3. Travel medicine—prevention based on epidemiological data

Abstract

In travel medicine efforts should be concentrated on preventive measures that are necessary, and travellers should be spared the side effects, costs and stress of superfluous measures. Excess mortality abroad is mainly due to traffic and swimming accidents, indicating the need for appropriate control strategies. The morbidity in travellers to developing countries is high, and is primarily due to traveller's diarrhoea. As prophylaxis is ineffective or unrealistic, and as travellers often need fast relief, it is recommended to include loperamide and an antimicrobial agent in the travel kit. Recent studies have shown that the incidence rate per month of Plasmodium falciparum malaria in Africa may reach . The most frequently occurring immunizable diseases are hepatitis A () and hepatitis B (). For many tourists and some expatriates pre-travel advice (hygiene, measures against mosquito bites, etc.) as well as chemoprophylaxis and immunization can be limited to these infections, but those travelling or staying outside large centres need additional measures Abstract In travel medicine efforts should be concentrated on preventive measures that are necessary, and travellers should be spared the side effects, costs and stress of superfluous measures.

Use of the Parasight-F diagnostic test for imported malaria in a travel clinic.

“…This figure is in keeping with published data on imported malaria in France. 13 A diagnosis of Loa loa filariasis and malaria coinfection was made in one case, underlining the value of microscopy for the identification of blood parasites other than Plasmodium.…”

Médecine des voyages

“…Là encore quelques chiffres peuvent situer le problème (Tableau I): la proportion des voyageurs se plaignant d'un problème de santé, quel qu'il soit, est de l'ordre de 60 % avec des écarts qui varient de 15 à 78 % selon les études, et la fameuse diarrhée du voyageur, la turista, touche près de un voyageur sur deux [3][4][5][6]. En revanche, certaines maladies typiquement tropicales, particulière-ment redoutées par les voyageurs, sont relativement rares voire très rares: 2 à 3 % pour le paludisme, 3/100000 pour la fièvre thyphoïde et 3/1000000 pour le choléra.…”

“…En revanche, certaines maladies typiquement tropicales, particulière-ment redoutées par les voyageurs, sont relativement rares voire très rares: 2 à 3 % pour le paludisme, 3/100000 pour la fièvre thyphoïde et 3/1000000 pour le choléra. Des problèmes de santé beaucoup moins « exotiques » sont plus fréquents et souvent graves: 1/3 des rapatriements sanitaires sont justifiés par des accidents traumatiques, 1/3 par des accidents cardio-vasculaires et près de 1/10 par des décompensations psychiatriques [3,7]. Cet aspect quantitatif global de l'évaluation des risques ne rend pas compte de la diversité des situations.…”

Mefloquine versus Quinine plus Sulphalene-Pyrimethamine (Metakelfin) for Treatment of Uncomplicated Imported Falciparum Malaria Acquired in Africa

“…Although it has been eradicated from temperate zones, each year an increasing number of travelers from these areas are exposed to the risk of malaria while visiting tropical countries. The risk for travelers to sub-Saharan African countries is estimated to be 1.5 to 2.4% per month of exposure in the absence of chemoprophylaxis (13). The number of malaria cases reported in European countries each year reaches 11,000, and the number of patients with falciparum malaria is estimated to be 8,000 per year; significant underreporting is assumed (6).…”