emporiatrics
Post on 26-May-2015
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EmporiatricsDr. Gopalrao M.D. Ph.D.
Professor & Head,Community Medicine Department
It is a science which deals with promoting and protecting the health of international travelers, providing them the advice related to the travel they are about to undertake.
It is a fast developing specialty as the international travel is fast increasing.
Every year 660 million people travel internationally.
Definition
Travel Medicine
Practice of “Emporiatrics” Rapid development over the last 25 years Fairfield Hospital in Melbourne started travel
clinic in early-mid 80s - one of the world’s first travel clinics
Now a recognised clinical entity primarily involved in risk management
Strong overlap with public health and occupational health and general practice
Knowledge of Travel-related Risks Knowledge of morbidity and mortality of
travellers Understanding of epidemiology and geography of
communicable diseases Awareness of non-communicable risks Vaccines, indications, side-effects Knowledge of post-travel illness presentation and
management Geography , esp of major tourist destinations Ability to communicate complex issues in simple
ways Understanding of when to refer
Food and Water InsectsAnimals and BirdsEnvironmental hazards Soil Sun Heat/humidity Cold/ dryAltitude Marine hazards Respiratory HazardsSex and body-fluid exposure Vehicular and other Accidents DVT risk
Risk to be considered and discussed
Factors affectingindividual risk
Individual
r
isk
TRAVEL
Destination
Country of origin
Duration of stay
Itinerary
Travel conditions
Season
TRAVELER
Reason for travel
Behavior
Age and gender
Health education
Medical history
- Allergies
- Immunosuppressed
- Pre-existing disease
Immunization status
Special needs
- Pregnant women
- Children
- Elderly
Special Risk Groups Pregnancy Children Elderly Expats and long-term travellers VFR Cardiac or Lung disease Diabetes HIV infections Immunocompromised
Cruise ships Diving Extended stay Extreme travel Mass gatherings Wilderness
Special itineraries
“This person, this trip, this time” Person; medical conditions past and
present, allergies, medications, vaccine history, previous travel
Trip: reason, style and comfort level, rural vs urban, accomodation, activities, exposures, budget
Time: duration, season, frequency
Risk Management
Identifying risks for individuals or groups
Advising about risk reduction strategies
Recommending and providing risk reduction interventions
Encouraging behavioural change to change risk level
Risk Reduction Interventions
Information enabling behaviour modification
vaccinations medications (including
antimalarials) other - travel insurance, pre
existing medical problems, nets, syringes, medical kits
Provide Up-to date Information
Understand basic current epidemiology Be aware of outbreaks and emergent issues Provide written material targeting specific
risks Be able to communicate using electronic
media
Travel Consultation
Cornerstone of clinical decision process Opportunity to define the risk profile Requires appropriate time, and done in advance
of travel. May need multiple visits, allow a plan Good documentation essential Discussion of costs and priorities Consider family requirements
Individualise Advice Tailored advice to the traveller, itinerary and time Travellers vary by age, sex, pregnancy, medical
history, immune status, current health, medications, vaccination history, allergies and prior travel experience
Itineraries vary by length of stay, activities, environmental exposures, types of accommodation, season and budget
Time variation is obviously important Advice should be understandable, re-inforced and in
various media
Personal advice is more likely to be understood, remembered or facilitate behavioural change.
Consider Costs
Advice and recommendations should be within the travellers budget
Costs should be made clear and should presented in some priority order
Alternate strategies may need to be discussed
Medical travel kits
Additional items for less developed countries (gastro kit)
◦ Rehydration solution◦ Loperamide◦ Tinidazole◦ Norfloxacin – or azithromycin for children
Comprehensive medical kit ; Asia, Africa and South America
◦ All of the above◦ Sterile needles and syringes. Alcohol swabs◦ Antihistamines◦ Antifungal and antibiotic cream
Medical travel kits Essential items for all travelers
◦ Items to treat cuts, scratches, burns, strains, splinters
◦ Paracetamol◦ Repellent◦ Consider condoms
Additional items for Europe, USA, Japan◦ Antinauseants, eg prochlorperazine◦ Broad-spectrum antibiotic for respiratory infection◦ Antacids◦ Sudafed◦ Minor sedative◦ Laxative
These are designed to assist travelers in meeting medical needs when their access to quality medical care is compromised.
All travel medicine consultants recommend that travelers carry some form of medical first aid kit. A range is available, and often needs to be tailored to meet the specific requirements of the traveler and their proposed itinerary.
Many travel clinics sell medical first aid kits; these often contain prescription items.
Medical travel kits
No antimalarial gives 100% prevention P vivax and P ovale may be present months
after return No global consensus Fever in returned travellers is malaria until
proved otherwise Patient compliance and education is
essential
Principles of malaria prophylaxis
3 prong approach behavioral modification
◦ awareness of malarial risk◦ minimising exposure to mosquitoes
emphasis on extreme significance of early diagnosis & treatment
antimalarial chemoprophylaxis
Malarial Prophylaxis
Avoid outdoor exposure, dawn to dusk Wear long sleeved loose clothing after dusk,
light colours Avoid perfumes and colognes Use repellent with 20-40% DEET Use knockdown sprays, coils, vapours, etc
indoors Sleep under nets impregnated with
permethrin
Personal Protection from Mosquitoes
Category A – considered low risk◦ Western Europe/North America/Japan/UK/NZ/Singapore
Should be fully vaccinated & up to date with◦ Diphtheria/tetanus/whooping cough◦ Routine paediatric vaccines◦ MMR◦ Polio◦ Chicken pox◦ Influenza
Vaccinations 1
Category B Travel – considered to be low to intermediate risk◦ Eastern Europe/Israel/Korea/Malaysia/Pacific Is/South
Africa Vaccinations should be as for Category A, plus:
◦ Hepatitis A & B◦ Typhoid◦ QFT
Vaccinations 2
Catergory C Travel – considered to be of higher risk◦ African sub-continent/Central & South America/East
Asia/SE Asia/Melanesia Vaccinations should be as for Category B, plus:
◦ Polio booster◦ Japanese B Encephalitis◦ Rabies◦ Meningitis◦ Yellow Fever
Malaria Prevention
Vaccinations 3
Routine ( background) vaccine Childhood, standard
Required ( compulsory) vaccine Cross borders, entry requirements IHR
Recommended ( elective based on risk) Travel vaccines
Some vaccines can be in more than category. Not all the same or available in all countries
Vaccine classification-3 Rs
Yellow fever Plague Cholera Typhoid Meningococcal meningitis SARS Influenza
Internationally Quarantinable diseases
For visiting some countries or on incoming travel the traveler must have a valid vaccination certificate attached to the passport.
At the entry point or exit ie. airports, ports, land entry points, the authorities will check the certificates.
No valid certification traveler may face quarantine or deportation.
Continued….
Thank You
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