Chapter 117. Health Advice for International Travel (Part 1)

Harrisons Internal Medicine Chapter 117. Health Advice for International TravelHealth Advice for International Travel: IntroductionAccording to the World Tourism Organization, the number of international tourist arrivals in 2004 reached an all-time record of 763 million. This number represents an increase over the 2003 figure of almost 11%—the highest and the only double-digit percentage increase since 1980, when these statistics were first collected. Not only are more people traveling; travelers are seeking more exotic and remote destinations. ...
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Chapter 117. Health Advice for International Travel (Part 1) Chapter 117. Health Advice for International Travel (Part 1) Harrisons Internal Medicine > Chapter 117. Health Advice forInternational Travel Health Advice for International Travel: Introduction According to the World Tourism Organization, the number of internationaltourist arrivals in 2004 reached an all-time record of 763 million. This numberrepresents an increase over the 2003 figure of almost 11%—the highest and theonly double-digit percentage increase since 1980, when these statistics were firstcollected. Not only are more people traveling; travelers are seeking more exoticand remote destinations. Studies show that 50–75% of short-term travelers to the tropics orsubtropics report some health impairment. Most of these health problems areminor: only 5% require medical attention, and Incidence rate, per month, of health problems during a stay indeveloping countries. PCV, Peace Corps volunteer. (From Steffen R, Lobel HO: Epidemiologicbasis for the practice of travel medicine. J Wilderness Med 5:56, 1994. Reprintedwith permission from Chapman and Hall, New York.) General Advice Health maintenance recommendations are based not only on the travelersdestination but also on assessment of risk, which is determined by health status,specific itinerary, and lifestyle during travel. Detailed information regardingcountry-specific risks and recommendations may be obtained from the Centers forDisease Control and Prevention (CDC) publication Health Information forInternational Travel (available athttp://wwwn.cdc.gov/travel/contentYellowBook.aspx). Fitness for travel is an issue of growing concern in view of the increasednumbers of elderly and chronically ill individuals journeying to exotic destinations(see Travel and Special Hosts, below). Since most commercial aircraft arepressurized to 2500 m (8000 ft) above sea level (corresponding to a PaO2 of ~55mmHg), individuals with serious cardiopulmonary problems or anemia should beevaluated before travel. In addition, those who have recently had surgery, amyocardial infarction, a cerebrovascular accident, or a deep-vein thrombosis maybe at high risk for adverse events during flight. A summary of currentrecommendations regarding fitness to fly has been published by the AerospaceMedical Association Air Transport Medicine Committee(www.asma.org/publications/). A pretravel health assessment may be advisable forindividuals considering particularly adventurous recreational activities, such asmountain climbing and scuba diving.