国际旅行卫生保健中心旅行医学专业化的探讨

旅行医学是一门新兴学科,主要研究旅行者在旅行中可能遇到的各种健康问题,为旅行者提供旅行前的医学建议、旅行中的预防和自我治疗措施以及旅行后的临床诊治。为国际旅行者提供高质量的卫生保健服务是保健中心的主要业务之一,通过对国际旅行卫生保健中心应用旅行医学实践现状分析,提出了加快保健中心旅行医学科学专业化发展的一系列建议。     

Comprehensive care of travelers

Travel, especially if it is international, often means major changes for the family. Family physicians should assess the epidemiologic risk and psychosocial significance of travel or relocation in light of the family's life-cycle stage and antecedent health. Using core references, which are kept current in partnership with public health agencies, family physicians are able to provide comprehensive immunization, medications, and patient education for all travel risks. Families are given medical record summaries and recommended sources of care at their destination. Eight weeks after their return patients are reassessed for newly acquired illness and helped to integrate the perspectives gained during the travel into the family's future dynamics. Taking advantage of growing travel medicine opportunities, family medicine educators should base the care of travelers and teaching of residents on defined competence priorities. Travelers' health provides a mutually rewarding model of shared care with public health consultants in the community medicine curriculum.     

邮轮旅行相关健康指导和旅行建议

近年来随着邮轮经济的不断发展及人民生活水平的提高,越来越多的旅行者选择乘坐国际邮轮作为一种休闲度假方式,随之与邮轮相关的各种旅行医疗问题也逐一显现,旅行医学工作者应针对这一特殊旅行群体给予详尽的健康指导和旅行建议,最大程度保护国际旅行者、船上从业人员及国民的健康,从而促进邮轮旅行业的健康发展。     

非洲旅行的健康咨询

健康咨询是指旅行医生根据旅行者自身健康状况、日常生活、工作、行程、饮食情况、旅行地的气候和地理环境因素、疫病流行情况、卫生法规政策、卫生保障水平等为旅行者分析可能发生的医学问题和健康风险,提供预防或检查的方法、意见或建议。为旅行者提供健康咨询一直是国际旅行卫生保健中心的重要工作之一。非洲吸引着很多旅行者前往,但同时非洲也是全球多种疾病发病率和死亡率较高的地区。本文将非洲旅行健康咨询的主要内容进行归纳总结。     

Travelers and travel vaccines at six health care systems in the Vaccine Safety Datalink

BackgroundStudying the safety of travel vaccines poses challenges since recipients may be traveling during the risk window for adverse events and the identification of a suitable comparison group can also be difficult. The examination of traveler characteristics, travel vaccination patterns, and health care utilization using electronic health record (EHR) data can inform the feasibility of future travel vaccine safety studies.MethodsA retrospective cohort study of health plan members in the Vaccine Safety Datalink Project aged 9 months and older who had a travel-related encounter or received a travel vaccine from 2009 to 2018 was performed. Travel regions visited, travel duration, type of travel vaccine received (typhoid, yellow fever, Japanese encephalitis, rabies, and cholera), and timing of vaccination date before departure date were described. Sociodemographic information, clinical characteristics, and health care utilization were compared between travelers who received travel vaccines and travelers who did not.ResultsA total of 1,026,822 unique travelers departing from the United States were identified; 612,795 travelers received 898,196 doses of travel vaccines. The most commonly administered travel vaccine was typhoid vaccine and 77% of all travel vaccines were given more than one week prior to departure. Compared with travelers without travel vaccines, travelers with travel vaccines were overall similar but as a group were slightly younger, healthier, and had lower Hispanic representation. Health care utilization dramatically decreased during travel. Outpatient visits decreased from 294.8 visits per 10,000 person-days before travel to 24.2 visits per 10,000 person-days during reported travel dates.ConclusionsThrough the EHR information from almost a million travelers, a departure date and duration of travel were successfully captured for the majority of travelers with corresponding health care utilization data. Time after vaccination and prior to departure can potentially be used in the future to compare travelers who receive travel vaccines with travelers who do not receive travel vaccines when looking at adverse events of interest after vaccination.     

