Travel Health Care for Immigrant Children Visiting Friends and Relatives Abroad: Retrospective Analysis of a Hospital-Based Travel Health Service in a US Urban Underserved Area

Background. There is a lack of studies evaluating pre-travel health care for children who travel to visit friends and relatives (VFR). We evaluated travel health services provided to children VFR travelers (CVFRs) as compared with adult VFR travelers (AVFRs). CVFRs and AVFRs were also compared with children and with adults traveling as tourists (CTs and ATs, respectively), to explore relevant differences within each age group between VFRs and tourist travelers.
Methods. Retrospective chart review of all pre-travel consultations from March 2005 to July 2006 at the Bronx-Lebanon Hospital Center travel health clinic, Bronx, New York.
Results. Of 204 pre-travel consultations, 51% comprised CVFRs, 20% AVFRs, 7% CTs, and 23% ATs. About 54, 44, 57, and 30% of CVFRs, AVFRs, CTs, and ATs, respectively, presented within 14 days of departure. CVFRs were more likely than AVFRs and CTs to plan long-term travel (> 6 months). CVFRs and AVFRs traveled mostly to West Africa (75 and 73%) in contrast to CTs and ATs (7 and 35%). Mefloquine was the most frequently prescribed antimalarial medication overall (70%) and among CVFRs (94%). Yellow fever vaccine was most frequently administered overall and to CVFRs and AVFRs followed by hepatitis A, typhoid fever, and meningococcal vaccine. CTs were more likely than CVFRs to receive rabies vaccine. Delayed yellow fever administration (< 10 d before departure) was noted for 48% of CVFRs and 33% of AVFRs.
Conclusions. CVFRs frequently plan to travel for long-term trips to West Africa and present late for pre-travel care. Routine screen for high-risk travel activities and coordination of pre-travel care within the routine preventive health care may improve the effectiveness of the travel health services.     

Health Problems of Corporate Travelers: Risk Factors and Management

Background: Numerous studies have been done regarding health problems experienced by tourists in developing countries; however, little data exist about these health risks and illnesses experienced by corporate travelers.
Methods: The authors examined by electronic survey the health risks encountered, compliance with pretravel health recommendations, and illnesses and injuries experienced by employees of the Coca-Cola Company who travel internationally.
Results: Two hundred twenty-six travelers responded. Although most travelers ate meals at their hotels and chose foods that were cooked and still hot, over half also ate foods that remained at room temperature for prolonged periods and/or ate from cold salad bars. Almost half drank untreated tap water. Thirty-five percent of travelers developed diarrhea and 29% reported respiratory illnesses, with 12% seeking medical attention for their problems. Forty-three percent of those traveling to malarious regions admitted to noncompliance with antimalarial recommendations. Health kits provided were used by only 51% of travelers.
Conclusions: Although many corporate travelers followed pretravel health recommendations, some did not. Injuries, fever, and illnesses such as diarrhea and respiratory infections occurred. Strategies to improve access to the travel clinic and the acquisition of health information and travel health kits are being implemented. The health risks and behaviors of corporate travelers, including the potential impact of psychosocial stressors, need greater attention.     

Compliance of malaria chemoprophylaxis among travelers to India

Background: Compliance is an important issue in malaria chemoprophylaxis. The objective of the study was to determine reasons for noncompliance with chemoprophylaxis among international travelers to India.
Methods: A group of 452 subjects traveling in the subcontinent were interviewed by directly administered questionnaire at two selected locations in Calcutta during October 1992. Full compliance was defined as the uninterrupted use of drugs, as per the World Health Organization (WHO) schedule, during travel up to the date of interview.
Results: Overall, the sample had a male preponderance (61%), with 155 (34%) being business travelers and 56% traveling for more than 3 weeks. Of the 158 (35%) reporting illness during travel, 5 persons tested positive for malaria. Compliance with chemoprophylaxis noted among 320 (71%) respondents in comparison to 21 (5%) found taking inadequate dosage or incorrect medication and 111 (24%) travelers being without any drugs. Backpackers and ethnic travelers as a group reported lower usage. Female, first visit and long-term travelers were less compliant. Inadequacy in pretravel advice, discontinuation due to side effects and active decision despite pretravel advice were common reasons for noncompliance. Past travel experience, concern for side effects, perceived uselessness and confusion arising from alternative regimens were also found to have influenced the decision making.
Conclusion: We need to address the identified areas of conflict especially during pretravel counseling since improving compliance is our primary goal in malaria prevention among travelers today.     

