Health Guidelines for International Travel Pre-Travel Preparation Essential immunizations that should be reviewed: DPT (diphtheria-pertussis-tetanus) MMR (measles, mumps, rubella) H. flu b Polio
Immunizations that may be required: Recommended immunizations: Hepatitis A, especially for travelers to rural areas Hepatitis B for health workers who have direct contact with body fluids Typhoid for travelers to rural areas and immunosuppressed subjects Meningococcal vaccine for travel to the Haaj and epidemic areas of sub-Saharan Africa Rabies and Japanese B encephalitis immunization for selected exposures
Prophylactic Medications (Chemoprophylaxis): Malaria chemoprophylaxis (begin 2 weeks before departure, safety in pregnancy) Mefloquine (Lariam), Malarone, Doxycycline, Chloroquine (+ Proguanil)
During Travel Preventive Strategies (preventing traumatic injury and/or death): Minimizing Exposure to Vector-borne Disease (yellow fever, Japanese B vaccines): General Precautions: Empirical Treatment: Altitude Sickness: Post-Travel Continue malaria prophylaxis; Seek medical assistance for persistent fever, diarrhea. Medical Evacuation Insurance Most common reasons for medical evacuation are: auto accidents, severe illness (e.g., malaria)
Coverage: up to 10 days ($60-165, from single to family, children up to 18 or 21 years of age), up to 17 days ($80-220), up to 31 days ($135-360), per year ($245-625)
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Phone: (215)244-1500; (800)523-8662
Fax: (215) 244-0165 Resources at Tulane Tulane Travel Clinic
Regular hours by appointment on Thursday mornings, and by special arrangement at other times at the Internal Medicine Practice Clinic. Physician charges are covered by the Student Health Service
Address: 275 LaSalle Street, New Orleans LA
Phone: (504)588-5800 Center for Infectious Diseases
Director, Susan McLellan, MD, MPH&TM
Travel Medicine, Infectious Diseases Additional Sources of Information: Center for Disease Control
Medical Letter References General Preparation for Travelers Ryan ET, Kain KC: Health advice and immunizations for travelers. N Engl J Med 2000; 342: 1716-1725.
Spira AM: Preparing the traveler. Lancet 2003; 361: 1368-1381. Anonymous. Advice for travelers. Med Lett Drugs Ther 2002; 44: 33-38. Travelers’ Diarrhea Thielman NT, Guerrant RL: Acute infectious diarrhea. N Engl J Med 2004; 350: 38-47.
Coker AO, Isokpehi RD, Thomas BN, Amisu KO, Obi CL: Human campylobacteriosis in developing countries. Emerg Infect Dis 2002; 8: 237-244. Anderson EJ, Weber SG: Rotavirus infection in adults. Lancet Infect Dis 2004; 4: 91-99. Adachi JA, Ostrosky-Zeichner L, DuPont HL, Ericsson CD: Empirical antimicrobial therapy for travelers’ diarrhea. Clin Infect Dis 2000; 31: 1079-1083. DuPont HL: Treatment of travelers’ diarrhea. J Travel Med 2001; 8 (Suppl 3): S31-S33. Vaccines Wilson ME: Travel-related vaccines. J Travel Med 2001; 15: 231-251. Leder K, Weller PF, Wilson ME: Travel vaccines and elderly persons: review of vaccines available in the United States. Clin Infect Dis 2001; 33: 1553-1556. Ryan ET, Calderwood SB: Cholera vaccines. Clin Infect Dis 2000; 31: 561-565. Craig AS, Schaffner W: Prevention of hepatitis A with the hepatitis vaccine. N Engl J Med 2004; 350: 476-481. Spira AM: A review of combined