Travel medicine

Most of the infectious diseases to which travellers are exposed can now be prevented by immunization, chemoprophytaxis protection against insect bites, strict food and water hygiene and avoidance of unprotected sexual activity. Some basic childhood immunizations (tetanus, diphtheria, poliomyelitis) may need to be boosted. Special vaccines are available for regional disease problems such as Japanese encephalitis in Asia and tick- borne encephalitis in Central Europe. Yellow Fever vaccination is statutory in endemic areas of Africa and Latin America. Pre-exposure immunization against rabies is increasingly advocated for travellers. When advising travellers it is important to obtain up-to-date information about recent epidemics. This is provided by Morbidity and Mortality Weekly Report (MMWR) and WHO epidemiological reports. Annual epidemics of meningococcal meningitis are predictable in some areas such as the 'meningitis' belt of Africa. Traveller's diarrhea remains the commonest of diseases of travellers, with an incidence of >50% in some countries, while malaria is the most likely to prove fatal. However, most deaths in travellers are caused by trauma, including road traffic accidents, and chronic conditions not directly related to travel (for example, cardiovascular disease).