Transcript Part I Introduction to travel health and the risks of

Preparing Students for
International Travel
Gail Rosselot, NP, MS, MPH, COHN-S, CTH
Travel Well of Westchester
Briarcliff Manor, NY
ACHA Presentation FR 180
This presentation was delivered on Friday,
June 2, 2006 at the annual meeting of the
American College Health Association
held at the Marriott Marquis in NYC. It
is published on this website as a
supplementary resource for those health
professionals who attended the program
and for other clinicians with an interest
in the topic.
The Presenter
Gail Rosselot is a certified adult nurse practitioner with more
than 20 years experience providing travel health care in a
variety of clinical settings, including college health,
occupational health, ambulatory care and infectious diseases.
Ms Rosselot has maintained Travel Well of Westchester, a
private practice for consulting, education and patient care,
since 1991 in Briarcliff Manor, NY. She writes and lectures
frequently on travel health topics at national and
international meetings of AAOHN, ACHA, ISTM, and the
VNAA.
Since 2002 she has taught a short course in pre-travel care,
The Westchester Course, as well as on-site clinical practicum.
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Overview
This 90 minute session will review:
 General health risks for international travelers
 Pre-travel preparation for the college student
 Suggested site requirements to promote quality
travel health care in the college setting
 Student challenges!
Part I
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Introduction to travel health and the
risks of international travel for students
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The pre-travel consultation visit:
 assessment of traveler and trip
 itinerary search for vaccine & non-vaccine
preventable hazards
“More and more people are traveling
each year to unhealthy places”
Jane Howarth, MD, author Bugs, Bites & Bowels
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At least 40 million Americans travel
internationally each year
8 million to developing countries
Everyone now travels abroad: young, old,
persons with chronic disease, disabilities, and
pregnancy
They travel for pleasure, humanitarian work,
business, to visit friends and relatives
International student travel for study and all
other reasons is increasing at U.S. colleges
What is the
health experience of travelers?
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If 100,000 travelers go to developing countries
x 1 month (Steffen et al):
50,000-75,000 develop some health problem
(30% TD)
8,000 will see a physician about the problem
5,000 will stay in bed & 300 will be hospitalized
50 air evacuated & 1 will die
But individual risk will vary depending upon a
number of variables
Steffen, R et al. (1987) J of Infectious Disease, 156, 84-91
CDC, 2001, Health Information for International Travel
Important to Remember
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Individual health risk is not quantifiable
Travelers at risk for trauma, routine illness
& exotic disease
#1 causes of death in travelers: accidents &
cardiovascular disease
Risk varies with geographic destination, but
also health status of the traveler, trip activity,
& duration
Travel health care is the
prevention & management of
injury and illness in travelers
Not all travel is alike:
risk is individualized, not universal
Travel health prevention strategies must
be customized, realistic, & attainable
The Trip Risk Reduction Process
Pre-travel Consultation is cornerstone of care
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Risk Assessment
 Traveler & Trip
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Risk Reduction Efforts
Pharmacological
 Immunizations
 Medications / Med Kit
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Non-Pharmacological
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Health counseling
Referrals
Monitoring & Evaluation
Policies & Services
Four Step Process
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Step 1:
 Ask student about his / her health
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Step 2:
 Ask student about trip plans
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Step 3:
 Research trip risks & health recommendations
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Step 4:
 Create and implement plan to reduce travel health
risks
Risk Assessment
Ask Student About Self:
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Age, gender, place of birth
Travel medical evacuation insurance
Who will pay for travel care?
Prior travel experience
Hobbies, recreational interests
More Critical Questions for Student
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Medical history: chronic, new or unstable problems?
other red flags*?
Pregnancy / or risk of pregnancy
Immunity issues?
Meds: all including Rx and OTC
Allergies (vaccines, components, environment, foods,
etc)
Immunizations: full history of vaccinations and
vaccine preventable diseases, past titers? scheduling
problems? documentation issue?
* Could be problem during the trip
Use Pre-printed Assessment
Documents
for completeness, clarity & continuity
For example:
Thompson, Routine
and Travel
Immunizations,2004
Or
Rosselot (2004)
AAOHN J, 52(1), 28-41
Risk Assessment
Ask the Student About Trip
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Exact itinerary: all
destinations in order of travelspecific regions to be visited;
all airport landings; any
possible trip extensions?
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Departure: how far off?
4 to 6 wks? short-notice?
traveler accessible in interim?
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Trip duration & season: > 3
wks, long-stay?
More Trip Variables
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Rural vs urban travel / remote?
Trip purpose & activities: study, leisure,
HCW? VFR (visiting friends &
relatives)?
Accommodations: 5 – 3 – 0 star, private
homes? camping, long-stay apartment?
Modes of transportation: air, car, public
buses & trains, biking, hiking, ship
Contact: local people, children, animals?
Destination Search
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Use a dedicated computer with Internet and
printer access
Starts with visit confirmation
Use updated resources only!
Use multiple resources as may be needed for
maps, outbreak information, activity risks, and
vaccine recommendations
Search all destinations in order of travel,
including airport landings
Outcome of Itinerary Search
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After completing your internet search you will
have: a print-out of health and safety risks for
trip destinations that includes:
 Recommendations for travel vaccinations
 Recommendations for travel medications (e.g. antimalarial agents)
 Suggestions for health counseling topics
 Area maps and local contact numbers for
consulates, others
Combining information from your
assessment& your itinerary search, you are
now creating your risk reduction plan…
1. With the student, identify immunizations needed for
this itinerary- then create a schedule for administration
2. Prioritize non-vaccine preventable risks and create a
patient education plan
3. Determine if you need to recommend any travel
medications or supplies (e.g. repellent). Write or obtain
prescriptions for any indicated Rx drugs such as antimalarials or antibiotics.
4. Determine if you need to make any referrals (e.g.
dentist, source for overseas vaccines, etc)
U.S. Search Resources
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www.cdc.gov/travel: site for patients, good updates on
outbreaks, excellent resource for in-depth information
on travel health risks
Travax @ www.shoreland.com: subscription software
for the provider
International SOS @ www.travelcare.com:
subscription software for the provider
U.S. State Department Travel Information @
www.travel.state.gov: information on visas, country
alerts, etc
International Society of Travel Medicine @
www.istm.org: members can participate in ListServe to
get answers to individual patient issues
Risk Reduction Plan- your counseling
plan may include any of these topics:
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Accidents
Food and water
precautions
Insect precautions
Malaria prevention
STI’s
Safety & security
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Environmental: sun,
heat, cold, altitude
Travel evacuation
insurance
Special needs
Cultural Issues
Post-trip / re-entry
End of Part I
In the next set of slides, you will review the
different travel vaccines available to
protect your student