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Background: School-organized travels abroad provide an opportunity for students to undertake supervised travel that reinforces scholastic study of various geographical locations under the direction and protection of experienced tour leaders and health professional support. Little is known concerning the nature of illnesses and injuries occurring on overseas school excursions. This study was designed to investigate the prevalence of injury and illness suffered by older teenagers on a school excursion to South America., Methods: In 2010, the school's tour physician (EH) diagnosed and recorded all illnesses and injuries among 29 school girls and 6 accompanying adults on a school excursion to Peru. Information recorded included age, sex, the nature of the presenting illness, number of days into the tour, the assessment of the condition, and the treatment employed during the excursion's field phase of 21 days., Results: A total of 32 (91%) travelers sought medical advice at least once for a total of 371 consultations, resulting in 153 separate diagnoses. The mean age of the students was 16 years with six adults accompanying the students being significantly older. Primary illnesses diagnosed were related to the following systems and conditions: gastrointestinal (58, 37%), respiratory (25, 16%), altitude sickness (19, 12%), genitourinary (8, 5%), dermatological (10, 7%), trauma (7, 5%), neurological (7, 5%), anxiety or psychological adjustment (7, 5%), adverse drug reactions (4, 3%), and musculoskeletal (5, 3%). The most commonly used medications were antidiarrheal and antiemetic medication. 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 hospitalization., Conclusions: On this school excursion, the health problems encountered were consistent with those reported for other specialized tours, including expeditions and premium tours, although altitude illness needs to be carefully planned for in tours to higher elevation destinations as in South America. As well as being part of the service provided to the school students, the inclusion of a physician with appropriate medical supplies for this tour increased the independence of the travel group. A proposed medical kit for such an excursion is presented., (© 2014 International Society of Travel Medicine.)

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., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Global disease outbreaks, such as the recent Pandemic (H1N1) 2009 (the so-called Swine flu), may have an impact on travel, including raising the concerns of travelers. The objective of this study was to examine the level of concern of Australians regarding travel during Pandemic (H1N1) 2009 and how this impacted on their travel., Methods: Data were collected by interviews as part of the Queensland Social Survey (QSS) 2009. Specific questions were incorporated regarding travel and Pandemic (H1N1) 2009. Multivariate logistic regression was used to analyze associations between demographic variables and concern and likelihood of cancelling travel., Results: There were 1,292 respondents (41.5% response rate). The sample was nearly equally divided between males and females (50.2% vs 49.8%). Younger people (18-34 y) were under-represented in the sample; older people (> 55 y) were over-represented in the sample. About half (53.2%) of respondents indicated some level of concern about Pandemic (H1N1) 2009 when traveling and just over one-third (35.5%) indicated they would likely cancel their air travel if they had a cough and fever that lasted more than one day. When cross-tabulating these responses, people who expressed concern regarding Pandemic (H1N1) 2009 when they traveled were more likely than those without concern to cancel their air travel if they had a cough and fever lasting more than one day (44.7% vs 27.7%, χ² = 33.53, p < 0.001). People with higher levels of education [adjusted odds ratio (AOR): 0.651], people with higher incomes (AOR: 0.528) and people living outside of metropolitan Southeast Queensland (AOR: 0.589) were less likely to be concerned about Pandemic (H1N1) 2009 when traveling, and younger people (AOR: 0.469) were less likely than others to cancel travel if they had a cough and fever., Conclusions: Pandemic (H1N1) 2009 was of some concern to more than half of Queensland travelers. None-the-less, the majority of Queenslanders would not have postponed their own travel, even if they exhibited symptoms consistent with Pandemic (H1N1) 2009., (© 2010 International Society of Travel Medicine.)

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 2010 Elsevier Ltd. All rights reserved.)

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.

