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The increasing noncommunicable disease burden and frequency of natural disasters across the world has created an immediate need to implement strategies for reducing the risk of indirect mortality and morbidity post disaster. People at greatest risk of their condition worsening or even death post disaster are those with cancer, cardiovascular conditions, diabetes, renal diseases and respiratory diseases. To help reduce this risk, this study ranked and prioritized mitigation strategies based on the perspectives of people with noncommunicable diseases and disaster responders, coordinators and government officials. Data was collected through a sequential modified Delphi process in Queensland, Australia. This included three phases: questionnaire (n = 14); workshop (n = 18); and survey (n = 552). Descriptive statistics were used to group differences and to rank and prioritize mitigation strategies. The research identified 31 mitigation strategies across 12 public health service infrastructure themes. Specific mitigation strategies included: “The need for water treatment plants with back-up power”; “Designated primary healthcare hubs post disaster over health services being designed to be disaster resilient”; and “Streamlining processes for patients to access medication after a disaster”. Access to water was the highest priority public health service infrastructure theme followed by the strategies related to communication, sanitation, workforce, supplies All mitigation strategies are interrelated and together provide a theoretical basis for addressing this problem. To implement they must be integrated into monitoring and performance measures for the disaster and health sectors during non-disaster periods. The result would be a sustainable approach towards reducing indirect mortality and morbidity from noncommunicable diseases post natural disaster. [ABSTRACT FROM AUTHOR]

Pharmacists have an important role in providing travel health services and medications to travelers. However, given the limited literature on this topic, the aim of this study is to systematically review the types and outcomes of pharmacist-managed travel health services. A comprehensive literature search was performed in four electronic databases, namely Scopus, Web of Science, PubMed and ProQuest to identify studies published in English from 1999 to July 2022. The inclusion criteria included the studies that reported an experience of providing dedicated travel health services by pharmacists and reported the outcomes and/or evaluation of these travel health services. Nine studies were identified from the literature and included in the review. The pharmacists have provided a wide range of general and specialized travel health services including pre-travel risk assessment, routine and travel-related vaccination service, prescribing or recommending medications for travel-related illnesses, counseling and travel health advice. Overall, 94–100% of the patients were satisfied or very satisfied with pharmacist-managed travel health services. In addition, a good acceptance rate of pharmacist recommendations for vaccines and travel-related mediations was reported with most studies reporting an overall acceptance rate of ≥75% (acceptance rate range: 48%–94.2%). In addition, high rates of acceptance of other nonpharmacological advices were noted. Pharmacists with training in travel medicine have successfully provided a wide range of general and specialized travel health services. Most travelers were highly satisfied with the pharmacy-based travel health services and accepted the pharmacist recommendations. [ABSTRACT FROM AUTHOR]

The Travel Health Advisory Group (THAG), established in 1997, is a joint initiative between the travel industry and travel health professionals in Australia that aims to promote healthy travel. THAG seeks to promote cooperation in improving the health of travellers between the travel industry and travel medicine professionals and to raise public awareness of the importance of travel health. From 2011, THAG has been a Special Interest Group of The Australasian College of Tropical Medicine and its membership has been active in several areas, including web-based travel health information, travel health promotion, media releases, research and education in Australia. Information is given on the objectives, membership and an overview of the various activities of the group. [ABSTRACT FROM AUTHOR]

Summary: A profile of the recent genesis of the Sub-Faculty of Expedition Medicine into a Faculty of Expedition and Wilderness Medicine of The Australasian College of Tropical Medicine is presented. Information is given on aims, structure, professional grades of membership, and the various activities of the Faculty, including publications and scientific meetings. [Copyright &y& Elsevier]

Summary: A review of the recent foundation by The Australasian College of Tropical Medicine of the Sub-Faculty of Expedition Medicine is presented. Information is given on aims, professional grades of membership, and the various activities of the Sub-Faculty, including publications and scientific meetings. [Copyright &y& Elsevier]

Summary: The 19th Commonwealth Games, conducted once in every four years since 1930, will be held in New Delhi from the 3rd through until the 14th of October, 2010. There will be approximately 17 sports on display and there will also be 15 para-sporting events. This paper focuses on health and safety issues for travellers to India in general, although it provides specific references to advice for visiting Commonwealth Games athletes and team staff, who will be travelling to the games. Whilst it needs be remembered that travel health advice can change, travellers are advised to seek up-to-date travel health advice for India, from their professional providers, closer to their departure. [Copyright &y& Elsevier]

Summary: Background: Commercial expeditions and upmarket tours provide an opportunity for travellers to undertake various specialised travel to more adventurous and extreme destinations often in the relative security of accompanying medical cover provided by an expedition physician. There is limited knowledge of the nature of illnesses and injuries occurring on premium seniors'' tours to Asia. This present study was designed to investigate the prevalence of injury and illness suffered by travellers on a premium tour to Indochina. Methods: In 2004, the tour expedition physician (MTMS) diagnosed and recorded all illnesses and injuries amongst 23 travellers on a premium seniors'' tour to Viet Nam and Cambodia. Information recorded included age, sex, number of days into the tour, the nature of the presenting illness, the assessment of the condition and the treatment employed during the field phase of 14 days. Travel was by air, train and coach, for a total period of 18 days. Results: Nineteen (82%) travellers sought medical advice at least once for a total of 35 consultations. Females presented on 66% of occasions. The mean age of the travellers was 62 years (SD=13) with males being significantly older (p =0.002). Primary illnesses diagnosed related to the following systems: gastrointestinal 29%, respiratory 14%, dermatological 14%, cardiovascular 14%, musculoskeletal 9%, central nervous system 6%, ear/nose/throat 6%, dental 6%, and other problems on 3% of occasions. Of the gastrointestinal problems, diarrhoea was the commonest complaint on 17% of occasions, occurring at any stage throughout the journey. There was a mean of 2.5 presentations per day of the field phase of the tour. Presentations were highest on day 12. More than one third of presentations (37%) were handled conservatively without any further need for therapy, 17% requiring dressings, and 46% requiring specific medications. The commonest medications used were: lozenges/gargles (31%), antiemetic (25%), anti-diarrhoeal or other medications (13%). There were six accidents during the journey resulting in minor soft tissue injuries. There were no deaths or other major accidents requiring emergency evacuation or hospitalisation. Conclusions: On this premium seniors'' tour, the health problems encountered were largely similar to those reported for other specialised tours, including premium expeditions. The most common medical problems included gastrointestinal, respiratory, dermatological, cardiovascular and musculoskeletal conditions in descending order. One aspect requiring further study is the psychological adjustments made by travellers on group tours and expeditions. As well as being part of the service provided to travellers, the inclusion of an expedition physician on this premium seniors'' tour increased the independence of the travel group on this journey. [Copyright &y& Elsevier]

