(WTO) 30 200 10 US Resident Air Outbound (ITA) All US Resident Outbound (ITA) 40 US20Resident travel in millions
US nonresident Inbound (ITA) Worldwide arrivals in millions 100 0 0 1996 1997 1998 1999
2000 2001 2002 2003 2004 2005 4 Where Do U.S. Residents Travel? 40
Of the 17% who traveled outside the U.S. . . . 30 %20 10 0 Canada Europe Aus/NZ Mexico C or S America Africa Japan Caribbean Oceania/Other PI Asia Middle East
Source: HealthStyles Survey 2005 5 VFRs: Visiting Friends and Relatives Foreign-born increased 57% since 1990 from 19.8 million to 31.1 million1 20% of US population are first- or secondgeneration immigrants VFRs comprised ~46% of US international air travelers in 20043 US Census Bureau, Census 2000 Brief, The Foreign-Born Population: 2000, issued Dec 2003 (Previous: US Census Bureau, Profile of the Born Outside the United States Population 2000, issues Dec 2003??? 2 Angell & Cetron, 2005 32004 Profile of U. S. Resident Travelers Visiting Overseas Destinations Reported From: Survey of International Air Travelers, Office of travel and tourism Industries,
6 USDOC 1 Travelers Health Risks Of 100,000 travelers to a developing country for 1 month: 50,000 will develop some health problem 8,000 will see a physician 5,000 will be confined to bed 1,100 will be incapacitated in their work 300 will be admitted to hospital 50 will be air evacuated 1 will die Steffen R et al. J Infect Dis 1987; 156:84-91 7
The Patient: Medical Issues Age-specific issues Underlying illness, immunosuppression Systems review Medical history Medication use Vaccination history Allergies Contraindications to vaccines and medications 8 The Patient: Other Issues Reproductive
Pregnant Breastfeeding Preconception Risk-taking behaviors 9 Travel Itinerary Full itinerary Dates, duration, stopovers Seasonal considerations Styles of travel Rural vs. urban Budget vs. luxury
Accommodation Hotel vs. camping Activities Business vs. tourism Adventure, safari Missionary/Humanitarian/NGO 10 Travel Health Resources CDC Travelers Health Website www.cdc.gov/travel World Health Organization www.who.int/int
State Department travel.state.gov International Society of Travel Medicine www.istm.org Health Information for International Travel CDC Yellow Book International Travel and Health WHO Green Book 11 Travelers Health Website www.cdc.gov/travel
12 Regional Destinations Region-specific pages Goal to move to country-specific format 13 Travel Notices & Announcements 14 Deaths Related to International Travel Cardiovascular Medical Injury
Homicide/Suicide Infectious Disease Other N = 2463 Hargarten S et al, Ann Emerg Med, 1991. 20:622-626 15 Infectious Disease Risks to the Traveler
Altitude acetazolamide Motion sickness scopolamine, dimenhydrinate (Dramamine) 20 Patient Counseling Sufficient time for patient education Tailored to suit traveler Fitness for travel Understanding impact on existing conditions Advisability of destinations 21
Travel Preparation Travel health insurance Medical care Hospitalization Evacuation Obtaining medical care abroad Awareness of travel notices Hand washing and hygiene 22 Environmental Precautions
Air Travel Jet Lag Sun Protection Extreme Heat and Cold dehydration, heat stroke hypothermia, frostbite Altitude Water recreation Drowning, boating & diving accidents Risk of schistosomiasis or leptospirosis Biological and chemical contamination 23 Food and Water Precautions Bottled water
Selection of foods well-cooked and hot Avoidance of salads, raw vegetables unpasteurized dairy products street vendors ice 24 Vector Precautions
Covering exposed skin Insect repellent containing DEET 25 50% Treatment of outer clothing with permethrin Use of permethrin-impregnated bed net Use of insect screens over open windows Air conditioned rooms Use of aerosol insecticide indoors Use of pyrethroid coils outdoors 25 Inspection for ticks
Bloodborne and STD Precautions Prevalence of STDs Hepatitis B Hepatitis C
HIV Unprotected sexual activity Commercial sex workers Tattooing and body piercing Auto accidents Blood products Dental and surgical procedures 26 Animal Precautions Animal avoidance Rabies Specific animal threats Medical evaluation of bites/scratches Post exposure immunization and
immunoglobulin Envenomations Snakes, scorpions, spiders Maritime animals 27 Injury and Crime Vehicles Risk of road and pedestrian accidents Night travel Seat belts and car seats Use of drugs and alcohol Understanding local crime risks Scam awareness Situational awareness
Location avoidance 28 Travel Emergency Kit Copy of medical records and extra pair of glasses Prescription medications Over-the counter medicines and supplies Analgesics Decongestant, cold medicine, cough suppressant Antibiotic/antifungal/hydrocortisone creams Pepto-Bismol tablets, antacid Band-Aids, gauze bandages, tape, Ace wraps Insect repellant, sunscreen, lip balm Tweezers, scissors, thermometer 29
Post-Travel Care Post-travel checkup Long term travelers Adventure travelers Expatriates in developing world Post-travel care Fever, chills, sweats Persistent diarrhea Weight loss 30 Questions? 31 Other Resources
32 Journals American Journal of Tropical Medicine and Hygiene Bulletin of the World Health Organization Emerging Infectious Diseases Journal Eurosurveillance Weekly Journal of Travel Medicine Morbidity and Mortality Weekly Report Tropical Medicine and International Health Vaccine 33 Books Textbook of Travel Medicine and Health, 2nd
Ed. DuPont, H.L. and Steffen R. (editors) The Travel and Tropical Medicine Manual, 3rd Ed. Jong, E.C., McMullen, R. Travel Medicine Keystone, J.S., Kozarsky, P.E., et al 34 Websites Eurosurveillance www.eurosurveillance.org Travax EnCompass www.travax.com GIDEON
www.gideononline.com International SOS www.internationalsos.com Medical Advisory Service for Travelers Abroad (MASTA) http://www.masta.org/ Armed Forces Medical Intelligence Center www.afmic.detrick.army.mil/ Central Intelligence Agency www.cia.gov/cia/publications/factbook/ 35
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