Principles and Practice of Travel Medicine - 2001 - Zuckerman

Principles and Practice of Travel Medicine. Edited by Jane N.
Zuckerman
Copyright © 2001 John Wiley & Sons Ltd
ISBNs: 0-471-49079-2 (Hardback); 0-470-84251-2 (Electronic)
Principles and Practice of

Travel Medicine
Principles and Practice of Travel Medicine. Edited by Jane N. Zuckerman
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Principles and Practice of

Travel Medicine
Edited by
Jane N. Zuckerman
Academic Centre for Travel Medicine and Vaccines,
Royal Free and University College Medical School, London, UK
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Library of Congress Cataloging-in-Publication Data

Principles and practice of travel medicine / edited by Jane N. Zuckerman
p. cm.
Includes bibliographical references and index.
ISBN 0-471-49079-2 (cased : alk. paper)
1. Travel—Health aspects. I. Zuckerman, Jane N.
[DNLM: 1. Travel. 2. Communicable Diseases. 3. Preventive Medicine—methods. QT
250 P957 20001]
RA783.5.P75 2001
2001026216
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
ISBN 0-471-49079-2
Typeset in 9/10pt Times from the author’s disks by Vision Typesetting, Manchester
Printed and bound in Great Britain by Antony Rowe Ltd, Chippenham, Wiltshire
This book is printed on acid-free paper responsibly manufactured from sustainable forestry,
in which at least two trees are planted for each one used for paper production.
Contents
List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . vii 8 Vector-borne Parasitic Diseases . . . . . . . . . . . . . 91
Indran Balakrishnan and Stephen H. Gillespie
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
SECTION III
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi PREVENTION AND MANAGEMENT OF
TRAVEL-RELATED DISEASE . . . . . . . . . . . . . . . 125
SECTION I 9 Tropical Skin Infections . . . . . . . . . . . . . . . . . . 127
TRAVEL MEDICINE . . . . . . . . . . . . . . . . . . . . . . . . 1 Francisco Vega-López and Verity Blackwell
1 Trends in Travel . . . . . . . . . . . . . . . . . . . . . . . . . . 3 10 Travelers’ Diarrhea . . . . . . . . . . . . . . . . . . . . . . 153
Thomas L. Treadwell Luis Ostrosky-Zeichner and Charles D. Ericsson
2 Epidemiology of Health Risks and Travel . . . . . . . 7 11 Vaccine-preventable Disease . . . . . . . . . . . . . . . 165

Hans D. Nothdurft and Eric Caumes Jane N. Zuckerman
12 Returned Travellers . . . . . . . . . . . . . . . . . . . . . 185
3 Fitness to Travel . . . . . . . . . . . . . . . . . . . . . . . . . 15 Nicholas J. Beeching and Sharon B. Welby
Dominique Tessier
SECTION IV
4 Management of a Travel Clinic . . . . . . . . . . . . . . 23 HAZARDS OF AIR AND SEA TRAVEL . . . . . . . 211
Elaine C. Jong
13 Aviation Medicine . . . . . . . . . . . . . . . . . . . . . . . 213
Michael Bagshaw
SECTION II
INFECTIOUS DISEASES AND TRAVEL . . . . . . . 29 14 Aviation Psychology . . . . . . . . . . . . . . . . . . . . . 237
Robert Bor, Justin Parker
5 Epidemiology and Surveillance of Travel-related
and Linda Papadopoulos
Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Norman T. Begg 15 Altitude and Expedition Medicine . . . . . . . . . . . 247
David R. Murdoch, Andrew J. Pollard
6 Virus Infections . . . . . . . . . . . . . . . . . . . . . . . . . 39 and J. Simon R. Gibbs
Arie J. Zuckerman
Viral Hepatitis 16 Diving Medicine . . . . . . . . . . . . . . . . . . . . . . . . 261
HIV and AIDS Peter J. Benton
Viral Gastroenteritis
Poliomyelitis and Other Enterovirus 17 Travel Health at Sea:
Infections Cruise Ship Medicine . . . . . . . . . . . . . . . . . . . . 275
Influenza Robert E. Wheeler
Genital Herpes
Rabies SECTION V
Yellow Fever ENVIRONMENTAL HAZARDS OF TRAVEL . . 289
Dengue Fever
18 Travel-related Injury . . . . . . . . . . . . . . . . . . . . . 291
Japanese Encephalitis, St Louis Encephalitis,
Robert Grenfell
Tick-borne Encephalitis and other
Flavivirus Infections 19 Aeromedical Repatriation . . . . . . . . . . . . . . . . . 297
Viral Haemorrhagic Fevers Alex T. Dewhurst and John C. Goldstone
7 Bacterial Infections in Travellers . . . . . . . . . . . . . 81 20 Poisons and Travel . . . . . . . . . . . . . . . . . . . . . . 311

Christopher J. Ellis and Ann L. N. Chapman Virginia Murray
vi CONTENTS
21 Venomous Bites and Stings . . . . . . . . . . . . . . . . 321 26 Special High-risk Travel Groups:
R. David G. Theakston and David G. Lalloo Immunocompromised, Older, Disabled
and Chronically Ill Travelers . . . . . . . . . . . . . . . 431
22 Ophthalmic Conditions in Travellers . . . . . . . . . 343 Maria D. Mileno, Kathryn N. Suh,
Theresa Richardson and Claire Davey Jay S. Keystone and Frank J. Bia
SECTION VI 27 Aid Workers, Expatriates

