Travelling for the Holidays? Don’t Bring The Germs Home!

What are microbes?

Microbes are microscopic living organisms, which may be single-celled or multicellular.

The study on these microorganisms is called microbiology. The microbes were discovered in late 17th century by Antoine Van Leeuwenhoek, using a microscope of his own design.

Bacteria are single celled microbes. They come in different shapes. The different bacterial shapes:

• bacillus (rod),
• coccus (spherical),
• spirillum (spiral),
• spirochaete (corkscrew),
• vibrios (comma),
• chain of cocci,
• cluster of cocci,
• pair of cocci,
• chain of bacilli

Viruses are ultramicroscopic (20 to 300 nm in diameter), metabolically inert, infectious agent that replicates only within the cells of living hosts, mainly bacteria, plants, and animals: composed of an RNA or DNA core, a protein coat, and, in more complex types, a surrounding envelope.

Fungi can be single celled or very complex multicellular organisms. A very small number of fungi cause diseases in animals. In humans these include skin diseases such as athletes’ foot, ringworm and thrush.
Yeasts Candida is the scientific name for yeast. It is a fungus that lives almost everywhere, including in your body. Usually, your immune system keeps yeast under control. If you are sick or taking antibiotics, it can multiply and cause an infection.

Yeast infections affect different parts of the body in different ways:

• Thrush is a yeast infection that causes white patches in your mouth
• Candida esophagitis is thrush that spreads to your esophagus, the tube that takes food from your mouth to your stomach. It can make it hard or painful to swallow.
• Women can get vaginal yeast infections, causing itchiness, pain and discharge
• Yeast infections of the skin cause itching and rashes
• Yeast infections in your bloodstream can be life-threatening

Parasites

What is a parasitic infection?

Parasites are organisms that live off other organisms, or hosts, to survive. Some parasites don’t noticeably affect their hosts. Others grow, reproduce, or invade organ systems that make their hosts sick, resulting in a parasitic infection.

Parasitic infections are a big problem in tropical and subtropical regions of the world. Malaria is one of the deadliest parasitic diseases.

Common parasitic infections are:

• Trichomonas
• Giardiasis
• Cryptosporidiosis
• Toxoplasmosis

Are antibiotics ‘cure all’ for these infections?

Antibiotics are powerful medicines that fight bacterial infections. Used properly, antibiotics can save lives. They either kill bacteria or keep them from reproducing. Your body’s natural defenses can usually take it from there.

Antibiotics do not fight infections caused by viruses, such as:

• Colds
• Flu
• Most coughs and bronchitis
• Sore throats, unless caused by strep

If a virus is making you sick, taking antibiotics may do more harm than good. Using antibiotics when you don’t need them, or not using them properly, can add to antibiotic resistance. This happens when bacteria change and become able to resist the effects of an antibiotic.

When you take antibiotics, follow the directions carefully. It is important to finish your medicine even if you feel better. If you stop treatment too soon, some bacteria may survive and re-infect you. Do not save antibiotics for later or use someone else’s prescription.

How do antibiotics work?

According to the US National Library of Medicine says that antibiotics – powerful medicines that fight bacterial infections – can save lives when used properly. Antibiotics either stop bacteria from reproducing or kill them. “Your body’s natural defences can usually take it from there.” Although there are a number of different types of antibiotic they all work in one of two ways:

• A bactericidal antibiotic kills the bacteria. Penicillin is a bactericidal. A bactericidal usually either interferes with the formation of the bacterium’s cell wall or its cell contents.
• A bacteriostatic stops bacteria from multiplying.

Some possible problems with antibiotics

Overusing antibiotics

Here is concern worldwide that antibiotics are being overused. Antibiotic overuse is one of the factors that contribute towards the growing number of bacterial infections which are becoming resistant to antibacterial medications.

According to the CDC (Centers for Disease Control and Prevention), outpatient antibiotic overuse in many countries, is a particular problem. The ECDC (European Centre for Disease Prevention and Control) says that antibiotic resistance continues to be a serious public health threat worldwide. The ECDC informed that more than 25,000 people die each year in the European Union from antibiotic-resistant bacterial infections.

Travel medicine and vaccination

A public knowledge in travel medicine is growing with rapid globalisation and fast expanding economy the travel across the globe is a necessity and a demand. This increasing globalisation of travel, now over 1 billion annually (with ~80% from developed-to-low/middle–income countries), facilitates increased health
exposures in different environments and the potential spread of disease.

The travel medicine is dynamic and it focuses on the prevention and management of health issues related to global travel. Areas of expertise include:

• Vaccinations,
• Epidemiology,
• Region-specific travel medicine,
• Pre-travel management -adequate pre-travel education and preparation.
• Travel-related illnesses and Post-travel management.

Pre-travel preparation

Further information can be quickly and easily accessed through the CDC Yellow Book, an online resource providing country-specific information related to endemic diseases. Both the medical profession and the travel industry can provide advice, the traveler is responsible to ask for information, to understand the risks involved, and to take the necessary precautions for the journey. In addition, consideration underlying medical or comorbid condition of each traveller—as medications and emergency planning should be established prior to leaving.

General health information such as vaccine requirements, prophylactic medications, disease outbreaks, political environment, and medical resources. As can be seen, this includes but is not limited to a pre-travel medical consultation and evaluation.

