Abdul Salam M.

Sofro
Faculty of Medicine
YARSI UNIVERSITY

http://www.who.int/ith/chapters/en/index.html
www.kma.org.kw/Conferance/Travel%20Medicine.ppt
Learning objectives

By the end of lectures, students are

expected to :
Acknowledge the increasing number of
global travelling
Describe the influence of travelling on
human health
Describe the roles of the medical profession
in avoiding health problems related to
travelling
Ref. WHO. 2010. International Travel and Health. World Health Organization
WHO. 1988. International Medical Guide for Ships. World Health Organization
Introduction
Human migration & travelling

Migration (human) is the movement of

people from one place in the world to
another for the purpose of taking up
permanent or semipermanent residence,
usually across a political boundary
Travelling on the other hand is to go from
one place to another, as on a trip; journey.
Migrations have occurred throughout
human history, beginning with the
movements of the first human groups
from their origins in East Africa to
their current location in the world,
Migration of Melanesian &
Austronesian people through & to the
present day Indonesian archipelago

www.dailymail.co.uk/sciencetech/article-10706
 Tourism has become a popular global
leisure activity. In 2008, there were over
922 million international tourist arrivals,
with a growth of 1.9% as compared to
2007. International tourism receipts
grew to US$ 944 billion (euro 642
billion) in 2008, corresponding to an
increase in real terms of 1.8%.
International arrivals are expected to
reach 1 billion by 2010 and 1.6 billion
by 2020.
The World Tourism Organization reports on ten countries as the most visited from
2006 to 2009 by the number of international travelers.

International International International International

UNWTO
tourist tourist tourist tourist
Rank Country Regional
arrivals arrivals arrivals arrivals
Market
(2009)[11] (2008)[11] (2007)[11] (2006)[11]

1 France Europe 74.2 million 79.2 million 80.9 million 77.9 million
North
2 54.9 million 57.9 million 56.0 million 51.0 million
United States America
3 Spain Europe 52.2 million 57.2 million 58.7 million 58.0 million
4 China Asia 50.9 million 53.0 million 54.7 million 49.9 million
5 Italy Europe 43.2 million 42.7 million 43.7 million 41.1 million

6 Europe 28.0 million 30.1 million 30.9 million 30.7 million

United Kingd
om
7 Turkey Europe 25.5 million 25.0 million 22.2 million 18.9 million
8 Germany Europe 24.2 million 24.9 million 24.4 million 23.6 million
9 Malaysia Asia 23.6 million 22.1 million 21.0 million 17.5 million
North
10 Mexico 21.5 million 22.6 million 21.4 million 21.4 million
America
 Motivation (in 2008)
leisure, recreation and holidays a
total of 467 million; Business travel
accounted for some 15% of arrivals;
and travel for other purposes (visiting
friends and relatives, religious reasons/
pilgrimages, health treatment, etc.) for
27%.
 Mode of transport :
Slightly more than half of arrivals (52%)
travelled by air transport in 2008 while
the remainder arrived at their
destinations by surface transport (48%)
by road (39%),
rail (3%) or
over water (6%)
 International travel can pose various risks to
health, depending both on :
the characteristics of the traveler and
on the type of travel travelers may
encounter sudden and significant
changes in altitude, humidity,
temperature and microbes, which can
result in ill-health.
Health risk & precaution
Travel related risks factors determine:
Mode of transport
Destination(s)
Duration and season of travel
Purpose of travel
Standards of accommodation & food
hygiene
Behaviour of the traveller
Underlying health of the traveller
 Medical kit should be considered:
First aid items
Additional items according to
destination & individual needs:
Antidiarrhoeal medication
Broadspectrum antibiotics
Antifungal powder
Antimalarial medication etc
 Travellers with pre-existing medical
condition & special needs
Special group of travellers
Age special attention for infants
Pregnancy
Disability
Pre-existing illness
Insurance for travellers
Mode of travel: health consideration

Travel by air
Cabin air pressure
Travel by sea
Travel by road or rail
The more you travel, the more you see

The more you see the more you know or

The more you see the less you know
Variation in panoramic views
Variation in hair shape
Variation in skin color
Diversity in Religions
Mode of transport for travelling
CARS
TRAINS
AIRCRAFTS
SHIPS
 Oasis of the Seas own by Royal Caribbean Internat.
Spec.16 decks ~ 20 storey building; length: 360 meter. Facilities: golf course, 4
swimming pools; volley & basket court.
30 Oktober 2009, leaft its dock of STX Finland, di Turku, Finlandia. .
Travel Health
Travel Health

