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Biomedical subjects

Alan M Spira

Publications and source records attributed to Alan M Spira.

5 recordsLinked to original sources
PubMed2003

Assessment of travellers who return home ill.

Every year, millions of people travel abroad, exposing themselves to various diseases. Advice on risk avoidance and on self-medication is not always successful; sometimes travellers return home ill or become unwell soon afterwards. There are many possible causes for such illnesses, and physicians should try to establish whether the disease is specifically associated with the recent journey. The approach to assessment of the ill traveller should make use not only of signs and symptoms, but also of geography and epidemiology. Travellers with fever need immediate attention to rule out serious and potentially life-threatening conditions. Faced with a difficult diagnosis, physicians should consult with experts in tropical and travel medicine.

Developing Countries↗
PubMed2003

Preparing the traveller.

The four steps for giving travellers the foundation for healthy journeys are to assess their health, analyse their itineraries, select vaccines, and provide education about prevention and self-treatment of travel-related diseases. This process takes time. Since there is a risk of information overload, travellers should leave the clinic with some written advice for reinforcement. The order of these steps can be tailored to what best suits the travel clinic, but vaccinating early in the process allows monitoring for adverse reactions. Face-to-face discussion is vital for explaining the use and side-effects of medications. Those who provide a travel medicine service should be seeing many travellers and should seek specialist training. In 2003, the International Society of Travel Medicine introduced a certificate of knowledge examination in travel medicine. We cannot make travellers bullet-proof but it is possible to make them bullet-resistant. The pre-travel visit should minimise health risks specific to the journey, give travellers the capability to handle most minor medical problems, and allow them to identify when to seek local care during the trip or on return.

Adult↗
PubMed2003

A review of combined hepatitis A and hepatitis B vaccination for travelers.

BACKGROUND: Hepatitis A virus (HAV) and hepatitis B virus (HBV) are the 2 most common vaccine-preventable diseases for which travelers are at risk. These viruses are a significant public health concern, as both HAV and HBV cause substantial morbidity and both can be fatal. OBJECTIVE: This article provides the practitioner with the facts about hepatitis and travel, including why travelers are at risk, which travelers are at greatest risk, and how travelers can protect themselves from both HAV and HBV through vaccination. METHODS: A review of the English-language literature published from 1966 to 2002 was conducted through the PreMedline and MEDLINE databases with the search terms hepatitis A, hepatitis B, and travelers. Reference lists from relevant articles were also searched, and abstracts presented at recent conferences were evaluated. Articles containing information from the past 2 decades were used to reference this article. RESULTS: Travelers need protection against both hepatitis A and B. In addition to making travelers aware of a number of behavior modifications, vaccination should be provided. Tolerable and effective monovalent vaccines are available that can prevent these viruses. In addition, a combination HAV/HBV vaccine is available that is well tolerated and decreases the time to immunity. CONCLUSIONS: Travelers are often unaware of the risk factors for acquiring hepatitis A and B while traveling, such as the degree of endemicity at the travel destination, the length of stay in the endemic area, and the extent and frequency of contact with the local population. Because these risk factors and areas for endemicity of both hepatitis A and hepatitis B overlap, health care providers can protect travelers from both of these diseases by providing a combination vaccine, thus affording a lifetime of protection against both diseases.

Endemic Diseases↗