1. Helping Globetrotting Students Travel Safely
Good morning. Thank you for having me today.
My name is Kelly Holton, and I work in CDC’s Travelers’ Health and Animal Importation group. Our mission is to keep US travelers safe and healthy while traveling and living overseas and to prevent the importation of disease via animals and animal products. Today, of course, we will be focusing on some of the health and safety risks facing student travelers – and ways to mitigate those risks.
Kelly Holton
Division of Global Migration and Quarantine
Centers for Disease Control and Prevention

2. Travelers’ Health Epidemiology
We’ll start with travel health epidemiology.

3. Number of US Residents Traveling Abroad, 2000-2007
Many people are surprised by the number of Americans who travel abroad each year.
This graph shows the number of US residents who traveled abroad from
You will notice the general upward trend.
Also notice the decline in travel in reaction to the events of September 11, 2001, and SARS in 2003 and the subsequent resurgence in numbers for
In 2007 over 40 million US residents traveled abroad.
These travelers made more than 64 million international trips.
Source
*ITA, includes travel to Canada and Mexico

4. Study-Abroad Students
Academic Year
Number of Students
1994/95
84,403
1995/96
89,242
1996/97
99,448
1997/98
113,959
1998/99
129,770
1999/2000
143,590
2000/01
154,168
2001/02
160,920
2002/03
174,629
2003/04
191,321
2004/05
205,983
2005/06
223,534
2006/07
241,791
So how may students study abroad? The Institute of International Education found that the number of study abroad students increases each year. In the 2006/2007 school year, there were 241,791 students receiving credit for study abroad.
This figure represents an increase of nearly 150% in about the past decade and an 8% increase from 2005/2006 school year.
Source: Open Doors (Institute of International Education)
Open Doors (Institute of International Education)

5. Leading Destinations of U.S. Study-Abroad Students, 2006/07
United Kingdom
Japan
Italy
Argentina
Spain
Greece
France
South Africa
China
Czech Republic
Australia
Chile
Mexico
Ecuador
Germany
Austria
Ireland
New Zealand
Costa Rica
India
So where do these students go? While destinations in Europe remain popular, study abroad in non-traditional destinations is rapidly expanding, with large increases in the number of Americans studying in China and India. Students are also traveling to developing countries for low budget backpacking and adventure travel, and humanitarian work. It is important to note that health risks are greater in developing countries.
The countries marked with red boxes have greater health risks than the others on this list.
Source: Open Doors (Institute of International Education)

6. Health Risks to Student Travelers
Next we are going to discuss some of the health risks that affect student travelers.

7. Travelers’ Health Risks
Of 100,000 travelers to a developing country for 1 month:
50,000 will develop some health problem
8,000 will see a physician
5,000 will be confined to bed
1,100 will be incapacitated in their work
300 will be admitted to hospital
50 will be air evacuated
1 will die
Steffen R et al. J Infect Dis 1987; 156:84-91
This slide examines the overall health risks to Travelers who visit a developing country.
Of 100,000 travelers to a developing country for 1 month:
50% will experience some health problem while abroad
8% will need to be seen by a doctor, and
5% will be confined to bed
300 will be admitted to hospital, and
50 will require air evacuation, and
1 in 100,000 will die while traveling abroad.

8. Deaths Related to International Travel
This pie chart summarizes the major causes of death in international travelers
You will observe that the greatest single cause of death, almost 50% of all deaths in overseas travelers, are caused by cardiovascular problems. Indicated by the blue slice.
Deaths related to other medical conditions (indicated in green) are ranked next at approximately 25%
Injuries (in red) are the cause of approximately 20% of deaths
Some people are surprised to learn that infectious diseases (indicated in yellow) are a factor in only a fraction of the deaths related to international travel.
Don’t forget, though, that many infectious diseases are preventable either with medications, vaccinations, or personal protective behaviors.
N = 2463
Hargarten S et al, Ann Emerg Med, :