Risk and burden associated with the acquisition of viral hepatitis A and B in the corporate traveler

As the number of international business travelers continues to grow, so does the list of destinations, many of which are endemic for both hepatitis A and B. Generally, travelers are unaware of the risks of acquiring viral hepatitis when traveling; many are unsure of modes of transmission and do not seek pretravel advice or do not follow the recommendations of travel health professionals. Infected employees can result in increased health care costs and reduced productivity in the workplace. Safe and efficacious monovalent vaccines and a combined hepatitis A and B vaccine are available. Successful corporate health and immunization programs can prevent hepatitis A and B when employees are abroad on business. This article examines the distribution, risks, costs, burden, and prevention of hepatitis A and B in the international business traveler.     

Use of an accelerated immunization schedule for combined hepatitis A and B protection in the corporate traveler

Increased international business travel to moderate or high endemic areas of hepatitis A and B may leave many business travelers at risk for infection if not vaccinated. Many international business travelers depart for hepatitis A and B endemic areas within 2 months of the decision to travel. Many of these travelers do not seek pretravel medical advice and are unaware of the risks and modes of acquiring hepatitis A and B. Monovalent vaccines and a combined hepatitis A and B vaccine are available and can be administered on an accelerated schedule. Because many areas endemic for hepatitis A are also endemic for hepatitis B, accelerated administration of the combined vaccine can offer protection for many international business travelers destined for areas endemic for both diseases and should be part of corporate travel immunization programs.     

Fatal yellow fever in a traveler returning from Amazonas, Brazil, 2002

Yellow fever (YF) is a mosquitoborne viral disease that has caused deaths in U.S. and European travelers to sub-Saharan Africa and tropical South America. Although no specific treatment exists for YF and the case-fatality rate for severe YF is approximately 20%, an effective vaccine is available. This report describes a case of fatal YF in an unvaccinated traveler who had returned from a 6-day fishing trip on the Rio Negro west of Manaus in the state of Amazonas, Brazil. Because information from some commercial outfitters and travel agents might underestimate health risks, healthcare providers and travelers should review vaccination and other traveler's health recommendations from public health agencies.     

预防接种咨询中应注意的若干问题

〔目的〕进一步提高国际旅行卫生保健医师的旅行预防接种咨询水平,保证旅行者的旅途健康、安全。〔方法〕结合实践经验,通过对4个典型个案的分析,为国际旅行预防接种咨询工作提出参考建议。〔结果〕旅行卫生保健医师应学习掌握全球传染病疫区分布情况,熟悉各种疫苗的接种禁忌症及除疫苗外的其它预防措施,并能够根据旅行者个人实际情况进行健康评估及推荐预防措施。〔结论〕旅行卫生保健医师不仅要熟悉各国对入境者预防接种要求,同时还必须具有扎实的预防医学理论知识,根据旅行者的实际情况推荐合理的预防措施。     

Japanese encephalitis in a U.S. traveler returning from Thailand, 2004

Japanese encephalitis (JE) virus is a mosquito-borne flavivirus that is closely related to the West Nile and St. Louis encephalitis viruses endemic to North America. JE virus is a leading cause of viral encephalitis in Asia but is rarely reported among travelers to countries where JE is endemic. This report describes a case of an unvaccinated Washington resident who had JE after traveling to northern Thailand. The Advisory Committee on Immunization Practices (ACIP) recommends JE vaccine for travelers to JE-endemic areas of Asia during the transmission season, especially those spending > or =1 month in those areas and whose travel itineraries include rural settings. JE vaccine should also be considered for travelers visiting areas with epidemic transmission or those engaging in extensive outdoor activity in rural settings in areas where JE is endemic, regardless of the duration of their visit. In addition, health-care providers and organized international travel programs should ensure that travelers obtain appropriate preventive health guidance before travel.     

我国出境旅行者腹泻流行特征及其经济损失研究

〔目的〕揭示我国当前出境旅行者腹泻(TD)的流行特征、规律及其对经济造成损失的情况,科学地指导我国国际旅行卫生保健工作。〔方法〕对2004年经广州机场口岸入境的中国籍回国旅行团进行整群抽样的问卷调查。利用计算机Excel软件对资料进行整理、归类和计算,运用SPSS统计软件对计算结果进行统计分析。〔结果〕根据对988名回国旅行者的问卷调查,共发现115例TD病人,总发病率为11.64%。去东南亚国家旅行组的TD发病率为15.31%,明显高于去其他国家旅行组(5.26%);探亲和文化科技交流活动组的TD发病率为20.23%,显著高于观光和商务旅行组(9.82%)。运用非条件logistic回归分析法建立的中国出境TD发病的回归模型,同时反映了旅行目的地、旅行目的、职业等8个因素与TD发病的相关程度,其中旅行目的地与TD发病的相关程度最大。旅行总消费费用中位数为人民币7800元的115例TD病例,每例TD的直接经济损失中位数为340元,占病例旅行总消费费用中位数的4.36%;每例TD因耽误旅行行程时间所造成的间接经济损失中位数为2642元,占病例旅行总消费费用中位数的33.87%。[结论]面对当前较高的出境TD发病率及其巨额的经济损失,建议我国旅游行政管理部门、旅行社、口岸卫生检疫部门、航空公司等单位重点加强对去东南亚国家旅行的重点人群的健康教育和宣传,同时采取其他行之有效措施来预防和控制TD。     

