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Med Mal Infect ; 49(4): 257-263, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30583868


BACKGROUND: Travelers 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). METHODS: Vaccine 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. RESULTS: In 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. CONCLUSION: Obtaining 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.

Melhoria de Qualidade , Encaminhamento e Consulta , Medicina de Viagem , Cobertura Vacinal , Adolescente , Adulto , Idoso , Certificação , Criança , Estudos Transversais , Feminino , França/epidemiologia , Humanos , Esquemas de Imunização , Masculino , Registros Médicos/normas , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Melhoria de Qualidade/normas , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Viagem/estatística & dados numéricos , Medicina de Viagem/métodos , Medicina de Viagem/organização & administração , Medicina de Viagem/normas , Medicina de Viagem/estatística & dados numéricos , Cobertura Vacinal/organização & administração , Cobertura Vacinal/normas , Cobertura Vacinal/estatística & dados numéricos , Adulto Jovem
Prim Care ; 45(3): 541-554, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30115340


Most travel medical care is provided by patients' primary care physicians; only 10% of international travelers visit a travel clinic. The main purposes for travel include vacationing, visiting friends and family, business, and for educational purposes. The purposes of the pretravel consultation are to estimate risk and provide recommendations to mitigate risk.

Guias de Prática Clínica como Assunto , Medicina de Viagem/normas , Humanos , Viagem , Medicina de Viagem/métodos
Travel Med Infect Dis ; 22: 66-72, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29454050


Travellers with recognised disabilities or the dis-ability to function as required during a trip have been overlooked in the travel medicine literature. This paper provides a starting point for further discussion and research into this neglected traveller population. In contrast, tourism research has explored travel with a disability for some time in order to understand the travellers' needs and to improve services accordingly. The contemporary bio-psycho-social understanding of disability serves as the framework for exploring motivations to travel as well as barriers, such as inter and intrapersonal, economic, structural and attitudinal obstacles. The demands of complex travel planning are acknowledged. Attention is also drawn to the particular issue of acquired disability. The theoretical discussion is complemented by travellers' own accounts using as examples mobility impairment on aeroplanes, sensory impairments, and obesity. These insights should inform high quality travel health care starting with an exploration of the health professionals' own views on such endeavours. Important are appropriate communication skills, an understanding of the travellers'/carers' views, wishes and judgment of abilities, as well as the appreciation of the reason for the trip, destination and planned activities. Challenging may be the need to accept that the traveller/carer will be more knowledgeable about the disability, needs, potential problems and solutions than the health professional. Finally, medical requirements for destination and activity need to be combined with the medical requirements for the dis-abling condition. Scarce literature and increasing numbers of travellers with disabilities should make this field a research priority in travel medicine. Unless there is an absolute medical contraindication, travel health professionals should encourage and support travellers for whom travel is a challenge.

Pessoas com Deficiência , Medicina de Viagem/educação , Medicina de Viagem/normas , Viagem , Humanos
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 35(10): 617-623, dic. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-169560


Algunas enfermedades infecciosas han adquirido más relevancia por el aumento de los movimientos poblacionales. La eosinofilia es un hallazgo frecuente en inmigrantes y en viajeros. Una de las causas más frecuentes de eosinofilia es la infección por helmintos y algunos protozoos intestinales. El objetivo de este trabajo es describir las características epidemiológicas de los casos con eosinofilia y su asociación con la presencia de parásitos en la red de datos REDIVI. Se trata de un estudio observacional multicéntrico prospectivo, donde se incluyen los casos diagnosticados de eosinofilia registrados en la Red cooperativa para el estudio de las infecciones importadas por viajeros e inmigrantes (+REDIVI) desde enero de 2009 hasta diciembre de 2012. Se registraron en la red un total de 5.255 episodios durante el periodo de estudio, y la eosinofilia fue un hallazgo en el 8,1 al 31,3% de los casos (dependiendo del tipo migratorio). Fueron hombres el 60,2%, con una mediana de 31,0años, inmigrantes el 72,4% y asintomáticos el 81,2%. Los parásitos más frecuentemente identificados fueron S.stercoralis(34,4%), Schistosoma sp. (11,0%) y uncinarias (8,6%). Existía asociación entre eosinofilia y presencia de parásitos para todos los helmintos (excepto para larva migrans cutánea). La sintomatología y la duración del viaje no determinaron significativamente la presencia de eosinofilia. Ante una eosinofilia en una persona que ha vivido en zonas endémicas de helmintiasis es aconsejable realizar estudios dirigidos para su diagnóstico, independientemente del tipo migratorio, la duración de la estancia o la presencia de sintomatología (AU)

