Transcript Major regional Disease Risks of International Travel

Major regional Disease Risks of International Travel
~ 2 billion people travel by air each year; 2009, The Lancet.
Americans took 64 million trips outside the U.S. in 2007.
Many “exotic” diseases are only a plane flight away...
… in either direction !!
Ronald D. Warner, DVM, MPVM, PhD
Professor
Director, TravelMed Clinic
TTUHSC School of Medicine - Lubbock
TTUHSC Dept Family and Community Medicine’s
TravelMed Clinic “activity”
 CY 2009: 198 clients; traveling to 79 countries
 1996 - 2009, over 1800 travelers to ~ 137 countries
--- the “Top 20“destinations have been:
Brazil, Kenya, China, India, Peru, South Africa, Uganda,
Costa Rica, Viet Nam, Thailand, Mexico, Tanzania,
Panama, Ecuador, Guatemala, Russia, Egypt, Nigeria,
Honduras, and Belize (the rest: Algeria to Zimbabwe)
the more-common Infect. disease risks
… estimated disease burdens, world-wide
 Malaria: ~1-3M human deaths/year; tropical Latin America, India,
SE Asia, and Africa; 1 in 5 deaths of African children
 Typhoid fever: ~16 to 33 million cases/year, with 216,000 deaths
 Dengue fever: estimated 50 million cases/year; 125,000 are fatal
 Rabies: ~60K human deaths/yr.; India, China, Pakistan, Bangladesh,
and the Philippine Islands account for the majority
 Yellow Fever: ~ 30,000 human deaths/year; most in S. America
 hepatitis A: estimated 26,975 cases/year, with 4,000 deaths
 … a/o 10 Feb 2010: 478 human cases of avian H5N1 influenza (bird
flu); 282 fatalities [Indonesia, Viet Nam, China, Thailand, Egypt]
primary: Risk Assessment
Past and current health status
reminder: carry all required meds in original containers
travel plans; itinerary
* destination(s) ... any required vaccinations ?
** length of stay
*** activities while there
current vaccinations
endemic & epidemic diseases at destination(s)
- counseling @ primary prevention
- list of recommended vaccinations
- “scripts” for recommended prophylactic meds
Routine “adult” vaccines are important
 Tetanus-diphtheria (Td) * - recently Tdap for those 18 - 64 y/o
* booster every 10 years
 Measles-mumps-rubella (MMR), if not “current”
esp. for those born after 1956
 current Influenza vacc, esp. if traveling Oct – Feb, and/or > 65 y/o.
Remember: “opposite” flu season in the S. Hemisphere
 Pneumococcal vacc, if > 65 y/o
and esp. if serious underlying cardio-pulmonary disease(s)
 possibly, an adult Polio booster ** ; esp. for some countries in
Africa, mid-East, India or SE Asia
** only i.m. IPV (original Salk); oral polio vaccine no longer available
Arthropod- or insect-borne diseases
of most concern for international travel
 malaria: anti-malaria pills before, during, & after your trip, as directed
 yellow fever: modified-live virus vaccine; good for 10 years
 dengue fever: no vaccine or pill available
 Japanese encephalitis: 2-vaccine series; one month apart
 African or American trypanosomiasis: no vaccines or pills available
 Tick-borne encephalitis; no vaccine in U.S.
Malaria – endemic in W. Hemisphere
map from
CDC web
site.
Malaria – endemic in E. Hemisphere
map from CDC web site
Mefloquine–resistant Malaria ; E. Hemisphere
map from
CDC web
site.
Yellow Fever - endemic in the Americas
map from
CDC web
site.
Yellow Fever - endemic in Africa
map from
CDC web
site.
Dengue – endemic in the W. Hemisphere
map from
CDC web
site.
Dengue – endemic in the E. Hemisphere
map from
CDC web
site.
Japanese Encephalitis virus – endemic risk areas
E. Hemisphere
map from
CDC web
site.