hepatitis A and hepatitis B vaccination for travelers. Clin Ther 2003; 25: 2337-2351. Steffen R: Immunization against hepatitis A and hepatitis B infections. J Travel Med 2001; 8 (Suppl 1): S9-S16. Jong EC: Risks of hepatitis A and B in the traveling public. J Travel Med 2001; 8 (Suppl1): S3-S8. Shlim DR, Solomon T: Japanese encephalitis vaccine for travelers: exploring the limits of risk. Clin Infect Dis 2002; 35: 183-188. Anonymous. A new rabies vaccine. Med Lett Drugs Ther 1998; 40: 64-65. Monath TP, Cetron MS: Prevention of yellow fever in persons traveling to the tropics. Clin Infect Dis 2002; 34: 1369-1378. Immunizations in Immunocompromised Patients Avery RK: Immunizations in adult immunocompromised patients: which to use and which to avoid. Clev Clin J Med 2001; 68: 337-348. Rousseau MC, Moreau J, Delmont J: Vaccination and HIV: a review of the literature. Vaccine 1999; 18: 825-831. Vector-borne Diseases other than Malaria Gibbons RV, Vaughn DW: Dengue: an escalating problem. Br Med J 2002; 324: 1563-1566. Jelinek T: Dengue fever in international travelers. Clin Infect Dis 2000; 3: 144-147. Monath TP: Yellow fever: an update. Lancet Infect Dis 2001; 1: 11-20. Malaria Chemoprophylaxis Anonymous. Advice for travelers. Med Lett Drugs Ther 2002; 44: 33-38. Steffen R: Malaria prophylaxis: setting the scene. J Travel Med 2003; 19 (Suppl 1): S3-S7. Shanks GD, Kain KC, Keystone JS: Malaria chemoprophylaxis in the age of drug resistance: II. Drugs that may be available in the future. Clin Infect Dis 2001; 33: 381-385. Hughes C, Tucker R, Bannister B, Bradley DJ: Malaria prophylaxis for long-term travelers. Commun Dis Publ Hlth 2003; 6: 200-208. Increased Risk of Malaria Shulman CD, Dorman EK: Importance and prevention of malaria in pregnancy. Trans R Soc Trop Med Hyg 2003; 97: 30-35. Keystone JS: Re-emergence of malaria: increasing risks for travelers. J Travel Med 2001; 8 (Suppl 3): S42-S47. Ryan ET: Malaria: epidemiology, pathogenesis, diagnosis, prevention and treatment – an update. Curr Clin Top Infect Dis 2001; 21: 83-113. Martens P, Hall L: Malaria on the move: human population movement and malaria transmission. Emerg Infect Dis 2000; 6: 103-109. Travel and HIV Infection Perrin L, Kaiser L, Yerly S: Travel and the spread of HIV-1 genetic variants. Lancet Infect Dis 2003; 3: 22-27. Castelli F, Patroni A: The human immunodeficiency virus-infected traveler. Clin Infect Dis 2000; 31: 1403-1408. Karp CL, Neva FA: Tropical infectious diseases in human immunodeficiency virus-infected patients. Clin Infect Dis 1999; 28: 947-963. Colebunders R, Nachega J, Van Gompel A: Antiretroviral treatment and travel to developing countries. J Travel Med 1999; 6: 27-31. Other Groups (Individuals) at Increased Risk Watson DA: Pretravel health advice for asplenic individuals. J Travel Med 2003; 10: 117-121. Ericsson CD: Travelers with pre-existing medical conditions. Intl J Antimicrob Agents 2003; 21: 181-188. Risks linked to Specific Destinations Minooee A, Rickman LS: Infectious diseases on cruise ships. Clin Infect Dis 1000; 29: 737-743. Memish ZA, Ahmed AQ: Mecca bound: the challenges ahead. J Travel Med 2002; 9: 202-210. Pollard AJ, Shlim DR: Epidemic meningococcal disease and travel. J Travel Med 2002; 9: 29-33. Waner S, Durrheim DN, Leggat PA, Ross