Summary: Background: Southeast Asia and East Asia are regarded as highly endemic regions for hepatitis B virus (HBV) and include many popular destinations for Australian travellers. The objectives of this survey were to evaluate the extent of pre-travel health advice, the prevalence of behaviours with HBV infection risks and the prevalence of HBV vaccination amongst Australian travellers to Southeast Asia and East Asia. Methods: In 2004, a telephone survey was conducted amongst Australians, who had travelled overseas to Southeast Asia and East Asia in the past three years for three nights or more. Results: Three hundred and nine travellers aged 14 years and over completed the interview, including 138 males (45%) and 171 females (55%). Respondents travelled for leisure (64%), business (20%), and visiting friends and relatives (VFR) (16%). The most common destinations were Indonesia (34%), Thailand (32%), and China (27%). About half of the travellers (54%) sought vaccination specific health advice before travel of which about half (56%) had sought this advice more than six weeks before travel. Just over one quarter of travellers reported receiving HBV vaccination (28%) of whom most (70%) were vaccinated at least three weeks before travel. About half of the travellers (49%) had participated in at least one activity with HBV risk during their last overseas trip. Of those travellers aged 18 years and over who either had no HBV vaccination or who were unsure, about half (49%) had participated in at least one activity with HBV risk during their last overseas trip. Conclusions: Australian travellers to Southeast Asia and East Asia commonly undertake activities with a risk of exposure to HBV. Hepatitis B vaccination coverage amongst this group remains low. It is important that travellers to this region seek travel health advice from a qualified source, which will include a risk assessment for hepatitis B vaccination. [Copyright &y& Elsevier]

Summary: Background: Calls for disaster medical assistance teams (DMATs) are likely to continue in response to international disasters. As part of a national survey, the present study was designed to evaluate Australian DMAT experience in relation to pre- and post-deployment health care. Methods: Data was collected via an anonymous mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 South East Asian Tsunami disaster. Results: The response rate for this survey was estimated to be around 50% (59/118). Most of the personnel had deployed to the tsunami affected areas. The DMAT members were quite experienced with 53% of personnel in the 45–55 years age group (31/59). Seventy-six percent of the respondents were male (44/58). Only 42% (25/59) received a medical check prior to departure and only 15% (9/59) received a psychological assessment prior to deployment. Most respondents indicated that both medical and psychological screening of personnel would be desirable. Most DMAT personnel received some vaccinations (83%, 49/59) before departure and most felt that they were adequately immunised. While nearly all DMAT members participated in formal debriefing post-deployment (93%, 55/59), far less received psychological debriefing (44%, 26/59), or a medical examination upon return (10%, 6/59). Three respondents reported experiencing physical ill health resulting in time off work following their return. While only one reportedly experienced any adjustment problems post-deployment that needed time off work, 32% (19/59) found it somewhat difficult to return to work. There were multiple agencies involved in the post-deployment debriefing (formal and psychological) and medical examination process including Emergency Management Australia (EMA), Australian Government, State/Territory Health Departments, District Health services and others. Conclusions: This study of Australian DMAT members suggests that more emphasis should be placed on health of personnel prior to deployment with pre-deployment medical examinations and psychological assessment. Following the return home, and in addition to mission and psychological debriefing, there should be a post-deployment medical examination and ongoing support and follow-up of DMAT members. More research is needed to examine deployment health support issues. [Copyright &y& Elsevier]