PRACTICAL ISSUES FOR TRAVELLERS . . . . . 365 and Travel . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447
Kenneth L. Gamble, Debbie Lovell, Ted Lankester
23 Traveling with Children . . . . . . . . . . . . . . . . . . 367 and Jay S. Keystone
Philip R. Fischer
28 The Health of Migrants and
24 Women’s Health and Travel . . . . . . . . . . . . . . . 381 Refugees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467
Susan Anderson Louis Loutan
25 The Immunocompromised Traveller . . . . . . . . . 423 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477
Robert J. Ligthelm and Pieter-Paul A. M. van Thiel
Contributors
Susan Anderson Clinical Assistant and Professor of Christopher J. Ellis Consultant Physician, Department of
Medicine, Office of Medical Education, Stanford University Infection and Tropical Medicine, Birmingham Heartlands
School of Medicine, 251 Campus Drive, MSOB X-365, Hospital, Bordesley Green East, Birmingham B9 5SS, UK
Stanford, CA 94305-5490, USA
Charles D. Ericsson Professor of Medicine, Head,
Michael Bagshaw Head of Medical Services, British Clinical Infectious Diseases and Director, Travel Medicine
Airways Health Services, Waterside, PO Box 365 (HMAG), Clinic, Division of Infectious Diseases, Department of
Harmondsworth UB7 0GB, UK Internal Medicine, University of Texas Houston Medical
School, 6431 Fannin Street, JFB, 1.728, Houston, TX
Indran Balakrishnan Clinical Lecturer, Department of
77030, USA
Medical Microbiology, Royal Free and University College
Medical School, Rowland Hill Street, London NW3 2PF, Philip R. Fischer Professor of Pediatrics, Mayo Medical
UK School, Mayo Clinic, 2000 First Street SW, Rochester, MN
55905, USA
Nicholas J. Beeching Senior Lecturer in Infectious
Diseases, Liverpool School of Tropical Medicine, Kenneth L. Gamble Executive Director, Missionary
Pembroke Place, Liverpool L3 5QA, UK Health Institute, Toronto General Hospital, 200 Elizabeth
Street, Eng-212, Toronto, ON M5G 2C4, Canada
Norman T. Begg Head of Medical Affairs,
GlaxoSmithKline, Stockley Park West, Uxbridge, J. Simon R. Gibbs Consultant Cardiologist, National
Middlesex UB11 1BT, UK Heart and Lung Institute, Imperial College of Science,
Technology and Medicine, Department of Cardiology,
Peter J. Benton Surgeon Commander, Institute of Naval
Charing Cross Hospital, London W6 8RF, UK
Medicine, Alverstoke, Gosport, Hampshire PO12 2DL, UK
Stephen H. Gillespie Professor of Medical Microbiology,
Frank J. Bia Professor of Medicine and Laboratory
Royal Free and University College Medical School,
Medicine, Yale University School of Medicine, 333 Cedar
Rowland Hill Street, London NW3 2PF, UK
Street, New Haven, CT 06520-8030, USA
John C. Goldstone Consultant Anaesthetist, Academic
Verity Blackwell Specialist Registrar in Dermatology,
Department of Anaesthetics, 1st Floor Crosspiece, The
The Middlesex Hospital, 1st Floor, Arthur Stanley House,
Middlesex Hospital, Mortimer Street, London W1N 8AA,
Tottenham Street, London W1P 6PG, UK
UK
Robert Bor Professor, Psychology Department, London
Robert Grenfell Public Health Physician, Grenfell
Guildhall University, Calcutta House, 1 Old Castle Street,
Health Consulting Pty Ltd, 126 Barnes Boulevard,
London E1 7NT, UK
Horsham, Victoria 3400, Australia
Eric Caumes Consultant Dermatologist, Department of
Elaine C. Jong Clinical Professor of Medicine,
Infectious Diseases, Hôpital Pitié Salpétrière, 47–83
University of Washington, Seattle, and Co-Director, Travel
Boulevard de L’Hôpital, 75651 Paris, Cedex 13, France
and Tropical Medicine Service, Hall Health Travel Clinic,
Ann L. N. Chapman Specialist Registrar, Department of Box 35-4410 Seattle, WA 98195-4410, USA
Infection and Tropical Medicine, Birmingham Heartlands
Jay S. Keystone Professor of Medicine, University of
Hospital, Bordesley Green East, Birmingham B9 5SS, UK
Toronto, Tropical Disease Unit, Toronto General Hospital,
Claire Davey Consultant Ophthalmologist, 200 Elizabeth Street, Eng-212, Toronto, ON M5G 2C4,
Royal Free Hampstead NHS Trust, Pond Street, London Canada
NW3 2QJ, UK
David G. Lalloo Senior Clinical Lecturer in Tropical
Alex T. Dewhurst Research Registrar in Anaesthesia Medicine, Alistair Reid Venom Research Unit and WHO
and Transport Medicine, Academic Department of Collaborating Centre for the Control of Antivenoms,
Anaesthetics, 1st Floor Crosspiece, The Middlesex Liverpool School of Tropical Medicine, Pembroke Place,
Hospital, Mortimer Street, London W1N 8AA Liverpool L3 5QA, UK
viii CONTRIBUTORS
Ted Lankester Director, InterHealth, 157 Waterloo Theresa Richardson Specialist Registrar, Department of
Road, London SE1 8US, UK Ophthalmology, Royal Free Hampstead NHS Trust, Pond
Street, London NW3 2QJ, UK
Robert J. Ligthelm Consultant Physician,
Havenziekenhuis and Instituut voor Scheeps en Kathryn N. Suh Consultant in Infectious Diseases,
Tropenziekten, Haringvliet 2, 3002 TD Rotterdam, The Department of Medicine, Division of Infectious Diseases,
Netherlands Queen’s University, Kingston, Ontario, Canada
Louis Loutan Head of Unit and Senior Consultant, Dominique Tessier Medical Director, Medisys Travel
Travel and Migration Medicine Unit, Department of Health Clinic, 500 Sherbrooke St West, 11th Floor,
Community Medicine, University Hospital of Geneva, Rue Montreal, Quebec H3E 1X5, Canada
Micheli-du-Crest 25, 1211 Geneva 14, Switzerland R. David G. Theakston Professor of Medical Biology,
Debbie Lovell Research Clinical Psychologist, Oxford Alistair Reid Venom Research Unit and WHO
University Psychiatry Department, Warneford Hospital, Collaborating Centre for the Control of Antivenoms,
Oxford OX3 7JX, UK Liverpool School of Tropical Medicine, Pembroke Place,
Liverpool L3 5QA, UK
Maria D. Mileno Assistant Professor of Medicine,
Department of Medicine, Brown University School of Thomas L. Treadwell Chief, Infectious Disease,
Medicine, and Director of The Travel Medicine Service, Metrowest Medical Center, Framingham Union Campus,
The Miriam Hospital, Providence, RI, USA 115 Lincoln Street, Framingham, MA 01702, USA
David R. Murdoch Clinical Microbiologist, Canterbury Pieter-Paul A. M. van Thiel Consultant Physician,
Health Laboratories, P.O. Box 151, Christchurch, New Department of Infectious Diseases, Tropical Medicine and
Zealand Aids, Academic Medical Centre, University of Amsterdam,
Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
Virginia Murray Deputy Medical Director, Medical
Toxicology Unit, Avonley Road, London SE14 5ER, UK Francisco Vega-López Consultant Dermatologist, The
Middlesex Hospital, 1st Floor, Arthur Stanley House,
Hans D. Nothdurft Director, University Travel Clinic, Tottenham Street, London W1P 6PG, UK
Department of Infectious Diseases and Tropical Medicine,
University of Munich, Leopoldstrasse 5, 80802 Munich, Sharon B. Welby Clinical Lecturer in Travel Medicine,
Germany Liverpool School of Tropical Medicine, Pembroke Place,
Liverpool L3 5QA, UK
Luis Ostrosky-Zeichner Clinical Fellow, Division of
Infectious Diseases, Department of Internal Medicine, Robert E. Wheeler President, Voyager Medical
Univesity of Texas Houston Medical School, 6431 Fannin Seminars, 9 Corduroy Road, Amherst, NH 03031-2724,
Street JFB 1.728, Houston, TX 77030, USA USA
Linda Papadopoulos Senior Lecturer, Psychology Arie J. Zuckerman Professor of Medical Microbiology,
Department, London Guildhall University, Calcutta House, Royal Free and University College Medical School,
1 Old Castle Street, London E1 7NT, UK Rowland Hill Street, London NW3 2PF, UK
Justin Parker Lecturer, Psychology Department, London Jane N. Zuckerman Medical Director of Academic
Guildhall University, Calcutta House, 1 Old Castle Street, Centre for Travel Medicine and Vaccines and Royal Free
London E1 7NT, UK Travel Health Centre, Royal Free and University College
Medical School, Rowland Hill Street, London NW3 2PF,
Andrew J. Pollard Pediatric Infectious Disease Society UK
Clinical Fellow, BC Research Institute for Children’s and
Women’s Health, Room 375, 950 West 28th Avenue,
Vancouver, BC V5Z 4H4, Canada
Foreword
Travel medicine is one of the newer and important areas guidance on contraception, safety of food and water, and
of medicine requiring specialist knowledge, academic hygienic and other precautions.
centres and dedicated clinical services to meet the health It is well known that medical students, nurses, doctors
and medical needs of the increasing number of leisure and and other health care professionals, particularly in the
business travellers, and also to cater for the medical as- industrialised and developed countries, receive little
pects of population movements related to economic, pol- training in tropical medicine and in diseases and hazards
itical and social factors. outside their own environment. Yet many infectious dis-
Health, preventive medicine, environmental factors eases largely ignore temperature gradients. This has now
and safety are essential considerations, not only for the been recognised by a number of universities and medical
traveller but also for the host country and for the country schools in North America, Europe, Australia and the Far
of residence on return. The hundreds of millions of people East, which have established academic departments in
who travel between countries each year influence travel and geographical medicine.
profoundly the epidemiology of disease, particularly in- The opportunity to advance the subject of travel medi-
fections, the environment, facilities and natural resources, cine arose when Jane Zuckerman proposed the establish-
and they also have a marked impact on economic, demo- ment of an academic centre at the Royal Free Hospital
graphic, technological and cultural factors. School of Medicine of the University of London. The
Disease knows no frontiers and almost any place in the concept and the need for such a centre was approved by
world can be reached within 24—36 hours, which is less the Research and Development Committee, by the Edu-
than the incubation period of most infectious diseases. cation Committee and subsequently by the Council of the
Health care professionals must be able to prevent, ident- School, and the Centre for Travel Medicine and Vaccines
ify and treat all known infectious diseases irrespective of was opened in 1995. The Royal Free Hampstead NHS
geographical and climatic limitations. They must be well Hospital Trust supported the School’s initiative and,
versed in the development of new and improved vaccines later, the proposal for a dedicated travel clinic to serve the
and the rapid advances in the development of new drugs staff, students and patients and the travelling public.
and treatments. On a more personal note, my wife and I are proud of
While the discipline of travel medicine evolved initially the achievements of our daughter, Jane, and of her dedi-
from infectious diseases, tropical medicine and preventive cation to the advancement of her subject, and we are
medicine, and historically from quarantine and interna- confident that this volume on the principles and practice
tional health regulations, the subject encompasses the of travel medicine will meet with the success it so clearly
whole range of clinical and preventive medicine; this in- deserves.
cludes care of the traveller with special needs, such as
children, the elderly, pregnant women and the disabled,
and travellers with cardiovascular, respiratory, meta- Arie J. Zuckerman
bolic, renal, gastrointestinal, neurological and malignant Professor of Medical Microbiology in the
diseases, and other conditions, including behavioural dis- University of London
orders. Important components of travel medicine include Principal and Dean of the Royal Free Hospital School of
not only vaccinations and prophylaxis against malaria Medicine and of the Royal Free and University College
but also advice on accident prevention, sexual health and Medical School, 1989–1999
Preface
The specialty of travel medicine has evolved rapidly as a Knowledge of all these aspects of travel health and
result of the massive increase in international travel facili- medicine are, therefore, an essential requirement for the
tated by the introduction of economical and fast air trans- many health care professionals providing advice to and
port across the world, the construction of transcontinen- clinical care of the traveller. This volume of Principles and
tal road and rail connections, giant ship cruisers, travel to Practice of Travel Medicine is addressed to practising
and exploration of regions and areas that were previously physicians and nurses in primary care, occupational
inaccessible or remote, and the explosive increase in health and hospital settings, and to public health phys-
tourism. The World Tourism Organisation, for example, icians, pharmacists and administrators, and, as a source
has predicted that international travel, currently in excess textbook, to undergraduate and postgraduate students. A
of 500 million people each year, will increase by 80% welcome recent development has been the implementa-
between 1995 and 2010. This also means exposure of tion of teaching of the discipline of travel health and
travellers to genes, bacteria, viruses, fungi and parasites medicine in the form of postgraduate diploma and degree
and other health hazards in the new environment, and the courses as well as study days. Teaching of the subject in
transfer of genes and microorganisms across continents the undergraduate curriculum is a feature in medical
to the host population. schools, and it has been introduced successfully at the
Travel medicine extends well beyond diseases of warm Royal Free and University College Medical School, in-
climate and the exigencies of travel and tropical life. It cluding the provision of a special study module. We hope
includes exposure to new environments and new cultures, that this book will serve the students well.
and new hazards ranging from high-altitude and deep-sea I am grateful to my many friends and colleagues who
environments to medical problems of cosmic radiation have contributed so willingly and enthusiastically to this
and space travel; emerging and re-emerging infections; book, through which we hope to stimulate health care
safe food, safe water, safe clothing; natural and accidental professionals to consider issues in travel medicine as part
disasters; and issues such as jet lag, fear of flying, air rage of their clinical practice. I also hope that this text may
and tourist risk of violence. Extensive knowledge of cur- enhance the profile of travel medicine and contribute to
rent and new vaccines and of prophylactic and thera- its development as a distinct specialty, which may subse-
peutic drugs is essential. The re-emergence of infections quently be recognised as a component of training in
such as diphtheria and syphilis in parts of eastern Europe, infectious disease and tropical medicine as well as part of
the HIV pandemic, increasing numbers of cases of the undergraduate curriculum.
legionella infection in travellers, the epidemiology of I would also like to express my gratitude to the editor-
drug-resistant malaria, extensive outbreaks of dengue fe- ial and production staff of John Wiley & Sons, in particu-
ver and antigenic shifts of influenza A are examples of the lar Charlotte Brabants and Suzanne Kriston, for their
imperative need for rapid access to accurate information patience and unwavering support.
an internationally recognised epidemiological database. Finally, I am particularly indebted to my parents for
Travellers with special needs must be evaluated with their continued support and encouragement and without
care and advised accordingly. They include the diabetic whom the inspiration for and concept of this book would
traveller, the immunocompromised, those with car- never been realised.
diovascular, renal, neurological, gastrointestinal, malig-
nant and other disorders, psychological and psychiatric Jane N. Zuckerman
illnesses, pregnant women, children and the elderly. London
Index
abdominal pain S-adenosylhomocysteine hydrolase 75 age
fever with 195 adenoviruses, enteric 56, 57 acute mountain sickness and 248—9
in Latrodectus envenoming 335 adjuvants 167 cruise ship passengers 278
abdominal surgery, air travel after 302, adolescents decompression sickness and 219
442 body fluid exposures 376 fatigue and 222
abortion risk-taking behavior 189—90, 244 motion sickness and 225, 282
induced 391—2 see also children; young people ultraviolet light damage and 343
spontaneous, mefloquine and 406 adoption, children for 204, 376 see also children; elderly travelers;
abscesses, skin 134 adrenaline see epinephrine young people
acanthamoeba corneal infections 354 adventure travel 186, 247 aggressive behavior, air passengers
acceleration forces, air travel 300 gender-related issues 415—18 240—1
accidents insurance 295 agricultural workers 189
air 241—2, 318—19 see also expedition travelers AIDS 52
in children 373—4 advertising, in injury prevention 293—4 definition 55
epidemiology 34 advice, pretravel see pretravel advice risk to travelers 35
see also drowning; injury, AEA/SOS International 394, 395 travelers’ diarrhea risk 156
travel-related; motor vehicle Aedes aegypti see also HIV infection; human
accidents dengue fever 10, 67—8 immunodeficiency virus
acclimatization to high altitude 248, 253 yellow fever 64, 65, 67 aid workers 189, 447—66
in pregnancy 418 Aedes albopictus 10 see also expatriates
acetaminophen (paracetamol) Aedes mosquitoes 35, 65, 67—8, 119 ainhum 149
for children 374 aerodontalgia 218 air
in decompression illness 271 aerodynamic suck, in cabin filters, in aircraft 220, 228
acetazolamide decompression 221 flow rates, in aircraft 220
in acute glaucoma 353 aeromedical repatriation 297—309 pollution 317
in acute mountain sickness 251 expatriates and aid workers 459 recirculation, in aircraft 220
in altitude illness prophylaxis 250, in eye trauma 357 air ambulance transfers 230, 297—309
253—4 see also air ambulance transfers aircraft 297, 303, 304
in children 376 Aeromonas sp. 153, 154 costs 297—8
in eye trauma 357 aerophagia, by divers 271 deciding on need 298—9
in high-altitude cerebral edema 252 Aerospace Medical Association 227 detrimental effects 300—1
for periodic breathing at high altitude Africa equipment 303, 304, 305
254 fever in travelers from 192 guidelines 308
side-effects 250, 360 HIV infection 54 physics and physiology 299—300
acetylsalicylic acid see aspirin meningitis belt 35, 176 primary 297
achlorhydria, travelers’ diarrhea risk African green monkey 72, 73 problems encountered 301—2
156 African tick typhus 139 secondary 297
aciclovir 62, 352 African trypanosomiasis 109—14 service providers 297—8
acquired immune deficiency syndrome clinical features 111, 196, 198 stages 303—8
see AIDS diagnosis 111—13 arrival at aircraft 307—8
actinic keratoses 146—7, 344 disease suppression 114 arrival at destination 308
Actinomadura infections 137—8 East 110, 111 arrival at referring hospital 305—7
actinomycetoma 137—8 epidemiology 110—11 ground transfer 307
activities, for child travelers 373 haemolymphatic stage 111, 113 initial information 303—5, 306
acupressure wrist bands 283 international spread 9 preparing patient 307
adaptability, motion sickness and 226 life cycle 109—10 prior planning 305
adaptation meningoencephalitic stage 111, take off and ascent 308
migrants and refugees 472—3 113—14 aircraft
to motion sickness 227 pathogenesis 111 acceleration and deceleration 300
retention of 226 prevention 114 accidents 241—2, 318—19
adder treatment 113—14 for aeromedical repatriation 297, 303,
puff (Bitis arietans) 321, 326, 329 West 110—11 304
South African Berg 326 in women 413—14 cabin, stressful environment 241
478 INDEX
cabin pressurization 215, 220—1, 227 stressful nature 237—8, 243 composition of air 215—16
air ambulances 299 transmeridian see time zone changes failure of fluid clearance 253
effects of rapid decompression 221, venous thrombosis risk 34, 190, 227 amantadine 60
300 see also jet lag Amblyomma 132
environmental requirements 220 albendazole ambulances
loss of pressure 220—1, 300 in cutaneous larva migrans 128 air see air ambulance transfers
methods 220 in filariasis 120 for ground transfer 307
chemical incidents 317—19 in pregnancy 411 amebiasis 154, 198
emergency medical equipment 232, presumptive treatment 377 gender-related issues 409, 413
233—4 alcohol consumption 186 in pregnancy 408, 413
emergency oxygen supplies 230, 300 air passengers 223, 241 amebic liver abscess 198, 413
first-aid kits 232, 233, 234 decompression sickness and 219 American College of Emergency
infant seating 373—4 driving and 294 Physicians (ACEP) 285
medical diversion 231 expatriates 456 Cruise Ship and Maritime Section
oxygen supplies 230, 300 fatigue and 222 278—81
see also oxygen, supplemental in hepatitis C 52 Health Care Guidelines for Cruise Ship
inflight motion sickness and 225—6 Medical Facilities 281, 286—7
pesticide disinfection 315—16 alcohol nystagmus, positional 225—6 American Council of the Blind 444
resuscitation equipment 232—5 alcohol poisoning, visual effects 360—1 American Diabetes Association (ADA)
aircrew Alexander Graham Bell Association for 436
in air accidents 241—2 the Deaf 444 American Society of Tropical Medicine
death in flight procedures 235 allergies and Hygiene (ASTMH) 24, 25
disrupted relationships 237—8 bee, wasp and hornet stings 337 contact details 28, 285
first aid/medical training 230, 232, food 17 travel medicine training 378
235 to vaccines 169 Americas, tourism to 4
scheduling 222 alopecia, oral contraceptive-related 149 amodiaquine
sleep disturbances and fatigue 222 alpha herpesvirinae 61 malaria resistant to 100—1
stress 241 alternative remedies, toxic effects malaria therapy 98, 99—100
airline medical advisor 235—6 313—14 in pregnancy 407
airport altitude 247—57 amphotericin B 108
environment, in disability 228 acclimatization 248, 253, 418 liposomal 108
malaria 191 alveolar air composition at 215—16 ampicillin
‘air rage’ 240—1 ascent rates 250, 252, 253 in pregnancy 408
air sickness 223, 224 in cardiorespiratory disease 16, 255—7 in travelers’ diarrhea 158
see also motion sickness children and 255, 374—6 analgesics
air travel 227—35 decompression sickness and 218—19, in acute mountain sickness 251
after decompression illness 229, 272 272 in decompression illness 271
children 373 descent from 251, 252, 254 anaphylactic reactions
in diabetes 347—8, 437 in diabetes 257, 437 bee, wasp and hornet stings 337
in disability/immobility 227, 228, 236, effects of 218—19 snake venom 332
440 equivalent aircraft cabin 299 Ancylostoma brasiliense 128
effects of reduced pressure 218—19 exercise at, in pregnancy 415—18 Ancylostoma caninum 128
infants and 374—5 expeditions 257—9 Ancylostoma ceylanicum 128
with infectious diseases 190, 228 extreme 247 Ancylostoma duodenale 410, 411
inflight medical emergencies see inflight heart disease and 255—6 Ancylostoma stenocephalae 128
medical emergencies high 247 anemia 186, 442
medical contraindications 229, 432, illness 248—54 in immigrants 472
441—2 in children 255, 374, 375—6 in pregnancy 17, 394
passengers in expedition travelers 259 screening children 376
advice for 244 see also high-altitude cerebral edema; angels’ trumpets brugmansia 314
contact lens wear 353 high-altitude pulmonary edema; angina
death in flight 235, 441 mountain sickness air ambulance transfers and 301
disrupted relationships 237—8, 243 intermediate 247 altitude travel 255—6
disruptive behavior 240—1 long-term residents 252 animal bites 33
eye disorders 229, 346—8 ocular changes 348 in immunocompromised travelers 426
fear of flying 238—40 oxygen requirements 214—16 rabies prophylaxis 64
giving birth 235 pre-existing medical conditions and rabies transmission 63, 454
medical clearance 227—30 255—7 see also insect bites; snake bites; tick(s),
medical support 227, 297 respiratory disease and 256—7 bites
risk-taking behavior 243—4 sleeping 250 Anopheles mosquitoes 91, 102, 119
safety 241—2 venous thrombosis risk 255, 393 anthelminthics
on stretchers 227, 228—30, 297 very high 247 in pregnancy 411
in pregnancy 229, 394—5 aluminium acetate, for swimmer’s ear presumptive treatment 205
scheduled, for medical repatriation 270 see also specific agents
228—30, 297 alveoli 214 anthrax vaccine 171, 172
INDEX 479
antibiotics Chironex 339 see also aircraft, cabin pressurization
in children 370 scorpion 334 effects of reduced 218—19
cholera vaccine interaction 181 snake see snake antivenoms at high altitude 247, 248
in chronic disease 424 sources 340—1 oxygen requirements and 215—16
in eumycetoma 142 spider 336 atopic disorders, eosinophilia 201
in eye infections 349, 354, 356 stonefish 338 atovaquone-proguanil (Malarone)
in leptospirosis 87 antiviral drugs in children 368, 369
oral contraceptive interactions 390 in hepatitis B 47 in expatriates and aid workers 455
in pregnancy 17, 408 in influenza 60 in immunocompromised travelers 20
in pyogenic skin infections 135 see also antiretroviral therapy malaria prophylaxis 103
in relapsing fever 89 anxiety malaria therapy 98, 101
resistance 187 flight 239 in pregnancy 405, 406, 407
emerging 7, 8, 34, 36 in motion sickness 226 Atrax robustus (funnel-web spider) 335
prophylactic therapy and 162 aorta, coarctation of 256 signs and symptoms of bites 335—6
travelers’ diarrhea 155, 158 aphthoviruses 58 treatment of bites 336
in syphilis 135 Apicomplexa 91 attapulgite 159
topical 135 Arenavirus infections 75—6 avalanche phenomenon, in motion
travelers’ diarrhea prophylaxis 157, Argentinian hemorrhagic fever 77 sickness 223
161—2, 433 arrhythmias aviation medicine 213—36
travelers’ diarrhea therapy 156, altitude travel 256 aviation psychology 237—45
157—8, 432—3 deceleration forces and 300 Ayurvedic remedies, toxic 313
urgent treatment 81 arsenic, in traditional remedies 313 azithromycin
for women travelers 416 artemether in children 370
anticoagulants, bismuth subsalicylate in malaria 98, 101 in immunocompromised travelers 20
and 161 in schistosomiasis 118 in legionellosis 83
antiemetics artemisinin (qinghaosu) derivatives in pregnancy 405, 408
in acute mountain sickness 251 in children 369 in travelers’ diarrhea 157, 158
for sea sickness 282—3 in expatriates and aid workers 455 aztreonam, in travelers’ diarrhea 157
antifungal agents 141, 143 malaria therapy 98, 101
antigenic drift 59 in pregnancy 407 Babesia 91, 434
antigenic shift 59 arterial gas embolism, in divers 263, 264 Baby Comp 390
antigenic variation artesunate, in malaria 98, 101 bacille Calmette—Guérin vaccine see BCG
malaria parasites 92—3, 95 arthralgia, fever with 195 vaccine
trypanosomes 111 Ascaris lumbricoides (ascariasis) 202, 203 backpackers 186
antihistamines in pregnancy 411, 414 back pain, in decompression illness 271
in antivenom reactions 331 in women 409, 410 bacterial infections 81—9
for sea sickness 282, 283 ascent rates clinical history 81
antimalarial agents aircraft 299 eye 349, 350, 351, 352, 354
in elderly 439—40 at high altitude 250, 252, 253 skin 133—8
in immunocompromised travelers underwater 263 snake bite wounds 324, 328
434, 435 Asia Pacific Travel Health Association travelers’ diarrhea 153—4
malaria prophylaxis see malaria, (APTHA) 24 urgent treatment 81
chemoprophylaxis aspirin 187 see also specific infections
malaria treatment 98—101, 199—201 altitude illness prophylaxis 251 bacterial mycetoma 137—8
ocular toxicity 359—60 bismuth subsalicylate and 161 bacterial vaginosis 383, 416
photosensitive reactions 149 venous thrombosis prophylaxis 393 bandaging, pressure see pressure
in pregnancy 101, 404—8, 429 asplenic travelers 425—6, 433—4 bandaging
see also specific agents vaccinations 177, 434 barometric pressure see atmospheric
antimonials, pentavalent, in assassinations 458 pressure
leishmaniasis 108, 130 asthma barotrauma
anti-peristaltic (anti-motility) agents altitude travel 256 gastrointestinal 270—1
158—9, 432 in divers 266 inner ear 269—70
in children 370 astroviruses 56, 57 middle ear 218, 269
in immunocompromised travelers 20 asylum seekers 467, 468 pulmonary 218, 262—3, 271
in pregnancy 408 factors affecting health 469 sinus 218, 270
antiprogestins 392 hepatitis B prevalence 470, 471 barotraumatic facial palsy 270
antiretroviral therapy see also immigrants; migration basal cell carcinoma 147, 344
highly active (HAART) 427 ataxia, in high-altitude cerebral edema B cells 165
in HIV infection 55 251, 252 congenital deficiency 424—5
HIV postexposure prophylaxis 416, athlete’s foot 140, 141 BCG vaccine 166, 171, 180—1
457 atmosphere 213—14 booster doses 180—1
antiseptics, topical 135 composition 213, 215 in children 171, 371, 372
antisera, animal 166 physical gas laws 213—14 in expatriates and aid workers 456
antivenom atmospheric pressure 213 in immunocompromised travelers 18
bee, wasp and hornet 337 aircraft cabin 227, 299 intradermal administration 168
480 INDEX
beach-related trauma 293—4 blood samples Calabar swellings 119, 202, 363
bed nets 103, 367 diabetes self-monitoring 437 calcium antagonists
bee stings 336—7, 361 toxicological assessment 312 for motion sickness 226—7
bends, the 219, 269 blood transfusion see also nifedipine
see also decompression illness Chagas disease risk 114—15, 116 calcium gluconate, in Latrodectus
benznidazole, in Chagas disease 115—16 on cruise ships 284 envenoming 336
benzodiazepines exchange, in severe malaria 199 caliciviruses 56
in elderly travelers 439 HIV risk 54, 55 Calloselasma rhodostoma 321, 322
for sleep disturbances at altitude 254 in snake envenoming 333 Campylobacter (jejuni) infection 153,
benzolamide, altitude illness viral hepatitis risk 41, 45—6, 48, 51 154, 198
prophylaxis 250 bluebottle (Physalia spp.) 338, 339 antibiotic resistance 158
Berloque 146 B lymphocytes see B cells antimicrobial therapy 158
beta-blockers body fluids epidemiology 155
in divers 268 exposures, children and adolescents Canadian National Institute for the
eyedrops, side-effects 360 376 Blind 444
for fear of flying 240 hepatitis B transmission 45—6 Canadian Transportation Agency 445
bicozamycin 161 Bolivian hemorrhagic fever 77—8 cancellation, trip 432
bilirubin, raised 199 bone marrow transplant recipients 170, cancer
see also jaundice 434 chemotherapy 170, 426, 435
‘Binational Third Culture’ 448 borders, international, restrictions on immunodeficiency 425—6
Bioself Fertility Indicator 390 crossing 19—20 role of infectious agents 7
birth, in flight 235 Bordetella pertussis 167 screening, expatriates and aid
bisexual men 54 Borrelia burgdorferi 176, 363, 401 workers 451
bismuth subsalicylate (BSS) 57 see also Lyme disease treatment 170, 426—7
in children 370 Borrelia recurrentis 88, 89 see also skin cancer
travelers’ diarrhea prophylaxis 161, Borrelia species 88, 89 Candida infections (candidiasis)
162 Bothrops atrox (Barba amarilla) 321 antibiotic prophylaxis and 162
travelers’ diarrhea treatment 154, 158, boutonneuse fever 85, 139 in diabetes 438
159 bovine diarrhoea virus 65 skin and nail 141
bites 34, 127—33 box jellyfish (Chironex fleckeri) 338, 339 vaginitis 383, 416
venomous 321—41 Boyle’s law 213, 218, 262, 300 cap, contraceptive 386, 388
see also animal bites; insect bites; snake breastfeeding see lactation capillary tube centrifugation, in
bites; stings; tick(s), bites breast masses, parasitic 409 trypanosomiasis 111
Bitis arietans (puff adder) 321, 326, 329 breathing carbocyclic 3-deazaadenosine 75
Bitis caudalis 326 periodic, at high altitude 254 carbon dioxide
black flies (Simulium spp.) 119, 130, 361 pressure 216, 217 carriage in body 214
avoiding bites 362 breathlessness, in high-altitude exchange 214
control measures 121 pulmonary edema 253 partial pressure (PCO ) 214—15