Becomes more important these days

Travelling to different places with
different climates and environments
abroad can expose you to disease and
health risks.
You should be aware of the dangers and
how to stay healthy.
 These travellers should therefore be
prepared for such risks, and seek
appropriate advice about their health
before they venture abroad.
Travelers' health is the responsibility of:

Clinicians

Travelers

Travel Industry
 Doctors involved in travel medicine are
expected to help and advise travelers
look after their health before, during and
after their trip.
Responsibilities of Clinicians

A clinician should provide the traveler with:

Knowledge that enables them to protect
themselves from potential health risks.
Emphasize the importance of a pre-travel
consultation and educates the patient that
international travel can pose special
health risks that should be addressed.
Evaluate the traveler including the
medical history, the assessment of
the epidemiology of endemic
diseases or health risks at the
destination, and the behavioral risks
that may be taken.
Educate the traveler about
importance of having a medical kit
during his journey and construct
him about its contents.
 Provide post-travel medical care.
The extent of the care given is
personally determined according to
condition of traveller and travel
circumstances.
Recognize common disease
symptoms and syndromes of
international travelers.
 General travel health tips
Take out adequate travel insurance
drink plenty of water in hot climates to avoid
dehydration
be safe in the sun - use a high-factor sunscreen and
avoid excessive sunbathing between 11am 3 pm
find out the local emergency services numbers and
the number of the local hospital
practice safe sex - take condoms with you as quality
varies in different countries. HIV and Aids, and other
sexually transmitted diseases can be caught
worldwide.
 Long distance journey:
dont wear tight clothing on long-distance
journeys
do regular stretching exercises such as
flexing and extending your ankles to avoid
circulation problems
walk round at regular intervals on long
flights
drink plenty of water on flights and avoid
drinking too much alcohol.
 Consult your doctor before long-distance
travel if you:
are pregnant or have given birth in the last 6
months
have a history of blood disorders, deep vein
thrombosis or pulmonary embolism
are taking hormonal medication (including the
contraceptive pill)
have cancer, heart problems or have recently
had surgery.
Vaccination
It should be noted that vaccines do not
fully protect 100% of the recipients.
The vaccinated traveler should not
assume that there is no risk of
catching the disease against which he
has been vaccinated.
All additional precautions against
infection should be followed carefully.
 The protective effect of vaccines takes a
period of time to be fully developed.
The duration varies according to the
vaccine, the number of doses required
and whether the individual has previously
been vaccinated against the same
disease. .

For this reason, travelers are advised to

consult a travel medicine clinic or personal
physician 46 weeks before departure
Choice of vaccines for travel

Vaccines for travelers include:

(1) Vaccines used routinely, particularly
for children.
(2) Vaccines that may be advised before
travel.
(3) Vaccines that, in some situations, are
mandatory.
Mandatory vaccination:
Yellow fever (for protection of
vulnerable countries)
Meningococcal disease (required by
Saudi Arabia for pilgrims visiting Mecca
for the Hajj (annual pilgrimage) or for
the Umrah.
 The International Health Regulations
mandates yellow fever vaccination for
two different reasons:

(1) to protect the individual in areas

where there is a risk of yellow fever
infection.
(2) to protect vulnerable countries from
importation of the yellow fever virus.
According to the international measures,
The world is divided into three zones:

1. Infected (endemic) zone.

2. Infectable (receptive) zone.

3. Non-infectable zone.
Infected (endemic) zone:

In this zone, the three requirements for

perpetuation of yellow fever are
present; the virus, the vector and
suitable environmental conditions.

The objective of the control measures

is to prevent exportation of the disease
and diminish local spread.
Measures applied to infected zone:

Ports and airports:

should be away from the city.
Apply insecticides periodically to
control mosquito.

The plans: Application of insecticides on

planes before leaving.
 Individuals:
Those working in the airport and
travelers going outside or entering
should have valid vaccination
certificate .
Cases of yellow fever should not
leave the country.
Infectable (receptive) zone:

Between endemic zone and latitude 43N

and 43S. Only the vector and suitable
environmental conditions are present, but
there is no virus.
virus

Measures applied to infectable zone:

All planes and ships coming from infected
areas should be disinfected on arrival.
Only travelers carrying valid vaccination
certificates are allowed to enter.
 If travelers were not vaccinated or
since less than ten days they should
be kept in quarantine to complete the
six days
Monkeys and apes should be kept in
quarantine for seven days.
Non-infectable zone:

The area north and south of the

latitude 43.
In this area, there is no virus, no
vector and the environmental
conditions are not suitable.
Thus, no preventive measures are
required.
Yellow fever vaccine

1 dose
Protection: 10 years
Age range: Minimum age 9 months.
Seek medical advice for infants 6-9
months who are travelling to high risk
areas
 International Certificate of Vaccination or
Prophylaxis (ICVP) for Yellow Fever
The International Health Regulations allow
countries to require proof of vaccination for entry
of travelers arriving from certain countries.
Travelers arriving without a completed ICVP may
be quarantined or refused entry unless submitting
to onsite vaccination.
Vaccinees should receive a completed ICVP,
signed and validated with the centers stamp
where the vaccine was given.
This certificate is valid 10 days after vaccination
and for a subsequent period of 10 years.
 Malaria chemoprophylaxis

Antimalarial drugs are recommended for

prophylaxis of non-immune travelers visiting
malaria-endemic areas.
In areas of chloroquine-sensitive malaria,
weekly chloroquine is the drug of choice.
In areas where chloroquine-resistant P.
falciparum is transmitted, weekly mefloquine
or daily doxycycline is recommended.
Chemoprophylaxis should be started 1 week
before arriving in a malaria-endemic area and
continued during travel and for 4 weeks after
leaving the area.
 Responsibilities of Travelers
Each traveler needs to realize
the value of health and the
risks that traveling
internationally may pose.
Every travelers responsibility
is to weigh the personal risk
versus benefits of a particular
journey.
Recent studies have shown that a small portion of
travelers do not even seek general information about
their travel destination
 Some important things for travellers :
Medical kit and hygiene items:
Sufficient medical supplies should be
carried to meet all needs for the duration of
the trip.
A medical kit should be carried for all
destinations where there may be significant
health risks, particularly those in developing
countries, and/or where the local availability
of specific medications is not certain.
Certain categories of medicine should
be carried together with a medical
prescription, signed by a physician.
Hygiene items should also be carried in
sufficient quantity for the entire visit
unless their availability at the travel
destination is assured. These will
include items for dental care, eye care
including contact lenses, skin care and
personal hygiene.
 This kit will include:
Basic medicines to treat common
ailments.
First-aid articles.
Special medical items that may be
needed by the individual traveler.
 Contents of a basic med kit (First-aid items):
Adhesive tape.
Antiseptic wound cleanser.
Bandages.
Emollient eye drops.
Insect repellent.
Insect bite treatment.
Nasal decongestant.
Oral re-hydration salts.
Scissors and safety pins.
Simple analgesic (e.g. Paracetamol).
Sterile dressing.
Clinical thermometer.
 If you have a pre-existing medical condition
tell your travel insurer about your
condition
ask your doctor how the trip might affect
you
check local conditions such as climate
and pollution levels and consider how you
might be affected
carry a doctors letter and a copy of any
prescriptions
ensure your medication is legal in the
country you are visiting
learn key words and phrases in the local
language for your condition, medication
and emergency help
take the same precautions you normally
would if you werent going to be at home
for a while
if you suffer from a mental illness you
should be aware that facilities and local
attitudes to mental health problems may
differ from back home.
Responsibilities of the Travel Industry

Travel agencies, tour

operators, air and cruise lines
should learn about the basics
of travel medicine as it affects
the areas of the world where
their customers are traveling.
 Their responsibilities are:
Consult travelers about health risks
and preventive actions they should
take. (such as the presence of
malaria or the fact that vaccinations
may be beneficial).
Provide resources in travel
medicine.
Chapters
Preface [pdf 419kb]
Chapter 1 [pdf 503kb]
Health risks and precautions:
general considerations
Chapter 2 [pdf 528kb]
Mode of travel: health
considerations
Chapter 3 [pdf 548kb]
Environmental health risks
Chapter 4 [pdf 478kb]
Injuries and violence
Chapter 5 [pdf 149kb]
Infectious diseases of potential
risk for travellers
Chapter 6 [pdf 663kb]
Vaccine-preventable diseases
and vaccines
Chapter 7 [pdf 575kb]
Malaria
Chapter 8 [pdf 517kb]
Exposure to blood or other body
fluids
Chapter 9 [pdf 557kb]
Special groups of travellers
Chapter 10 [pdf 505kb]
Psychological Health
Country list: yellow fever
vaccination requirements and
recommendations; and malaria
situation [pdf 612kb]
Annexes [pdf 460kb]
Acknowledgements [pdf 428kb]
Assignment