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The Royal College of Nursing of the United Kingdom (RCN UK) Travel Health Forum
ARTICLE IN PRESS 404
P04 Health problems among international travellers: From a subtropical region to tropical and non-tropical regions
H.H. Paia,, W.T. Wanga, J.L. Laib a
Department of Kinesiology, Health, and Leisure Studies, National University of Kaohsiung, Kaohsiung, Taiwan, ROC, Taiwan b Center for Disease Control, Department of Health, Taiwan, ROC, Taiwan International travel may be associated with the risk of a wide range of infectious diseases. This study was designed to obtain information on the health problems among international travellers from a subtropical region to the neighbouring tropical, subtropical, and temperate regions. The population was travellers (aged over 15 years) returning from the neighbouring Asian regions and entering the Kaohsiung International Airport in November 1999. A random sample of 150 travellers was selected from each of nine airlines (from the Philippines, Malaysia, Indonesia, Singapore, Vietnam, Thailand, Hong Kong, Macao, and Japan). Telephone numbers of these travellers were obtained from the airport. Health problems among international travellers from Taiwan to the Philippines, Malaysia, Indonesia, Singapore, Vietnam, Thailand (tropical group), Hong Kong, Macao, China and Japan (non-tropical group) were surveyed through the telephone. Of 649 travellers surveyed, 8.2% had one or more health problems and insect bite (3.4%) and coughing or sore throats (3.2%) were the most important ones. The rate of coughing or sore throats was significantly higher among those returned from the non-tropical regions. However, no associations were found between health problems and the demographic factors, travelling style or travelling duration.
Abstracts For the most of this cases, the etiological agent is Plasmodium falciparum. Timis is the most extensive of the Romanian counties, a western gate of the country from which a lot of people travel abroad. The aim of this study is to inform about some imported cases of malaria discovered in an universitary laboratory in the past decade and to describe two recent, severe cases. Material and methods: There were analysed the results of the blood exams (Giemsa-stained thin and thick smears) performed in an universitary parasitological laboratory from 1998 until present and the medical recordings of the last two clinical cases from an universitary Infectious Clinical Hospital. Results: Malaria was diagnosed in the 4 of the 6 blood films performed (in 3 cases—75%—the parasitic agent was P. falciparum). The most recent cases (2006–2007) were: a 50 years old male, christian missionary returned from Uganda who refused the prophylaxis, and a 40 years old male, worker in constructions who returned from Republic of Equatorial Guinea. Both were diagnosed with P. falciparum malaria and both died. Discussion: P. falciparum, the main parasitic agent of this imported Romanian cases was found in a similar percentage like in other studies. We perform a comparison between the 2 cases emphasizing on the clinical aspects, complications and the laboratory tests. Although in Romania malaria does not represent a public health concern, the imported cases are difficult to manage in terms of early diagnosis and treatment. Also it is important for people who travel in tropical countries to understand the importance of the preventive measures and to apply them unconditionally. KEYWORDS Malaria; Plasmodium falciparum; Import; Romania 10.1016/j.tmaid.2007.09.019
KEYWORDS
P06
Health problems; Travellers; Tropical; Subtropical
The Royal College of Nursing of the United Kingdom (RCN UK) Travel Health Forum
10.1016/j.tmaid.2007.09.018
S. Grieve, J. Skeet, L. Boyne, C. Driver, A. Jordan
P05
Royal College of Nursing, UK
Recent import of malaria in a romanian western county
R. Neghina, A.M. Neghina, L. Tirnea, R. Olariu, I. Iacobiciu Victor Babes University of Medicine and Pharmacy Timisoara, Romania Introduction: Malaria is not a concern for Romania nowadays because it was eradicated in 1965, but yearly appear some imported cases especially from people travelling in Africa.
Travel Medicine in the United Kingdom is a nurse-led speciality, with services provided mainly in Primary Care, but also in Occupational Health (NHS and Industry) Armed Services, schools, universities, independent clinics and charitable organisations. The Royal College of Nursing (RCN) is a professional body for nurses, within which are 75 Forums supporting the spectrum of specialist areas of practice. The Travel Health Forum (THF) Steering Committee consists of seven elected nurse members with a shared objective to support nurses in the field, disseminate knowledge, promote education and best standards of practice and influence related National Policies. Forum membership is currently 5309.
