Vaccination contre la grippe A (H1N1) de 2009

Travel medicine or emporiatrics is the branch of

medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...

that deals with the prevention and management of health problems of international

travel Travel is the movement of people between distant geographical locations. Travel can be done by foot, bicycle, automobile, train, boat, bus, airplane, ship or other means, with or without luggage, and can be one way or round trip. Travel c ...

ers.

Globalization and travel

Globalization facilitates the spread of disease and increases the number of travelers who will be exposed to a different health environment. Major content areas of travel medicine include the global

epidemiology Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population. It is a cornerstone of public health, and shapes policy decisions and evidenc ...

of health risks to the traveler,

vaccinology A vaccine is a biological Dosage form, preparation that provides active acquired immunity to a particular infectious disease, infectious or cancer, malignant disease. The safety and effectiveness of vaccines has been widely studied and verifie ...

malaria Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. S ...

prevention, and pre-travel counseling designed to maintain the health of the approximately 600 million international travelers. It has been estimated that about 80 million travelers go annually from developed to developing countries.Supercourse on Travel Medicine

Mortality and morbidity

Mortality Mortality is the state of being mortal, or susceptible to death; the opposite of immortality. Mortality may also refer to: * Fish mortality, a parameter used in fisheries population dynamics to account for the loss of fish in a fish stock throug ...

studies indicate that

cardiovascular disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, h ...

accounts for most deaths during travel (50–70%), while

injury An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, o ...

and

accident An accident is an unintended, normally unwanted event that was not directly caused by humans. The term ''accident'' implies that nobody should be blamed, but the event may have been caused by unrecognized or unaddressed risks. Most researcher ...

follow (~25%).

Infectious disease An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

accounts for about 2.8–4% of deaths during/from travel.

Morbidity A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...

studies suggest that about half of people from a developed country who stay one month in a developing country will get sick.

Traveler's diarrhea Travelers' diarrhea (TD) is a stomach and intestinal infection. TD is defined as the passage of unformed stool (one or more by some definitions, three or more by others) while traveling. It may be accompanied by abdominal cramps, nausea, fever, ...

is the most common problem encountered.

Disciplines

The field of travel medicine encompasses a wide variety of disciplines including

infectious disease An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...

, tropical medicine, high altitude

physiology Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...

, travel related

obstetrics Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgi ...

psychiatry Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry. Initial psych ...

occupational medicine Occupational medicine, until 1960 called industrial medicine, is the branch of medicine which is concerned with the maintenance of health in the workplace, including prevention and treatment of diseases and injuries, with secondary objectives ...

, military and migration medicine, and

environmental health Environmental health is the branch of public health concerned with all aspects of the natural and built environment affecting human health. In order to effectively control factors that may affect health, the requirements that must be met in ...

. Special itineraries and activities include

cruise ship Cruise ships are large passenger ships used mainly for vacationing. Unlike ocean liners, which are used for transport, cruise ships typically embark on round-trip voyages to various ports-of-call, where passengers may go on tours known as "s ...

travel,

diving Diving most often refers to: * Diving (sport), the sport of jumping into deep water * Underwater diving, human activity underwater for recreational or occupational purposes Diving or Dive may also refer to: Sports * Dive (American football), a ...

, mass gatherings (e.g. the

Hajj The Hajj (; ar, حَجّ '; sometimes also spelled Hadj, Hadji or Haj in English) is an annual Islamic pilgrimage to Mecca, Saudi Arabia, the holiest city for Muslims. Hajj is a mandatory religious duty for Muslims that must be carried ...

), and

wilderness Wilderness or wildlands (usually in the plural), are natural environments on Earth that have not been significantly modified by human activity or any nonurbanized land not under extensive agricultural cultivation. The term has traditionally re ...

/remote regions travel. Travel medicine can primarily be divided into four main topics:

prevention Prevention may refer to: Health and medicine * Preventive healthcare, measures to prevent diseases or injuries rather than curing them or treating their symptoms General safety * Crime prevention, the attempt to reduce deter crime and crimi ...

