1. Dr. Gopalrao M.D. Ph.D.
Professor & Head,
Community Medicine Department

2.  It is a science which deals with promoting and
protecting the health of international
travelers, providing them the advice related
to the travel they are about to undertake.
 It is a fast developing specialty as the
international travel is fast increasing.
 Every year 660 million people travel
internationally.

3.  Practice of “Emporiatrics”
 Rapid development over the last 25 years
 Fairfield Hospital in Melbourne started travel
clinic in early-mid 80s - one of the world’s
first travel clinics
 Now a recognised clinical entity primarily
involved in risk management
 Strong overlap with public health and
occupational health and general practice

4.  Knowledge of morbidity and mortality of travellers
 Understanding of epidemiology and geography of
communicable diseases
 Awareness of non-communicable risks
 Vaccines, indications, side-effects
 Knowledge of post-travel illness presentation and
management
 Geography , esp of major tourist destinations
 Ability to communicate complex issues in simple
ways
 Understanding of when to refer

5. Food and Water
Insects
Animals and Birds
Environmental hazards
Soil
Sun
Heat/humidity
Cold/ dry
Altitude
Marine hazards
Respiratory Hazards
Sex and body-fluid exposure
Vehicular and other Accidents
DVT risk

6. TRAVELER
 Reason for travel
 Behavior
I  Age and gender
n  Health education
TRAVEL d
i  Medical history
 Destination
v - Allergies
 Country of origin i - Immunosuppressed
 Duration of stay d - Pre-existing
u disease
 Itinerary
a
Travel conditions  Immunization
 l
status
Season

r  Special needs
i - Pregnant women
s - Children
k
- Elderly

7.  Pregnancy
 Children
 Elderly
 Expats and long-term travellers
 VFR
 Cardiac or Lung disease
 Diabetes
 HIV infections
 Immunocompromised

8.  Cruise ships
 Diving
 Extended stay
 Extreme travel
 Mass gatherings
 Wilderness

9.  Person; medical conditions past and present,
allergies, medications, vaccine history,
previous travel
 Trip: reason, style and comfort level, rural vs
urban, accomodation, activities, exposures,
budget
 Time: duration, season, frequency

10.  Identifying risks for individuals
or groups
 Advising about risk reduction
strategies
 Recommending and providing
risk reduction interventions
 Encouraging behavioural change
to change risk level

11.  Information enabling
behaviour modification
 vaccinations
 medications (including
antimalarials)
 other - travel insurance, pre
existing medical
problems, nets, syringes, med
ical kits

12.  Understand basic current epidemiology
 Be aware of outbreaks and emergent issues
 Provide written material targeting specific
risks
 Be able to communicate using electronic
media

13.  Cornerstone of clinical decision process
 Opportunity to define the risk profile
 Requires appropriate time, and done in advance of
travel.
 May need multiple visits, allow a plan
 Good documentation essential
 Discussion of costs and priorities
 Consider family requirements

14.  Tailored advice to the traveller, itinerary and time
 Travellers vary by age, sex, pregnancy, medical
history, immune status, current health,
medications, vaccination history, allergies and prior
travel experience
 Itineraries vary by length of stay, activities,
environmental exposures, types of
accommodation, season and budget
 Time variation is obviously important
 Advice should be understandable, re-inforced and
in various media
 Personal advice is more likely to be understood,
remembered or facilitate behavioural change.

15.  Advice and recommendations should be
within the travellers budget
 Costs should be made clear and should
presented in some priority order
 Alternate strategies may need to be discussed

16.  Additional items for less developed countries (gastro
kit)
◦ Rehydration solution
◦ Loperamide
◦ Tinidazole
◦ Norfloxacin – or azithromycin for children
 Comprehensive medical kit ; Asia, Africa and South
America
◦ All of the above
◦ Sterile needles and syringes. Alcohol swabs
◦ Antihistamines
◦ Antifungal and antibiotic cream

17.  Essential items for all travelers
◦ Items to treat
cuts, scratches, burns, strains, splinters
◦ Paracetamol
◦ Repellent
◦ Consider condoms
 Additional items for Europe, USA, Japan
◦ Antinauseants, eg prochlorperazine
◦ Broad-spectrum antibiotic for respiratory infection
◦ Antacids
◦ Sudafed
◦ Minor sedative
◦ Laxative

18.  These are designed to assist travelers in
meeting medical needs when their access to
quality medical care is compromised.
 All travel medicine consultants recommend
that travelers carry some form of medical
first aid kit. A range is available, and often
needs to be tailored to meet the specific
requirements of the traveler and their
proposed itinerary.
 Many travel clinics sell medical first aid kits;
these often contain prescription items.

19.  No antimalarial gives 100% prevention
 P vivax and P ovale may be present months
after return
 No global consensus
 Fever in returned travellers is malaria until
proved otherwise
 Patient compliance and education is essential

20. 3 prong approach
 behavioral modification
◦ awareness of malarial risk
◦ minimising exposure to mosquitoes
 emphasis on extreme significance of
early diagnosis & treatment
 antimalarial chemoprophylaxis

21.  Avoid outdoor exposure, dawn to dusk
 Wear long sleeved loose clothing after dusk,
light colours
 Avoid perfumes and colognes
 Use repellent with 20-40% DEET
 Use knockdown sprays, coils, vapours, etc
indoors
 Sleep under nets impregnated with
permethrin

22.  Category A – considered low risk
◦ Western Europe/North America/Japan/UK/NZ/Singapore
 Should be fully vaccinated & up to date with
◦ Diphtheria/tetanus/whooping cough
◦ Routine paediatric vaccines
◦ MMR
◦ Polio
◦ Chicken pox
◦ Influenza

23.  Category B Travel – considered to be low to
intermediate risk
◦ Eastern Europe/Israel/Korea/Malaysia/Pacific Is/South
Africa
 Vaccinations should be as for Category A, plus:
◦ Hepatitis A & B
◦ Typhoid
◦ QFT

24.  Catergory C Travel – considered to be of higher risk
◦ African sub-continent/Central & South America/East
Asia/SE Asia/Melanesia
 Vaccinations should be as for Category B, plus:
◦ Polio booster
◦ Japanese B Encephalitis
◦ Rabies
◦ Meningitis
◦ Yellow Fever
 Malaria Prevention

25.  Routine ( background) vaccine
Childhood, standard
 Required ( compulsory) vaccine
Cross borders, entry requirements IHR
 Recommended ( elective based on risk)
Travel vaccines
Some vaccines can be in more than category. Not all the same or
available in all countries

26.  Yellow fever
 Plague
 Cholera
 Typhoid
 Meningococcal meningitis
 SARS
 Influenza

27.  For visiting some countries or on incoming
travel the traveler must have a valid
vaccination certificate attached to the
passport.
 At the entry point or exit ie. airports, ports,
land entry points, the authorities will check
the certificates.
 No valid certification traveler may face
quarantine or deportation.