ARTICLE IN PRESS Abstracts The poster describes some of the methods employed, including the biannual Newsletter, informative website and established annual conference. The THF participated in the organisation and scientific programme for the 2006 Northern European Conference on Travel Medicine (NECTM) in Edinburgh and similarly with the proposed 2008 NECTM2 in Helsinki. The committee acts as a professional source of expert opinion to the RCN and advises on policy and accreditation matters when approached. The forum collaborates with the British Travel Health Association and other RCN Forums where areas of practice cross. The Guidance for Practice Document produced in 2005 was the first of its kind available to describe minimum standards of practice for nurses working in the field. Competencies encompassing the skills and expertise required to manage and advise travellers, to promote best practice in patient centred care and to contribute to the health outcomes in UK travellers were developed and published in May 2007. The Faculty of Travel Medicine (FTM) established in 2006 at the Royal College of Physicians and Surgeons of Glasgow (RCPSG) was the first Medical College to recognise the speciality and admit nurses. KEYWORDS Competencies; Guidelines; Newsletter; Conference
405 showed good knowledge of malaria symptoms even in infants and children; however in the event of malaria infection consumption of herbal preparation is the first line of treatment. Health is also sought from drug hawkers that sell modern drugs in the communities. The antimalarial drugs bought were wrongly used and none of the respondents were aware of the current trend in malaria management with modern drugs. Hospital visitation is usually after many days of persistent illness without improvement despite all forms of self medication. The main measure used against malaria vectors was insecticide coils (74.6%). None of the respondents used insecticide treated net (ITN). Distance, cost and poor quality of hospital treatment were reasons for refusal to seek proper medical care. We recommend health education and improved health care services for these farmers in order for them to be able to translate extension services provided into maximum agricultural yields. KEYWORDS Malaria; Perceptions; Agriculture; Knowledge 10.1016/j.tmaid.2007.09.021
10.1016/j.tmaid.2007.09.020
P08 P07 Perceptions and home management practices of malaria in some rural communities in Abeokuta, Nigeria
O.A. Idowu, C.F. Mafiana, I.J. Luwoye, O. Adehanloye
Disease severity, host characteristics and Plasmodium falciparum multiple infections in malaria affected travellers returning from Africa
E. Nicastria, M.G. Pagliaa, C. Severinib,, P. Ghirgaa, N. Bevilacquaa a
University of Agriculture, Abeokuta, Nigeria, Nigeria
Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, Italy b Istituto Superiore di Sanita `, Italy
A survey was carried out in five rural communities that enjoy Agricultural extension services from the University of Agriculture Abeokuta. Questionnaires and Focus Group Discussions (FGDs) were used to assess perceptions and home management practices of malaria infection. The inhabitants consider malaria (which they refer to as ‘‘Iba Otutu’’) has the least dangerous of other types of common fever such as yellow fever and Thyphoid fever. A vast majority of the respondents (73%) attributed malaria infection to doing of strenuous jobs in the hot sun, while only 11.7% attributed it to mosquito bites. Hunger, eating or drinking of contaminated food or water were other sources of malaria infection mentioned by the respondent. During the FGDs, other source of infection of malaria described includes excessive exposure to heat of fire used in frying cassava (garri). Those frying garri and spreading cassava flakes in the sun were identified as most vulnerable to malaria infection. High level of malaria infection in children was attributed to children playful activities in the sun. It is believed that malaria infection will occur even without mosquito bites but with exposure to these other factors especially the intense heat of the sun. Respondents
Introduction: The pathogenesis of malaria is the result of complex interactions between parasites, host and environment. Several studies have assessed the role of genetic characteristics of P. falciparum infection in the clinical severity of malaria infection comparing different genotypic determinants in mild and severe cases. The MSP-1, MSP- 2 and DHFR encoding genes have been extensively used as molecular markers to investigate genetic diversity and population structure of P. falciparum. Aim of this study was to assess the epidemiological, clinical, host- and parasite-related determinant factor of the genetic diversity of P. falciparum infections in travellers returning from Africa. Methods: We have retrospectively studied 64 inpatients all returning to Italy from African malaria-endemic countries. Designation of severe malaria was determined according to WHO definition. P. falciparum infections detected by species-specific PCR were genotyped at the msp-1 and msp-2 loci and a number of clones were determined. PCRRFLP method was used to screen the mutation occurring at codon 108 of dhfr gene.
