Rabies

Rabies is a viral infection which is transmitted in the saliva of infected mammals it causes an acute encepha-lomyelitis that is almost always fatal. Human pathogens of medical importance are members of the genus Lys-savirus and Vesiculovirus. Almost all cases of human rabies, a lyssavirus infection, are caused by a bite of a rabid animal. Although the risk of rabies is highest in countries of most of Asia, Africa and South America and it is rare as a human infection in Western Europe and North...

Yellow Fever and Oral Cholera Vaccines

These vaccines are only indicated for travellers to certain specific destinations in some countries. The consultation should thus ascertain the exact itinerary and the eventual indications. These vaccines are contraindicated in severely immunocompromised individuals. Such travellers to an area for endemic yellow fever should be recommended to change the itinerary or to follow strictly physical mosquito precautions if the trip is unavoidable. When yellow fever vaccine is required to cross a...

Iud

Need to use additional method to prevent STDs (condoms, etc.) Need to know how to check for string Need to know warning signs and what to do in an emergency Need to know what to do in case of emergency Back-up method if falls out Need to protect against STDs Good for 10 years Need fewer supplies, etc. FSH follicle-stimulating hormone Hep B Hepatitis B virus HIV Human immunodeficiency virus HSV Herpes simplex virus ITP idiopathic thrombocytopenic purpura LH luteinizing hormone OCP oral...

Air Travel and Infants

Anecdotally, there have been sudden, unexplained deaths in infants following long trips in commercial aircraft (Parkins et al., 1998). This should not be surprising because sudden infant death syndrome (SIDS) is both sudden and idiopathic. Tragically, infants might suddenly die after any coincidental activity, be it air travel, vaccination, or kissing. The anecdotal association of a few cases does not prove causality. To date, there is no documented evidence that air travel in pressurized craft...

Inert Gas Absorption

The concentration of the inert gas nitrogen in arterial blood is approximately the same as the concentration of nitrogen in the air we breathe. At sea level, where the partial pressure of the nitrogen (PiN2) in the air we breathe is 79 kPa, the Pn2 in arterial blood will also be approximately 79 kPa. During a dive, the ambient pressure surrounding the diver increases, and so too will the partial pressures of the component gases of the gas breathed by the diver (Figure 16.1). If the diver is...

Bcg

Plagued by popular concern over side-effects, but the acellular vaccines (aP) are effective without as many adverse reactions. The initial series of injections is usually at 2,4, and 6 months of age in industrialized countries, but it may be given as early as 6, 10, and 14 weeks of age. Traveling infants should be as completely protected as possible before departure. An additional immunization (DTaP) is given after the first birthday to complete the primary series. A booster of DTaP is given at...

Why Did They Travel and What Did They Do

Some occupational groups are inevitably at greater risk of exposure to vectors and illness. Health care personnel are particularly prone to the risk of needlesticks and similar accidents, as well as dealing with patients with pathogens that can be spread by airborne droplets or by direct contact with body fluids and faeces. The difficulties in preserving high levels of risk avoidance in a rural hospital setting are all too common and emphasised by the tragic deaths of health care workers...

Route of Administration of Vaccines

The route of administration of vaccines varies according to the type of vaccine. Most vaccines are given by intramuscular injection. 1. By mouth. Oral polio vaccine (OPV) and oral typhoid vaccine are given by mouth. 2. Intramuscular and subcutaneous injection. With the exception of oral vaccines and BCG, all vaccines available currently should be given by intramuscular injection or by deep subcutaneous injection. The site of injection is important the upper arm (the deltoid region) or the...

Haemophilus influenzae Type b

Haemophilus influenzae type b is an important cause of meningitis and pneumonia in infants in areas of the world where the vaccine is not available. For women traveling to endemic areas to live, the Haemophilus influenzae type b (Hib) vaccine could be considered. This vaccine has been a model for the protection of infants from bacterial disease through maternal immunization (Glezen and Alpers, 1999). In the 1980s Hib capsular polysaccharide vaccines given to women in the third trimester of...

Specific Infections Affecting The Eyes In Travellers

Ocular symptoms following travel are often a cause for great concern for both traveller and clinician alike. Some of the more esoteric and visually devastating ocular disease may well have been seen by travellers when visiting far-off countries such as India and Africa and South America. Travellers may then become anxious about whether they could have caught these diseases. The venom from spitting cobras can cause acute ophthalmic symptoms. They are found in Africa and Asia (Sumat-ran spitting...