blackwater fever 97 Brill—Zinsser disease 139 toxicity, in divers 265
bleeding see hemorrhage/bleeding British SubAqua Club (BSAC) 273, 274 carbon monoxide poisoning 317
blepharitis 346, 351, 352 Brocq—Lyell syndrome 148 carbuncle 134
blindness Brucella abortus 87 card agglutination test for
childhood 364 Brucella melitensis 87 trypanosomiasis (CATT) 112
global problem 364 Brucella suis 87 card indirect agglutination test for
in leprosy 363 brucellosis 82, 87—8 trypanosomiasis (TrypTect
river see onchocerciasis clinical features 87, 198 CIATT) 112—13
snow 344, 348 transmission in laboratories 191 cardiomyopathies, fitness to dive 268
in trachoma 362 Brugia malayi 119, 202 cardiopulmonary resuscitation (CPR),
travelers with 440 in women 410 inflight 232—5
blisters, snake bites 324, 328 see also lymphatic filariasis cardiorespiratory problems see
blood disorders, fitness to fly 229 Brugia timori 119 cardiovascular disease; respiratory
blood donors see also lymphatic filariasis disease
Chagas disease 115, 116 Brugmansia spp. 314—15 cardiotoxicity, snake envenoming 324
exclusion of travelers as 205 buclizine, for sea sickness 283 cardiovascular disease 16, 34, 441
blood films 199 Bunyaviridae 78 air ambulance transfers 301—2
in filariasis 120 Burkholderia pseudomallei 438 altitude travel 16, 255—6
for malaria 81, 97, 193—4, 195 ‘burnout’, expatriates 448 death rates 13
for trypanosomiasis 111, 112 burns, fitness to fly 229 fitness to dive 268
blood group O, travelers’ diarrhea risk Buruli ulcer 136, 137 fitness to fly 228, 229, 441
156 business travel 5—6, 241 in migrants and refugees 472
blood pressure measurements, during air susceptibility to infections 423
travel 302 C3F8, intraocular 347 cardiovascular function, in air ambulance
blood products cabin pressurization see aircraft, cabin transfers 300, 301—2
HIV spread 54, 55 pressurization cardioviruses 58
viral hepatitis risk 41, 45—6, 48, 51 caffeine 223 -carotene 145
INDEX 481
car sickness 223 chemoreceptors 214—15 side effects 98, 149, 187
car travel see motor vehicle travel chemotherapy, cancer 170, 426, 435 chloroquine/proguanil
Carukia barnesi 338 chest trauma in children 368, 369
cataract 345—6, 364 air transport after 302 in expatriates and aid workers 455
risk factors 345—6 diving after 266—7 malaria prophylaxis 103
surgery, flying after 347 chest wall disorders, altitude travel in pregnancy 405, 406
catfish 337 256—7 chlorpheniramine, for antivenom
cats chest X-rays reactions 331
bites 426 in high-altitude pulmonary edema chokes 219
cutaneous larva migrans and 127—8 253 cholera 198
toxoplasmosis spread 414 in legionellosis 83 clinical features 156
CD4; T cells Cheyne—Stokes respiration, at high epidemiology 33
counts 55 altitude 254 trends 35
susceptibility to infection and 427, Chiclero ulcer 106, 129 vaccine 162, 171—3
428 chigoe (jigger) infestation 131, 201 in children 371, 372
travelers’ diarrhea risk 156 children 367—79 in expatriates and aid workers 454
HIV infection 53, 54, 427 for adoption 204, 376 in pregnancy 398
cell-mediated immunity 165 aeromedical repatriation 302 chromoblastomycosis 142—3
congenital deficiency 424—5 air travel 373 chronic disease
in pregnancy 396 altitude illness 255, 374, 375—6 immunodeficiency of 423—4
cellulitis 134, 135 altitude travel 255, 374—6 in migrants and refugees 472
orbital 351 blindness 364 travelers with 441—2
preseptal 351 body fluid exposures 376 see also medical conditions,
Center for Reproductive Law and comfort 373 pre-existing
Policy 385, 391 diarrhea 56, 369—70, 377 chronic fatigue syndrome, in aid
Centers for Disease Control and expatriate 448, 453, 455—6, 460 workers 449
Prevention (CDC) 24, 25, 28 with fever 191, 192, 377 chronic obstructive pulmonary disease
cruise ship health 283—4 hepatitis A 41, 42, 372 441—2
travelers’ hotline 285, 444 immigrant 376—7 altitude travel 256
vaccinations in pregnancy 397 insect-borne diseases 367—9 special cruises 276
Central European encephalitis virus 70, malaria 96, 191, 367—9, 455—6 susceptibility to infections 423, 424
71 motion sickness 225, 282, 373 Chrysops (tabanid) flies 119, 121, 362
central nervous system (CNS) post-travel screening and care 186, cinchonism 99
damage, in divers 268 376—7 Cinerama sickness 223, 224
oxygen toxicity, in divers 265 rabies risk 454 cinnarizine, for motion sickness 226, 283
see also neurological disorders safety 373—4 ciprofloxacin
cercariae 116 snake bites 322, 329, 331 in children 370
cercarial dermatitis (swimmer’s itch) vaccination 370—3 in HIV infection 427
116, 150, 202 routine immunizations 171, 370—2 in immunocompromised travelers 20
Cercopithicus aethiops (African green travel-related vaccines 371, 372—3 in pregnancy 408
monkey) 72, 73 see also adolescents; infants; neonates; in rickettsial infections 140
cerebral edema young people travelers’ diarrhea prophylaxis 162
in acute mountain sickness 249—50 China International Travel Health travelers’ diarrhea therapy 157
high altitude see high-altitude cerebral Association (CIHTA) 24 for women 416
edema Chironex fleckeri (sea wasp) 338, 339 circadian desynchronisation see jet lag
cerebral embolism, gas, in divers 264 chlamydial conjunctivitis (trachoma) circadian rhythm 222, 223, 242
cerebral thromboembolism, at high 349, 362, 364 circulation 214
altitude 254 chloasma 149 circulatory disorders, fitness to fly 229
cerebrospinal fluid (CSF) chloramphenicol circumsporozoite protein (CSP, CS) 91
examination, in trypanosomiasis 112, ocular 349, 355 antibodies 12, 13
113 in rickettsial infections 140 candidate malaria vaccines 105
leaks, in eye trauma 358 side-effects 360 cirrhosis 186
cerebrovascular events 441 in travelers’ diarrhea 158 in hepatitis C 52
cestodes (tapeworms) 203, 409 chloroquine travelers with 435
Chagas disease see South American in children 368, 369 Cladosporium 142—3
trypanosomiasis in elderly 440 clam digger’s itch 150
chagoma 115, 196 in expatriates and aid workers 455 Clear Plan Fertility Monitor 390
chalazion 350 in HIV infection 427 climate change 10
chancre, trypanosomal 111 malaria prophylaxis 103 climatic droplet keratopathy 345
charcoal, activated 162 malaria stand-by treatment 105 clindamycin, for malaria therapy 98, 101
Charles’s law 213 malaria therapy 98, 99 clinic, travel see travel clinic
Chemical Incident Response Service ocular toxicity 359—60 clinical examination, expatriates 461
(CIRS) 312 in porphyria cutanea tarda 146 clioquinol, in travelers’ diarrhea 158
database 313, 316—19 in pregnancy 105, 404, 405, 407 Clonorchis (clonorchiasis) 202, 203
chemicals, detection techniques 312—13 -resistant malaria 34, 99—100, 404, 405 reproductive effects 409
482 INDEX
Clostridium difficile infection 158, 162 conjunctivitis 349 in scrub typhus 85
clothes acute bacterial 349 Councilman bodies 66
for children 374 chlamydial (trachoma) 349, 362, 364 coxsackie virus 58
insecticide-impregnated 367 viral 350 Creative Age Publications 444
clotting test, whole blood see whole blood consciousness, disturbances of creeps 219
clotting test, 20 minute in diabetic divers 267 Crimean—Congo hemorrhagic fever 72,
coagulopathy, in snake envenoming 325 in high-altitude cerebral edema 251—2 78
management 329—30, 332, 333 in hyperventilation 217 virus 72, 78
pathophysiology 323 in hypoxia 217 crisis management training 458
coarctation of aorta 256 Consortium for Emergency critical incident stress debriefing (CISD)
cobras 321, 324, 329 Contraception 421 459, 462
spitting construction workers 189 critically ill patients
bites 324, 329 contact dermatitis, photoallergic 145 aeromedical repatriation 297, 300—1,
eye injuries 327, 333, 361 contact lenses 347, 353—4, 440 308
Thai 322 daily disposable 354, 440 evacuation see evacuation
Coca-Cola incident, Belgium 316 hard 353—4 at sea 284—5
Coccidioides immitis 143 lost in eye 354 crosscultural training 457
coccidioidomycosis 143 problems and complications 354 Crotalus durissus 321, 326
Cochliomyia homnivorax 201 soft 354 cruise ship(s) 275—87
cockpit resource management training contraception 384—92, 416 critical care 284—5
242 choice of method 384, 386—7 disabled travelers 276, 440
cognitive-behavioral treatment, fear of emergency see emergency health care guidelines 286—7
flying 240 contraception influenza outbreaks 32, 283
cognitive dissonance theory 243—4 at high altitude 257 medical care 278—81
cognitive dysfunction, in divers 268 options 384 medical facilities 275, 278—81, 286—7
cognitive impairment, travelers with 20 potentially available methods 388—9 medicine 275
cold vaccines/immunocontraceptives 389 onboard maladies 190, 281—4
hypoxia susceptibility and 217 web sites 385 physicians 275, 278, 281
rapid cabin decompression 221 see also condoms; oral contraceptives; in pregnancy 396
cold, common other specific methods pre-travel planning 275—8
air travel risks 218 coordination, impaired, in hypoxia 216 telemedicine 284—5
high altitude travel and 375—6 Cordylobia (anthropophaga) 131, 201 traveler’s first-aid kit 277—8
colostomy patients 442 cornea travel medical insurance 277
colubrid snakes, venomous 321 abrasions 347, 355 useful addresses 285—6
coma bee stings 361 cryotherapy, cutaneous larva migrans
diabetic, in divers 267 disorders 351—3 128
in high-altitude cerebral edema 252 foreign bodies 355—6 Cryptosporidium (cryptosporidiosis) 91,
comfort, children during travel 373 ulcers 351—2, 354 154
common variable immunodeficiency ultraviolet light damage 344—5 risk factors 155
(CVD) 425 coronary artery disease transmission 19
communication altitude travel 255—6 Culex mosquitoes 69, 70, 119
air ambulance transfers 298, 307 fitness to dive 268 Culex tritaenorhynchus 69
by divers 262 corticosteroids 435 cultural competence, acquiring 473
flight deck crew 242 in African trypanosomiasis 113 cultural issues, women travelers 418—19
for injury prevention 294—5 immunosuppression 426 culture shock, reverse 205, 243, 462
rapid cabin decompression and 221 in schistosomiasis 202 cutaneous larva migrans 127—8, 201, 203
compartmental syndromes, in snake topical ocular 357 cutaneous lupus erythematosus 145—6
envenoming 324, 333 vaccinations and 170, 435 cyanosis, in hypoxia 217
complement deficiency 425 see also dexamethasone cyclizine, for sea sickness 283
compliance Corynebacterium diphtheriae 88, 136 cyclopentolate 355, 357
air travelers 244 co-trimoxazole Cyclospora cayetanensis 154
malaria advice 243, 244, 455 (trimethoprim-sulfamethoxazole) Cyclospora infections 198
conditioning, fear of flying 239 in children 370 cytokines
condoms 384, 386 in immunocompromised travelers 20 as adjuvants 167
HIV prevention 55 in pregnancy 408 in cerebral malaria 96
use by expatriates 456 travelers’ diarrhea prophylaxis 162 in leishmaniasis 106
cone shells 339 travelers’ diarrhea therapy 157 cytomegalovirus, human 61
conference travel 5—6 cough cytotoxic drugs 426
confusional state, acute, in diabetic fevers with 195, 198
divers 267 at high altitude 255 Daboia russelii (Russell’s viper) 321, 322,
congenital heart disease, altitude travel in high-altitude pulmonary edema 324, 326
256 253 dactylolysis, spontaneous 149
congenital protozoan infections 412, in legionellosis 83 Dalton’s law 214
414 in malaria 97 dapsone/pyrimethamine see
conjunctival disorders 349—50 in pulmonary oxygen toxicity 265 pyrimethamine/dapsone
INDEX 483
DDT 102, 114 referred to eye 347 travelers’ see travelers’ diarrhea
resistance 102 Depo-Provera 387 dieldrin resistance 102
deafness see hearing impairment depression, in expatriates and aid dietary advice 19, 161
death workers 449, 462—3 diethylcarbamazine (DEC)
in altitude illness 252, 253 Dermacentor ticks 132, 139 in filariasis 120, 202
causes 13, 34 dermatitis in pregnancy 411
certificates 36 cercarial (swimmer’s itch) 116, 150, prophylaxis 121
expatriates and aid workers 449—50 202 N,N-diethyl-m-toluamide see DEET
in flight 235, 441 photoallergic contact 145 diffusion 214
injuries as cause 13, 34, 291 see also eczema --difluoromethylornithine, in African
snake bites 322 Dermatobia (hominis) 131, 201 trypanosomiasis 113
debriefing dermatophyte infections 140—1 dimenhydrinate, for motion sickness
critical incident stress (CISD) 459, descent 283, 373
463 in altitude illness 251, 252, 254 diphenhydramine, for sea sickness 283
returned expatriates 462—3 rates, aircraft 299 diphenoxylate 158, 408
deceleration forces, air travel 300 desensitisation diphtheria 82, 88
decompression bee, wasp and hornet stings 337 antitoxin 88
collapse 219 fear of flying 238—40 changing pattern 35
divers 263 motion sickness 227 clinical features 88, 197
decompression illness (DCI) 264, 269, developing countries cutaneous 136
271—3 blindness in 364 epidemiology 33, 88
clinical features 219, 271 burden of infectious diseases 7—8 toxin 88
during flying 218—19 child immigrants from 376 vaccine 88, 171, 173
causes 218—19, 221 incidence of travel-related health in children 370—1
treatment 219 problems 11, 32 in pregnancy 397—9
flying after 229, 272 tourism to 4 with tetanus (DT) 173
management 271—3 travelers’ diarrhea risk 154 diphtheria, tetanus and pertussis vaccine
drugs 273 dexamethasone see DTP vaccine
recompression therapy 272 altitude illness prophylaxis 250—1 diplopia 348
outcome 272 altitude illness therapy 251, 252 dipteran larvae, skin colonization
in pregnancy 418 in expedition medical kits 259 (myiasis) 131—2, 201
return to diving after 268 diabetes mellitus 15—16, 186, 435—8 direct agglutination testing (DAT), in
versus diabetic coma 267 altitude travel 257, 437 leishmaniasis 108
deep venous thrombosis see venous complications 16 disability, physical 20, 440
thrombosis fitness to dive 267 air travel 227, 228, 236, 440
DEET (N,N-diethyl-m-toluamide) 102, identity bracelets/cards 15, 436 cruise ship travel 276, 440
439 infections 16, 423, 438 disease, travel-related 31—7
for children 367—8, 456 insulin products 436 epidemiology 31—6
in pregnancy 404 new insulin delivery systems 436—7 changes in 34—6
defibrillation, inflight 235 new technological advances 437 surveillance 36—7
defibrillators prolonged air travel 437 information dissemination 36—7
automatic advisory external (AED) time zone changes 437 sources of data 36
234—5 travelers’ diarrhea 424 displaced persons 204
implanted 441 trip preparation 435—6 internally (IDPs) 468
dehydration diabetic retinopathy 347—8, 437 see also immigrants; refugees
avoidance in pregnancy 408, 415, 418 diagnostic methods 37 disruptive behavior, air passengers
in decompression illness 271 dialysis 240—1
venous thrombosis risk 395 travelers on 435 disseminated intravascular coagulation
delta hepatitis 48—9 see also peritoneal dialysis (DIC), in snake envenoming 323
dengue fever 10, 67—8 Dialysis Traveler/Dialysis at Sea diuresis, at high altitude 248
clinical features and diagnosis 68, Cruises 445 diuretics 187
194—6 Dialysis Travel and Vacations 445 diving 261—74
epidemiology 12—13, 34, 35, 67—8 diamidines, aromatic, in leishmaniasis assessment of fitness 265—9
pathology 68 109 breath-hold 262
prevention 68 diaphragm, contraceptive 386, 388 depth limits 264
surveillance 36 diarrhea emergency helpline 274
versus yellow fever 67 air transport 302 flying after 219, 229
dengue hemorrhagic fever 68 bloody (dysentery) 156, 198 gas toxicity 264—5
dengue shock syndrome 68 chronic 153 mask 261
dengue virus 67, 68 definition 153 in pregnancy 418
dental health in expatriates and aid workers 456 pressure effects 262—4
expedition travelers 257 fever with 195, 198—9 protective measures 273
immigrants 472 in intestinal schistosomiasis 117 recreational 261, 265—6
dental pain in malaria 192 -related disorders 269—71
in air travelers 218 oral contraception and 385—90 underwater environment 261—2
484 INDEX
diving (cont.) infections 12 international availability 421—2
see also decompression illness earache, in children 373 venous thrombosis risk 393
dizziness, in hyperventilation 217 eardrum, ruptured 269 web site 385, 391
DNA vaccines 163 Ebola fever 72, 74—5 emergency medical equipment, aircraft
doctors see physicians experimental prophylaxis and 232, 233—4
dogs treatment 74—5 emerging infectious diseases 7—8, 10,
bites 426 outbreaks 35, 74 34—6
cutaneous larva migrans and 127—8 prevention 75 emotional exhaustion, expatriates 448
guide, travel with 440 Ebola virus 72, 74 emotional reactions, returned
rabies 63, 454 ECG expatriates 462
Rocky Mountain spotted fever 85, 139 in Chagas disease 115 emphysema
domestic animals telemedicine 232 interstitial, in divers 262—3
brucellosis 87 Echinococcus spp. 409 mediastinal, in divers 262—3
imported 191 echinoderm stings 339 surgical, in orbital fractures 358
leptospirosis 86 Echis ocellatus 322, 326 encephalitis
trypanosomiasis 111, 114 Echis spp. 321, 322 fever with 196, 198
domestic products, overseas 315 economics, international tourism 4—5 flaviruses causing 68—71
doxycycline ‘economy-class syndrome’ 34 St Louis 69—70
bismuth subsalicylate interaction 162 ectoparasites 127—33 tick-borne see tick-borne encephalitis
in brucellosis 87—8 eczema see also Japanese encephalitis
in children 368, 369 atopic, fungal infections 140 endotracheal cuffs, air ambulance
contraindications 105 pyogenic infections 135 transfers 301
in expatriates and aid workers 455 see also dermatitis Entamoeba dispar 413
in HIV infection 427 edema Entamoeba histolytica 154, 198
in immunocompromised travelers 20 in acute mountain sickness 249 gender-related issues 413
malaria prophylaxis 103 peripheral, at high altitude 254 reproductive effects 409
malaria stand-by treatment 105 see also cerebral edema; pulmonary see also amebiasis
malaria therapy 98, 101 edema enteric fever 196, 198
in pregnancy 407, 408 education, pretravel see pretravel advice see also typhoid
in rickettsial infections 86, 140 Edwardsiella lineata 150 ENTERNET 37
side effects 187 eflornithine, in African trypanosomiasis Enterobius vermicularis (pinworm)
in travelers’ diarrhea 158 113 in pregnancy 411, 414
driving conditions, varying 294 egg in women 409, 410
drowning 13, 269, 291 allergies, vaccination and 169 enteroviruses 40, 58—9
risk-based approach 293 raw or undercooked 19 Entonox, in decompression illness 271
drowsiness, in motion sickness 224 elapid snakes environmental risks,
drug-induced disorders effects of envenoming 324, 325, 326 immunocompromised travelers
eosinophilia 201 venomous 321, 323 19
immunosuppression 426—7 elderly travelers 17, 439—40 environmental samples, toxicological
ocular 359—60 heatstroke and hypothermia 439 assessment 312
skin diseases 148—9 injuries and accidents 439 eosinophilia 198, 199, 202—4
drugs see medications jet lag 439 definition 202
Drugs in Pregnancy and Lactation malaria 439—40 in expatriates and aid workers 460
(Briggs) 402 motion sickness 439 investigation 204
dry eye 346, 350 thromboembolic disease 439 in migrants and refugees 472
dry suits, for diving 262 travelers’ diarrhea 432—3 screening asymptomatic travelers 205
DTP vaccine 173, 177, 180 travel insurance 295 tropical pulmonary 119, 203
adverse events 169 vaccine-preventable illness 440 epidemics 187
routine immunization 171, 370—1 electrical stimulation wrist bands 283 epidemiology
Duffy (FyFy) blood group glycoprotein electrocardiogram see ECG health risks and travel 7—14
92 elephantiasis 119 travel-related disease 31—6
Dugbe virus 78 ELISA tests, snake envenoming 327 Epidermophyton 140
Duvenhage virus 62 e-mail discussion groups 25 epilepsy 442
dysentery 156, 198 embolism contraindicating diving 267
amebic see amebiasis arterial gas 263, 264 malaria chemoprophylaxis 368
dysfunctional uterine bleeding 416 see also pulmonary embolism; post-traumatic, assessment of risk
thromboembolism 267—8
ear emergencies epinephrine (adrenaline)
barotrauma 218, 269—70 evacuation see evacuation bee, wasp and hornet sting reactions
function underwater 261—2 expatriates and aid workers 459 337
infections 12, 198, 441 inflight medical see inflight medical in food allergies 17
squeeze, external (reversed ears) 270 emergencies in snake antivenom reactions 331
swimmer’s 270 in pregnancy 394, 395 EPINET 313
ear, nose and throat (ENT) emergency contraception 390—1, 392, episcleritis 350
disorders, air travel 229 416 Epstein—Barr virus 61
INDEX 485
equipment 199 major 356—9
air ambulances 303, 304, 305 exercise minor 355—6
resuscitation, on aircraft 232—5 decompression sickness and 219 penetrating 356
see also medical kits hypoxia susceptibility and 217 eyedrops, stability 359
erythema multiforme 148 in pregnancy 415—18 eyeglasses see spectacles
erythema nodosum 149 at altitude 415—18 eyelids
erythrocytapheresis, in severe malaria guidelines 415 disorders 350—1
201 stress testing 432 lacerations/injuries 358—9
erythrocyte membrane-binding protein tolerance, fitness to fly and 228 in red eye 349
(EBA-175) 92—3 exotic viruses 71—2 ultraviolet light damage 343—4
erythrocyte membrane protein 1, expatriates 186, 447—66
Plasmodium falciparum debriefing 462—3 F(ab’) fragments, snake antivenoms