The population movements during the last decades have resulted in a progressively increasing interest in certain infectious diseases. Eosinophilia is a common finding in immigrants and travelers. One of the most common causes of eosinophilia is helminth infection, and some intestinal protozoa. The aim of this paper is to describe the epidemiological characteristics of cases with eosinophilia and its association with the presence of parasites in the REDIVI data network. This is a multicenter prospective observational study that includes patients diagnosed with eosinophilia registered in the cooperative network for the study of infectious diseases in travelers and immigrants (+REDIVI) from January 2009 to December 2012. A total of 5,255 episodes were recorded in the network during the study period, and eosinophilia was observed in 8.1-31.3% of cases (depending on the immigration group). There were 60.2% men, with a median age of 31years. There were 72.4% immigrants, and 81.2% were asymptomatic. The most commonly identified parasites were S.stercoralis (34.4%), Schistosoma sp. (11.0%), and hookworm (8.6%). The relationship between eosinophilia and parasite infection was significant for all helminths (except for cutaneous larva migrans). The symptoms and duration of the journey did not significantly determine the presence of eosinophilia. In the case of eosinophilia in a person who has lived in helminth endemic areas, it is advisable to carry out targeted studies to diagnose the infection, regardless of immigration type, length of stay, or the presence of symptoms (AU)

Humanos , Eosinofilia/epidemiologia , Eosinofilia/prevenção & controle , Saúde do Viajante , Fatores de Risco , Emigrantes e Imigrantes , Protocolos Clínicos , Doenças Transmissíveis/epidemiologia , Estudos Prospectivos , Eosinofilia/microbiologia , Medicina de Viagem/normas , Eosinofilia/parasitologia
J Travel Med ; 24(5)2017 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-28931151


Millions of patients travel internationally for medical and surgical care. We found that the annual number of centers accredited by the Joint Commission International increased from one center in 1999 to 132 centers in 2016; there are currently 939 accredited centers across 66 countries. Public health and medicolegal implications related to medical travel deserve attention.

Acreditação/tendências , Necessidades e Demandas de Serviços de Saúde , Medicina de Viagem/normas , Saúde Global , Humanos , Joint Commission on Accreditation of Healthcare Organizations , Estados Unidos
Travel Med Infect Dis ; 19: 37-48, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28712659


BACKGROUND: Immunocompromised and chronically ill travellers (ICCITs) are susceptible to travel related diseases. In ICCITs, pre-travel care regarding vaccinations and prophylactics is complex. We evaluated the protection level by preventive measures in ICCITs by analysing rates of vaccination protection, antibody titres, and the prescription of standby antibiotics. METHODS: We analysed, and reported according to STROBE guidelines, pre-travel care data for ICCITs visiting the medical pre-travel clinic at the Academic Medical Centre, The Netherlands from 2011 to 2016. RESULTS: We analysed 2104 visits of 1826 ICCITs. Mean age was 46.6 years and mean travel duration 34.5 days. ICCITs on immunosuppressive treatment (29.7%), HIV (17.2%) or diabetes mellitus (10.2%) comprised the largest groups. Most frequently visited countries were Suriname, Indonesia, and Ghana. Most vaccination rates were >90%. Of travellers in high need of hepatitis A and B protection, 56.6 and 75.7%, underwent titre assessments, respectively. Of ICCITs with a respective indication, 50.6% received a prescription for standby antibiotics. CONCLUSION: Vaccination rates in our study population were overall comparable to those of healthy travellers studied previously in our centre. However, regarding antibody titre assessments and prescription of standby antibiotics, this study demonstrates that uniform pre-travel guidelines for ICCITs are highly needed.