Genital Herpes

Herpesviruses are disseminated widely in nature and infect most animal species. Eight herpesviruses have been isolated from humans so far Human herpesvirus 1 (HHV-1 Herpes simplex 1, HSV-1) HHV-2 (Herpes simplex 2, HSV-2) HHV-3 (Varicella-zoster virus, VZV) HHV-4 (Epstein Barr Virus, EBV) HHV-5 (Human cytomega-lovirus) and HHV-6, -7 and -8. Herpesviruses share a number of biological properties, including the ability to code for a large number of enzymes involved in nucleic acid metabolism,...

Live attenuated Virus Vaccines

These include oral poliomyelitis (Sabin type) vaccine, measles, rubella, mumps and yellow fever vaccine, which have been produced by essentially the random selection of mutants, principally by serial passage in cells cultured in vitro and by adaptation to growth at low temperatures. With the development of recombinant DNA technology, genetic changes can be induced deliberately and precisely in a microorganism, and a virus, bacterium or yeast can also be used as a vector or carrier of genetic...

Immunoglobulins

The administration of immunoglobulins has been mostly superseded by the advent of improved methods of immunisation with new and improved active vaccines. Human normal immunoglobulin provides immediate protection against infection with hepatitis A, measles, mumps, rubella and varicella in particular, as high titres of these circulating antibodies are found in the population from whom pooled plasma donations are sought. This preparation may, in theory, cause interference with the immune response...

Psychometric Tests

It is rare for an expatriate assignment to 'fail' due to lack of skill or ability 80 of 'failed' assignments are due to adjustment difficulties (Holmes and Piker, 1980). Therefore, the focus here will be on tests that help to assess the presence and severity of psychological difficulties, and measures which give an indication of personality characteristics, as these may help to predict adjustment. There are three main advantages of psychometric testing. First, the candidate's score can be...

Clinical Findings and Diagnosis

Individuals of both sexes and all age groups are affected by dermatophytes however, children under the age of 10 rarely present with tinea pedis. The main clinical pictures are those of localised tinea pedis, interdigital, plantar hyperkeratotic, and onychomycosis. Common names for these conditions include ringworm and athlete's foot. Dermatophyte infections can manifest as localised single or multiple circinate plaques with erythema and variable degrees of scaling on the body in cases of tinea...

Screening of Asymptomatic Individuals

Each returned or immigrating traveler carries a wealth of memories and a growing perspective on life. Sometimes, they also carry health concerns and microbial pathogens. Asymptomatic children returning to their home country following a brief overseas trip rarely need to undergo a medical evaluation or screening procedures. Other travelers coming from a prolonged stay in an area of limited hygiene and nutrition deserve extensive screening. Medical personnel asked to see a child who has...

Approach to Travelers Diarrhea

Perhaps the most common problem about which a traveler should be well versed is an approach to travelers' diarrhea. The older traveler is somewhat more predisposed to developing travelers' diarrhea, but complications such as dehydration and electrolyte imbalances are more poorly tolerated and may result in serious morbidity, especially in those with underlying cardiac, renal, gastrointestinal, or immune disorders. Preventive measures and supportive therapy should be reviewed, as well as the...

Transplant Recipients

Immunosuppressive agents, particularly cyclosporine and tacrolimus used to prevent graft rejection in transplant recipients, have profound effects on T cells. Aza-thioprine and corticosteroids may also be part of an immunosuppressive regimen and further impair neu-trophil function. Intracellular pathogens pose the greatest risk to these individuals. Persons who have undergone allogeneic bone marrow transplantation (e.g. for leukemia) have more severe immunosuppression than solid organ...

Acquired Immune Deficiency

In haematological malignancies it is obvious that immune deficiency can occur because of either T- and or B-cell impairment. Depending upon the clinical situation, travel should be discouraged or appropriate measures should be in place, as mentioned above. Metastatic solid tumour disease will lead to immune suppression, depending on the type and measure of progressive disease. Advice on travel should be in relation to the patient's condition (Karnofski scale). The level of immune deficiency in...