Background: Expeditions provide an opportunity for travelers to undertake specialized travel to more extreme destinations in the security of an expeditionary group with medical coverage. Little is known about the illnesses and injuries occurring to expeditioners in Mongolia or access to dental care in the local population. This study was designed to investigate the prevalence of health problems suffered by travelers and managed among the local population on a research expedition to Mongolia., Methods: In June 2005, the expedition physician (MTMS) and dentist (DD) prospectively diagnosed and recorded all illnesses and injuries among 16 travelers (eight males and eight females) as well as any indigenous people on a 22-day paleontological expedition to the Mongolian Gobi Desert., Results: There were 53 health presentations and 14 dental problems among the indigenous population and the Mongolian escort. Males and females presented in equal proportions with the average age of 49 years (SD = 16). Presentations involved locomotor/accident (32%), dermatological (23%), gastrointestinal (19%), neurological (17%), psychological (6%), and with other systems (11%). Most accidents were due to lacerations (85%). Presentations were highest on days 4 and 5 (10% or 18%). Females were significantly more likely to present later in the expedition (p= 0.013). One quarter (25%) were handled conservatively with 28% requiring topical treatments with others requiring antiemetics (9%) and anti-inflammatory drugs (4%). There were no dental concerns reported among the expeditioners, although there were 14 cases among the indigenous population. While there were no deaths on the expedition, there were two major incidents, one of which required emergency evacuation., Conclusions: The health problems encountered were largely similar to those reported for other expeditions. The most common problems included trauma as well as dermatological, dental, gastrointestinal, and neurological conditions. It is important that expedition teams are prepared to manage common problems, such as trauma and dental lesions.

Background: The health and safety of international visitors remain an important issue for Australia and other tourist destinations. The death of visitors remains an important indicator of safety. The aim of this study was to provide updated figures on deaths of overseas travelers in Australia., Methods: Data were sourced from the Australian Bureau of Statistics concerning deaths of overseas visitors for the years 2001 to 2003., Results: There were 1,068 overseas visitor deaths (701 males, 66%) during the study period 2001 to 2003. Death by natural causes increased with age, while deaths associated with accidents were more frequent among younger age groups. The majority of deaths were from natural causes (782, 73%), particularly ischemic heart diseases (26%). There were a total of 247 accidental deaths (23% of all deaths) with the main causes being transportation accidents (14% of all deaths) and accidental drowning/submersion (5% of all deaths). The countries contributing the most deaths were the UK (247, 23%), New Zealand (108, 10%) Melanesia/Micronesia (95, 9%), and the United States (57, 5%)., Conclusions: Australia remains a relatively safe destination for international travelers, at least in terms of fatalities, which appear to be declining. Most deaths of overseas tourists in Australia are due to natural causes with cardiovascular disease being the predominant cause of death in this group. Accidents remain the most common preventable cause of death of travelers, with road and water safety being the major issues. It is important that tourism and travel medicine groups continue to advocate for improved health and safety of international travelers visiting Australia.

Background: Rabies is a fatal disease, and travelers going to endemic areas need to take precautions. Little is known about the rabies postexposure management of travelers from New Zealand., Methods: A total of 459 post-travel records from October 1998 until February 2006 at two travel medicine clinics, in Auckland and Hamilton, were examined for those who reported postexposure management to animals while abroad., Results: Fifty-four patients were included, 48 (88.9%) were New Zealand residents and 52.0% were male. The mean age of exposed travelers was 30.4 years (SD = 15.5). There was an adult to child ratio of 5:1. The highest exposure risk group was those aged 16 to 30 years. South and Southeast Asia were the most prominent geographical regions where exposure occurred, with 45 (83.3%) of subjects being potentially exposed to rabies. Dogs were the commonest animals involved, accounting for two thirds of incidents (36; 66.7%). The commonest sites of animal exposure on the body were the thigh and lower leg (26; 48.1%) and the hand (10; 18.5%). Forty-six (85.2%) of the animal exposures were graded as World Health Organization (WHO) category III. Forty-nine (90.7%) of the travelers had not had preexposure prophylaxis. Once in New Zealand, the correct WHO postexposure prophylaxis regime was applied on 44 of 52 (84.6%) occasions. However, overall, only 25% of the sample received postexposure treatment consistent with WHO guidelines, reflecting inappropriate management abroad., Conclusions: Post-travel consultations at two New Zealand travel clinics were analyzed for prophylactic rabies postexposure management. The majority were travelers aged 16 to 30 years, who sustained WHO category III exposures to the lower limb in Asia, predominantly from dogs. Few of these travelers had been immunized prior to travel, and only 25% of them received postexposure prophylaxis consistent with WHO guidelines. Thus, 75% of the study sample remains at theoretical risk of contracting rabies due to inappropriate management overseas.