9. Injury Deaths and International Travel
We saw in the previous slide that injuries make up approximately 20% of all deaths during international travel.
This chart shows the breakdown of these injuries.
The point to be made here is that motor vehicle accidents and drowning are the largest causes of injury deaths in travelers.
The high risk of motor vehicle accidents is particularly relevant in the developing world, where:
Tourists are 4 to 5 times more likely to be involved in road trauma than locals
Wounds sustained in these countries are at higher risk of becoming septic, and
Emergency medical services are often rudimentary
N = 601
Hargarten S et al, Ann Emerg Med, :

10. Infectious Disease Risks to the Traveler
Schistosomiasis
Tuberculosis
Leptospirosis
Polio
Yellow Fever
Measles
Mumps
Rubella
Tetanus
Japanese encephalitis
Malaria
Diarrhea
Leishmaniasis
Rabies
Dengue Fever
Chikungunya Fever
Meningococcal Meningitis
Varicella
Influenza
Hepatitis A
Hepatitis B
Next, let’s look at some of the infectious disease risks that could affect travelers.
This is by no means a complete list but it does represent the diseases that travel medicine providers, study abroad coordinators, and travelers themselves should be aware of.
Each of these diseases has a particular epidemiology and a reasonably defined geographic range. Some are preventable with medications, others with vaccines, and some are only prevented with personal protective measures.
Let’s take a look at some of these travel diseases in more detail. We’ll start with mosquito-borne diseases.
ETC.

11. Malaria Mosquito-borne disease Parasite: Plasmodium
May lead to severe complications or death
~500 million cases/year worldwide
Risk in over 100 countries
Prophylactic medication
before, during, and after travel
Malaria is a potentially severe disease passed to humans by the bite of an infected mosquito.
In 2006, 1,564 US residents acquired malaria infection abroad.
It is important for travelers to malaria-risk areas to see a doctor before they travel to receive prescriptions for medicine to prevent malaria and also to learn about personal protective measures.

12. Malaria Risk Areas
I’m pleased today to debut our new disease risk maps. These maps will be included in the 2010 edition of CDC Health Information for International Travel, which will be published in May. But you are seeing them first.
Risk of malaria infection exists in over 100 countries and as can be seen in these maps extends across much of the tropical regions of the world.
For a number of different reasons, individuals can become sick with malaria even if they have been on the appropriate medications.
It is therefore extremely important for travelers to malaria risk areas to seel prompt medical attention for any unusual illness, especially fever, while traveling and also for up to one year after returning home from travel. They should also know to tell the doctor of their travel history.

13. Yellow Fever Mosquito-borne viral infection Varying severity:
Aedes aegypti
Varying severity:
influenza-like syndrome to severe hepatitis and hemorrhagic fever
200,000 YF infections cause 30,000 deaths per year
Yellow fever is a viral disease that is transmitted to humans through the bite of infected mosquitoes. Illness ranges in severity from an influenza-like syndrome to severe hepatitis and hemorrhagic fever.
The case-fatality rate of yellow fever is highly variable but approximates 20%. That means about 1 in 5 persons contracting the disease will die.
A traveler's risk of acquiring yellow fever is determined by various factors, including immunization status, location of travel, season, duration of exposure, occupational and recreational activities while traveling, and the local rate of virus transmission at the time of travel

14. Distribution of Yellow Fever
As can be seem from these maps the disease occurs only in sub-Saharan Africa and tropical South America, where it is endemic and intermittently epidemic. Yellow fever risk, particularly in South America, is changing frequently, so it is important for anyone advising travelers to stay informed about yellow fever.
The incidence of yellow fever in South America is lower than that in Africa. However, it is important to note that four of the six cases of yellow fever reported among travelers from the United States and Europe in acquired yellow fever in South America. All six cases were fatal and occurred among unvaccinated travelers.
Yellow Fever can be prevented by a highly effective and relatively safe vaccine. All persons traveling to a yellow fever risk area should receive the vaccine at least 10 days before departure.
A booster dose is required every 10 years.
Reactions to yellow fever vaccine are generally mild. However since 1992, a small number of serious adverse events associated with the vaccine have been reported. The risk of these events appear to be higher for persons older than 60 years of age. In addition, a history of thymus disease has recently been identified as a contraindication to yellow fever vaccine. It is therefore important for the medical provider to assess these risks carefully.

