Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Travel-Acquired Illnesses Associated with Fever

The evaluation of fever in travelers poses a diagnostic challenge to clinicians for many reasons. First, there are many possible etiologies, some of which are geographically localized and are, thus, unfamiliar ( Table 20.1 ). Diagnosis may be delayed owing to lack of familiarity with routes of infection or clinical presentations of these geographically limited illnesses. Fever in travelers may be caused by infections that are…

Health Screening in Immigrants, Refugees, and International Adoptees

In an increasingly globalized world, migration and population mobility are important factors in the demographic makeup of national populations. In the United States, for example, recent estimates indicate that the foreign-born cohort comprises some 40 million people, or 13% of the total population. Many foreign-born individuals arrive as immigrants, refugees, or children adopted abroad. As such, and depending on their status, health screening may be a…

Pre-Travel Assessment and Advice for Expatriates and Volunteers

Expatriates Definitions Expatriates are defined as travelers who reside abroad for work or volunteer reasons but intend to return eventually to their home country, in contrast to immigrants, who intend to stay in the destination country. They typically spend longer durations abroad than tourists or short-term business travelers. Type of Expatriate Exposures depend largely on the nature of work. This may range from executives in large…

Travel and Mental Health

Medevac Statistics Although mental health is often an afterthought in travel medicine, in fact, the psychiatric impact of travel is an area of growing interest, not only because of the prevalence of international travelers from all sectors of the population, but also because of the changing nature of international travel. A recent Swiss travel clinic study of 22,584 travelers seeking pre-travel advice revealed the purposes of…

Travel with Chronic Medical Conditions

In addition to travel by rail, ship, and automobile, almost 2 billion people travel by air annually. It is generally expected that primary care providers as well as travel medicine clinic personnel will identify individuals who are unfit for air travel and provide them with advice. Studies show that more than 95% of travelers with health problems who travel by air would like to receive additional…

The Immunocompromised Traveler

As the world becomes increasingly interconnected, more people have the opportunity to travel outside their home communities and thus be at risk for novel and unexpected infections. The immunocompromised host requires special attention in pre-travel planning. This chapter will review travel preparations for immunocompromised patients, including human immunodeficiency virus (HIV)-infected individuals, solid organ or hematopoietic transplant recipients, and persons taking immunosuppressive medications. The Immunocompromised Traveler People…

Advice for Women Travelers

Travel health issues for women will vary according to the life stage and lifestyle of the women. Issues differ depending on whether the woman is in her second trimester of pregnancy or about to go on her first solo journey at age 80. To adapt the standard pre-travel health recommendations to the needs of a female traveler, one needs to consider potential gender- and age-related issues…

Students Traveling Abroad

Students are traveling abroad in increasing numbers, with the largest increase observed in the university-student age group. Preparing the student for travel abroad encompasses the depth and breadth of travel medicine. The benefits of foreign travel and educational international exchange programs include cross-cultural knowledge and competency, international language development, leadership development, and personal growth. Current data show shifting patterns of travel within the 13- to 17-year-old…

Travel Advice for Pediatric Travelers

Pediatric travelers present unique challenges to the travel medicine provider. Each facet of travel medicine has special caveats relating to the different developmental stages, sizes, and maturity levels of the infant, child, or adolescent traveler. In addition, children traveling to any destination require attention to basic pediatric issues. The pre-travel consultation provides an opportunity to highlight specific travel medicine issues and vulnerabilities in the pediatric population.…

Dive Medicine

In diving, the predominant forces of nature are the gas laws, and the two most important ones are Boyle's law and Henry's law. Simply stated, Boyle's law refers to a pressure–volume relationship. As a diver descends in the water, each 33 ft of seawater (fsw) adds approximately one additional atmosphere of pressure. At that pressure (33 fsw = 1 bar = 1 atm = 760 mmHg = 14.7 psi) the volume in…