(PfEMP1) 94—5 morbidity 448—9 329, 330
erythrocytes mortality 449—50 Fab fragments, snake antivenoms 329,
increased mass, at altitude 248 overseas medical care 458—9 330
malaria life cycle 91—5 in emergencies 459 facial nerve palsy
parasitised (pRBC) 94 future trends 458—9 barotraumatic 270
erythromycin postreturn screening and care 459—63 in leprosy 363
in legionellosis 83 components 461—2 facies latrodectismica 335
in pregnancy 408 evidence for validity 460 faecal examination see stool examination
in travelers’ diarrhea 158 indications 460—1 Faget sign 66
erythropoietin, at high altitude 248 purpose 460 fainting see syncope
eschar predeparture assessment 450—3 falls, on beaches 293
in poisonous spider bites 335, 336 medical assessment 450—1 famciclovir 47
in typhus 85, 86, 139 psychological assessment 451—3 family see relatives
Escherichia coli purpose of screening 450 family planning, natural 390
cholera vaccine cross-protection 171 predeparture preparation 453—8 Fansidar see sulfadoxine-pyrimethamine
enterohemorrhagic 155 diarrheal diseases 456 Fasciola hepatica (fascioliasis) 202, 203
enterotoxigenic (ETEC) 31, 153, 154, HIV 456—7 fasciotomy, in snake envenoming 333
198 immunizations 453—4 fasting, religious, in diabetes 436
in children 369 malaria 454—6 fatigue 221—3
epidemiology 155 psychological 457—8 in acute mountain sickness 249
milk immunoglobulins 163 risk behavior 456 hypoxia susceptibility and 217
treatment 159 safety aspects 458 motor vehicle accidents and 294
vaccine 371, 372 sexually transmitted diseases 456 prevention and management 222—3
espundia (mucocutaneous tuberculosis 456 FDA see Food and Drug Administration
leishmaniasis) 106, 107 premature attrition 449 fear of flying 238—40
treatment 108, 109 re-entry issues 463 febrile convulsions, malaria
estrogen expedition travelers 190, 257—9 chemoprophylaxis after 368
for emergency contraception 391 evacuation 259 Federal Aviation Regulations (USA),
replacement therapy 393, 417 immunizations and health check 257 aircraft emergency medical
vaginal absorption 390 managing illness/injury 259 equipment 233
ethambutol, ocular toxicity 360 medical kits 258, 259 feeding, in travelers’ diarrhea 157
eucalyptus oil 102 pre-expedition planning 257 female genital schistosomiasis (FGS)
eumycetoma 142 pretravel education 257—9 409, 410, 412—13
Europe expiratory positive airways pressure, in female genital tract disorders, in parasitic
outbound tourism 5 high-altitude pulmonary edema infections 409—11
tourism to 4 254 Fem Cap 388
European bat virus 62 eye feminine hygiene products 382, 416
European Joint Aviation Requirements, air travel and 229, 346—8 fertility, effects of parasitic infections
aircraft emergency medical at altitude 348 409
equipment 234 discharge, sticky 348 fetus
European Working Group on Legionella dry 346, 350 effects of altitude 417—18
Infections (EWGLI) 37 examination 349 parasitic infections 409
evacuation itchy 349 in scuba diving 418
in altitude illness 252, 254 light reflection from 349 fever 191—201
cruise ship travelers 284 in onchocerciasis 119, 130, 361—2 in African trypanosomiasis 111
in decompression illness 272 red 348—9 in antivenom reactions 331
expatriates and aid workers 459 shields 347 causes 189, 192
expedition travelers 259 snake venom in 327, 333, 361 children with 191, 192, 377
insurance cover 277 sunlight exposure 343, 344 common syndrome/disease
see also aeromedical repatriation surgery, flying after 347 associations 195
evolved gas dysbarism 218 trauma 354—9 in dengue fever 68, 194—6
examination rooms, patient 25 adnexal tissues 358—9 diagnostic algorithm 200
exchange transfusion, in severe malaria blunt 356—8 diarrhea with 195, 198—9
486 INDEX
fever (cont.) in travelers’ diarrhea treatment 157, laws, physical 213—14
in early pregnancy 396 432—3 toxicity, in divers 264—5
frequency 12 flying see also carbon dioxide; nitrogen;
investigations 199 fear of 238—40 oxygen
lymphadenopathy with 196—7 see also air travel gastric contents, aspiration 302
in malaria 93—4, 96, 191—4 folic acid supplements 406, 435 gastric rupture, in divers 271
in neurological syndromes/diseases folinic acid supplements 407 gastroenteritis, viral 56—7, 154
196, 198 folliculitis 134 see also travelers’ diarrhea
in pregnant travelers 407 Fonsecaea 142—3 gastrointestinal disease
rashes with 196 food aeromedical repatriation 302
in respiratory infections 197—8 allergies 17 in Chagas disease 115
treatment 81, 199—201 extra, in diabetes 15—16 fitness to fly 229, 442
in typhoid and paratyphoid fever imported 191 in schistosomiasis 117
84 safety precautions 19, 161 travelers’ diarrhea risk 156
in yellow fever 66 toxic contamination 313, 316 gastrointestinal tract
filariasis 119—21, 202—3 food-borne illness 31 barotrauma 270—1
clinical features 119 cruise ships 283—4 gas expansion within 218, 270—1, 302
consequences of not hepatitis A 41 GB viruses 39
detecting/treating 205 in immunocompromised travelers 19 gender differences
diagnosis 120 travelers’ diarrhea 155 acute mountain sickness 248
global burden 7, 9 typhoid and paratyphoid fever 83—4 sea sickness 282
prevention and control 121 Food and Drug Administration (FDA) gender-related issues
treatment 120—1 use-in-pregnancy categories 399 sports and adventure activities
in women 409, 410 vaccination in pregnancy guidelines 415—18
see also loiasis; lymphatic filariasis; 396 tropical diseases 381, 408—14
onchocerciasis foot see also women
fires, air pollution from 317 care, in diabetes 16, 438 genital herpes 61—2
first aid fungal infections 140—1 Geosentinel 37
snake bites 327 injuries, on beaches 293 G forces, air travel 300
training, expedition travelers 257 Madura 137—8, 142 Giardia lamblia (giardiasis) 154, 198—9
first-aid kits foramen ovale, patent, in divers 264 in expatriates and aid workers 460
aircraft 232, 233, 234 foreign body in immunocompromised travelers 425
see also medical kits corneal 355—6 in pregnancy 408, 413
fish stings 337—8 intraocular 356 prevalence in returned travelers 205
fish-tank granuloma 136 sensation, eye 348 reproductive effects 409
fitness forestry workers 189 screening children 377
to dive 265—9 fractures, air travel and 228, 229, 442 treatment 158
to fly 227—30, 432 frequency, urinary, in women 383 ginger root, for sea sickness 283
improving, before travel 431—2 friends girdle pain, in decompression illness 271
physical, divers 266 travel by 190—1 ‘glandular fever’ infections 196
to travel 15—21, 431—2 visiting see visiting friends/relatives glaucoma
fits see seizures frusemide, in high-altitude cerebral acute 349, 353
flashes, visual 357 edema 252 drug-induced 360
Flavirus 65, 67 fungal diseases 140—4 post-traumatic 357
flaviviruses 65, 68—71 cornea 355 Global Malaria Control Strategy 102
fleas 133 furazolidone, in travelers’ diarrhea 158 global warming 10
burrowing 131, 201 furuncle 134 Glossina species see tsetse flies
Flight Anxiety Modality questionnaire glucagon, in diabetes 15—16, 437
238 gametocytes, malaria 95 glucocorticosteroids see corticosteroids
Flight Anxiety Situations questionnaire gangrene 134, 135 glucose
238 in Rocky Mountain spotted fever 139 for diabetic divers 267
flight crew see aircrew Ganjam virus 78 monitoring, in diabetes 437
floaters, intraocular 357 gardening holidays 146 glucose-6-phosphate dehydrogenase
flucytosine 143 gas (G6PD) deficiency
fluid replacement dysbarism antimalarial chemotherapy 97, 98, 99
in decompression illness 271 evolved 218 in immigrants 472
in snake envenoming 333 trapped 218 malaria chemoprophylaxis 369
in viral gastroenteritis 57 embolism, arterial, in divers 263, 264 melarsoprol treatment 113
see also oral rehydration therapy equation (general gas law) 213 glycemic control, diabetic travelers 436,
flukes see trematodes exchange, in body 214 437
fluorescein staining, eye 349, 354, 355 expansion gnathostomiasis 131, 203
fluoroquinolones during air travel 300 gonorrhoea 33
in immunocompromised travelers 20 in gut 218, 270—1, 302 Good Samaritan law 231
in travelers’ diarrhea prophylaxis 162, inert, absorption during diving 263 Good Samaritans 231
433 intraocular, air travel and 347, 348 governments, injury prevention 295—6
INDEX 487
granuloma fitness to dive 268 174, 175
annulare 140—1 heart failure in immunocompromised travelers
fish-tank 136 altitude travel 256 19
swimming 136 congestive 16, 424 interaction with immunoglobulins
green monkey disease 72 heart rate, at high altitude 248 175
grittiness, ocular 348 heat loss, during diving 262 in older travelers 440
Guadalajara incident (April 1992) 319 heatstroke 439 in pregnancy 169, 398, 400
Guanarito virus 75 Helicobacter pylori infection 436 in transplant recipients 434
Guggul 313 helicopter rescue and typhoid vaccine combination
guide dogs, travel with 440 cruise ship travelers 284 174, 181
gut see gastrointestinal tract in decompression illness 272 virus (HAV) 39, 40, 58
gynaecologic problems, parasitic diseases helium hepatitis B 43—8
causing 409—11 absorption, during diving 263 carriers 43, 400
Gyneseal 388 use by divers 265 clinical features 46—7
helium—oxygen mixtures (heliox) 262, diagnosis 46—7
H-2 blockers, travelers’ diarrhea risk 265 e antigen 47
156 hemagglutinin, influenza virus 59 epidemiology 33, 45—6
HACE see high-altitude cerebral edema hematological malignancies 425 immune responses 46
Haemagogus mosquitoes 65 hematuria, in schistosomiasis 117 immunization 47—8, 49
Haemaphysalis 132 hemoconcentration, at high altitude 248 immunoglobulin 47, 175
Haemophilus influenzae b (Hib) vaccine hemodialysis, during travel 435 incubation period 187
for children 171, 173, 371 hemoglobin 214 management 47
in pregnancy 398, 400 oxygen saturation curve 216 in migrants and refugees 470, 471
Hajj pilgrims (Mecca) 35, 176, 472 hemolysis, in malaria 97, 98, 99 pathology 46
haloes, visual 348 hemophilia 54 prevention 47—8
halofantrine 455 hemoptysis 198 reservoir 46
Hamman sign 263 hemorrhage/bleeding risk to travelers 48, 376, 400
hantavirus infections 198 in Crimean—Congo hemorrhagic fever screening children for 376
HAPE see high-altitude pulmonary 78 surface antigen (HBsAg) 43, 46, 47
edema in Marburg virus disease 74 delta antigen and 48
Hazara virus 78 massive, cruise ship travelers 284 epitopes 44—5
Hazard Analysis Critical Control Point in snake envenoming 323, 325, 326, mutants 45
(HACCP) program 284 332 vaccine 47—8, 175
headache subconjunctival 349 adverse events 169
in acute mountain sickness 249 hemorrhagic factors, snake venom 323 booster doses 175
in motion sickness 224 hemorrhagic fevers, viral 34—5, 71—8 in children 171, 371
head injury Henry’s law 214, 218 in diabetes mellitus 15
aeromedical repatriation 302 Hepacivirus 65 effectiveness 187
diving after 267—8 hepatitis expatriates and aid workers 453
Health Canada 285 infectious 40 hepatitis A vaccine combination
health care see medical care non-A, non-B 50—1 174, 175
HealthCare Abroad 444 serum 43 in older travelers 440
health care workers viral 39—52 in pregnancy 169, 398, 400
air ambulance transfers 308 clinical features 41—2, 197 in renal disease 435
cruise ships 278, 281 in migrants and refugees 470 route of administration 168
expatriate and aid worker services versus yellow fever 66—7 routine immunization 172, 371
458 hepatitis A 40—3 virus (HBV) 39, 43—4
infection control precautions 199 active immunization see hepatitis A, core antigen antibodies 46, 47
in travel clinics 23—4 vaccine hepatitis delta virus and 48
travel-related risks 189 in children 41, 42, 372 open reading frames (ORFs) 43—4
see also physicians clinical features 41—2 precore mutants 45
health reasons, travel for 6 diagnosis 42 replication 45
health risks, travel-related epidemiology 32, 40—1 subtypes 44—5
epidemiology 10—13 in immunocompromised travelers 19 hepatitis C 50—2
pretravel assessment 25—7 in migrants and refugees 470 in migrants and refugees 470
health status, traveler’s 26 passive immunization 42, 174, 400 risk in pregnancy 400
hearing, underwater 261—2 pathology 41 screening 377
hearing impairment prevention 42—3 virus (HCV) 39, 51
diving-related 269, 270 reservoir of infection 41 hepatitis D 48—9
travelers with 20, 440 risk to travelers 48 hepatitis delta antigen (HDAg) 48, 49
heart treatment 42 hepatitis delta virus (HDV) 39, 48
in Chagas disease 115 vaccine 42—3, 48, 172, 173—4 genotypes 48, 49
in yellow fever 66 in children 371, 372 molecular detection 49
heart disease 16, 433 effectiveness 187 hepatitis de Sierra Nevada de Santa
altitude travel 255—6 and hepatitis B combined vaccine Marta 48
488 INDEX
hepatitis E 49—50, 191 management 55 hydroxychloroquine
prevention 401 pathology 54 ocular toxicity 359—60
vaccine, in pregnancy 400—1 postexposure prophylaxis 384, 416, photosensitive reactions 149
virus (HEV) 39, 49 457 for polymorphic light eruption 145
hepatitis G virus (HGV) 39 prevention 55—6 hygiene measures
hepatocellular carcinoma 43, 52 reservoir 54 cruise ships 284
hepatomegaly risk to travelers 35, 190, 376 hepatitis A prevention 42
fevers with 197 screening trachoma prevention 362
in malaria 193 asymptomatic travelers 205 viral gastroenteritis prevention 57
Hepatovirus 40 children 376—7 hymenoptera stings 336—7
Her Own Way — Advice for the Woman returned expatriates and aid hyoscine (scopolamine)
Traveler 419, 422 workers 461 contraindications 431
herpes, genital 61—2 travelers with 17—20, 427—8 in elderly travelers 439
herpes simplex virus crossing international borders for motion sickness 226, 282, 283
corneal (dendritic) ulcer 351, 352 19—20 hyperbaric chambers, portable 251, 252,
type 1 (HSV-1) 61 environmental risks 19 254, 259
type 2 (HSV-2) 61 malaria chemoprophylaxis 20, 427 hypercapnia, in divers 265
herpesviruses 61 susceptibility to infection 20, 428 hypersensitivity reactions, to vaccines
herpes zoster ophthalmicus 351—2 travelers’ diarrhea 20, 156 169
hiatus hernia, paraoesophageal, in vaccination 18—19, 170, 178, 428 hypertension
divers 271 yellow fever vaccination 67, 182 altitude travel 255
high-altitude cerebral edema (HACE) see also AIDS fitness to dive 268
251—2 hog cholera virus 65 hyperthermia, avoidance in pregnancy
clinical and pathological features homesickness 243 415
251—2 homosexual men 54 hyperventilation 217
pathophysiology 249—50, 251 honey bee, Africanized 336 factors inducing 217
prevention 250, 251 hookworms 202, 203 in hypoxia 217
treatment 251, 259 animal 127—8, 201, 202, 203 symptoms 217
high-altitude pulmonary edema (HAPE) gender-specific issues 409, 410 hyphaema, traumatic 356—7
252—4 in pregnancy 411 hypnozoites 91
in children 375—6 hormone replacement therapy 393, 417 Hypoderma flies 131
clinical features 253 hornet stings 336—7 hypoglycemia 199
differential diagnosis 253 hospitals avoidance in pregnancy 415
pathophysiology 252—3 admission, in fever ?malaria 194 in diabetes 16, 436
prevention 250, 253—4 Crimean—Congo hemorrhagic fever in diabetic divers 267
prognosis and mortality 253 78 in malaria 99, 102, 199
recurrence rates 252 as data sources 36 hypopyon 352, 354
treatment 254, 259 Ebola virus transmission 74, 75 hypotension, in snake envenoming 323,
high-altitude retinopathy (HAR) 254, hostage taking 458 325
348 host factors, individual 186 hypothermia 269, 439
high frequency radio communication hotels, legionellosis risk 82 hypoxia 216—17
(HF), aircraft 232 hot water treatment, painful stings 338, air passenger behavior and 241
highly active antiretroviral therapy 339 decompression sickness and 219
(HAART) 427 human chorionic gonadotropin (hCG), factors increasing susceptibility 217
histidine-rich protein II, Plasmodium beta core 383 at high altitude 216, 248
falciparum (Pf HRPII) 98, 194, human enterovirus 71 58 acclimatization 248
195 human herpesviruses (HHV) 61 fetal effects 418
Histoplasma capsulatum 143 human immunodeficiency virus (HIV) 9, in high-altitude pulmonary edema
history 53—4 253
medical, expatriates 61 drug resistance 55 inducing hyperventilation 217
travel see travel history infection see HIV infection inflight 227, 299—300
HIV see human immunodeficiency virus laboratory tests 55 in air ambulance transfers 301
HIV infection 52—6 transmission 54 assessing ability to tolerate 228,
acute seroconversion 54—5, 196 in dialysis centers 435 441—2
clinical features 54—5 type 1 (HIV-1) 53—4 in pregnancy 394
consequences of not type 2 (HIV-2) 53, 54 in pulmonary disease 441—2
detecting/treating 205 vaccine development 55—6 in rapid cabin decompression 221
diagnosis 54—5 human T-cell leukaemia virus 1 symptoms 216—17
epidemiology 54 (HTLV-1) 53 hypoxia—altitude simulation test
in expatriates and aid workers 456—7 human T-cell leukaemia virus 2 (HAST) 441, 442
female genital schistosomiasis and 412 (HTLV-2) 53 hypoxic ventilatory response (HVR) 248
geographical distribution 54 humoral immunity 165
home testing kits 384 congenital deficiency 424—5 ibuprofen, for children 374
in immigrants and refugees 471 hydatid cysts 203 ice 19, 155
leishmaniasis risk 109 hydrofluoric acid 315 identity bracelets/cards (Medic-Alert)
INDEX 489
423, 433 immunosuppression vaccine-preventable 165—83
in diabetes 15, 436 immunofluorescent antibody testing epidemiology 32—3
in food allergies 17 (IFAT), in leishmaniasis 108 in older travelers 440
IgA deficiency, congenital 425 immunoglobulins 165, 175 see also immunization; vaccination
immigrants (migrants) 186, 467—75 hepatitis B 47, 175 infertility
child 376—7 hyper immune 165—6 in female genital schistosomiasis 412
factors affecting health 468—9 live vaccine interactions 166, 175, 178 parasitic diseases causing 409
first encounter with health services measles 397 inflammatory illness, high-altitude
469—70 normal human 165, 175 pulmonary edema and 252, 254
health care 470—3 hepatitis A immunization 42, 174 inflight medical emergencies 190, 230—5,
illegal 468, 469 in pregnancy 399 236
infectious diseases 469, 470—2 rabies 64, 175, 179, 454 aircraft diversion 231
international trafficking 468 tetanus 175 causes 230, 231
medical screening 204, 469—70 varicella-zoster 19, 175, 397 definition 230
mental health and violence 472—3 immunosuppression emergency medical equipment 232,
noninfectious diseases 472 drug-induced 426—7 233—4
numbers and trends 8, 10, 467—8 in pregnancy 396, 403, 428—9 good samaritans 231
presumptive treatment 205—6 see also immunodeficiency resuscitation equipment 232—5
return home 469 immunosuppressive drugs 426, 434, 435 telemedicine 231—2
rubella vaccination 179 impetigo 134, 135 influenza 32, 59—61
tuberculosis 180—1, 470 implanted cardiac devices 441 clinical features and diagnosis 60
varicella risk 182, 472 incoordination, in hypoxia 216 cruise ship outbreaks 32, 283
visiting friends/relatives 6, 186, 471 incubation periods 187, 188, 470 epidemiology 9, 59
see also migration; refugees indemnity, inflight medical emergencies high-risk groups 60
immobility 231 management 60
in air passengers 228 indinavir 416 pathology 60
medical risks 228 infants prevention 60—1
immune complexes, in hepatitis B 46 aeromedical repatriation 302 risk factors 190
immune enhancement, in dengue virus air travel and 374—5 vaccine 60—1, 171, 176
infections 68 altitude travel 255, 375 in chronic disease 424
immune responses, in hepatitis B 46 diarrhea 369 contraindications 169
immunization seating in aircraft 373—4 in HIV infection 170
active 165 see also children; neonates in pregnancy 398, 399
for cruise ship passengers 276 infections virus 59
expatriates and aid workers 453—4 bacterial 81—9, 133—8 information
for expedition travel 257 in diabetes 16, 423, 438 for air ambulance transfers 303—5,