15. Japanese Encephalitis
Flavivirus transmitted via bite of Culex mosquito
50,000 cases and 15,000 deaths yearly
Supportive care only
Up to 50% of survivors have significant neurologic sequelae
Japanese encephalitis virus is a mosquito-borne disease transmitted to humans by mosquitoes. Part of the transmission cycle includes vertebrate hosts, primarily pigs and wading birds.
The majority of human infections are asymptomatic, but serious disease and death do occur. Children are at greatest risk of infection in endemic areas.
The risk to short-term travelers and those who confine their travel to urban centers is very low.
Expatriates and travelers living for prolonged periods in rural areas where JE is endemic or epidemic are at greater risk.
Travelers with extensive outdoor, evening, and nighttime exposure in rural areas, such as might be experienced while bicycling, camping, working outdoors, or sleeping in unscreened structures without bed nets, may be at high risk even if their trip is brief.

16. Distribution of Japanese Encephalitis
JE transmission principally occurs in rural agricultural locations where flooding irrigation is practiced. In many areas of Asia, these may occur near, or occasionally within, urban centers
Transmission is seasonal and occurs in the summer and autumn in the temperate regions of China, Japan, Korea, and eastern Russia. Elsewhere, seasonal patterns of disease may be extended or vary with the rainy season and irrigation practices. Thus, the risk of JE transmission varies by season and geographic area.

17. Dengue Fever
Mosquito-borne flavivirus endemic in most tropical areas of the world
No vaccine and no medication for dengue
Illness usually mild; it can be severe and cause dengue hemorrhagic (bleeding) fever (DHF)
Dengue is another mosquito-borne illness common in most tropical parts of the world. There is no vaccine or specific medical treatment for dengue. Although the illness is often mild, it can be severe. It is sometimes called “break-bone” fever because of the severe joint pain it can cause.

18. Distribution of Dengue
Dengue occurs in tropical parts of Africa and Asia and in parts of Australia.

19. Chikungunya Fever
Mosquito-borne disease - primary vector is aedes aegypti
Mainly occurs in areas of Africa and Asia
Symptoms can include sudden fever, chills, headache, nausea, vomiting, joint pain with or without swelling, lower back pain, and a rash.
No specific drug treatment
People usually recover on their own; fatalities are rare
A lesser known, but spreading travel disease is chikungunya fever. Chikungunya can cause symptoms similar to dengue; like dengue there is no vaccine or specific treatment for the infection. Most people who become ill with chikungunya recover on their own.

20. You’ll see that Chikungunya occurs primarily in tropical areas in Africa and Asia. However, notice that Italy now has transmission of chikungunya. The first cases in Italy were documented in returning travelers. Since then, the local population of mosquitoes has become infected and there have been instances of local transmission.

21. Hepatitis A Viral infection transmitted via fecal-oral route
Contaminated food and water
Person to person
Asymptomatic, or ranges in severity from a mild illness to severely disabling disease lasting months
Treatment is supportive
Hepatitis A is a viral infection of the liver.
Transmission can occur through direct person-to-person contact or through exposure to contaminated water and foods.
Hepatitis A infection may be asymptomatic or its clinical manifestations may range in severity from a mild illness lasting 1-2 weeks to a severely disabling disease lasting several months.

22. Distribution of Hepatitis A
Hepatitis A infection is common throughout the developing world, where infections most frequently are acquired during early childhood and usually are asymptomatic or mild.
In developed countries, Hepatitis A infection is less common, but community wide outbreaks still occur in some areas.