Background: Prescribing patterns of antimalarial drugs have previously been observed to vary considerably in Australia. The aim of this study was to investigate the trends in prescription of antimalarial drugs recommended for chemoprophylaxis in Australia from 2002 to 2005., Methods: In 2007, data were extracted from the online Australian Statistics on Medicines reports published by the Pharmaceutical Benefits Advisory Committee, Drug Utilization Sub-Committee on antimalarials used in Australia for the period 2002 to 2005., Results: Doxycycline probably remains the malaria chemoprophylaxis of choice prescribed for Australians visiting multiple drug-resistant malarious areas. Over the past 15 years, there has been a marked drop in the prescription of less useful antifolate drugs, such as pyrimethamine-containing antimalarial drugs. There has also been a reduction in the number of prescriptions of chloroquine and proguanil, although the downward trend in prescriptions of mefloquine appears to have arrested and has trended upward. The number of prescriptions of atovaquone and proguanil has been increasing dramatically, particularly since inclusion of this combination antimalarial in the prevailing Australian guidelines. Artemether plus lumefantrine combination is now available, but it is used in relatively small quantities., Conclusions: The prescription of the antimalarial drugs, proguanil, chloroquine, and the pyrimethamine-containing compounds, has generally reduced in number. Prescription of mefloquine trended upward during 2002 to 2005, following a period of reducing prescriptions. The atovaquone plus proguanil combination has steadily increased in use and is presumably displacing older antimalarials. The use of quinine has halved, which might be related in part to the uptake of newer antimalarial drugs for treatment. Trends in antimalarial use may be influenced by a number of factors, including the availability of antimalarials, increasing resistance, the issuing of updated guidelines for malaria chemoprophylaxis, and continuing education.

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 at least 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.

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.

Background: Fever is among the most frequently reported problems in returning travellers., Objective: This article provides an overview of the general approach to fever in the returned traveller, including identification of common causes and management., Discussion: The returned traveller may present with fever and it is important to exclude life threatening conditions such as malaria that may be related to the travel. A complete risk assessment should be undertaken, including a complete travel history, examination and further investigations, to help to narrow the differential diagnosis. Common tropical diseases found include malaria, dengue, enteric fever, rickettsial infections and respiratory infections. General practitioners should be alert to the public health implications of travel related diseases.

Background: Traveller's diarrhoea is among the most frequently reported problems for travellers. Prevention remains a challenge in travellers and the appropriate management of traveller's diarrhoea remains paramount., Objective: This article provides an overview of the general approach to diarrhoea in the returned traveller, including identification of common causes and management., Discussion: The most common causes of traveller's diarrhoea are bacterial contamination of food and water, particularly with enterotoxigenic Escherichia coli. Most cases of traveller's diarrhoea are mild, are of short duration and do not require antibiotic treatment. Where the diarrhoea is severe, bloody and/or prolonged, then laboratory investigation is necessary. Where the patient is severely ill and possibly septicaemic, blood culture is mandatory. Presently, one of the most useful groups of the antibiotics routinely available for treatment is the fluoroquinolones.

Background: Little is known about the level of concern and sources of information of hostelers concerning personal safety and terrorism. This study was designed to investigate these in the Australian context., Methods: In 2006, self-administered questionnaires were distributed to hostelers attending a travelers' information evening in Brisbane., Results: Forty questionnaires (60.8%) were returned. Over two thirds of attendees were women (71.4%). About two thirds of the hostelers attending the travelers' information evening reported being aged 29 years or younger (64.2%). Anticipated main destinations were Europe (68.3%), Asia (14.3%), and North America (11.9%). Nearly two thirds (63.4%) intended to travel in more than 8 weeks time or were not sure. Of those departing within 8 weeks, only 40% had sought travel health advice from their general practitioner and/or travel clinic. Nonmedical sources of information on travel health included travel books and guides (40.5%), Internet (35.7%), and travel agents (19.0%). On a five-point rating scale (1 being not concerned to 5 being extremely concerned), median ratings of hostelers' concern for personal safety (4.0) was significantly higher than for terrorism (2.5), with the range being 1 to 5 in each case (p < 0.001). Nearly three quarters (73.8%) of hostelers would seek personal safety advice from multiple sources, and sources of information included the Internet (69.0%, 29), travel books and guides (59.5%), physicians (57.1%), and travel agents (45.2%). Only three (7.1%) nominated the physician as their only source of personal safety advice., Conclusions: Hostelers attending a travelers' information night in Australia expressed more concern for their personal safety when traveling than for terrorism. Since this group of travelers uses multiple sources of information with the Internet most commonly used, Web sites that provide accurate and relevant information in an acceptable format could play an important role in supporting this group. It is important that policies being promoted by travel health advocacy groups in Australia continue to advocate that travelers seek travel health advice from a qualified source early, preferably around 6 to 8 weeks before travel, and that personal safety be discussed as part of the travel health consultation.

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 (p<0.05). 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 (p<0.05)., 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.

