Emporiatrics: An Introduction to Travel Medicine

Editor:

Mary D. Nettleman, M.D., M.S.*
Professor
Department of Internal Medicine

Associate Editor:

Stephen Sigworth, M.D., M.S.H.A.
Assistant Professor of Medicine
Virginia Commonwealth University
Richmond, Virginia

The University of Iowa

*Currently Chair of the Department of Medicine, Michigan State University

Artwork:
Robyn Hepker, M.S.

Peer Review Status: Externally Reviewed by the Author
First Published: 1993
Last Revised: 2000

Support for this project was provided by an Instructional Improvement Award from the Council on Teaching, University of Iowa.

Copyright © 1993. No portion of this book may be reprinted without the written consent of the author.

Table of Contents

• Immunizations and Chemoprophylaxis for Travel-Related Diseases
• Travelers with Special Medical Conditions
• Traveling with Children
• General Precautions and Advice
• Recommendations for Travel to Specific Areas
• Sources of Information and References

INTRODUCTION

Imagine for a moment that you had some free time, some extra money, and a desire for travel and adventure. Where would you go? Hiking in the Himalayas? Canoeing the Amazon? On a picture safari in Africa? To the temples of Asia? Perhaps you prefer the cities of the world...Cairo, Bombay, Rio, Bangkok. Exotic vistas stretch before you: new faces, new foods, new places. You picture yourself treading ancient highways and watching the sun sparkle on distant seas...no one ever pictures themselves becoming ill during travel. Yet, up to one-half of visitors to the tropics will spend a large part of their journey flitting between bathrooms and others may spend days feeling too sick to leave their hotel rooms. Still others will have the misfortune to encounter more rare, but potentially deadly, tropical diseases.

The study of travel-related disease has been called "emporiatrics". The physician's goal should be to minimize the risk of common diseases that may inconvenience travelers and uncommon diseases that may cause serious illness. Recommendations for immunizations and medications will vary according to the destination country. Children and travelers with special medical conditions -- pregnancy, emphysema, heart disease, diabetes -- require expert advice to protect them during travel.

This booklet will provide basic information for clinicians interested in the prevention of travel-related illness. More detailed information and information on the evaluation of returned travelers with tropical illnesses may be found in the references and in standard Tropical Medicine texts. Information on vaccine side effects and dosages may be found in the package inserts.

In general, persons planning to visit developing countries should consult a physician before departure. A list of Travel Clinics is available from the International Society for Travel Medicine (www.istm.org/) or the American Society for Tropical Medicine and Hygiene (www.astmh.org/). Most travelers should contact their physician at least six weeks prior to travel. Adventure travelers, those who plan prolonged stays, and those who will leave the usual tourist routes should contact their physician six months prior to travel. Advice may also be obtained from the Centers for Disease Control and Prevention (www.cdc.gov/travel/) or the World Health Organization (www.who.int/ith). Although vaccinations may be recommended or even required for travel to a developing country, no vaccines are required for re-entry into the United States.

A list of English-speaking physicians meeting minimum requirements is available from IAMAT, the International Association for Medical Advice to Travelers. This list is particularly helpful for patients with chronic medical conditions. The American Embassy can also supply the names of local physicians, but does not facilitate or pay for medical care abroad. Additional references are found at the end of this text.