Common Infections in the Traveling Diabetic

Diabetic travelers are at risk for other serious infections while traveling abroad on the basis of their predilection for cutaneous Gram-positive infections, neuropathies, vascular compromise, and abnormal phagocytic cell function. Unnoticed foot trauma from new footwear or hiking shoes may lead to diabetic foot ulcers and osteomyelitis. Careful instructions regarding local care of early ulcers, changes of socks to avoid persistent pressure points, and careful wound dressings at night to...

Sunrelated Skin Diseases And Cancer

Many dermatoses may be provoked by exposure to ultraviolet (UV) radiation and they may be acute or chronic. In addition, a number of other dermatoses may be exacerbated by exposure to sunlight these include acne, atopic eczema, dermatomyositis, erythema multiforme, herpes simplex, Darier disease, lichen planus, autoimmune blistering disorders, psoriasis, rosacea, and seborrhoeic dermatitis. Some of the more common problems included in this section are presented in Table 9.4. Figure 9.25...

Introduction and Definitions

The last three decades have witnessed an explosion in knowledge of viral hepatitis, a major public health problem throughout the world affecting several hundreds of millions of people. Viral hepatitis is an important cause of morbidity and mortality, both from acute infection and chronic sequelae which include, with hepatitis B, hepatitis C and hepatitis D (delta) infection, chronic active hepatitis and cirrhosis, and primary liver cancer with hepatitis B and hepatitis C. The hepatitis viruses...

Eosinophilia

A raised eosinophilia count usually suggests a helminth infection in returned travellers. Although the traditional definition of eosinophilia is an absolute count > 0.44 x 109 r1 (Wolfe, 1999), many clinicians use a cut-off level of > 0.5 x 109li in working practice (Gyawali and Whitty, 2000). This level of eosinophilia is used for travellers returning from the tropics, but no normal ranges have been published for those who live in the tropics long-term. Up to 10 of the travelling...

Physiology of Sleep

Sleep can be divided into five stages stages 1 to 4 and rapid eye movement (REM) sleep. Stage 1 is a transitional phase between waking and sleeping and this normally lasts around 10 min as an individual falls asleep. Sleep then becomes deeper, with 15 min in stage 2 sleep and a further 15 min in stage 3 sleep before moving into stage 4. Approximately 90 min after sleep onset, REM sleep will occur. The cycle of REM sleep and stages 1-4 sleep repeats during the course of the night in 90 min...

Pyrimethamine with sulfadoxine Fansidar

Pyrimethamine with sulfadoxine (Fansidar) has been recommended by WHO as a prophylactic and for treatment of malaria at any stage of pregnancy. It is also recommended for stand-by treatment until the traveler can get help. Concerns about this drug in pregnancy were the teratogenic effects of pyrimethamine in rats, preventable by folate supplementation, and hyperbilirubinemia and kericterus in the newborn state due to sulfadoxine near term. Folinic acid should be given and or continued by the...

Diphtheria

Routine childhood immunisation against diphtheria has been instigated for many years throughout the industrialised countries of the world. In the United Kingdom, diphtheria vaccine has been administered routinely as part of the national childhood immunisation programme since 1940, with a schedule of administration of 0.1ml vaccine at 2, 3 and 4 months of age by the intramuscular route, now combined with tetanus and pertussis, (DTP). Booster doses of diphtheria and tetanus (DT) are given at...

Foreword

Travel medicine is one of the newer and important areas of medicine requiring specialist knowledge, academic centres and dedicated clinical services to meet the health and medical needs of the increasing number of leisure and business travellers, and also to cater for the medical aspects of population movements related to economic, political and social factors. Health, preventive medicine, environmental factors and safety are essential considerations, not only for the traveller but also for the...

17251227 Com 10 C

Abioye AA (1973) Fatal amoebic colitis in pregnancy and the puerperium a new clinico-pathological entity. Journal of Tropical Medicine and Hygiene, 76, 97-100. ACOG (1994) Exercise during pregnancy and the postpartum period. American College of Obstetricians and Gynecologists technical bulletin no. 189. Agnostini R (1994) Medical and Orthopedic Issues of Active and Athletic Women. Hanley and Belfus, Philadelphia. Ali KZ, Ali ME et al. (1996) High altitude and spontaneous preterm birth....