The Australian Travel Health Advisory Group was established in 1997 and its membership has been active in several areas, including networking, policy development, research and education in Australia. Information is given on purpose, membership and the various activities of the group.

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.

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.

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.

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.

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.

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 0.1 ml, 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 >0.5 IU/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 27.9 IU/ml in the study cohort, the mean antibody level for the group was 4.7 IU/ml (SD=4.1 IU/ml). The mean antibody level for males was 4.3 IU/ml (SD=3.3), and for females, 5.2 IU/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.

Background: Previous research in a number of countries has suggested considerable variability in prescribing patterns of antimalarial drugs. The aim of this study was to investigate the trends in prescription of antimalarial drugs recommended for chemoprophylaxis in Australia from 1998 to 2002., Methods: In 2005 data was extracted from the online Australian Statistics on Medicines reports published by the Pharmaceutical Benefits Advisory Committee, Drug Utilization Sub-committee, on antimalarials used in Australia from 1998 to 2002., Results: Doxycycline probably remains the malaria chemoprophylaxis of choice prescribed for Australians visiting multiple drug-resistant malarious areas. Over the past 10 years, there has been marked drop in the prescription of less useful antifolate drugs such as pyrimethamine combination antimalarial drugs, especially pyrimethamine plus dapsone, which was withdrawn by 1999. There has also been a reduction in the number of prescriptions for chloroquine, mefloquine, and proguanil. The number of prescriptions for atovaquone and proguanil remain small, although they have increased steadily since its introduction in 2000, in the absence of a recommendation in the prevailing Australian guidelines., Conclusions: The prescription of antimalarials such as proguanil, chloroquine, mefloquine, and the pyrimethamine-containing compounds reduced considerably between 1998 and 2002. This was probably largely influenced by the availability of antimalarials, increasing resistance, the issuing of updated guidelines for malaria chemoprophylaxis, and continuing education. Newer drugs such as atovaquone plus proguanil may displace older antimalarials, particularly in the prevention of Plasmodium falciparum infection.

Objective: To determine the knowledge, beliefs, and behavior of local residents and visitors to North Queensland who may be at risk of contact with "Irukandji" jellyfish., Methods: Structured interviews were conducted with 208 ferry passengers (92.9% response) traveling between Magnetic Island and Townsville (19 degrees S)., Results: A total of 88.1% of the locals, 69.8% of the domestic tourists, and 34% of the international tourists knew what an Irukandji was (P < .001). Half of the international tourists, 20% of the domestic tourists, and 3.9% of the locals with this knowledge incorrectly assumed it was safe to swim inside stinger-resistant enclosures or were unsure (P < .001). Visitors to Magnetic Island who had swum or intended to swim in the sea (47%) knew less about Irukandji than other visitors (P = .05). Only 42.3% of the respondents realized that Irukandji posed a risk to swimmers on the outer reefs, and only 33.1% knew that Irukandji were also found outside North Queensland., Conclusions: International tourists had little knowledge about Irukandji. Thus, accurate educational messages may need to be targeted at this group. Offshore water sport and reef tour operators should be encouraged to provide clients with protective clothing to minimize the risk of stings. A coordinated educational response across northern Australia may be necessary to inform the public about both the box jellyfish (Chironex fleckeri) and Irukandji.

There has been an increasing trend for people to travel internationally, further afield, but fewer people are now going on programmed package tours. One of these groups of travelers comprises backpackers, who are distinct from endurance hikers or trekkers and longer-term and more remote expeditioners. Backpackers comprise individuals who travel alone or in a small group on a limited budget, and usually stay in hostels (hostelers), campsites, or similar low-cost accommodation, and carry their belongings in personal load-carrying equipment, most notably backpacks. Individual travel through backpacking, especially hosteling, appears to have become more popular for three probable reasons: travelers are seeking more cost-effective means of traveling and accommodation; they are looking to travel to regions where there is less likelihood of meeting fellow travelers; and they are looking for travel with more risk attached.

