February 28, 2001
Travel
Health—A Resource for the Business Traveler
Peter P. Greaney, MD
Board-Certified Occupational Physician
President, WorkCare
International business
travelers are perhaps the world's savviest
travelers. With business meetings to
attend, deals to negotiate, and tight deadlines
to meet--there is no room for missed flights,
passport problems or travel mishaps. Yet
when it comes to protecting their own health and
safety abroad, they may be less prepared.
According to travel
health experts, about 30-50% of travelers get
sick, with about one third requiring a doctor's
visit. And given the fact that there are
more than 212 million business trips a year,
business travelers need to be especially aware
of travel-related health risks.
Becoming ill oversees is
quite different than getting sick at home.
When a traveler is stricken by a disease or
illness while in a foreign country, the road to
recovery is often more complex and challenging.
Health care resources we take for granted, such
as clean blood supplies, appropriate medications
and facilities, may be limited or unavailable in
foreign or developing countries. In
addition, business travelers in a foreign
country may face language barriers or
administrative obstacles when seeking medical
attention.
In some countries, the
local doctors or hospitals may not treat you
unless you can pay for the services with cash on
the spot. Also, many insurance companies
will not cover the costs of an injury or illness
that takes place abroad.
To fill this need, Travel
Health Medicine was developed in the 1980s.
This specialty field of
medicine is focused on providing preventive
measures that minimize the risks of common and
uncommon diseases that may affect travelers.
These prevention measures include consultative,
medical, and technological resources designed to
safeguard a traveler's health.
Many large U.S. companies
with global offices have adopted travel health
programs as a means to--not only protect
employees from illnesses and hazards--but to
better manage travel-related health costs.
For example, some travel health consultants
offer pre-travel packages that can cover
oversees medical treatment costs, should an
employee become ill or injured while on business
travel.
Without such services,
employers may face exorbitant costs to evacuate
an injured/ill employee from a foreign country.
It is not uncommon for fees to reach $30,000 to
airlift a person to another country for medical
care. Company coverage for such medical
costs varies per employer and often depends upon
the nature of the illness/injury, and whether it
occurred within the course of employment
functions and duties.
A travel health
consultant should be qualified to provide or
connect you with an array of consultative,
medical and technological resources. The
following information provides background on
travel health medicine, as well as guidelines in
selecting a provider.
Overview of Travel
Health Medicine
Travel health medicine
uses the principle of “the distribution
of diseases,” and then applies proven,
preventive measures to reduce health risks for
international travelers.
The primary emphasis in
travel medicine is to ensure that the
international traveler receives proper
immunizations and medications based upon the
destination country. Providers of travel
medicine follow immunization guidelines and
preventive medication measures issued by the
Centers for Disease Control in Atlanta .
Risk factors for
acquiring a disease during international travel
are based upon the area visited and the
susceptibility of the traveler. Those traveling
to underdeveloped regions are at greater risk
than those traveling to industrialized nations.
Other environmental
exposure factors include living conditions,
sanitation standards and hygiene. The type
of immunization coverage that a traveler has is
also a significant factor. Because these
factors vary from region to region, and person
to person, the risk of acquiring a disease
cannot be predicted with certainty.
Travelers who stray from
populated tourist areas may also be at greater
risk because of exposure to local water or food
of questionable quality. Also, children,
the elderly, pregnant women or immunocompromised
persons may be more vulnerable to certain
infectious diseases.
Injury Abroad
Car accidents are the
most common type of events that can cause a
traveler to be evacuated to the United States or
another country for medical treatment. If
you are traveling on personal business, you
should prepare for the possibility of injury by
contacting your insurance company to determine
which medical services are covered abroad—as
many insurance companies do not provide foreign
travel coverage.
If your health insurance
policy does not provide coverage for hospital or
medical costs abroad, it's advised to purchase a
temporary health policy that provides this
coverage. There are short-term health and
emergency assistance policies designed for
travelers. You can find the names of companies
that provide such policies from your travel
health consultant, your health insurance
company, or from advertisements in travel
publications.
If you do have coverage
for travel abroad, make sure to carry both your
insurance policy identity card as proof of such
insurance, as well as a claim form. Although
many health insurance companies will pay
"customary and reasonable" hospital
costs abroad, very few will pay for your medical
evacuation back to the United States . The
U. S. consular officer can assist in locating
appropriate medical services and informing
family or friends.
Partial List of
Travel-Related Diseases
There are a number of
mild to life-threatening diseases that can be
contracted from travel to foreign countries.
According to the World Health Organization,
Traveler's Diarrhea, Malaria, and Hepatitis A
are among those diseases with the highest
incident rate for people traveling to developing
countries.
Traveler's Diarrhea
The most common travel
related disease is Traveler's Diarrhea (TD).
Destinations that pose a high risk for this
disease are developing countries in Latin
America, Africa, the Middle East and Asia .
This illness may be
caused by viruses, bacteria, or parasites found
in food or water. The symptoms
include abdominal cramps, nausea, bloating,
urgency, fever and malaise. Episodes of TD
usually begin abruptly, occur during travel or
soon after returning home, and are generally
self-limited. The medium duration of TD is
3-4 days. 10% of cases persist longer than a
week.
There are two approaches
to prevent the onset of TD: following
proper usage and preparation instructions for
food and beverage consumption, and use of
medications.
Selecting appropriate
foods and following proper procedures for food
and drink consumption can greatly reduce the
risk of TD. Travelers should avoid risky
foods such as raw or undercooked meat and
seafood and raw fruits and vegetables. Tap
water, ice and unpasteurized milk and dairy
products are also associated with an increased
risk of TD, and thus should be avoided.