23. Hepatitis B Viral infection transmitted via bloodborne route
Sexual contact
Transfusions, surgical or dental procedures
Shared injection needles
Ranges in severity from no symptoms to fulminant hepatitis
Treatment is supportive
Risk determined by behavior and prevalence of chronic infections at destination
Hepatitis B is a viral disease transmitted through activities that involve contact with blood or blood-derived fluids. Such activities can include unprotected sex; shared needles; work in health-care fields; blood transfusions; or having dental or medical procedures, or cosmetic procedures such as tattooing or body piercing.
The clinical manifestations of Hepatitis B infection range in severity from no symptoms to fulminant hepatitis.

24. Distribution of Hepatitis B
The risk of Hepatitis B infection for international travelers is generally low, except for certain travelers in countries where the prevalence of chronic Hepatitis B infection is high or intermediate (as indicated on this map).

25. Typhoid
Acute, life-threatening febrile illness caused by Salmonella enterica serotype Typhi
Transmission via fecal-oral route, usually contaminated food or water
Chronic asymptomatic carrier
Worldwide: 22 million cases and 200,000 related deaths each year
Typhoid fever is an acute, life-threatening illness.
An estimated 22 million cases of typhoid fever and 200,000 related deaths occur worldwide each year. Approximately 400 cases of typhoid fever are reported in the United States each year. Most of these are associated with travel.

26. Distribution of Typhoid
Risk is greatest for travelers to South Asia and developing countries in Asia, Africa, the Caribbean, and Central and South America.
Travelers to South Asia are at highest risk for infections that are multidrug-resistant.
Travelers who are visiting relatives or friends and who may be less likely to eat only safe foods and beverages are at greater risk.
Source: sanofi pasteur MSD

27. Traveler’s Diarrhea
> 50% of travelers away from home even for only 2 weeks develop TD
~ 40% will have to alter itineraries
~ 20% will be confined to bed
Travelers’ diarrhea can be caused by bacteria, viruses, and parasites. Travelers’ diarrhea is very common in many areas of the world -- It affects more than 50% of travelers. Sometimes traveler’s diarrhea can be so bad that travelers have to alter their itineraries or even be confined to bed.

28. Polio Viral infection Acute onset flaccid paralysis
Transmitted via fecal-oral
route or pharyngeal spread
High transmission areas are India, Pakistan, Afghanistan, Nigeria
Polio is a disease that many people in the United States don’t think very much about, but it is still endemic in India, Pakistan, Afghanistan, and Nigeria.

29. Polio Risk Areas WHO/POLIO database, as of Sept. 2007
In addition to the endemic areas, shown here in red, there are several countries that have sporadic cases. CDC recommends one-time polio boosters for adults traveling to these areas.
Right now, new polio cases are being seen in Sudan and the outbreak has spread to Kenya and Uganda. This is the first reported case of polio in Uganda since 1996.
WHO/POLIO database, as of Sept. 2007

30. Meningococcal Meningitis
Bacterial infection transmitted via the respiratory route
Outbreaks in Africa during dry season (December to June)
Associated with crowded conditions
Meningococcal disease is bacterial infection characterized by sudden onset with fever, intense headache, nausea, vomiting, stiff neck, and, frequently, a rash. Formerly, more than 50% of people who developed meningitis died, but early diagnosis, modern therapy, and supportive measures have lowered that number to about 10% in developed countries. 11%-19% of survivors have long-term affects.

31. Distribution of Meningococcal Disease (“Meningitis Belt”)
Sporadic cases and outbreaks of meningococcal disease occur throughout the world.
In the sub-Saharan African "meningitis belt," which extends from Mali to Ethiopia, peaks of meningococcal disease occur regularly during the dry season (December through June).
In 2000, an epidemic occurred in Saudi Arabia in association with the Hajj pilgrimage.

32. Rabies Acute viral encephalomyelitis Invariably fatal
Humans contract rabies by being bitten or occasionally by being scratched by an infected animal
55,000 deaths per year
Rabies is not a disease that we typically think of when traveling. But for those students going to developing countries, rabies can be a very real risk. Rabies affects the brain and nervous system, and it always (with one exception) fatal.
People contract rabies by being bitten or occasionally by being scratched by an infected animal.
There are approximately 55,000 deaths per year due to rabies.
Right now the supply of rabies vaccine is very limited and is being reserved for post-exposure use and no pre-travel vaccine is available.
Travelers to rabies-risk areas should always be counseled to avoid contact with animals and to seek medical care immediately if they are bitten or scratched.

