International Travel Clinic Occupational Medicine

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International Travel Clinic Occupational
Medicine

• Linda Manke RN, COHN
• Sandia International Travel Clinic Program
  Coordinator

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Workshop Objectives

• Provide information about the development of an
  international travel clinic (ITC)
• Identify core elements of ITC services
• Clarify resources, professional education and
  staffing to support ITC activities
• Discuss primary organizational interfaces with
  ITC services
• Identity the role of ITC in emergency response
  (injury, illness, emerging diseases)

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Background

• The International Travel Clinic (ITC) has the
  responsibility for providing quality medical
  services to ensure the health and safety of SNLs
  business travelers.
• 1993, travelers and management identified
  requirements for international travel.
• Medical services were contracted to outside
  provider (hospital occupational medicine
  practice).

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Background
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Development of
International
Travel Clinic

• Identify needs of business
• Cost effectiveness-medical services, medications,
  immunizations
• On-site availability of medical services
• Maintaining accurate medical records
• Convenience to customer, and customer
  satisfaction
• Review Gostin, International Infectious Disease
  Law,
• JAMA, 6/2/04, v.291, n. 21

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Organizational Interfaces with ITC

• Foreign Travel Department-responsible for travel
  arrangements, DOE trip approval process,
  itineraries
• International Program Department- 50 of SNL
  foreign travel
• N.M. Infectious Disease and Internal Medicine
  Specialists-referral for positive PPD, or
  infectious diseases

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Core Elements of ITC Services

• Immunization guidelines
• Destination specific counseling
• Food and water precautions insect precautions
• Medication packet with education to self treat
  common travel illnesses
• ISOS, worldwide emergency assistance
• Frequent International Travel (FIT)
  Program-surveillance for frequent travelers
• Tuberculosis (TB) Surveillance

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International Travel Services

• Post Trip Review
• Interview/questionnaire
• Problem review
• Pre-planning for next trip
• ITC Program Review
• Evaluate aggregate information
• Engage high travel organization
• Prepare for special needs

• Travel Planning
• Notification/approvals
• Risk Assessment
• Security Review
• ITC Consultation
• Personal Health Assessment
• Evaluate destination risks
• Immunizations
• Emergency Preparedness

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VaccinationsRisk Assessment and Priorities

• Vaccinations generally based upon required,
  routine and recommended prophylactic strategy.
• In all cases,
• consideration must be given to
• Location and duration
• Reason for travel
• Health of the traveler
• Individual travel plans

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Immunization Guidelines

• Required
• Yellow Fever
• Recommended
• Influenza
• Pneumococcal
• Typhoid Fever
• Meningococcal
• TB
• Varicella

• Routine
• Tetanus/Diphtheria
• Tdap
• Polio (IPV)
• MMR
• Hepatitis A
• Hepatitis B
• Hepatitis A/B

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International TravelCommon Problems

• Acute Travelers Diarrhea
• Dietary Precautions
• Bismuth
• Antimicrobials (quinolones, macrolides,
  rifaximin)
• Persistent Diarrhea
• Parasitic infection
• Latent non-infectious disease

• Hepatitis A
• Most frequent vaccine preventable disease
• Common world wide
• Active immunization preferred approach

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Emergency Support

• Emergency support may be needed for personal
  health, emerging disease, local conflict, and
  natural disaster
• Medial Assistance companies are a necessity
• Global emergency assistance (evacuations,
  hospitalizations, interpreters, etc.)
• Medical services (site surveys, development of
  medical resources, planning)
• Security Services (monitoring, analysis,
  transportation)

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Special Issues

• ITC support may vary widely to support/respond
  to special needs
• Extended stay for larger groups
• Regional conflict
• Limited regional infrastructure
• Regional security concerns
• Family support
• Infectious disease (expected unexpected)

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Resources, Education and Staffing for ITC

• Education
• Conference attendance
• MMWR resource
• CDC, WHO, ISOS-informational websites

• Resources
• Shoreland Travax
• CDC Travel Health
• ISOS-informational website

• Staffing
• One RN per day
• 1 Physician available for consultation

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Web Travel Resources

• CDC Home Page
• http//www.cdc.gov
• CDC Travel Information
• http//www.cdc.gov/travel/travel.html
• IAC (Immunization Action Coalition)
• http//www.immunize.org
• Travel Medicine Sites
• Shoreland/Travax http//www.shoreland.com
• International SOS http//www.internationalsos.
  com

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Web Resources(continued)

• US State Department
• http//www.state.gov
• Wilderness Medical Society
• http//www.wms.org
• WHO (World Health Organization)
• http//www.who.int/vaccines
• This presentation is exclusively
• available to participants of this workshop _at_
• http//www.sandia.gov/health/update/docs/itc.pdf

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Thank You

• Feel free to contact us
• 505-844-HBES (4237)
• hbe_at_sandia.gov
• For up-to-date information on contemporary health
  or benefits topics, preventive, screening and
  health education visit the HBE Weekly UPDATE _at_
  www.sandia.gov/health/update