Counseling (primary prevention)
Re: insect/arthropod avoidance & animal bites
 Protect yourself from insects: well-screened residence; and
esp @ dusk & dawn: wear long sleeves & long pants; &
use 25-50% DEET repellent; do not use scented toiletries …
may need permethrin-impregnated bed nets
* dengue (usually day-time biters); ** malaria (often night-time biters)
 Take anti-malarial preventive Rx before, during, & after the trip,
as directed.
 When in E. African “savanna”, wear long sleeves & trousers;
both of tan / khaki or other neutral colors
 don’t handle monkeys, dogs, cats, bats; avoid animal bites
 avoid poisonous / venomous species (snakes, jellyfish, etc)
Water- / Food-borne (hand-to-mouth) diseases
of most concern for international travel
 hepatitis A: good vaccines available; booster once @ 6-12 months
 typhoid: good Vi capsular polysaccharide vaccine available (inject)
[oral vaccine available once again; however, matter of compliance]
 many others; viruses, bacteria, and parasites:
* adequate counseling @ food & water hygiene
 polio: possible IPV booster, if none since 18 y/o
 cholera: poor vaccine efficacy; vaccine now unavailable in US
* adequate counseling @ food & water hygiene
Counseling (primary prevention)
Re: food & water ‘hygiene’
 Drink only bottled water, boiled water, and/or factory-sealed
carbonated beverages … if water is “suspect”, ice is also suspect
 May want to take iodine tablets --- to “treat” boiled water
 Foods: “wash it, peel it, boil or cook it … or forget it !!”
* don’t eat food purchased from street vendors
* generally, avoid dairy products in developing nations
(pasteurization often suspect)
* cold vegetable & fruit salads, and puddings are especially risky
 take over-the-counter anti-diarrheal medications that you use
at home; unwise to routinely take a broad-spectrum antibiotic
Person-to-person transmitted diseases
of most concern for international travel
 Influenza: esp those > 65 y/o, or w/cardio-respiratory co-morbidities.
 hepatitis B: esp for those who do medical mission work, or
who plan to have sexual contact w/“natives” while traveling.
 meningococcal disease: esp in sub-Saharan Africa; also Saudi
Arabia during the annual hajj.
 measles & rubella: esp young children traveling internationally.
 pneumococcal disease: esp for those > 65 y/o, and w/cardiorespiratory co-morbidities.
 diphtheria & pertussis: esp those traveling to E. Europe.
 all STDs (including HIV): esp in young, single, and/or sexually-active.
countries with recent Epidemics of Meningococcal Meningitis
map from
CDC web
site.
Counseling (primary prevention)
Re: personal hygiene
 Wash hands often w/soap & water.
 prevent fungal & parasitic infections: keep feet clean/dry, and
do not go barefoot, esp. on “unclean” beaches.
- Freshwater swimming: only in adequately chlorinated pools.
 Don’t share needles w/anyone; & if sex, then safest sex !!
 take: sun-block, sun glasses, broad-brimmed hat, as needed
 If going to High altitude, > 7000 ft, counsel @ altitude illness;
Rx: acetazolamide [ Diamox ® ] at 125mg QID - 250 mg, BID
 all medications: Keep them in original containers !!
… take enough for time + few days; take copy of ‘scripts’
Sources of information :
Disease risks in countries outside the USA
 US Centers for Disease Control & Prevention (CDC):
“ Travelers’ Health Topics ” * [on-line]
* http://wwwn.cdc.gov/travel/default.aspx a very “rich” source
 Pro-MED Digest; moderated listserve (several times/week)
 Various other on-line sites: i.e., World Health Organization (WHO);
vaccine manufacturers; Eurosurveillance weekly; & many others
 an atlas; US State Dept. web site; your state Health Dept; and/or you
may wish to consult an infectious disease physician
Questions ??
 I’m enjoying a great trip through life, and many of
you have been a part of it; thanks …