Hospedeiro Imunocomprometido , Medicina de Viagem/normas , Doença Relacionada a Viagens , Antibioticoprofilaxia , Anticorpos/sangue , Doença Crônica , Humanos , Países Baixos , Estudos Retrospectivos , Medicina de Viagem/estatística & dados numéricos , Vacinação
Rev Med Suisse ; 13(561): 934-937, 2017 May 03.
Artigo em Francês | MEDLINE | ID: mdl-28627850


As more and more quality of life becomes a goal of personnel and sustainable development, long-distance travel is becoming more widespread. Sailing around the world is an example of this evolution. The keys to a successful journey are rigorous preparation and adherence to some prevention rules. Medical or surgical emergencies are rare, and can often be dealt with by remote medical contact. New communication technologies such as satellite phones make it possible to seek medical advice from professionals, or even for sailers to treat themselves with very short prior training, provided that the required equipment and medicines have been embarked before leaving. Sophisticated rescue can also be organized. These technological innovations have changed the security and lives of sailors and explorers in remote areas of the world.

Serviços Médicos de Emergência/métodos , Navios , Medicina de Viagem , Emergências , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/normas , Guias como Assunto , Humanos , Medicina Preventiva/métodos , Medicina Preventiva/organização & administração , Viagem , Medicina de Viagem/métodos , Medicina de Viagem/organização & administração , Medicina de Viagem/normas
Rev Med Suisse ; 13(561): 938-943, 2017 May 03.
Artigo em Francês | MEDLINE | ID: mdl-28627851


Zika virus suddenly emerged in Latin America in 2015­2016. Congenital malformations have been observed in infected pregnant women, causing a major public health impact in affected countries, particularly in Brazil. In addition, sexual transmission of Zika virus has been well documented. This led to the development of prevention strategies and recommendations for travellers visiting at risk countries. These documents are regularly amended depending on the evolution of scientific knowledge, the epidemiologic trends and the national and international guidelines. Through practical cases, we present here the guidelines developed by the Geneva University Hospitals.

Guias de Prática Clínica como Assunto , Medicina de Viagem/normas , Infecção por Zika virus , Diagnóstico Diferencial , Serviços de Planejamento Familiar/normas , Feminino , Humanos , América Latina , Masculino , Gravidez , Medicina de Viagem/métodos , Medicina de Viagem/organização & administração , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/prevenção & controle , Infecção por Zika virus/terapia
Rev Med Suisse ; 13(561): 944-947, 2017 May 03.
Artigo em Francês | MEDLINE | ID: mdl-28627852


Antimicrobial resistance is a global problem which affects also tropical countries. Travelers to these regions expose themselves to the risk of being colonised and infected with multidrug-resistant bacteria. The region visited, the occurrence of diarrhoea and the use of antibiotics are the principal risk factors leading to colonisation with multidrug-resistant Enterobacteriaceae, which can affect up to 80% of travellers. Colonisation with meticillin resistant Staphylococcus aureus and vancomycin resistant enterococci are often due to contacts with the health care system of the visited country. For the practitioner evaluating a patient returning from abroad it is important to consider the risk of infection with multidrug-resistant bacteriae. Screening for these bacteriae in the stool or by mucocutaneous swabs can be discussed in certain situations.

