RECENT DEVELOPMENT

OF TRAVEL MEDICINE
CURRENT ISSUES
Prof. Dr. Soesanto Tjokrosonto
2006
 BASIC CONCEPTS
DISEASE KNOWS NO BORDERS AND NEED
NO PASSPORT
Travel Health business has been blooming
the last decade
Travel Health aims to provide protection to
travelers against diseases and promote
the success of TRAVEL INDUSTRY
Concept: pre-travel, during travel, post-
travel
 Travel Medicine
Basic concept
The main goal of travelers is to depart
from their origin with confidence, safe and
convenient during their journey, arrive
safely at the destination, comfortable
during their stay, safe upon their return
without any impact of contracting any
disease they may carry along
The latest related to attitude and practices
contract diseases (mostly infectious
diseases)
 KNOWLEDGE
Indonesia go international
200.000 haj pilgrimage
80.000 umroh
30.000 seeking work (TKI).
Etc. . Studying abroad
No more distance problem
Only in a matter of hours will reach destination
10-20 hrs reach Europe, Africa and Middle
East therefore..
International Health Regulation (IHR)
provide traveling knowledge and legal
requirements for traveling
 KNOWLEDGE
International Health Regulation (IHR)
was introduced in the 22nd World
Health Assembly in 1969
IHR should not affect the
convenience of travelers diseases
not listed in the IHR (AIDS) may
create problem if certificate
required against IHR (point 81):NO
HEALTH DOCUMENT IS REQUIRED UNLESS STATED IN THE IHR
 KNOWLEDGE
1973 WHO amended IHR:
vaccination to cholera no longer
required to travelers
 KNOWLEDGE
1983 : First documented in Italia Center
for travel health; Association of Travel
Health
1988 Rimini, Italia: international meeting
sponsored by World Health Organization
(WHO) and World Tourism Organization
(WTO) talking on prevention on
infectious diseases among travelers in the
Mediteranian developing since.
 WORLD TOURISM
ORGANIZATION (WTO)
To provide appropriate information
and services (including health)
suitable to the travelers and travel
industries (government and private)
Distribution of information to the
travelers
 KNOWLEDGE
International Society of Travel
Medicine (ISTM) founded in 1991 at
Atlanta, USA congress every
alternate years the 7th congress
in Innsbruck Austria:
Minimum knowledge and skill for
doctors in Travel Medicine/clinics
international standard examination on
Travel Medicine took place in New York
 KNOWLEDGE
Problems arising from speedy
migration and transportation and
new development of new disease
(NEW EMERGING and REEMERGING
DISEASES) IHR REVISION IN
1995
 KNOWLEDGE
DOES YOUR DESTINATION NEED A
VACCINATION? Travel well, Travel save, Travel
vaccinated. ASK BEFORE YOU DEPART
Aventis Pasteur: the most comprehensive range
of vaccines against travel diseases including
vaccine against:
Typhoid fever - Yellow fever
Hepatitis A - Rabies
Hepatitis B - Tetanus and diphtheria
Meningococcal
meningitis - Japanese encephalitis
Influenza - Poliomyelitis
 KNOWLEDGE (HALF)
International Certificate of
Vaccination (ICV): contains proofs of
kinds of vaccination given, date and
validity of each.
Examples: a must to travelers
Yellow fever (Africa and America)
visitor or transit
Meningitis (meningococcal, Neisseria
meningitidis) to haj pilgrim
 Health problems needed evacuation among
foreign travelers in Sanglah hospital in Bali
(Rudhiarta,2000)
No Disease 1998 19991 2000
1 Infectious disease 8 10 0
2 Fractures of limb 6 10 0
3 Acute Myocardial 6 5 4
Infarct
4 Head injuries 3 6 1
5 Ileus 2 1 2
6 Stroke 2 5 2
7 Others 6 8 0
33 45 8
 EVACUATION DURING FLIGHT
INCAPACITY OF TRAVELING
International Air Transport
Association (IATA) 1980:
INCAPACITY during flight high risk
travelers (sick, children and pregnant
women) refusal or delayed
INCAPACITY physical or/and mental
disorder requiring special attention
disturbance or endangering others
 EVACUATION DURING FLIGHT
Physiological consideration:
In-flight environment cabin pressure
is lower than sea-level pressure
Barotrauma drop of air-pressure (eg.
in maximum cruising altitude) of 25%
reduce partial oxygen pressure by 25%
and 32% in alveoli no problem in
normal passengers BUT resulting
hypoxia in passenger with anemia, lung
problem, coroner circulation disorder
 EVACUATION DURING FLIGHT
Physical consideration:
Lack of space in flight->
improper position to lay down eg. in an
emergency requiring CPR
Placement of a stretcher for a particular
patient removal of 6-9 seats
 EVACUATION DURING FLIGHT
ESCORTER for a sick traveler:
Cabin crew are food handler
not allowed to handle a sick people
only for emergency purpose
Requirement of an health assistant who
has appropriate knowledge in in-flight
health to escort a sick traveler
 HEALTH PROBLEMS (HP) during
flight
1. HP aggravated the disease during flight
caused by lack of oxygen:
Coronary diseases lung disease anemia
epilepsy shock severe infectious disease
2. HP (diseases) contagious to others
3. HP endangering environment:
psychosis, psychoneurosis
4. Condition requiring special care: infant,
pregnancy, elderly
 HEALHT PROBLEM DURING
PILGRIMAGE
High risk: 40% manifest on their return
Cardiovascular
GIT infection
URT infection
RTI infection
Bone and muscles disorder
Infectious disease: prohibited to fly:
Typhoid, cholera, TB (active with caverns)
 MEDICAL INFORMATION FORM
(MEDIF)
MEDIF PART I:
AIR ITINERARY of passenger
Requirement needed during flight
If allowed to fly (given by airline) or
medical clearance go to MEDIF PART
II
 MEDICAL INFORMATION FORM
(MEDIF)
MEDIF PART II:
MEDIF part II is forwarded to the
personal physician responsible for the
traveler
Statement of aides needed (oxygen,
stretcher etc)
Result: if everything OK permission
to fly will be awarded to the passenger
 MEDICAL LICENCE
Problem on travel health requires
appropriate handling by health
profession urges special training
on travel medicine (under and post
graduates) knowledge and skill
Leggat (1999): most doctors in New
Zealand had no formal training on
travel medicine
 APPROACHES TO TRAVEL
MEDICINE
1. Training on travel medicine to doctors
done continuously
2. Collaborations between pharmacist and
travelers : Switzerland
3. Travel Health Association:
Travel Doctor Group /Travel Medicine and
Vaccination Centres (TMVC) : Australia, New
Zealand, Canada, Singapore, South Africa
Pre-travel whilst away upon return
 DEVELOPMENT
1995 booming of travelers
1997 founding of Perhimpunan Kesehatan
Wisata Indonesia (PKWI) working on
national, regional and international scopes
1998. Congress on Asia Pacific Travel Health
Society (APTHS) at Taipeh
2000. Congress of APTHS in Bali
2002. Congress of APTHS in Shanghai
2004. Congress of APTHS in Sydney
2006. Congress of APTHS in Kuala Lumpur