High-Altitude Travel

Increasing numbers of people are traveling to high altitude for work or pleasure. While the rewards of such travel are often great and include opportunities to see places of great beauty or historical and cultural significance, to accomplish lifelong objectives, or to simply have an enjoyable vacation, there are risks associated with such travel. Unacclimatized lowlanders are at risk for one of several forms of acute…

Disequilibrium: Jet Lag, Motion Sickness, Cold Exposure, and Heat Illness

When travelers cross several time zones, go to hot or cold climates, or are subject to novel motion stimuli, they may face problems adapting to new environmental situations. This chapter presents some common states of disequilibrium likely to be encountered by the traveler and suggests practical approaches to the problems. Socioeconomic position, class, or economic status can affect individuals with these conditions profoundly, but like most…

Traveler’s Diarrhea : Prevention and Self-Treatment

Traveler's diarrhea is a common malady affecting up to 60% of international travelers during a 2-week trip. Areas of the world can be divided into high, intermediate, and low risk for acquiring traveler's diarrhea ( Fig. 8.1 ). Lowering risk from high to intermediate speaks to excellent efforts by many countries to improve their food and beverage hygiene. However, in the preparation of travelers for self-treatment…

Water Disinfection

Risk of Water-Borne Infection Water disinfection is an essential component of the prevention strategy for enteric infections. In developing countries, surface water may be highly contaminated with human waste. The World Health Organization (WHO) reports that 780 million people still lack access to an improved drinking water supply, and 2.4 billion people lack access to improved sanitation. This lack of safe drinking water, sanitation, and hygiene…

Malaria Prevention

Malaria is the most important parasitic disease in the world. Human malaria is a blood-borne protozoal infection caused by five species of the genus Plasmodium : P. falciparum , P. vivax , P. ovale , P. malariae , and P. knowlesi . The infection is transmitted through the bite of infected female Anopheles mosquitoes. Less commonly, malaria may be transmitted by blood transfusion, with shared needle…

Immunizations for Travelers

Recommendations for travel immunizations are based on a risk assessment of each traveler's general health, trip itinerary, and knowledge of current health conditions at a given destination. Most travelers seek protection against vaccine-preventable diseases, yet their acceptance of the vaccines recommended for travel may depend largely on other concerns, such as number of doses and vaccine schedules, route of administration (oral vs. injection), and cost. Many…

Jet Health

Once onboard a commercial jet aircraft headed to destination, the traveler faces the novel environment of the airplane cabin, in which a passenger's health may be impacted by the air quality and pressurization, among other prevailing conditions. Chronic health concerns may be exacerbated and new health issues may arise after spending hours sitting with limited mobility in the company of strangers and in contact with potentially…

Emerging Infectious Diseases and the International Traveler

In 1992 a landmark report by the Institute of Medicine titled “Emerging Infections: Microbial Threats to Health in the United States” highlighted the importance of the often underappreciated concept of emerging infectious diseases (EIDs). This report brought EIDs back into scientific discourse; however, the awareness that diseases emerge and periodically reemerge goes back millenia, as highlight in their historical review. The term “emerging infectious diseases” is…

Urban Medicine: Threats to Travelers to Cities in Low-Income Nations

Each year, more than 50 million travelers from industrialized nations visit low-income nations. Whereas many travelers and travel providers associate international travel with rustic and sparsely peopled environments, an increasing proportion of travelers, including students and international business travelers, spend most or all of their time abroad in urban environments. Even tourists whose final destinations are rural and remote must contend with urban settings for at…

COVID-19 in Children and Adolescents

Coronavirus Infections in Children and Adolescents Coronaviruses are enveloped single-stranded RNA viruses comprising four genera: alpha, beta, gamma, and delta. They infect humans and animals and were first described in the 1960s as causative agents of mild upper respiratory tract infections. Four human coronaviruses caused up to 35% of upper respiratory tract infections in humans: 2229E, NL63 (both alpha coronaviruses), and HKU1 and OC43 (beta coronaviruses).…