Travel medicine consultation: An opportunity to improve coverage for routine vaccinations

BackgroundTravelers may be responsible for the spread of vaccine-preventable diseases upon return. Travel physicians and family physicians may play a role in checking and updating vaccinations before traveling. Our aim was to evaluate the vaccine coverage for mandatory and recommended vaccination in travelers attending a travel medicine clinic (TMC).MethodsVaccine coverage was measured using the current French immunization schedule as reference for correct immunization, in travelers providing a vaccination certificate during the TMC visit (university hospital of Saint-Étienne), between August 1, 2013 and July 31, 2014.ResultsIn total, 2336 travelers came to the TMC during the study period. Among the 2019 study participants, only 1216 (60.3%) provided a vaccination certificate. Travelers who provided a vaccination certificate were significantly younger than travelers who did not (mean age: 34.8 ± 17.8 vs. 46 ± 18.4 years, P < 0.005) and were less likely to be Hajj pilgrims. Vaccine coverage against Tetanus, Diphtheria, and Poliomyelitis (Td/IPV vaccine) was 91.8%, 78.6% against Measles, Mumps, and Rubella (MMR), and 59.4% against Viral Hepatitis B (HBV). BCG vaccine coverage was 71.9%. Older travelers were less likely to be correctly vaccinated, except against HBV as vaccinated travelers were significantly older than unvaccinated travelers.ConclusionObtaining information about immunization in travelers is difficult. Coverage for routine vaccines should be improved in this population. Travel medicine consultations could be the opportunity to vaccinate against MMR, HBV, and Td/IPV.     

Travel medicine

The risk of the health join to travel are briefly presented. The following factors are mentioned: travel by fly, climate, expose for diseases. The most often pathogens are considered: bacteria, viruses, parasites, and some imported diseases and their vectors. The crucial importance of the stress and conditions of travel is underlined. It has been suggested some procedures which can protect before the risk of travel.     

在国际旅行中1例突发精神病的报告及相关处理对策

目的通过1例国际旅行精神病的相关情况的详细报告，分析国际旅行对于患有精神病的旅行者的影响，保证旅行者完成旅行并平安回到原驻地。方法陪护人员针对患病旅行者实际情况，进行医疗、护理及流行病学调查。结果精神病并非是国际旅行的绝对禁忌症，在治疗后医生认为病情稳定的情况下患者可以继续旅行，但旅行中需由陪护人陪同。陪护人在药品管理、治疗监督、情绪疏导等方面的作用对旅途中患者病情的稳定至关重要。结论在中国境内处理患精神病外籍公务人员除考虑中国的相关法律法规外，在处置中参考他国的相关法律法规也是极其必要的。由于跨国境长途旅行时旅行者面临各方面的巨大变化，精神压力和挑战并存，他们的精神心理状况应得到国际旅行卫生工作人员的适当关注。     

Travel medicine and its correlations with insurance medicine

The author describes the basic ideas and skills of travel medicine, as a new discipline of medical science in Hungary. He also emphasizes the importance of the knowledge of assistance medicine (as a substructure of the travel medicine). The author points out that travel medicine should be assigned to the discipline of insurance medicine in Hungary. In respect of Hungary's joining the European Union, Hungarian doctors should be fully aware of the importance of the traveller's medical treatment.     

国际旅行者健康体检、预防接种网络远程申报及信息服务系统的研究

随着我国对外交流的不断扩大，出入境商务、劳务、留学以及旅游人员的数量与日俱增；国际旅行者对卫生保健服务的质量及要求亦在不断提高。实现国际旅行者信息服务的电子管理，是国际旅行卫生保健工作的重要内容。国内外还没有有关国际旅行者健康体检、预防接种网上申报及预约系统的报道。为切实做好出入境人员的国际旅行卫生保健工作，山东出入境检验检疫局主持研发了国际旅行者健康体检、预防接种网络远程申报及信息服务系统。     

Traveler's diarrhea: epidemiology and impact on visitors to Fortaleza, Brazil.

