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Travel Health

Travel Health. Nancy Rudner Lugo, DrPH, NP. Our community is global. The vaccine you give here is felt around the world Increasingly mobile and global society Immunizations for travel- protect patient, protect others from diseases that could be spread.

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Travel Health

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  1. Travel Health Nancy Rudner Lugo, DrPH, NP

  2. Our community is global • The vaccine you give here is felt around the world • Increasingly mobile and global society • Immunizations for travel- protect patient, protect others from diseases that could be spread

  3. “Every one of those deaths is totally unacceptable” • VPDs kill over 1 million children <5 each year • Measles, diphtheria, polio, or tetanus “Every one of those deaths is totally unacceptable when we have an affordable and effective means to prevent those deaths.” —Melinda Gates World Health Organization. 2004 Global Immunization Data. http://www.who.int/immunization_monitoring/data/GlobalImmunizationData.pdf

  4. Child Mortality from VPDs World Health Organization. 2004 Global Immunization Data. http://www.who.int/immunization_monitoring/data/GlobalImmunizationData.pdf

  5. Global Progress • “immunization has proven to be one of the most important and cost-effective ways of ensuring that children survive their early years.” – UNICEF • Since 1974, immunization coverage of infants for diphtheria, measles, pertussis, polio, tetanus, and TB increased 5% - 80% in 2004. • In past 20 years, 20 million VPD deaths averted • Global eradication of measles and polio in reach. United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO). Immunization Summary 2006. A Statistical Reference. Data Through 2004. http://www.unicef.org/publications/files/Immunization_Summary_2006.pdf

  6. Global Challenges • 27 million children remain unvaccinated. • 60% (16.3 million) of unvaccinated children live in 5 of the 10 most populous developing countries: China, India, Indonesia, Nigeria, and Pakistan. • In 10 countries6 in sub-Saharan Africa (Central African Republic, Gabon, Equatorial Guinea Liberia, Nigeria, Somalia), 3 in Southeast Asia (Lao People’s Democratic Republic, Papua New Guinea, and Vanuatu), and Haiti,fewer than half of 1-year-olds have received DTP3, leaving 4.3 million infants unvaccinated • War and other barriers: Iraq 40% immunized v measles United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO). Immunization Summary 2006. A Statistical Reference. Data Through 2004. http://www.unicef.org/publications/files/Immunization_Summary_2006.pdf

  7. Global Challenges Cost • $20-$25 to immunize a child for measles, polio, tuberculosis, tetanus, diphtheria, and pertussis in developing countries, • Equivalent to about $1 per capita per year for most heavily indebted poor nations countries. • $20-$40 with administrative costs per child. • Add hepatitis B - $28.50 to $39 ($1.14-$1.95 per capita/year). • PAHO bulk purchasing cooperative World Health Organization. Immunization Against Diseases of Public Health Importance. March 2005. http://www.who.int/mediacentre/factsheets/fs288/en/print.html

  8. Global Alliance for Vaccines and Immunizations (GAVI), • A private–public partnership charged with boosting vaccination rates in developing countries, formation of partnerships for improving immunization rates. • To immunize 90% of the world’s children by 2015 will cost $8 to $12 billion. • Bill and Melinda Gates support, GAVI working with international leaders to establish an international finance facility that will help developing nations get funding to pay for vaccines

  9. Increasing Globalization Over 800 million people traveled internationally annually • U.S. residents - almost 60 million international trips by air =>1 trip for every 5 persons in the country. • 81% for leisure, visit friends and relatives, • 28% for business • 41% from U.S. go alone • Some travel without an official border crossing World Tourism Organization. World Tourism Barometer. 2006;4(2). U.S. Department of Commerce, Office of Travel and Tourism Industries. Total International Travelers Volume to and from the U.S. 1995-2005. http://tinet.ita.doc.gov/outreachpages/inbound.total_intl_travel_volume_1995-2005.html U.S. Department of Commerce, Office of Travel and Tourism Industries. 2004 Profile of U.S. Resident Traveler Visiting Overseas Destinations, from Survey of International Air-Travelers. Available at:http://tinet.ita.doc.gov/view/f-2004-101-001/f-2004-101-001.csv

  10. We are all connected

  11. Who is a traveler? • International Business • Retirees • Students studying abroad • Mission groups • Adopting parents • Immigrants • Central Florida tourists • Undocumented workers

  12. Where do they go? From where do they come?

  13. Diphtheria Tetanus Polio Hepatitis A Hepatitis B Measles Mumps Rubella Varicella Malaria* Influenza Meningitis Yellow fever Japanese encephalitis Typhoid Pneumococcal disease Rabies Cholera Parasitic diseases* Dengue fever* Travelers’ diarrhea* And more…. *not VPD but preventible What do they get? >= 23 travel-related VPDs

  14. Health Risks of Travel Unique for each traveler, each trip. • Developed countries or developing country? • Marriott or a yak? • Limo or donkey? • Meetings or hiking? • Healthy or compromised? • Diabetes? Asthma? Migraine? • Young? Old? Pregnant? • A week? A year?