References

Addiss DG, Beach MJ, Streit TG et al. (1997) Randomised placebo-controlled comparison of ivermectin and albendazole alone and in combination for Wuchereria bancrofti micro-filaraemia in Haitian children Lancet, 350, 480-484. Addy M and Nandy A (1992) Ten years of kala-azar in West Bengal Part 1. Did post kala-azar dermal leishmaniasis initiate the outbreak in 24 Parganas Bulletin of the World Health Organization, 70, 341-346. Agostoni C, Dorigoni N, Malfitano A et al. (1998) Mediterranean...

Contributors

Susan Anderson Clinical Assistant and Professor of Medicine, Office of Medical Education, Stanford University School of Medicine, 251 Campus Drive, MSOB X-365, Stanford, CA 94305-5490, USA Michael Bagshaw Head of Medical Services, British Airways Health Services, Waterside, PO Box 365 (HMAG), Harmondsworth UB7 0GB, UK Indran Balakrishnan Clinical Lecturer, Department of Medical Microbiology, Royal Free and University College Medical School, Rowland Hill Street, London NW3 2PF, UK Nicholas J....

Preflight Assessment and Medical Clearance

The objectives of medical clearance are to provide advice to passengers and their medical attendants on fitness to fly, and to prevent delays and diversions to the flight as a result of deterioration in the passenger's well-being. It depends upon self-declaration by the passenger, and upon the attending physician having an awareness of the flight environment and how this might affect the patient's condition. Most major airlines provide services for those passengers requiring extra help, and...

Special Considerations For Altitude Travel

Children are probably no more susceptible to high-altitude illnesses than individuals of other ages. However, altitude illness may be difficult to identify because young children do not report the very subjective symptoms of these syndromes, resulting in the possibility of a delay in recognition and treatment. An international consensus statement concerning ascent to high altitude with children has considered this issue in detail (Pollard et al., 2001). There is some suggestion that there may...

Preparations for Travel

Safe drinking water and prevention of enteric infections are particularly important for younger patients with IDDM traveling in developing countries. Chronic Helicobacter pylori infection, in particular, has been associated with increased insulin requirements and poor diabetes control in children with IDDM. Safe drinking water should decrease H. pylori seroconversion rates as well as other acute enteric infections. If either the traveler or health provider has not yet joined their national...

Bacterial Mycetoma Aetiology and Pathogenesis

Nocardia, Actinomadura, and Streptomyces species are the common aetiological agents of 'Madura foot' or Figure 9.16 Bacterial mycetoma of the leg by Nocardia braz-iliensis. Deformity of the region with hiperpigmented skin, sinus tract formation, and scarring Figure 9.16 Bacterial mycetoma of the leg by Nocardia braz-iliensis. Deformity of the region with hiperpigmented skin, sinus tract formation, and scarring actinomycetoma. This form of bacterial mycetoma occurs in tropical countries and the...

Jellyfish Stings

Jellyfish have myriads of microscopic stinging capsules called nematocysts on their tentacles. When touched, these capsules rapidly fire a sting, which can inject venom however, only a small number of jellyfish have stings that can penetrate intact human skin. The most dangerous jellyfish, the cubomedusan or box jellyfish, sometimes called sea-wasp, Chironex fleckeri, is confined to tropical waters, mainly off the eastern coast of Australia in the region of the Great Barrier Reef and around the...

Further Reading

Fenner PJ (1998) Dangers in the ocean the traveler and marine envenomation. II. Marine vertebrates. Journal of Medicine, 5, 213-216. Meier J and White J (1995) Handbook of Clinical Toxicology of Animal Venoms and Poisons. CRC Press, New York. ADDITIONAL RESOURCES Some Institutes Making Antivenom For a more complete list see Theakston and Warrell (1991). 1. Algeria. Institut Pasteur d'Algeria, Rue Docteur Laveran, Algiers. 2. Argentina. Instituto Nacional de Microbiologia, Av. Velez Sarsfield...

Epidemiology and Geographical Distribution

Although various body fluids (blood, saliva, menstrual and vaginal discharges, serous exudates, seminal fluid and breast milk) have been implicated in the spread of infection, infectivity appears to be especially related to blood and to body fluids contaminated with blood. The epidemiological propensities of this infection are therefore wide they include infection by inadequately sterilised syringes and instruments, transmission by unscreened blood transfusion and blood products, by close...