Travel health knowledge, attitudes and practices among Australasian travelers

BACKGROUND: Although the Asia Pacific region is the focus of the fastest-growing tourist and travel industry, few data are available on the knowledge, attitudes and practices (KAP) of travelers from this region with regard to travel-related infectious diseases. METHODS: We conducted a cross-sectional survey among travelers at the departure lounges of five airports in Australasia (Singapore, Kuala Lumpur, Taipeh, Melbourne, Seoul) whose travel destinations were Asia, Africa or South America. Two standardized questionnaires directed towards KAP in travel health, travel immunizations and malaria were administered. RESULTS: Of 2,101 respondents (82% Asian, 17% Western), 31% had sought pretravel health advice and only 4% sought travel health advice from the travel medicine specialist. The risk of vaccine-preventable infectious diseases and malaria at the destination country was perceived to be low. Overall, fewer than 5% of travelers had been vaccinated in preparation for their trip. The most frequent travel vaccinations were for hepatitis A and B. Only 40% of travelers to malaria-endemic areas carried malaria prophylaxis. Compared to Western travelers, those of Asian nationality were significantly less likely to obtain pretravel advice and malaria prophylaxis and to receive travel vaccinations. CONCLUSION: There is an urgent need for increased awareness about travel-related infectious diseases among Asian travelers, and greater uptake of pretravel health advice, vaccinations and malaria prophylactic measures.     

Travel Illness and the Family Practitioner: A Retrospective Assessment of Travel-Induced Illness in General Practice and the Effect of a Travel Illness Clinic

Background: As the recognition of the discipline of Travel Medicine grows with increased international travel, an examination of both the value of pretravel advice as well as the general practitioner's role in preparation for, care during, and diagnosis and treatment after travel is necessary. This study was conducted to determine the incidence of travel-related illness in a typical urban population in Scotland and to examine the efficacy of our pretravel clinic related to reduction of illness, preparedness of our patients for travel, and the effects of our travel clinic on the workload generated by the returning ill in our practice.
Methods: In this retrospective study, 1568 patients, presenting within a 1-year period from 1992–1993 at a medical practice and 100 patients at a travel clinic were studied. Their morbidity rates and, therefore, the effect of the travel clinic on prophylaxis and pretravel advice were determined.
Results: In the practice sample, 42% of travelers became ill while abroad, with 48% of ill travelers returning to consult their family doctor at home. Travelers to Africa and Asia were shown to have the highest rates of illness. Travel clinic attendees were more likely to be traveling to high-risk destinations, but were better prepared, experiencing a significantly lower rate of illness during travel (22%). Clinic attendees were less likely to consult their doctor on return home, preferring instead to resolve their illness by self-medication.
Conclusions : The results suggest that travel clinics significantly reduce the morbidity of illness for travelers and that the burden on general practices could be reduced with the pretravel advice and prophylaxis that travel clinics provide.     

Health Behavior of International Travelers to Calcutta: Identifying the Need for a Travelers' Clinic

Background : With the growing rates of travel and, potentially therefore, of travel-related illness in India, this study was conducted to establish both the need of a travelers' clinic in Calcutta and a profile of the group or groups at risk of illness best served by such facilities.
Methods: A total of 452 visitors, half business and package holiday travelers (group A) and half younger, low-budget tourists with less pretravel advice (group B), were compared. Through a questionnaire, their health, pretravel advice and prophylaxis, use of first aid, safe water use, posttravel treatment, and opinion concerning the need for a travelers' clinic were determined.
Results: Group A travelers stayed in deluxe hotels with more pretravel advice (90% compared to 72% in group B), were taking antimalarial agents (82% compared to 61% in group B), remained healthy (72% compared to 58% in group B), consumed safe water (87% compared to 47% in group B), and were more likely to seek posttravel treatment (75% compared to 60% in group B). The Group B travelers, consequently, felt an increasing need for a travelers' clinic (92% compared to 82% in group A).
Conclusions: Given the complexities of travel in India, there is a palpable need for appropriate medical attention to travelers, especially among the young, budget tourists, which is best provided at a traveler's clinic.     

