Helping Globetrotting Students
Travel Safely
Kelly Holton
Division of Global Migration and Quarantine
Centers for Disease Control and Prevention
Travelers’ Health Epidemiology
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*ITA, includes travel to Canada and Mexico
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Number of Travelers (millions)
Number of US Residents Traveling
Abroad, 2000-2007
Study-Abroad Students
Academic Year
Number of Students
1994/95
84,403
1995/96
89,242
1996/97
99,448
1997/98
113,959
1998/99
129,770
1999/2000
143,590
2000/01
154,168
2001/02
160,920
2002/03
174,629
2003/04
191,321
2004/05
205,983
2005/06
223,534
2006/07
241,791
Source:
Open
Doors
(Institute
of International
Education)
Open
Doors
(Institute
of International
Education)
Leading Destinations of U.S. StudyAbroad Students, 2006/07
United Kingdom
Japan
Italy
Argentina
Spain
Greece
France
South Africa
China
Czech Republic
Australia
Chile
Mexico
Ecuador
Germany
Austria
Ireland
New Zealand
Costa Rica
India
Source: Open Doors (Institute of International Education)
Health Risks to Student Travelers
Travelers’ Health Risks
Of 100,000 travelers to a developing country for
1 month:
– 50,000 will develop some health problem
– 8,000 will see a physician
– 5,000 will be confined to bed
– 1,100 will be incapacitated in their work
– 300 will be admitted to hospital
– 50 will be air evacuated
– 1 will die
Steffen R et al. J Infect Dis 1987; 156:84-91
Deaths Related to
International Travel
Cardiovascular
Medical
Injury
Homicide/Suicide
Infectious Disease
Other
N = 2463
Hargarten S et al, Ann Emerg Med, 1991. 20:622-626
Injury Deaths and
International Travel
Motor Vechicle
Drowning
Air Crash
Homicide/Suicide
Poisoning
Other
N = 601
Hargarten S et al, Ann Emerg Med, 1991. 20:622-626
Infectious Disease Risks to
the Traveler
Schistosomiasis
Tuberculosis
Leptospirosis
Polio
Yellow Fever
Measles
Mumps
Rubella
Tetanus
Japanese encephalitis
Malaria
Diarrhea
Leishmaniasis
Rabies
Dengue Fever
Chikungunya Fever
Meningococcal
Meningitis
Varicella
Influenza
Hepatitis A
Hepatitis B
ETC.
Malaria
Mosquito-borne disease
Parasite: Plasmodium
May lead to severe complications or
death
~500 million cases/year worldwide
Risk in over 100 countries
Prophylactic medication
– before, during, and after travel
Malaria Risk Areas
Yellow Fever
Mosquito-borne viral infection
– Aedes aegypti
Varying severity:
– influenza-like syndrome to
severe hepatitis and
hemorrhagic fever
200,000 YF infections cause
30,000 deaths per year
Distribution of Yellow Fever
Japanese Encephalitis
Flavivirus transmitted via bite of Culex
mosquito
50,000 cases and 15,000 deaths yearly
Supportive care only
Up to 50% of survivors have significant
neurologic sequelae
Distribution of Japanese
Encephalitis
Dengue Fever
Mosquito-borne flavivirus endemic in most
tropical areas of the world
No vaccine and no medication for dengue
Illness usually mild; it can be severe and
cause dengue hemorrhagic (bleeding)
fever (DHF)
Distribution of Dengue
Chikungunya Fever
Mosquito-borne disease - primary vector is
aedes aegypti
Mainly occurs in areas of Africa and Asia
Symptoms can include sudden fever,
chills, headache, nausea, vomiting, joint
pain with or without swelling, lower back
pain, and a rash.
No specific drug treatment
People usually recover on their own;
fatalities are rare
Hepatitis A
Viral infection transmitted via fecal-oral
route
– Contaminated food and water
– Person to person
Asymptomatic, or ranges in severity
from a mild illness to severely disabling
disease lasting months
Treatment is supportive
Distribution of Hepatitis A
Hepatitis B
Viral infection transmitted via bloodborne route
– Sexual contact
– Transfusions, surgical or dental procedures
– Shared injection needles
Ranges in severity from no symptoms to fulminant
hepatitis
Treatment is supportive
Risk determined by behavior and prevalence of
chronic infections at destination
Distribution of Hepatitis B
Typhoid
Acute, life-threatening febrile
illness caused by Salmonella
enterica serotype Typhi
Transmission via fecal-oral route,
usually contaminated food or
water
Chronic asymptomatic carrier
Worldwide: 22 million cases and
200,000 related deaths each year
Distribution of Typhoid
Source: sanofi pasteur MSD
Traveler’s Diarrhea
> 50% of travelers away from home
even for only 2 weeks develop TD
~ 40% will have to alter itineraries
~ 20% will be confined to bed
Polio
Viral infection
Acute onset flaccid paralysis
Transmitted via fecal-oral
route or pharyngeal spread
High transmission areas are India,
Pakistan, Afghanistan, Nigeria
Polio Risk Areas
WHO/POLIO database, as of Sept. 2007
Meningococcal Meningitis
Bacterial infection transmitted via the
respiratory route
Outbreaks in Africa during dry season
(December to June)
Associated with crowded conditions
Distribution of Meningococcal
Disease (“Meningitis Belt”)
Rabies
Acute viral encephalomyelitis
Invariably fatal
Humans contract rabies by being bitten or
occasionally by being scratched by an
infected animal
55,000 deaths per year
Distribution of Rabies
Schistosomiasis
Parasite found in some areas of tropical S.