33. Distribution of Rabies
There are very few countries which are considered rabies free. The list of countries considered rabies free can be found on WHO’s website and are highlighted here in the lighter color.

34. Schistosomiasis
Parasite found in some areas of tropical S. America, Africa, and the Far East
Second only to malaria in terms of morbidity – over 200 million infected
Transmitted while swimming in fresh water lakes, streams, rivers
Most will have no symptoms; if exposed, requires testing on return, and then treatment if infected
Missionaries and VFRs more likely to be infected*
Many people like to go swimming and participate in water sports when they are traveling. However, student travelers should know that there are health risks associated with swimming in some areas of the world. Schistosomiasis occurs in tropical areas of South America, Africa, and Asia. While most people have no symptoms, some people who become infected do get sick with Katayama Fever.
There is risk for schistosomiasis in fresh water – including fast-flowing rivers.
*Nicolls D & GeoSentinal, ISTM 2005

35. Geographic Distribution of Schistosomiasis
This map shows the risk areas for Schistosomiasis.

36. Travel Vaccinations
Are you scared yet? There’s good news – many of these diseases can be prevented with vaccines, medicines, and personal protective behaviors.

37. Immunizations for Adult Travelers
Routine immunizations
Required immunizations for travel
Recommended immunizations for travel
Travel vaccinations can be divided into three categories; the 3 Rs of travel vaccination:
Routine immunizations
Required immunizations for travel
Recommended immunizations for travel
Since not all vaccines are available in many countries, students should get vaccines before traveling.

38. Routine Immunizations
Diphtheria
Tetanus
Pertussis
Measles
Mumps
Rubella
Varicella
Pneumococcus
Influenza
Human papillomavirus (HPV)
Students are probably up-to-date with routine vaccinations, but the pre-travel consultation is an opportunity to double-check.
Influenza is now the most common vaccine preventable disease in travelers. Travelers should be aware that influenza season in the southern hemisphere is from June to October and in the tropics it is transmitted year round. It is recommended that travelers receive flu vaccine when it is available in the US and until it expires, which is typically June of the year after it's availability.
* Td or Tdap
+ MMR

39. Required Immunizations for Travel
Yellow Fever
Meningococcal
Yellow Fever vaccine is a REQUIRED vaccine for entry into many countries.
CDC provides a country-by-country list of vaccination requirements, as well as recommendations for each of those countries.
Meningococcal vaccine was recently added as a requirement for pilgrims traveling to the Hajj in Saudi Arabia.
Required vaccines should be noted on the International Certificate of Vaccination or Prophylaxis, shown here. Travelers are required to show this card at certain international border crossings. Without this proof of vaccination, they may be denied entry to the country or vaccinated on the spot.

40. Recommended Immunizations for Travel
Hepatitis A
Hepatitis B
Typhoid
Japanese encephalitis
Polio
Rabies
RECOMMENDED travel vaccines include:
Hepatitis A, Hepatitis B, and Typhoid
Depending on the travel destination and planned activities other vaccinations may be recommended, such as:
Japanese encephalitis, Polio and Rabies

41. Medications

42. Travel Medications: Prophylaxis & Self Treatment
Malaria
chloroquine, atovaquone/proguanil (Malarone), doxycycline, mefloquine (Lariam), primaquine
Diarrhea
quinolone (Cipro), azithromycin
Altitude sickness
acetazolamide
dexamethasone
Motion sickness
scopolamine, dimenhydrinate (Dramamine)
We’ve already talked about the seriousness of malaria. Travelers who are going to malaria risk-areas should take prescription medicine to prevent malaria. There are several options available, depending on the medical history and itinerary of the traveler.
Many travelers may also want to take prescription medicines with them to prevent or treat diarrhea, altitude sickness, and motion sickness.
For those travelers who may be unable to get urgent medical care consideration should be given to a self-treatment regimen.
I wish to point out a very grave problem facing travelers today. Many medications sold in a number of developing countries are counterfeit and often will not only provide no benefit but may in fact cause harm. It is therefore important for the travelers to travel with enough medications to last the duration of their travel.