history 186—7 needing urgent treatment 81 306
immigrant children 376 ocular 361—4 brochures, patient 27
immunological mechanisms 165—6 opportunistic 54, 55 sources, travel clinics 24—5
passive 165—6 skin 127—44 on travel-related disease 36—7
in pregnancy 17, 169, 396—402, 429 susceptibility to 186 infusions, in air ambulance transfers 301
records of previous 25—6 in chronic disease 423—4 injecting drug users see intravenous drug
routine 171, 370—2 in diabetes 16, 423, 438 users
travel 172 in HIV infection 20, 428 injury, travel-related 291—6
see also vaccination in immunocompromised travelers on the beach 293—4
immunocompromised travelers 7, 20, 425—6, 433 case-based approach 291—3
17—20, 423—30, 433—8 in pregnancy 17, 396 epidemiology 12, 13, 291
environmental risks 19 virus 39—80, 144 eye 354—9
rabies vaccination 179 infectious diseases government approach 295—6
susceptibility to infection 20, 425—6, contraindicating travel 20 insurance 295
433 death rates 13 mortality 13, 34, 291
travelers’ diarrhea 20, 156 drug resistance 7, 8, 34 in older travelers 439
vaccines 18—19, 170 emerging and re-emerging 7—8, 10, operated eyes 347
see also HIV infection; 34—6 pre-travel advice 295
immunodeficiency; in expatriates and aid workers 448, prevention 295—6
immunosuppression 460 protection of children 373—4
immunocontraceptives 389 fitness to fly 228, 229 risk management framework 292—3
immunodeficiency gender-related issues 381, 408—14 tourism industry approach 295
acquired 424, 425—6 global burden 7—8, 9 see also motor vehicle accidents
in chronic disease 423—4 importation and spread 9—10, 11 inner-ear barotrauma 269—70
common variable (CVD) 425 incubation periods 187, 188, 470 insect bites 132—3, 201
congenital 424 mandatory notification 36 epidemiology 12, 34
non-HIV-related 423—7 in migrants and refugees 469, 470—2 hepatitis B transmission 46
vaccination 170 spread in aircraft 190, 228 protection of children 367—8
see also HIV infection; surveillance 36 see also specific insects
490 INDEX
insecticides International Travel Health Guide jigger 131, 201
flea control 133 (Rose) 444 judgement, impaired, in hypoxia 216
impregnated bed nets 103, 367 Internet resources see web sites Junin virus 75, 77
malaria vector control 102 interpreters 473
onchocerciasis control 121 intracranial pressure, increased 442 kala-azar see leishmaniasis, visceral
reduviid bug control 116 intradermal administration, vaccines Kaposi sarcoma 144
topical, for scabies 132 168 Katayama fever 116, 202
toxic risks 315—16 intramuscular administration, vaccines kdr (knock-down resistance) 102
tsetse fly control 114 168 keratitis
vector resistance 102 intrauterine contraceptive devices acute 344—5
insect repellents 102 (IUDs) 387, 389 chronic 345
for children 367—8 for emergency contraception 391, 392 Labrador 345
in older travelers 439 intrauterine growth retardation, at high keratotomy, radial 257
in pregnancy 404 altitude 418 kerion 141
see also DEET intravaginal contraceptive rings 389 kidnapping 458
insulin intravenous drug users kidneys, in yellow fever 66
delivery systems 436—7 hepatitis A risk 41 kraits 321
lispro, rapidly acting 436—7 HIV risk 54, 55 Kunjin virus 70
melioidosis and 438 iodine, for water disinfection 408 Kyasanur Forest disease virus 70
preparations 16, 436 Ipecac 374 kyphoscoliosis, altitude travel 256—7
pumps 436, 437 iritis, acute 352—3
insurance, travel 20—1, 295, 444 irrigation schemes 116, 118—19 laboratories 25
for aeromedical repatriation 298, 459 Irukandji syndrome 338, 339 as data sources 36
companies, disease surveillance 37 ischaemia, in decompression illness 264 information provision to 191
for cruise ship passengers 277 ischaemic heart disease see coronary transmission risks in 191
for divers 273 artery disease Laboratory Centre for Disease Control,
for expedition travelers 259 isolation 199 Canada 20, 21, 24
for high-risk travel groups 432 isoniazid, in children 376 Labrador keratitis 345
importance 227 isoprenaline, for bee, wasp and hornet Labrea black fever 48
in pregnancy 17, 394 stings 337 lacrimal system injuries 359
intensive care patients see critically ill Isospora 91 lactase deficiency, transient 198
patients itching see pruritus lactate dehydrogenase (LDH),
intercostal drain, air ambulance itinerary, review of 26—7 Plasmodium 98, 194, 195
transfers 301 itraconazole 143 lactation
interferon ivermectin malaria chemoprophylaxis 406
in hepatitis B 47 in cutaneous larva migrans 128 medical supplies 417
in hepatitis C 52 in filariasis 120 vaccination 429
in hepatitis D 49 mass treatment 121, 131 yellow fever vaccination 401
International Air Transport Association in onchocerciasis 120, 121, 131 Lactobacillus preparations 162
(IATA) 227 in pregnancy 411 Lady Comp 390
International Association for Medical in scabies 132 Lagos bat virus 62
Assistance to Travellers Ixodes 132, 401 lamivudine 47, 416
(IAMAT) 21, 285—6, 395, 433, Ixodes persulcatus 70 language barriers 473
444 Ixodes ricinus 70 Larium see mefloquine
International Committee of the Red larva currens 203
Cross (ICRC) 448 Japanese encephalitis 69 larva migrans
International Council of Cruise Lines epidemiology 33, 69 cutaneous 127—8, 201, 203
(ICCL) 281, 286 vaccine 69, 172, 176 visceral 203
International Diabetes Federation 16, in children 371, 372 LASIK surgery 257
21, 436 in expatriates and aid workers Lassa fever 72, 75—6
International Dialysis Organization 445 453—4 clinical features and diagnosis 76,
International Health Regulations 165 in pregnancy 398, 401, 429 197—8
International Maritime Health virus (JEV) 68, 69 epidemiology 34, 76
Association 286 Jarisch—Herxheimer reaction 89 Lassa virus 72, 75, 76
International Maritime Organization jaundice Latrodectus spp. (black widow spiders)
281, 286 fevers with 197 334—5
International Planned Parenthood in malaria 192 antivenoms 336
Federation (IPPF) 385, 391 in viral hepatitis 41 envenoming (latrodectism) 335, 336
International Programme on Chemical in yellow fever 66 symptoms and signs of bites 335
Safety (IPCS) 311 jellyfish stings 338—9 lead poisoning 313, 314
International Society of Travel Medicine jet injectors, for vaccination 168 Lea’s Shield 388
(ISTM) 24, 25, 423 jet lag 222, 242 Legionella pneumophila 81, 82
contact details 28, 286 in children 373 legionellosis (Legionnaire’s disease)
travel medicine training 378 in elderly travelers 439 81—3
International SOS 444 management 223, 242 clinical features 82—3, 198
INDEX 491
epidemiology 32, 82 levator aponeurosis injuries 359 diagnosis 120, 202—3
management 83 levofloxacin, in travelers’ diarrhea 157, in pregnancy 411
risk factors 186, 190 162 prevention and control 121
surveillance 37 levonorgestrel treatment 120
Leishmania 105—6 for emergency contraception 390, 391, lymph node aspiration, in
Leishmania aethiopica 106, 107, 108 392 trypanosomiasis 112
Leishmania chagasi 106, 107 intrauterine system (LNg IUS) 389 lymphocytic choriomeningitis virus 75,
Leishmania donovani 106, 107, 109, 129 liability, Good Samaritans 231 76
Leishmania infantum 106, 107 lidocaine (lignocaine) lymphoedema 119
Leishmania (L.) amazonensis 106, 107, in decompression illness 273 lyssaviruses 62
108 infiltration, fish stings 338
Leishmania (L.) garnhami 107 light, bright 223 Machupo virus 75, 77—8
Leishmania (L.) mexicana 106, 107, 201 limb pain, in decompression illness 271 Madura foot 137—8, 142
Leishmania (L.) pifanoi 106, 107 lionfish 337 Madurella mycetomatis 142
Leishmania major 106, 107, 108 liposomes 167 maggots, skin colonization (myiasis)
leishmaniasis 105—9 liver 131—2, 201
clinical features 106—7 cancer 43, 52 malaria 91—105
cutaneous 105, 107, 129—30 function abnormalities 199 airport 191
clinical features 106, 129—30, 201 in Lassa fever 76 algid 97
diagnosis 107, 108, 129—30 in yellow fever 65—6 in asplenic travelers 434
treatment 108, 109, 130 see also cirrhosis; hepatitis cerebral 96—7, 198
diagnosis 107—8 Loeffler syndrome 118, 203 chemoprophylaxis 103, 104
disseminated cutaneous 106, 107, 109 loiasis (Loa loa) 119, 203, 362—3 for children 368—9, 455—6
etiology and pathogenesis 129 diagnosis 120 diving safety and 269
life cycle 106 prevention and control 121 in expatriates and aid workers
mucocutaneous (espundia) 106, 107, treatment 120, 363 454—5
108, 109 Lomotil 158 in HIV infection 20, 427
post-kala-azar dermal (PKDL) 109, loperamide immunocompromised travelers 20,
129 in children 370 426, 434, 435
in pregnancy 414 in pregnancy 408 in migrants visiting home 471
prevention 109 in travelers’ diarrhea 157, 158, 159 in pregnancy 105, 404—7
recidivans 107 in viral gastroenteritis 154 presentation of malaria and 192
reproductive effects 409 loss control 295 pretravel advice 26
treatment 108—9 louse-borne relapsing fever 88, 89 rabies vaccination and 64, 179
visceral (kala-azar) 105, 106, 107 louse-borne typhus 85, 139 in transplant recipients 434
clinical features 106 Loxosceles spiders 335 typhoid vaccination and 181
diagnosis 107—8 signs and symptoms of bites 335, 336 in children 96, 191, 367—9, 455—6
infantile 106, 107 treatment of bites 336 chloroquine-resistant 34, 99—100, 404,
in pregnancy 414 lumbar puncture, in high-altitude 405
treatment 108, 109 cerebral edema 252 classification 91
Leishmania tropica 106, 107, 108, 201 lung clinical features 96, 192—3
Leishmania (Viannia) braziliensis 107 barotrauma 218, 262—3, 271 complications of falciparum 96—7
clinical features 106, 129 disease, chronic see chronic obstructive diagnosis 97—8, 193—4, 195, 199
treatment 108, 201 pulmonary disease self-diagnostic kits 455
Leishmania (Viannia) columbiensis 107 oxygen toxicity, in divers 265 endemic 95—6
Leishmania (Viannia) guyanensis 107, rupture, in divers 262, 266 epidemiology 12, 32, 95—6
108 volumes, depth underwater and 262, in expatriates and aid workers 454—6
Leishmania (Viannia) panamensis 107 263 fever in 93—4, 96, 191—4
Leishmania (Viannia) peruviana 107 lupus erythematosus geographical origins 192, 193
Leishmania (Viannia) venezuelensis 107 cutaneous 145—6 global burden 7, 9
lenses, contact see contact lenses discoid 146 global distribution 91, 92
leprosy 136—7 systemic (SLE) 145 in immunocompromised travelers 20
eye involvement 363 lupus vulgaris 137 life cycle 91—5
incubation period 187 Lutzomyia sandflies 106, 129 in migrants and refugees 471
treatment 363 Lyme disease 176 multidrug resistant 100—1, 406—7
Leptosphaeria senegalensis 142 clinical presentation 196 in older travelers 439—40
leptospirosis 82, 86—7 ocular features 363 post-travel advice 205
clinical features 86—7, 197 in pregnancy 401—2 pregnancy and see pregnancy, malaria
management 81, 87 vaccine 172, 176 prevention 102—5
versus yellow fever 67 in pregnancy 399, 402 compliance 243, 244, 455
letter of authorisation, to carry lymphadenopathy in expatriates and aid workers
medications 15, 16, 423, 432 in African trypanosomiasis 111 455—6
leucocytosis, polymorph, in snake fevers with 196—7 in immunocompromisedtravelers 20
envenoming 325 local, in snake envenoming 325 in pregnancy 17, 105, 403—4
leukemia 435 lymphatic filariasis 119 reproductive effects 409
492 INDEX
malaria (cont.) expedition travel and 257 melanoma, malignant 147—8, 344
risk factors 186, 454 fitness to dive 266—9 melarsoprol, in African trypanosomiasis
treatment 98—102, 199—201 fitness to fly 228, 229, 432, 441—2 113
in children 369 fitness to travel 15—21, 431—2 melatonin
expatriates and aid workers 455 insurance cover 21, 277, 295 in children 373
in pregnancy 101, 105, 407—8 Medic-Alert bracelets/cards see identity for jet lag 223, 439
presumptive 205, 369 bracelets/cards melioidosis 186, 438
stand-by emergency 105, 407—8 Medic Alert Foundation 444 memory, immunological 165
urgent 81 medical facilities, cruise ship 275, memory impairment, in hypoxia 216
vaccine 103—5, 369, 373 278—81, 286—7 meningitis
versus yellow fever 66 medical information form belt, Africa 35, 177
Malarone see atovaquone-proguanil airline (MEDIF) 227 in brucellosis 87
Malassezia furfur 141 cruise ship travelers 278, 279—80 eosinophilic 203
malasseziosis 140—1 medical kits 432 fever with 196, 198
mal de débarquement 282 air ambulances 303, 304, 305 herpes simplex 62
syndrome (MDDS) 282 aircraft emergency 232, 233—4 meningococcal see meningococcal
mal morado 130 for children 374 disease
Maloprim see pyrimethamine/dapsone for cruise ship travelers 276, 277—8 meningococcal disease
Mansonella perstans 202, 409 for expeditions 258, 259 clinical features 196
Marburg virus 72—3 for women 416—17 epidemiology 33, 35
disease 72—4 medical records in migrants and refugees 472
Marie Stopes International 385, 391—2 high-risk travel groups 433 meningococcal vaccines 33, 172, 177
marital relationships immunocompromised travelers 423 in children 371, 372
air travel and 237—8, 243 in pregnancy 393—4 in immunocompromised travelers 434
expatriates 453 medical supplies in pregnancy 398, 399—400
Mastomys rats 76 traveling with 15, 16, 432 menopausal women 417
Mazzotti reaction 120, 202 see also medical kits; medications menstrual cycle
Mazzotti test 120 Medical Toxicology Laboratory 312—13 charting 382
meals Medical Toxicology Unit (MTU) control 382
insulin therapy and 436—7 311—13 menstrual supplies 382, 416
special, in diabetes 16 medications menstruation 382—3
measles for air ambulance transfers 305 mental health, migrants and refugees
epidemiology 33 in aircraft emergency medical kits 472—3
immune globulin, in pregnancy 397 232, 233, 234 mental illness see psychiatric disorders
vaccine contaminated 313 mental status, in high-altitude cerebral
in children 371—2 for cruise ship passengers 276, 278 edema 251—2
in pregnancy 397, 398 in diabetes 15—16 mepacrine 149
measles, mumps and rubella (MMR) diving safety 268 mercury 167
vaccine 171, 177 history 186—7 merozoites 91—3
adverse events 169 hypoxia susceptibility and 217 merozoite surface proteins (MSP-1—5)
in children 371—2 ocular, stability 359 92
contraindications 169 in pregnancy 402 metastatic tumours 425
in immunocompromised travelers 18, traveling with 15, 16, 423, 432 methanol poisoning 361
170 see also drug-induced disorders methemoglobinaemia, antimalarial drugs
in pregnancy 397, 398 MedicinePlanet 395 inducing 98, 99
meat Mediterranean spotted fever 85, 139 metoclopramide, for sea sickness 283
raw or undercooked 19 mefloquine metrifonate, in schistosomiasis 118
tenderiser, for bee stings 337 adverse effects 103, 187 metronidazole, in pregnancy 408, 413
mebendazole, in pregnancy 411 for children 368—9 microfilariae 119
Mecca, pilgrimage to 35, 176, 472 contraindications 431 detection 120, 361
meclozine, for sea sickness 283 diving safety 269 in follicular fluid 409
medical advisors, airline 235—6 in elderly 440 microhaematocrit centrifugation
medical assistance companies 298, 394, in expatriates and aid workers 455 technique, in trypanosomiasis
395 in HIV infection 427 111
medical attendants, sick air passengers in immunocompromised travelers 20 Microsporum 140
228—30 in liver disease 435 middle ear
medical care malaria prophylaxis 103 barotrauma 218, 269
abroad 433 malaria stand-by treatment 105 oxygen absorption syndrome 270
cruise ships 278—81 malaria therapy 98, 100—1 mifepristone (RU-486) 391, 392
expatriates and aid workers 458—9 in pregnancy 105, 405, 406, 407, 455 migraine, at high altitude 254
migrants and refugees 470—3 resistant malaria 407 migrants see immigrants
medical conditions, pre-existing 441—2 typhoid vaccine interaction 181 migration 3
altitude travel and 255—7 meglumine antimoniate, in journey phase 468—9
cruise ship travelers 276 leishmaniasis 108 numbers and trends 8, 10, 467—8
expatriates and aid workers 450 meibomian cyst 350 postmigration environment 469
INDEX 493
predeparture phase 468 risk-based analysis 294 Necator (americanus) 410, 411
process, health impact 468—9 motor vehicle travel necrosis, in snake bites 324—5, 333
tropical infectious diseases and 9—10 with children 373, 374 necrotizing soft tissue lesions 134, 135
military personnel 189 in pregnancy 396 needles, travel with 15
motion sickness 227 risk analysis 294 needlestick injuries 191
miniature anion-exchange centrifugation mountain climbers Negri bodies 62, 63
technique, in trypanosomiasis ocular hazards 345, 348 Neisseria meningitidis 177
111—12 see also altitude; expedition travelers see also meningococcal disease
Minnesota Multiphasic Personality mountain sickness nematode infections 201—3
Inventory (MMPI) 452 acute (AMS) 248—51, 259 gender-specific issues 409, 410
missionary workers 447, 449—50 in children 375 intestinal 203, 409, 410
MMR vaccine see measles, mumps and clinical features 249 neonates
rubella (MMR) vaccine pathophysiology 249—50 aeromedical repatriation 302
mobility prevention 250—1, 253 air travel 229
concept of global 473—4 treatment 251 hepatitis B prophylaxis 47
problems see disability, physical chronic 248 yellow fever vaccination 401
Mobility International 445 subacute infantile (SIMS) 255 see also children; infants
Mokola virus 62 mud huts, relapsing fever risk 89 neural mismatch theory, motion
moles, assessment of 147 mumps vaccine sickness 224—5, 282
molluscicides 118 in children 371—2 neuraminidase, influenza virus 59
molluscum contagiosum 144 in pregnancy 398 neurocysticercosis 203
monkeys see also measles, mumps and rubella neurological disorders 442
African green 72, 73 (MMR) vaccine aeromedical repatriation 302
cynomolgus, Ebola virus 74 muramyl dipeptide (MDP) 167 African trypanosomiasis 111
mortality see death muscle infections, in diabetes 438 cerebral malaria 96—7
mosquito coils 102 myalgia decompression illness 219, 268, 271
mosquitoes fever with 195 fevers with 196, 198
attraction to pregnant women 404 in snake envenoming 325—6 fitness to fly 229
bite avoidance 102—3, 367, 403—4 mycetoma at high altitude 254—5
control measures 68, 70, 102, 121 bacterial 137—8 neurosurgery, aeromedical repatriation
dengue fever 67—8 true fungal (eumycetoma) 142 after 302
insecticide resistance 102 mycobacterial infections neurotic reactions, in motion sickness
Japanese encephalitis 69 management 137 226
lymphatic filariasis 119 skin 136—7 neurotoxic snake bite reactions
malaria life cycle 91, 93, 95 see also leprosy; tuberculosis clinical features 325, 326
malaria transmission 96 Mycobacterium leprae 136 management 329, 330, 332, 333
repellents 102 Mycobacterium marinum 136 pathophysiology 323
Rift Valley fever 72, 78 Mycobacterium tuberculosis 136 neurotoxins, cone shell 339
St Louis encephalitis 70 see also tuberculosis neutropenia 199
yellow fever 64, 65 Mycobacterium ulcerans 136 neutrophilia 199
mosquito nets (bed nets) 103, 367 mycolactone 136 niacin deficiency 149—50
mosquito netting 102 mycosis, systemic 143—4 nifedipine
motion sickness 223—7 myeloma 435 in expedition medical kits 259
in aeromedical repatriation 302 myiasis 131—2, 201 high-altitude pulmonary edema
in children 225, 282, 373 myocardial infarction 441 prophylaxis 253
in elderly travelers 439 altitude travel after 256 for motion sickness 227
etiology 224—5, 282 in cruise ship passengers 284 in scorpion stings 334
factors affecting susceptibility 225—6 myotoxicity, in snake envenoming 324, nifurtimox, in Chagas disease 115
incidence 224 325—6 Nipah virus 35
prevention and treatment 226—7 nitrogen
symptoms and signs 223—4 Nairobi sheep disease virus 78 absorption, in diving 263
see also sea sickness Nairovirus 78 in decompression sickness 218
motivation, expatriates and aid workers Naja kaouthia 322 narcosis 264
451 Naja nigricollis 324 partial pressure (PN ), depth