Sexual risk behavior of travelers who consulted a pretravel clinic

Objective.  The objective of this study was to determine to which degree travelers who received pretravel advice at a travel clinic have protected or unprotected sexual contact with a new partner and what factors influence this behavior.
Method.  An anonymous questionnaire was sent to travelers who came to a pretravel clinic between June 1 and August 31, 2005. Risk factors for casual travel sex and predictors of protected sex were studied in a multivariate model.
Results.  A total of 1,907 travelers were included (response rate 55%) in the study. Only 4.7% of the respondents had sexual contact with a new partner, and 63.1% of these new partners were from the country of destination. Of those who had casual travel sex, 52.4% did not expect this (women 75%), 30.9% did not always use condoms, and 41% were not protected against hepatitis B. Independent risk factors for casual travel sex were traveling without steady partner (OR 14.4), expecting casual travel sex (OR 9.2), having casual sexual contacts in the home country (OR 2.4), non-tourist journeys (OR 2.2), being male (OR 2.1), the fact that the information on sexually transmitted infections (STI) had been read (OR 2.0), and traveling to South and Central America (OR 2.0). Taking condoms along (OR 5.4) and reading the information on STI (OR 3.3) were identified as independent predictors of protected sex.
Conclusions.  Travelers have substantial sexual risk behavior. Casual sex is usually not expected, and the most important predictor is traveling without a steady partner. We would advice every client of a travel clinic who will travel without a steady partner to read the STI information, to take condoms along, and to be vaccinated against hepatitis B.     

Hepatitis A Risk in Travelers

Background.  Traveling to highly endemic areas for hepatitis A is increasing while the immunization level in travelers has been shown to be low in the countries studied.
Methods.  In this population-based study, we have estimated the incidence rate of travel-related hepatitis A during 1997 to 2005 by use of the Swedish notification system of communicable diseases and an ongoing national database on travel patterns. We have also acquired airport-based immunization data from 2007.
Results.  During the study period, 636 cases of travel-related hepatitis A were notified. Traveling to East Africa was associated with the highest incidence rate (14.1 cases/100,000 person months), followed by the Middle East (5.8/100,000 person months), and India with neighboring countries (5.6/100,000 person months). Visiting Friends and Relatives (VFR) travelers represented 83, 91, and 70% of the cases to these three regions. By age-group, the highest incidence was found in children 0 to 14 years (3.1/100,000 travelers) where 88% of the cases were VFR travelers. Incidence rate in unprotected travelers to East Asia, North Africa, and the Middle East was 2, 12, and 18 cases/100,000 person months, respectively. In 2007, 79% of the travelers were immunized against hepatitis A.
Conclusions.  We conclude that travelers, and especially children, who are VFR in endemic areas constitute a high-risk group for acquiring hepatitis A infection, while the risk for unprotected tourists to East Asia is low.     

Immunity to hepatitis A and hepatitis B in Indian and Chinese immigrants seen in a travel clinic in Massachusetts, United States

