Travel Medicine

by Dean A. Haycock

(Posted July 10, 1998 · Issue 34)

Captain Sir Richard Francis Burton remains one of the most romantic real-life characters any library explorer could discover. The nineteenth-century British explorer, soldier, scholar, author, and translator learned 29 languages and spent much of his life traveling to exotic lands, many of which were depicted by blank areas on the maps of his day. As Edward Rice suggests in his excellent biography, Captain Sir Richard Francis Burton, The Secret Agent Who Made the Pilgrimage to Mecca, Discovered the Kama Sutra, and Brought the Arabian Nights to the West, Burton paid a considerable price to satisfy his wanderlust. Here is how Rice describes the health of Burton and fellow explorer John Hanning Speke as they sought the source of the Nile:

Continually, both Burton and Speke were ill, pursued by illnesses, as if illness had become a permanent member of the expedition, an unseen, unfriendly companion who nagged, teased, struck down, and even paralyzed. When Burton threw off his latest fever, his mouth became ulcerous, and he was unable to talk. At the same time, he could not walk.

Today, anyone who can get his or her hands on a plane ticket can visit lands as remote and as exotic as any Burton visited. And, unfortunately, anyone can just as easily become as ill.

The International Society of Travel Medicine explains:

The scale on which travel takes place today could hardly have been imagined even twenty years ago. Destinations that in the past were, in effect, restricted to explorers, soldiers and missionaries, are becoming commonplace choices for the ordinary traveler from the United States and other western countries.

The diseases that modern-day adventurers may bring home from such excursions are often unfamiliar to their family doctors. Fortunately, in the 1980s, the new medical specialty of travel medicine was established. It is easy to understand the need for this discipline by visiting Travel Health Online. The site lists on its Summaries of Travel Illnesses page over fifty medical conditions and diseases that might await the today's unprepared adventurer. These include familiar infections such as travelers' diarrhea, malaria, plague, cholera, dysentery, typhoid, and typhus as well as three types of encephalitis and two of hepatitis. Less-familiar threats may be waiting after the plane touches down: bartonellosis, Brazilian purpuric fever, Chikungunya fever, ciguatera, Lassa fever, sandfly fever, scombroid poisoning, African tungiasis, and West Nile fever.

Presumably, the 1,200 members of the International Society of Travel Medicine (ISTM) practicing in 53 countries are more familiar with the symptoms and treatment of these exotic conditions than the average Western family practitioner. They discuss their specialty in a members-only, moderated listserv group discussion, TravelMed. Everyone, however, has free access to the useful ISTM News Service. Up-to-date medical alerts provide details of reports from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). Recent examples alert travelers to news from Burundi and Tanzania, where epidemic meningococcal disease threatens; from Kenya and Somalia, which have experienced recent outbreaks of Rift Valley fever; and from Malaysia, where dengue and dengue hemorrhagic fever lurk. It is undoubtedly better to learn about these outbreaks before you retrieve your luggage and head into the countryside.

Travel-related medical studies are reported in the Journal of Travel Medicine, which is the official publication of the ISTM and the Asia Pacific Travel Health Association. Resources useful to clinicians practicing travel medicine or tropical medicine are listed on the Links to Key Clinical Tropical Medicine Sites page at the Traveler's Health Clinic of the University of Alabama at Birmingham.

A few travel medicine texts are available online for serious consultation or light browsing. CDC Travel Information provides access to The Yellow Book of Health Information for International Travel 1996-97. This indexed reference includes sections on vaccinations, geographic regions, risks, and health hints. The World Health Organization provides a hypertext version of International Travel and Health: Vaccination Requirements and Health Advice.

The Virtual Hospital of the University of Iowa College of Medicine provides Emporiatrics: An Introduction to Travel Medicine, by Mary D. Nettleman of the university's Tropical Medicine Clinic and Department of Internal Medicine. This resource presents basic information for clinicians, with an emphasis on preventing illnesses that can be picked up in exotic locales. Topics include "Immunizations and Chemoprophylaxis for Travel-Related Diseases" and "Travelers with Special Medical Conditions and Pediatric Travelers," as well as general precautions, advice, and recommendations for travel to specific areas. General recommendations for travelers heading to Africa, Asia, the Middle East, eastern Europe, the former Soviet Union, Oceania, South America, and Central America are reviewed. The Sources of Information and References section provides titles of pamphlets, textbooks, and journal articles describing in depth the diagnosis and treatment of diseases that may await travelers to unfamiliar lands.

If you want a lighter course of study, try the Travel Medicine page of the MedInfo-Online site. It offers a very simple Travel Medicine Quiz. One example: "Taking Pepto-Bismol everyday while traveling will ensure you won't be affected with 'traveler's diarrhea'. True or False?”

The answer to this question has important implications for travelers because this disorder represents the greatest overall risk for foreign travelers. According to Robert Steffen of the University of Zurich, 40 to 50 percent of tourists are affected by "traveler's diarrhea."

The answer, by the way, is: "True. One study in the New England Journal of Medicine found that correct prophylactic dosages of Pepto-Bismol decreased incidence of traveler's diarrhea. Although antibiotics, careful food selection, and purified water will help decrease your risk of traveler's diarrhea, there is no guarantee."

Steffen's estimates of the risks of contracting other illnesses overseas are cited by Gary P. Barnas in the Travel Risk Overview at the International Travelers Clinic at the Medical College of Wisconsin. In an unprotected population,

For every one million people traveling to developing countries for a one month stay, about 24,000 would develop malaria if visiting western Africa, while 500 would if visiting South America. About 3,000 travelers would develop hepatitis A and 3,000 would contract a sexually transmitted disease such as gonorrhea or AIDS. Around 300 visitors to Africa or India and about 30 visiting other countries would get typhoid fever. . . .

It is possible to protect yourself from all of these risks and others. Your individual risk depends on where you are going, how long you stay, and what you do. Specialists are available for consultation at many travel health clinics around the world. Travel Medicine, Inc. provides a list of travel clinics along with a catalog of the products it sells for safe travel. An example of a travel clinic Web site is the International Travel Medicine Clinic at the University of North Texas Health Science Center at Fort Worth.

With such resources, Captain Burton would certainly have suffered less during his explorations. Fortunately, these resources are readily available today to everyone who is considering filling in some of the blank spaces on his or her own personal map of the world.

Dean A. Haycock is a journalist who writes science articles for many magazines and newspapers. He received his Ph.D. in neuroscience from Brown University.

Send us your comments and ideas for future articles.

Endlinks

Traveling While Pregnant - special precautions to take to avoid risk to the developing fetus.

Travel Health Online - extensive site also includes discussions of general travel health concerns including special concerns, preventive vaccinations, and AIDS and sexually transmitted diseases. Travel Health Online also hosts U.S. Department of State publications ranging from "A Safe Trip Abroad" to "Overseas Citizens Services" to "Tips for Travelers to . . ." most countries and regions. The Directory of Country Summary Profiles is a good section to consult after you set your itinerary.

1997 World Fact Book - the CIA's source of intelligence information about your vacation destination.

Advice for Travel Medicine Practitioners - provides tips for physicians who want to use the Internet to help their traveling patients.

Medscape - A search of "infection and travel medicine" at Medscape yields many accounts of medical challenges bought by travelers to travel healthcare workers. Examples are A Physician Returning from Africa with Fever and a Rash and Tropical Diseases in Urban New Jersey. Free registration is required to access articles at Medscape.

All the Virology on the WWW - HMS Beagle's Site Review; includes online resources for viral infectious diseases.

Previous HMS Beagle articles on infectious diseases: