Get Smart on Travel Health!

9/2/20098:40:54 AM Link 0 comments | Add comment

H1N1 influenza pandemic, Health, Swine Flu, Travel Health

As the current global H1N1 influenza pandemic continues to be highlighted in almost daily news reports, travelers are reminded more than ever that there is more to trip planning than checking the weather and booking flights and hotels. One vital factor that must always be considered is the current health situation for destinations abroad -- and it’s something you as travel agents need to be aware of when serving your clients.

Endemics, which are diseases present in a particular locality or population, are found in all corners of the world, which is why it is important for travelers to know what sorts of diseases are out there, as well as what precautions can be taken before traveling. When booking a trip for your clients, remember to share helpful information that will enable them to make smart decisions about their health.

Infectious diseases vary by country and can be influenced by factors like food, water and climate. While some countries see low rates of disease, such as meningitis, dengue or malaria, others see higher rates and even fatalities. For instance, travelers to Brazil should be aware that transmission of yellow fever virus, which can cause kidney and liver failure in humans, is expanding in certain areas. Those visiting the Netherlands, on the other hand, should know that there has been a reported outbreak of Q fever, a disease passed from sick farm animals to humans. As trips to Asia become increasingly popular, it is important to examine what types of endemic diseases are prevalent in the area at this time.

For trips to South and Southeast Asia, your clients should be advised that a small mosquito bite can cause a disease known as Japanese encephalitis, a potentially fatal virus that infects the brain. The disease, known as “brain fever,” causes inflammation and swelling and can cause irreversible brain damage or death. The Japanese encephalitis virus is found in different regions of Southeast Asia, and is active during various transmission seasons. It is transmitted by certain types of mosquitoes found in rural rice-growing and pig-farming regions, but can also be found at the outskirts of cities. About 10,000 cases out of 50,000 reported annually end fatally, and half of the survivors require extensive long-term care.

Most infections result in mild symptoms or no symptoms at all, which is why it is essential to be aware of the risks. On average, one in 300 Japanese encephalitis infections result in clinical illness. For those who develop the illness, the symptoms are usually similar to the flu, including fever, chills, tiredness, headache, nausea and vomiting. In children, abdominal pain can dominate the early stage of the disease. Confusion and agitation can also occur in the early stage. The illness can progress to encephalitis, where patients may experience seizures, paralysis, coma or loss of speech.

Close to three billion people live in regions at risk for infection by Japanese encephalitis virus, though the disease is not contagious. The geographic range of the virus extends from eastern, southern and southeastern Asia to Papua, New Guinea and the Torres Strait of Northern Australia. The overall risk of travelers for Japanese encephalitis is low, but can vary based on season, destination, duration of stay and activities. In the past, the virus has affected different types of travelers and unfortunately, the outcomes have often been severe.

While there is no specific treatment for Japanese encephalitis, prevention is the best strategy in controlling the burden of the virus, and vaccination is the only protective and effective measure to control it. IXIARO, a vaccine for Japanese encephalitis, was developed by Intercell AG and Novartis Vaccines, and is suitable for travelers who want to reduce their risk of acquiring the disease. Two immunizations of the vaccine given four weeks apart are required to achieve optimal protection.

This June, the Advisory Committee on Immunization Practices (ACIP), an expert committee of the U.S. Centers for Disease Control and Prevention voted to broaden the current Japanese encephalitis vaccination recommendations. ACIP recommends that immunization should be considered for all travelers to Asia, regardless of length of visit, except individuals who will be staying solely in urban areas or who will be there at times outside of a well-defined Japanese encephalitis season.

Before booking your clients on their next international trip, be sure to advise them to consult with travel doctors, who are aware of Japanese encephalitis and other endemic diseases abroad, as well as necessary immunization and preventive measures.

You can also direct your clients to various website for more information on travel health, including www.cdc.gov/travel (Centers for Disease Control and Prevention – Traveler’s Health), www.who.int (World Health Organization), www.travelhealthresource.com (Travel Health Resource) and www.istm.org (International Society of Travel Medicine).

Dr. Bradley Connor is clinical associate professor of medicine at the Weill Medical College of Cornell University and founder and medical director of Travel Health Services. For more information on Travel Health Services, visit www.travelhealth.net.