motorcycle accidents 13 National Association for the Deaf 444 underwater and 263
expatriates and aid workers 450 National Health and Medical Research nitrous oxide and oxygen, in
insurance cover 295 Council (NHMRC), Australian decompression illness 271
motor vehicle accidents 294—5 24 Nocardia infections 137—8
deaths 13, 34 National Poisons Information Service norfloxacin, in travelers’ diarrhea 157,
epidemiology 34, 291 (NPIS), London 311—12 162
expatriates and aid workers 450 database 313—16 NorLevo 391
eye trauma 355 National Water Safety Council 294 Norplant 1 and 2 387
in older travelers 439 nausea Norwalk-like viruses 56
in pregnancy 395—6 in motion sickness 223, 224 Norwalk virus 56, 283
prevention 294—5, 374 oral contraceptive pill and 385 nosocomial infections, HIV 54
494 INDEX
nurses, cruise ship 278, 281 interactions 175, 178, 181 red eye with 348
nutritional deficiencies 472 in pregnancy 397 scorpion stings 334
nystagmus, positional alcohol 225—6 oral rehydration therapy Pan American Health Organization 286
in children 370 papulonecrotic tuberculide 137
obesity, decompression sickness and 219 in travelers’ diarrhea 157 paracetamol see acetaminophen
OBGYN.net 395 in viral gastroenteritis 57 paracoccidioidomycosis 143—4
obstetric patients, aeromedical oral vaccines 168 paragonimiasis (Paragonimus infections)
repatriation 302—3 orbit 203
occupational groups blow-out fractures 358 diagnosis 198, 202
post-travel checks 204 cellulitis 351 reproductive effects 409
travel-related risks 189 disorders 350—1 paralysis
ultraviolet light damage 343 floor fractures 358 in poliomyelitis 58
ocean fractures 357—8 in snake envenoming 325
rescues 293 organ donors, Chagas disease screening Parasight-F test 98, 194
travel see cruise ship(s) 116 parasitic diseases
ocular preparations organ transplant recipients 170, 434 in asymptomatic travelers 204
side-effects 360 oriental sore 105, 106 consequences of not
stability 359 see also leishmaniasis, cutaneous detecting/treating 204—5
oedema see edema Ornithodoros ticks 89 eosinophilia 201—3
oestrogen see estrogen orthopedic conditions 442 in expatriates and aid workers 460
Office of Population Research 385 Oseltamivir 60 gender-related issues 408—14
ofloxacin ossicles, auditory, dislocation 269 in migrants and refugees 471—2
in eye infections 354 otic barotrauma 218, 269—70 in pregnancy 409—12
in travelers’ diarrhea 157, 162 otitis externa, in swimmers 270 screening asymptomatic children 376,
older travelers see elderly travelers outbreaks 187 377
Omsk hemorrhagic fever virus 70 Oves 388 skin 127—33, 201
Onchocerca volvulus 119, 202, 361 oxamniquine, in schistosomiasis 118 travelers’ diarrhea 154
onchocerciasis (river blindness) 130—1, oxygen vector-borne 91—124
361—2 absorption syndrome, middle ear 270 paratyphoid fever 83—4
clinical features 119, 130, 361 carriage in body 214 clinical features 84, 196
diagnosis 120, 130, 202 dissociation curve 216 see also typhoid
etiology and pathogenesis 119, 130 exchange 214 paromomycin, in pregnancy 408, 413
global problem 364 hyperbaric 348 patent foramen ovale, in divers 264
international spread 9 lack see hypoxia PATH (Program for Appropriate
in pregnancy 411 requirements at altitude 214—16 Technology in Health) 385
prevention and control 121, 362 saturation patient information brochures 27
treatment 120—1, 131, 202 at altitude 216 Peace Corps personnel 448, 450, 457
Onchocerciasis Control Programme inflight 227, 394 pediatric travel medicine 367—79
(OCP) 121 supplemental inflight 215, 230 service organization 377—8
onchocercomas 361 after decompression illness 272 training 378
onychomycosis 140 in chronic medical conditions 16, see also children; infants; neonates
ophthalmia neonatorum 364 441—2 pellagra 149—50
ophthalmic conditions 343—64 in pregnancy 17, 394 pentamidine
Opisthorchis spp. 202 supplies in African trypanosomiasis 113
opportunistic infections 54, 55 aircraft emergency 230, 300 in leishmaniasis 109
OptiMAL test 194 expeditions 259 performance, effects of jet lag 222
oral contraceptives 385—90 tension (partial pressure) perinatal transmission
drug interactions 390 in alveolar air 215, 299 HIV 54
for emergency contraception 390, 391, depth underwater and 263 parasitic infections 412
392 in hypoxia 216, 299—300 viral hepatitis 46, 47, 51
at high altitude 257 therapy periodic breathing, at high altitude 254
for menstrual cycle control 382 air ambulance transfers 303 peritoneal dialysis
missed pills 385 in altitude illness 251, 252, 254 during travel 435
pill absorption problems 385—90 cruise ship travelers 276 in snake envenoming 333
pros and cons 386—7 in decompression illness 271 Persona 390
skin complications 148—9 toxicity, in divers 265 personality
time zone changes and 385 Oxyuranus scutellatus (canni) 322, 326 assessment, expatriates and aid
vaginal administration 385 oysters, raw 19 workers 452
venous thrombosis risk 392—3 ozone layer 343, 346 change, in hypoxia 216
oral health see dental health fear of flying and 238
oral polio (Sabin) vaccine (OPV) 58—9, pacemakers, cardiac 441 Personal Physicians Worldwide 433,
178 pain 444
adverse events 169 in decompression illness 271 pertussis immunization 177
in immunocompromised travelers 19, fish stings 337, 338 children 370—1
178 ocular, after air travel 347 see also DTP vaccine
INDEX 495
pesticides malaria polymorphic light reaction 144, 145
toxic risks 315—16 chemotherapy 98, 99—101 Pontiac fever 81
see also insecticides complications 96—7 porphyria 144
Pestivirus 65 geographical origins 193 cutanea tarda 146, 149
petroleum-related incidents 319 mortality 192 portable hyperbaric chambers 251, 252,
pets, international movement 191 in pregnancy 403 254, 259
Pf60 antigens 93 multidrug-resistant Portuguese man-o’-war (Physalia spp.)
PFT 1-2-3-KIT 390 chemoprophylaxis 103 338, 339
pharmacies 25 chemotherapy 100—1 positional alcohol nystagmus 225—6
pharmacokinetics, in pregnancy 402 Plasmodium malariae postdecompression collapse 219
pharyngitis 197 life cycle 91—2, 93—4 Postinor 391, 392
Phialophora 142—3 malaria post-kala-azar dermal leishmaniasis
Phlebotomus sandflies 106, 129 chemotherapy 98, 99 (PKDL) 109, 129
Phlebovirus 78 presentation 193 post-traumatic stress disorder (PTSD)
phobia, flight 238—40 Plasmodium ovale in aid workers 449, 462
Phoneutria nigriventer 335, 336 life cycle 91—2, 93—4 in migrants and refugees 469, 472
phospholipases A , in snake venom 323, malaria prevention 459
324 chemotherapy 98—9 post-travel check 204—6
photoageing 146—8 presentation 193 children 376—7
photoallergic reactions 149 treatment in pregnancy 404—6 expatriates see expatriates, postreturn
photodermatoses 144—5 Plasmodium vivax screening and care
photophobia 348 life cycle 91—2, 93—4 screening methods 205
photophytodermatitis 146 malaria treatment versus screening 205—6
photosensitivity, drug-induced 149 chemotherapy 98—9, 201 potassium iodide 142
phototoxic reactions 144—5, 149 geographical origins 193 potassium permanganate 134
Physalia spp. 338, 339 in pregnancy 403 poultry, raw or undercooked 19
physical activity see exercise presentation 193 Powassan virus 70
physical disability see disability, physical treatment in pregnancy 404—6 praziquantel
physical examination, expatriates 461 pleasure, travel for 5, 6 insusceptibility 118
physicians (doctors) Plesiomonas shigelloides 154, 425 in pregnancy 411
abroad, finding 433 pneumococcal vaccine 171, 178 in schistosomiasis 118, 202
air ambulance transfers 308 in asplenic travelers 426, 434 prazosin, for scorpion stings 334
airline 235—6 in chronic disease 423—4 pregnancy 17, 393—408
assistance at inflight emergencies 231 in HIV infection 170 aeromedical repatriation 302—3
care of migrants and refugees 470—3 in pregnancy 398, 399 air travel 229, 394—5
confirmation of death 235 Pneumocystis carinii, reproductive altitude travel 257
cruise ship 275, 278, 281 effects 409 amebiasis 408, 413
cultural competence 473 pneumonia 197—8 birth in flight 235
injury prevention role 295 in diabetes 438 Chagas disease screening 116
travel medicine training 378 pneumothorax 441 contraindications to travel 394
picornaviruses 40, 56, 58 air ambulance transfers 301 emergency care 394, 395
pigmentation, ultraviolet light damage in divers 262 female genital schistosomiasis and 412
and 343 diving after 266—7 giardiasis 408, 413
pigmented skin lesions, assessment of poisons 311—20 helminth infections 414
147 police, notification of deaths 235 immunizations 17, 169, 396—402, 429
pilgrims 6 poliomyelitis 58—9 immunosuppression 396, 403, 428—9
meningococcal disease 35, 176, 472 clinical features and diagnosis 58 malaria 186, 402—8, 429
pilocarpine eyedrops, side-effects 360 epidemiology 33, 36, 58 chemoprophylaxis 105, 404—7, 429
‘pilot error’ 242 eradication 59 in expatriates and aid workers 455
pingueculum 345 in pregnancy 397 pathogenesis 403
pinworms see Enterobius vermicularis prevention 58—9, 178—9 prevention 17, 105, 403—4
piperazine, in pregnancy 414 vaccine-associated 178 treatment 101, 105, 407—8
placenta polio vaccines 58—9, 171, 178—9 medical and obstetric risk factors
drug transfer 402 in children 371 393—4
in malaria 403 enhanced inactivated (eIPV) 178—9, medical supplies 417
in parasitic infections 409—11 397 parasitic infections 409—12
plague 35—6, 177—8 in HIV infection 170 pretravel assessment 17, 393
vaccine 172, 178 inactivated (Salk) 58—9, 178—9 susceptibility to infections 17, 396
plants, exposure to 146, 314—15 in pregnancy 169, 397, 398 teratogen reference sources 422
Plasmodium falciparum in transplant recipients 434 termination 391—2
chemoprophylaxis 103 see also oral polio (Sabin) vaccine tests 383, 417
chloroquine-resistant poliovirus 58 timing of travel 394
chemoprophylaxis 103 polymerase chain reaction (PCR) toxoplasmosis 363—4, 414
chemotherapy 98, 99—100 in malaria 194, 195 travelers’ diarrhea 17, 408
life cycle 91, 92—5 in trypanosomiasis 113 travel insurance 17, 394
496 INDEX
pregnancy (cont.) proton pump inhibitors, travelers’ in drug reactions 148
unplanned 391—2 diarrhea risk 156 in Rocky Mountain spotted fever 86
venous thrombosis risk 17, 393, 395 protozoan infections pyogenic skin infections 133—4
water sports 418 in pregnancy 411—12, 414 pyomyositis, in diabetes 438
Premarin 416 reproductive effects 409 pyrethrins, toxicity 316
premature labor, at high altitude 418 pruritus pyrethroids
premenstrual symptoms 382 in onchocerciasis 119, 130 toxicity 315, 316
prescriptions 432 vaginal 383—4 vector control 114, 116
for diabetic travelers 436 Pseudoallescheria boydii 142 pyrexia see fever
preseptal cellulitis 351 pseudoephedrine, in children 373 pyrimethamine
pressure psittacosis 191, 198 in expatriates and aid workers 455
aircraft cabin 227, 299 psoralen—UVA (PUVA) phototherapy malaria therapy 98, 99
atmospheric see atmospheric pressure 145 with sulfadoxine see
breathing 216, 217 psoriasis sulfadoxine-pyrimethamine
effects, in divers 262—4 antimalarial agents and 149 pyrimethamine/dapsone (Maloprim)
pressure bandaging differential diagnosis 140—1, 150 in expatriates and aid workers 455
jellyfish stings 339 guttate 134, 135 malaria prophylaxis 103
snake bites 327, 328 psychiatric disorders 442 in pregnancy 405, 407
pressurization, aircraft cabin see aircraft, aeromedical repatriation 303
cabin pressurization air passenger behavior and 240 Q fever 198
pretravel advice 25—6, 244 in expatriates and aid workers 448—9, qinghaosu derivatives see artemisinin
air travelers 244 460 (qinghaosu) derivatives
disabled travelers 440 fear of flying 238 quantitative buffy coat (QBC) technique
elderly travelers 439 fevers with 198 in malaria 97—8, 194, 195
expatriates and aid workers 453—8 fitness to fly 229 in trypanosomiasis 111
expedition travelers 257—9 in migrants and refugees 472—3 quarantine period 190
high-risk travel groups 431—3 psychological assessment Queensland tick typhus 139
injury prevention 294 expatriates and aid workers 451—3 quinidine
malaria prevention 26 interview 452—3 malaria therapy 99, 199
travelers’ diarrhea 26, 159—61, 257, psychological interventions in pregnancy 407
432—3 expatriates and aid workers 457—8 quinine
pretravel assessment 25—7 in fear of flying 239 in children 369
for air travel 227—30 psychology, aviation 237—45 malaria stand-by treatment 105
expatriates and aid workers 450—3 psychometric testing 451—2 malaria therapy 98, 99, 101
health status 26 pterygium 345, 350 in pregnancy 407
in pregnancy 17, 393 ptosis, in snake envenoming 325 side effects 99, 149
review of itinerary 26—7 PTSD see post-traumatic stress disorder
three basic topics 25—6 Public Health Laboratory Service rabies 62—4, 179
women travelers 382 (PHLS) 24 clinical features and diagnosis 63, 198
primaquine puce chique 131 epidemiology 33, 63
in children 368, 369 Pulex irritans 133 furious 63
for malaria therapy 99 pulmonary artery immunoglobulin 64, 175, 179, 454
in pregnancy 404 congenital hypoplasia/absence 252, importation of animals and 191
prochlorperazine, for sea sickness 283 253, 254 management 63—4
Professional Association of Diving gas embolism 263 paralytic 63
Instructors (PADI) 273, 274 obstruction 252, 253, 254 postexposure immunization 64, 179,
progestin pulmonary barotrauma 218, 262—3, 271 454
for emergency contraception 390, 391, pulmonary edema prevention 63—4
392 high altitude see high-altitude reservoirs 63
only contraceptive pill 386 pulmonary edema vaccine 172, 179
Program for Appropriate Technology in immersion, in divers 268 in children 371, 372—3
Health (PATH) 385 pulmonary embolism in expatriates and aid workers 454
proguanil at high altitude 255 in immunocompromised travelers
in children 368, 369 risk factors 190 179
malaria prophylaxis 103 pulmonary eosinophilia, tropical 119, malaria chemoprophylaxis and 64,
in pregnancy 105 203 179
in renal disease 435 pulmonary hypertension postexposure 64, 179, 454
side effects 187 in HAPE 252—3 pre-exposure 64, 179
see also chloroquine/proguanil in infants at high altitude 255, 375 in pregnancy 399, 402
ProMED 25, 28 pulmonary vasoconstriction, in HAPE route of administration 179
prone position, in retinal detachment 253 virus 62—3
357 pulse oximetry, telemedicine 232 radial keratotomy 257
Protectaid Sponge 388 Pulsineuron 313 radiation exposure
protein deficiency 472 pupils, irregular, in ocular trauma 356 accidental 318—19
proteinuria, in yellow fever 66 purpura in air travel 395
INDEX 497
radiographs, telemedicine 285 pulmonary disease ringworm 140
radiotherapy 170 respiratory failure risk
rapid eye movement (REM) sleep 221 altitude travel 256—7 analysis 292, 293, 294
rash in snake envenoming 326 assessment, pretravel see pretravel
in decompression illness 271 respiratory function, in air ambulance assessment
in dengue fever 68 transfers 301 evaluation 292, 293, 294
drug reactions causing 148 respiratory paralysis, in snake identification 291, 292, 293, 294
in Marburg virus disease 74 envenoming 325 treatment 292, 293—4
in Rocky Mountain spotted fever 139 respiratory tract infections risk-based approach, travel-related
in typhus fevers 85, 86 altitude illness and 253, 255, 375—6 injury 291—5
rats, leptospirosis 86 clinical presentation 197—8 risk-taking behavior 243—4, 456
rattlesnake, tropical 321, 326 epidemiology 11—12, 31—2 river blindness see onchocerciasis
readjustment, returned expatriates 462 risk factors 190 road traffic accidents see motor vehicle
‘rebreathers’, diving using 265 resuscitation accidents
receptivity, motion sickness and 226 during air ambulance transfers 307 road travel see motor vehicle travel
recompression chambers 272 equipment, aircraft 232—5 Robles disease see onchocerciasis
recompression therapy 271, 272 reticulocytes, malaria life cycle 92 Rocky Mountain spotted fever (RMSF)
flying after 272 retinal detachment 85—6, 139
outcome 272 surgery, air travel after 347, 348 rodents
red blood cells see erythrocytes traumatic 357 arenaviruses 75—6
red eye 348—9 retinal hemorrhages leishmaniasis 106, 109
examination 349 in cerebral malaria 96 typhus 139, 140
symptoms 348—9 at high altitude 254, 348 Roll Back Malaria 102
reduviid bugs 114, 115, 116 in high-altitude cerebral edema 252 Roma na sign 115
re-emerging infectious diseases 7—8, retinopathy rose oxide 317, 318
34—6 diabetic 347—8, 437 rose spots 196
‘re-entry shock’ 243 high-altitude (HAR) 254, 348 rosetting 94
refractive errors 364 retroviruses 53 rosettins/rifins 94, 95
refugees 186, 204, 467—75 returned travelers 185—209 rotaviruses 56, 154
cholera risk 35 children 376—7 gastroenteritis 56—7
numbers and trends 18, 20, 467—8 eosinophilia 201—3, 204 vaccine (RRV-TV) 57, 372
presumptive treatment 205—6 fever 191—201 round window, ruptured 270
relapsing fever risk 89 history 185—91 Royal Navy recompression table 272
return home 469 post-travel check see post-travel check RU-486 (mifepristone) 391, 392
see also immigrants skin disease 201 rubella 179
relapsing fever 66, 82, 88—9 tropical diseases in asymptomatic 204 vaccine
louse-borne 88, 89 reverse culture shock 205, 243, 462 adverse events 169
tick-borne 88, 89, 132 ribavirin in children 371—2
relationships, impact of air travel 237—8, in hepatitis C 52 in pregnancy 397, 398
243 in Lassa fever 76 see also measles, mumps and rubella
relatives Rickettsia akari 139 (MMR) vaccine
aeromedical repatriation 307 Rickettsia australis 139 Russian Spring—Summer encephalitis
travel by 190—1 Rickettsia conorii 85, 139 virus 70, 71
visiting see visiting friends/relatives rickettsial infections 84—6, 138
relaxation training, for fear of flying 239 clinical features 85—6, 196 Sabin vaccine see oral polio (Sabin)
Relenza 60 diagnosis 86, 138 vaccine
religious fasting, in diabetes 436 skin diseases 138—40 SAFEtrip 395
religious pilgrims see pilgrims spotted fever group 138—9 safety
renal failure treatment 86, 140 air passengers 241—2
acute, in snake envenoming 323—4, typhus group 138, 139—40 children 373—4
326, 333 see also typhus expatriates and aid workers 458
aeromedical repatriation 302 rickettsialpox 139 women travelers 418—19
travel with 276, 435 Rickettsia mooseri 139 St Louis encephalitis 6970
repatriation Rickettsia prowazeki 139 virus 69—70
aeromedical see aeromedical Rickettsia rickettsii 85, 139 Salk (inactivated poliovirus) vaccine
repatriation Rickettsia sibirica 139 58—9, 178—9
expatriates and aid workers 459 Rickettsia tsutsugamushi 85 Salmonella gastroenteritis 153—4, 198
reports, on returned expatriates 462 rifampicin, in brucellosis 87—8 epidemiology 155
respiration 214 rifaximin, in travelers’ diarrhea 157, 158 in HIV infection 20
control 214—15 rifins 94, 95 surveillance 37
respiratory disease 441—2 Rift Valley fever 72, 78 Salmonella paratyphi 83, 84
altitude travel 16, 256—7 imported 191 Salmonella typhi 83, 84, 153—4
cruise ship passengers 283 vaccine 78 antibiotic resistance 33
fitness to fly 228, 229 virus 72, 77, 78 attenuation 166
see also asthma; chronic obstructive rimantadine 60 risk factors 155
498 INDEX
Salmonella typhi (cont.) Scytalidium infections 141 reduction of risk 55, 62
see also typhoid sea anemone larvae 150 viral hepatitis 41, 46, 48
Samaritans, Good 231 sea-bather’s eruption 150 shellfish
sandflea 131 seaborne infections, skin 135—6 hepatitis A risk 41
sandflies seaborne skin conditions 150 venomous (cone shells) 339
bite avoidance 109 seafood, raw or undercooked 19 Shigella infection (shigellosis) 153, 198
leishmaniasis transmission 106, 129, sea sickness 223, 224, 281—3 regional distribution 154
414 factors affecting susceptibility 282 treatment 158
sanitation prevention and treatment 282—3 vaccine 163
cruise ships 284 see also motion sickness ships see cruise ship(s)
hepatitis A prevention 42 sea snakes 321, 322 shock, in snake envenoming 323, 325,
schistosomiasis prevention 118 envenoming 324, 325, 326 333
Sarcoptes scabiei 132 seasonal variations, travelers’ diarrhea Shoreland’s EnCompass 433, 444
satellite communication system (satcom), risk 155 Siberian tick typhus 139
aircraft 232 seatbelts 294 sickle cell disease 186, 426, 442
scabies 132 for children 374 altitude travel 257, 442
Schistosoma haematobium 116—17 in pregnancy 396 simian immunodeficiency virus 54
diagnosis 118, 189, 202 sea travel see cruise ship(s) simulator sickness 223, 224
treatment 118 sea urchin stings 339 Simulium spp. see blackflies
