February 28, 2001

Travel Health—A Resource for the Business Traveler

Peter P. Greaney, MD
Board-Certified Occupational Physician
President, WorkCare

International business travelers are perhaps the world's savviest travelers.  With business meetings to attend, deals to negotiate, and tight deadlines to meet--there is no room for missed flights, passport problems or travel mishaps.  Yet when it comes to protecting their own health and safety abroad, they may be less prepared. 

According to travel health experts, about 30-50% of travelers get sick, with about one third requiring a doctor's visit.  And given the fact that there are more than 212 million business trips a year, business travelers need to be especially aware of travel-related health risks. 

Becoming ill oversees is quite different than getting sick at home.  When a traveler is stricken by a disease or illness while in a foreign country, the road to recovery is often more complex and challenging.  Health care resources we take for granted, such as clean blood supplies, appropriate medications and facilities, may be limited or unavailable in foreign or developing countries.  In addition, business travelers in a foreign country may face language barriers or administrative obstacles when seeking medical attention. 

In some countries, the local doctors or hospitals may not treat you unless you can pay for the services with cash on the spot.  Also, many insurance companies will not cover the costs of an injury or illness that takes place abroad. 

To fill this need, Travel Health Medicine was developed in the 1980s.

This specialty field of medicine is focused on providing preventive measures that minimize the risks of common and uncommon diseases that may affect travelers.  These prevention measures include consultative, medical, and technological resources designed to safeguard a traveler's health.

Many large U.S. companies with global offices have adopted travel health programs as a means to--not only protect employees from illnesses and hazards--but to better manage travel-related health costs.  For example, some travel health consultants offer pre-travel packages that can cover oversees medical treatment costs, should an employee become ill or injured while on business travel. 

Without such services, employers may face exorbitant costs to evacuate an injured/ill employee from a foreign country.  It is not uncommon for fees to reach $30,000 to airlift a person to another country for medical care.  Company coverage for such medical costs varies per employer and often depends upon the nature of the illness/injury, and whether it occurred within the course of employment functions and duties.

A travel health consultant should be qualified to provide or connect you with an array of consultative, medical and technological resources.  The following information provides background on travel health medicine, as well as guidelines in selecting a provider.

Overview of Travel Health Medicine

Travel health medicine uses the principle of  “the distribution of diseases,” and then applies proven, preventive measures to reduce health risks for international travelers. 

The primary emphasis in travel medicine is to ensure that the international traveler receives proper immunizations and medications based upon the destination country.  Providers of travel medicine follow immunization guidelines and preventive medication measures issued by the Centers for Disease Control in Atlanta . 

Risk factors for acquiring a disease during international travel are based upon the area visited and the susceptibility of the traveler. Those traveling to underdeveloped regions are at greater risk than those traveling to industrialized nations. 

Other environmental exposure factors include living conditions, sanitation standards and hygiene.  The type of immunization coverage that a traveler has is also a significant factor.  Because these factors vary from region to region, and person to person, the risk of acquiring a disease cannot be predicted with certainty. 

Travelers who stray from populated tourist areas may also be at greater risk because of exposure to local water or food of questionable quality.  Also, children, the elderly, pregnant women or immunocompromised persons may be more vulnerable to certain infectious diseases. 

Injury Abroad

Car accidents are the most common type of events that can cause a traveler to be evacuated to the United States or another country for medical treatment.  If you are traveling on personal business, you should prepare for the possibility of injury by contacting your insurance company to determine which medical services are covered abroad—as many insurance companies do not provide foreign travel coverage.

If your health insurance policy does not provide coverage for hospital or medical costs abroad, it's advised to purchase a temporary health policy that provides this coverage. There are short-term health and emergency assistance policies designed for travelers. You can find the names of companies that provide such policies from your travel health consultant, your health insurance company, or from advertisements in travel publications.

If you do have coverage for travel abroad, make sure to carry both your insurance policy identity card as proof of such insurance, as well as a claim form. Although many health insurance companies will pay "customary and reasonable" hospital costs abroad, very few will pay for your medical evacuation back to the United States .  The U. S. consular officer can assist in locating appropriate medical services and informing family or friends.

Partial List of Travel-Related Diseases

There are a number of mild to life-threatening diseases that can be contracted from travel to foreign countries. According to the World Health Organization, Traveler's Diarrhea, Malaria, and Hepatitis A are among those diseases with the highest incident rate for people traveling to developing countries.

Traveler's Diarrhea

The most common travel related disease is Traveler's Diarrhea (TD).  Destinations that pose a high risk for this disease are developing countries in Latin America, Africa, the Middle East and Asia .  

This illness may be caused by viruses, bacteria, or parasites found in food or water.   The symptoms include abdominal cramps, nausea, bloating, urgency, fever and malaise. Episodes of TD usually begin abruptly, occur during travel or soon after returning home, and are generally self-limited.  The medium duration of TD is 3-4 days. 10% of cases persist longer than a week.

There are two approaches to prevent the onset of TD:  following proper usage and preparation instructions for food and beverage consumption, and use of medications. 

Selecting appropriate foods and following proper procedures for food and drink consumption can greatly reduce the risk of TD.  Travelers should avoid risky foods such as raw or undercooked meat and seafood and raw fruits and vegetables.  Tap water, ice and unpasteurized milk and dairy products are also associated with an increased risk of TD, and thus should be avoided.  Travelers should limit their drinks to “safe” beverages, such as bottled carbonated beverages, beer, wine, hot coffee, tea or water boiled appropriately or treated with iodine or chlorine.  Food eaten from street vendors is considered a higher-risk food than restaurant food.

Using medications that contain the active ingredient Bismuthy Subsalicylate, which is found in products like Pepto-Bismol®, may also be effective in preventing TD.

Prophylactic antibiotics are not recommended to prevent TD.  Antibiotics should be used as a treatment option .  The effectiveness of antibiotic therapy will depend on the agent and its sensitivity to the drug.  Bactrim®, Septra® and Cipro® are among the most effective of these drugs.  Other antibiotics, such as Noroxin®, may be equally effective.  Consult your doctor for instructions on dosage and information on side effects. 

Hepatitis A

Hepatitis A is virus that is highly contagious and is transmitted primarily via the fecal-oral route.  Food that is handled by infected natives can transmit the disease, or raw vegetables and fruit that have been grown in soil contaminated by human fecal matter.  Shellfish that is raw or partially cooked and found in polluted water is another source of the disease. This disease attacks the liver and symptoms include mild to severe:  fever, vomiting, abdominal pain, fatigue, jaundice and lack of appetite.  The average incubation period is 28 days.

Although the disease is found throughout the world, there is a higher incident rate in developing countries.  Travelers to such regions should protect themselves from the virus by getting a vaccination.  There are two Hepatitis A vaccines currently licensed in the United States : HAVRIX ® and VAQTA ® .  The vaccines should be taken four weeks prior to travel departure, with a secondary dose 6 months after the first dose, depending on the vaccine used.  Please consult your travel health physician for complete dosage requirements, which differ according to age. 

Malaria

Malaria is caused from the bite of a female Anopheles mosquito.  Symptoms of the disease include fever and flu-like symptoms, including chills, headache, myalgias and malaise.  These symptoms can appear as early as six days after exposure and up to several months after leaving a high-risk area.  The disease may also be associated with jaundice and anemia.  Kidney failure, coma and death have occurred in persons affected by a severe strain of the disease.  High-risk destinations for this disease include: large portions of Central and South America , Haiti and the Dominican Republic , Africa, the Indian subcontinent, Southeast Asia, the Middle East, and Oceania . 

Those traveling to malaria-risk areas should practice personal protection measures and use the appropriate drug regime to prevent the disease.  

Personal protective measures include avoiding exposures in mosquito-prone areas between dusk and dawn (when the mosquitoes are active), using mosquito nets and pyrethroid-containing insect spray, wearing clothes that cover the entire body and remaining in well-screened areas.  Travelers are also advised to purchase insect repellant that contains N,N diethylmetatoluamide (DEET).  Follow all instructions regarding usage of DEET to minimize adverse reactions.   

If the destination is high risk for Malaria, travelers should consider the medicinal use of chemoprophylaxix, which should be taken prior to, during and after travel to such areas.

Your travel health doctor can provide consultation on the regime to take, if warranted, based upon known allergic reactions to anti-malaria drugs, and consideration of possible side affects. 

Guidelines for Selecting a Travel-Health Provider

The traveler should consult a travel health physician to determine appropriate preventive measures to be used against the above diseases, or the many others known to a specific region.  When obtaining a travel health provider, make sure the physician can provide the following resources and services to ensure a safe and healthy trip:

Consultative & Administrative Resources

• Provide information, educational materials and consultative services regarding diseases that may be associated with your itinerary
• Provide international Certificate of Vaccination.  For instance, some countries require proof of a Yellow Fever vaccination if you are traveling from a region that is infected with Yellow Fever or areas where Yellow Fever transmission has occurred
• Traveler's medical records information kit that can be used as a vital resource by a treating physician, should you become ill or injured abroad
• Information on country-specific blood-screening and testing requirements for AIDS—this may be required for those travelers on extended trips due to work or study
• Notification of epidemics and environmental risks
• Special illness prevention and treatment tips designed for pregnant women and children
• Maps indicating areas of known disease or infection, as well as incident rate
• Listing of U.S. board-certified physicians practicing abroad
• Addresses and phone numbers of U.S. and British embassies and consulates

Medical Resources

• Provide complete immunization service for diseases such as Hepatitis A&B, Typhoid, Meningitis, Rabies, etc.
• Preventive prescriptions for travel-related diseases, such as Malaria and Traveler's Diarrhea or others  (Travel-health physicians advise that you take twice the amount of your regular prescription supply.  You should split the supply and store in two different places as a precaution in losing them).
• First-aid kit
• Physical examination

Technological Resources

• Resources, internal or outsourced, that provide travelers with technological capabilities to communicate medical needs in a foreign country, such as
• Confidential electronic medical records that may be accessed via the internet

• Using wireless devices to obtain proper translation for prescription or over-the-counter medication products that may be needed in a foreign country
• Wireless access to the latest health news, tips for a specific geographical region

Summary

The primary responsibility of health and safety departments is to protect and maintain employee health and safety at the worksite. 

Yet in today's global economy, the “worksite” can be in South American , Haiti or Africa , depending on the nature of the business.  Travel Health services are designed to assist managers in extending the reach and impact of their corporate health programs to even remote corners of the world. 

Educating travelers on health prevention programs just may mean the difference of how an employee returns from a business trip—with a briefcase in hand or plenty of leg room to spare (on a stretcher). 

For more information, see the links below.

Travel Health at the CDC

U.S. Department of State

www.workcare.com or email info@workcare.com