P04 Health problems among international travellers: From a subtropical region to tropical and non-tropical regions
H.H. Paia,, W.T. Wanga, J.L. Laib a
Department of Kinesiology, Health, and Leisure Studies, National University of Kaohsiung, Kaohsiung, Taiwan, ROC, Taiwan b Center for Disease Control, Department of Health, Taiwan, ROC, Taiwan International travel may be associated with the risk of a wide range of infectious diseases. This study was designed to obtain information on the health problems among international travellers from a subtropical region to the neighbouring tropical, subtropical, and temperate regions. The population was travellers (aged over 15 years) returning from the neighbouring Asian regions and entering the Kaohsiung International Airport in November 1999. A random sample of 150 travellers was selected from each of nine airlines (from the Philippines, Malaysia, Indonesia, Singapore, Vietnam, Thailand, Hong Kong, Macao, and Japan). Telephone numbers of these travellers were obtained from the airport. Health problems among international travellers from Taiwan to the Philippines, Malaysia, Indonesia, Singapore, Vietnam, Thailand (tropical group), Hong Kong, Macao, China and Japan (non-tropical group) were surveyed through the telephone. Of 649 travellers surveyed, 8.2% had one or more health problems and insect bite (3.4%) and coughing or sore throats (3.2%) were the most important ones. The rate of coughing or sore throats was significantly higher among those returned from the non-tropical regions. However, no associations were found between health problems and the demographic factors, travelling style or travelling duration.
Abstracts For the most of this cases, the etiological agent is Plasmodium falciparum. Timis is the most extensive of the Romanian counties, a western gate of the country from which a lot of people travel abroad. The aim of this study is to inform about some imported cases of malaria discovered in an universitary laboratory in the past decade and to describe two recent, severe cases. Material and methods: There were analysed the results of the blood exams (Giemsa-stained thin and thick smears) performed in an universitary parasitological laboratory from 1998 until present and the medical recordings of the last two clinical cases from an universitary Infectious Clinical Hospital. Results: Malaria was diagnosed in the 4 of the 6 blood films performed (in 3 cases—75%—the parasitic agent was P. falciparum). The most recent cases (2006–2007) were: a 50 years old male, christian missionary returned from Uganda who refused the prophylaxis, and a 40 years old male, worker in constructions who returned from Republic of Equatorial Guinea. Both were diagnosed with P. falciparum malaria and both died. Discussion: P. falciparum, the main parasitic agent of this imported Romanian cases was found in a similar percentage like in other studies. We perform a comparison between the 2 cases emphasizing on the clinical aspects, complications and the laboratory tests. Although in Romania malaria does not represent a public health concern, the imported cases are difficult to manage in terms of early diagnosis and treatment. Also it is important for people who travel in tropical countries to understand the importance of the preventive measures and to apply them unconditionally. KEYWORDS Malaria; Plasmodium falciparum; Import; Romania 10.1016/j.tmaid.2007.09.019
KEYWORDS
P06
Health problems; Travellers; Tropical; Subtropical
The Royal College of Nursing of the United Kingdom (RCN UK) Travel Health Forum
10.1016/j.tmaid.2007.09.018
S. Grieve, J. Skeet, L. Boyne, C. Driver, A. Jordan
P05
Royal College of Nursing, UK
Recent import of malaria in a romanian western county
R. Neghina, A.M. Neghina, L. Tirnea, R. Olariu, I. Iacobiciu Victor Babes University of Medicine and Pharmacy Timisoara, Romania Introduction: Malaria is not a concern for Romania nowadays because it was eradicated in 1965, but yearly appear some imported cases especially from people travelling in Africa.
Travel Medicine in the United Kingdom is a nurse-led speciality, with services provided mainly in Primary Care, but also in Occupational Health (NHS and Industry) Armed Services, schools, universities, independent clinics and charitable organisations. The Royal College of Nursing (RCN) is a professional body for nurses, within which are 75 Forums supporting the spectrum of specialist areas of practice. The Travel Health Forum (THF) Steering Committee consists of seven elected nurse members with a shared objective to support nurses in the field, disseminate knowledge, promote education and best standards of practice and influence related National Policies. Forum membership is currently 5309.