(vaccination and travel advice), assistance (dealing with

repatriation Repatriation is the process of returning a thing or a person to its country of origin or citizenship. The term may refer to non-human entities, such as converting a foreign currency into the currency of one's own country, as well as to the pro ...

and medical treatment of travelers),

wilderness medicine Wilderness medicine is a rapidly evolving field and is of increasing importance as more people engage in hiking, climbing, kayaking, and other potentially hazardous activities in the backcountry. The modern definition of wilderness medicine is "m ...

(e.g. high-altitude medicine, cruise ship medicine, expedition medicine, etc.) and access to health care, provided by

travel insurance Travel insurance is an insurance product for covering unforeseen losses incurred while travelling, either internationally or domestically. Basic policies generally only cover emergency medical expenses while overseas, while comprehensive policies ...

Focus

Travel medicine includes pre-travel consultation and evaluation, contingency planning during travel, and post-travel follow-up and care. Information is provided by the WHO that addresses health issues for travelers for each country as well as the specific health risks of air travel itself. Also, the

CDC The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...

publishes valuable and up-to-date information. Key areas to consider are vaccination and the seven I's: # Insects: repellents,

mosquito net A mosquito net is a type of meshed curtain that is circumferentially draped over a bed or a sleeping area, to offer the sleeper barrier protection against bites and stings from mosquitos, flies, and other pest insects, and thus against the di ...

antimalarial medication Antimalarial medications or simply antimalarials are a type of antiparasitic chemical agent, often naturally derived, that can be used to treat or to prevent malaria, in the latter case, most often aiming at two susceptible target groups, young c ...

# Ingestions: safety of

drinking water Drinking water is water that is used in drink or food preparation; potable water is water that is safe to be used as drinking water. The amount of drinking water required to maintain good health varies, and depends on physical activity level, a ...

, food # Indiscretion:

HIV The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...

sexually transmitted disease Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are spread by sexual activity, especially vaginal intercourse, anal sex, and oral ...

# Injuries:

avoidance,

personal safety Human security is a paradigm for understanding global vulnerabilities whose proponents challenges the traditional notion of national security through military security by arguing that the proper referent for security should be at the human rather th ...

, safety around animals # Immersion:

schistosomiasis Schistosomiasis, also known as snail fever, bilharzia, and Katayama fever, is a disease caused by parasitic flatworms called schistosomes. The urinary tract or the intestines may be infected. Symptoms include abdominal pain, diarrhea, bloody s ...

# Immunization (pre-travel vaccination) #

Insurance Insurance is a means of protection from financial loss in which, in exchange for a fee, a party agrees to compensate another party in the event of a certain loss, damage, or injury. It is a form of risk management, primarily used to hedge ...

: coverage and services during travel, access to

health care Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...

Specific disease problems

Yellow fever Yellow fever is a viral disease of typically short duration. In most cases, symptoms include fever, chills, loss of appetite, nausea, muscle pains – particularly in the back – and headaches. Symptoms typically improve within five days. In ...

is endemic to certain areas in Africa and South America. The CDC site delineates the risk areas and provides information about vaccination and preventive steps.

Meningococcal meningitis Meningococcal disease describes infections caused by the bacterium ''Neisseria meningitidis'' (also termed meningococcus). It has a high mortality rate if untreated but is vaccine-preventable. While best known as a cause of meningitis, it can a ...

is endemic in the tropical meningococcal belt of Africa. Vaccination is required for pilgrims going to

Mecca Mecca (; officially Makkah al-Mukarramah, commonly shortened to Makkah ()) is a city and administrative center of the Mecca Province of Saudi Arabia, and the Holiest sites in Islam, holiest city in Islam. It is inland from Jeddah on the Red ...

. Detailed information is available on the CDC site.