Background.  Immigrants to the United States from developing countries have a higher probability of previous infection with hepatitis A virus (HAV) and/or hepatitis B virus in their countries of origin. Prior knowledge of hepatitis A and B seroprevalence in this population may aid in determining the need for pretravel immunizations when these individuals travel to endemic regions.
Methods.  We conducted a retrospective analysis of hepatitis A and B serologies in a travel clinic population (from March 1999 through September 2002) to determine the seroprevalence in our predominantly highly educated foreign-born subjects.
Results.  All our patients who had immigrated from China and India and who were older than 60 years (born on or before 1940) were immune to hepatitis A. The Indian and Chinese subjects who were anti-HAV positive were also significantly older than the anti-HAV negative group. In addition, in our Indian study group, the hepatitis A–seropositive individuals first left India at a significantly older age than the hepatitis A–seronegative group (mean age 22.7 years vs 11.4 years, p < 0.05). Our small sample size of Chinese subjects may not have permitted a statistically significant difference to be detected for hepatitis A seroprevalence and age at departure from their country of origin.
Conclusions.  These results have helped tailor our recommendations for pretravel immunizations for our groups of foreign-born individuals planning to visit endemic areas. Individuals born in China or India on or before 1940 are likely to have preexisting antibody to hepatitis A and probably do not need the vaccine when they travel. Younger individuals may elect to have a hepatitis A antibody titer checked before getting the vaccine.     

Travelers' knowledge,attitudes, and practices on prevention of infectious diseases: results from a pilot study

BACKGROUND: The European Travel Health Advisory Board conducted a cross-sectional pilot survey to evaluate current travel health knowledge, attitudes, and practice (KAP) and to determine where travelers going to developing countries obtain travel health information, what information they receive, and what preventive travel health measures they employ. METHOD: Trained interviewers invited passengers at the departure gates of three international airports: London Heathrow, Paris Charles de Gaulle, and Munich to respond to a self-completion questionnaire. A total of 609 responses were collected. RESULTS: The study showed that more than one-third of travelers questioned had not sought pretravel health advice and of those who did, over 20% sought advice 14 days or less prior to travel. One-third of the respondents were aged 50 or more, and 20% had planned their trip less than 2 weeks before leaving. Only a minority were able to demonstrate that they had been immunised as per the World Health Organization or national recommendations. Respondents often misperceived both the risk of malaria at the destination and recommended preventive measures. CONCLUSIONS: The results of this pilot survey provided a valuable insight into the KAP of travelers and highlighted an important educational need among those traveling to risk destinations. Strategies are needed for raising awareness of preventable travel health issues and for raising compliance with existing recommendations.     

Enterotoxigenic Escherichia coli heat-labile toxin seroconversion in US travelers to Mexico

Background and Aims.  Enterotoxigenic Escherichia coli (ETEC) is the most common bacterial pathogen isolated from travelers suffering of diarrhea. Exposure to heat-labile toxin (LT) produces a high rate of seroconversion. However, the role of LT-producing ETEC (LT-ETEC) as a cause of diarrhea is controversial. We conducted a cohort study in US students traveling to Mexico to assess the ETEC-LT seroconversion rate after natural exposure.
Methods.  Participants provided a serum sample on arrival and departure and a stool sample when ill. ETEC-LT immunoglobulin G antibodies were measured by enzyme-linked immunosorbent assay, and LT-ETEC were detected by means of polymerase chain reaction done on fecal DNA.
Results.  A total of 422 participants with a mean age of 34.5 years were followed a mean of 19.9 days; 304 were females (72.0%), and 319 (75.6%) traveled during the summer months. In total, 177 individuals (41.9%) developed travelers' diarrhea and 33.9% had LT-ETEC identified in their stools. Among individuals having an LT-ETEC strain, 74% seroconverted compared to 11% of those not having diarrhea ( p < 0.0001). When analyzed with a logistic regression model, the odds of seroconversion were significantly reduced in participants not having LT-ETEC in their stool (odds ratio = 0.1, p < 0.0001) after adjusting for season, length of stay, age, gender, race, and ethnicity.
Conclusion.  In US young adults traveling to Mexico, ETEC-LT seroconversion reliably identifies individuals naturally exposed to ETEC and correlates with symptomatic illness, length and season of travel.     

