19341

Introduction to travel medicine: 

Introduction to travel medicine Dr Peter A Leggat MD, PhD, DrPH, FAFPHM, FACTM, FFTM Associate Professor, School of Public Health and Tropical Medicine, James Cook University, Australia, & Visiting Professor, School of Public Health, University of the Witwatersrand

About the author: 

About the author Dr Peter Leggat has co-ordinated the Australian postgraduate course in travel medicine since 1993. He has also been on the faculty of the South African travel medicine course, conducted since 2000, and the Worldwise New Zealand Travel Health update programs since 1998. Dr Leggat has assisted in the development of travel medicine programs in several countries and also the Certificate of Knowledge examination for the International Society of Travel Medicine.

Objectives: 

Objectives In this session Define travel medicine Examine some figures for global and local migration Hopefully gain an appreciation of the importance of giving travel health advice Discuss some of components that are needed in order to give correct advice to traveller

What is travel medicine?: 

What is travel medicine? It is a science and an art

What is travel medicine?: 

What is travel medicine? It is that part of health professional practice that: seeks to prevent illnesses and injuries occurring to travellers going abroad manages problems arising in travellers coming back or coming from abroad is concerned about the impact of tourism on health and also advocates for improved health and safety services for tourists is increasing concerned about refugee and migrant health (Primer of Travel Medicine 3rd Ed)

Slide6: 

“the art of travel medicine is selecting the necessary prevention strategy without unnecessary adverse events, cost or inconvenience” (Steffen, 1994)

Challenge of travel medicine: 

Challenge of travel medicine Sea of global migration of people More people travelling People travelling further a field Rapid movement of travellers

Slide8: 

USA / Canada 35.2 million Europe 25.0 million Japan 11.4 mio AUS / NZ 3.3 million Travellers from industrialised areas to developing areas 1999 (WTO) 2.8 2.3 19 7.8 1.9 3.6 6.8 2.5 1.3 1.6 2.4 4.6 6.1 4.8 2.6 Total: n million travelers 0.2-1 million travelers ~ 80 million travelers 1.2

Globalization of health and safety: 

Globalization of health and safety Affects Health of local populations Health determinants Safety and security Results in Global impacts Emerging and re-emerging infectious disease Commerce and Health Pathogens travel as fast as transportation: borders are not respected Tsunami SARS Influenza Terrorism

Slide10: 

Travellers are exposed to a variety of hazards

The Importance of Travel Health Measures: 

The Importance of Travel Health Measures 100,000 travelers to the developing world for 1 month….. 50,000 will become ill 8,000 will see a physician 5,000 will stay in bed 1 will die Steffen, 1994

The Importance of Travel Health Measures: 

The Importance of Travel Health Measures Per 100,000 travellers that have travel insurance ….. 8000 will make a claim (8%) 2000 will use emergency assistance (2%) 400 ER or clinic referrals (0.4%) 200 Hospital admissions (0.2%) 50 Aeromedical evacuations (0.05%) Leggat et al. Travel Med Inf Dis 2005;3:9-17.

The Importance of Travel Health Measures: 

The Importance of Travel Health Measures Mortality Cardiovascular Disease (50 to 70%) Accidents/Trauma (20-25%), esp. MVAs Infectious diseases (2.8-4%) (Reid and Cossar, BMBull. 1993;257-268; Prociv, MJA. 1995;163:27-30; Baker et al., PHR 1992;107:155-159; MacPherson et al, JTM. 2000; 2000:227-233; Steffen, Trans RSTM&H 1991;85: 156-162 )

Travel medicine is a continuum: 

Travel medicine is a continuum Travellers do get sick or injured abroad or when they come back The commitment to travel health can therefore be regarded as a continuum

Slide15: 

The Continuum of Travel Medicine Preventive Medicine Contingency Planning Treatment & Rehabilitation

What do we need to do in order to be giving the correct advice to travellers?: 

What do we need to do in order to be giving the correct advice to travellers?

Travel Health Advice needs Information: 

Travel Health Advice needs Information “Information is power in Travel Medicine”

Travel Health Advice needsTraining: 

Travel Health Advice needs Training Training gives you a framework for using that information

Travel Health Advice needsExperience: 

Travel Health Advice needs Experience Experience helps put the information and training in perspective

Travel Health Advice needsto be Documented: 

Travel Health Advice needs to be Documented Documentation is important for Quality assurance and reinforcing travel health advice

Travel Health Advice needsTravellers: 

Travel Health Advice needs Travellers Marketing is essential in travel health, whether in general practice or in specialist travel clinics

Giving the correct advice to travellers: 

Giving the correct advice to travellers Giving the correct health advice to travellers needs: Information Training Experience Documentation Travellers

Travel Health Advice needs Information: 

Travel Health Advice needs Information Guidelines Policies Textbooks, including an World Atlas Journals Professional organisations Staff/colleagues Electronic Databases WWW

International Guidelines: 

International Guidelines WHO International Health Regulations International Travel and Health www.who.int/ith Yellow fever requirements

“National Guidelines”: 

“National Guidelines” Travel Health Guidelines Malaria Guidelines Immunisation Guidelines Antibiotic Guidelines Journals Seminars

You need access to www-sites: 

You need access to www-sites International Society of Travel Medicine www.istm.org US Centers for Disease Control and Prevention www.cdc.gov/travel US Guidelines Similar government sites for UK and Canada World Health Organization http://www.who.int/ith The former “yellow book” is now published as the “blue book” online

It is very useful to have access to a multicountry travel medical advisory service: 

It is very useful to have access to a multicountry travel medical advisory service CDC Travel Health, see http://www.cdc.gov/travel/index.htm MASTA, see http://www.masta.org TRAVAX, see http://www.travax.nhs.uk Shorelands, see http://www.tripprep.com

Professional Organisations: 

Professional Organisations Local professional groups and THE ISTM

ISTM: 

ISTM International Society of Travel Medicine International Network International Clinic Directory Useful for marketing/recognition www.istm.org Listserve Outbreak alerts Journal Geosentinel Certificate of Travel Health Great Conferences!!

