Helping Globetrotting Students Travel Safely

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Helping Globetrotting Students Travel Safely

• Kelly Holton
• Division of Global Migration and Quarantine
• Centers for Disease Control and Prevention

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Travelers Health Epidemiology
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Number of US Residents Traveling Abroad, 2000-2007
ITA, includes travel to Canada and Mexico
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Open Doors (Institute of International Education)
Source Open Doors (Institute of International
Education)
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Source Open Doors (Institute of International
Education)
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Health Risks to Student Travelers
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Travelers Health Risks

• Of 100,000 travelers to a developing country for
  1 month
• 50,000 will develop some health problem
• 8,000 will see a physician
• 5,000 will be confined to bed
• 1,100 will be incapacitated in their work
• 300 will be admitted to hospital
• 50 will be air evacuated
• 1 will die
• Steffen R et al. J Infect Dis 1987 15684-91

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Deaths Related to International Travel
N 2463
Hargarten S et al, Ann Emerg Med, 1991. 20622-626
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Injury Deaths and International Travel
N 601
Hargarten S et al, Ann Emerg Med, 1991. 20622-626
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Infectious Disease Risks to the Traveler

• Schistosomiasis
• Tuberculosis
• Leptospirosis
• Polio
• Yellow Fever
• Measles
• Mumps
• Rubella
• Tetanus
• Japanese encephalitis

• Malaria
• Diarrhea
• Leishmaniasis
• Rabies
• Dengue Fever
• Chikungunya Fever
• Meningococcal Meningitis
• Varicella
• Influenza
• Hepatitis A
• Hepatitis B

ETC.
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Malaria

• Mosquito-borne disease
• Parasite Plasmodium
• May lead to severe complications or death
• 500 million cases/year worldwide
• Risk in over 100 countries
• Prophylactic medication
• before, during, and after travel

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Malaria Risk Areas
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Yellow Fever

• Mosquito-borne viral infection
• Aedes aegypti
• Varying severity
• influenza-like syndrome to severe hepatitis and
  hemorrhagic fever
• 200,000 YF infections cause 30,000 deaths per year

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Distribution of Yellow Fever
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Japanese Encephalitis

• Flavivirus transmitted via bite of Culex mosquito
• 50,000 cases and 15,000 deaths yearly
• Supportive care only
• Up to 50 of survivors have significant
  neurologic sequelae

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Distribution of Japanese Encephalitis
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Dengue Fever

• Mosquito-borne flavivirus endemic in most
  tropical areas of the world
• No vaccine and no medication for dengue
• Illness usually mild it can be severe and cause
  dengue hemorrhagic (bleeding) fever (DHF)

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Distribution of Dengue
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Chikungunya Fever

• Mosquito-borne disease - primary vector is aedes
  aegypti
• Mainly occurs in areas of Africa and Asia
• Symptoms can include sudden fever, chills,
  headache, nausea, vomiting, joint pain with or
  without swelling, lower back pain, and a rash.
• No specific drug treatment
• People usually recover on their own fatalities
  are rare

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Hepatitis A

• Viral infection transmitted via fecal-oral route
• Contaminated food and water
• Person to person
• Asymptomatic, or ranges in severity from a mild
  illness to severely disabling disease lasting
  months
• Treatment is supportive

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Distribution of Hepatitis A
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Hepatitis B

• Viral infection transmitted via bloodborne route
• Sexual contact
• Transfusions, surgical or dental procedures
• Shared injection needles
• Ranges in severity from no symptoms to fulminant
  hepatitis
• Treatment is supportive
• Risk determined by behavior and prevalence of
  chronic infections at destination

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Distribution of Hepatitis B
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Typhoid

• Acute, life-threatening febrile illness caused by
  Salmonella enterica serotype Typhi
• Transmission via fecal-oral route, usually
  contaminated food or water
• Chronic asymptomatic carrier
• Worldwide 22 million cases and 200,000 related
  deaths each year

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Distribution of Typhoid
Source sanofi pasteur MSD
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Travelers Diarrhea

• gt 50 of travelers away from home even for only 2
  weeks develop TD
• 40 will have to alter itineraries
• 20 will be confined to bed

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Polio

• Viral infection
• Acute onset flaccid paralysis
• Transmitted via fecal-oral
• route or pharyngeal spread
• High transmission areas are India, Pakistan,
  Afghanistan, Nigeria

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Polio Risk Areas
WHO/POLIO database, as of Sept. 2007
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Meningococcal Meningitis

• Bacterial infection transmitted via the
  respiratory route
• Outbreaks in Africa during dry season (December
  to June)
• Associated with crowded conditions

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Distribution of Meningococcal Disease
(Meningitis Belt)
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Rabies