Korean travelers' knowledge, attitudes, and practices regarding the prevention of malaria: measures taken by travelers departing for India from Incheon International Airport

BACKGROUND: Although many Koreans travel each year to countries where malaria is present, few data are available on the knowledge, attitudes, and practices of Koreans with regards to malaria. METHODS: The study was conducted in the departure lounge of Incheon International Airport in May 2006. A 22-item questionnaire was administered to Korean travelers whose travel destination was India. RESULTS: Of 188 respondents, 24% had sought pretravel health information. Independent predictors for seeking pretravel health information were the following: being a Korean woman, longer duration of travel, planning to travel independently or to a rural area, and perceived risk of malaria. A total of 47% of travelers answered that they had not perceived any risk of malaria, and only 7% of travelers carried malaria prophylaxis. CONCLUSIONS: There is an urgent need for increased awareness about travel-related infectious diseases (especially malaria) among Korean travelers, and they should be encouraged to seek pretravel health information.     

Pretravel advice and hepatitis A immunization among Australian travelers

BACKGROUND: More Australians are traveling to overseas destinations where preventable infectious diseases, such as hepatitis A, are endemic. Yet, there is only limited data concerning the extent to which Australians seek travel advice and vaccination before their departures. METHOD: Annual telephone surveys were conducted among adult Australians travelers. Information was collected on the travel advice and vaccinations received before departure. Perceptions about, and their potential exposure to, travel-related infections while overseas were also assessed. This paper presents data from the 2003 survey related to travel advice and hepatitis A, while hepatitis B is discussed in the companion article. RESULTS: Only a third of interviewees had sought health advice before travel. Infrequent travelers, those departing for endemic countries or for longer journeys, were more likely to seek medical advice. Overall, 32% of interviewees had been vaccinated against hepatitis A, with travelers to high/medium-hepatitis A endemicity destinations being more likely to be vaccinated than those visiting low-endemicity countries (44% vs 20%). Among the 263 visitors to endemic countries, those who stayed with friends and relatives were least likely to be vaccinated against hepatitis A compared to other styles of accommodation. CONCLUSIONS: Despite government recommendations and industry group campaigns about the need for pretravel advice, the majority of Australians travel overseas without adequate health advice and protection against hepatitis A and other travel-related infectious diseases.     

Risk and spectrum of diseases in travelers to popular tourist destinations

BACKGROUND: Traveling to tropical regions is related to increased health risks. Travelers' diarrhea is the most frequent health problem, but the range of travel-related diseases also includes potential life-threatening diseases such as malaria. The actual risk of European travelers acquiring specific infectious diseases and other hazards in the tropics is to a large extent unknown and is therefore often adopted from that of the indigenous population. The objective of this study was to elucidate the risk for travel-related diseases, symptoms, and accidents in a population of Europeans who travel to popular tourist destinations. METHODS: From July 2003 to June 2004, 794 travelers consulting the travel clinic of the Berlin Institute of Tropical Medicine were recruited for a questionnaire-based observational study before traveling to Kenya, Tanzania, Senegal, the Gambia, India, Nepal, Thailand, or Brazil. RESULTS: Overall, illness was reported by 42.9% of travelers, with 10.2% reporting more than one adverse health event. Most frequently gastrointestinal symptoms were noted (34.6%), followed by respiratory symptoms (13.7%). More than 5% experienced an accident. Travel to the Indian subcontinent nearly doubled the risk of becoming ill; travel to Thailand significantly decreased the risk. Additional risk factors were a long duration of staying abroad, young age, and traveling under basic conditions. Of all travelers, 80% did not follow the traditionally recommended dietary restrictions. Among travelers visiting malaria-endemic areas, 20% did not carry any antimalarial drugs with them, not continuous chemoprophylaxis or standby medication. CONCLUSIONS: Because of the rising travel activity, especially to tropical countries, the importance of qualified pretravel advice consultation is increasing. To improve the travelers' health, attention needs to be paid to individual risk factors, the prevention and therapy of travelers' diarrhea, malaria prophylaxis, management of respiratory illness, and personal safety.     

