What you need to know and prepare before your trip

1. Travelers’ health and safety Dr Kenneth T. Tran, B.Pharm, MD President, YCPA Mars 2010 Thanks to

2. Objectives Understand travel-related risks Recognize the importance of well planned trip Comprehend the consequences of travel-related diseases and accidents Appreciate the necessity of medical consultation before and after trip Realize the need of appropriate coverage

3. Everything is bookedEverything is packed Ready to go…

4. You are excited….

5. What if….

6. And what if….?

7. You don’t want to come back like this…

8. So, are you really ready? Don’t you need a travel health consultation?

9. More and more travelers…

10. Probability of 6/49 jackpot 1/13,983,816 = 0.00000007151 (0.000007151%)

11. Probability of death during a trip: 0.001% Developing country: 0.8 – 1,5 per 100 000 per month North America: 0.3 per 100 000 per month Nepal: 15 per 100 000 per month Swiss traveler

12. 140 times more chance to die during a trip than win the 6/49

13. Causes of Death during travel Cardiovascular disease: 50% Accidents: 25% Infectious disease: 2% US travelers abroad

14. Felt subjectively ill

15. Probability of medical event during a trip 1/3 travelers abroad experience a travel-related illness, usually diarrhea or an upper respiratory infection 5 in 1 million (pulmonary embolism with long distance air travel)

16. 20-60% 10% 1% 0.1% 0.001%

17. Why you need medical consultation Medical Coverage

18. Medical Travel-Related Vaccine-Preventable Diseases Hepatitis A Hepatitis B Typhoid and Paratyphoid Fever Yellow Fever Japanese Encephalitis (JE) Meningococcal Disease Rabies

19. HAV prevalence

20. Medical Travel-Related Vaccine-Preventable Diseases Hepatitis A Hepatitis B Typhoid and Paratyphoid Fever Yellow Fever Japanese Encephalitis (JE) Meningococcal Disease Rabies

21. HVB Prevalence

22. Hepatitis B Blood or blood-derived fluids contacts Worldwide, 360 millions of hepatitis B carrier 120-130 millions in China (10% of China population)

23. Medical Travel-Related Vaccine-Preventable Diseases Hepatitis A Hepatitis B Typhoid and Paratyphoid Fever Yellow Fever Japanese Encephalitis (JE) Meningococcal Disease Rabies

24. Yellow fever

25. Medical Travel-Related Vaccine-Preventable Diseases Hepatitis A Hepatitis B Typhoid and Paratyphoid Fever Yellow Fever Japanese Encephalitis (JE) Meningococcal Disease Rabies

26. Risk of Japanese Encephalitis Dependant of the period of the year highest among travelers to rural areas

27. Medical Travel-Related Vaccine-Preventable Diseases Hepatitis A Hepatitis B Typhoid and Paratyphoid Fever Yellow Fever Japanese Encephalitis (JE) Meningococcal Disease Rabies

28. Rabies Rabies is a serious problem in Asia India: highest incidence of rabies in the world. with 30,000–50,000 human cases per year. China: >3000 human deaths per year => No 1 killer among infectious disease.

29. Medical consultation Routine Vaccine-Preventable Diseases Diphtheria Human Papillomavirus (HPV) Influenza (Seasonal, Avian, and Pandemic) Measles (Rubeola) Mumps Pertussis Pneumococcal Disease (Streptococcus pneumoniae) Poliomyelitis Rubella Tetanus Varicella (Chickenpox)

30. When to go for consultation?

31. Malaria-endemic countries Western Hemisphere Eastern Hemisphere

32. Incidence rate per month of health problems during a stay in developing countries—2008 10%

33. Medical consultation Counseling and Advice for Travelers STD: syphilis, HIV, gonorrhea, and chlamydia Sunburn Mosquitoes Water Disinfection for Travelers Food Poisoning from Marine Toxins: Ciguatera fish and Scombroid poisoning Animal-Associated Hazards – dogs, monkey, snake Deep Vein Thrombosis and Pulmonary Embolism Scuba Diving – a minimal of 12-24 hours before flying Medical Tourism Drug–Vaccine and Drug–Drug Interactions Travel Health Kits Travel Insurance and Evacuation Insurance

34. HIV global trends 33 million

35. Prevalence of HIV

36. Travel health kits Medication for Malaria, high-altitude, pain or fever, stomach upset, diarrhea, allergy, cold, motion sickness, oral rehydration salts, insecte bite Basic First aid Disposable gloves, bandages, gauze, adhesive tape, antiseptic, cotton swabs, tweezers, scissors, antifungal, antibiotic and cortisone ointments, sunscreen, saline eye drop, insect repellent, antibacterial hand wipes, water purification tablets, condoms, ear plug, thermometer Contact card

37. Medical consultation Self-Treatable Diseases Travelers’ Diarrhea Altitude Illness Jet Lag Motion Sickness Respiratory Infections

38. Altitude

39. Altitude sickness Initial symptoms: headache, nausea, and loss of appetite (4–8 hours after arrival) The hypoxemia of high altitude  restless sleep, frequent awakening, and periodic breathing Sometimes, severe forms of altitude illness: pulmonary edema and cerebral edema.

40. Important to remenber No vaccine is 100% effective Precautions should still be taken in selecting food and drinks.

41. Medical consultation after travel Travellers with chronic disease Weeks following return home: fever, persistent diarrhea, vomiting, jaundice, urinary disorders, skin disease, genital infection Malaria treatment while traveling >3 months in developing country

42. Why you need medical consultation Medical Coverage

43. Leading causes of injury death 33% U.S. citizens in foreign countries 2003–2005 (Excluding Afghanistan or Iraq) One accident every 1.4 million flights 17% 13% 1 in 5000: your chance of being killed in an automobile accident Road Traffic

44. Medical costs Brief consultation 500RMB (75$CAN) Standard consultation 850RMB (125$CAN) Comprehensive Consultation 1100RMB (165$CAN) Specialist consultation 1100-1250RMB Psychologist consultation 1000RMB (150$) Appendicectomy: 30 000 RMB (4500$CAN) normal hour services fees

45. Medical costs 800$US/day Hospital expenses Medical evacuation or repatriation 100 000 to 240 000$US

46. Insurance coverage Appropriate Coverage Medical evacuation and repatriation Medical expenses Pre-existing Exclusion Drunk driving Car racing, skiing, scuba diving, bungee jumping Other optional coverage changes to the itinerary Luggages loss etc

48. A bus accident in Guangxi

59. AMERICAN STABBED TO DEATH AT BEIJING OLYMPICS

60. References Canadian Family Physician American Family Physician Centers for Disease Control and Prevention Manual of Travel Medicine and Health,Robert Steffen, Herbert L. DuPont, Annelies Wilder-Smith

61. Thank you! YCPA wishes you a nice trip! Safe and healthy!