Infecções Bacterianas , Farmacorresistência Bacteriana Múltipla , Viagem , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/epidemiologia , Humanos , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Fatores de Risco , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Medicina de Viagem/métodos , Medicina de Viagem/normas , Enterococos Resistentes à Vancomicina/patogenicidade
J Travel Med ; 23(4)2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27529092


Advancements in technology have led to the development of medical applications (apps). Contents of 44 apps related to travel medicine were assessed demonstrating that many were updated infrequently and several developers had no medical background. There is an opportunity for healthcare professionals to develop apps in travel medicine.

Aplicativos Móveis , Telemedicina , Medicina de Viagem/normas , Estados Unidos
J Travel Med ; 23(1)2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26782127


Risk assessment relies on the accuracy of the information provided by the traveller. A questionnaire was administered to 83 consecutive travellers attending a travel medicine clinic. The majority of travellers was uncertain about destinations within countries, transportation or type of accommodation. Most travellers were uncertain if they would be visiting malaria regions. The degree of uncertainty about itinerary potentially impacts on the ability of the travel medicine specialist to perform an adequate risk assessment, select appropriate vaccinations and prescribe malaria prophylaxis. This study reveals high levels of traveller uncertainty about their itinerary which may potentially reduce the effectiveness of their pre-travel consultation.

Antimaláricos/uso terapêutico , Malária/prevenção & controle , Medicina de Viagem/normas , Viagem , Adulto , Humanos , Irlanda , Projetos Piloto , Medição de Risco , Inquéritos e Questionários , Incerteza , Vacinação , Adulto Jovem
Rev. clín. esp. (Ed. impr.) ; 215(8): 439-445, nov. 2015.
Artigo em Espanhol | IBECS | ID: ibc-145002


Introducción. La crisis económica mundial condiciona la migración de trabajadores europeos hacia países en vías de desarrollo con alta incidencia de enfermedades infecciosas. El objetivo de este estudio es valorar si este contexto produce un aumento de los riesgos de los viajeros internacionales que se desplazan por motivos laborales (VML). Métodos. Estudio observacional retrospectivo. La población de estudio fueron los VML atendidos antes de su viaje en una Unidad de Salud Internacional durante los años 2007 (año anterior al inicio de la crisis europea) y 2012 (con la crisis estructural establecida). Se realizó un análisis comparativo sociodemográfico y de los factores de riesgo presentes entre ambos grupos. Resultados. En 2007 y 2012 se atendieron un total de 9.197 viajeros. Los VML fueron 344 (3,4%); en 2007, 101 (2,8%) y en 2012, 243 (4,5%) (p<0,001). La edad media de los viajeros fue de 38,1 (DE: 10,57) años. El destino más frecuente fue África subsahariana con 164 (47,6%) casos. Se prescribió quimioprofilaxis antipalúdica a 152 (44%) y presentaban comorbilidades 80 (23,25%). Los VML del 2012 presentaron significativamente mayor edad (p=0,05), más comorbilidades (p=0,018), y mayor proporción de estancias en zonas rurales (p=0,009) durante periodos más largos (p=0,001). Conclusiones. A 5 años del inicio de la crisis económica, existe una variación en el perfil del VML. Su número ha aumentado significativamente, así como la proporción de los que presentan factores de riesgo para contraer enfermedades importadas. Las Unidades de Salud Internacional deberían adaptarse a las nuevas circunstancias y adoptar medidas preventivas en dicho colectivo (AU)

Introduction. The economic world crisis has led to the migration of European workers to developing countries with a high incidence of infectious diseases. The objective of this study was to assess whether this context has produced an increase in the risks to international travelers for work reasons (TWR). Methods. Observational, retrospective study. The study population included TWR who were attended before traveling at an International Health Unit in the year 2007 (the year before the initiation of the European crisis) and in the year 2012 (when the structural crisis was established). A comparative socioeconomic analysis was performed as well as an analysis of the risk factors present in both groups. Results. In 2007 and 2012 a total of 9197 travelers were attended. Of these, there were 344 TWR (3.4%); 101 TWR (2.8%) in 2007 and 243 TWR (4.5%) in 2012 (p<.001). The average age of the travelers was 38.1 years (SD: 10.57). The most common destination was Sub-Saharan Africa, in 164 (47.6%) of the cases. Malaria chemoprophylaxis was prescribed to 152 travelers (44%) and 80 presented comorbidity (23.25%). The TWR from 2012 presented a significantly greater age (p=.05), more comorbidity (p=.018) and a greater proportion of stays in rural areas (p=.0009) for longer time periods (p=.001). Conclusions. At 5 years from the start of the economic crisis, there was a change in the profile of TWR. Their number has increased significantly, as has the proportion who present risk factors for contracting imported diseases. The International Health Units should adapt to these new circumstances and adopt preventive measures for this population (AU)