Summary: Background: Disaster medical assistance teams (DMATs) have responded to numerous international disasters in recent years. As part of a national survey, the present study was designed to evaluate Australian DMAT experience in relation to health and safety aspects of actual deployment. Methods: Data were collected via an anonymous mailed survey distributed by State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the time of the 2004 South East Asian tsunami disaster. Results: The response rate for this survey was 50% (59/118). Most of the personnel had deployed to the tsunami affected areas. The DMAT members were quite experienced with 53% of personnel in the 45–55 years age group (31/59) and a mean level of clinical experience of 21 years. 76% of the respondents were male (44/58). Once deployed, most felt that their basic health needs were adequately met. Almost all stated there were adequate shelter (95%, 56/59), adequate food (93%, 55/59) and adequate water (97%, 57/59). A clear majority, felt there were adequate toilet facilities (80%, 47/59), adequate shower facilities (64%, 37/59); adequate hand washing facilities (68%, 40/59) and adequate personal protective equipment (69%, 41/59). While most felt that there were adequate security briefings (73%, 43/59), fewer felt that security itself was adequate (64%, 38/59). 30% (18/59) felt that team members could not be easily identified. The optimum shift period was identified as 12h (66%, 39/59) or possibly 8h (22%, 13/59) with the optimum period of overseas deployment as 14–21 days (46%, 27/59). Missing essential items were just as likely to be related to personal comfort (28%) as clinical care (36%) or logistic support (36%). The most frequently nominated personal items recommended were: suitable clothes (49%, 29/59); toiletries (36%, 22/59); mobile phone (24%, 14/59); insect repellent (17%, 10/59) and a camera (14%, 8/59). The most common personal hardship reported during their deployment was being away from home/problems at home (24%, 14/59); however, most felt that their family was adequately informed of their whereabouts and health status (73%, 43/59). Conclusions: This study of Australian DMAT members suggests that, in the field, attention should be given to basics, such as adequate food, water, shelter and personal hygiene as well as appropriate clothing, sunscreen and vector protection. The inclusion of appropriate personal items can be assisted by provision of a minimum suggested personal equipment list, with local conditions and the nature of the deployment being taken into account. A personal survival kit should also be recommended. There should be medical and psychological support for team members themselves, including the provision of a dedicated team member medical cache. Concern for their own health and ability to communicate with family members at home are major issues for deployed team members and need to be addressed in mission planning. This should also recognise security issues, including briefings, evacuation plans and exit strategies. The team members concerns about adequate security and the risk profile of humanitarian intervention in natural disasters compared with complex humanitarian emergencies may help determine future deployment of civilian or defence based teams. [Copyright &y& Elsevier]

Summary: Background: Commercial expeditions provide an opportunity for travellers to undertake various specialised travel to more adventurous and extreme destinations in the relative security of an expeditionary group with medical cover provided by an expedition physician. Little is known about the illnesses and injuries occurring on premium expeditions to Asia. This present study was designed to investigate the prevalence of injury and illness suffered by travellers on a premium expedition along the Asian Silk Route. Methods: In 2004, the expedition physician (MTMS) diagnosed and recorded all illnesses and injuries amongst 73 travellers on a premium expedition along the Asian Silk Route, a journey from Beijing to St Petersburg travelling through China, Kazakhstan, Uzbekistan and Russia. Information recorded included age, sex, number of days into the expedition, the nature of the presenting illness, the assessment of the condition and the treatment employed. The period of the expedition was for 27 days and travel was primarily by a private train, the China Orient Express. Results: Forty-seven (64%) travellers sought medical advice at least once for a total of 97 consultations. Ninety-seven health presentations were reported and recorded amongst the travellers. Females presented on 54% occasions with the average age of expeditioners presenting being 64 years (SD=12) with males being significantly older (t =3.15, df =95; p =0.002). The types of primary illness diagnosed were largely those related to the following systems: respiratory 36%, gastrointestinal 21%, dermatological 8%, minor trauma 7%, ears, nose and throat 6%, musculoskeletal 5%, central nervous system 5% and other problems 12%. Of the gastrointestinal problems, diarrhoea was the most common single complaint on 19% of occasions, occurring throughout the journey. There was a mean of 3.5 presentations per day of the expedition. In total, the China phase of the trip (days 1–13) accounted for 42 presentations with phases in Kazakhstan (days 14–15), Uzbekistan (days 16–23) and Russia (days 24–28) accounting for 9, 29, and 17 presentations, respectively. Presentations were highest on day 18. More than one third of presentations (37%) were handled conservatively, and the rest required medication: 16% requiring antihistamine medications, 11% requiring antidiarrhoeal medications, 11% requiring antibiotics and 25% requiring other specific medications. There was one major accidental incident but no deaths or other emergencies. Conclusions: On this premium expedition, the health problems encountered were largely similar to those reported for other expeditions. The most common problems included respiratory, gastrointestinal, dermatological conditions and minor trauma in descending order. As well as being part of the service provided to travellers, the inclusion of an expedition physician on this premium expedition increased the independence of the travellers on this journey and decreased the reliance of the tour on local health services, a source which is often scarce or absent on more remote location expeditions. [Copyright &y& Elsevier]

Summary: Background: Commercial expeditions provide an opportunity for travellers to undertake various specialised travel to more adventurous and extreme destinations in the relative security of an expeditionary group with medical cover provided by an expedition physician. Little is known about the illnesses and injuries occurring on premium expeditions. The present study was designed to investigate the prevalence of health problems suffered by travellers on a premium expedition to Iceland and the Arctic Circle. Methods: In 2004, the expedition physician diagnosed and recorded all illnesses and injuries amongst 45 travellers on a premium expedition to Iceland. Information recorded included age, sex, number of days into the expedition, the nature of the presenting illness, the assessment of the condition and the treatment employed. The period of the expedition was for 18 days and travel was by chartered aircraft, cruise ship and bus. Results: Thirty-one (69%) travellers sought medical advice atleast once for a total of 54 consultations (mean=1.7). Fifty-six health presentations were reported and recorded amongst the travellers. Females presented on 70% occasions, with the average age of expeditioners presenting being 62 years. The types of primary illness diagnosed were largely those related to the following systems: respiratory 34%, gastrointestinal 30%, dermatological 14%, and musculoskeletal 9%, and other problems 13%. Of the gastrointestinal problems, seasickness was the most common single complaint on 27% of occasions, occurring between day 4 and 9, the cruise phase of the journey. In total, the cruise phase accounted for 43 medical presentations with the pre-cruise phase accounting for 11% of them and the post-cruise phase accounting for the remaining 46%. Presentations were highest on day 5. About one third of presentations (34%) were handled conservatively with 23% requiring antiemetics and 6% requiring antibiotics. There were no deaths or other major incidents requiring emergency evacuation or hospitalisation; although 6 accidents were reported. Interestingly, accidents were significantly more likely to occur earlier in the expedition (t-test; t=2.828, df=54, p=0.007). Conclusions: On this premium expedition, the health problems encountered were largely similar to those reported for other expeditions. The most common problems included respiratory, gastrointestinal, dermatological conditions and musculoskeletal conditions in descending order. As well as being part of the service provided to travellers, the inclusion of an expedition physician on this premium expedition increased the independence of the travellers on this journey, yet decreased the reliance on local health services, a source which is often scarce or absent on more remote location expeditions. [Copyright &y& Elsevier]