43. Practice Healthy Behaviors
We will now examine a number of slides which outline precautions that travelers can take to ensure their own health

44. Food and Water Precautions
Drinks that are bottled and sealed
Selection of foods
well-cooked and hot
fruits you can peel
Avoidance of
salads, raw vegetables
unpasteurized dairy products
food from street vendors
Ice
Handwashing
Food and Water Precautions
Diarrhea is a common ailment in travelers, especially those to the developing world.
Travelers should be advised to:
Drink only bottled water
Select food carefully, and choose well-cooked items that are still hot
Many items should be avoided if possible:
Salads and raw vegetables may have been washed in contaminated water
Unpasteurized dairy products may have a risk for diseases such as brucelosis
Street vendors often have sub-optimal hygiene standards, and
Ice is usually produced with local tap water
Washing hands with soap and water or using an alcohol-based hand gel are important measures to prevent foodborne illnesses.

45. Insect and Mosquito Precautions
Protect yourself outside
Cover exposed skin
Use insect repellent
Inspect for ticks
Treat clothing with permethrin
Use pyrethroid coils outdoors
Protect yourself inside
Stay in air-conditioned rooms OR
Use window screens
Use permethrin-impregnated bed nets
Use aerosol insecticide indoors
Vector Precautions
Patients should be advised that prophylactic medications and vaccinations should be considered the last line of defense in the prevention of many vector borne diseases. The efficacy of medications and vaccines is never 100%.
Personal protective measures are essential in preventing these diseases.
All these measures are designed to prevent the vector from biting the traveler.

46. Animal Precautions Animal bites and scratches Envenomations
Snakes, scorpions, spiders
Marine animals
Avoid all animals, even pets
If you are bitten or scratched, seek medical care right away
Animal can spread many diseases to humans.
In areas with a risk of rabies patients should be advised to avoid all animals, including domestic animals.
While certain species of animal are often associated with rabies any bite or scratch from any animal should be medically evaluated and post-exposure immunization and immunoglobulin should be considered.
Travelers also need to be aware of the risk of envenomation from snakes, spiders and marine animals.

47. Bloodborne and STD Precautions
Prevalence of
STDs
Hepatitis B
Hepatitis C
HIV
Unprotected sexual activity
Commercial sex workers
Tattooing and body piercing
Auto accidents
Blood products
Dental and surgical procedures
The traveler also needs to be aware of the risks associated with STDs and blood borne infections. Particular advice may be given regarding:
Automobile accidents and the possible requirement for surgery and blood products
Elective dental and surgical procedures should be avoided in certain countries, and
Tattooing and body piercing also pose a risk of blood borne disease.
Unprotected sex

48. Environmental Precautions
Sun protection
Extreme heat and cold
dehydration, heat stroke
hypothermia, frostbite
Altitude
Water recreation
Drowning, boating, & diving accidents
Risk of schistosomiasis or leptospirosis
Biological and chemical contamination
Travelers should be reminded about
Sun protection
The extremes of heat and cold, and how to avoid dehydration and heat injuries or hypothermia and frostbite.
The possibility of altitude sickness.
Water recreation can pose a substantial risk, especially the risk of accidental injury or death.
Certain bodies of water should be avoided due to parasitic infections or to contamination.

49. Safety Precautions Wear a helmet Wear seatbelts Drink responsibly
Stay alert in crowds
Follow local laws and customs
Understand local crime risks
It is important for travelers to take good health and safety habits with them when they travel.
We have earlier discussed the risks of motor vehicle accidents. Travelers should also be aware of the risks to pedestrians, and should avoid night travel where possible. Seat belts should always be used.
Travelers should be aware of the risks associated with local crime activity and should be encouraged to maintain their situational awareness. They may also be targeted for scams and violent crime.