typhoid coinfection 84 sea wasp (Chironex fleckeri) 338, 339 sine nombre virus 198
Schistosoma intercalatum 116—17 sedation sinus barotrauma 218, 270
Schistosoma japonicum 116—17, 202 for aeromedical repatriation 303 sinusitis, paranasal 198, 347, 441
Schistosoma mansoni 116—17 children 373 skiing
diagnosis 202 seizures (fits) eye protection 345
international spread 9 fever with 196 in pregnancy 415
treatment 118 malaria chemoprophylaxis after 368 skin cancer 146—8
Schistosoma mekongi 116—17 post-traumatic, assessment of risk eyelids 344
schistosomiasis 116—19 267—8 in transplant recipients 434
changing patterns 34 self-defense, women travelers 419 skin diseases 127—51, 201
clinical features 116—17 self-efficacy 239 bacterial infections 133—8
diagnosis 117—18, 202—3 sensory loss, in hypoxia 216 drug-related 145, 148—9
epidemiology 116, 117 septicaemia with fevers 196
in expatriates and aid workers 460 in typhoid and paratyphoid fever 84 frequency in travelers 12, 127, 128
female genital (FGS) 409, 410, 412—13 Vibrio vulnificus 135—6 fungal 140—4
global burden 7, 9 serological tests miscellaneous 149—50
incubation periods 187, 189 asymptomatic travelers 205 in onchocerciasis 119
intestinal 116—17 in Chagas disease 115 parasites, ectoparasites and bites
in migrants and refugees 472 in fever 199 127—33
prevention 118—19 in leishmaniasis 108 rickettsial 138—40
in returned travelers 204—5, 377 in malaria 194, 195 seaborne/waterborne 150
treatment 118, 202—3 in schistosomiasis 118 sun-related 144—8
schizont 93—4 in trypanosomiasis 112—13, 114 viral 144
scleritis 350 serum sickness reactions, snake skin infections
scoop stretchers 307, 308 antivenom 331—2 bacterial 133—8
scopolamine see hyoscine severe combined immune deficiency pyogenic 133—4
scorpion antivenom 334 (SCID) 424 seaborne 135—6
scorpion-fish 337 sex differences see gender differences skull fractures, aeromedical repatriation
scorpion stings 333—4 sexual behavior 302
avoiding 334 expatriates 456 sleep 221—3
clinical features 334 high risk 189—90, 243, 244 debt 221
treatment 334 sexual harassment, women travelers disturbance, at altitude 254
screening 418—19 habits, good 223
epidemiological definition 460 sexual history 189—90 loss 221
immigrants and refugees 469—70 sexually transmitted diseases (STDs) physiology 221—2
postreturn 204 in adolescents 376 scheduling 222—3
asymptomatic children 376—7 epidemiology 12, 33—4 sleep apnoea, altitude travel 256—7
expatriates and aid workers 459—63 in expatriates 456 sleepiness 222
methods 205 female genital schistosomiasis and sleeping altitude 250
validity 460 412 sleeping sickness see African
versus treatment 205—6 in immigrants and refugees 471 trypanosomiasis
predeparture, expatriates and aid travelers at high risk 189—90, 243, 244 small round structured viruses (SRSVs)
workers 450—3 in women 384, 417 56, 57
screens, tsetse fly 114 sexual transmission smoking 186
scrub typhus 85, 86 genital herpes 61 chronic pulmonary disease and 442
scuba diving see diving HIV 54 hypoxia susceptibility and 217
INDEX 499
snails, fresh-water 116, 118—19 spermicides 386 triggering ‘air rage’ 240—1
snake antivenoms 328—30 Spf66 malaria vaccine 105 stress incontinence, in women 383
dose and administration 329—30 spider bites 334—6 stretchers
indications for use 328—9 avoiding 335 air passengers on 227, 228—30, 297
mono- and polyspecific 329 clinical features 335—6 scoop 307, 308
personal supply 332 treatment 336 strongyloidiasis (Strongyloides
reactions 330—2 spiders infections) 187, 202, 203
early 331 antivenoms 336 in migrants and refugees 472
late 331—2 black widow see Latrodectus spp. in pregnancy 411
prediction and prevention 330—1 Brazilian wolf (Phoneutria nigriventer) in women 409, 410
pyrogenic 331 335, 336 stye 350, 351
types 329 funnel-web see Atrax robustus subaqua swimming, flying after 219
unavailability 333 spinal cord subarachnoid hemorrhage, aeromedical
snake bites 34, 321—33 in decompression illness 271 repatriation after 302
avoiding 323 injuries, aeromedical repatriation 302 subcellular vaccines 167
epidemiology 322—3 spirochaetes 86, 88—9 subconjunctival hemorrhage 349
snake envenoming splenectomy 186, 425—6, 433—4 subcutaneous administration, vaccines
antivenoms see snake antivenoms splenic aspiration, in leishmaniasis 168
clinical features 324 107—8 suction, snake bite wounds 327
diagnosis 326—7 splenomegaly sudden cardiac death 441
early management 328 fevers with 197 sudden infant death syndrome (SIDS)
first aid and prehospital treatment in malaria 193 255, 374—5
327 sponge, contraceptive 386, 388 suicide 449—50
local 323, 324—5 Sporothrix schenckii 141 sulfadoxine-pyrimethamine
ocular 327, 333, 361 sporotrichosis 141—2 in children 369
pathophysiology 323—4 sporozoites 91, 95 in expatriates and aid workers 455
supportive therapy 332—3 sports activities, gender-related issues malaria resistant to 100—1
systemic 325—6 415—18 malaria stand-by treatment 105
snakes sprue, tropical 198—9 malaria therapy 98, 99, 101
identification 326—7 squamous cell carcinoma, cutaneous in pregnancy 405, 406—7
venomous 321—2 147, 344 sulfalene-pyrimethamine
Snellen chart 349 staff, travel clinic 23—4 malaria stand-by treatment 105
snorkeling 293, 418 staggers 219 malaria therapy 98
see also diving staphylococcal scalded-skin syndrome sulfisoxasole/proguanil, in pregnancy
snow blindness 344, 348 (SSSS) 136 407
Society for the Advancement of Travel for Staphylococcus aureus infections, in sulphonamides
the Handicapped 445 diabetes 438 hypersensitivity 99
sodium stilbogluconate, in leishmaniasis Staphylococcus skin infections 133, malaria therapy 98, 99, 101
108 134—5 sumatriptan, in acute mountain sickness
soft drinks 19 STDs see sexually transmitted diseases 251
solar keratoses 146—7, 344 Stevens—Johnson syndrome 148, 360 sunbeds 344
solar urticaria 144, 145 stillbirths, mefloquine and 406 sunburn 12, 145
sore throat stingrays 337, 338 in children 374
fever with 195 stings 34 eyelids 343
at high altitude 255 bee, wasp and hornet 336—7, 361 risk-taking behavior and 243
SOS/AEA International 394, 395 echinoderm 339 sunglasses 344, 345, 346
South African tick bite fever 85 fish 337—8 sunlight exposure
South American trypanosomiasis jellyfish 338—9 cataracts and 345—6
(Chagas disease) 114—16 scorpion 333—4 dermatoses exacerbated by 144
clinical features and pathogenesis venomous 321—41 eye protection 346
115, 196 see also bites ocular damage 343—6
congenital 115 stonefish 337, 338 skin diseases caused by 144—8
diagnosis 115 stool examination in transplant recipients 434
epidemiology 114—15 asymptomatic travelers 205, 377 sunscreens, for children 374
in pregnancy 413 Schistosoma diagnosis 118 suramin
prevention 116 Streptococcus pneumoniae 198 in African trypanosomiasis 113
transfusion-associated 114—15, 116 Streptococcus skin infections 133, 134—5 in onchocerciasis 120—1
treatment 115—16 Streptomyces skin infections 137—8 side-effects 113
SP303 159 stress surfing 293
space sickness 223, 224, 225 aircrew 241 surveillance, disease in travelers 36—7
space vehicles, cabin pressurization 220 air travel 237—8, 243 sweating, in motion sickness 223
spectacles 440 expatriates and aid workers 447—8, swimmer’s ear 270
dark (sunglasses) 344, 345, 346 449 swimmer’s itch 116, 150, 202
for refractive errors 364 hyperventilation 217 swimming
speech, while diving 262 management training 457—8 accident prevention 374
500 INDEX
swimming (cont.) air ambulance transfers and 302 reproductive effects 409
in freshwater 155 in older travelers 439 tracheostomy 442
granuloma 136 see also venous thrombosis trachoma 349, 362, 364
in pregnancy 418 thrombophlebitis, in pregnancy 17 traditional healers, snake bite
swing sickness 223, 224 thrombosis management 322
syncope at high altitude 255 traditional remedies, toxic effects
in rapid cabin decompression 221 see also venous thrombosis 313—14
in snake envenoming 323 thrombospondin-related adhesive protein training
syphilis 135, 190 (TRAP) 91 aircrew 230, 232, 235
epidemiology 34 tiabendazole 128, 143 crisis management 458
in immigrants and refugees 471 tick(s) divers 273
screening in children 377 bites 132—3, 133 first aid 257
syringes 15 avoidance 86 pediatric travel medicine 378
systemic lupus erythematosus (SLE) 145 clinical features 133 psychological, expatriates and aid
management 133 workers 457—8
tabanid (Chrysops) flies 119, 121, 362 Crimean—Congo hemorrhagic fever transdermal contraceptive patches 388
Tacaribe complex viruses 75, 76 72, 78 transmeridian travel see time zone
tache noir (eschar), in typhus 85, 86, 139 repellents 71 changes
Taenia solium 203 Rocky Mountain spotted fever 139 transplant recipients 170, 434
Taenia spp. 409 tick-borne encephalitis 70—1 trapped gas dysbarism 218
taipan 326 clinical features and diagnosis 71 traps, tsetse fly 114
Papuan 322 epidemiology 33, 70—1 trauma
Taiwan Travel Health Association 24 prevention 71 eye 354—9
Tamiflu 60 vaccine 71, 172, 180 travel-related see injury, travel-related
tapeworms (cestodes) 203, 409 in expatriates and aid workers 454 travel
T cells see T lymphocytes in pregnancy 399, 401 destinations 4
‘team building’ training 457 tick-borne relapsing fever 88, 89, 132 fitness for 15—21, 431—2
tears, artificial 346, 350 tick typhus 85 international 3—6
teenagers see adolescents clinical features 85, 139, 196 rapid growth 3—4, 8, 10
teeth, effects of altitude 218 treatment 86 tropical infectious diseases and
telemedicine tigerfish 337 9—10, 11
cruise ship 285 time zone changes 222, 242 types 5—6
for expatriates and aid workers 459 in diabetes 437 travel clinic 23—8
inflight 231—2 oral contraceptives and 385 immunization 162—3
temazepam, for jet lag 223 see also jet lag information requirements 24—5
temperature tinea 140—1 models 23, 24
body, control in pregnancy 415 corporis 140 operations 25
environmental pedis (athlete’s foot) 140, 141 patient information brochures 27
decompression sickness and 219 tingling sensations, in hyperventilation staff 23—4
hypoxia susceptibility and 217 217 trip risk assessment see pretravel
stability of ocular preparations 359 tinnitus, in barotrauma 270 assessment
teratogen reference sources 422 tiredness see fatigue web sites 28
terminal illness, fitness to fly 229 T lymphocytes travelers 467
terrorism 458 HIV infection 53, 54 health risks 10—13
tetanus 179—80 in immunization 165 returned 185—209
immunoglobulin 175 tobacco—alcohol amblyopia 361 risk-taking behavior 243—4
neonatal 397 torture victims 472, 473 see also pretravel advice; pretravel
vaccines 171, 173, 179—80 tourism 3—6 assessment
in childhood 370—1 destinations 4 travelers’ diarrhea 153—63
with low-dose diphtheria (Td) 173, economics 4—5 antibiotic resistance 155, 158
179—80, 397 government legislation 295—6 antimicrobial prophylaxis 20, 157,
in ocular trauma 356 industry, risk management 295 161—2, 433
in pregnancy 397—9 outbound 5 in children 56, 369—70, 377
snake bite victims 328 rapid growth 3—4, 8, 10 in chronic disease 424
see also DTP vaccine types 5—6 in cirrhosis 435
tetracycline tourniquets, snake bites 327, 328 clinical features 156, 198—9
in children 369 toxic epidermal necrolysis 148 on cruise ships 283—4
malaria stand-by treatment 105 toxicodermias 148 epidemiology 154—5, 369
for malaria therapy 98, 101 toxicology, medical 311—20 etiology 153—4, 369
in pregnancy 408 toxocariasis 203 frequency 11—12, 31, 153
in rickettsial infections 86, 140 toxoid immunization 166 in high-risk travel groups 432—3
thalassaemia 426, 472 toxoids 167 host susceptibility factors 155—6, 433
thiomersal 167 toxoplasmosis (Toxoplasma infections) in immunocompromised travelers 20,
thrombocytopenia 199 91, 363—4 156
thromboembolism in pregnancy 363—4, 414 in pregnancy 17, 408
INDEX 501
pretravel advice 26, 159—61, 257 control measures 114 vision 261
prevention 159—63, 369—70 T. brucei life cycle 109—10 see also diving
risk factors 155—6, 190 T. brucei transmission 110—11 United States (US)
self-treatment 156—7 tsutsugamushi fever 85 outbound tourism 5
for children 370 TT virus 39 State Department Travel Warnings
in diabetes 16 tuberculide, papulonecrotic 137 286
in immunocompromised travelers tuberculin skin testing 180 tourism to 4
20 children 376 uranium, depleted (DU) 318—19
in transplant recipients 434 in diabetes 438 urgency, in women 383
treatment 156—9 expatriates and aid workers 461 urinary catheterisation, air ambulance
algorithm 159, 160 immigrants 180—1 transfers 302
antimicrobial therapy 157—8 tuberculosis (TB) 32, 180—1 urinary tract infections
in children 370 cutaneous 136, 137 in diabetes 438
symptom management 158—9 ethambutol therapy 360 in women 383, 416
vaccination 159, 162—3 in expatriates and aid workers 456 urinary tract problems
viruses causing 56—7, 154 extrapulmonary 470 in schistosomiasis 117
travel health clinics 23, 24 in immigrants 180—1, 470 in women 383
travel history 185—91 incubation period 187 urine
countries/localities visited 187 occupational risks 189 pregnancy testing 383
drugs and vaccinations 186—7 risk factors 190 Schistosoma detection 118
mode of travel 190 screening toxicological assessment 312
patients who haven’t traveled 190—1 expatriates and aid workers 461 urticaria
reasons/activities undertaken 189 immigrant children 376 in drug reactions 148
sexual activities 189—90 transmission in aircraft 32 solar 144, 145
timing of travel 187—9 vaccine see BCG vaccine uta 106, 107
type of travel 185—6 verrucosa cutis 137 uveitis 349
travel immunization clinics 23, 24, 25 tularaemia 198 anterior 352—3
travel medicine clinics 23, 24 tumbu fly (Cordylobia anthropophaga)
travel medicine physicians, training 378 201 vaccination 165—70
travel and tropical medicine clinics 23, tumours, in AIDS 54 allergies and hypersensitivity
24, 25 Tunga penetrans 131, 201 reactions 169—70
TravMed 444 tungiasis 131 asplenic travelers 177, 434
tree datura 314 tympanic membrane rupture, in divers booster 165
trematodes (flukes) 201—2, 203 269 in cancer patients 435
gender-specific issues 409, 410 typhoid 82, 83—4, 181—2 children 171, 370—3
treponemal skin lesions 135 clinical features 84, 196, 198 in congenital immunodeficiency 425
Treponema pallidum pertenue 135 epidemiology 32—3, 83—4 contraindications 169—70
Trichinella spiralis 409, 410 risk factors 155 in corticosteroid-treated patients 170,
trichinosis 203 typhoid vaccines 162—3, 172, 181—2 435
Trichuris trichiura (trichuriasis) 202, 203 in children 371, 372 in diabetes mellitus 15, 16, 438
reproductive effects 409 effectiveness 187 history 186—7
in women 411 hepatitis A vaccine combination 174, in HIV infection 18—19, 170, 178, 428
trimethobenzamide, for sea sickness 283 182 in immunocompromised travelers
trimethoprim-sulfamethoxazole see oral 178, 181 18—19, 170, 426—7
co-trimoxazole in children 372 in lactation 429
trimix 265 interactions 181 in older travelers 440
tropical pulmonary eosinophilia 119, in pregnancy 398, 400 in pregnancy 17, 169, 396—402, 429
203 in pregnancy 398, 400 in transplant recipients 170, 434
tropical skin diseases 127—51 typhus 84—6, 138, 139—40 in travel clinics 25
tropical sprue 198—9 clinical features 85—6 see also immunization; vaccines
Trychophyton 140 epidemic 85, 139 vaccines 166—70
Trypanosoma brucei epidemiology 82, 85 adverse events/safety 168—70
life cycle 109—10 louse-borne 85, 139 combination 167
var. gambiense 109, 112—13 murine 139—40 components 167
var. rhodesiense 109, 112—13 scrub 85, 86 contraceptive 389
Trypanosoma cruzi 114, 115 sporadic 139 inactivated (killed) 165, 166, 167
trypanosomiasis 109—16 tick see tick typhus live attenuated 166, 167, 431
African see African trypanosomiasis treatment 81, 86, 140 in asplenic travelers 434
gender-related issues 409, 413—14 in immunocompromised travelers
South American see South American ultraviolet (UV) radiation 343, 344 18, 170, 426
trypanosomiasis ocular damage 343—6 immunoglobulin interactions 166,
trypanosomiasis agglutination card test skin disorders 144—8 175
(TACT) 112 underwater environment 261—2 interactions between 178
TryptTect CIATT 112—13 hearing 261—2 mechanism of immunization 165
tsetse flies heat loss 262 in pregnancy 169, 396, 397, 429
502 INDEX
vaccines (cont.) in inner-ear barotrauma 270 in snake envenoming 325
novel approaches 163 Vessel Sanitation Program (VSP) 284
route of administration 168 vestibular system, in motion sickness war, exposure to 472—3
routine and travel-related 170—82 224, 225 warts, plantar 144
storage 167—8 veterinarians 189 wasp stings 336—7
subcellular 167 vibration, inducing hyperventilation 217 water 261
toxoid 167 Vibrio cholerae 154 chemical contamination 316—17
travelers’ diarrhea 159, 162—3 0139 35 hot, for stings 338, 339
types 166—7 attenuation 166 pressure effects 262—4
see also immunization; vaccination; see also cholera resource engineering 118—19
specific vaccines Vibrio vulnificus 135—6, 435 safety precautions 19, 161, 435—6
vacuum mattress 307, 308 videoconferencing 285 treatment (disinfection) 19, 408
vagina vinegar, for jellyfish stings 339 see also underwater environment
discharge/itching 383—4 violence water-borne illness 31
dryness 383 against women 418 cruise ships 283—4
oral contraceptive administration effects on migrants and refugees in diabetes 435—6
385—90 472—3 hepatitis E 50
vaginitis, candidal 383, 416 vipers 321 in immunocompromised travelers 19
Valsalva manoeuvre, forcible carpet 321, 322 leptospirosis 86
underwater 269—70 effects of envenoming 324, 325, 326 schistosomiasis 116, 118, 202
valvular heart disease, fitness to dive Malayan pit 321, 322 skin conditions 150
268 pit 321 travelers’ diarrhea 155
variant surface glycoprotein, Russell’s (Daboia russelli) 321, 322, typhoid and paratyphoid fever 83—4
trypanosomal 111 324, 326 water sports
varicella 144, 182 true 321 in pregnancy 418
in migrants and refugees 182, 472 viral gastroenteritis 56—7, 154 see also diving; swimming
vaccine 172, 182 clinical features 56—7 web sites
in children 371, 372 on cruise ships 283 for expatriates and aid workers 459
in immunocompromised travelers diagnosis 57 for travel clinics 24—5, 28
19 epidemiology 56—7 travel-related 38
in pregnancy 397, 398 management 57 for women travelers 385
varicella zoster immune globulin pathology 57 weeverfish 337
(VZIG) 19, 175, 397 prevention 57 Weill disease 86
varicella-zoster virus 61 viral hemorrhagic fevers 34—5, 71—8 welder’s flash 344, 345
vascular injury presentation 196 West Nile-like virus 70
in decompression illness 264 South American 77—8 wet suits, diving 262
in typhus 85 viral hepatitis see hepatitis, viral wheelchairs 440
vasculitis, in drug reactions 148 virus infections 39—80 whipworms see Trichuris trichiura
vector-borne parasitic diseases 91—124 eye 350, 351—2 whole blood clotting test, 20 minute
vectors high-altitude pulmonary edema and (20WBCT)
control measures 102, 114 252 snake antivenom therapy and 330
imported 191 skin 144 in snake envenoming 326, 327, 328
international spread 10 visceral larva migrans 203 Wilderness Medical Society 286
South American trypanosomiasis 114 vision Winterbottom sign 111
see also black flies; mosquitoes; tick(s); blurred 348 women 381—422
tsetse flies double 348 contraception 384—92
Venezuelan hemorrhagic fever 75 in hyperventilation 217 cultural and safety issues 418—19
venomous bites and stings 321—41 system, in motion sickness 225 medical kit 416—17
venous thrombosis underwater 261 menstruation 382—3
air travel risks 34, 190, 227 ‘Vision 20/20: right to sight’ program pretravel assessment 382
at high altitude 255, 393 364 sexually transmitted diseases 384
in older travelers 439 visiting friends/relatives 6, 186 sports and adventure activities
in pregnancy 17, 393, 394—5 malaria in pregnancy risk 403 415—18
in women 392—3 malaria risk 471 tropical parasitic diseases 408—14
ventilation, mechanical, in air ambulance visual acuity assessment 349 urinary tract problems 383
transfers 301, 303, 307 visual impairment useful websites 385
ventilators travelers with 20, 440 vaginal discharge/itching 383—4
air ambulances 301, 303 see also blindness venous thrombosis risk 392—3
ground ambulances 307 vitamin A deficiency 364 see also gender differences; pregnancy
ventilatory failure see respiratory failure vitamin B deficiency 361 World Health Organization (WHO)