Prospective analysis of parasitic infections in Canadian travelers and immigrants

BACKGROUND: International travel is associated with increased risk of vector-borne illnesses, particularly malaria. The objective of this study was to prospectively assess the relative frequency of parasitic diseases in Canadian travelers and to characterize demographic and travel-related predictors of these infections. METHODS: Data on Canadians and new immigrants who crossed international borders and were seen in the Tropical Disease Unit of Toronto General Hospital between November 1997 and June 2003 were prospectively collected and entered into the GeoSentinel Surveillance Network database. RESULTS: Of 3,528 returned Canadian travelers and new immigrants in the database, 1,010 had a parasitic infection diagnosed. Mean age of the 3,528 travelers was 37.3 years, and 42.6% were male. Those diagnosed with parasitic infections were more likely than the remaining cohort to have been traveling for the purpose of immigration (21.1% vs 7.1%, p < 0.001), or visiting friends and relatives (VFR) (17.9% vs 11.8%, p < 0.01). Common parasitic infections included nonhistolytica amebiasis (N= 209), malaria (N= 143), cutaneous larva migrans (N= 105), giardiasis (N= 74), and schistosomiasis (N= 48). CONCLUSIONS: Parasitic infections occurred in 29% of Canadian travelers. New immigrants and VFRs are at increased risk for malaria, as well as protozoal and helminthic infections.     

Prevalence of travel related illness amongst a group of Chinese undergraduate students in Hong Kong

BACKGROUND: Regional and global travel by Asian residents is increasing. Young people seeking new experiences through travel may be particularly at risk of a wide spectrum of health problems. This study assesses travel-associated health risks and examines the prevalence and likely impact of pretravel health advice among Chinese undergraduate students in Hong Kong. METHODS: Year 1 and year 3 undergraduate students of the University of Hong Kong were surveyed during September to December 1996, using a structured self-administered questionnaire. A total of 1,067 subjects were required to give a power of 95% (p =.50+/-3%). RESULTS: Of 1,197 students (514 male and 680 female) surveyed, 52% had traveled outside Hong Kong at least once within the previous 12 months. Of these travelers (n = 578), 41% had developed one or more health problems, 7% had to consult a doctor and 2% needed hospitalization during travel, and 8% developed health problems within 2 weeks of returning for which they had to consult a doctor. Most (75%) took no pretravel health advice and 48% took no travel health precautions. About half (41%) of those who received advice received this from nonexpert sources. Those more likely to develop health problems were aged over 20 years (Odds Ratio, 1.49, 95% confidence interval, 1.06-2.10), in financial difficulties (1.60, 1.02-2.51), ever-smokers (1.69, 1.03-2.77), reporting poorer current health status (1.64, 1.04-2.57). Also, those who sought health advice from nonprofessional sources (2.13, 1.03-4.01) and took precautions (1.88, 1.33-2.63) were more likely to develop health problems. CONCLUSIONS: This study demonstrated that young Chinese adults, with the benefits of higher education, are potentially at risk of a variety of avoidable travel-related health problems. Taking pretravel health advice from nonprofessional sources was common among respondents, but taking precautions did not reduce health problems. The comprehensibility and effectiveness of the advice and appropriateness of precautions taken need scrutiny in randomized trials. Specific topics for pretravel health education that will target higher risk travelers with preventive messages need to be identified and evaluated.     

Risk of exposure to hepatitis B and other blood-borne viruses among Australians who travel abroad

BACKGROUND: European studies indicate that up to 67% of travelers traveling abroad participate in activities that put them at risk of exposure to hepatitis B. Australians are increasingly traveling to destinations where hepatitis B is highly endemic, such as Asia, and are likely to have similar levels of involvement in activities with an associated risk of hepatitis B exposure. METHOD: A series of annual telephone surveys of approximately 500 randomly selected Australian overseas travelers have been conducted under the auspice of the Travel Health Advisory Group over the years 2001 to 2003. The surveys examined the extent to which travelers seek pretravel health advice, what immunizations they receive and what risks they are exposed to during travel including the risk of hepatitis B and other blood-borne virus acquisition. RESULTS: In the 2003 survey, 281 (56%) of the 503 people interviewed had visited at least one country with high or medium hepatitis B endemicity on their most recent overseas trip in the past two years. Approximately a third of travelers undertook one or more activities that were considered to be associated with increased risk of potential hepatitis B exposure. Less than half the travelers (46%) had been vaccinated against hepatitis B. CONCLUSIONS: The results have implications for the individual traveler, as well as to the broader community. Infected travelers can be an important source of hepatitis B into their own home communities. Improved advice and clear recommendations for hepatitis B vaccination are needed to avoid infection.     