Malaria Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. S ...

prevention consists of preventing or reducing exposure to mosquitos by using screened rooms, air-conditioning, and nets, and use of repellents (usually

DEET ''N'',''N''-Diethyl-''meta''-toluamide, also called DEET () or diethyltoluamide, is the most common active ingredient in insect repellents. It is a slightly yellow oil intended to be applied to the skin or to clothing and provides protection ag ...

). In addition, chemoprophylaxis is started before travel, during the time of potential exposure, and for four weeks (

chloroquine Chloroquine is a medication primarily used to prevent and treat malaria in areas where malaria remains sensitive to its effects. Certain types of malaria, resistant strains, and complicated cases typically require different or additional medi ...

doxycycline Doxycycline is a broad-spectrum tetracycline class antibiotic used in the treatment of infections caused by bacteria and certain parasites. It is used to treat bacterial pneumonia, acne, chlamydia infections, Lyme disease, cholera, typhus, an ...

, or

mefloquine Mefloquine, sold under the brand name Lariam among others, is a medication used to prevent or treat malaria. When used for prevention it is typically started before potential exposure and continued for several weeks after potential exposure. It ...

) or seven days (

atovaquone Atovaquone, sold under the brand name Mepron, is an antimicrobial medication for the prevention and treatment of ''Pneumocystis jirovecii'' pneumonia (PCP). Atovaquone is a chemical compound that belongs to the class of naphthoquinones. Atovaq ...

proguanil Proguanil, also known as chlorguanide and chloroguanide, is a medication used to treat and prevent malaria. It is often used together with chloroquine or atovaquone. When used with chloroquine the combination will treat mild chloroquine resistan ...

primaquine Primaquine is a medication used to treat and prevent malaria and to treat ''Pneumocystis'' pneumonia. Specifically it is used for malaria due to ''Plasmodium vivax'' and ''Plasmodium ovale'' along with other medications and for prevention if othe ...

) after leaving the risk area.

Medication kit

The traveler should have a medication kit to provide for necessary and useful medication. Based on circumstances, it should also include malaria prophylaxis,

condom A condom is a sheath-shaped barrier device used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection (STI). There are both male and female condoms. With proper use—and use at every act of in ...

s, and medication to combat

traveler's diarrhea Travelers' diarrhea (TD) is a stomach and intestinal infection. TD is defined as the passage of unformed stool (one or more by some definitions, three or more by others) while traveling. It may be accompanied by abdominal cramps, nausea, fever, ...

. In addition, a basic

first aid kit A first aid kit or medical kit is a collection of supplies and equipment used to give immediate medical treatment, primarily to treat injuries and other mild or moderate medical conditions. There is a wide variation in the contents of first aid ...

can be of use. Studies have shown there are four main medical problems that travellers develop—diarrhoea or gut problems, respiratory problems, wounds and pain. The medical kit should at least address these common things. Research has also shown that the best treatment for travellers diarrhoea is to take an antibiotic (e.g.

ciprofloxacin Ciprofloxacin is a fluoroquinolone antibiotic used to treat a number of bacterial infections. This includes bone and joint infections, intra abdominal infections, certain types of infectious diarrhea, respiratory tract infections, skin infec ...

) plus a stopper (e.g.

loperamide Loperamide, sold under the brand name Imodium, among others,Drugs.co Page accessed September 4, 2015 is a medication used to decrease the frequency of diarrhea. It is often used for this purpose in inflammatory bowel disease and short bowel synd ...

). Due to bacterial resistance, different parts of the world require different antibiotics. It is best to consult a travel doctor to sort out the best medical kit for the exact destination and medical history of the person travelling.

References

External links

CDC Travelers' Health
- includes information on destinations, outbreaks, and recommended or required vaccinations
International Association for Medical Assistance to Travellers (IAMAT)

International Society of Travel Medicine

WHO - List of Country Members
- includes information on outbreaks and health profiles {{Authority control Medical specialties Travel