Yellow fever - prevention in travellers.

BACKGROUND: Yellow fever is a mosquito borne flaviviral haemorrhagic fever endemic to parts of Africa and South America. One in seven patients develop severe, frequently fatal disease characterised by multi-organ involvement. OBJECTIVE: This article outlines the clinical features, epidemiology, prevention and vaccine recommendations for yellow fever in order to assist the general practitioner when providing travel medicine advice to patients. DISCUSSION: Travellers are at risk of yellow fever in endemic areas, especially in forested and rural regions and during urban outbreaks. In addition to antimosquito measures, it is important to prevent yellow fever by vaccinating where there is true risk, or where it is required by international health regulations. However, the vaccine is associated with rare but severe adverse reactions and the need for vaccination should be carefully evaluated.

Rabies - prevention in travellers.

UNLABELLED: This article forms part of our travel medicine series for 2010, providing a summary of prevention strategies and vaccination for infections that may be acquired by travellers. The series aims to provide practical strategies to assist general practitioners in giving travel advice, as a synthesis of multiple information sources which must otherwise be consulted. BACKGROUND: Rabies is an acute, almost invariably fatal, progressive encephalomyelitis caused by neurotropic lyssaviruses of the Rhabdoviridae family. OBJECTIVE: Rabies prevention, vaccines and postexposure prophylaxis are discussed, and information regarding vaccines, immunoglobulin products and vaccine regimens that may be encountered overseas is also given. DISCUSSION: Rabies viruses are present in most parts of the world, although it is mainly a problem in developing countries with more than 50,000 people dying from rabies each year, usually after a dog bite. All travellers require education regarding rabies prevention if travelling to an endemic area, and those at high risk of exposure should be offered pre-exposure vaccination.

Japanese encephalitis - prevention in travellers.

This article is the fourth in a series providing a summary of prevention strategies and vaccination for infections that may be acquired by travellers. The series aims to provide practical strategies to assist general practitioners in giving travel advice, as a synthesis of multiple information sources which must otherwise be consulted. Japanese encephalitis (JE) is a potentially fatal arboviral infection prevalent in large parts of Asia, as well as Papua New Guinea and the outer Torres Strait Islands. It is the commonest cause of encephalitis worldwide. Although it seldom affects travellers, its serious consequences and at times unpredictable epidemiology make its prevention an important part of the pre-travel consultation. The phasing out of the previously used mouse brain derived inactivated JE vaccine, and the availability of new, safer vaccines now and in the near future, have prompted a reassessment of vaccination recommendations internationally to include a greater number of travellers.

Typhoid and paratyphoid fever - prevention in travellers.

UNLABELLED: This article forms part of our travel medicine series for 2010, providing a summary of prevention strategies and vaccinations for infections that may be acquired by travellers. The series aims to provide practical strategies to assist general practitioners in giving travel advice, as a synthesis of multiple information sources which must otherwise be consulted. BACKGROUND: Typhoid and paratyphoid (enteric) fever, a potentially severe systemic febrile illness endemic in developing countries, is associated with poor sanitation, reduced access to treated drinking water and poor food hygiene. It is one of the leading causes of infectious disease in the developing world. OBJECTIVE: This article discusses the clinical features and prevention opportunities for typhoid and paratyphoid fever. DISCUSSION: Travellers to developing countries are at risk of infection. This risk varies from 1:30 000 for prolonged stays in endemic regions to 1:3000 in high endemicity areas such as the Indian subcontinent, where risk is highest. The mainstay of prevention is hygiene and food and water precautions. Vaccines against typhoid fever are discussed. However, when used alone they provide incomplete protection. Treatment and future developments in typhoid fever diagnostics and vaccines are also briefly discussed to provide a general overview of typhoid fever and its prevention for use in travel related consultations in general practice.

Hepatitis A - prevention in travellers.

BACKGROUND: Hepatitis A is the second most common vaccine preventable infection in travellers. Highly effective vaccines exist for its prevention for travellers from 12 months of age, including last minute travellers and those in special risk groups. OBJECTIVE: Information about hepatitis A infection, its epidemiology and existing vaccine options is presented for use in travel related consultations in general practice. DISCUSSION: Most travellers at risk of hepatitis A should be vaccinated, as the vaccine is a safe and effective means of prevention. Combination vaccines - hepatitis A/hepatitis B and hepatitis A/typhoid - aim to facilitate the vaccination process for travellers, who are often also at risk of exposure to hepatitis B and typhoid fever.

Cholera - recommendations for prevention in travellers.

This article about cholera is part of our travel medicine series for 2010, providing a summary of prevention strategies and vaccination for infections that may be acquired by travellers. The series aims to provide practical strategies to assist general practitioners in giving travel advice, as a synthesis of multiple information sources which must otherwise be consulted. Cholera is a severe diarrhoeal disease associated with worldwide pandemics. It affects vulnerable populations who lack adequate quality drinking water and sanitation. Travellers are generally at low risk of contracting cholera, even in endemic areas. It is prevented with general water and food precautions (also advisable for prevention of traveller's diarrhoea). In some situations, the oral killed whole cell B subunit vaccine may be recommended for travellers considered at risk.

Tuberculosis--prevention in travellers.

UNLABELLED: This article on tuberculosis forms part of our travel medicine series for 2010, providing a summary of prevention strategies and vaccinations for infections that may be acquired by travellers. The series aims to provide practical strategies to assist general practitioners in giving travel advice, as a synthesis of multiple information sources which must otherwise be consulted. BACKGROUND: Tuberculosis is a disease of significant worldwide prevalence, morbidity and mortality. Multi-drug resistant and extensively drug resistant strains, poverty, and co-endemic human immunodeficiency virus infection have hampered efforts to reduce transmission worldwide. OBJECTIVE: To outline risk assessment of tuberculosis infection for travellers and discuss potential interventions. DISCUSSION: Long term travellers to areas of high tuberculosis incidence are potentially at risk of contracting the disease. Infants and children are particularly at risk of severe complications of tuberculosis. There is no consensus about methods to prevent tuberculosis. Health practitioners need to carefully consider the risks and benefits for their patients. Possible strategies include education, personal protection devices, BCG vaccination, tuberculin (Mantoux) skin testing and testing with newer interferon-gamma release assays.

Meningococcal meningitis - prevention in travellers.

This article is the first in a series providing a summary of prevention strategies and vaccination for infections that may be acquired by travellers. The series aims to provide practical strategies to assist general practitioners in giving travel advice, as a synthesis of multiple information sources which must otherwise be consulted.

Poliomyelitis--prevention in travellers.

This article is the second in a series providing a summary of prevention strategies and vaccination for infections that may be acquired by travellers. The series aims to provide practical strategies to assist general practitioners in giving travel advice, as a synthesis of multiple information sources which must otherwise be consulted. Poliomyelitis is a potentially fatal viral illness, which may cause acute flaccid paralysis and permanent central nervous system damage. Ongoing global efforts to eradicate poliomyelitis have been under way since 1988. Travellers are at risk of infection in countries with endemic wild poliomyelitis virus or imported cases, and can spread the infection to areas where poliomyelitis has been eradicated. While all adults should be immune to poliomyelitis, it is important that at-risk travellers are vaccinated appropriately. Vaccine options and regions currently reporting poliomyelitis are presented from a number of sources, which may facilitate the process of giving travel advice in a general practice setting, although it is also important to seek up-to-date epidemiological information.