International Journal of Travel Medicine and Global Health
Volume:4 Issue: 4, Autumn 2016

Zika virus infection has become a worldwide public health problem that needs everyone’s attention. This dengue-like illness is classified as an arboviral infection1 and has already been seen in several countries around the world. Apart from simple transmission by mosquito, the disease is reported to be transmittable through sexual contact and blood transfusion. In travel medicine, the importation and exportation of the disease is a grave concern.2 How to travel safely is another big issue in travel medicine. Since there is still no effective vaccine against the Zika virus, selfprevention is advisable. First, avoiding travel to endemic areas when not necessary is suggested. However, it should be noted that due to the expansion of the outbreak area and the emerging modes of disease transmission, the disease might occur anywhere around the world. Preventing mosquito bites and safe sex are basic rules. Second, one must be checked for illness after travel; early detection of the disease might be useful in its management. In travel medicine, delivering updates on the disease through international collaboration and online data exchange is a key.

Noroviruses (NoVs), an important pathogenic agent of foodborne illness, lead to acute and chronic gastroenteritis in humans of all ages and to travelers’ diarrhea. Many genotypes exist in nature; GII.4 is widely known as the most predominant. Outbreaks mostly occur in semi-closed settings. Although the disease is self-limited to person, many cases have resulted in death, which has raised more concerns. However, a lack of microbial culture techniques limits research and thus knowledge about these viruses. To date, there are no specific antiviral drugs that fight NoVs. Rehydration is the ideal approach at present for severe cases. The only way to prevent infection is to improve personal hygiene. So many variants and ambiguous evolution mechanisms make research for a vaccine much more difficult. In recent years, several vaccine candidates entered pre-clinical development. This review concentrates on summarizing the aspects of NoV structure, culture, genetic evolution, and the vaccine.

Increasing international travel to low-income areas is confronting travelers with new health threats. This study investigated international travelers’ health advice, behavior, and information needs in a low-income setting. This is a descriptive and cross-sectional study. Between October 27–31, 2014, 127 semi-structured surveys were conducted in Jinja, Uganda with international travelers selected by central-location intercept convenience sampling. Data was analyzed using SPSS software. Among all the 127 respondents, 88% sought pre-travel medical advice. The surveys revealed a pool of many traveling longer than six months (32.3%) with 72.3% of those being for volunteer purposes, while 41.2% of those traveling for less than one month (40.2%) were volunteers. Compliance with malaria chemoprophylaxis was reported by 94.1% of those traveling less than one month and 53.7% of those traveling longer than six months. Malaria topped the list of travel concerns among travelers, with sexually transmitted infections and Ebola virus disease cited as additional concerns. Long-term travelers were heavily represented in the current sample, perhaps due to current events harming short-term tourism. Consistent with prior research, compliance with malaria prophylaxis decreased with length of travel as younger respondents trended toward poorer compliance. This survey highlights the need to accurately define “traveler” and its specific categories to better assess health risks for future travelers.

The pilgrimage to Ka’beh (God’s house in Mecca) is a special opportunity in the life of most Muslims. Female pilgrims try to postpone menstruation during the pilgrimage by taking hormonal medicines. However, women are seen in this disorder. This paper aimed to determine the frequency of menstrual disorders and related factors among female pilgrims of Umrah Mufradah in 2012.

This study was a descriptive type, the population of which comprised 400 female Iranian pilgrims aged 15-50 years who were selected through random cluster sampling from Umrah caravans. Data was collected with a questionnaire developed by the researchers that contained questions about menstrual disorders. The questionnaire was distributed among participants at their hotels three days prior to their return to Iran.

 Among all the participants, 98.7% of them reported taking pills to suppress menstruation. Of this group, 74.7% successfully prevented menstruation, 26% reported spotting, and 11.6% reported menstruation. There was no significant difference between consumption of medicine and factors such as marital status, city, and educational background of the individuals. Participants reported that spotting and menstruation caused them to experience stress and anxiety when performing Umrah rituals.

Experiencing menstrual disorders during pilgrimage can be stressful for pilgrims. To reduce such problems, counseling sessions on menstruation postponement as part of the justification classes before departing for Hajj and compiling an equal and coordinated nationwide protocol seem necessary.

Medical tourism is currently accepted as a developing industry. It describes the act of leaving home for treatment and care abroad. There are several factors that influence choice of destination for patients in medical tourism. Identification of these factors and prioritization according to importance weights could help international healthcare providers develop their marketing strategy. In the first stage of this research, an extensive review was done on recently published studies in medical tourism to identify influential factors on selecting a destination for medical tourism. The review yielded fourteen factors. In the second stage, 40 related papers were selected and the content analysis method was used to calculate frequency of repetition for each factor in the 40 papers. Furthermore, by using the Shannon entropy formula, marginal entropy and importance weight were analyzed for each factor. Results indicated that the most influential factors on selection of a destination for medical tourism were “quality of care,” “cost” and “promotional programs,” results that indicate common sense. The least influential factor was “employer encouragement programs,” an indication that most medical tourists make a personal choice to embark on medical tourism and employer encouragement programs had lower priority in the decision making process. This study highlights the most important influential factors on choice of destination among patients, internationally. According to these findings, hospitals providing a service internationally must provide a high quality service at affordable cost. Consideration of travelers’ priorities can be applied to develop performance and promotional activities that will attract more patients and increase medical treatment revenue in a country.

Citation analysis reflects the extent to which published work has been recognized in the scientific community. The purpose of this study was to characterize the most cited publications in travel medicine. Travel medicine articles indexed on Scopus which had been published in the English language through 2016 were retrieved independently by two researchers using various search terms. Eligible articles with at least 50 citations were ranked according to citation count. Additional information was recorded, including authorship, year of publication, journal, journal impact factor, source country, institution of origin, category of article, level of evidence and principal article theme. Among the 174 most cited articles, the greatest number of citations recorded was 1217 for an original research article published in 2013. The most productive decade for most cited articles was 2000-2010. Of the articles, 122 were original research, 47 were reviews, and 5 were of other article types. The top-ranked author published 15 articles among the most cited. The most prolific institution among the most influential papers was based in Munich, Germany. Nine broad themes emerged from the most cited publication list, with air travel (29), malaria (26), post-travel assessment (16), travelers’ diarrhea (14), and high altitude illness (13) being the most prominent subjects. Travel medicine research has proliferated since the founding of the discipline in the 1970s. This first citation analysis of travel medicine research provides an historical perspective and highlights sources of greatest influence on the travel medicine community.

Chronic mountain sickness (CMS) represents a syndrome of secondary polycythemia along with thrombocytopenia, altered hemorheology, pulmonary and systemic hypertension, and congestive heart failure, occurring due to hypobaric hypoxia-anoxia-induced erythropoiesis reported in both native mountain residents and new climbers after prolonged stays at high and extreme altitudes.

A healthy non-smoker non-drinker reported occipital headache, breathlessness, and insomnia after an uneventful stay of 70 days at 6400 m/21000 ft. His hemoglobin was 21 gm/dL. The patient was diagnosed as having a case of CMS with a Qinghai CMS score >6. Therapeutic phlebotomy was performed; 350 mL was drained on two occasions, reducing his hemoglobin to 14.6 gm/dL.

The altered presentation, difficult diagnosis, evacuation, and long-term management highlighted in this case occurring at 6400 m/21 000 ft in the Karakoram Himalayas represents the insidious nature of altitude sickness in acclimatized subjects.