Travel Medicine and Infectious Disease RSS feed: Current Issue. The journal will publish original papers and invited reviews covering all aspects of travel medicine and infectious disease. These will include the epidemiology and surveillance of travel-related infectious disease, vaccine-preventable disease, illness in returning travellers, aviation medicine including psychological aspects, environmental hazards of travel, practical clinical issues for travellers, tropical medicine and tropical skin disease and general aspects of travel medicine and infectious disease. The journal will also bring together knowledge from different specialties involved in the research and clinical practice of travel medicine and infectious disease. The journal will publish topical leading academic reviews and opinion papers, original articles and case reports as well as a correspondence section.http://www.travelmedicinejournal.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Travel Medicine and Infectious Disease1477-893973May 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.travelmedicinejournal.com/article/PIIS1477893909000647/abstract?rss=yesEditorial board10.1016/S1477-8939(09)00064-7Travel Medicine and Infectious Disease 7, 3 (2009)2009-05-01Travel Medicine and Infectious Disease2009-05-0173S1477-8939(09)X0004-9iihttp://www.travelmedicinejournal.com/article/PIIS1477893909000337/abstract?rss=yesDental problems represent a significant health concern of travellers abroad. In terms of travel insurance claims, studies in Australia indicate that about 7–8% of claims made by Australians returning from abroad are for dental conditions. About three-quarters of these claims were for conservative (30%), endodontic (18%) or prosthodontic (26%) treatment overseas, primarily for problems such as lost fillings, dental caries, root canal treatment and repair of prosthetic devices. About one quarter of travel insurance claims for dental conditions were not accepted, primarily because the condition claimed was a pre-existing problem. It is important therefore that travellers have recently had a dental check-up before travel and care for their teeth and dentures during travel. Travellers may still suffer a dental problem abroad and it is important that travellers take out appropriate travel insurance and are able to find dentists abroad. Insurance companies usually have links to an emergency assistance service and, in an Australian study, about 14% of calls to the emergency assistance service of the travel insurance company involved dental problems. Such calls may involve anything ranging from claiming advice to seeking emergency dental treatment abroad. Some dental associations, such as the American Dental Association (ADA), maintain international directories of dental associations and dental schools, which may be a useful starting point for travellers and travel health providers.Dental health, ‘dental tourism’ and travellersPeter Leggat, Ureporn Kedjarune10.1016/j.tmaid.2009.02.001Travel Medicine and Infectious Disease 7, 3 (2009)2009-03-31Travel Medicine and Infectious Disease2009-03-3173S1477-8939(09)X0004-9Editorial123124http://www.travelmedicinejournal.com/article/PIIS1477893909000532/abstract?rss=yesSummary: Skin diseases are the third most common cause of morbidity in returning travellers and may affect 8% of travellers during travel. Classic tropical diseases account for one quarter and the remainder are cosmopolitan diseases. The majority are of infectious origin, and of these bacterial infections are the most common and lead to the most hospitalisations. The ten most frequently encountered diagnoses comprise four classical tropical infections (cutaneous larva migrans, myiasis, tungiasis and cutaneous leishmaniasis) and six nontropical diseases (bacterial skin infections, arthropod bites, allergic reactions, scabies, animal bites and superficial fungal infections). Other notable skin problems include swimmer's itch, dengue fever presenting with a rash and rickettsial infections presenting with a rash or eschar. Delayed diagnosis, especially of tropical diseases, is common and may be reduced by improved knowledge and a systematic approach to skin problems. This involves a thorough travel specific, traveller specific and skin problem based history, combined with targeted examination and investigations. A frequency weighted differential diagnosis of the most common skin lesions is presented. An increased emphasis on preventative advice in relation to skin disease is encouraged during pre-travel consultations.A practical approach to common skin problems in returning travellersBrigid M. O'Brien10.1016/j.tmaid.2009.03.003Travel Medicine and Infectious Disease 7, 3 (2009)2009-04-13Travel Medicine and Infectious Disease2009-04-1373S1477-8939(09)X0004-9Invited Submission125146http://www.travelmedicinejournal.com/article/PIIS1477893909000039/abstract?rss=yesSummary: Background: Splenic rupture during acute malaria is rare but underreported. Because splenic rupture occurs mostly in non-immune adults, ongoing malaria elimination efforts may paradoxically increase the proportion of Plasmodium-infected patients suffering from this life-threatening complication. The pathogenesis and optimal patient management are still debated.Method: We collected and analysed reports of pathological rupture of the spleen associated with malaria published over the last 50 years in five languages.Results: Fifty-five cases were reported, due to Plasmodium falciparum (n=26), Plasmodium vivax (n=23), Plasmodium ovale (n=2), Plasmodium malariae (n=2), or P. vivax–falciparum (n=2), and occurred in travellers (n=24), locals (n=21), expatriates (n=6) or migrants (n=4). Median age was 31.5 years and sex ratio M/F 3.2. Splenic rupture was complete with hemoperitoneum (n=50), or partial (n=5). Death occurred in 12 patients (22%), 8 of whom from early irreversible collapse (n=7) or unexpected death (n=1). Death rate was higher among travellers than in other patients (9/24, 38%, versus 3/31, 10%, p=0.01). Clinical features of P. falciparum- or P. vivax-associated splenic rupture were strikingly similar. Treatment included in-hospital medical observation without surgery (conservative management, n=14), immediate splenectomy (n=29), delayed splenectomy (n=4), or none (patients dying at admission, n=8). The type of treatment, conservative or not, had no influence on prognosis. The median duration of malaria symptoms before diagnosis was longer in our review (5–6 days) than in previous reports on imported malaria (3–4 days), suggesting that early diagnosis and therapy of malaria may reduce the incidence of splenic rupture.Conclusions: Abdominal pain, collapse, or fainting is warning symptoms. Fourteen published observations support conservative management in carefully selected patients. Spleen preservation likely reduces the risk of future severe malaria attacks in patients with potential further exposition to Plasmodium sp., and also that of overwhelming sepsis in all.Pathological rupture of the spleen in malaria: Analysis of 55 cases (1958–2008)Patrick Imbert, Christophe Rapp, Pierre A. Buffet10.1016/j.tmaid.2009.01.002Travel Medicine and Infectious Disease 7, 3 (2009)2009-02-09Travel Medicine and Infectious Disease2009-02-0973S1477-8939(09)X0004-9Invited Submission147159http://www.travelmedicinejournal.com/article/PIIS1477893909000301/abstract?rss=yesSummary: Background: Tick-borne relapsing fever is an acute febrile and endemic disease in Iran. For many reasons, the incidence of disease is on decrease, however tick-borne relapsing fever is still a health issue in the rural areas for travelers. This study was carried out during 1997–2006 to investigate the tick-borne relapsing fever in Iran.Methods: Based on a cross-sectional, retrospective and descriptive study in all the provinces, the residents in the endemic areas who were febrile and suspicious to tick-borne relapsing fever were enrolled in the study. Tick-borne relapsing fever is a notifiable disease in Iran and the national communicable disease surveillance data were used through questionnaires. The infectivity of Ornithodoros species to Borrelia also was studied in two highly endemic areas including Hamadan and Qazvin provinces.Results: During 1997–2006, a total of 1415 cases have been reported from the entire country. The highest prevalence was observed in year 2002 with the incidence rate of 0.41/100,000 population. Ardabil province is the first ranked infected area (625 out of 1415), followed by Hamadan, Zanjan, Kurdestan and Qazvin provinces sequentially. The disease is recorded during the whole year but its peak occurs during summer and autumn. There have been 87.6% of the cases recorded from June to November. Forty five percent of the infected cases were male and one third of the patients were under 5 years of age. Fifty four percent of the patients comprise the children under 10 years. Ninety two percent of the cases were living in rural areas where their dwellings were close to animal shelters. They were involved mainly with farming and animal husbandry activities. All the febrile patients with confirmed spirochetes in their blood samples were treated according to a national guideline for tick-borne relapsing fever treatment. Only 7% of the patients were hospitalized and 0.8% of them exhibited the Jarisch–Herxheimer reaction. The study of infectivity of Ornithodoros species to Borrelia revealed that Ornithodoros tholozani was infected with Borrelia persica and Ornithodoros erraticus with Borrelia microti.Conclusion: Travelers to the rural areas with high prevalence of the disease should be made aware of the risk of tick-borne relapsing fever and use of appropriate control measures. Communicable disease surveillance including tick-borne relapsing fever should be pursued as well.The epidemiology of tick-borne relapsing fever in Iran during 1997–2006H. Masoumi Asl, M.M. Goya, H. Vatandoost, S.M. Zahraei, M. Mafi, M. Asmar, N. Piazak, Z. Aghighi10.1016/j.tmaid.2009.01.009Travel Medicine and Infectious Disease 7, 3 (2009)2009-03-02Travel Medicine and Infectious Disease2009-03-0273S1477-8939(09)X0004-9Original Articles160164http://www.travelmedicinejournal.com/article/PIIS1477893909000325/abstract?rss=yesSummary: Objective: To assess the range and quality of malaria prevention advice in the County of Bedfordshire, England. To compare standards of knowledge of nurses and GPs. To relate questionnaire performance to deprivation and percentage non-white population in the practice areas.Design: A self-administered four A4 page questionnaire comprising 34 questions was sent to 92 general practices. Separate responses were requested from one doctor and one nurse within each practice.Participants: Doctors and nurses from general practices in the county of Bedfordshire.Setting: Primary care in an English County.Results: For malaria prevention advice in the County of Bedfordshire, UK.Nurses were more knowledgeable than GPs.Group practices were more knowledgeable