Summary: The 29th modern Olympic Summer Games, conducted once every 4 years since 1896, will be held in Beijing, China, from 8 to 24 August 2008. There will be approximately 28 major and 302 minor events in 37 venues in the prominent cities of Beijing, Hong Kong and Shanghai, and also in Qingdao (a coastal town in Shandong Province), Qinhuangdao (northeast of Beijing), Shanghai, Shenyang (an industrial city in Liaoning Province) and in Tianjin (on the coast near Beijing). Following the Olympic Games, the Paralympic Games will be conducted from 6 to 17 September 2008 in Beijing and 20 Paralympic Sports will be represented. This paper focuses on health and safety issues for travellers to China in general, although it makes specific references to advice for visiting Olympic and Paralympic athletes and team staff, who will be travelling to the games. It must be remembered that travel health advice can change, and that travellers should be advised to seek up-to-date travel health advice for China closer to their departure. [Copyright &y& Elsevier]

Summary: Q fever is a common zoonosis with almost a worldwide distribution caused by Coxiella burnetii. Farm animals and pets are the main reservoirs of infection and transmission to humans is usually via inhalation of contaminated aerosols, which may be carried by the wind far from the original source of infection. Occupational groups with close association with farm or wild animals are most at risk, however travellers occasionally become infected. The disease is associated with a wide spectrum of clinical manifestations and symptoms, ranging from asymptomatic infection to fatal disease. Awareness of the disease and newer diagnostic methods led to increase of recognition and detection in cases with various or multiple symptoms in adults and children. However, children seem to be less frequently symptomatic and may have milder disease. This review of Q fever cases examines clinical manifestations and symptoms of Q fever in both adults and children and shows that certain symptoms and their severity have altered presentation in children with acute and chronic Q fever when compared to adults. [Copyright &y& Elsevier]

Summary: Background: Little is known about hostellers’ knowledge of transmission and prevention of avian influenza when travelling abroad. This study was designed to investigate these in the Australian context. Methods: In 2006, hostellers attending a travellers’ information evening in Brisbane, Queensland, were asked to complete self-administered questionnaires. Results: Forty-two questionnaires (60.8%) were returned. Over two-thirds of attendees were females (71.4%, 30). About two-thirds of the hostellers attending the travellers’ information evening reported being aged 29 years or younger (64.2%, 27). On a five-point rating scale, the median rating of hostellers indicated that they were moderately concerned about avian influenza (3.0) with the range being 1–5. About one-fifth of hostellers did not know or were not sure what the source of avian influenza infection in humans was and most of this group also did not know how bird flu was prevented (). Almost all hostellers (40, 95.2%) responded to the question concerning the source of infection for avian influenza. Nominated sources of infection included handling sick poultry (69.0%, 29), eating poultry (45.2%, 19), contact with humans who have avian influenza (38.1%, 16), and handling healthy poultry (26.2%, 11). More than four-fifths 35 (83.3%) of hostellers responded to the question concerning precautions against avian influenza. Nominated precautions included hand washing (28.6%, 12), avoiding birds (23.8%, 10), avoiding affected areas (14.3%, 6), not eating poultry (7.1%, 3), and avoiding poultry droppings (7.1%, 3). Hand washing was the only measure to prevent bird flu that was significantly more likely to be nominated following the travel health lecture (). Conclusions: Hostellers attending the travellers’ information night in Australia reported having moderate concern about avian influenza. They also had a variable knowledge of the sources of infection of avian influenza. Most hostellers correctly identified infected poultry as a source; however, human-to-human transmission as the predominant current source of avian influenza infections in humans was incorrectly identified by nearly two-fifths of hostellers. Although hostellers responded positively to hand washing advice provided in the travel health lecture, reinforcement of other possible measures to prevent avian influenza, particularly the possible role of antiviral drugs, may be needed. [Copyright &y& Elsevier]

Summary: Background: On 26 December 2004, the Asian tsunami hit countries around the Indian Ocean rim, particularly around its earthquake-associated epicentre off Indonesia. A number of popular tourist destinations for Australian travellers are located in this region. This study was designed to investigate travel insurance claims reported by travellers from Australia following the Asian tsunami and to examine the role of travel insurance and emergency assistance companies. Methods: In December 2005, all claims reported, following the Asian tsunami on 26 December 2004, to a major Australian travel insurance company were examined for those claims associated with the Asian tsunami. Results: Twenty-two tsunami-related claims were submitted of which nine travellers (40.9%) used the travel insurance company''s emergency assistance service. Four travellers (18.2%) cancelled their trip to Asia, mainly to Thailand. Five travellers (27.3%), who were already abroad, also curtailed their trip as a result of the tsunami. Half of travellers (50.0%) were claiming loss of personal belongings. Of those using the emergency assistance service, five travellers (22.7%) sought policy and claiming advice, two (9.1%) sought assistance with flight rearrangements, and one (4.5%) sought situation advice. There was also assistance provided following the death of one insured traveller as a direct consequence of the tsunami, which included a lump sum payment to the deceased estate. The mean refund, where a travel insurance claim was paid, was Australian dollars (AUD)2234 (SD=AUD5755). Conclusions: This study highlights the importance of travellers taking out appropriate travel insurance, which provides for emergency assistance. Travel insurance agencies do play some role after emergencies, such as the Asian tsunami. This assistance predominantly involves dealing with cancellation of travellers’ intended visits to the affected area, but does also involve some assistance to travellers affected by the crisis. Travellers should be advised to seek travel health advice well before departure overseas and to ensure that they are aware of travel advisories for their destination. [Copyright &y& Elsevier]

Summary: Background: Wilderness travellers to remote National Parks of Brazil may be particularly at risk of tropical diseases and injury. The aim of this study was to describe injury and illness, potentially hazardous situations, accidents and other incidents experienced by travellers to a remote National Park in Brazil. Method: The study was done in the National Park, “Serra da Capivara”, in Piauí State northeast Brazil. Key informants were interviewed using semi-structured interviews, and a self-administered questionnaire was used for visitors. Questions included information on health problems and risk behaviour in the park, as well as pre-travel health advice. Results: In total, 14 tour guides, 7 hotel managers and 17 health professionals were interviewed, as key informants. Eighty visitors returned the completed questionnaires (60 Brazilian, 20 foreigners). The key informants reported different risk behaviour of groups and individuals travellers, and incidents most commonly mentioned were minor injuries, insect bites/bee stings and allergic reactions. Seventy percent of the Brazilian and 55% of the foreign visitors had obtained pre-travel health advice, but only 5% of Brazilians and 15% of foreign visitors has obtained this advice from a physician. The most common source of information was other people who already had visited the park and travel books. Of the Brazilians, 13.3% reported some health incident during their stay, most commonly bee bites and headache. Two foreign travellers reported three incidents (insect bites/bee stings, diarrhoea and sunburn). Most commonly reported hazardous situations perceived by the tourists were possible accidents caused by falling from a stairway or falling stones, poisonous animals and insect bites/bee stings. Conclusions: Surveys conducted at remote tourist destinations are a feasible approach to report vulnerable situations, practices and incidents of visitors to a National Park. We have shown that most travellers are not adequately prepared and many experienced vulnerable situations during their visit to the National Park. It is important that visitors to National Parks in Brazil are encouraged to obtain travel health advice. The most common and potentially serious incident (bee stings) is rarely addressed in pre-travel health advice. Travel health advisers should ensure that they have access to locally relevant information for travellers, so that appropriate preventive measures can be instituted. [Copyright &y& Elsevier]

Summary: A New Zealander travelling recreationally to Asia became exposed to Bancroftian filariasis. The traveller had presented incidentally with gastrointestinal illness. In addition to diarrhoea, the traveller''s symptoms were non-specific and there was no eosinophilia, lymphoedema, lymphangitis, lymphadenitis, or pain. The immunochromatographic test for Wuchereria bancrofti was positive indicating that there was or had been an adult filarial worm. The illness resolved completely following treatment with ivermectin. [Copyright &y& Elsevier]

Summary: Accidents and injury contribute greatly to the morbidity and mortality of travellers worldwide, with road traffic accidents being a major contributer. Those travelers with serious illness and injury may need specialised medical evacuation services, which may involve an air ambulance and a specialised medical team. Such aeromedical repatriations require considerable organisation and liaison between the sending and receiving medical services and other interested parties. However, the majority of travellers requiring emergency assistance are stable patients requiring referral for medical or dental attention or special requirements for carriage on scheduled aircraft. [Copyright &y& Elsevier]

Summary: Risk assessment is an integral part of pre-travel and post- assessment. Risk assessment largely determines what health and safety advice and interventions are given within the relevant prevailing travel health guidelines. Risk assessment needs time and depends on information, including that given by the traveller. Risk assessment also needs to be documented. Risk assessment of the traveller preferably starts before they enter the consulting room, where travellers may complete a pre-travel health questionnaire. Armed with this information, risk assessment may be assisted by access to computerised travel health databases and the published literature. Experience of travel to the destination may also assist in risk assessment and the tour operator, overseas employer or agency, the traveller or even the travel health advisers themselves may provide this information. [Copyright &y& Elsevier]

Summary: Background: Rabies is a fatal infection and immunisation is important to consider in those travellers going to rabies endemic areas. In those at high risk, a course of three immunisations may be given by the intramuscular (IM) or intradermal (ID) route, both of which are approved by the World Health Organization (WHO) and the Centers for Disease Control (CDC). Little is known in the New Zealand context regarding the effectiveness of pre-exposure ID rabies immunisation. Methods: The data was collected prospectively on all travellers requiring the immunisation from July 2001 to September 2003 in Auckland. The standard WHO rabies immunisation protocol was used with three ID injections of 0.1ml, given on days 0, 7, and 21 or 28 with a booster after 12 months. The vaccine used was the Pasteur Merieux human diploid cell vaccine (HDCV) or the Rabipur Purified chick embryo cell (PCEC) vaccine. Both vaccines are approved by the WHO and the CDC, and are interchangeable. Serology was performed approximately 2 weeks after completion of the primary immunisation course or after a booster, wherever possible. Antibody levels were measured using EIA, and levels of >0.5IU/ml were considered protective. Results: Of the 263 travellers assessed in this study, 125 were males and 138 were females. The mean age of the cohort was 34.8 years (SD=11.7). There were not found to be any statistically significant correlations between age and antibody levels neither was there any significant association between gender and antibody levels. In addition to the sample group, a further 12 travellers had rabies serology performed but were excluded from the study because they had IM vaccines as part of their primary course. Whilst rabies serology ranged from 0.2 to 27.9IU/ml in the study cohort, the mean antibody level for the group was 4.7IU/ml (SD=4.1IU/ml). The mean antibody level for males was 4.3IU/ml (SD=3.3), and for females, 5.2IU/ml (SD=4.6). Of the 263 travellers, all had some level of detectable antibodies. The overall seroconversion rate was 95.1%. Conclusions: ID rabies immunisation appears effective, when given according to the standard WHO protocol, in New Zealand. ID rabies immunisation is also more affordable for travellers, especially those on a restrictive budget. ID rabies immunisation can continue to be recommended, particularly where follow-up serology can be done before travel and where there are staff who are experienced in ID immunisation. [Copyright &y& Elsevier]

