BOOK
Travel Medicine E-Book
Jay S. Keystone | Phyllis E. Kozarsky | Bradley A. Connor | Hans D. Nothdurft | Marc Mendelson | Karin Leder
(2018)
Additional Information
Book Details
Abstract
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Half title page | i | ||
| Dedication | ii | ||
| Travel Medicine | iii | ||
| Copyright Page | iv | ||
| Preface | v | ||
| List of Contributors | vi | ||
| Table Of Contents | xi | ||
| Acknowledgments | xiii | ||
| 1 Practice of Travel Medicine | 1 | ||
| 1 Introduction to Travel Medicine | 1 | ||
| Reference | 2 | ||
| 2 Epidemiology | 3 | ||
| Abstract | 3.e1 | ||
| Keywords | 3.e1 | ||
| Key points | 3 | ||
| Introduction | 3 | ||
| Cornerstones of Travel Health Epidemiology | 3 | ||
| Mortality | 6 | ||
| Accidents | 6 | ||
| Infectious Diseases | 8 | ||
| Other Illness and Mortality | 8 | ||
| Aeromedical Evacuation | 8 | ||
| Morbidity | 8 | ||
| Travelers’ Diarrhea | 8 | ||
| Malaria | 9 | ||
| Vaccine-Preventable Infections | 9 | ||
| Required Immunizations. | 10 | ||
| Routine Immunizations. | 10 | ||
| Recommended Immunizations. | 11 | ||
| Other Infections | 11 | ||
| Sexually Transmitted Diseases. | 11 | ||
| Upper Respiratory Tract Infection (URTI). | 11 | ||
| Other Arboviral Infections: Dengue, Chikungunya, Zika. | 11 | ||
| Legionella. | 12 | ||
| Leishmaniasis. | 12 | ||
| Schistosomiasis. | 12 | ||
| Trypanosomiasis. | 12 | ||
| Noninfectious Health Problems | 12 | ||
| Environmental. | 12 | ||
| Host. | 12 | ||
| Conclusion and Prioritization | 12 | ||
| References | 12 | ||
| 3 Starting, Organizing, and Marketing a Travel Clinic | 15 | ||
| Abstract | 15.e1 | ||
| Keywords | 15.e1 | ||
| Key points | 15 | ||
| Introduction | 15 | ||
| The Practice of Travel Medicine | 15 | ||
| Starting a Travel Health Program | 16 | ||
| Frequently Asked Questions | 16 | ||
| Who Is Qualified to Offer Travel Health Services? | 16 | ||
| What Can Health Care Professionals Do to Develop Expertise in Travel Health? | 16 | ||
| Are There Different Models of Care Delivery? | 16 | ||
| What Policies, Procedures, and Resources Should Be in Place? | 17 | ||
| Is Special Documentation Required? | 17 | ||
| What Support Services Are Needed? | 17 | ||
| Should a Clinic Offer Travel Health Services Full Time? What Are the Best Times for Clinic Sessions? | 17 | ||
| What Vaccines Should Be Provided? Should the Clinic Offer Yellow Fever Vaccine? | 17 | ||
| How Much Time Should Be Set Aside for Appointments? | 18 | ||
| How Should a Clinic Determine Charges? | 18 | ||
| What Is It Going to Cost to Establish a Travel Health Program? | 18 | ||
| Organizing a Clinic: Equipment and Supplies | 18 | ||
| Equipment | 18 | ||
| Refrigerator and freezer. | 18 | ||
| Computer. | 18 | ||
| Supplies | 18 | ||
| Vaccine supply. | 18 | ||
| Vaccination supplies. | 18 | ||
| Managing adverse events. | 18 | ||
| Infection control and hazardous waste supplies. | 18 | ||
| Other patient supplies. | 18 | ||
| Documentation | 18 | ||
| Information Resources for the Clinician | 19 | ||
| Information Resources for the Traveler: Patient Education | 19 | ||
| Legal Issues | 19 | ||
| Professional Standards. | 20 | ||
| Financial Considerations | 20 | ||
| Fees and Revenue for a Travel Health Practice | 20 | ||
| Fee-for-Service Care | 20 | ||
| When a Clinic Participates in Insurance Plans | 20 | ||
| Clinic Charges | 20 | ||
| Selling Travel-Related Products | 20 | ||
| Combining a Travel Clinic With Other Services | 20 | ||
| Pretravel Physical Examinations and Posttravel Care | 20 | ||
| Services to Travelers During Their Journeys | 20 | ||
| Offsite Services | 20 | ||
| Running a Travel Health Program | 21 | ||
| Staff and Administrative Issues | 21 | ||
| Before the Visit, Preparation of Reception Staff | 21 | ||
| Key Issues During the Pretravel Consultation | 21 | ||
| After the Consultation | 21 | ||
| Reporting Vaccine Adverse Events | 21 | ||
| Service Evaluation | 21 | ||
| After the Trip | 21 | ||
| Marketing and Promoting a Travel Health Program | 21 | ||
| Word of Mouth | 21 | ||
| Referrals | 21 | ||
| Direct Marketing Methods: Internet, Print, and Media | 21 | ||
| Other Marketing Approaches | 22 | ||
| Mailings | 22 | ||
| Contract Services | 22 | ||
| Brochures | 22 | ||
| Management Challenges | 22 | ||
| Telephone, Email, and Text Advice | 22 | ||
| Professional Development | 22 | ||
| Conclusion | 23 | ||
| References | 23 | ||
| 4 Pretravel Consultation | 25 | ||
| Abstract | 25.e1 | ||
| Keywords | 25.e1 | ||
| Key points | 25 | ||
| Introduction | 25 | ||
| Logistics and Mechanics of the Pretravel Consultation | 25 | ||
| Components of Pretravel Consultation and Order of Importance | 26 | ||
| Fitness to Travel | 26 | ||
| Analysis of Expected Health Risks in Travelers | 26 | ||
| General Considerations | 26 | ||
| General Topics to Be Covered | 27 | ||
| Application of Preventive Measures | 28 | ||
| Health Problems During and After Travel | 28 | ||
| Challenges Regarding Travel Advice | 28 | ||
| Acknowledgments | 29 | ||
| References | 30 | ||
| 2 The Pretravel Consultation | 31 | ||
| 5 Water Disinfection for International Travelers | 31 | ||
| Abstract | 31.e1 | ||
| Keywords | 31.e1 | ||
| Key points | 31 | ||
| Introduction | 31 | ||
| Etiology and Risk of Waterborne Infection | 31 | ||
| Water Treatment Methods for Short-Term and Long-Term Travelers and Expatriates | 32 | ||
| Heat | 32 | ||
| Clarification | 32 | ||
| Sedimentation. | 33 | ||
| Coagulation–Flocculation. | 33 | ||
| Granular Activated Carbon. | 34 | ||
| Filtration | 34 | ||
| Halogens | 35 | ||
| The Disinfection Reaction. | 35 | ||
| Iodine Resins. | 35 | ||
| Improving Halogen Taste. | 35 | ||
| Halogen Toxicity. | 36 | ||
| Miscellaneous Disinfectants | 36 | ||
| Silver. | 36 | ||
| Photocatalytic Disinfection. | 36 | ||
| Ultraviolet. | 36 | ||
| Solar UV Disinfection (SODIS). | 36 | ||
| Citrus and Potassium Permanganate. | 36 | ||
| Preferred Technique | 36 | ||
| Sanitation | 39 | ||
| Conclusion | 39 | ||
| References | 39 | ||
| 6 Insect Protection | 43 | ||
| Abstract | 43.e1 | ||
| Keywords | 43.e1 | ||
| Key points | 43 | ||
| Introduction | 43 | ||
| Stimuli That Attract Insects | 43 | ||
| Personal Protection | 43 | ||
| Habitat Avoidance | 43 | ||
| Physical Protection | 45 | ||
| Insect Repellents | 46 | ||
| Chemical Repellents | 46 | ||
| DEET. | 46 | ||
| Choosing a DEET Formulation. | 46 | ||
| DEET Safety and Toxicity. | 46 | ||
| IR3535. | 47 | ||
| Picaridin. | 47 | ||
| Botanical Repellents. | 47 | ||
| Citronella. | 47 | ||
| BiteBlocker. | 48 | ||
| BioUD (2-undecanone). | 49 | ||
| Lemon Eucalyptus. | 49 | ||
| Geraniol. | 49 | ||
| Efficacy of DEET Versus Botanical Repellents. | 49 | ||
| Alternative Repellents. | 49 | ||
| Insecticides | 50 | ||
| Permethrin | 50 | ||
| Reducing Local Mosquito Populations | 50 | ||
| Relief From Mosquito Bites | 51 | ||
| Summary—A Comprehensive Approach to Personal Protection | 51 | ||
| References | 51 | ||
| 7 Pretravel Considerations for Non-vaccine-Preventable Travel Infections | 53 | ||
| Abstract | 53.e1 | ||
| Keywords | 53.e1 | ||
| Key points | 53 | ||
| Introduction | 53 | ||
| Dengue, Chikungunya, and Zika | 53 | ||
| Overview | 53 | ||
| The Mosquito Vectors: Aedes aegypti and A. albopictus | 53 | ||
| Dengue | 53 | ||
| Chikungunya | 55 | ||
| Zika | 55 | ||
| Prevention of Dengue, Chikungunya, and Zika | 56 | ||
| Additional Considerations for the Prevention of Congenital Zika Infection | 56 | ||
| Severe Respiratory Infections With Regional Endemicity | 56 | ||
| Middle Eastern Respiratory Syndrome | 57 | ||
| Avian Influenza | 57 | ||
| Preventative Advice for Severe Respiratory Infections | 57 | ||
| Other Regionally Important Infections in Travelers | 57 | ||
| References | 59 | ||
| 8 Travel Medical Kits | 61 | ||
| Abstract | 61.e1 | ||
| Keywords | 61.e1 | ||
| Key points | 61 | ||
| Introduction | 61 | ||
| Summary of Factors Determining Medical and First-Aid Kit Construction | 61 | ||
| Contents of Medical and First-Aid Kits | 62 | ||
| The Basic Medical and First-Aid Kit | 63 | ||
| More Comprehensive Kits | 63 | ||
| Expedition and Group Kits | 64 | ||
| References | 64 | ||
| 3 Immunization | 65 | ||
| 9 Principles of Immunization | 65 | ||
| Abstract | 65.e1 | ||
| Keywords | 65.e1 | ||
| Key points | 65 | ||
| Introduction | 65 | ||
| Immunology of Vaccination | 65 | ||
| Immunization | 65 | ||
| Active Immunization | 65 | ||
| Passive Immunization | 66 | ||
| Immune Memory and Booster Doses. | 66 | ||
| Vaccines | 68 | ||
| Inactivated Vaccines. | 68 | ||
| Live Attenuated Vaccines. | 68 | ||
| Vaccine Administration | 68 | ||
| Route of Immunization. | 68 | ||
| Intramuscular route. | 69 | ||
| Subcutaneous route. | 70 | ||
| Intradermal route. | 70 | ||
| Oral application. | 70 | ||
| Simultaneous Administration/Interchangeability of Vaccines. | 70 | ||
| Serologic Testing Before and After Immunizations. | 70 | ||
| Vaccine Safety and Management of Adverse Reactions | 71 | ||
| Special Conditions/Contraindications | 71 | ||
| Immunizations in Travelers/Conclusion | 72 | ||
| References | 72 | ||
| 10 Routine Adult Vaccines | 75 | ||
| Abstract | 75.e1 | ||
| Keywords | 75.e1 | ||
| Key points | 75 | ||
| Introduction | 75 | ||
| Tetanus, Diphtheria, Pertussis | 75 | ||
| Indications | 75 | ||
| Contraindications | 75 | ||
| Precautions | 78 | ||
| Dosing Schedules | 78 | ||
| Measures of Immune Response and Duration of Immunity/Protection | 79 | ||
| Adverse Effects | 79 | ||
| Measles, Mumps, and Rubella Vaccine | 79 | ||
| Indications | 80 | ||
| Contraindications | 80 | ||
| Precautions | 80 | ||
| Dosing Schedule | 81 | ||
| Adverse Effects | 82 | ||
| Measures of Immune Response and Duration of Immunity/Protection | 82 | ||
| Varicella and Herpes Zoster Vaccines | 82 | ||
| Indications for Varicella Vaccination | 83 | ||
| Contraindications: Varicella Vaccination | 83 | ||
| Precautions | 83 | ||
| Dosing Schedules | 83 | ||
| Measures of Immune Response and Duration of Immunity/Protection | 83 | ||
| Adverse Events | 83 | ||
| Drug and Vaccine Interactions | 83 | ||
| Herpes Zoster Vaccination | 83 | ||
| Pneumococcal Vaccine | 83 | ||
| Indications | 84 | ||
| Contraindications | 84 | ||
| Precautions | 84 | ||
| Dosing Schedule | 84 | ||
| Measures of Immune Response and Duration of Immunity/Protection | 84 | ||
| Adverse Events | 84 | ||
| Human PapillomaVirus Vaccine | 84 | ||
| 4 Malaria | 137 | ||
| 14 Malaria | 137 | ||
| Abstract | 137.e1 | ||
| Keywords | 137.e1 | ||
| Key points | 137 | ||
| Introduction | 137 | ||
| Distribution of Malaria Species | 137 | ||
| Who Is at Risk? | 137 | ||
| Where Are Travelers at Risk of Acquiring Malaria? | 140 | ||
| Drug-Resistant Malaria | 142 | ||
| Chloroquine | 142 | ||
| Mefloquine | 142 | ||
| Doxycycline | 142 | ||
| Atovaquone/Proguanil | 142 | ||
| Primaquine | 142 | ||
| References | 143 | ||
| 15 Malaria Chemoprophylaxis | 145 | ||
| Abstract | 145.e1 | ||
| Keywords | 145.e1 | ||
| Key points | 145 | ||
| Approach to Malaria Prevention | 145 | ||
| Assessing Individual Risk—Parasite, Place, and Person | 145 | ||
| Preventing Mosquito Bites With Personal Protection Measures | 146 | ||
| Taking the “THINK MALARIA” Approach if Fever Develops During or After Travel | 146 | ||
| Using Malaria Chemoprophylaxis | 146 | ||
| Current Chemoprophylactic Drug Regimens | 146 | ||
| Chloroquine, Hydroxychloroquine, Chloroquine/Proguanil | 146 | ||
| Description, Pharmacology, and Mode of Action. | 146 | ||
| Efficacy and Drug Resistance. | 147 | ||
| Tolerability. | 149 | ||
| Contraindications, Precautions, and Drug Interactions. | 149 | ||
| Indications and Administration. | 150 | ||
| Mefloquine | 150 | ||
| Description, Pharmacology, and Mode of Action. | 150 | ||
| Efficacy and Drug Resistance. | 150 | ||
| Prophylactic Failures and Resistance. | 151 | ||
| Tolerability. | 151 | ||
| Moderate/Severe Adverse Events. | 152 | ||
| Serious Adverse Events. | 152 | ||
| Neuropsychiatric Adverse Events. | 152 | ||
| Contraindications, Precautions, and Drug Interactions. | 152 | ||
| New contraindications | 153 | ||
| New precautions. | 153 | ||
| Pregnancy. | 153 | ||
| Indications and Administration. | 153 | ||
| Doxycycline | 153 | ||
| Description. | 153 | ||
| Pharmacology and Mode of Action. | 153 | ||
| Efficacy and Drug Resistance. | 153 | ||
| P. vivax. | 154 | ||
| P. ovale, P. malariae, and P. knowlesi. | 154 | ||
| Tolerability. | 154 | ||
| Contraindications, Precautions, and Drug Interactions. | 154 | ||
| Indications and Administration. | 155 | ||
| Atovaquone/Proguanil | 155 | ||
| Description. | 155 | ||
| Pharmacology and Mode of Action. | 155 | ||
| Efficacy and Drug Resistance. | 155 | ||
| Tolerability. | 156 | ||
| Contraindications, Precautions, and Drug Interactions. | 156 | ||
| Indications and Administration. | 156 | ||
| Primaquine | 157 | ||
| Introduction and Description. | 157 | ||
| Pharmacology and Mode of Action | 157 | ||
| Efficacy and Drug Resistance. | 157 | ||
| Tolerability. | 157 | ||
| Contraindications and Precautions. | 157 | ||
| Indications and Administration. | 157 | ||
| Future Directions | 158 | ||
| Tafenoquine | 158 | ||
| Introduction and Description. | 158 | ||
| Efficacy and Drug Resistance. | 158 | ||
| Tolerability. | 158 | ||
| Contraindications, Precautions, and Drug Interactions. | 158 | ||
| Indications and Administration. | 158 | ||
| New Pipeline Drugs for Malaria Chemoprophylaxis | 158 | ||
| Chemoprophylaxis in Special Populations | 159 | ||
| Pregnant and Breastfeeding Travelers | 159 | ||
| Breastfeeding. | 159 | ||
| Long-Term Travelers | 159 | ||
| Business Travelers | 159 | ||
| Migrant and VFR Travelers | 160 | ||
| Infants/Children | 161 | ||
| Differences in Guidelines and Recommendations on Malaria Chemoprophylaxis | 161 | ||
| Primaquine. | 162 | ||
| References | 162 | ||
| 16 Self-Diagnosis and Self-Treatment of Malaria by the Traveler | 169 | ||
| Abstract | 169.e1 | ||
| Keywords | 169.e1 | ||
| Key points | 169 | ||
| Introduction | 169 | ||
| Rapid Diagnostic Tests for Malaria | 170 | ||
| Rationale | 170 | ||
| Principle and Availability of Test Kits | 170 | ||
| Performance of RDTs for Laboratory Diagnosis of Malaria | 170 | ||
| Performance of RDTs for Self-Use by Travelers | 171 | ||
| SBET for Malaria | 172 | ||
| Principle and Rationale for Use. | 172 | ||
| Recommendations for Choice of Drugs | 174 | ||
| SBET Recommendations for Pregnant Women, Children, and Chronically Ill Patients | 174 | ||
| Balancing of Recommendations | 175 | ||
| Summary and Outlook | 176 | ||
| Conclusion | 176 | ||
| References | 176 | ||
| 17 Approach to the Patient With Malaria | 179 | ||
| Abstract | 179.e1 | ||
| Keywords | 179.e1 | ||
| Key points | 179 | ||
| Introduction | 179 | ||
| The Threat | 179 | ||
| The Malarias | 179 | ||
| Clinical Presentation of Uncomplicated Malaria | 180 | ||
| Clinical Presentation of Severe and Complicated Malaria | 181 | ||
| Diagnosis of Infection | 181 | ||
| Clinical Diagnosis | 181 | ||
| Microscopic Diagnosis. | 182 | ||
| Rapid Diagnostic Tests | 182 | ||
| Nucleic Acid Diagnostic Tests | 182 | ||
| Treatment of Uncomplicated Malaria | 182 | ||
| Treatment of Severe Malaria | 183 | ||
| Treatment of Severe Malaria in Children | 184 | ||
| Treatment of Malaria in Pregnancy | 184 | ||
| Antirelapse Therapy With Primaquine | 184 | ||
| Primaquine and G6PD Deficiency | 185 | ||
| Managing Relapse Risk in Patients Unable to Receive Primaquine | 185 | ||
| Conclusion | 185 | ||
| References | 185 | ||
| 5 Travelers' Diarrhea | 187 | ||
| 18 Epidemiology of Travelers’ Diarrhea | 187 | ||
| Abstract | 187.e1 | ||
| Keywords | 187.e1 | ||
| Key points | 187 | ||
| Introduction | 187 | ||
| History | 187 | ||
| Clinical Characteristics | 187 | ||
| Etiology | 188 | ||
| Bacteria | 188 | ||
| Diarrhea Producing E. coli | 188 | ||
| Campylobacter spp. | 189 | ||
| Salmonella spp. | 189 | ||
| Shigella spp. | 189 | ||
| Vibrio spp. | 189 | ||
| Viruses | 189 | ||
| Parasites | 189 | ||
| Giardia | 189 | ||
| Entamoeba spp. | 190 | ||
| Cyclospora | 190 | ||
| Cystoisospora belli | 190 | ||
| Cryptosporidium | 190 | ||
| Blastocystis hominis | 190 | ||
| Host Factors | 190 | ||
| Age/Gender | 190 | ||
| Travelers’ Diarrhea in Children | 190 | ||
| Country of Origin | 191 | ||
| Immunity | 191 | ||
| Underlying Medical Conditions | 191 | ||
| Specific Host Factors | 191 | ||
| Environmental Factors | 192 | ||
| Pretravel Advice | 192 | ||
| Travel Packages and Meals | 192 | ||
| Lodging | 193 | ||
| Risk by Geographic Region | 193 | ||
| Complications of Travelers’ Diarrhea | 194 | ||
| Postinfectious Irritable Bowel Syndrome | 194 | ||
| Association With Travelers’ Diarrhea | 194 | ||
| Military Epidemiology | 194 | ||
| Conclusion | 194 | ||
| References | 195 | ||
| 19 Prevention of Travelers’ Diarrhea | 199 | ||
| Abstract | 199.e1 | ||
| Keywords | 199.e1 | ||
| Key points | 199 | ||
| Introduction | 199 | ||
| The Impact of Prevention | 199 | ||
| Prevention Strategies | 200 | ||
| Identifying Hosts at Risk | 200 | ||
| Education and Behavior Modification | 200 | ||
| Probiotics and Other Nonantibiotic Forms of Prophylaxis | 201 | ||
| Vaccines | 202 | ||
| Antimicrobial Agents | 202 | ||
| Prophylaxis Versus Early Treatment | 203 | ||
| Conclusion | 203 | ||
| References | 203 | ||
| 20 Clinical Presentation and Management of Travelers’ Diarrhea | 205 | ||
| Abstract | 205.e1 | ||
| Keywords | 205.e1 | ||
| Key points | 205 | ||
| Classical and Functional Impact–Based Definitions | 205 | ||
| Syndromic Presentations and Etiology | 205 | ||
| Acute and Chronic Complications | 206 | ||
| Differential Diagnosis | 206 | ||
| Management of Travelers’ Diarrhea | 206 | ||
| Pretravel Counseling | 207 | ||
| Fluids | 207 | ||
| Mild Diarrhea | 208 | ||
| Moderate Diarrhea | 208 | ||
| Severe (Watery) Diarrhea and Dysentery | 208 | ||
| Other Nonantibiotic Alternatives | 208 | ||
| When to Seek Care | 209 | ||
| Antibiotic Resistance as Both Cause and Consequence of Travelers’ Diarrhea | 209 | ||
| Conclusion | 210 | ||
| References | 210 | ||
| 21 Persistent Gastrointestinal Symptoms in the Ill-Returning Traveler | 213 | ||
| Abstract | 213.e1 | ||
| Keywords | 213.e1 | ||
| Key points | 213 | ||
| Introduction | 213 | ||
| Definitions and Epidemiology | 213 | ||
| Persistent Gastrointestinal Symptoms Incidence | 213 | ||
| Pathoetiologic Mechanisms | 214 | ||
| Persistent Infection or Coinfection | 214 | ||
| Parasites | 214 | ||
| Giardia lamblia. | 214 | ||
| Entamoeba histolytica. | 214 | ||
| Dientamoeba fragilis. | 215 | ||
| Microsporidia. | 215 | ||
| Cyclospora cayetanensis. | 215 | ||
| Cryptosporidium parvum. | 215 | ||
| Cystospora Belli. | 215 | ||
| Bacteria | 215 | ||
| Enterobacteriaceae. | 215 | ||
| Clostridium difficile. | 216 | ||
| Unknown Pathogens | 216 | ||
| Tropical Sprue. | 216 | ||
| Brainerd Diarrhea. | 216 | ||
| Postinfectious Processes | 216 | ||
| Postinfectious Malabsorptive States. | 216 | ||
| Postinfectious Functional Gastrointestinal Disorders Epidemiology and Pathogenesis. | 216 | ||
| Chronic Gastrointestinal Diseases Unmasked by an Enteric Infection | 218 | ||
| Idiopathic Inflammatory Bowel Disease. | 218 | ||
| Celiac Sprue. | 218 | ||
| Colorectal Cancer. | 218 | ||
| Clinical Approach | 219 | ||
| History and Physical Examination | 219 | ||
| Noninvasive Laboratory Workup | 219 | ||
| Stool Studies. | 219 | ||
| Blood Testing. | 219 | ||
| Endoscopic Evaluation. | 220 | ||
| Therapy | 220 | ||
| Conclusion | 222 | ||
| References | 222 | ||
| 6 Travelers With Special Needs | 225 | ||
| 22 The Pregnant and Breastfeeding Traveler | 225 | ||
| Abstract | 225.e1 | ||
| Keywords | 225.e1 | ||
| Key points | 225 | ||
| Introduction | 225 | ||
| Pretravel Preparation | 225 | ||
| Access to Medical Care Abroad | 225 | ||
| Travel by Air. | 226 | ||
| Water Sports and Travel by Boat. | 226 | ||
| Exercise. | 228 | ||
| Travel by Automobile. | 228 | ||
| Immunizations | 229 | ||
| Infectious Diseases in Pregnancy | 229 | ||
| Zika Virus and Pregnancy | 229 | ||
| Malaria and Pregnancy | 231 | ||
| Guidelines for Prevention | 231 | ||
| Personal Protective Measures. | 231 | ||
| Chemoprophylaxis. | 231 | ||
| Treatment. | 231 | ||
| Food and Water Precautions | 232 | ||
| Travelers’ Diarrhea | 232 | ||
| Water Purification | 233 | ||
| Treatment | 233 | ||
| Other Infectious Disease Risks | 233 | ||
| Altitude and Pregnancy | 233 | ||
| Pregnancy Planning | 234 | ||
| Breastfeeding | 234 | ||
| Drugs in Breast Milk | 234 | ||
| Malaria Prevention | 234 | ||
| Immunizations | 234 | ||
| Practicalities | 234 | ||
| Medications | 234 | ||
| Other Issues | 234 | ||
| Medical Kit | 234 | ||
| Alternative Medications | 235 | ||
| References | 235 | ||
| 23 The Pediatric and Adolescent Traveler | 237 | ||
| Abstract | 237.e1 | ||
| Keywords | 237.e1 | ||
| Key points | 237 | ||
| Introduction | 237 | ||
| Comfort and Safety | 237 | ||
| Should Children Be Subjected to the Discomforts of International Travel? Is It Safe for Children to Travel Internationally? | 237 | ||
| Schedules | 238 | ||
| Air Travel | 238 | ||
| Is It Safe for Infants to Travel in Commercial Airplanes or Go to High Altitudes? | 238 | ||
| What Are the Risks of Injury During Air Travel? | 238 | ||
| Assuming Reasonable Safety Precautions Are in Order, What Can Be Done to Ensure Comfort for a Child and Family Traveling by Air? | 238 | ||
| Should Children Be Sedated During Long Flights? | 238 | ||
| Does Jet Lag Occur in Children? | 238 | ||
| What About Earaches With Air Travel? | 239 | ||
| Motor Vehicles | 239 | ||
| Motion Sickness | 239 | ||
| Outdoor Activities | 239 | ||
| Water. | 239 | ||
| Skin Protection. | 239 | ||
| Altitude. | 239 | ||
| Animal Contact. | 240 | ||
| What Precautions Should Be Taken for Children With Chronic Medical Conditions? | 240 | ||
| Risk-Taking Behaviors Especially for Adolescents | 240 | ||
| Medical Kit for Families | 240 | ||
| Immunization | 240 | ||
| Insect-Borne Diseases | 241 | ||
| Treatment of Bites | 242 | ||
| Additional Preventive Strategies for Specific Insect-Borne Diseases | 242 | ||
| Malaria. | 242 | ||
| Tickborne Diseases. | 242 | ||
| Yellow Fever and Japanese Encephalitis; Dengue, Chikungunya, and Zika. | 243 | ||
| Diarrhea | 243 | ||
| Food and Water Hygiene | 243 | ||
| Epidemiology of Diarrhea in Pediatric Travelers | 243 | ||
| Treatment | 243 | ||
| Which Antibiotic Should Be Used in Children? | 244 | ||
| Screening | 244 | ||
| What Should Be Done for Children Returning From International Journeys? | 244 | ||
| Managing Illness in Arriving Pediatric Travelers | 244 | ||
| Psychosocial Adjustment and Integration Into the New Setting | 244 | ||
| Conclusion | 244 | ||
| References | 245 | ||
| 24 The Older Traveler | 247 | ||
| Abstract | 247.e1 | ||
| Keywords | 247.e1 | ||
| Key points | 247 | ||
| Introduction | 247 | ||
| Why Are Elderly Travelers at Greater Risk? | 247 | ||
| General Advice | 247 | ||
| Choosing a Trip | 247 | ||
| Fitness to Travel | 247 | ||
| Making Travel Arrangements | 248 | ||
| Health Insurance | 248 | ||
| Medications and Medical Supplies | 248 | ||
| Accessing Medical Services Abroad | 249 | ||
| Practical Tips During Air Travel | 249 | ||
| Medical Conditions Arising During Travel | 249 | ||
| Motion Sickness | 249 | ||
| In-Flight Medical Emergencies | 249 | ||
| Venous Thromboembolic Disease | 249 | ||
| Jet Lag | 249 | ||
| Hyperthermia and Hypothermia | 250 | ||
| Heat Stress. | 250 | ||
| Cold Stress. | 250 | ||
| Altitude Sickness | 250 | ||
| Accidents and Injury | 250 | ||
| Travel-Related Infections in the Elderly | 250 | ||
| Malaria | 250 | ||
| Travelers’ Diarrhea | 250 | ||
| Sexually Transmitted Infections | 251 | ||
| Vaccine-Preventable Infections | 251 | ||
| Routine Immunizations | 251 | ||
| Pneumococcal Vaccine. | 251 | ||
| Travel Vaccines | 251 | ||
| Hepatitis A and B. | 251 | ||
| Japanese Encephalitis. | 251 | ||
| Cholera Vaccine for Travelers’ Diarrhea. | 251 | ||
| Typhoid Fever. | 251 | ||
| Varicella. | 252 | ||
| Yellow Fever. | 252 | ||
| Conclusion | 252 | ||
| Additional Resources | 252 | ||
| References | 252 | ||
| 25 The Physically Challenged Traveler | 255 | ||
| Abstract | 255.e1 | ||
| Keywords | 255.e1 | ||
| Key points | 255 | ||
| Introduction | 255 | ||
| General Advice | 255 | ||
| Choosing a Trip and Making Travel Arrangements | 255 | ||
| Traveling With an Attendant | 257 | ||
| The Physically Disabled Traveler | 258 | ||
| Air Travel With a Wheelchair or Scooter | 258 | ||
| Air Travel With Canes, Crutches, Walkers, and Other Medical Devices | 259 | ||
| Cruising With a Wheelchair or Scooter | 259 | ||
| The Hearing-Impaired Traveler | 259 | ||
| The Speech-Impaired Traveler | 259 | ||
| The Visually Impaired Traveler | 259 | ||
| Service Animals | 259 | ||
| The Developmentally or Cognitively Impaired Traveler | 260 | ||
| Conclusion | 260 | ||
| References | 260 | ||
| 26 The Traveler With Preexisting Disease | 261 | ||
| Abstract | 261.e1 | ||
| Keywords | 261.e1 | ||
| Key Points | 261 | ||
| General Principles | 261 | ||
| Before You Go | 261 | ||
| The Voyage | 262 | ||
| While in the Destination Country | 263 | ||
| After the Trip | 263 | ||
| Specific Medical Problems | 263 | ||
| Cardiac Disease | 263 | ||
| Anemia | 264 | ||
| Respiratory Disease | 264 | ||
| Renal Disease | 264 | ||
| Diabetes Mellitus | 264 | ||
| Gastrointestinal Disease | 265 | ||
| Liver Disease | 266 | ||
| Neurologic Disease | 266 | ||
| Malaria Prophylaxis in Patients With Neurologic Diseases | 266 | ||
| Allergies | 266 | ||
| Conclusion | 266 | ||
| References | 266 | ||
| 27 The Immunocompromised Traveler | 269 | ||
| Abstract | 269.e1 | ||
| Keywords | 269.e1 | ||
| Key points | 269 | ||
| Introduction | 269 | ||
| Corticosteroids, Disease-Modifying Antirheumatic Drugs, and Biologic Therapies | 269 | ||
| Asplenic Travelers | 271 | ||
| Transplant Recipients | 272 | ||
| Cancer Chemotherapy | 273 | ||
| Special Vaccine-Related Topics | 273 | ||
| Pretravel Vaccination of the Immunocompromised Host | 273 | ||
| Yellow Fever | 273 | ||
| Measles | 274 | ||
| Influenza | 274 | ||
| Rabies Vaccination and Postexposure Prophylaxis | 274 | ||
| Health Care Workers and Medical Missions | 274 | ||
| Cholera | 274 | ||
| Meningococcal Meningitis | 274 | ||
| HIV and Bloodborne Risk | 274 | ||
| Suspending Immunosuppression for Vaccination | 274 | ||
| Vaccination of Family Members and Household Contacts | 274 | ||
| Additional Considerations | 275 | ||
| Medication-Related Issues in the Traveling Transplant Recipient | 275 | ||
| Gastroenteritis | 275 | ||
| Sun Protection | 275 | ||
| Environmental Exposures, Animal Bites, Sexual Contact | 275 | ||
| Tuberculosis | 275 | ||
| Strongyloides | 275 | ||
| Medical and Transplant Tourism | 276 | ||
| Conclusions | 276 | ||
| References | 276 | ||
| 28 The Traveler With HIV | 279 | ||
| Abstract | 279.e1 | ||
| Keywords | 279.e1 | ||
| Key points | 279 | ||
| Introduction | 279 | ||
| Health Risks to the Traveler | 280 | ||
| Pretravel Advice | 280 | ||
| Behavioral Precautions | 281 | ||
| Vaccination | 281 | ||
| Immune Status of the Traveler. | 281 | ||
| Nature of Vaccine. | 281 | ||
| Inactivated vaccines. | 281 | ||
| Risk and Severity of Vaccine Preventable Disease in the HIV-Infected Traveler. | 282 | ||
| Risk of HIV Rebound as a Consequence of Vaccination. | 284 | ||
| Antiretroviral Prophylaxis to Prevent HIV in Travelers | 284 | ||
| Drug Interactions | 284 | ||
| Health Care Abroad | 284 | ||
| Crossing International Borders | 284 | ||
| Conclusion | 284 | ||
| References | 285 | ||
| 29 The Business Traveler | 287 | ||
| Abstract | 287.e1 | ||
| Keywords | 287.e1 | ||
| Key points | 287 | ||
| Introduction | 287 | ||
| Health Risks of International Business Travelers | 287 | ||
| Travel-Related Infections | 288 | ||
| Environmental Risks | 288 | ||
| Air Pollution | 288 | ||
| Safety and Security Risks | 289 | ||
| Medical Considerations for International Travel | 289 | ||
| Pretravel Considerations for Health Risks Before International Travel | 289 | ||
| Travel Health Considerations During Travel and at the Destination | 291 | ||
| Posttravel Care Considerations | 291 | ||
| Special Issues for Business Travelers | 291 | ||
| Travel Kits | 291 | ||
| Jet Lag | 292 | ||
| Zika | 292 | ||
| Medical Insurance Coverage for Business Travel | 292 | ||
| Conclusion | 292 | ||
| References | 293 | ||
| 30 VIP Traveler | 295 | ||
| Abstract | 295.e1 | ||
| Keywords | 295.e1 | ||
| Key points | 295 | ||
| Introduction | 295 | ||
| The Man, the Mission, and Medicine | 295 | ||
| Mission-oriented Medicine and VIP Travel Medicine | 295 | ||
| Operationalizing VIP Travel Support | 296 | ||
| Medical Threat Assessment and Countermeasures | 297 | ||
| Communicate: Translating the Medical Threat Assessment Into a Medical Travel Advisory | 298 | ||
| Support Requirements | 298 | ||
| The Plan | 298 | ||
| Nothing More, Nothing Less | 298 | ||
| Right Problem. | 299 | ||
| Right Person. | 299 | ||
| Right person: expeditionary medical staffing. | 299 | ||
| Staffing options: right training. | 299 | ||
| Staffing options: right team. | 299 | ||
| Right Equipment. | 299 | ||
| Common pitfalls. | 300 | ||
| Right Place, Right Time. | 301 | ||
| Rested and ready to respond. | 301 | ||
| Right environment. | 301 | ||
| Knowing Where to Get Help: Host Country Solutions | 301 | ||
| What Next? Evacuation Planning | 302 | ||
| Operational Security: Don’t Become a Liability | 302 | ||
| Economics of VIP Travel Medicine Support | 302 | ||
| Conclusion | 302 | ||
| References | 302 | ||
| 31 Health Aspects of International Adoption | 303 | ||
| Abstract | 303.e1 | ||
| Keywords | 303.e1 | ||
| Introduction | 303 | ||
| Preadoption | 303 | ||
| 7 Travelers With Special Itineraries | 321 | ||
| 33 Expatriates | 321 | ||
| Abstract | 321.e1 | ||
| Keywords | 321.e1 | ||
| Key points | 321 | ||
| Expatriates: Preparing and Caring | 321 | ||
| Hidden Costs of Expatriation | 321 | ||
| Premature Attrition | 322 | ||
| Deaths, Accidents, and Injuries | 322 | ||
| Predeparture Assessment | 322 | ||
| The Purpose of Predeparture Medical Assessments | 322 | ||
| Tuberculosis Skin Test | 322 | ||
| Predeparture Psychologic Assessment | 322 | ||
| Psychologic Interview. | 323 | ||
| Psychologic Interview—When There Is No Time or Expertise. | 323 | ||
| The Role of Psychometric Testing. | 323 | ||
| Predeparture: Preparation | 323 | ||
| Health Briefings | 323 | ||
| Immunizations | 323 | ||
| Hepatitis A and B. | 323 | ||
| Japanese Encephalitis. | 323 | ||
| Rabies. | 323 | ||
| Malaria | 324 | ||
| Rapid Diagnostic Testing. | 324 | ||
| Diarrheal Diseases | 324 | ||
| Sexually Transmitted Diseases | 324 | ||
| Infection Control Policies | 324 | ||
| Risk Behavior | 324 | ||
| Security Issues and Evacuation Policies | 324 | ||
| Psychologic Training and Preparation | 324 | ||
| Information and General Counsel. | 324 | ||
| Culture Shock and the U-Curve Hypothesis | 324 | ||
| “Normal” Adjustment Difficulties | 325 | ||
| Children | 326 | ||
| Factors That Can Facilitate Cultural Adaptation | 326 | ||
| Caring for Expatriates in International Settings | 326 | ||
| Models of care that are utilized: | 326 | ||
| Self-Care | 326 | ||
| Telemedicine and the Internet | 326 | ||
| Organizational Support | 326 | ||
| Caring for Expatriates at the Time of Repatriation | 326 | ||
| Returning Home | 326 | ||
| Premature Repatriation and Medical Evacuation | 327 | ||
| Who Requires a Medical Consultation on Return Home? | 327 | ||
| Illness in Returning Expatriates | 327 | ||
| Infectious Diseases | 327 | ||
| Mental Health | 327 | ||
| Factors Influencing Reintegration | 327 | ||
| Issues for Families | 327 | ||
| Easing Return | 327 | ||
| References | 328 | ||
| 34 The Migrant Traveler | 331 | ||
| Abstract | 331.e1 | ||
| Keywords | 331.e1 | ||
| Key points | 331 | ||
| Health Evaluation of Migrants | 331 | ||
| Health Status of Migrants | 331 | ||
| Infectious Diseases | 331 | ||
| Tuberculosis. | 331 | ||
| Chronic Viral Hepatitis. | 332 | ||
| Human Immunodeficiency Virus. | 333 | ||
| Intestinal Parasites Including Strongyloides and Schistosomiasis. | 333 | ||
| Other Parasitic Infections. | 333 | ||
| Immunizations | 333 | ||
| Noncommunicable Diseases, Women’s Health, and Mental Health | 333 | ||
| Noncommunicable Diseases. | 333 | ||
| Women’s Health Issues. | 334 | ||
| Mental Health Issues. | 334 | ||
| Core Values and Best Practices in the Care of Immigrant Patients | 334 | ||
| Optimizing Health During Pretravel and Posttravel Visits | 334 | ||
| Conclusion | 334 | ||
| References | 334 | ||
| 35 Humanitarian Aid Workers | 335 | ||
| Abstract | 335.e1 | ||
| Keywords | 335.e1 | ||
| Key points | 335 | ||
| Introduction | 335 | ||
| Mortality in Humanitarian Workers | 335 | ||
| Morbidity in Humanitarian Workers | 336 | ||
| Morbidity Among Rescue Teams and Volunteers Working in Acute Disaster-Stricken Areas | 336 | ||
| Specific Diseases and Medical Conditions | 336 | ||
| Malaria | 336 | ||
| Tuberculosis | 337 | ||
| Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome | 337 | ||
| Rabies | 337 | ||
| Dental Care | 337 | ||
| Mental Health | 338 | ||
| Humanitarian Aid Workers—The Public Health Aspects | 338 | ||
| Health Recommendations for the Relief Worker Traveling to Challenging Work Zones | 338 | ||
| References | 339 | ||
| 36 The Deployed Military | 341 | ||
| Abstract | 341.e1 | ||
| Keywords | 341.e1 | ||
| Key points | 341 | ||
| Introduction | 341 | ||
| Noncombat-Related Injuries and Back Pain | 343 | ||
| Combat-Related Injuries | 343 | ||
| Psychiatric Disorders | 343 | ||
| Malaria and Other Vectorborne Diseases | 343 | ||
| Sexual Health | 344 | ||
| Dermatologic Diseases | 344 | ||
| Gastrointestinal and Respiratory Infections | 345 | ||
| Conclusion | 345 | ||
| Disclosure | 345 | ||
| References | 345 | ||
| 37 Expedition Medicine | 347 | ||
| Abstract | 347.e1 | ||
| Keywords | 347.e1 | ||
| Key points | 347 | ||
| Introduction | 347 | ||
| Questions to Ask | 347 | ||
| Risk Assessment and Preparation | 348 | ||
| Personal Preparation | 349 | ||
| First-Aid Kits | 351 | ||
| Contents | 351 | ||
| Design | 351 | ||
| Supplies | 351 | ||
| Liability | 353 | ||
| On the Road | 353 | ||
| Field Data | 353 | ||
| Psychiatric Problems | 354 | ||
| Polar Environments | 355 | ||
| Mountaineering | 355 | ||
| Desert Environments | 356 | ||
| Jungle/Tropical Environments | 356 | ||
| Kayaking and Rafting | 357 | ||
| Scuba Diving Expeditions | 357 | ||
| The Luxury Expedition | 358 | ||
| Local Health Care | 358 | ||
| Difficult Situations | 358 | ||
| Medical Care of Others | 358 | ||
| Safety and Security | 359 | ||
| Repatriation | 359 | ||
| Death Overseas | 359 | ||
| Back Home | 360 | ||
| Conclusion | 360 | ||
| References | 360 | ||
| 38 Ecotourism | 363 | ||
| Abstract | 363.e1 | ||
| Keywords | 363.e1 | ||
| Key points | 363 | ||
| Introduction | 363 | ||
| Ecotourists | 363 | ||
| Physical Risks | 364 | ||
| Physical Risks From Other Species. | 364 | ||
| Infectious Disease Risks | 364 | ||
| Zoonotic Disease Risks. | 365 | ||
| Risks to Other Species. | 365 | ||
| Recommendations | 366 | ||
| References | 366 | ||
| 39 Medical Tourism | 371 | ||
| Abstract | 371.e1 | ||
| Keywords | 371.e1 | ||
| Key points | 371 | ||
| Introduction | 371 | ||
| Medical Tourism Defined | 371 | ||
| General Considerations Related to Medical Treatment Abroad | 372 | ||
| Cosmetic Surgery Tourism Recommendations | 372 | ||
| Dental Work Abroad | 373 | ||
| Transplant Tourism | 373 | ||
| Bariatric Tourism | 373 | ||
| Reproductive Tourism | 373 | ||
| Medications | 373 | ||
| Adverse Effects and Complications | 373 | ||
| Conclusions | 374 | ||
| References | 374 | ||
| 40 Cruise Ship Travel | 377 | ||
| Abstract | 377.e1 | ||
| Keywords | 377.e1 | ||
| Key points | 377 | ||
| Introduction | 377 | ||
| The Cruise Industry | 377 | ||
| The North American Cruise Industry | 377 | ||
| The Passengers and Crew | 377 | ||
| Cruise Health, Sanitation, and Safety Regulations | 377 | ||
| International Regulations | 377 | ||
| US Regulations | 378 | ||
| Medical Care Aboard Cruise Ships | 378 | ||
| Illness on Cruise Ships | 378 | ||
| Respiratory Infections | 378 | ||
| Influenza. | 378 | ||
| Legionnaires Disease. | 379 | ||
| Gastrointestinal Illness | 379 | ||
| Waterborne Diseases. | 379 | ||
| Foodborne Diseases. | 379 | ||
| Norovirus. | 379 | ||
| Miscellaneous | 379 | ||
| Vaccine-Preventable Diseases (VPD) | 379 | ||
| Injuries | 379 | ||
| Seasickness | 379 | ||
| Health Preparation and Prevention Measures for Cruise Travel in Large/Small Vessels | 380 | ||
| Pretravel | 380 | ||
| During Travel | 380 | ||
| After Travel | 381 | ||
| Conclusion | 381 | ||
| Acknowledgment | 381 | ||
| References | 381 | ||
| 41 Mass Gatherings | 383 | ||
| Abstract | 383.e1 | ||
| Keywords | 383.e1 | ||
| Key points | 383 | ||
| Introduction | 383 | ||
| Communicable Diseases | 383 | ||
| Noncommunicable Diseases and Trauma | 383 | ||
| Specific Mass Gatherings | 384 | ||
| Hajj Pilgrimage | 384 | ||
| Olympic Games, FIFA, and Other Sport Events | 384 | ||
| Other Community Events | 384 | ||
| Canceling Mass Gatherings | 384 | ||
| Planning for Mass Gatherings | 384 | ||
| Individual Pregathering Advice | 385 | ||
| Conclusions | 385 | ||
| References | 385 | ||
| 8 Environmental Aspects of Travel Medicine | 387 | ||
| 42 High-Altitude Medicine | 387 | ||
| Abstract | 387.e1 | ||
| Keywords | 387.e1 | ||
| Key points | 387 | ||
| Introduction | 387 | ||
| The High-Altitude Environment | 387 | ||
| Acclimatization | 387 | ||
| Effects of High Altitude on Exercise | 389 | ||
| Sleep at High Altitude | 389 | ||
| High-Altitude Syndromes | 389 | ||
| High-Altitude Headache | 389 | ||
| 9 Health Problems While Traveling | 437 | ||
| 48 Bites, Stings, and Envenoming Injuries | 437 | ||
| Abstract | 437.e1 | ||
| Keywords | 437.e1 | ||
| Key points | 437 | ||
| Introduction | 437 | ||
| Nonvenomous Injuries | 437 | ||
| Arthropod Bites | 437 | ||
| Prevention of Arthropod Bites. | 437 | ||
| Treatment of Arthropod Bites. | 437 | ||
| Animal Attack Injuries | 439 | ||
| Prevention of Animal Attack. | 439 | ||
| Treatment of Animal Attack Injuries. | 440 | ||
| Infection From Animal Attacks. | 440 | ||
| Venomous Bites and Stings | 440 | ||
| Prevention of Venomous Bites and Stings | 441 | ||
| Venomous Arthropods | 441 | ||
| Hymenoptera. | 442 | ||
| Spiders and Scorpions. | 443 | ||
| Venomous Reptiles | 443 | ||
| Marine Animal Bites and Stings | 445 | ||
| Prevention of Marine Animal Stings and Attacks | 445 | ||
| Treatment of Marine Bites, Stings, and Attacks | 446 | ||
| Marine Infections | 446 | ||
| References | 447 | ||
| 49 Seafood Poisoning | 449 | ||
| Abstract | 449.e1 | ||
| Keywords | 449.e1 | ||
| Key Points | 449 | ||
| Introduction | 449 | ||
| Ciguatera | 449 | ||
| Scombroid (Histamine Fish Poisoning) | 452 | ||
| Pufferfish (Fugu) Poisoning | 453 | ||
| Paralytic Shellfish Poisoning | 454 | ||
| Neurotoxic Shellfish Poisoning | 454 | ||
| Diarrheic Shellfish Poisoning | 455 | ||
| Amnesic Shellfish Poisoning | 455 | ||
| CONCLUSION | 455 | ||
| References | 455 | ||
| 50 Injuries and Injury Prevention | 457 | ||
| Abstract | 457.e1 | ||
| Keywords | 457.e1 | ||
| Key points | 457 | ||
| Introduction | 457 | ||
| Fatal Injury | 457 | ||
| Nonfatal Injuries | 458 | ||
| A Global Public Health Approach for Travel Medicine | 458 | ||
| Road Traffic Safety | 459 | ||
| Seatbelts and Child Safety Seats | 459 | ||
| Helmets | 459 | ||
| Water-Related Injuries | 459 | ||
| Alcohol as a Risk Factor | 460 | ||
| Conclusion | 461 | ||
| References | 461 | ||
| 51 Mental Health Issues of Travelers | 463 | ||
| Abstract | 463.e1 | ||
| Keywords | 463.e1 | ||
| Key points | 463 | ||
| Introduction | 463 | ||
| Sources of Stress in International Travel | 463 | ||
| Epidemiology of Psychiatric Disorders and International Travel | 464 | ||
| Clinical Operating Environments Overseas and Their Vicissitudes | 464 | ||
| The Pretravel Risk Assessment | 465 | ||
| Psychosis: Some Specifics and Relation to International Travel | 465 | ||
| Mania | 466 | ||
| Substance Use Disorders | 466 | ||
| Relationship to International Travel. | 466 | ||
| Posttravel Consultations | 466 | ||
| References | 467 | ||
| 52 Travelers’ Thrombosis | 469 | ||
| Abstract | 469.e1 | ||
| Keywords | 469.e1 | ||
| Key points | 469 | ||
| Introduction | 469 | ||
| Venous Thrombosis | 469 | ||
| Size of the Risk After Travel | 469 | ||
| Factors Influencing the Risk | 470 | ||
| Passenger-Related Risk Factors | 470 | ||
| Travel-Related Risk Factors | 471 | ||
| Mechanism | 471 | ||
| Prevention | 472 | ||
| Conclusions and Recommendations | 472 | ||
| References | 473 | ||
| 53 Health Care Abroad | 475 | ||
| Abstract | 475.e1 | ||
| Keywords | 475.e1 | ||
| Key points | 475 | ||
| Introduction* | 475 | ||
| Risks of Needing Care Abroad | 475 | ||
| Factors Influencing Development of Health Care Abroad | 475 | ||
| Continued Globalism of Quality | 475 | ||
| Growth of Medical Tourism | 476 | ||
| Obtaining Care While Abroad | 476 | ||
| Critical Incident Management Principles | 476 | ||
| Preparation. | 476 | ||
| Risk considerations. | 476 | ||
| Health Care Resources. | 476 | ||
| Self-care or buddy-care. | 477 | ||
| Telemedicine services. | 477 | ||
| Local physician offices/clinics. | 477 | ||
| For-profit international health care organizations. | 477 | ||
| Foreigners’ clinics. | 477 | ||
| Hospital care. | 477 | ||
| Planning for and Accessing Care. | 477 | ||
| Self-care. | 477 | ||
| Medical assistance plans. | 477 | ||
| Other resources for locating care. | 478 | ||
| Evacuation Issues | 479 | ||
| Local Evacuation Issues | 479 | ||
| Long-Distance Evacuation | 479 | ||
| Paying for Care | 479 | ||
| Critical Differences in Approaches to Health Care Abroad | 480 | ||
| Cultural Differences | 480 | ||
| Nursing Care | 480 | ||
| No “Right to Care” | 480 | ||
| Pharmacy and Medication Issues | 480 | ||
| Conclusion | 481 | ||
| References | 481 | ||
| 54 Personal Security and Crime Avoidance | 483 | ||
| Abstract | 483.e1 | ||
| Keywords | 483.e1 | ||
| Key points | 483 | ||
| Introduction | 483 | ||
| Before Departure | 483 | ||
| Priorities Upon Arrival | 484 | ||
| In the Hotel | 484 | ||
| Out and About | 484 | ||
| Taxis and Public Transport | 485 | ||
| Theft | 485 | ||
| Accidents | 485 | ||
| Getting Sick | 485 | ||
| Learn Local Regulations Early | 486 | ||
| Mobile Phones and Electronic Devices | 486 | ||
| Active Shooter | 486 | ||
| Being a Hostage | 486 | ||
| Conclusion | 486 | ||
| References | 486 | ||
| 10 Posttravel | 487 | ||
| 55 Posttravel Screening | 487 | ||
| Abstract | 487.e1 | ||
| Keywords | 487.e1 | ||
| Key points | 487 | ||
| Introduction | 487 | ||
| Who and When to Screen? | 487 | ||
| Targeted Populations | 488 | ||
| Asymptomatic Short-Term Traveler. | 488 | ||
| Asymptomatic Long-Term Traveler or Expatriate. | 488 | ||
| Asymptomatic Adventurous Traveler. | 488 | ||
| Travelers With Self-Identified Risk Factors and/or Disease Symptoms During Travel. | 488 | ||
| General Screening | 488 | ||
| Medical Interview | 488 | ||
| Physical Examination | 488 | ||
| General Paraclinical Tests | 489 | ||
| General Laboratory Tests. | 489 | ||
| Blood Eosinophil Count. | 489 | ||
| Abdominal Ultrasound. | 489 | ||
| Resting Electrocardiogram. | 489 | ||
| Specific Screening Tests in a Posttravel Evaluation | 489 | ||
| Screening for Latent Tuberculosis | 489 | ||
| Chest X-ray | 489 | ||
| Tuberculin Skin Testing and Interferon-γ Release Assay | 489 | ||
| Sexually Transmitted Infections | 489 | ||
| Viral Hepatitis | 491 | ||
| Dengue | 491 | ||
| Zika. | 491 | ||
| Foodborne Infections | 491 | ||
| Screening for Parasitic Diseases | 491 | ||
| Introduction. | 491 | ||
| Strongyloidiasis. | 492 | ||
| Schistosomiasis. | 492 | ||
| (Neuro)cysticercosis. | 492 | ||
| Other Intestinal Helminths. | 492 | ||
| Invasive Amebiasis. | 492 | ||
| Other Intestinal Protozoa. | 493 | ||
| Infections With Blood-Dwelling or Tissue-Dwelling Parasites. | 493 | ||
| Malaria. | 493 | ||
| Leishmaniasis. | 493 | ||
| Trypanosomiasis. | 493 | ||
| Conclusions | 493 | ||
| References | 493 | ||
| 56 Fever in Returned Travelers | 495 | ||
| Abstract | 495.e1 | ||
| Keywords | 495.e1 | ||
| Key points | 495 | ||
| Introduction | 495 | ||
| Epidemiology of Fever in Travelers | 495 | ||
| Prevalence of Fever in Travelers | 495 | ||
| Causes of Fever in Travelers | 495 | ||
| Approach to the Patient With Fever | 497 | ||
| The Travel and Exposure History | 497 | ||
| Incubation Period | 497 | ||
| Mode of Exposure | 498 | ||
| Impact of Pretravel Vaccination | 498 | ||
| Clinical Presentations | 498 | ||
| Undifferentiated Fever | 499 | ||
| Always Look for Malaria. | 499 | ||
| Dengue. | 499 | ||
| Chikungunya. | 499 | ||
| Zika. | 499 | ||
| Rickettsial Infections. | 499 | ||
| Enteric Fever. | 500 | ||
| Leptospirosis. | 500 | ||
| Acute Schistosomiasis. | 500 | ||
| Amebic Liver Abscess. | 501 | ||
| Hemorrhagic Fevers | 501 | ||
| Fever and CNS Changes | 501 | ||
| Persistent and Relapsing Fevers | 501 | ||
| Laboratory Clues | 501 | ||
| Routine Laboratory Studies | 501 | ||
| Elevated Liver Enzymes | 501 | ||
| Fever and Eosinophilia | 502 | ||
| Initial Diagnostic Workup | 502 | ||
| Management | 502 | ||
| Conclusion | 502 | ||
| References | 503 | ||
| 57 Skin Diseases | 505 | ||
| Abstract | 505.e1 | ||
| Keywords | 505.e1 | ||
| Key points | 505 | ||
| Epidemiological Data | 505 | ||
| Dermatoses Diagnosed Abroad. | 505 | ||
| Dermatoses Diagnosed Upon Return | 505 | ||
| Tropical Dermatoses in the Traveler | 505 | ||
| Hookworm-Related Cutaneous Larva Migrans | 505 | ||
| Localized Cutaneous Leishmaniasis | 507 | ||
| Myiasis | 508 | ||
| Tungiasis | 509 | ||
| Cutaneous Gnathostomiasis | 510 | ||
| Other Tropical Dermatoses of Interest for Travelers | 510 | ||
| Cosmopolitan Dermatoses | 510 | ||
| Pyodermas | 510 | ||
| Dermatophytosis | 511 | ||
| Arthropod-Related Dermatoses | 511 | ||
| Scabies | 511 | ||
| Cercarial Dermatitis | 512 | ||
| Sea-Bather’s Eruption | 512 | ||
| Marine Life Dermatitis | 512 | ||
| Photosensitivity and Photo-Induced Disorders | 512 | ||
| Other Cosmopolitan Dermatoses of Interest to Travelers | 513 | ||
| Diagnosis of a Skin Lesion in the Traveler | 513 | ||
| Pruritus | 513 | ||
| Creeping Eruption, Cutaneous Larva Migrans | 513 | ||
| Urticaria | 513 | ||
| Febrile Rash | 514 | ||
| Edema | 515 | ||
| Nodular Lymphangitis | 515 | ||
| Sexually Transmitted Infections | 515 | ||
| Conclusion | 516 | ||
| References | 516 | ||
| 58 Eosinophilia | 519 | ||
| Abstract | 519.e1 | ||
| Keywords | 519.e1 | ||
| Key points | 519 | ||
| Introduction | 519 | ||
| Causes of Eosinophilia | 519 | ||
| Overview | 519 | ||
| Allergic Disorders/Asthma | 519 | ||
| Drug Hypersensitivity | 519 | ||
| Infection | 520 | ||
| Helminths. | 520 | ||
| Ectoparasites. | 521 | ||
| Protozoa. | 521 | ||
| Fungi. | 521 | ||
| Other. | 521 | ||
| Other Causes. | 521 | ||
| Clinical Syndromes | 521 | ||
| Skin/Soft Tissue Involvement | 521 | ||
| Pulmonary Manifestations | 522 | ||
| Gastrointestinal Symptoms | 522 | ||
| Neurologic Disease | 523 | ||
| Fever | 523 | ||
| Other. | 523 | ||
| Asymptomatic Eosinophilia | 523 | ||
| Schistosomiasis. | 523 | ||
| Filarial Infection. | 524 | ||
| Strongyloidiasis. | 524 | ||
| Hookworm Infection. | 524 | ||
| Evaluation of Patients With Eosinophilia | 524 | ||
| Approach to the Patient With Undiagnosed Eosinophilia | 525 | ||
| Conclusion | 525 | ||
| References | 525 | ||
| 59 Respiratory Infections | 527 | ||
| Abstract | 527.e1 | ||
| Keywords | 527.e1 | ||
| Key points | 527 | ||
| Introduction | 527 | ||
| Causative Agents and Clinical Presentation | 527 | ||
| Epidemiology | 527 | ||
| Risk Factors | 529 | ||
| Transmission | 529 | ||
| Management of Respiratory Tract Infections | 529 | ||
| Prevention in Travelers | 531 | ||
| Infections of the Respiratory Tract Associated With Epidemics | 532 | ||
| Severe Acute Respiratory Syndrome | 532 | ||
| Avian Influenza | 532 | ||
| Influenza | 532 | ||
| Middle East Respiratory Syndrome Coronavirus | 533 | ||
| Legionellosis | 533 | ||
| Tropical and Geographically Restricted Respiratory Infections | 533 | ||
| Melioidosis | 533 | ||
| Leptospirosis | 534 | ||
| Anthrax | 534 | ||
| Plague | 534 | ||
| Paragonimiasis | 534 | ||
| Coccidioidomycosis and Histoplasmosis | 535 | ||
| Tuberculosis | 535 | ||
| TB Among Travelers From Low-Endemic to High-Endemic Areas. | 535 | ||
| Conclusion | 535 | ||
| References | 536 | ||
| Appendix Sources of Travel Medicine Information | 539 | ||
| Key points | 539 | ||
| Abstract | 539.e1 | ||
| Keywords | 539.e1 | ||
| Introduction | 539 | ||
| Reference Texts | 539 | ||
| Journals | 539 | ||
| Travel Medicine Websites | 539 | ||
| Point-of-Care Travel Clinic Destination Resources | 539 | ||
| Electronic Discussion Forums | 544 | ||
| Electronic Notifications and Feeds | 544 | ||
| Index | 545 | ||
| A | 545 | ||
| B | 546 | ||
| C | 547 | ||
| D | 548 | ||
| E | 549 | ||
| F | 550 | ||
| G | 550 | ||
| H | 551 | ||
| I | 552 | ||
| J | 553 | ||
| K | 553 | ||
| L | 553 | ||
| M | 554 | ||
| N | 555 | ||
| O | 556 | ||
| P | 556 | ||
| Q | 558 | ||
| R | 558 | ||
| S | 559 | ||
| T | 560 | ||
| U | 561 | ||
| V | 561 | ||
| W | 562 | ||
| Y | 562 | ||
| Z | 562 | ||
| Inside Back Cover | ibc1 |