Dr. Kendall Billick is an expert in infectious diseases. He practices at the Bon Séjour Inc. Travellers Health Service in Pointe Claire, Quebec, http://bonsejour.ca/index.php. If you have questions relating to illness and travel, you can ask them via the comments field at the bottom of this article until Jan. 15, 201. We will publish Dr. Billick’s responses in early February.
Despite the risks of infectious diseases, the threat of terrorism and natural disasters, international travel has continued to increase. During 2010, international tourist arrivals surpassed pre-economic crisis levels after more than 940 million people crossed international borders. To place this in perspective, there were 50 million in 1950.
A new breed of tourist
Who are these travellers? They form a diverse group and perhaps different than you may expect: business travellers commonly pursue opportunities in remote areas, others enjoy prolonged visits with friends and relatives in developing countries, and increasing numbers travel for humanitarian reasons often to volunteer in exotic corners of the world where there is little access to health care. The majority, however, are tourists.
But tourist travel has changed: Adventure travel, especially to jungle areas in Latin America, is common and high school students now fulfill community service requirements in West Africa or stay with host families in Ecuador. With increasing health care costs, medical tourism to developing countries is on the rise especially for dental and cosmetic work and even organ transplants! Older travellers have fewer barriers than ever to international travel. More effective medical management of chronic conditions combined with the conveniences of modern day travel means this growing segment of the population will constitute an increasing portion of international tourists.
Unfortunately, travellers get sick. Health problems are reported in about half of all travellers and just under 10% become sick enough to seek health care while abroad or upon returning home. Ill returned travellers very often had inadequate (or no) pre-travel health care. Many were not advised (even by their physicians!) that they should have seen a specialist ahead of time. A common theme is the patient (or family member) who is incredulous that this has actually happened to them! “But I have been going to [fill in the blank] with no problems for years, Doc!?” While many illnesses cause suffering alone, some, such as malaria and others, can be life threatening.
What are common travel illnesses?
What illnesses do travellers acquire? They say travel broadens the mind and loosens the bowels…..Diarrhea is certainly the most common travel related infection and affects 20-50% of travellers.(7) Though usually mild, diarrhea can be severe and the associated dehydration can have devastating consequences especially in very young or older travellers. Fever has a multitude of causes that include both infectious as well as non-infectious possibilities. These range from mild respiratory tract infections to potentially dangerous problems such a dengue fever, typhoid, malaria and blood clots. Skin disease, sun related problems and insect reactions have increasingly been appreciated as a cause of suffering and this is only to name a few.
Special concerns for older travellers
Certain groups of travellers deserve special mention because they shoulder a disproportionate burden of travel related illness: pregnant, pediatric or disabled travellers or those with weakened immune systems are at significantly higher risk for illness as are long stay travellers. Older travellers, in particular, are at increased risk of illness, injury, or death while traveling, even in the absence of pre-existing medical problems.(5) Vaccines may be less effective or take longer to work in this group as well. In addition, acclimatizing to environmental changes may take longer and there is an increased risk for motion sickness, jet lag, insomnia and constipation. Importantly, there are potential interactions between patient medications and the vaccines/drugs used to minimize travel health related illness.
What can I do to prepare myself?
Is travel related illness preventable? Many infections can be effectively prevented with immunization. Vaccines are safe and effective when used in the right setting. Those who dislike needles will be happy to hear that certain vaccines are even available as drinks and sprays! It is a shame that some people mistrust these critical tools that we are so fortunate to have access to in the industrialized world. Accurate and up-to-date advice on the prevention of mosquito related illness is crucial in the prevention of malaria, dengue, yellow fever, Japanese B encephalitis and others. Traveller’s diarrhea can often be prevented or mitigated with sound advice and a variety of tools. Other topics to be reviewed with the travel doctor include environmental concerns such as altitude illness, air transportation issues such as jet lag and blood clots as well as many others from safety and security to travel insurance. As you can appreciate, Travel Medicine is more than just vaccination!
Travel Medicine is still a relatively young field and the requirements to practice it have actually not been very tightly regulated. In light of the public perception that vaccines are all you need before travel, there are increasing numbers of locations popping up where you can go to get your “shots”. For this reason, travellers are encouraged to do a little homework prior to departure – make sure health risk can be accurately assessed and then minimized in a way that is tailored specifically to you. Some sites that may be useful are the International Society of Travel Medicine or the Public Health Agency of Canada but even these don’t tell all. Find out if you will be evaluated by a physician or a nurse and determine whether that individual has a Certificate in Travel Health. Does the clinic have the expertise to evaluate ill-returned travellers, as well? When a clinic takes care of ill returned travellers, they are better equipped to advise those about to leave.
Exploring our beautiful world has become increasingly easy – we can visit almost anywhere in less than 36 hours. (4) But travel is not without risk. Comprehensive and individualized pre-travel care can minimize such risk so that fond memories and pretty photos will be all that is brought back from adventures abroad.
Kendall Billick, M.D., DTM&H
Adjunct Professor McGill University
J.D. MacLean Centre for Tropical Diseases, Montreal General Hospital
Division of Dermatology, Jewish General Hospital
Internal Medicine and Infectious Diseases, Lakeshore General Hospital
Certificate in Travel Health®