MH: Preventing infectious diseases in long-term travelers to rural Africa. J Travel Med 2001; 8: 304-308. Joubert JJ, Evans AC, Schutte CH: Schistosomiasis in Africa and international travel. J Travel Med 2001; 8: 92-99. Specialized Activities during Travel Spira AM: Diving and marine medicine review part I: diving physics and physiology. J Travel Med 1999; 6: 32-44. Emergent Contraception Patton PG: Emergency contraception in a travel context. J Travel Med 1999; 6: 24-26. Sexually Transmitted Diseases Matteelli A, Carosi G: Sexually transmitted diseases in travelers. Clin Infect Dis 2001; 32: 1063-1067. Tuberculosis Rieder HL: Risk of travel-associated tuberculosis. Clin Infect Dis 2001; 33: 1393-1396. Cutaneous Manifestations of Illness (Myiasis) Tamir J, Haik J, Schwartz E: Myiasis with Lund’s fly (Cordylobia rodhaini) in travelers. J Travel Med 2003; 10: 293-295. Jet Lag Parry BL: Jet lag: minimizing its effects with critically timed bright light and melatonin administration. J Mol Microbiol Biotechnol 2002; 4: 463-466. Katz G, Durst R, Zislin Y, Barel Y, Knobler HY: Psychiatric aspects of jet lag: review and hypothesis. Medical Hypotheses 2001; 56: 20-23. Venous Thrombosis and Pulmonary Emboli Gallus AS, Goghlan DC: Travel and venous thrombosis. Curr Opinion Pulm Med 2002; 8: 372-378. Giangrande PL: Air travel and thrombosis. Br J Haematol 2002; 117: 509-512. Analyses of Risk Franco E, Giambi C, Ialacci R, Coppola RC, Zanetti AR: Rick groups for hepatitis A virus infection. Vaccine 2003; 21: 2224-2233. Travelers who Return Ill Anonymous. Drugs for parasitic infections. Med Lett Drugs Ther 2002; 44: 1-12. Spira AM: Assessment of travelers who return home ill. Lancet 2003; 361: 1459-1469. Moore DA, Jennings RM, Doherty TF, Lockwood DN, Chiodini PL, Wright SG, Whitty CJ: Assessing the severity of malaria. Br Med J 2003; 326: 808-809. Wolfe MS: Eosinophilia in the returning traveler. Med Clin N Amer 1999; 8: 1019-1032. Suh KN, Kozarsky PE, Keystone JS: Evaluation of fever in the returned traveler. Med Clin N Amer 1999; 83: 997-1017. Taylor DN, Connor BA, Shlim DR: Chronic diarrhea n the returned traveler. Med Clin N Amer 1999; 83: 1033-1052. General Aspects of Travel Medicine Zuckerman JN: Recent developments: Travel medicine. Br Med J 2002; 325: 260-264. Frenk J, Gomez-Dantes O: Globalisation and the challenges to health systems. Br Med J 2002; 325: 95-97. Klion AD, Nutman TB: Infectious diseases of international travel. Adv Intern Med 2001; 47: 265-292. World MJ: A practical approach to problems on return from deployment. J R Army Med Corps 2001; 147: 129-134. Leggatt PA: Sources of health advice given to travelers. J Travel Med 2000; 7: 85-88. Burchard GD: Travel medicine – the next 10 years. Eur J Med Res 1999; 4: 3999-402. Freedman DO, Woodall J: Emerging infectious diseases and risk to the traveler. Med Clin N Amer 1999; 83: 865-883. Children as Travelers Zeind CS, Wilson ME: Drugs and vaccines for pediatric travelers: an integrated table. J Travel Med 2001; 8: 274-275. Training of Physicians in Travel Medicine Barry M, Maguire JH, Weller PF: The American Society of Tropical Medicine and Hygiene Initiative to stimulate educational programs to enhance medical expertise in tropical diseases. Am J Trop Med Hyg 1999; 61: 681-688. | 
