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Travel and expedition medicine 

Travel and expedition medicine

Chapter:
Travel and expedition medicine
Author(s):

C.P. Conlon

and David A. Warrell

DOI:
10.1093/med/9780199204854.003.0704_update_001

Update:

Yellow fever—reduced geographical area in which vaccination is recommended by WHO.

Meningococcal disease—Conjugate (ACYW135—Menactra) vaccine recommended.

Japanese encephalitis—new Vero cell vaccine available.

Travellers’ diarrhoea—possible new vaccine, rifaximin and loperamide for treatment.

Malaria prophylaxis—standby treatment rather than chemoprophylaxis for areas of relatively low risk.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 23 April 2017

Tourists, business people, pilgrims, and visitors to friends and relatives are making increasing numbers of trips to tropical and developing parts of the world, where the risk and range of infectious and environmental diseases and injuries may be much higher than in Western countries. The aim of travel and expedition medicine is to reduce risk through education, appropriate immunizations and other medical advice, hence enhancing the enjoyment and achievements of travelling abroad. Explorers, expeditioners, and wilderness travellers face the greatest health challenges, but risk can be minimized by technical competence, careful planning, training in practical medical skills, and rehearsing emergency evacuation.

Pretravel advice—this requires precise information about the mode of travel, geographical itinerary and the purpose of the visit, and must take into account the age, background health and immunocompetence of the traveller. Important provisions are (1) a first-aid kit, (2) sun-block, (3) insect repellent, (4) treatments for motion sickness, jet lag and high altitude sickness, (5) supplies of regular medications for chronic medical conditions, and (6) generous, comprehensive travel insurance.

Pre-travel immunization—this involves (1) boosting childhood vaccinations - e.g. tetanus, poliomyelitis, and diphtheria; (2) adding protection against hepatitis A (and B in those at risk of parenteral or sexual exposure) and infections endemic in the areas to be visited, e.g. yellow fever in equatorial Africa and South America, Japanese encephalitis in South-East Asia, tick-borne encephalitis in northern Europe and Asia, Neisseria meningitidis in the meningitis belt of Africa, typhoid in South Asia, and rabies in most parts of the world. Pregnancy and immunocompromise present particular problems of vulnerability to infections and restrict the use of live vaccines.

Reducing the risk of infections—food and water hygiene are crucial for prevention of travellers’ diarrhoea, the commonest medical problem likely to be encountered. Avoidance of bites by disease vectors such as mosquitoes and ticks and use of appropriate prophylactic drugs reduces the risk of malaria and many other tropical infections.

Other medical hazards of travel—long flights can lead to deep vein thrombosis and respiratory infection. Underestimated hazards of travel include sexually transmitted infections, schistosomiasis, drowning and road traffic accidents.

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