Journals: 

Journals Weighing the Evidence

Weighing the evidence: 

Weighing the evidence “Travel medicine prevention should be based on epidemiological data.” Robert Steffen, 1991 What are the likely risks of a person travelling to particular destinations? What are the likely benefits of intervention?

Giving the correct advice to travellers: 

Giving the correct advice to travellers Giving the correct health advice to travellers needs: Information Training Experience Documentation Travellers

Pre-Travel Health Advice needs Training: 

Pre-Travel Health Advice needs Training Helps give structure and consistency Provides a framework for practice Discusses evidence for practice Policy and Procedures Manual Consistent approach to travel health

Part of the commitment is to also have a consistent and structured approach to travel health advice: 

Part of the commitment is to also have a consistent and structured approach to travel health advice WHO Checklist (www.who.int/ith) Information on local conditions Prevention Accident avoidance Medical and dental check-up NZPHR-Prevention Vaccinations Health Advice Prescription Source: http://www.who.int/ith

VACCINATE (IHC): 

VACCINATE (IHC) Always National schedule Often hepatitis A Sometimes Japanese encephalitis meningococcal disease polio rabies yellow fever Influenza Pneumococcal disease Other vaccines (adapted* from NZPHR; 1996;3(8):57-59)

ADVISE AND DISCUSS: 

ADVISE AND DISCUSS Insects repellents, nets, permethrin Ingestions care with food and water diet/teeth (including airlines/jetlag/DVT)* Indiscretions STI’s, HIV Injuries accident avoidance, personal safety Immersion schistosomiasis Insurance* health and travel insurance* finding medical assistance o/s* (adapted* from NZPHR; 1996;3(8):57-59)

PRESCRIBE (Script/Dr’s letter/bracelet): 

PRESCRIBE (Script/Dr’s letter/bracelet) Always regular medication medical kit (first aid)* Sometimes antimalarial medication diarrheal self-treatment condoms (NZPHR; 1996;3(8):57-59)

Courses: 

Courses Increasing number of travel medicine academic programs globally (see educational opportunities at www.istm.org) Get relevant endorsements Aviation medical examiner Diving medical certification (SPUMS) Certificate of Travel Health (ISTM) Occupational health training

Courses: 

Courses Weighing the evidence Contributing to the discipline through research (also through GeoSentinel) Despite training, still need to keep up to date and to keep seeing travellers to help build experience

Giving the correct advice to travellers: 

Giving the correct advice to travellers Giving the correct health advice to travellers needs: Information Training Experience Documentation Travellers

Travel health advice needs experience: 

Travel health advice needs experience Let’s just do it! Affiliation with a group with experience can be useful Travel clinic group Travel medical advisory group (eg MASTA, Worldwise, Travax etc) University Those NZ GPs that were interested in travel medicine were significantly more likely to have had tropical medicine/developing country experience (Leggat et al. JTM 1999; 7: 55-58.)

Slide42: 

Travel is part of experience

Travel is part of experience: 

Travel is part of experience Professionals working in travel medicine need to travel and have that personal experience to communicate to travellers Helps to put travel health advice in context and helps to build a positive travel experience

Giving the correct advice to travellers: 

Giving the correct advice to travellers Giving the correct health advice to travellers needs: Information Training Experience Documentation Travellers

Travel health advice needs to be documented: 

Travel health advice needs to be documented Standardised forms/questionnaires Informed consent International Health Certificate/Vaccination record Doctor’s letter/copy of prescription/medialert bracelet Written advice/videos/Books/Health advisory documents

Correct advice is even better if the advice is actually followed by the traveller: 

Correct advice is even better if the advice is actually followed by the traveller Documentation Follow-up Use staff resources Reinforce health advice

Giving the correct advice to travellers: 

Giving the correct advice to travellers Giving the correct health advice to travellers needs: Information Training Experience Documentation Travellers

Travel Health Advice needs Travellers: 

Travel Health Advice needs Travellers Inform own patients concerning the need for seeking travel health advice, and seeking this advice early Market travel health advice Direct, if possible Join group/affiliate Links/promotion with traveller groups, travel agents, travel insurance, consulates etc Join travellers health networks, such as ISTM, IAMAT etc

Take home points: 

Take home points More people are traveling to more destinations, becoming exposed to the health and safety of that destination and also having the potential to impact on the health and safety of that destination, especially through emerging infectious disease Travelers’ health is a continuum and includes the pre-travel health, contingency planning while abroad and caring the traveler after travel Travel health advice needs information (including a capacity to undertake a risk assessment), training, experience, documentation and travelers