Travelers should limit their drinks to
“safe” beverages, such as bottled carbonated
beverages, beer, wine, hot coffee, tea or water
boiled appropriately or treated with iodine or
chlorine. Food eaten from street vendors
is considered a higher-risk food than restaurant
food.
Using medications that
contain the active ingredient Bismuthy
Subsalicylate, which is found in products like
Pepto-Bismol®, may also be effective in
preventing TD.
Prophylactic antibiotics
are not recommended to prevent TD.
Antibiotics should be used as a treatment option
. The effectiveness of antibiotic therapy
will depend on the agent and its sensitivity to
the drug. Bactrim®, Septra® and Cipro®
are among the most effective of these drugs.
Other antibiotics, such as Noroxin®, may be
equally effective. Consult your doctor for
instructions on dosage and information on side
effects.
Hepatitis A
Hepatitis A is virus that
is highly contagious and is transmitted
primarily via the fecal-oral route. Food
that is handled by infected natives can transmit
the disease, or raw vegetables and fruit that
have been grown in soil contaminated by human
fecal matter. Shellfish that is raw or
partially cooked and found in polluted water is
another source of the disease. This disease
attacks the liver and symptoms include mild to
severe: fever, vomiting, abdominal pain,
fatigue, jaundice and lack of appetite.
The average incubation period is 28 days.
Although the disease is
found throughout the world, there is a higher
incident rate in developing countries.
Travelers to such regions should protect
themselves from the virus by getting a
vaccination. There are two Hepatitis A
vaccines currently licensed in the United States
: HAVRIX ® and VAQTA ® . The vaccines
should be taken four weeks prior to travel
departure, with a secondary dose 6 months after
the first dose, depending on the vaccine used.
Please consult your travel health physician for
complete dosage requirements, which differ
according to age.
Malaria
Malaria is caused from
the bite of a female Anopheles mosquito.
Symptoms of the disease include fever and
flu-like symptoms, including chills, headache,
myalgias and malaise. These symptoms can
appear as early as six days after exposure and
up to several months after leaving a high-risk
area. The disease may also be associated
with jaundice and anemia. Kidney failure,
coma and death have occurred in persons affected
by a severe strain of the disease.
High-risk destinations for this disease include:
large portions of Central and South America ,
Haiti and the Dominican Republic , Africa, the
Indian subcontinent, Southeast Asia, the Middle
East, and Oceania .
Those traveling to
malaria-risk areas should practice personal
protection measures and use the appropriate drug
regime to prevent the disease.
Personal protective
measures include avoiding exposures in
mosquito-prone areas between dusk and dawn (when
the mosquitoes are active), using mosquito nets
and pyrethroid-containing insect spray, wearing
clothes that cover the entire body and remaining
in well-screened areas. Travelers are also
advised to purchase insect repellant that
contains N,N diethylmetatoluamide (DEET).
Follow all instructions regarding usage of DEET
to minimize adverse reactions.
If the destination is
high risk for Malaria, travelers should consider
the medicinal use of chemoprophylaxix, which
should be taken prior to, during and after
travel to such areas.
Your travel health doctor
can provide consultation on the regime to take,
if warranted, based upon known allergic
reactions to anti-malaria drugs, and
consideration of possible side affects.
Guidelines for
Selecting a Travel-Health Provider
The traveler should
consult a travel health physician to determine
appropriate preventive measures to be used
against the above diseases, or the many others
known to a specific region. When obtaining
a travel health provider, make sure the
physician can provide the following resources
and services to ensure a safe and healthy trip:
Consultative
& Administrative Resources
- Provide information,
educational materials and consultative
services regarding diseases that may be
associated with your itinerary
- Provide international
Certificate of Vaccination. For
instance, some countries require proof of a
Yellow Fever vaccination if you are
traveling from a region that is infected
with Yellow Fever or areas where Yellow
Fever transmission has occurred
- Traveler's medical
records information kit that can be used as
a vital resource by a treating physician,
should you become ill or injured abroad
- Information on
country-specific blood-screening and testing
requirements for AIDS—this may be required
for those travelers on extended trips due to
work or study
- Notification of
epidemics and environmental risks
- Special illness
prevention and treatment tips designed for
pregnant women and children
- Maps indicating areas
of known disease or infection, as well as
incident rate
- Listing of U.S.
board-certified physicians practicing abroad
- Addresses and phone
numbers of U.S. and British embassies and
consulates
Medical Resources
- Provide complete
immunization service for diseases such as
Hepatitis A&B, Typhoid, Meningitis,
Rabies, etc.
- Preventive
prescriptions for travel-related diseases,
such as Malaria and Traveler's Diarrhea or
others (Travel-health physicians
advise that you take twice the amount of
your regular prescription supply. You
should split the supply and store in two
different places as a precaution in losing
them).
- First-aid kit
- Physical examination
Technological Resources
- Resources, internal or
outsourced, that provide travelers with
technological capabilities to communicate
medical needs in a foreign country, such as
- Confidential
electronic medical records that may be
accessed via the internet
- Using wireless
devices to obtain proper translation for
prescription or over-the-counter
medication products that may be needed in
a foreign country
- Wireless access to
the latest health news, tips for a
specific geographical region
Summary
The primary
responsibility of health and safety departments
is to protect and maintain employee health and
safety at the worksite.
Yet in today's global
economy, the “worksite” can be in South
American , Haiti or Africa , depending on the
nature of the business. Travel Health
services are designed to assist managers in
extending the reach and impact of their
corporate health programs to even remote corners
of the world.
Educating travelers on
health prevention programs just may mean the
difference of how an employee returns from a
business trip—with a briefcase in hand or
plenty of leg room to spare (on a stretcher).
For more information, see
the links below.
Travel
Health at the CDC
U.S.
Department of State
www.workcare.com
or email info@workcare.com
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