Feminino , Humanos , Masculino , Controle Sanitário de Viajantes , Saúde do Viajante , Medicina de Viagem/métodos , Medicina de Viagem/normas , Infecção/epidemiologia , Fatores de Risco , Estudos Retrospectivos , Controle de Infecções/tendências , Emigração e Imigração/tendências , Regulamento Sanitário Internacional
Aerosp Med Hum Perform ; 86(7): 657-8, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26102149


INTRODUCTION: Medical Guidelines for Airline Travel provide information that enables healthcare providers to properly advise patients who plan to travel by air. Treating physicians should advise patients in need of special services to contact the airline well before travel to find out if the required services will be available. Ensuring the required services are available throughout a journey can be challenging, especially when different airlines and aircraft types are involved. For example, airlines carry a limited supply of oxygen for use in the event of an unexpected in-flight emergency; however, this supply is not intended for use by passengers needing supplemental oxygen. Arrangements must be made in advance with the airline. Therefore, early contact with the airline is helpful.

Medicina Aeroespacial/métodos , Medicina Aeroespacial/normas , Viagem Aérea , Aeronaves/normas , Medicina de Viagem/normas , Guias como Assunto , Humanos , Oxigenoterapia
Rev. clín. med. fam ; 8(2): 145-146, jun. 2015. ilus
Artigo em Espanhol | IBECS | ID: ibc-140652


Estas historias de la LIBRETA DE VIAJE DEL MÉDICO DE FAMILIA, que forman una biblioteca del médico caminante o viajero emocional, son hojas sueltas en las que se escribe sobre paisajes y emociones; son un atlas de geografía emocional. La evocación de un paisaje ante la asistencia a un paciente –montañas, ríos, valles, playas, mares, desiertos, mesetas, islas, pantanos, cascadas, dunas, bosques, salinas, lagos, etc.-, con las sensaciones sentidas por el médico, de calor, frescor, humedad, dificultad, agobio, serenidad, inmensidad, soledad, etc. No es un diario, solo una libreta de apuntes con las vivencias del médico sobre los patrones y procesos de la consulta en un cierto caso clínico, que a su vez, puede ilustrar un prototipo de esa clase de casos (AU)

These stories of the FAMILY PHYSICIAN’S TRAVEL NOTEBOOK, which form a library of the walking doctor or emotional traveler, are loose sheets with writings about landscapes and emotions; they are an atlas of emotional geography. The evocation of a landscape before attending a patient –mountains, rivers, valleys, beaches, seas, deserts, plateaus, islands, swamps, waterfalls, dunes, forests, salt marshes, lakes, etc.-, with the sensations felt by the doctor -heat, coolness, humidity, hardship, stress, serenity, vastness, loneliness, etc. It is not a diary, only a notebook with the doctor’s experiences about the patterns and processes of consultation in a clinical case, which in turn may illustrate a prototype for this type of cases (AU)

Feminino , Humanos , Masculino , Medicina de Família e Comunidade , Medicina de Família e Comunidade/organização & administração , Medicina de Família e Comunidade/normas , Saúde do Viajante , Medicina de Viagem/métodos , Medicina de Viagem/organização & administração , Medicina de Viagem/normas , Emoções Manifestas/fisiologia , Medicina de Viagem/instrumentação , Medicina de Viagem