Summary: Travel medicine is emerging as a new multidisciplinary specialty area catering for an increasing number of travellers worldwide. Travel health advisers are engaged in the provision of pre-travel health advice, chemoprophylaxis against travel-related diseases, traveller''s medical kits, and post-travel assessments and eradication treatment for various travel-related diseases. They are also in a key position to liaise with public health authorities on possible imported disease risks. In terms of risk assessment and provision of preventive measures, vector-borne diseases, in particular malaria and the arboviral diseases, stand out as major concerns for travellers, however, common problems, such as travellers'' diarrhoea and respiratory tract infection, also need to be addressed. Travel and aviation medicine have many linkages, especially in terms of fitness to fly and dealing with problems that may arise in travellers due to physiological and psychological stresses of travel. In the face of recent terrorism and conflict, travel advisories have assumed great importance in travellers planning. Travel insurance remains an important safety net for travellers, which provides coverage for medical and dental treatment abroad as well as an emergency assistance service, which may include aeromedical evacuation. [Copyright &y& Elsevier]

Summary: Background: Little is known about the travel health advice obtained by tourists travelling to Magnetic Island, which is a known risk area for the potentially fatal ‘Irukandji’ jellyfish on the Great Barrier Reef coast of north Queensland, Australia. Methods: Structured interviews were conducted with 208 ferry passengers (93% response) travelling between Townsville (Latitude 19°S) and Magnetic Island. Results: Less than half of the international tourists (21, 46%) had obtained travel health advice before coming to north Queensland, although they were significantly more likely to have done so than domestic tourists (p<0.001). Travel health advice obtained by international tourists was sourced mainly from their general practitioner (8, 50%) or from a guidebook (6, 38%). Eighty-eight percent of north Queensland residents, 70% of domestic tourists, and 34% of international tourists knew what an Irukandji jellyfish was (p<0.001), although this was not associated with having obtained travel health advice. For those passengers returning from the Island, 8 (44%) domestic tourists and 4 (35%) international tourists recalled seeing some information on the Island that improved their knowledge about Irukandji jellyfish. Most of the international tourists travelled to north Queensland by bus (30, 65%), while most domestic tourists arrived by private car (12, 40%) or plane (10, 33%). Conclusions: Only a small proportion of international tourists knew about Irukandji jellyfish and most tourists had not received travel health advice. The majority of tourists had not received further information about Irukandji jellyfish risk whilst on the island. All travellers to popular north Queensland tourist areas need travel health advice, which includes advice on avoiding contact with Irukandji and Chironex box jellyfish. Health promotion campaigns directed at providing this advice need to be aware that most tourists to north Queensland arrive by bus or car and the only ‘shared’ vehicle, at least to Magnetic Island, is the passenger ferry. [Copyright &y& Elsevier]

Summary: Background: Emergency assistance provided on behalf of travel insurance companies may include direct services such as medical advice, referral for local medical or dental treatment abroad, or aeromedical evacuation (AME) back to Australia or a third country. Little is known about the nature of these services provided by emergency assistance services on behalf of travel insurance companies. This study is designed to investigate the nature of emergency assistance provided abroad to travellers from Australia. Methods: All travel insurance claims reported during 2001 to a major Australian travel insurance company were examined for those claims utilising the insurer''s emergency assistance service. Results: Four hundred claims (25.3%) reported utilising emergency assistance Medical and dental claims made up over two thirds of claims requiring emergency assistance (275, 69.3%), with cancellation and curtailment, mostly for medical reasons, making up more than one eighth of claims (59, 14.8%). The most common nature of illness requiring emergency assistance was musculoskeletal disorders (87, 28.2%), followed by gastrointestinal disorders (45, 14.6%), dental conditions (42, 13.6%) and respiratory problems (36, 11.7%). The problem reportedly occurred at a median of 19.5 (range=281.0) days into travel. Emergency assistance provided included policy advice (395, 99.0%), claiming advice (394, 98.7%), civil advice or assistance (79, 19.8%), medical advice or GP referral (22, 5.5%), hospital emergency room (ER) review (58, 14.5%), hospital admission (46, 11.5%), medical or dental follow-up (25, 6.3%) and AME (10, 2.5%). Conclusions: Use of the travel insurer''s emergency assistance service was reported by about one quarter of claimants. In most cases, travellers sought simple claiming and policy advice, however, the emergency assistance service occasionally co-ordinated the provision of direct medical services. AME was an uncommon but expensive form of emergency assistance. Further research is needed into how useful the services provided by emergency assistance services of travel insurance companies were to the travellers that use these services. [Copyright &y& Elsevier]

Access to global information through the Internet is the domain of travellers as much as travel health practitioners. It is important in travel medicine practice for travel health practitioners to be aware of some of the sites that travellers may visit for travel health information or possibly even referred to for further information. It is important that travel health practitioners can guide travellers as to the most reliable sites and what information may be useful. Travellers will be attracted to major national Internet sites on travel health, but also possibly to popular travel industry sites. Access to search engines on the Internet also makes searching for travel health information much easier for travellers. [Copyright &y& Elsevier]

Travellers'' diarrhoea is a frequent problem for travellers. Access to a safe water supply when travelling, is undoubtedly a paramount issue. Water and food precautions are important for travellers to be aware of and followed, as is attention to general hygiene. In some situations, chemoprophylaxis and standby treatment with antibiotics may be needed. It is essential that travellers, especially those travelling with young children, be familiar with the use of oral rehydration solutions and the prevention of dehydration. [Copyright &y& Elsevier]