Druginduced Immune Suppression

The drugs responsible most frequently for serious immune suppression are listed in Table 25.4. The exact amount of systemic glucocorticosteroids and the duration of administration needed to suppress immunity are not known. Controlled randomised studies indicated that the rate of infectious complications in patients given a daily dose of less than 10mg prednisone or a cumulative dose of less than 700 mg prednisone was not increased compared with that of controls. As a general rule, it is...

Snake Bites Venomous Snakes

The majority of venomous snakes have fangs at the front of their mouths which enable them to inject venom. This is produced by the venom glands, of which there are two, one on each side of the head behind the eye. Each gland is surrounded by muscle, which, on contraction, forces the venom out of the lumen of the gland, along the venom duct, which is positioned on either side of the upper jaw, and then down the canal or groove in the fang. Venomous snakes are divided into three major groups...

Marburg Virus Disease

Torus Medicine

Marburg virus disease, commonly but incorrectly named 'green monkey' disease, is a severe distinctive haemorrhagic febrile illness of humans, first described in 1967, when 31 cases with seven deaths in Germany and Yugo slavia were traced to direct contact with blood, organs or tissue cell cultures from a batch of African green monkeys (Cercopithicus aethiops) that had been trapped in Uganda. Several secondary cases occurred in hospital personnel by contact with the blood of patients. One...

Additional Resources

Centres for Disease Control and Prevention. Travellers' Health. Health information for international travel. www.cdc.gov World Health Organisation. International Travel and Health Vaccination requirements and Health Advice. www.who.int Principles and Practice of Travel Medicine. Edited by Jane N. Zuckerman Copyright 2001 John Wiley amp Sons Ltd ISBNs 0-471-49079-2 Hardback 0-470-84251-2 Electronic

Bacterial Infections Pyogenic Infections Aetiology and Pathogenesis

Common bacterial infections in the skin of the traveller are caused by Staphylococcus and Streptococcus species. These infectious agents are ubiquitous in both urban and rural environments and are capable of causing disease in travellers of all age groups. Healthy and immunocom-promised hosts develop pyogenic infections of the skin following direct inoculation of bacteria. Less often, hae-matogenous dissemination and even a septicaemic state may develop as a result of a minor skin injury. The...

Active Immunisation

Active Immunisation

Killed hepatitis A vaccines are prepared from virus grown in tissue culture and inactivated with formalin. The first such vaccine was licensed in 1992 and several preparations are available, including a combined hepatitis A and B vaccine. These vaccines are highly immunogenic and provide long-term protection against infection. In areas of high prevalence, most children have antibodies to HAV by the age of 3 years and such infections are generally asymptomatic. Infections acquired later in life...

Parasitic Infection

Parasitic infections are common throughout the world but until recently differences between effects on women and men have not been studied. Due to the increase in international travel and the immigration of people from tropical areas to more developed countries, physicians are likely to see an increase in tropical disease with both common and uncommon presentations. Pretravel advice for women should include a risk assessment as to potential exposure to parasitic disease. Knowledge about how a...

Or

Maintenance regimen 1.6mgkgi o.d. for 6 days' 'Contraindicated in first trimester of pregnancy. 'May be given orally if patient can swallow. If parenteral administration is not possible, artemisinin or artenesunate suppositories can be given Maintenance regimen 20 mg kg at 24, 48 and 72 h P.R. An oral antimalarial drug such as mefloquine 25 mg kgi in two divided doses 10 and 15mgkgi-24h apart history. The alternative to mefloquine is quinine, possibly in...

Malaria And Other Insectborne Diseases

Geographical considerations regarding the need for protection from malaria and other insect-borne diseases are similar for children and adults. Within endemic areas, however, the need for protection for children is a critical concern. Children can become very ill very quickly, and they do not always show easily localized signs of infection. Many different illnesses present with fever in children, and even where medical care is good, delayed diagnosis of malaria is common Emanuel et al., 1993...

Epidemiology Clinical Features and Geographical Distribution

Viral gastroenteritis occurs throughout the world. The incubation period of rotavirus gastroenteritis is 1-2 days with a sudden onset of illness with watery diar rhoea lasting 4-7 days, vomiting and rapid dehydration. The spectrum of illness ranges from mild to severe. Virtually all children become infected during the first 3-5 years of life, but severe diarrhoea and dehydration occur primarily in children under the age of 3 years. Rotavirus is also an important cause of nosocomial...