vertical transmission see perinatal vitamin deficiencies 472 286, 444
transmission vitreous detachment, posterior 357 Gender and Health Technical Paper
vertigo vomiting 385
alternobaric 270 in motion sickness 223 Gender and Tropical Disease Task
caloric 270 oral contraceptive absorption 385 Force 381, 408
INDEX 503
information provision 24, 25, 28 bush 106 effectiveness 187
International Health Regulations 165 crab 135 in immunocompromised travelers
malaria chemoprophylaxis 103, 104 forest 107 18, 182
malaria stand-by treatment 105 yellow fever 64—7, 71, 182 in older travelers 440
malaria treatment 99—101 clinical features and diagnosis 66—7 in pregnancy 398, 401
Roll Back Malaria campaign 102 epidemiology 33, 65 in transplant recipients 434
Weekly Epidemiological Record jungle 64, 65 virus (YFV) 64—5, 68
(WER) 36 management 67 young people
Worldwide Assistance 394, 444 pathology 65—6 risk-taking behavior 189—90, 244
wound management prevention 67 travelers’ diarrhea risk 155
in rabies exposure 64 reservoirs 65 ultraviolet light damage 343
in snake bites 327, 328, 333 trends 34—5 see also children
Wuchereria bancrofti 119, 202, 203 urban 64, 65
in women 410 vaccination certificate 182 zaldaride 159
see also lymphatic filariasis vaccination exemption certificate 18, Zanamavir 60
67, 182, 401 zebrafish 337
Xenopsylla cheopis 133 vaccine 67, 172, 182 Zeitgebers 222
in children 371, 372 zidovudine 416
yaws 135 contraindications 67, 169, 182 Zithromax see azithromycin
Index compiled by Liza Furnival

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Principles and Practice of Travel Medicine. Edited by Jane N.

Principles and Practice of

Principles and Practice of

JOHN WILEY & SONS, LTD

Copyright © 2001 by John Wiley & Sons, Ltd.,

National 01243 779777

Other Wiley Editorial Oﬃces

John Wiley & Sons, Inc., 605 Third Avenue,

WILEY-VCH Verlag GmbH, Pappelallee 3,

John Wiley & Sons Australia, Ltd, 33 Park Road, Milton,

John Wiley & Sons (Canada), Ltd., 22 Worcester Road,

Library of Congress Cataloging-in-Publication Data

British Library Cataloguing in Publication Data

2 Epidemiology of Health Risks and Travel . . . . . . . 7 11 Vaccine-preventable Disease . . . . . . . . . . . . . . . 165

7 Bacterial Infections in Travellers . . . . . . . . . . . . . 81 20 Poisons and Travel . . . . . . . . . . . . . . . . . . . . . . 311

SECTION VI 27 Aid Workers, Expatriates

Index compiled by Liza Furnival

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