50. Travel Health Kit Copy of medical records and extra pair of glasses
Prescription medications
Over-the counter medicines and supplies
Analgesics
Decongestant, cold medicine, cough suppressant
Antibiotic/antifungal/hydrocortisone creams
Pepto-Bismol tablets, antacid
Band-Aids, gauze bandages, tape, Ace wraps
Insect repellant, sunscreen, lip balm
Tweezers, scissors, thermometer
The CDC recommends that all travelers make or purchase a travel emergency kit which includes.
Copy of medical records and extra pair of glasses
Prescription medications
Over-the counter medicines and supplies
Over the counter pain medicines
Decongestant, cold medicine, cough suppressant
Antibiotic/antifungal/hydrocortisone creams
Pepto-Bismol tablets, antacid
Band-Aids, gauze bandages, tape, Ace wraps
Insect repellant, sunscreen, lip balm
Tweezers, scissors, thermometer

51. Travel Health Insurance
Health insurance may not cover services abroad
Consider supplemental health insurance and evacuation insurance
US Department of State consular offices can assist in finding medical facilities
Check with insurance company before traveling to see what, if anything, they cover. Consider supplemental coverage. Mention to explore policy on pre-existing conditions
Also mention that can register with US embassy or consulate

52. Health Monitoring Post-travel checkup is recommended for
Long term travelers
Adventure travelers
Expatriates in developing world
Post-travel care is recommended for
Fever, chills, sweats
Persistent diarrhea
Weight loss
Any fever in a traveler returning from an endemic area should be considered malaria until proven otherwise.

53. Sources of Information

54. Travel Health Resources
CDC Travelers’ Health Website
Health Information for International Travel
CDC “Yellow Book”
World Health Organization
International Travel and Health
WHO “Green Book”
State Department
travel.state.gov
International Society of Travel Medicine
This brings us to a quick review of some of the resources available to the provider and patient.
The Travelers Health team at the CDC maintains a comprehensive website aimed at meeting the informational needs of the traveling public. I will look at this website a little more closely in the next few slides.
The CDC also produces the “Yellow Book” or “Health Information for International Travel” which is published every two years. The next edition will be published in May.
The WHO maintains a similar website and also publishes a “green book” on international travel and health.
The State Department has a travelers website
And many organizations, both local or international, such as ISTM, offer comprehensive websites advising travelers on their health needs.

55. Travelers’ Health Website www.cdc.gov/travel
This is the CDC’s Travelers’ Health Home Page
It is usually ranked in the top 5 CDC websites based on the volume of web use
We have 2 primary audiences:
Traveling public and
Health professionals advising travelers
There is a tremendous amount of content on this site
There are Destination Pages for each country in the world
Travel Notices & Announcements are easily viewed
The entire content of the Yellow Book, which I mentioned on the previous slide, is available online
Additional Topics provide information on:
Many of the diseases faced in international travel, and
Advice for Special Needs Travelers

56. Travel Notices & Announcements
Situation Info
Advice for Travelers
Disease Info
Provider Info
Resources for more information and Data Sources
The website also provides current information about situations that may impact the health of travelers.
CDC issues different types of notices for international travelers:
They describe both the levels of risk for the traveler and the recommended preventive measures to take at each level of risk.

57. Destination Pages
We recently upgraded this site to provide country specific destination information.
Each country page has information about:
Travel Notices in effect for that country
Safety and Security issues
Preparing for your trip, which includes advice to see a provider before travel, and the vaccines and medications you will probably require.
If malaria is present in that country detailed information is provided about risk areas and appropriate medications
There is information on the diseases found in that region
And lastly advice to the traveler on how to keep themselves safe and healthy while away.

58. Study Abroad Information
The website also has a special page for students planning to study abroad.

59. Your Survival Guide to Safe and Healthy Travel
Also on our website, Your Survival Guide to Safe and Healthy Travel gives travelers step by step information on how to prepare for a healthy trip.

60. Podcasts
Student travelers might be especially interested in some of our “new media” efforts, such as podcasts.

61. Questions?