  15. Travel Vaccinations • Get most current information • Up to date on recommended vaccines www.cdc.gov/vaccines • Current travel vaccine recommendations

  16. Malaria prevention before, during, and after travel • 41% of the world’s population lives in malaria area • Malaria eradicated in U.S. 1950s, • 1337 cases of malaria and 8 deaths in U.S. ,2002. • 1332 were acquired in malaria-endemic countries. • 63 malaria outbreaks in US 1957 – 2003 from mosquitoes biting people who are carrying malaria parasites acquired outside US and then biting local residents. Centers for Disease Control and Prevention. Malaria Facts. May 4, 2004.Available at: http://www.cdc.gov/malaria/facts.htm

  17. TD….. • Travelers’ diarrhea • Affects 25% to 90% of travelers in first two weeks of travel • The most careful plans for business or recreation can be sabotaged by TD……….. • Can give a unique view of travel.. Von Sonnenburg F, Tornieporth N, Waiyake P, et al. Risk and aetiology of diarrhea at various tourist destinations. Lancet. 2000;356:133-134.

  18. Sex + Travel • Travel for sex and sex tourism • Sex while traveling 4% to 19% of travelers engage in casual sex Half do not use condoms Steffen R, deBernardis C, Banos A. Travel epidemiology—a global perspective. Int J Antimicrob Agents. 2003;21(2):89-95

  19. Other risks • personal safety, • transportation-related injuries, • mental illness triggered by disorientation in unfamiliar environments, • altitude sickness. • food poisoning, • snake bites • DVT • exacerbations of underlying or chronic diseases. • “not a covered benefit”

  20. Most travelers depart without adequate preparation • Prevent infectious diseases including hepatitis A, malaria, and typhoid. • Study of 404 travelers departing from JFK to destinations high risk for malaria or hepatitis A • only 36% had sought travel health advice before departure. • only 17% thought they had a high risk for hepatitis A. • Few vaccinated: 11% for tetanus, 14% for hepatitis A, 13% for hepatitis B, and 5% for yellow fever. • While 73% knew malaria was a risk, but only 46% carried antimalarial medication Hamer DH, Connor BA. Travel health knowledge, attitudes and practices among United States travelers. J Travel Med. 2004;11(1):23-26.

  21. PreTravel Care • Educate and prepare (4-6 weeks prior to departure if possible) • travel health kits, information for self-treatment of illness • personal protective measures (use of condoms, waterless hand sanitizers, and barrier protection such as bed nets and insect repellents; and restriction of outdoor activity at peak mosquito times of dawn and dusk). • Immunizations

  22. Be Current! Be Continuous! • Know the changing epidemiology • shifting drug resistance and disease patterns. • JFK study- many had chloroquine for malaria prevention, but they were traveling to regions where chloroquine resistance was widespread. • Travel health needs do not end when the trip ends. • gastrointestinal illness, skin lesions, respiratory infections, fever (r/o malaria, dengue fever, hepatitis A, typhoid fever, UTI) • Some travel illnesses show up months later.Ask about travel whenever evaluating ill patients. • Hamer DH, Connor BA. Travel health knowledge, attitudes and practices among United States travelers. J Travel Med. 2004;11(1):23-26.

  23. 1st Annual World Congress of VaccineDecember 1-5, 2008, Guangzhou, China The Future: Human Preventive and Therapeutic VaccinesDengue FeverCancerGI and enteric infectious diseasesCardiovascularCNS disordersBlood diseasesAutoimmune diseasesAND…………. Therapeutic vaccines osteoporosis, arthritis, Lyme disease

  24. Summary • Vaccinations – All routine recommended vaccines in the ACIP schedule, based on age, risks • Vaccinations specific to countries, style of travel, based on most current advisories • Malaria prevention-- mosquito repellant, medication • First aid, safety measures, diarrhea treatment • Disease management, planning • Post travel follow up

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