Basic health travel kit

A medical kit is an essential item that should be carried by all travelers to developing countries. A physician letter and the original pharmacy bottle is mandatory in certain countries with strict prescription rules.

First-aid items to consider often include the following:

• Antiseptic wound cleanser
• Antihistamines
• Insect repellent/insect bite treatment
• Oral rehydration powder
• Simple analgesics (e.g., ibuprofen, acetaminophen)
• Antidiarrheal medication
• Antinausea medication (if any water travel or winding roads anticipated)
• Antifungal medication

Malaria prophylaxis (based on travel-clinic and/or CDC recommendations depending on destination)
Consider carrying a medication, such as ciprofloxacin, which despite some growing resistance issues, treats travelers’ diarrhea (TD) as well as respiratory, wound, bladder, and other infections. Another example is diphenhydramine, which is excellent as an injectable local anesthetic as well as treatment for nausea, allergic reactions, and insomnia.

Summary of recommendation

All travelers should visit their physician or travel health clinic before traveling to take the recommended vaccinations.

• Hepatitis A and B, MMR : all travelers
• Tetanus and diphtheria : 10 yearly
• Typhoid : tend to eat out in restaurants/hotels
• Yellow fever : Africa, America
• Japanese encephalitis : >1 month in rural areas
• Rabies : work with animals and a lot of outdoor activities
• Travelers’ diarrhea

By far, the most common health risk for travelers, especially those visiting developing countries, is traveler’s diarrhea (TD), According to the US CDC, high-risk destinations include the developing countries of Latin America, Africa, the Middle East, and Asia. Persons at particular high-risk include young adults, immunosuppressed persons, persons with inflammatory bowel disease or diabetes, and persons taking H2 blockers or antacids

Most cases are benign and resolve in 1-2 days without treatment. Traveler’s diarrhea is rarely life threatening. Infectious agents are the primary cause of traveler’s diarrhea. The most common causative agent isolated in countries surveyed has been enterotoxigenic, Escherichia coli (ETEC). The natural history of traveler’s diarrhea is that 90% of cases resolve within 1 week, and 98% resolve within 1 month.

Antibiotics are usually given for 3-5 days. While fluoroquinolones is the drugs of choice, an alternative is azithromycin.

When to see a medical advisor?

When all the medications and precautions advised have been tried to improve the health conditions and the physical health is getting worse a medical practioner should be visited for further assessment.

Summary

Travel medicine is a dynamic field because conditions worldwide are subject to rapid change and are highly variable as it relates to the medical resources at hand. Clinicians must maintain a current base of knowledge encompassing a wide variety of disciplines including epidemiology, infectious disease, public health, tropical medicine, immigrant and refugee health, and occupational medicine. As a unique and growing specialty, it has become necessary to establish standards of practice in the field. These standards have been established to identify the scope of competencies expected of travel medicine practitioners, guide their professional training and development, and ensure a uniform level of patient care.

Currently, the CDC advises all physicians to ask patients about recent travel Ebola outbreak. Several years ago, with the severe acute respiratory syndrome (SARS) scare, physicians were advised to ask all patients about travel to China and Hong Kong SEA. It is evident that increased diligence concerning travel history as it pertains to illness is essential, as is a general awareness of ongoing diseases around the world. In addition, realizing that many serious diseases initially present similarly to common viral illnesses places even more importance on that travel history and the providers’ due diligence. With global travel being common, keep in mind that modern travel vessels, whether airplane or high-speed train, may contain passengers from 50 countries or 50 states. Documenting recent travel for a patient with “the flu” may, one month later, provide a clue for the CDC or the WHO.

The following are important points to consider prior to departure:

• Assess physical and medical limitations related to the anticipated travel;
• Colds are a common problem among tourists, especially when confined to crowded conditions (e.g., buses, cruise ships). Practice exquisite handwashing and limiting personal contact with others to minimize contamination.
• Sexually transmitted diseases are frequently associated with unsafe practices while traveling. Avoid unsafe sex to protect yourself and your partner.
• Gastrointestinal disorders are very common ailments among travelers. Purified hydration and good hygiene are essential.

Cruise Ship medicine

Travel by cruise ship often congregates large groups of people from different parts of the world. In such settings, diseases (influenza, measles, rubella, Norwalk virus, and gastrointestinal illnesses) can spread from person-to-person contact.

Historically, cruise ships were poorly staffed and equipped. Today, most cruise ships require a ship physician to have some emergency medicine experience. Many ships have minimal medications and few, if any, have laboratory or radiographic capabilities. However, some have mini–critical care units complete with monitors, ventilators, defibrillators/pacers, and appropriate medications. In general, the lack of resources can exhaust a physician’s diagnostic and medical skills on a regular basis.

Common medical conditions include the following:

• Sunburn
• Alcohol intoxication
• Seasickness
• Upper and lower respiratory infections
• Diarrhea and subsequent dehydration
• Minor orthopedic injuries
• Geographic specific illnesses
  Exacerbation of common medical illnesses
  Major orthopedic injuries, cardiac, diabetic crisis, and cerebrovascular accident (CVA) are not uncommon

Cruise ships have onboard medical staff who should be sought for any illness. In addition, any traveler who becomes ill while onboard should see his or her health care provider upon returning home. Persons who are ill should limit contact with the general population on board as much as possible to reduce further spread of disease. Ship authorities will report infectious diseases of public health significance to state or federal health officials.