P&S Journal: Spring 1997, Vol.17, No.2
Travel Medicine: What to Know Before You Go
Used to be, vacations were a relatively simple affair: Mom, Dad, kids, and Rover piling into the family station wagon for a week in the mountains or at the shore. Nowadays, though, with the increasing popularity of "adventure travel," a vacation is just as likely to encompass everything from trekking in Nepal to helicopter skiing in New Zealand. All the better for new travel medicine specialists, such as Dr. Deborah E. Rudin, assistant professor of clinical medicine, infectious diseases specialist, and medical director of CPMC's new Eastside Travel Medicine Center. From vaccinations, to country-specific travel tips, to post-vacation diagnoses of illnesses, the travel medicine center tends to the needs of both the run of the mill and the adventurous traveler.
One of the main services the center provides is vaccinations for travelers. With the exception of yellow fever immunizations (which in New York state can be given only by an approved provider), any doctor can administer the injections. But, notes Dr. Rudin, because of the possible complications the vaccinations can cause, travelers are better off getting them from an infectious disease specialist. "You can't give a person all the vaccines at once, for instance," she says. "Live vaccines are generally only compatible with live vaccines, inactivated bacterial or viral vaccines with inactivated vaccines." And in people on high doses of prednisone, who have cancer, or are infected with HIV, live vaccines can be potentially dangerous. "You have to be very careful how you vaccinate," says Dr. Rudin.
Dr. Rudin also stays up to date on disease outbreaks worldwide, via the Centers for Disease Control and Prevention and the World Health Organization. "That's not something that a general internist would necessarily do," she says.
Among the packet of information that patients at the Columbia travel medicine center receive is a detailed set of instructions on exactly how and when to take any immunizations or medications given orally. For instance, travelers taking mefloquine (Larium) to head off malaria have to start one week before they arrive in a malaria-infested area then continue taking the medicine for as long as they are in the area and for four weeks afterward.
Dr. Rudin also offers travelers a "survival guide" customized to the area they plan to visit. The guide provides advice on avoiding--and treating--everything from traveler's diarrhea ("cook it, boil it, peel it, or forget it") to altitude sickness. ("Young, active people who race up the mountains are the ones who get in trouble with altitude sickness," says Dr. Rudin.) This type of advice can be invaluable, especially when it comes to avoiding infections. "Most people from the U.S. are what we call 'virgin hosts'--they've never been exposed to many of the parasites or bacteria in foreign countries," she says.
Travelers who do take ill on their journeys can turn to the travel medicine center afterward for diagnosis and treatment. Both chronic diarrhea and parasitic illnesses are common in returning travelers, says Dr. Rudin, though the likelihood of a traveler picking up a foreign bug increases as the conditions become more primitive. For instance, risk of contracting malaria is greater for a traveler camping in Africa than for a traveler seeing the sights via an air-conditioned bus tour.
The Travel Medicine Center is located at Columbia-Presbyterian/Eastside, 16 E. 60th St., (212) 326-8420.
Book By Alumnus Aids World Travelers|
Another health resource for travelers is the "International Travel Health Guide," a paperback written by Stuart R. Rose'65 and updated yearly. "The only other travel publications that come out annually are the ones published by the government or the World Health Organization," says Dr. Rose. "But they're mainly written for health professionals or travel agents. And they don't always include information about new travel health developments." For instance, readers of Dr. Rose's book can learn that recent studies show that Primaquine, long used to treat malaria, is also effective at preventing it.
In addition to information on the prevention and treatment of diseases travelers might encounter, the book includes chapters on jet lag, medical care abroad, travel insurance, emergency medical transport, business travel and health, and travel and pregnancy. A world medical guide summarizes the types of diseases prevalent in various regions, and an appendix lists American and Canadian medical clinics for travelers.
When he is not updating his book or attending patients, Dr. Rose, an emergency physician in Northampton, Mass., researches travel supplies to offer in his latest edition of a 40-page catalog of health and medical supplies for travelers. The catalog, which many travel medicine clinics carry, offers a wide range of supplies, such as mosquito nets, water purification kits, and first aid kits.
Information about the "International Travel Health Guide" or Dr. Rose's company, Travel Medicine Inc.: 1-800-TRAV-MED.
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Diabetes and Pregnancy Program
Travel Medicine Center
"International Travel Health Guide" and Travel Medicine Inc.