Background. On 12 October 2002, terrorist bombs detonated in the Kuta entertainment district of Bali, Indonesia, a popular tourist destination for Australian travellers. This study was designed to investigate travel insurance claims reported by travellers from Australia requiring emergency assistance and/or aeromedical evacuation, as well as to examine the role of travel insurance and emergency assistance companies, following the Bali bombing.Methods. In 2003, all claims reported, following the Bali bombing attack on 12 October 2002, to a major Australian travel insurance company were examined for those claims that described the use of the insurer''s emergency assistance contractor by travellers in Bali following the bombing.Results. Thirteen insured travellers used the emergency assistance service following the Bali bombing. Six travellers cancelled their trip to Bali. Five travellers, who were already abroad cancelled their trip to Bali and one was given evacuation assistance. One traveller required aeromedical evacuation by scheduled aircraft with glass injuries resulting from the bomb blast, and there was also assistance provided to significant others following the death of one insured traveller as a direct consequence of the bombing. Two travellers sought only claiming and policy advice and no claim was made. The mean refund, where a travel insurance claim was made, was AUD1185.09 (SD=AUD3047.31).Conclusions. This study highlights the importance of travellers taking out appropriate travel insurance, which provides for emergency assistance. Travel insurance agencies do play some role after emergencies such as the Bali bombing. This assistance involves predominantly dealing with cancellation of travellers'' intended visits to the affected area, but does also involve some assistance to travellers evacuating from the crisis, including some who require aeromedical evacuation. Travellers should be advised to seek travel health advice well before departure overseas and to ensure that they are aware of travel advisories for their destination. [Copyright &y& Elsevier]

Access to global information through the Internet has become an essential ingredient to successful practice in travel medicine. Internet sites that may be useful to travel health practitioners include those that represent international organisations (eg. http://www.who.int), national and international professional bodies (eg. http://www.istm.org), national public health and disease control centres (eg. http://www.cdc.gov). These useful sites often include online journals, geographic epidemiological information, regular outbreak alerts and news and downloadable information sheets for travellers, as well as those providing official guidelines and policies in travel medicine. It is also useful to have access to search engines, which can search the literature as well as the Internet. [Copyright &y& Elsevier]

Objectives: To describe an interesting case of bilateral calf (tibial) deep venous thrombosis (DVT) in a traveller. Methods: Clinical case notes and reports of further investigations were analysed in the light of the existing literature concerning DVT and travellers. Results: A 56-year-old university lecturer presented within 48 h of a return to New Zealand from international travel abroad. An otherwise fit and healthy man he developed bilateral calf pains most notable on arising the day of presentation, although he reported some mild pain in the lower legs within 5 h of landing at Auckland. He reported no other complaints. Physical examination was unremarkable, except for the bilateral calf tenderness and being overweight. An urgent outpatient ultrasound to both lower limbs was reported as follows: ‘There is evidence of extensive thrombus involving the paired posterior tibial veins of both calves’. He was admitted to hospital for 24 h and started on low-molecular weight heparin. On completion of the course of heparin, he was further treated orally with warfarin. A follow-up assessment with a Clinical Haematologist occurred one month after hospitalisation. Conclusions: The present case illustrates bilateral calf (tibial) DVT in an otherwise fit male traveller following extensive long haul travel. It also illustrates the need to consider the possible diagnosis and the need for bilateral ultrasound scanning of the legs, particularly in travellers undertaking long haul air travel, who are symptomatic. All travellers undertaking extensive, long-haul air travel need to be warned of the risks of DVT and venous thromboembolism (VTE) and advised of appropriate preventive measures as have been outlined. In addition, all travellers should be aware of the signs and symptoms of DVT/VTE and of the need to seek medical advice should they develop them; in order to help prevent progression of a DVT to a VTE. [Copyright &y& Elsevier]

Background. General practitioners (GPs) may refer travellers to practice staff and to outside agencies to assist in the provision of travel health advice and preventive measures. In Australia, little is known about the referral patterns of travellers for travel health advice by GPs in the Australian context. This study was designed to investigate how frequently GPs'' practice staff became involved in providing basic travel health advice and travel vaccination and to identify referral sources and how frequently GPs referred travellers to these sources for travel health advice.Method. In 2000, 433 GPs from western Sydney and Townsville were randomly selected from the register of the Australian Medical Association''s Medical Directory of Australia database and sent self-administered questionnaires. Two reminders were sent.Results. Two hundred and thirteen questionnaires (43%) were returned. Approximately two thirds of the sample were male (133/207, 64.3%) and one third female (74/207, 35.7%). The mean age of the GPs was 46.7 (SD±12.1) years. About one tenth of GPs reported having a Yellow Fever Licence (11.3%, 23/203). The majority of GPs did not use their practice staff for giving travel health advice (60.7%, 122/201) or giving travel vaccinations (55.7%, 112/201). More than three quarters of GPs would never refer their patients for travel health advice to GPs with a special interest in travel medicine (76.4%, 152/199), specialists (76.8%, 152/198), or other agencies (77.8%, 63/81). Almost half of GPs stated that they would refer to travel clinics at least sometimes (46.6%, 95/204).Conclusions. GPs do sometimes refer travellers to specialised practices for travel health advice, especially to travel clinics, but also to other agencies, possibly for specialised services, such as yellow fever vaccination. Further studies may be needed on capacity of general practice staff to contribute to the travel health consultation and also the reasons and the appropriateness of the referral to outside agencies, where this occurs. Practices may need to consider further training of their auxiliary health staff in travel medicine, so that they can become more involved in the provision of travel health advice and immunization, where possible. [Copyright &y& Elsevier]

