Travel Medicine

          First time, I come across the word "travel medicine". From the word itself, it is not hard to deduce that it is about medicine or something to do with travelling, pretty easy ha? Now, please elaborate more. Medicine = drugs? vaccine? travel? aeroplane? Bali island? Okay, so much for the brain storming.

           In fact, travel medicine is a branch of medicine that deals with the prevention and management of health problems of international travellers. Interesting isn't it? More people travelling, travelers are seeking more exotic and remote destinations are the logical reason behinds this branch of medicine. Studies show that 50- 75% of short term travelers to tropics may have medical problem after their return home. 5% of the cases would require medical attention, and less than 1% need hospitalization. To be suprised, cardiovascular disease and injuries ( *traffic accident) record the most common causes of death among travelers.

           Commonly, health advice for international travel would be immunization or vaccination especially to those long- stay travelers. According to Harrison, there are three broad categories that clasify immunizations for travel. The 3 Rs.

1) Routine immunization : childhood/ adult boosters that are neccesary despite no travel

2) Required immunization : immunizations that are mandated by international regulations for border crossing

3) Recommended immunization :immunizations that are desirable due to travel-related risk

If you are interested to know the full desciption of these immunizations, please refer here.

     

         One more interesting information to share. For a short term traveler, they are advised to bring traveler's medical kit with

1) an anelgesic,

2) an anti-diarrheal agent and an antibiotic for self- treatment of travelers' diarrhea,

3) antihistamines,

4) laxative (wonder what is this for?)

5) oral rehydration salts,

6) a suncreen with a skin-protection factor of at least 30, ( specific huh?)

7) insect repellent, an insecticide for clothing ( permethrin),

8) and if neccessary, an antimalarial drug.

For long- term traveler, they may add

9) a broad-spectrum general purpose antibiotic (levofloxacin or azithromycin)

10) an antibacterial eye and skin oitment

11) a topical antifungal cream

          What a long list! and it is just traveler's medical kit ?! Lastly, fun things to share today, self treatment of infections for the long-stay traveler:

1) "below the waist" ( bowel and bladder infections) : antibiotics, once daily, 3 tablets

2) "above the waist" ( skin and respiratory infections) : antibiotics, once daily, 6 tablets

          Unbelieveable, isnt it? I mean, if this really work, everyone can be their own doctor, ha. Just so to know, the above information is taken from a reputed reference book, Harrison. Anyway, risk disclaimer here: anything happens, the author of this blog is not responsible.  

Reference:

1) Lecture note by dr. Tri Wibawa : Travel Medicine

2) Harrison's, Principles of Internal Medicine, 17th edition, page 783 - 4

Surveillance System

           Lately, the word "surveillance" keep popping out in our tutorial discussion. We have disaster surveillance for week 6 scenario, communicable disease surveillance, non-communicable disease surveillance and blah blah blah for week 3 scenario. So what is surveillance? As usual, lets clarify the word  `surveillance'. According to CDC, (Centers for Disease Control and Prevention),

         "Surveillance is the ongoing, systematic collection, analysis, interpretation, and 

           dissemination of data regarding a health-related event for use in public health   

           action to reduce morbidity and mortality and to improve health".

"Data disseminated by a public health surveillance system can be used for immediate public health action, program planning and evaluation, and formulating research hypotheses", added by CDC. A lot of words to read huh? Ok, let picture do the job.

            This is the surveillance system in public health. What about applying it onto communicable disease, non-communicable disease, and disaster? If you understand the description above, it wouldn't be hard to apply the knowledge elsewhere. On the lecture about communicable disease surveillance,  Dr Rizka has gave a clear picture about malaria surveillance in Indonesia. Today, I am going to talk about TB surveillance. Hereby, I will answer a question which Dr Rizka threw at the end of lecture. The question sounds like this " data apa saja yang dibutuhkan untuk mensurvey TB????."  Answer will be revealed as you continue reading this blog.

           First, allow me to say something about the background of TB. TB is one of the world’s deadliest diseases as one third of the world’s population are infected with TB. Over nine million new cases of TB, and nearly two million deaths from TB, are estimated to occur around the world every year. Besides, statistics has shown that approximately 95 % of TB cases and 98% of TB-related deaths happen in developing countries. The reasons that the TB programme record not much success are believed to be caused by less commitment by governance and financing system, an insufficiency of TB control services and TB cases management within the community, a wrong perception of benefits and effectiveness of BCG and last but not least, health facilities established by those developing country is limited in terms of quality.

           Apparently, TB surveillance data are essential to evaluate the effectiveness of TB control programs, identify deficiencies, and assess interventions in order to control and eliminate TB. WHO has enhanced DOTS initiative and the CDC emphasize the importance of monitoring and evaluating surveillance program performance. Back to the flow of surveillance data, collection of valid,complete and right TB surveillance data would play an important role at the beginning. Of course it is, if no good data collection, how to utilize the data optimally for the rest? To answer dr's question, below are the examples of data I think would be helpful for TB surveillance system. It may not cover all data nessary or I could be wrong, correct me if so.

 * How many people died from TB?

 * How many cases of TB were reported?

 * How TB is transmitted?

 * Review of bacteriology, sputum culture, chest X-ray, drugs susceptibility test results

 * Survey regarding demographic features, environmental, social or behavioral risk

    factor, public general knowledge, attitudes, and etc..

 * Reports on severity of disease, previous anti TB status and site of TB infection site

       Next, surveillance data collected is compiled and analyzed by time, place, and person. Simple tables, maps, charts, and graphic are useful to summarize and present data in percentages or rates of disease cases. For instance, the chart below shows the TB case detection and treatment success rate  in Indonesia from 2003- 2007.

From the chart, we can interpret whether TB control measures are succeeding and where increased efforts should be focused. Thus, TB surveillance data is essential to improve our understanding of the true epidemiology of the disease as well as to increase our knowledge as to what factors might contribute to eliminate and control TB.

     Lastly, dissemination of data to those who make policy and implement intervention programs is critical to the usefulness of surveillance data. For example, TB surveillance system may provide important information on trends in the multi durgs resistance (MDR) therefore policy maker can make changes in prescribing drugs to TB patients. Besides, dissemination of surveillance data is useful for risk communication and education to health care professionals, the media and the general public. In conclusion, surveillance systems include the capacity for data collection and analysis, as well as the timely dissemination of information to persons or group of persons who can undertake effective prevention and control interventions related to specific health outcomes.

References:

1) Lecture note by Dr. Rizka Humardewayanti: Communicable disease Surveillance

2) Tuberculosis surveillance in Europe, 2007

3) Joan E.S et al..Assessing the validity of tuberculosis surveillance data in California.2006, BMC Public Health 6:217