Professional Documents
Culture Documents
Health
Consultation
Dr Peter A. Leggat
MD, PhD, DrPH, FAFPHM, FACTM, FFTM
Associate Professor
School of Public Health and Tropical Medicine
James Cook University &
Visiting Professor
School of Public Health
University of the Witwatersrand
About the author
Pre-Travel
Pre-Travel Preventive Medicine
Visitors
Visitors
Contingency During
During Travel
Travel Planning
Training
Experience
Documentation
Travellers
Need to be prepared with
adequate resources
Need adequate staff training and continuing
education
Need adequate time and good time management
Need to have access to national and international
guidelines for travel medicine
Need to have health education resources
Need to have access to good geographically
based epidemiological information regarding
risks to health and safety of travelers (internet,
computerized databases etc)
Travel Health Advice
Needs Adequate Notice
Travelers need to be informed that they
need travel health advice
Source: http://www.cdc.gov/travel/diseases/yellowfever.htm
Yellow fever
International regulations
WHO International Travel
and Health
Specially licensed Yellow
Vaccination Centers
Need to document on
appropriate certificate of
immunization card
Meningococcal
meningitis
Source: http://www.cdc.gov/travel/diseases/menin.htm
Meningococcal
meningitis
Neisseria meningitidis: At least 13 antigenically
distinct serogroups
A,B,C,W135 & Y are most common
Current vaccine for A,C,W135 & Y
NZ is trialing a vaccine against a specific B
strain
Mandatory: Pilgrims visiting Mecca for the Hajj
(annual pilgrimage) or for the Umrah
Recommended: Travelers roughing it in
areas where there are recurrent outbreaks of
disease
Routine vaccinations
The travel health consultation is a good
opportunity to update national schedule
or routine vaccinations
Vaccinations for most
travelers
Diseases
associated with
poor hygiene &
sanitation
ETEC?
Hepatitis A
Typhoid
Cholera
Various new vaccines
Some activity against ETEC in one
Routine use of cholera vaccine is not
recommended as risk is low
It is indicated for travelers to cholera
endemic areas, who are at high risk for
infection (2-3 years protection)
Travelers at special risk
Geographical risk
Wilderness/remote travel
Rabies
TB
Source: http://www.cdc.gov/ncidod/dvbid/jencephalitis/map.htm
Japanese encephalitis
Travelers spending one month or more in rural
areas of Asia, PNG & Torres Strait (Australia),
particularly if the travel is during the wet
season, and/or there is considerable outdoor
activity and/or the standard of accommodation
is suboptimal,
other travelers spending a year + in Asia
(except for Singapore), even if much of the
stay is in urban areas
Dengue
Vaccine in development
Is almost a
universally fatal
disease
Plague
Yesinia pestis, transmitted via fleas
from animal reservoir to humans
Rare in most parts of the world
Vaccination only of those at high risk,
usually those engaged in field
operations, laboratory workers or others
who reside in areas where plague is
present
Risk because age, pre-
existing conditions, or
occupation
Older travelers/pre-existing disease
Influenza
Pneumococcal infection
Occupational risk (including electives)
Hepatitis
B (usually part of national
schedule)
Q fever
Influenza
Routinely on annual basis for those 65
years and older
Travelers with chronic disorders of the
pulmonary or circulatory systems or
other chronic illnesses needing regular
follow-up
Those who wish to reduce the risk
Estimated monthly incidence of health problems
per 100 000 travellers to developing countries
Pneumococcal infection
Routinely on annual basis for those 65
years and older
Travelers with asplenia,
immunocompromized travelers
Others
Q Fever
Source: http://www.cia.gov/cia/publications/factbook/
SPECIAL RISK GROUPS
Travelers who need special assistance or
need assessment as to fitness to fly
Pregnant travelers/children/HIV travelers
Altitude/mountaineering/diving
Adventure/outback travelers
Travelers to areas of extreme climate
School/club/other groups
Occupational/students/military/aviation
Aid/refugee camp workers
Travel health advice
needs documentation
Medialert bracelets-allergies, serious
medical conditions
Written travel health advice (may be part
of doctors letter)-consider using a
proforma
Travelers health record ?
Other certificates, e.g. diving, airline
Is the traveler being escorted?
(aeromedical evacuation)
Educational Resources
Books
Travel industry guides
Pharmaceutical companies
Videos-popular in a number of
clinics in the USA
152 pp, Small
pocket book
52 pp,
passport sized
booklet
730 pp,
manual
144 pp, Small
pocket book
Disease specific
Specific to special
groups 428 pp, reader
PRE-TRAVEL HEALTH
ADVICE
Immunize travelers
Advise/educate travelers on other
precautions that should be taken
against conditions to which they are
likely to be exposed during travel
Prescribe appropriate
chemoprophylactic and self-treatment
medications
PRESCRIBE
(Script/Drs letter/medialert bracelet)