1499-539 PMID: 17109284
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  10. Centers for Disease Control and Prevention (CDC) Emergency Preparedness and Response. June 2, 2014 Guidance to US Clinicians Regarding New WHO Polio Vaccination Requirements for Travel by Residents of and Long-term Visitors to Countries with Active Polio Transmission. http://emergency.cdc.gov/han/han00362.asp
  11. Pan American Health Organization Health Alert. Enjoy the 2014 FIFA World Cup. Travel Safely without measles and rubella, http://www.paho.org/vwa/wp-content/uploads/2014/04/Measles-and-Rubella-Health-Alert-Flyer-English.jpg?ua=1
  12. Ruppe E et al. High rate of acquisition but short duration of carriage of multidrug-resistant enterobacteriaceae after travel to the tropics. Clin Infect Dis 2015 Aug 15; 61:593 PMID: 26276883 http://cid.oxfordjournals.org/content/61/4/593
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  19. Song A, Severini T, Allada R How jet lag impairs Major League Baseball performance. Proc Natl Acad Sci. U.S.A. January 23, 2017 PMID: 28115724 http://www.pnas.org/content/early/2017/01/17/1608847114
  20. Hyle EP, Rao SR, Jentes ES et al Missed Opportunities for Measles, Mumps, Rubella Vaccination Among Departing U.S. Adult Travelers Receiving Pretravel Health Consultations. Ann Intern Med. May 16, 2017. PMID: 28505632 http://annals.org/aim/article/2626466/missed-opportunities-measles-mumps-rubella-vaccination-among-departing-u-s - Handy LK, Offit PA. Why Aren't International Travelers Vaccinated for Measles? Ann Intern Med. May 16, 2017. PMID: 28505661 http://annals.org/aim/article/2627899/why-aren-t-international-travelers-vaccinated-measles
  21. Griffith J, Bozio CH, Poel AJ, et al. Imported Toxin-Producing Cutaneous Diphtheria - Minnesota, Washington, and New Mexico, 2015-2018. MMWR Morb Mortal Wkly Rep 2019;68:281-284 https://www.cdc.gov/mmwr/volumes/68/wr/mm6812a2.htm
  22. Freedman DO, Chen LH Vaccines for International Travel. Mayo Clin Proc. Nov 2019, 94(11):2314-2339 PMID: 31685156
  23. NEJM Knowledge+ Complex Medical Care
  24. Brooks M ASCO Releases Vaccination Guidelines for Adults With Cancer MDedge/Internal Medicine. March 28, 2024 https://www.mdedge.com/internalmedicine/article/268479/preventive-care/asco-releases-vaccination-guidelines-adults-cancer
  25. Tucker ME Air Travel Alters Insulin Pump Delivery on Takeoff, Landing. Medscape.September 27, 2024 https://www.medscape.com/viewarticle/air-travel-alters-insulin-pump-delivery-takeoff-landing-2024a1000hna
  26. CDC travel recommendations: Vaccines. Medicines. Advice. http://www.cdc.gov/travel - Yellow Book Homepage Explore Travel Health with the Yellow Book! http://wwwnc.cdc.gov/travel/page/yellowbook-home
  27. National Center for Complementary and Inegrative Health Complementary Health Approaches for Travelers https://www.nccih.nih.gov/health/complementary-health-approaches-for-travelers