America, Africa, and the Far East
Second only to malaria in terms of morbidity –
over 200 million infected
Transmitted while swimming in fresh water
lakes, streams, rivers
Most will have no symptoms; if exposed,
requires testing on return, and then treatment
if infected
Missionaries and VFRs more likely
to be infected*
*Nicolls D & GeoSentinal, ISTM 2005
Geographic Distribution of
Schistosomiasis
Travel Vaccinations
Immunizations for Adult Travelers
1. Routine immunizations
2. Required immunizations for
travel
3. Recommended
immunizations for travel
Routine Immunizations
Diphtheria
Tetanus
Pertussis
Measles
Mumps
Rubella
Varicella
Pneumococcus
* Td or Tdap
Influenza
+ MMR
Human papillomavirus (HPV)
Required Immunizations for Travel
Yellow Fever
Meningococcal
Recommended Immunizations
for Travel
Hepatitis A
Hepatitis B
Typhoid
Japanese encephalitis
Polio
Rabies
Medications
Travel Medications:
Prophylaxis & Self Treatment
Malaria
– chloroquine, atovaquone/proguanil (Malarone),
doxycycline, mefloquine (Lariam), primaquine
Diarrhea
– quinolone (Cipro), azithromycin
Altitude sickness
– acetazolamide
– dexamethasone
Motion sickness
– scopolamine, dimenhydrinate (Dramamine)
Practice Healthy Behaviors
Food and Water Precautions
Drinks that are bottled and sealed
Selection of foods
– well-cooked and hot
– fruits you can peel
Avoidance of
– salads, raw vegetables
– unpasteurized dairy products
– food from street vendors
– Ice
Handwashing
Insect and Mosquito Precautions
Protect yourself outside
–
–
–
–
–
Cover exposed skin
Use insect repellent
Inspect for ticks
Treat clothing with permethrin
Use pyrethroid coils outdoors
Protect yourself inside
– Stay in air-conditioned rooms
OR
– Use window screens
– Use permethrin-impregnated bed nets
– Use aerosol insecticide indoors
Animal Precautions
Animal bites and scratches
Envenomations
– Snakes, scorpions, spiders
– Marine animals
Avoid all animals, even pets
If you are bitten or scratched, seek
medical care right away
Bloodborne and STD
Precautions
Prevalence of
–
–
–
–
STDs
Hepatitis B
Hepatitis C
HIV
Unprotected sexual activity
Commercial sex workers
Tattooing and body piercing
Auto accidents
Blood products
Dental and surgical procedures
Environmental Precautions
Sun protection
Extreme heat and cold
– dehydration, heat stroke
– hypothermia, frostbite
Altitude
Water recreation
– Drowning, boating, & diving accidents
– Risk of schistosomiasis or leptospirosis
– Biological and chemical contamination
Safety Precautions
Wear a helmet
Wear seatbelts
Drink responsibly
Stay alert in crowds
Follow local laws and customs
Understand local crime risks
Travel Health Kit
Copy of medical records and extra pair of glasses
Prescription medications
Over-the counter medicines and supplies
– Analgesics
– Decongestant, cold medicine, cough suppressant
– Antibiotic/antifungal/hydrocortisone creams
– Pepto-Bismol tablets, antacid
– Band-Aids, gauze bandages, tape, Ace wraps
– Insect repellant, sunscreen, lip balm
– Tweezers, scissors, thermometer
Travel Health Insurance
Health insurance may not cover services
abroad
Consider supplemental health insurance
and evacuation insurance
US Department of State consular offices
can assist in finding medical facilities
Health Monitoring
Post-travel checkup is recommended for
– Long term travelers
– Adventure travelers
– Expatriates in developing world
Post-travel care is recommended for
– Fever, chills, sweats
– Persistent diarrhea
– Weight loss
Sources of Information
Travel Health Resources
CDC Travelers’ Health Website
– www.cdc.gov/travel
Health Information for International Travel
– CDC “Yellow Book”
World Health Organization
– www.who.int/int
International Travel and Health
– WHO “Green Book”
State Department
– travel.state.gov
International Society of Travel Medicine
– www.istm.org
Travelers’ Health Website
www.cdc.gov/travel
Travel Notices & Announcements
Situation Info
Advice for
Travelers
Disease Info
Provider Info
Resources for
more
information
and Data
Sources
Destination Pages
Study Abroad Information
Your Survival Guide to Safe and
Healthy Travel
Podcasts
Questions?