OBJECTIVE: To assess the epidemiology and impact of traveler's diarrhea (TD) among visitors to the city of Fortaleza, Ceará, Brazil, as part of a global study on TD carried out in four countries. METHODS: Within a cross-sectional survey, questionnaires were completed by departing travelers at the Fortaleza airport between March 1997 and February 1998. The questions inquired about demographics, duration of stay, reason for their visit, pretravel health advice they had received, risky food and beverage consumption while in Fortaleza, and quality of life during the visit to Fortaleza in relation to having or not having contracted TD. RESULTS: A total of 12,499 questionnaires were analyzed. The most common reason that the visitors gave for their travel to Fortaleza was a holiday (60.3%). The total diarrhea attack rate was 13.4%. Younger people (< 36 years) had significantly higher TD attack rates than did older persons. Using a logistic regression model, we investigated the visitors' risk factors, including age, gender, length of stay, and trip's purpose. According to that analysis, characteristics that are slightly predictive of TD are gender, length of stay, and visiting as a tourist rather than for some other purpose. Characteristics that protect against contracting TD include being older and traveling for business rather than for some other reason. Of those who were incapacitated by TD, the mean duration of the impairment was 42 hours. CONCLUSIONS: TD affected the travel plans and activities of many of the visitors to Fortaleza. Further, although aware of the health risks, the majority of those travelers did not avoid all potentially contaminated food or beverage items. Given this pattern of behavior, future efforts to combat TD may have to depend on such other alternative strategies as new vaccines.     

Animal-Associated Exposure to Rabies Virus among Travelers, 1997–2012

Among travelers, rabies cases are rare, but animal bites are relatively common. To determine which travelers are at highest risk for rabies, we studied 2,697 travelers receiving care for animal-related exposures and requiring rabies postexposure prophylaxis at GeoSentinel clinics during 1997–2012. No specific demographic characteristics differentiated these travelers from other travelers seeking medical care, making it challenging to identify travelers who might benefit from reinforced pretravel rabies prevention counseling. Median travel duration was short for these travelers: 15 days for those seeking care after completion of travel and 20 days for those seeking care during travel. This finding contradicts the view that preexposure rabies vaccine recommendations should be partly based on longer travel durations. Over half of exposures occurred in Thailand, Indonesia, Nepal, China, and India. International travelers to rabies-endemic regions, particularly Asia, should be informed about potential rabies exposure and benefits of pretravel vaccination, regardless of demographics or length of stay.     

Exchange between Andean and western medicine

Western medicine has not been functionally incorporated into Andean economic, cultural, and social systems. Evaluation studies show that even though accessibility to Western medicine has increased considerably for rural Andeans, they still rely on traditional medicine. Western medicine has not been able to articulate with Andean ethnomedicine because of different structural relations within each system. Western medicine assumes a mechanistic idealogy, chemical-based cures and technology which function efficiently within an urban-industrial framework; whereas Andean medicine assumes a synchronistic idealogy, natural-based cures and personal skills which function efficiently within a mountainous rural area with structural components of verticality, specialization and reciprocity.Verticality implies that Andeans specialize in extracting resources from a limited number of zones and then exchange their resources for those produced by people on other zones. Andean ethnomedicine follows principles of verticality in that certain communities specialize in various aspects of Andean medicines, according to the resources available to that community. These medical practitioners travel to other communities providing their services in exchange for services or goods. The author illustrates this from his research among the Qollahuaya Andeans. The community of Kaata specializes in curing by divination and ritual. These diviners are important for community health of Andeans. The communities of Curva and Chajaya specialize in herbal curing: these herbalists are important for treating physical causes. However, the diviners and herbalists complement each other in providing for the total health of Andeans.The final section deals with concrete suggestions of how certain features of Western medicine can functionally fit Andean economic and social structure.     

隐孢子虫和环孢菌与旅行者腹泻

腹泻是旅行中常见的医学问题。致病原以大肠杆菌为主,还有沙门氏杆菌、霍乱弧菌等。近年来发现环孢菌与隐孢子虫,也是一种引起腹泻的致病原。虽然它们不是旅行者腹泻的主要致病原,但是,它们引起腹泻的病程较长,尤其对有免疫缺陷的患者,可引起较严重的后果,故须对它们要有进一步的认识。