• Acute viral encephalomyelitis
• Invariably fatal
• Humans contract rabies by being bitten or
  occasionally by being scratched by an infected
  animal
• 55,000 deaths per year

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Distribution of Rabies
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Schistosomiasis

• Parasite found in some areas of tropical S.
  America, Africa, and the Far East
• Second only to malaria in terms of morbidity
  over 200 million infected
• Transmitted while swimming in fresh water lakes,
  streams, rivers
• Most will have no symptoms if exposed, requires
  testing on return, and then treatment if infected
• Missionaries and VFRs more likelyto be infected

Nicolls D GeoSentinal, ISTM 2005
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Geographic Distribution of Schistosomiasis
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Travel Vaccinations
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Immunizations for Adult Travelers

• Routine immunizations
• Required immunizations for travel
• Recommended immunizations for travel

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Routine Immunizations

• Diphtheria
• Tetanus
• Pertussis
• Measles
• Mumps
• Rubella
• Varicella
• Pneumococcus
• Influenza
• Human papillomavirus (HPV)

Td or Tdap MMR
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Required Immunizations for Travel

• Yellow Fever
• Meningococcal

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Recommended Immunizations for Travel

• Hepatitis A
• Hepatitis B
• Typhoid
• Japanese encephalitis
• Polio
• Rabies

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Medications
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Travel MedicationsProphylaxis Self Treatment

• Malaria
• chloroquine, atovaquone/proguanil (Malarone),
  doxycycline, mefloquine (Lariam), primaquine
• Diarrhea
• quinolone (Cipro), azithromycin
• Altitude sickness
• acetazolamide
• dexamethasone
• Motion sickness
• scopolamine, dimenhydrinate (Dramamine)

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Practice Healthy Behaviors
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Food and Water Precautions

• Drinks that are bottled and sealed
• Selection of foods
• well-cooked and hot
• fruits you can peel
• Avoidance of
• salads, raw vegetables
• unpasteurized dairy products
• food from street vendors
• Ice
• Handwashing

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Insect and Mosquito Precautions

• Protect yourself outside
• Cover exposed skin
• Use insect repellent
• Inspect for ticks
• Treat clothing with permethrin
• Use pyrethroid coils outdoors
• Protect yourself inside
• Stay in air-conditioned rooms
• OR
• Use window screens
• Use permethrin-impregnated bed nets
• Use aerosol insecticide indoors

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Animal Precautions

• Animal bites and scratches
• Envenomations
• Snakes, scorpions, spiders
• Marine animals
• Avoid all animals, even pets
• If you are bitten or scratched, seek medical care
  right away

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Bloodborne and STD Precautions

• Prevalence of
• STDs
• Hepatitis B
• Hepatitis C
• HIV
• Unprotected sexual activity
• Commercial sex workers
• Tattooing and body piercing
• Auto accidents
• Blood products
• Dental and surgical procedures

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Environmental Precautions

• Sun protection
• Extreme heat and cold
• dehydration, heat stroke
• hypothermia, frostbite
• Altitude
• Water recreation
• Drowning, boating, diving accidents
• Risk of schistosomiasis or leptospirosis
• Biological and chemical contamination

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Safety Precautions

• Wear a helmet
• Wear seatbelts
• Drink responsibly
• Stay alert in crowds
• Follow local laws and customs
• Understand local crime risks

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Travel Health Kit

• Copy of medical records and extra pair of glasses
• Prescription medications
• Over-the counter medicines and supplies
• Analgesics
• Decongestant, cold medicine, cough suppressant
• Antibiotic/antifungal/hydrocortisone creams
• Pepto-Bismol tablets, antacid
• Band-Aids, gauze bandages, tape, Ace wraps
• Insect repellant, sunscreen, lip balm
• Tweezers, scissors, thermometer

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Travel Health Insurance

• Health insurance may not cover services abroad
• Consider supplemental health insurance and
  evacuation insurance
• US Department of State consular offices can
  assist in finding medical facilities

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Health Monitoring

• Post-travel checkup is recommended for
• Long term travelers
• Adventure travelers
• Expatriates in developing world
• Post-travel care is recommended for
• Fever, chills, sweats
• Persistent diarrhea
• Weight loss

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Sources of Information
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Travel Health Resources

• CDC Travelers Health Website
• www.cdc.gov/travel
• Health Information for International Travel
• CDC Yellow Book
• World Health Organization
• www.who.int/int
• International Travel and Health
• WHO Green Book
• State Department
• travel.state.gov
• International Society of Travel Medicine
• www.istm.org

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Travelers Health Websitewww.cdc.gov/travel
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Travel Notices Announcements

• Situation Info
• Advice for Travelers
• Disease Info
• Provider Info
• Resources for more information and Data Sources

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Destination Pages
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Study Abroad Information
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Your Survival Guide to Safe and Healthy Travel
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Podcasts
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Questions?