ARTICLE IN PRESS Abstracts The poster describes some of the methods employed, including the biannual Newsletter, informative website and established annual conference. The THF participated in the organisation and scientific programme for the 2006 Northern European Conference on Travel Medicine (NECTM) in Edinburgh and similarly with the proposed 2008 NECTM2 in Helsinki. The committee acts as a professional source of expert opinion to the RCN and advises on policy and accreditation matters when approached. The forum collaborates with the British Travel Health Association and other RCN Forums where areas of practice cross. The Guidance for Practice Document produced in 2005 was the first of its kind available to describe minimum standards of practice for nurses working in the field. Competencies encompassing the skills and expertise required to manage and advise travellers, to promote best practice in patient centred care and to contribute to the health outcomes in UK travellers were developed and published in May 2007. The Faculty of Travel Medicine (FTM) established in 2006 at the Royal College of Physicians and Surgeons of Glasgow (RCPSG) was the first Medical College to recognise the speciality and admit nurses. KEYWORDS Competencies; Guidelines; Newsletter; Conference
405 showed good knowledge of malaria symptoms even in infants and children; however in the event of malaria infection consumption of herbal preparation is the first line of treatment. Health is also sought from drug hawkers that sell modern drugs in the communities. The antimalarial drugs bought were wrongly used and none of the respondents were aware of the current trend in malaria management with modern drugs. Hospital visitation is usually after many days of persistent illness without improvement despite all forms of self medication. The main measure used against malaria vectors was insecticide coils (74.6%). None of the respondents used insecticide treated net (ITN). Distance, cost and poor quality of hospital treatment were reasons for refusal to seek proper medical care. We recommend health education and improved health care services for these farmers in order for them to be able to translate extension services provided into maximum agricultural yields. KEYWORDS Malaria; Perceptions; Agriculture; Knowledge 10.1016/j.tmaid.2007.09.021
10.1016/j.tmaid.2007.09.020
P08 P07 Perceptions and home management practices of malaria in some rural communities in Abeokuta, Nigeria
O.A. Idowu, C.F. Mafiana, I.J. Luwoye, O. Adehanloye
Disease severity, host characteristics and Plasmodium falciparum multiple infections in malaria affected travellers returning from Africa
E. Nicastria, M.G. Pagliaa, C. Severinib,, P. Ghirgaa, N. Bevilacquaa a
University of Agriculture, Abeokuta, Nigeria, Nigeria
Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, Italy b Istituto Superiore di Sanita `, Italy
A survey was carried out in five rural communities that enjoy Agricultural extension services from the University of Agriculture Abeokuta. Questionnaires and Focus Group Discussions (FGDs) were used to assess perceptions and home management practices of malaria infection. The inhabitants consider malaria (which they refer to as ‘‘Iba Otutu’’) has the least dangerous of other types of common fever such as yellow fever and Thyphoid fever. A vast majority of the respondents (73%) attributed malaria infection to doing of strenuous jobs in the hot sun, while only 11.7% attributed it to mosquito bites. Hunger, eating or drinking of contaminated food or water were other sources of malaria infection mentioned by the respondent. During the FGDs, other source of infection of malaria described includes excessive exposure to heat of fire used in frying cassava (garri). Those frying garri and spreading cassava flakes in the sun were identified as most vulnerable to malaria infection. High level of malaria infection in children was attributed to children playful activities in the sun. It is believed that malaria infection will occur even without mosquito bites but with exposure to these other factors especially the intense heat of the sun. Respondents
Introduction: The pathogenesis of malaria is the result of complex interactions between parasites, host and environment. Several studies have assessed the role of genetic characteristics of P. falciparum infection in the clinical severity of malaria infection comparing different genotypic determinants in mild and severe cases. The MSP-1, MSP- 2 and DHFR encoding genes have been extensively used as molecular markers to investigate genetic diversity and population structure of P. falciparum. Aim of this study was to assess the epidemiological, clinical, host- and parasite-related determinant factor of the genetic diversity of P. falciparum infections in travellers returning from Africa. Methods: We have retrospectively studied 64 inpatients all returning to Italy from African malaria-endemic countries. Designation of severe malaria was determined according to WHO definition. P. falciparum infections detected by species-specific PCR were genotyped at the msp-1 and msp-2 loci and a number of clones were determined. PCRRFLP method was used to screen the mutation occurring at codon 108 of dhfr gene.