Background: Commercial expeditions provide an opportunity for travelers to undertake various specialized travel to more adventurous destinations in the relative security of an expeditionary group. Little is known about the illnesses and injuries occurring on such expeditions., Methods: From the commencement of the Blake Expedition in 2001, the expedition physician recorded all illnesses and injuries reported among the crew and also among the indigenous people encountered, while undertaking the expedition. The duration of the expedition was two and a half months, and involved travel by yacht, riverboat and jungle canoe or "bongo". The crew numbered 26 personnel: 24 men, including the expedition physician, and two women., Results: Seventy-eight health problems were reported and recorded among 19 (73.1%) members of the expeditionary team. There was one death, but there were no other major incidents requiring emergency evacuation or hospitalization. Types of illness were largely those related to ear, nose and throat disease (15/78, 19%), injuries (12/87, 15%), bites and stings (12/87, 15%), and respiratory (10/78, 13%), dermatologic (9/78, 12%) and gastroenterologic conditions (7/78, 9%). A further 24 health problems were reported and recorded among 22 indigenous people who approached the expedition physician for treatment. Types of illness were largely related to dermatologic conditions (9/24, 38%), accidents and injuries (4/24, 17%), and malaria (4/24, 17%)., Conclusions: This expedition was both noteworthy and newsworthy because of the death of the team leader, Sir Peter Blake, although the health problems encountered were largely similar to those reported for other expeditions. Tropical disease was uncommon. Adequate pre-trip preparation of expedition teams is considered important, and the inclusion of an expedition physician decreased the reliance on local health services, which are often scarce or absent on more remote-location expeditions. Adequate psychological preparation of expedition teams should also be included, to prepare expedition teams for unexpected outcomes, such as death or severe injury.

Objective: To describe illnesses of returned travellers presenting at GeoSentinel sites in New Zealand., Methods: Record data for all patients presenting for travel-related illnesses seen at two GeoSentinel sites, operating as commercial travel clinics, in Auckland and Hamilton, NZ, were extracted for the period November 1997 to December 2001., Results: 205 patients were identified with 262 diagnoses. Just over half were females (54.21%) and nearly half were in the 25-35 years age group (47.3%). About two-fifths of patients reported a pre-travel health consultation (41.0%). The commonest diseases diagnosed were diarrhoeal illnesses (23%), dermatological diagnoses (16%, excluding animal bites), animal bites (10%), and non-specific viral illnesses (8%), many of which manifest as respiratory infections. Tropical diseases, such as schistosomiasis (4%) malaria (2%) and dengue fever (0.5%), were not common., Conclusions: Information on travel-related illnesses, when reported through a global reporting system, can be useful for the travel health adviser in identifying issues of current concern. Although the frequency of tropical disease is low, it remains important to prevent these potentially fatal diseases., Implications: GeoSentinel makes a global contribution to the surveillance of emerging and re-emerging infectious diseases through a network of individual sites in various countries including New Zealand. This information can be used to help provide preventive advice for travellers as well as help in assessing illness in post-travel patients and potentially assist in preventing the secondary spread of some diseases acquired abroad following return.

The modern Olympic Games have been conducted only once every 4 years since 1900. They were held in Sydney, Australia, from September 15 to October 1, 2000, with approximately 35 competition venues, 5 villages, 100 training venues, a media center, and sponsor hospitality areas. Roughly 300 events for 28 sports involved 10,300 athletes from 200 countries, 5,100 team officials, 50,000 volunteers, 15,000 media, a worldwide audience of around 3.5 billion viewers and listeners, and up to several hundred thousand spectators at any one time. The Paralympic Games were also held in Sydney after the Olympic Games, from October 18 to October 29, 2000, with more than 4,000 athletes competing. A report detailing possible health advice and requirements for travelers attending the games has been published previously. Good systems of public and private health care operate in Australia, but health care is not free. Australian taxpayers contribute to a national public health system, Medicare, and even this does not necessarily cover all the costs of treatment. Section 3.5 of the Medicare Benefit Scheme refers to "Reciprocal Health Care Agreements," which exist for immediately necessary medical care ("emergency care"). Agreements with Australia cover New Zealand, United Kingdom, Netherlands, Sweden, Finland, Italy, Malta, and Ireland. Benefits for Italy and Malta may only be available for the first 6 months of a stay. The Australian government covered much of the costs of medical treatment for most team members competing or involved in the Olympic and Paralympic Games, when the Games Village was open. This did not however extend to other visitors, and public hospitals in Australia are not generally geared and staffed to provide timely general practice services.