Australia has a well-developed tourism industry and health care system. Despite the precautions recommended in this paper, Australia has been virtually free of local outbreaks of life threatening tropical diseases in recent decades. This paper focuses on health and safety issues for travellers to Australia, especially the special precautions for those travelling to more rural and remote areas in outback Australia. Travellers to Australia should be advised that, in general, Australia is a relatively safe country in which to travel, and it has high standards of health and hygiene. [Copyright &y& Elsevier]

Objectives. To examine fatal and non-fatal incidents involving tourists in Thailand.Methods. Press records from a major English language newspaper for the period from July 1997 to June 1999 were examined for reports of fatal and non-fatal incidents involving tourists.Results. From July 1997 to June 1999, up to 233 deaths were reported and up to a further 216 were reported injured in incidents involving tourists. One hundred and one deaths and 45 injured were reported following one major domestic jet aircraft crash in southern Thailand, however, it was not stated what proportion of casualties were tourists. Approximately 90 people perished in a single hotel fire in southeast Thailand. Most of the victims were local travellers attending meetings of two Thai companies. Sixteen deaths and 86 injured resulted from five road accidents. The majority of deaths and injuries involved foreigners. Twelve deaths and at least 33 injured resulted from three ferry and tour boat accidents. Most victims were reported to be foreigners. Three deaths and 35 injured resulted from a single cable car accident in northern Thailand. Most of these were Thai tourists, however, four of the injured were foreigners. Eight deaths and six injured resulted from 11 muggings and other violent incidents. All were foreigners. Six deaths were reportedly connected to a scam at the airport in Bangkok involving unlicensed airport taxis. Three deaths and four injured were due to other reported incidents.Conclusions. Newspaper reports of fatal and non-fatal incidents involving tourists in Thailand were probably uncommon, particularly given the volume of tourists entering the Kingdom, although better reporting mechanisms are needed. With the exception of the unusual major incidents, most reported fatal and non-fatal incidents involving tourists were due to road trauma and other transportation accidents, muggings, and occasional water sports and other accidents, which could occur at any major tourist destination. Travel health advisers should include advice concerning personal safety abroad and tourist authorities should endeavour to promote and advocate for tourism safety. [Copyright &y& Elsevier]

Objectives: To investigate the prevalence of travel health advice and written documentation reported to be given by general practitioners to travellers from Australia.Design and setting: A postal questionnaire was sent to general practitioners (GPs).Participants: 433 GPs were randomly selected from the register of the Medical Directory of Australia from the areas of western Sydney and Townville.Results: Two hundred and thirteen questionnaires (49.2%) were returned. Approximately two-thirds of the sample was male (133/207,64.3%) and one-third female (74/207,35.7%). The mean age of the GPs was 46.7 (SD±12.1) years. The GPs reportedly saw an average of 3.9 (SD±11.8) travellers per week. Most GPs (160/202,79.2%) reported that they spent between 5–25 min for pre-travel consultations. GPs generally reported giving advice to travellers on travel vaccines, malaria prophylaxis, personal protective measures against insect bites, geographic diseases, clothing, and sexually transmitted infections. The majority of GPs did not routinely give information on travel insurance, unsafe sex, barotrauma, in-flight exercise, jet lag or first aid knowledge. Most GPs reported not routinely giving written documentation in the form of written travel health advice, a doctor''s letter or a travellers'' vaccination record.Conclusions: GPs report seeking core information needed for formulating travel health advice. GPs also provided travellers with health advice on most of the areas, which need to be covered in the pre-travel consultation. More GPs may wish to consider advising travellers about the importance of travel insurance and managing common maladies of travellers, such as motion sickness, barotrauma, and jet lag. With limited time in general practice to advise travellers, more GPs should consider providing written advice and documentation for travel, including a travellers'' vaccination record. [Copyright &y& Elsevier]

Aircrew fitness-to-fly is among the elements that make aviation the safest form of long-distance transport. The health of cabin crew is a crucial determinant in carrying out safety-related duties. 'Fitness-to-fly' is associated with defined workplace conditions, for which airlines have a legal duty to ensure fitness for employment. We explored the literature on fitness-to-fly to obtain a pragmatic assessment of the challenges for aeromedical examinations. Regulations promulgated by aviation regulatory authorities and airline-internal policies have similar status and meaning, yet there is no harmonised approach internationally, and an inability to conform periodic medical assessments to actual operational fitness. The COVID-19 pandemic has highlighted the need to better understand fitness-to-fly criteria. Fitness-to-fly measures are mainly based on self-reported data and there is a need for a 'safety' factor for self-reports. Aeromedical evaluations should evolve from meeting medical standards to include pandemics as an element of the overall risk of aircraft operations. Re-evaluating criteria for fitness-to-fly assessment will further the goal of linking research to the actual needs of public health decisionmakers. If airlines are to resume operations at pre-pandemic levels, they must demonstrate to the public and public health agencies that fitness-to-fly assessment is appropriate and effective. [ABSTRACT FROM AUTHOR]

Summary: Yellow fever is a mosquito-borne disease, which can cause serious illness. The World Health Organization (WHO) requires travellers to have vaccination against Yellow fever for all international travel going into and from Yellow fever endemic areas in order to prevent the spread of this potentially deadly disease. Only clinics and hospitals authorised by health departments of national governments can administer the disease. Yellow fever vaccination centres are often subject to inspection in many countries, although the requirements for Yellow fever vaccinators (YFV) vary from country to country. In New Zealand, approval of YFV now requires specific postgraduate training in travel medicine or its equivalent, as well as continuing professional development to maintain this status. It is expected that this will assist in improving standards of travel medicine practice in New Zealand. [Copyright &y& Elsevier]