Harrison's Internal Medicine Chapter 117. Health Advice for International Travel
Health Advice for International Travel: Introduction
According to the World Tourism Organization, the number of international tourist arrivals in 2004 reached an all-time record of 763 million. This number represents an increase over the 2003 figure of almost 11%—the highest and the only double-digit percentage increase since 1980, when these statistics were first collected. Not only are more people traveling; travelers are seeking more exotic and remote destinations. ...
Rabies Domestic animals, primarily dogs, are the major transmitters of rabies in developing countries (Chap. 188). Several studies have shown that the risk of rabies posed by a dog bite in an endemic area translates into 1–3.6 cases per 1000 travelers per month of stay. Countries where canine rabies is highly endemic include Mexico, the Philippines, Sri Lanka, India, Thailand, and Vietnam. The three vaccines available in the United States provide 90% protection.
Prevention of Gastrointestinal Illness Diarrhea, the leading cause of illness in travelers (Chap. 122), is usually a short-lived, self-limited condition; however, 40% of affected individuals need to alter their scheduled activities, and another 20% are confined to bed. The most important determinant of risk is the destination. Incidence rates per 2-week stay have been reported to be as low as 8% in industrialized countries and as high as 55% in parts of Africa, Central and South America, and Southeast Asia. Infants and young adults are at particularly high risk.
Air Travel and High-Altitude Destinations Commercial air travel is not a risk to the healthy pregnant woman or to the fetus. The higher radiation levels reported at altitudes of 10,500 m (35,000 ft) should pose no problem to the healthy pregnant traveler. Since each airline has a policy regarding pregnancy and flying, it is best to check with the specific carrier when booking reservations. Domestic air travel is usually permitted until the 36th week, whereas international air travel is generally curtailed after the 32nd week.
Gastrointestinal Illness Decreased levels of gastric acid, abnormal gastrointestinal mucosal immunity, other complications of HIV infection, and medications taken by HIVinfected patients make travelers' diarrhea especially problematic in these individuals. Travelers' diarrhea is likely to occur more frequently, be more severe, be accompanied by bacteremia, and be more difficult to treat. Although uncommon, Cryptosporidium, Isospora belli, and Microsporidium infections are associated with increased morbidity and mortality in AIDS patients.
Diabetes Mellitus Alterations in glucose control and changes in insulin requirements are common problems among patients with diabetes who travel. Changes in time zone, in the amount and timing of food intake, and in physical activity demand vigilant assessment of metabolic control. The traveler with diabetes should pack medication (including a bottle of regular insulin for emergencies), insulin syringes and needles, equipment and supplies for glucose monitoring, and snacks in carryon luggage. Insulin is stable for ~3 months at room temperature but should be kept as cool as possible.
Immunizations for Travel Immunizations for travel fall into three broad categories: routine (childhood/adult boosters that are necessary regardless of travel), required (immunizations that are mandated by international regulations for entry into certain areas or for border crossings), and recommended (immunizations that are desirable because of travel-related risks). Vaccines commonly given to travelers are listed in Table 117-1.
Fever Fever in a traveler who has returned from a malarious area should be considered a medical emergency because death from P. falciparum malaria can follow an illness of only several days' duration. Although "fever from the tropics" does not always have a tropical cause, malaria should be the first diagnosis considered. The risk of P. falciparum malaria is highest among travelers returning from Africa or Oceania and among those who become symptomatic within the first 2 months after return.
International travel is undertaken by large, and ever increasing, numbers of people
for professional, social, recreational and humanitarian purposes. More people
travel greater distances and at greater speed than ever before, and this upward
trend looks set to continue. Travellers are thus exposed to a variety of health risks
in unfamiliar environments. Most such risks, however, can be minimized by suitable
precautions taken before, during and after travel.
Phần 1 cuốn sách "English for international Conferences – Tiếng Anh cho hội nghị quốc tế" là các bài học tiếng Anh về các nội dung: Travelling, making social contacts. Đây là một cuốn sách hữu ích dành cho các bạn đam mê học tiếng Anh dùng làm tài liệu tự học và nghiên cứu nâng cao trình độ tiếng Anh của bản thân. Mời các bạn cùng tham khảo nội dung chi tiết.
Many people begin their visit to the marvelous
country of Thailand by flying to Suvarnabhumi -
the international airport of Bangkok.
Suvarnabhumi means the mythological ”Land of
Gold”. There can be no better welcome as there
are new perspectives to the exciting historical legends
everywhere in Thailand… and gold and golden
adornments in such great numbers that it will make
you reach for your digital camera constantly.
Emergency medicine is, by its nature, borne out of necessity and through painful
lessons that specialized care is required for many patients presenting to hospital “ERs”
with complaints ranging from minor ailments to life threatening illness and even in
London is the centre of the British world. As the
capital of the British Empire, the city has been
ranked among the leading cities of Europe for
centuries, and cultures from all over the world
have left their mark upon the streets of the British
London is a colossal metropolis and has
something for every taste – also literally, due to the
many ethnic restaurants run by the international
The cosmopolitan city of Geneva has attracted a lot
of people through the ages, and with its very scenic
location by Lake Geneva, locally named Lac Léman,
it is worth a trip.
Geneva is also renowned across the world for being
the home of a number of international organizations,
such as the UN and the Red Cross, which
contributes to the distinctive atmosphere in this
The fantastic location of Cape Town is perhaps
one of the most scenic locations of any city in the
world. The Table Mountain, which is more than 1
kilometre high, together with the Atlantic Ocean
creates the perfect background for the
development of a modern city that throughout
offers visitors unique experiences on the southern
tip of Africa.
This modern South African city sparkles like a
diamond around the renovated harbour area, The
Waterfront. Here is an international atmosphere,
shops, restaurants as well as a number of other
Frankfurt is a fascinating meeting of new and old. It
has always been one of Germany’s most affluent
cities and has in many ways been the motive force
for German development through centuries.
Frankfurt is with its airport and its commerce a
nerve centre for all of Europe, and the international
atmosphere in the modern city with the many fine
museums and cultural offerings renders a visit here
an exciting experience.
Francis E. Andre is currently ‘retired’ but keeps himself busy as a part-time consultant in
vaccinology, a science he has dabbled in for most of his professional career.
Paul M. Arguin, Chief of the Domestic Response Unit in the Malaria Branch at the U.S.
Centers for Disease Control and Prevention in Atlanta, Georgia. Paul is also an editor
of Health Information for International Travel, also known as CDC’s Yellow Book. His
research interests include the prevention and treatment of infectious diseases associated
with international travel, including malaria and zoonoses....
According to the World Tourism Organization, the number of international tourist arrivals in 2004 reached an all-time record of 763 million. This number represents an increase over the 2003 figure of almost 11%—the highest and the only double-digit percentage increase since 1980, when these statistics were first collected. Not only are more people traveling; travelers are seeking more exotic and remote destinations. Studies show that 50–75% of short-term travelers to the tropics or subtropics report some health impairment.
Allan and Barbara Pease are the
internationally renowned experts in
human relations and body language,
whose 20 million book sales worldwide
have turned them into household
names. The Definitive Book of Body Language isolates, examines and explains in simple terms, each component of body langugage.
On April 6, 1998, the creation of Citigroup through the combination of
Citicorp and Travelers Inc. was announced to the general applause of
analysts and financial pundits. The “merger of equals” created the world’s
largest financial services firm—largest in market value, product range,
and geographic scope. Management claimed that strict attention to the
use of capital and rigorous control of costs (a Travelers specialty) could
be combined with Citicorp’s uniquely global footprint and retail banking
franchise to produce uncommonly good revenue and cost synergies.