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Introduction

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If you can't peel it, boil it or cook it—don't eat it.

Anon

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Emporiatics—the science of travel medicine

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With over 600 million international trips being taken annually, the health problems faced by travellers are considerable and variable depending on the countries visited and the lifestyle adopted by the traveller.1 There is evidence that many travellers are receiving inaccurate predeparture travel advice. Travellers to North America, Europe and Australasia are usually at no greater risk of getting an infectious disease than they would be at home, but those visiting the less developed tropical and subtropical countries of Africa, Central and South America and South-East Asia are at significant risk of contracting infectious diseases. The immunocompromised are those at greatest risk.

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Problems range in complexity from the most frequent and usually benign problems, such as traveller's diarrhoea, to more exotic and potentially fatal infections such as malaria, Japanese encephalitis and HIV. It must also be remembered that in some countries with volatile political changes there is the possibility of injury, incarceration or being left stranded. Travel means transport and thus the potential for accidents and crippled body and bank balance. Insurance for such contingencies is as important as preventive health measures.

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Principles of pre-travel health care

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  • Advise the patient to plan early—at least 8 weeks beforehand.

  • Advise a dental check.

  • Allow adequate time for consultation (e.g. 30–45 minutes).

  • Individualise advice.

  • Provide current information.

  • Provide written as well as verbal advice.

  • Provide a letter concerning existing medical illness and treatment.

  • Encourage personal responsibility.

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Key facts and checkpoints

  • The main diseases facing the international traveller are traveller's diarrhoea (relatively mild) and malaria, especially the potentially lethal Plasmodium falciparum malaria.

  • Most cases of traveller's diarrhoea are caused by enterotoxigenic Escherichia coli and Campylobacter species.

  • Enteroinvasive E. coli (a different serotype) produces a dysentery-like illness similar to Shigella.

  • Traveller's diarrhoea is contracted mainly from contaminated water and ice used for beverages, washing food or utensils, or cleaning teeth.

  • Poliomyelitis is endemic in at least 20 countries and thus immunisation for polio is still important.

  • One bite from an infected mosquito during a single overnight stop in a malaria area can result in a possible lethal infection.

  • Infections transmitted by mosquitoes include malaria, yellow fever, Rift Valley fever, Japanese B encephalitis, chikungunya and dengue fever. Avoiding their bites is excellent prevention.

  • Every year approximately 1000 Australians catch malaria while travelling overseas.

  • Malaria is a dusk-till-dawn risk only, but bites from daytime mosquitoes can cause dengue.

  • P. falciparum malaria is steadily increasing, as is resistance to newer antimalarials.

  • It is important for GPs to consult a travel medicine database to obtain specific information about ‘at risk’ countries.

  • Avoid tattooing, ear-piercing, acupuncture or any skin puncturing while overseas.

  • The commonest causes of death in travellers overseas are trauma (26%), particularly traffic accidents, and homicide (16.9%).

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Gastrointestinal ...

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