than single doctor practices.The standard of knowledge for the same population of practices rose between 1997 and 2006.Only a small percentage of practices used a protocol.Practices in more deprived areas were less knowledgeable.Practices in areas with a higher percentage non-white population were less knowledgeable.Conclusions: Ethnic minority travellers visiting friends and relations have the greatest need for improved malaria prevention, yet appear to receive the worst prevention advice. Substantial improvement in delivery of advice is required.The standard of malaria prevention advice in UK primary careJane Chiodini10.1016/j.tmaid.2009.02.003Travel Medicine and Infectious Disease 7, 3 (2009)2009-03-23Travel Medicine and Infectious Disease2009-03-2373S1477-8939(09)X0004-9Original Articles165168http://www.travelmedicinejournal.com/article/PIIS1477893909000076/abstract?rss=yesSummary: Syphilis serology is a basic screening test for the manual workers who wish to go abroad. In this work, the authors summarize results and prevalence screening syphilis serology in Thai manual workers going aboard from a tertiary hospital in Thailand. Although these manual workers have healthy general appearance there are a considerable number of a rapid plasma regain (RPR) positive cases (0.83%).Screening for syphilis by serology of Thai workers going abroadMayuna Srisupanant, Viroj Wiwanitkit10.1016/j.tmaid.2009.01.007Travel Medicine and Infectious Disease 7, 3 (2009)2009-02-17Travel Medicine and Infectious Disease2009-02-1773S1477-8939(09)X0004-9Original Articles169170http://www.travelmedicinejournal.com/article/PIIS1477893909000088/abstract?rss=yesSummary: Background: Screening of refugees resettled from areas with a high (>8%) or intermediate (2–7%) prevalence of hepatitis B virus infection (HBV) is critical to identify and to provide counseling to those with chronic HBV carriage; and to ensure entry into medical care of those with chronic hepatitis to prevent long-term sequelae.Methods: We performed a descriptive retrospective analysis of refugees resettled into the US seen at a US travel clinic over a 3-year period and in whom we have obtained HBV serologies and clinical evaluations to define various clinical stages of HBV infection.Results: During the study period, we evaluated a total of 80 patients categorized as refugees or asylum seekers resettled mostly from African countries. In our clinic, we performed HBV serologic analyses among 74/80 (90%) of them. Of those undergoing testing, 17/74 (23%) patients had evidence of HBsAg-positivity. Among these, one patient died secondary to HBV-associated hepatocellular carcinoma, three had chronic HBV infection, and thirteen were found to be chronic inactive HBV carriers. The average time of their resettlement to their time of HBV-related diagnosis was 3.5 years. All 17 patients with HBV surface antigenemia were counseled and enter into medical care for long-term clinical follow up.Conclusion: Earlier efforts are required to provide counseling for HBV chronic carriers, vaccinate the unexposed, and assure entry into medical care for those with chronic HBV infection among refugee communities resettled in the US.Epidemiology and clinical outcomes of hepatitis B virus infection among refugees seen at a U.S. travel medicine clinic: 2005–2008Oidda Museru, Carlos Franco-Paredes10.1016/j.tmaid.2009.01.008Travel Medicine and Infectious Disease 7, 3 (2009)2009-02-17Travel Medicine and Infectious Disease2009-02-1773S1477-8939(09)X0004-9Commentaries171174http://www.travelmedicinejournal.com/article/PIIS1477893909000489/abstract?rss=yesTravellers are increasingly taking the opportunity to explore more adventurous and wilderness destinations, sometimes as part of an expedition, which may have the additional benefit of medical cover that is often provided by an expedition physician, paramedic or nurse. Wilderness areas, although often unspoilt and spectacular, often harbour a multitude of biological and environmental hazards. Apart from major expeditionary organisations, such as the Royal Geographical Society, who have traditionally contributed guidelines in this area, often as part of broader publications, there have been few handbooks published specifically on guidelines related to wilderness medicine. This First Edition of Therapeutic Guidelines: Toxicology and Wilderness, the 14th instalment of the popular and respected Therapeutic Guidelines series in Australia, is a major step forward in filling this gap.Peter A. Leggat10.1016/j.tmaid.2009.02.002Travel Medicine and Infectious Disease 7, 3 (2009)2009-03-09Travel Medicine and Infectious Disease2009-03-0973S1477-8939(09)X0004-9Book reviews175176http://www.travelmedicinejournal.com/article/PIIS1477893908001506/abstract?rss=yesThis work is a large volume suited really neither to a desktop nor a pocket, although it might find a home on the top shelf of a travel clinic library. The format of the volume suggests it to be a reference work, although the preface positions the book as a practical work, intended to assist the travel medicine practitioner as he busies himself about his daily travel clinic duties; the preface describes the volume as a “how to” manual, which may be read in its entirety, from cover to cover, although few would have time for that in today's world.Stephen Toovey10.1016/j.tmaid.2008.11.002Travel Medicine and Infectious Disease 7, 3 (2009)2009-01-07Travel Medicine and Infectious Disease2009-01-0773S1477-8939(09)X0004-9Book reviews177177