Background: Little is known about travel insurance claims made by travelers returning from abroad. This study was designed to investigate travel insurance claims made by travelers from Australia, particularly examining demographic factors, type of travel insurance coverage, nature and duration of travel, when treatment was sought during travel or when the problem arose, use of emergency assistance, nature of claim, and claim outcome, including cost., Methods: A random sample of approximately one in five claims reported during the period 1996 to 1998 to a major Australian travel insurance company were examined., Results: A total of 855 claims were examined, of which 42.6% (356/836) were made by male travelers and 57.1% (477/836) were made by female travelers. The majority of claimants were in the 55 years and over age groups (445/836, 53.2%). Medical and dental conditions accounted for 66.6% of claims (569/854), with the remainder associated with loss, theft, and damage (285/854, 33.4%). The most common medical conditions were respiratory (110/539, 20.4%), musculoskeletal (90/539, 16.7%), gastrointestinal (75/539, 13.9%), ear, nose, and throat (67/539, 12.4%), and dental conditions (39/539, 7.2%). Only one case of venous thrombosis was reported, secondary to a lower limb infection. Use of the travel insurance company's emergency telephone service was reported in 17.1% of claims (146/853). Almost two-thirds (559/853, 65.5%) of claims were fully accepted. Those who claimed medical treatment, assault, and theft were significantly more likely to have their claims accepted compared to those claiming dental conditions, cancellation, curtailment, loss and damage (chi2 = 127.78, df = 40, p <.00001). The majority of medical and dental conditions did not require further medical investigations (427/569, 75.0%). The mean cost of claim refunds was Australian dollars (AUD)991.31 (standard deviation [SD] 6 AUD5400.76) for males and AUD508.90 (SD 6 AUD1446.10) for females. Claims for assault, cancellation, and curtailment were significantly more expensive than other types of claims (Kruskal-Wallis one way analysis of variance [ANOVA]; chi2 = 106.87, df = 8, p <.00001). Claims for treatment of gastrointestinal, cerebrovascular, cardiovascular, musculoskeletal conditions, and pyrexias of unknown origin were significantly more expensive than other medical and dental claims (Kruskal-Wallis one way ANOVA; x2 = 61.68, df = 15, p <.00001)., Conclusions: This explorative study highlights the importance of travelers taking out appropriate travel insurance. Claims for medical and dental conditions represent the majority of travel insurance claims made by Australian travelers returning from abroad, although travel insurance also covers against such contingencies as loss, theft, and cancellation. The most common medical conditions claimed were respiratory, musculoskeletal, and gastrointestinal disorders. Travelers should be advised to take out appropriate travel insurance before departure overseas and to take care with preexisting medical and dental conditions, which may not be able to be claimed against travel insurance.

Background: Little is known about the health advice provided to hostelers and the role and influence of hosteling organizations' travelers' information evenings in giving travel health advice. This study was designed to investigate these in relation to the Australian context., Methods: In 1997, hostelers attending travelers' information evenings in two regional centers and one metropolitan location in Queensland were asked to complete self-administered questionnaires., Results: Of 158 questionnaires, 110 (69.6%) were returned. Missing data have been excluded from the analysis. About two-thirds of the hostelers attending the travelers' information evening reported being age 35 years or younger (43/65, 66.2%). Almost two-thirds of attendees were female (42/65, 64.6%). The hostelers responding to this study were fairly evenly divided between regional centers (54/110, 49.1%) and the metropolitan center (56/110, 50.9%). Hostelers indicated that they were traveling to Europe and the United Kingdom (53/62, 85.5%), Canada (17/62, 27.4%), Asia (15/62, 24.2%), United States (10/52, 19.2%), and other destinations (7/51, 13.7%), mostly Africa. Hostelers were significantly more likely to have obtained travel health advice (x = 5.02, df = 1, p <.05) if they were traveling within 6 weeks. Hostelers indicated that they obtained advice from general practitioners (41/67, 61.2%), travel agents (29/67, 43.3%), books (22/67, 32.8%), travel clinics (10/67, 14.9%), and other sources (6/67, 9.0%). Most hostelers indicated that they learnt something new about healthy travel from the travelers' information evening (76/100, 76.0%). Of those hostelers who had not sought travel health advice or who had not planned to seek travel health advice prior to the travelers' information evening, almost all indicated that they now would seek travel health advice (32/33, 97.0%)., Conclusions: This cross-sectional study found that most hostelers attending an international hosteling organization's travelers' health information session in Australia were in the younger age groups and were predominantly female. Most of these hostelers had sought travel health advice from general practitioners, travel agents, and books. The information provided by the healthy travel session of the travelers' information evenings appeared to be of some benefit to hostelers, particularly as it appeared to have prompted most hostelers who had not yet sought travel health advice to do so.

Investigates the uptake of first aid training and travel insurance by hostelers in north and central Queensland, who were attending a Youth Hostels Association travelers' information evening. Distribution by gender of how many hostelers reportedly knew about first aid; Aspects about healthy travel.