Travel Medicine and Mens Health. Acurity Health GP Conference 2016 Dr Jenny Visser University of Otago, Wellington

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1 Travel Medicine and Mens Health Acurity Health GP Conference 2016 Dr Jenny Visser University of Otago, Wellington

2 Why Travel Medicine? Because People travel They travel to and within tropical and/or developing countries Travellers get sick Modern travel is usually rapid and the chance for acclimatisation is limited

3 People Travel: International Tourist Arrivals 2012: >1 billion for the first time

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5 Why Travel Medicine and Mens Health? Evidence that there are gender differences in travel-associated health risks

6 Male vs Female Travellers Men more likely to present with Febrile illness Vector borne diseases Sexually Transmitted Infections Viral hepatitis Cardiovascular disease Acute Mountain Sickness Frostbite Road traffic accidents Men more likely to be hospitalised Men less likely to obtain pre-travel advice Schlagenhauf et al. Sex and Gender Differences in Travel-Associated Disease. Clinical Infectious Diseases. 2010;50(6): Wadhwaniya S, Hyder AA. Pre-Travel Consultation Without Injury Prevention Is Incomplete. Journal of Travel Medicine. 2013;20(4):

7 Pre-Travel Consultation: What Information Do You Need? About them Travel experience Health Recent illnesses/operations/ hospitalisations Ongoing & specific medical conditions Regular & intermittent medications Allergies (general and specific) Past DVT/VTE Pregnancy/Contraception Previous vaccinations Routine Travel About the trip When do they leave Destinations (macro & micro) Fixed or flexible itinerary Who are they travelling with? How long Mode of transport Planned accommodation Planned activities

8 Pre-Travel Consultation: Range of Topics to Cover Fitness to Fly Vaccine preventable illnesses and vaccinations Preventing food and water borne illnesses Preventing vector borne illnesses Malaria Dengue Chikungunya Zika Other infectious diseases Schistosomiasis Leptospirosis Sexual & Reproductive health issues Activity specific advice Altitude Trekking Scuba diving Boating Management of ongoing medical conditions Psychological preparedness Accidents, Safety & Security issues/insurance Medical Kit & Self Management

9 Male vs Female Travellers: Geosentinel Data Men more likely to present with Febrile illness Vector borne diseases Sexually Transmitted Infections Viral hepatitis Cardiovascular disease Acute Mountain Sickness Frostbite Men more likely to be hospitalised Men less likely to obtain pre-travel advice Schlagenhauf et al. Sex and Gender Differences in Travel-Associated Disease. Clinical Infectious Diseases. 2010;50(6):

10 Male vs Female Travellers: Geosentinel Data 44 clinics that see ill travellers During and post-travel Database= patients Proportionate morbidity based on gender for specific diagnoses Schlagenhauf et al. Sex and Gender Differences in Travel-Associated Disease. Clinical Infectious Diseases. 2010;50(6):

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12 Male vs Female Travellers: Men Less Likely to Obtain Pre-travel Advice Geosentinel data Women more likely to have sought pre-travel advice (OR-1.28) Tourists in Peru Women more likely to have sought pre-travel advice (OR-1.18) Cabada et al. Pretravel Health Advice among International Travelers Visiting Cuzco, Peru. JTM. 2005;12(2):61-5.

13 Male vs Female Travellers: Geosentinel Data Men higher proportionate morbidity for All febrile illness (OR=1.6) including Vector borne diseases Malaria Dengue Rickettsioses Leishmaniasis Why? Less likely to access pre-travel advice Less likely to adhere to advice Higher exposure risk profile More attractive to mosquitos

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15 Male vs Female Travellers: Men Have Higher Risk of STIs

16 Male vs Female Travellers: Men Have Higher Risk of STIs Geosentinel data Female less likely to present with Sexually Transmitted Infections (OR=0.68) Meta-analysis*: Males More new sexual partners More casual sexual partners More unprotected sexual intercourse *Vivancos et al. Foreign travel, casual sex, and sexually transmitted infections: systematic review and meta-analysis. Int J Inf Dis. 2010;14(10):

17 Men More Likely to Present with Acute Mountain Sickness

18 Travellers to Altitude, Need to Know Previous experience at altitude? Previous history of altitude illness? Detailed itinerary of trek including maximum altitudes gained, passes, sleeping altitudes. What are the options for descent?

19 Prevention of AMS by Prophylaxis Acetazolamide Good evidence and consensus Long history of use Commonly used Would you prescribe in this scenario? Dexamethasone Good evidence Concerns regarding masking of symptoms/rebound/ euphoria Less commonly used Ibuprofen Good evidence but relatively new and limited to 3 studies Inhaled budesonide Very new and one study Not yet mainstream

20 Travel to Altitude Resource MedEx booklet dex_book/about_book.p hp Great information Free Translated into many languages

21 Graded Ascent Once above (2500)- 3000m Aim to sleep no more than m meters higher than the night before Build in an acclimatisation day for each 1000m gained or if exceeded recommended minimum In addition Try to build in an acclimatisation day around 2500m Ovoid over exertion Evidence that spending 3 nights >3000m in preceding 2 months is protective against AMS Schneider et al. Med Sci Sports Ex. 2002;34(12):

22 Road Traffic Injuries (RTIs) Male travellers Over-represented in injuries and deaths due to RTIs* Alcohol often contributing factor * Wadhwaniya S, Hyder AA. Pre-Travel Consultation Without Injury Prevention Is Incomplete. JTM. 2013;20(4):217-20

23 Advising Men Pre-Travel Target men for pretravel advice In the pre-travel consultation concentrate on Insurance Accidents Insect repellents & malaria chemoprophylaxis Condoms