Knowledge, Attitudes, and Practices of French Travelers from Marseille Regarding Rabies Risk and Prevention

Objective.  To assess the awareness of the mode of rabies transmission, travel-associated rabies risk, and adequate preventive measures among French travelers.
Methods.  Three hundred travelers were administered a detailed questionnaire prior to pretravel advice, addressing their knowledge, attitudes, and practices (KAP) with respect to animal-related injuries and rabies risk. Two hundred and nine were administered a post-travel questionnaire by telephone, addressing the occurrence of contacts with animals during travel.
Results.  Countries visited were at risk for rabies in 84.7% of the cases. Only 6.7% of travelers knew that the risk of rabies was important, while 40.1% considered it moderate or low. Dog bites appeared to be a well-known mode of transmission of rabies. By contrast, licks on broken skin or contamination of the mucous membrane with saliva (10%) and scratches (0.7%) were rarely known. Cats (23.7%), foxes (28.3%), monkeys (10.3%), and bats (5.0%) were rarely mentioned as possible rabies vectors. Only 50.7% of travelers were aware of the preventive vaccination. Approximately 57.6% of individuals traveling to rabies–endemic countries presented to the clinic less than 21 days before departing, rendering a complete preventive vaccination against rabies unfeasible. Immediate washing of the injury with water and soap was mentioned by only 3.0% of individuals and self-disinfection with antiseptics by 21.3%. Of those who traveled in a rabies-risk country, 3.8% declared that they had been attacked by animals; however, none was injured. Animal encounters were frequent with dogs (53.8%), monkeys (39.5%), bats (17.9%), and cats (15.4%).
Conclusions.  The KAP of French travelers with regard to travel-associated rabies risk need to be improved, particularly regarding the prevention of animal bites, postbite measures, and their urgency.     

Use of Malaria Prevention Measures by North American and European Travelers to East Africa

BACKGROUND: The use of preventive measures, including effective chemoprophylaxis, is essential for protection against malaria among travelers. However, data have shown that travelers and medical advisors are confused by the lack of uniform recommendations and numerous prophylactic regimens of varying effectiveness that are used. METHODS: To assess the use and type of preventive measures against malaria, we conducted a cross-sectional study in 1997 among travelers departing from the Nairobi and Mombasa airports in Kenya with European destinations. RESULTS: Seventy-five percent of the travelers studied were residents of Europe and 25% were residents of North America; all stayed less than 1 year, and visited malarious areas. Most travelers, 97.1%, were aware of the risk and 91.3% sought pretravel medical advice. Although 95.4% used chemoprophylaxis and/or antimosquito measures, only 61.7% used both regular chemoprophylaxis and two or more antimosquito measures. Compliance with chemoprophylaxis was lowest amongst those who used a drug with a daily, as opposed to, a weekly dosing schedule, stayed more than 1 month, attributed an adverse health event to the chemoprophylaxis, and were less than 40 years of age. Among US travelers, 94.6% of those taking chemoprophylaxis were taking an effective regimen, that is, mefloquine or doxycycline. Only 1.9% used a suboptimal drug regimen, such as chloroquine/proguanil. Among European travelers, 69% used mefloquine or doxycycline, and 25% used chloroquine/proguanil. Notably, 45.3% of travelers from the UK used chloroquine/proguanil. Adverse events were noted by 19.7% of mefloquine users and 16.4% of travelers taking chloroquine/proguanil. Neuropsychologic adverse events were reported by 7.8% of users of mefloquine and 1.9% of those taking chloroquine/proguanil. The adverse events, however, had a lesser impact on compliance than frequent dosing schedule. CONCLUSIONS: Health information should be targeted to travelers who are likely to use suboptimal chemoprophylaxis or may be noncompliant with prophylaxis. Uniform recommendations for effective chemoprophylaxis with simple dosing schedules are necessary to reduce rates of malaria among travelers to Africa.