BYDHANUSH ANAND NO.21

OBJECTIVES

Define emporiatricsEpidemology & risk factorsFood/water borne diseasesAir-borne diseasesDroplet infectionsHealth counselling&travel noticesMedical travel kitsTravel notices

What is Emporiatrics ?

“Emporiatrics or travel medicine is the branch of medicine that deals with the prevention & management of health problems of international travellers”

Basically, travel medicine can divide into 4 main topics:

GLOBAL ESTIMATES

According to WHO,there are approximately 600million international travellers anually Morbidity studies conducted by WHO

suggest that about half of the people from a developed country that stay one month in a developing country gets sick.

FACTORS AFFECTING INDIVIDUAL RISK

Internationally Quarantinable diseases

• Yellow fever• Plague• Cholera • Typhoid• Meningococcal meningitis• SARS• Influenza

FOOD/WATER BORNE DISEASES

Due To Contaminated Food Or Water Include :-

Travellers diarroheaTyphoidHepatitis ACholeraleptospirosis

TRAVELLERS DIARRHOEA

Traveller's diarrhoea (TD) is the most common illness affecting travelers

• It occurs within the first 14 days of travel, if it is caused by enterotoxic E. coli

• Typically, traveler’s diarrhea is self-limiting and will last 3-5 days.

Epidemiology

• Each year 20%–50% of international travelers ( >10 million people) develop traveler's diarrhea

• It is more common in the developing world, where rates exceed 60%, than in developed countries.

TYPHOID

Typhoid,is a worldwide bacterial disease, transmitted by the ingestion of food or water contaminated with the feces of an infected person, which contain the bacterium Salmonella enterica

EPIDEMOLOGY

• With an estimated 16–33 million cases of typhoid fever annually resulting in 216,000 deaths in endemic areas

• Its incidence is highest in children and young adults between 5 and 19 years old.

PROPHYLAXIS & TREATMENT

• Hygeinic food and water precautions should suffice

• antibiotics such as ciprofloxacin & levofloxacin can be used

• over the counter medicine like loperamide or which slows down overactive bowels should suffice mild to moderate diarrhea

Hepatitis A

• Hep A is transmitted via contaminated food and water and person-to-person.

• Morbidity increases with age and reports show 2% mortality in those greater than 40 years of age.

• Countries like South America, Mexico, China, India, Africa, and even Greenland have an elevated prevalence of Hep A.

• Vaccines are very effective and well tolerated and should be administered 2-4 weeks prior to visit.

VECTOR-BORNE DISEASES

(A) MALARIA Malaria in humans is caused by 1 of 4

protozoan species of the genus Plasmodium:

• P. falciparum• P.Vivax• P. Ovale• P. malariae

• All species are transmitted by an infective female Anopheles mosquito

EPIDEMIOLOGY

• Malaria transmission occurs in Africa, Central &South America, parts of the Caribbean, Asia

• causes 350–500 million infections worldwide and approx 1 million deaths annually

PREVENTIVE MEASURES FOR TRAVELERS

(a)MOSQUITO AVOIDANCE METHODS Mosquito bites can be reduced by remaining in well-screened areasusing mosquito bed netsusing a pyrethroid-containing insect spraywearing clothes that cover most of the bodymosquito repellent should be applied to exposed

parts of the skin (20-40% DEET)

(b)Chemoprophylaxis Prophylaxis should begin 7 days

before travel, during, and for 4 weeks after leaving the areas

Medications Used for ChemoprophylaxisAtovaquone & Proguanil.Chloroquine & HydroxychloroquineDoxycyclineMefloquine

Yellow Fever

• Yellow fever is an acute viral hemorrhagic disease cause by flavivirus

• The infection is transmitted by the bite of female mosquito Aedes aegypti

EPIDEMIOLOGY• Yellow fever is endemic in tropical and areas

of South America and Africa• WHO reports 200,000 cases of disease and

30,000 deaths a year• An estimated 90% of the infections occur on

the African continent• In 2008, the largest number of cases was

recorded in Togo.

Yellow fever Vaccination certificate is the only compulsory health certificate needed for international travel

This certificate has validity of 10 yrsThe vaccine used is attenuated live vaccineProtective effect starts 10days after

vaccination&lasts for atleast 10yrs

INTERNATIONAL CERTIFICATE OF VACCINATION

Injection of protective vaccination into the deltoid muscle

AIR-BORNE DISEASES

(a)Meningococcal meningitis

Meningitis is a fatal bacterial infection causing inflammation of lining of the brain and spinal cord.

Transmission by respiratory droplets , close personal contact

EPIDEMOLOGY

Meningitis risk is high in countries below sahara desert,

The region stretching from senegal in west africa to ethiopia in east africa is called the “MENINGITIS BELT”

VACCINATION

• Travellers at significant risk of infection should take either BIVALENT OR TETRAVALENT vaccines

• Bivalent vaccine for (A&C strains)• Tetravalent vaccine for (A,C,Y,w-135 strains)

• Vaccines take 7-10 days to take effect

TUBERCULOSIS(TB)

TB is an airborne droplet respiratory disease caused by M.TUBERCULOSIS

EPIDEMIOLOGY Endemic in Sub-Saharan Africa,

Russia&Asia.

Other Diseases Transmitted Through Blood Or Injuries

BLOOD BORNE DISESES 1.HIV2.HEPATITIS B&C3.STD’S

INJURY RELATED1.TETANUS

Pretravel consultation

Effective counseling begins with individual risk assesment for every traveller,taking into account:

destination country & related Risks,detailed itinerary, including specific citiestypes of accommodationseason&style of travel

Additional factors to be considered are ;

other medical conditions,medications being taken (to assess potential drug

interactions),

the cost of the medicines, & the potential side effects

conditions such as pregnancy malarial drug resistance at the destination may modify the risk assessment

Advice and recommendations should be within the travellers budget

MEDICAL TRAVEL KITS

These are designed to assist travelers in meeting medical needs when access to quality medical care is compromised.

Comprehensive medical kit --- Asia, Africa & South America

– Sterile needles and syringes– Antihistamines– Antifungal and antibiotic cream– Antinauseants, eg prochlorperazine

Additional items for less developed countries (gastro kit)– Loperamide– Tinidazole– Norfloxacin or azithromycin for children– ORS

Essential items for all travelers– Items to treat cuts, scratches, burns, strains, splinters– Paracetamol– Mosquito repellents– Consider condoms– Hand sanitizers

“THE YELLOW BOOK”

The Yellow Book is published every

two years by CDC as a reference for those who advise international travelers about health risks

SUMMARY

Common Illnesses Associated With TravellersVarious Edemic Areas&associated DiseasesHealth Measures&prophylaxis Needed for

prevention Health AdvicesMedical Travel Kits

REFERENCES

• PARK• WWW.CDC.GOV.ORG• WWW.WHO “TRAVEL GUIDE”• WIKIPEDIA• SURYAKANTHA